CN112870554A - Pulse stimulation equipment capable of effectively avoiding atrial vulnerable period pacing - Google Patents
Pulse stimulation equipment capable of effectively avoiding atrial vulnerable period pacing Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
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Abstract
The invention discloses a pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing, which comprises an atrial sensing module, a pacing control module, an atrial pacing module, a clock/timing module and a storage module, wherein the atrial sensing module is used for sensing the atrial sensing signal; the atrial sensing module senses and sends an atrial self-activity signal to the pacing control module; when the pace control module identifies the atrial self-activity signal as an atrial sensed event in a refractory period, the pace control module controls the clock/timing module to time the adjacent T1 period and the adjacent T2 period according to the adjacent T1 period and the adjacent T2 period stored in the storage module; the pacing control module refrains the atrial pacing module from delivering an atrial pacing event when it is determined that the expected atrial pacing event occurred at time T2. So as to solve the problem of atrial fibrillation danger caused by pacing in the vulnerable period of the atrium.
Description
Technical Field
The invention belongs to the technical field of medical instruments, and particularly relates to pulse stimulation equipment capable of effectively avoiding atrial vulnerable period pacing.
Background
The implanted medical equipment is an electronic therapeutic apparatus implanted in the body, and can be used for transmitting electric pulse powered by battery by means of pulse generator, and can be used for stimulating cardiac muscle contacted with electrode by means of conduction of conducting wire electrode so as to make the heart excite and contract so as to attain the goal of curing the cardiac dysfunction due to some arrhythmia.
After the action potential is generated by the cardiomyocytes, the excitability is completely or partially lost within a short period of time, and at this time, a new action potential is not generated by stimulating the cardiomyocytes again, which is called a cardiac refractory period. The heart refractory period is divided into an absolute refractory period and a relative refractory period, wherein the myocardial cells completely lose excitability in the absolute refractory period and the myocardial cells partially lose excitability in the relative refractory period. The atrial muscle has a short period of cardiac instability near its relatively refractory period, called the atrial vulnerable period. At this time, the cardiac muscle is in the early stage of repolarization, the excitability recovery speed and sequence difference between cell groups are large, so the reactivity, conductivity and refractory period are not consistent or not completely synchronous, and atrial fibrillation is easily caused if strong stimulation is given or premature beat occurs.
Atrial fibrillation may be easily induced when an implanted cardiac rhythm management device (e.g., a cardiac pacemaker) is operating and may improperly deliver atrial pacing stimulation during an atrial vulnerable period due to failure to sense atrial signals or improperly identifying atrial action potentials as interfering signals during a refractory period.
The following treatment schemes currently exist: 1. this approach runs the risk of inducing atrial fibrillation without dealing with atrial vulnerable pacing at all. 2. And immediately starting an atrial pacing suppression interval when the atrial sensing signal in the refractory period is detected, and adopting a scheme of delaying the atrial pacing till the atrial pacing suppression interval is expired when the expected atrial pacing occurs in the interval. This approach requires delayed atrial pacing, at which time adverse effects of shortened AV intervals and even decreased ventricular pacing frequency may occur, which are detrimental to atrioventricular hemodynamic conduction and ventricular stability. 3. An atrial pacing suppression interval is immediately activated when an atrial sense signal is detected during the refractory period, and when the anticipated atrial pacing occurs during the interval, the atrial pacing is directly suppressed, such as a medical device for treating arrhythmia disclosed in the patent application with publication number CN104623805A and a medical device for treating arrhythmia disclosed in the patent application with publication number CN 104623804A. In the method, a long interval after the atrial sensing signal in the refractory period is marked as an atrial pacing suppression interval, if the atrial sensing signal in the refractory period is an interference signal, one atrial pacing treatment and possible atrioventricular conduction are lost, and the adverse reaction is particularly obvious under the condition of more interference, so that the ventricular pacing percentage is increased.
Therefore, the prior art has a great defect and cannot effectively avoid the atrial vulnerable period pacing.
Disclosure of Invention
In view of the above, it is an object of the present invention to provide a pulse stimulation device that can effectively avoid atrial vulnerable period pacing to solve the problem of atrial fibrillation risk caused by atrial vulnerable period pacing.
In order to achieve the above object, an embodiment of the present invention provides a pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing, including an atrial sensing module, a pacing control module, an atrial pacing module, a clock/timing module, and a storage module;
the atrial sensing module senses and sends an atrial self-activity signal to the pacing control module; when the pace control module identifies the atrial self-activity signal as an atrial sensing event in a refractory period, the clock/timing module is controlled to time a T1 period and a T2 period which are adjacent in time sequence and stored in the storage module according to the T1 period and the T2 period which are adjacent in time sequence, wherein the T1 period is used as a stable period, the starting time of the T1 period is the time when the atrial sensing module detects the atrial sensing event, and the T2 period is used as an atrial pacing adjusting window interval of an atrial vulnerable period, and the starting time of the T2 period is the ending time of T1;
the pacing control module refrains the atrial pacing module from delivering an atrial pacing event when it is determined that the expected atrial pacing event occurred at time T2.
Preferably, the period T1 and the period T2 are dynamically adjustable according to the physiological state of the user.
Preferably, the pulse stimulation apparatus further comprises a therapy control module which automatically adjusts the T2 time period and the T1 time period according to the state of the atrial cardiac event of the user obtained from the pacing control module and updates to the storage module.
Preferably, the pulse stimulation apparatus further comprises a wireless control module, and the pulse stimulation apparatus receives the T2 time period and the T1 time period adjusted by the extracorporeal apparatus according to the physiological state of the user through the wireless control module and updates the received time period to the storage module.
Preferably, the pacing control module controls the atrial pacing module to normally deliver an atrial pacing event upon determining that an expected atrial pacing event occurs at time T1.
Preferably, the pacing control module controls the clock/timing module to start timing for a period T1 when it determines that an atrial event occurs within an atrial refractory period, the clock/timing module notifying the pacing control module when the timing for the period T1 expires; the pacing control module controls the clock/timing module to start timing for a period T2 according to the notification when the timing of the period T1 expires, and sets a T2 start identifier; the clock/timing module notifies the pacing control module when the period T2 expires; the pacing control module notifies the setting of the T2 end flag upon expiration of the T2 time period timing.
Preferably, the pacing control module inhibits the atrial pacing module from delivering an atrial pacing event when the pacing control module determines that the expected atrial pacing event occurs at time T2 based on the indication of the beginning of time T2.
Preferably, the pacing control module controls the atrial pacing module to normally deliver the atrial pacing event when the expected atrial pacing event occurs in the time period T1 according to the time period T1 timing expiration information.
Preferably, the pacing control module identifies an atrial sense event within the refractory period if atrial intrinsic activity occurs within the atrial refractory period when the atrial intrinsic activity signal identifies the atrial intrinsic activity, and identifies all atrial intrinsic activity as an atrial sense event within the refractory period if the atrial intrinsic activity does not affect the pacing timing.
Preferably, the pulse stimulation device is adapted for use in a mono-or bi-luminal mode with atrial pacing.
Compared with the prior art, the pulse stimulation device capable of effectively avoiding the atrial vulnerable period from pacing provided by the embodiment of the invention has the beneficial effects that at least:
the method divides a time sequence after an atrial sensing event in a refractory period into a stable period TI adjacent to the time sequence and an atrial pacing adjusting window interval T2 used as an atrial vulnerable period, and flexibly and accurately defines the atrial vulnerable period T2(T2 interval) to be more physiologically suitable for different patients and different physiological conditions, so that the risk of atrial fibrillation caused by atrial pacing in the atrial vulnerable period in a single-chamber and double-chamber atrial pacing mode can be reduced, the probability of normal atrial pacing treatment and possible atrioventricular conduction inhibition can be reduced, and the risk of ventricular pacing percentage increase can be reduced.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to these drawings without creative efforts.
FIG. 1 is a schematic diagram of a pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing according to an embodiment of the present invention;
FIG. 2 is a schematic diagram of the time period T1 and the time period T2 provided by an embodiment of the present invention;
FIG. 3 is a schematic diagram of a pulse stimulation apparatus according to another embodiment of the present invention, which is capable of effectively avoiding atrial vulnerable period pacing;
FIG. 4 is a schematic diagram of a pulse stimulation device according to another embodiment of the present invention, which is capable of effectively avoiding atrial vulnerable period pacing;
FIG. 5 is a timing flow of periods T1 and T2 as implemented by the pacing control module and the clock/timing module provided by embodiments of the present invention;
fig. 6 is a flow chart of a pacing control module and atrial pacing event control implemented by the atrial pacing module according to an embodiment of the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention will be further described in detail with reference to the accompanying drawings and examples. It should be understood that the detailed description and specific examples, while indicating the scope of the invention, are intended for purposes of illustration only and are not intended to limit the scope of the invention.
Risk of atrial fibrillation in order that atrial pacing may occur during an atrial vulnerable period due to disturbance or improper parameter setting; meanwhile, the risk that the delayed atrial pacing in the atrial vulnerable period in the prior art is easy to cause the adverse reaction of AV interval shortening and even ventricular pacing frequency reduction, and the atrioventricular hemodynamic conduction and ventricular stability are not facilitated is solved; meanwhile, the risk that the pacing percentage is increased due to the fact that the adverse reaction is particularly obvious under the condition of more interference is solved in order to solve the problem that the atrial pacing treatment and the possible atrioventricular conduction are easily lost due to the fact that the long atrial pacing inhibition period is after an atrial sensed event in the prior art; meanwhile, the risk that the atrial vulnerable period pacing is easy to cause atrial fibrillation in a single-cavity pacing mode is not solved in the prior art; meanwhile, the defect that the atrial vulnerable period definition cannot be flexibly adjusted in the prior art is overcome. Embodiments provide a pulse stimulation device that is effective in avoiding atrial vulnerable period pacing as an implantable medical device.
Fig. 1 is a schematic structural diagram of a pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing according to an embodiment of the present invention. As shown in fig. 1, the pulse stimulation device 100 for effectively avoiding atrial vulnerable period pacing provided by the embodiment includes an atrial sensing module 101, a pacing control module 102, an atrial pacing module 103, a clock/timing module 104, and a storage module 105, wherein the atrial sensing module 101 is used for sensing atrial intrinsic activity signals. The pacing control module 102, which is the core of the pulse stimulation device, is used to control the timing operation of the clock/timing module 104 according to the atrial intrinsic activity signal, and also to control the atrial pacing module 103 to deliver an atrial pacing event according to the timing result of the clock/timing module 104. The memory module 105 stores the time period T1 and the time period T2, which are adjacent in time sequence.
In the embodiment of the invention, a certain time sequence after an atrial sensing event in a refractory period is divided into a T1 period and a T2 period which are adjacent in time sequence, wherein the T1 period is used as a stable period, the starting time of the T1 period is the time when the atrial sensing event is detected, the T1 period is used as the stable period in the atrial refractory period after the atrial time, the risk of atrial fibrillation is not caused when atrial pacing is carried out in the time limit, and the risk of losing normal atrial pacing treatment and possible atrioventricular conduction caused by a long atrial pacing suppression period after atrial sensing when interference exists is reduced; is beneficial to atrioventricular hemodynamic conduction and reduces the ventricular pacing percentage. The period T2 is defined as an Atrial pacing adjustment window interval (ATAPA) following an Atrial sensed event in the refractory period to prevent Atrial Tachycardia, which is considered an Atrial vulnerable period during which no Atrial pacing event occurs to prevent the risk of Atrial fibrillation. Specifically, the start time of the T2 period is the end time of the T1 period, i.e., the T1 period and the T2 period are two periods adjacent in time sequence.
Fig. 2 is a schematic diagram of the T1 time period and the T2 time period provided by an embodiment of the present invention. The embodiment will clearly explain the T1 and T2 periods in conjunction with the attached drawings. As shown in fig. 2, the interval between Atrial Pacing (AP) and Ventricular Pacing (VP) is Atrial paced posterior Ventricular interval (PAVI), lri (lower Rate interval) is entered after Atrial Pacing (AP), post Ventricular event Atrial refractory period (PVARP) is entered immediately after Ventricular Pacing (VP), Atrial sensed events (AR) occur within PVARP, the AR is identified as an AR within the refractory period, the T1 period and the T2 period defined by the embodiments of the present invention are timings after AR, as shown in fig. 2, the start of the T1 period is the AR time, the start of the T2 is the end of the T1 period, the Atrial pacing event may be performed during the T1 period, the T2 Atrial pacing event is suppressed during the T2 period, and the Ventricular pacing timing is not affected. Embodiments of the present invention may more accurately determine the atrial vulnerable period range by defining the periods T1 and T2, reducing the risk of atrial pacing therapy and the corresponding inhibition of atrioventricular descent due to the defined atrial vulnerable period being too coarse, and reducing the risk of a resulting increase in the percentage of ventricular pacing.
In the embodiment of the present invention, the defined periods T1 and T2 are both stored in the storage module 105, and when the pulse stimulation device 100 is in operation, the atrial sensing module 101 senses and transmits the atrial self-activity signal to the pacing control module 102; when the pacing control module 102 recognizes the atrial intrinsic activity signal as an atrial sensed event within the refractory period, the clock/timing module 104 controls the timing of the adjacent T1 period and T2 period according to the T1 period and T2 period stored in the storage module 105, and the pacing control module 102 inhibits the atrial pacing module 103 from delivering the atrial pacing event when it determines that the expected atrial pacing event occurs within the T2 period. Pacing control module 102 controls atrial pacing module 103 to normally deliver an atrial pacing event when it determines that the expected atrial pacing event occurs at time T1. Pacing control module 102 controls atrial pacing module 103 to deliver atrial pacing events normally as needed when it determines that the expected atrial pacing events occur outside of periods T1 and T2.
In the embodiment of the present invention, when the pacing control module 102 identifies the atrial intrinsic activity signal, if the atrial intrinsic activity occurs in the atrial refractory period, the atrial intrinsic activity is identified as an atrial sensed event in the refractory period, and if the atrial intrinsic activity does not affect the pacing timing, all the atrial intrinsic activity is also identified as an atrial sensed event in the refractory period.
In the embodiment of the invention, the T1 period and the T2 period are dynamically adjustable according to the physiological state of the patient. The atrial vulnerable period T2 is accurately controlled by flexibly defining the size and the position of the period T2, so that the flexibility of defining the atrial vulnerable period is greatly increased, the atrial vulnerable period can be more physiologically adapted to different patients and different physiological states, and the risk of atrial fibrillation caused by atrial pacing in the atrial vulnerable period in an atrial pacing mode is further reduced.
In the embodiment of the present invention, the purpose of setting the ATAPA, that is, the period T2, is to define a physiological atrial vulnerable period, which is generally a certain period within thousands of milliseconds after the atrial sensed event, for example, a period of 200-300 ms after the atrial sensed event, and this period may be different according to different users, different diseases, different activity states, and different physiological states. Differences and changes in physiological atrial vulnerable periods are simulated by flexibly adjustable ATAPA intervals, and accurate control of ATAPA of each user is achieved. When the size and position of the time period T2 are dynamically adjusted, the end time of the time period T1 may be adjusted, or the end time of the time period T2 may be adjusted.
In one embodiment, as shown in fig. 3, the pulse stimulation apparatus 100 provided in the embodiment further includes a therapy control module 301, and the therapy control module 301 automatically adjusts the T2 period and the T1 period according to the state of the atrial cardiac event of the user or the physiological state of the user obtained from the pacing control module 102 and updates the adjusted states to the storage module 105. The ATAPA interval is automatically adjusted through a treatment method embedded in the treatment control module 301, and if the treatment method detects that atrial tachycardia occurs, the ATAPA interval is expanded for 100-350 ms, so that atrial pacing in an atrial vulnerable period is reduced to aggravate the atrial tachycardia, and meanwhile, the detection of atrial pacing in the atrial vulnerable period to an atrial tachycardia state is reduced.
In one embodiment, as shown in fig. 4, the pulse stimulation apparatus 100 provided in the embodiment further includes a wireless control module 401, and the pulse stimulation apparatus 100 receives the T2 period and the T1 period adjusted by the extracorporeal apparatus according to the physiological status of the user through the wireless control module 401 and updates the received periods to the storage module 105. Medical personnel can carry out data interaction through the extracorporeal device and the wireless control module 401 according to evaluation results of different users to set a targeted ATAPA interval range and update the ATAPA interval range into the storage module 105, for example, for a patient who frequently suffers atrial tachycardia, a wide ATAPA interval can be adopted, such as 100-350 ms, so that atrial pacing in the atrial vulnerable period is reduced to aggravate the atrial tachycardia, and internal data can be sent to the extracorporeal device through the wireless control module 401.
In one embodiment, as shown in fig. 5, the timing flow for the T1 and T2 periods implemented by the pacing control module 102 and the clock/timing module 104 includes:
when the pacing control module 102 determines that the atrial sensed event does not occur within the atrial refractory period, processing and controlling the pacing timing sequence according to the atrial sensed event outside the refractory period;
the pacing control module 102 controlling the clock/timing module 104 to start timing for a period T1 when it determines that an atrial sensed event occurs within an atrial refractory period, the clock/timing module 104 notifying the pacing control module 102 when the timing for the period T1 expires; the pacing control module 102 controls the clock/timing module 104 to start timing for the period T2 according to the notification when the period T1 expires, and sets a T2 start Flag, for example, to set ATAPA _ Flag to 1, indicating that the period T2 starts; the clock/timing module 104 notifies the pacing control module 102 when the time period T2 expires; upon expiration of the time period T2, the pacing control module 102 notifies the end of T2 Flag setting, e.g., ATAPA _ Flag is set to 0, indicating the end of the time period T2, i.e., the ATAPA interval is completed.
In one embodiment, as shown in fig. 6, the pacing control module and the atrial pacing module implement a control procedure for atrial pacing events that includes:
the pacing control module 102 is notified when the expected atrial pacing interval controlled by the clock/timing module 104 expires, and the pacing control module 102 refrains the atrial pacing module 103 from delivering an atrial pacing event when the expected atrial pacing event is determined to occur during the time period T2 based on the start identifier of the time period T2. Specifically, it may be determined whether ATAPA _ Flag is 1, indicating that it is currently in the period T2 when ATAPA _ Flag is 1, pacing control module 102 refrains from delivering an atrial pacing pulse by atrial pacing module 103.
The pacing control module 102 is notified when the expected atrial pacing interval controlled by the clock/timing module 104 expires, and the pacing control module 102 controls the atrial pacing module 103 to normally deliver the atrial pacing event when the expected atrial pacing event is determined to occur in the time period T1 according to the end identifier of the time period T2. Specifically, it may be determined whether ATAPA _ Flag is 1, and when ATAPA _ Flag is 0 and not 1, indicating that it is currently in the period T1, pacing control module 102 controls atrial pacing module 103 to deliver atrial pacing pulses normally. But ventricular pacing timing is not affected.
The pulse stimulation device capable of effectively avoiding the atrial vulnerable period pacing provided by the embodiment is suitable for the single-chamber mode and the double-chamber mode with atrial pacing, including but not limited to DDD, DVI, DDI, AAI and AOO. Compared with the prior art, the pulse stimulation device is also suitable for a single-cavity mode with atrial pacing, the application range is greatly expanded, and the risk of atrial fibrillation caused by pacing in an atrial vulnerable period can be reduced in a larger range.
The pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing provided by the above embodiments identifies atrial sensing events in a refractory period if atrial activities occur in an atrial refractory period in a mode in which atrial sensing can affect pacing timing, such as DDD, DDI, AAI, and identifies all atrial activities as atrial sensing events in a refractory period in a mode in which atrial sensing cannot affect pacing timing, such as DVI, AOO. In the dual-chamber mode, the Atrial refractory period in the embodiment generally refers to the post-Ventricular event Atrial refractory period (PVARP), and in the single-chamber mode, the Atrial refractory period in the present invention generally refers to the post-Atrial Refractory Period (ARP).
The pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing provided by the embodiment is to explain the process of effectively avoiding atrial vulnerable period pacing by dividing the functional modules, and the above function allocation can be completed by different functional modules according to needs, that is, a computer program stored in a storage medium is divided into different functional modules to complete all or part of the above described functions. In an embodiment, the pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing may be implemented in an application specific integrated circuit chip (ASIC), a digital signal processing chip (DSP), or a micro control chip (MCU).
In one embodiment, a pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing is provided, which comprises a memory, a processor and a computer program stored in the memory and executable on the processor, wherein a part of the memory in the memory is used as a storage module to store a T1 period and a T2 period which are adjacent in time sequence, and the processor executes the computer program to realize the following steps:
the atrial sensing module senses and sends an atrial self-activity signal to the pacing control module;
when the pace control module identifies the atrial self-activity signal as an atrial sensed event in a refractory period, the pace control module controls the clock/timing module to time the adjacent T1 period and the adjacent T2 period according to the adjacent T1 period and the adjacent T2 period stored in the storage module;
the pacing control module refrains the atrial pacing module from delivering an atrial pacing event when it is determined that the expected atrial pacing event occurs at time T2;
the pacing control module controls the atrial pacing module to normally deliver an atrial pacing event when it determines that the expected atrial pacing event occurs at time T1.
In one embodiment, the processor, when executing the computer program, further performs the following steps: the treatment control module automatically adjusts the time period T2 and the time period T1 according to the state of the atrial cardiac event of the user or the physiological state of the user obtained from the pacing control module and updates to the storage module.
In one embodiment, the processor, when executing the computer program, further performs the following steps: receiving the T2 period and the T1 period which are adjusted by the extracorporeal device according to the physiological state of the user, and updating the periods to the storage module.
The above-mentioned embodiments are intended to illustrate the technical solutions and advantages of the present invention, and it should be understood that the above-mentioned embodiments are only the most preferred embodiments of the present invention, and are not intended to limit the present invention, and any modifications, additions, equivalents, etc. made within the scope of the principles of the present invention should be included in the scope of the present invention.
Claims (10)
1. A pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing is characterized by comprising an atrial sensing module, a pacing control module, an atrial pacing module, a clock/timing module and a storage module;
the atrial sensing module senses and sends an atrial self-activity signal to the pacing control module; when the pace control module identifies the atrial self-activity signal as an atrial sensed event in a refractory period, the clock/timing module is controlled to time a T1 period and a T2 period which are adjacent in time sequence and stored in the storage module according to the T1 period and the T2 period which are adjacent in time sequence, wherein the T1 period is used as a stable period, the starting time of the T1 period is the time of detecting the atrial sensed event, the T2 period is used as an atrial pacing adjusting window interval of an atrial vulnerable period, and the starting time of the T1 period is the ending time of the T1 period;
the pacing control module refrains the atrial pacing module from delivering an atrial pacing event when it is determined that the expected atrial pacing event occurred at time T2.
2. The pulse stimulation device effective to avoid atrial vulnerable pacing according to claim 1, wherein the time period T1 and the time period T2 are dynamically adjustable according to a physiological state of the user.
3. The pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing according to claim 1, further comprising a therapy control module that automatically adjusts the time period T2 and the time period T1 according to the state of the user's atrial cardiac events or the user's physiological state obtained from the pacing control module and updates to the memory module.
4. The pulse stimulation device capable of effectively avoiding atrial vulnerable period pacing according to claim 1, further comprising a wireless control module, wherein the pulse stimulation device receives the T2 period and the T1 period adjusted by the extracorporeal device according to the physiological state of the user through the wireless control module and updates to the storage module.
5. The pulse stimulation device effective to avoid atrial vulnerable period pacing according to claim 1, wherein the pacing control module controls the atrial pacing module to normally deliver an atrial pacing event upon determining that the expected atrial pacing event occurs at time T1.
6. The pulse stimulation device effective to avoid atrial vulnerable period pacing according to claim 1, wherein the pacing control module controls the clock/timing module to start timing for a period T1 when it is determined that an atrial sensed event occurs within an atrial refractory period, the clock/timing module notifying the pacing control module when the timing for the period T1 expires; the pacing control module controls the clock/timing module to start timing for a period T2 according to the notification when the timing of the period T1 expires, and sets a T2 start identifier; the clock/timing module notifies the pacing control module when the period T2 expires; the pacing control module notifies the setting of the T2 end flag upon expiration of the T2 time period timing.
7. The pulse stimulation device effective to avoid atrial vulnerable period pacing according to claim 6, wherein the pacing control module inhibits the atrial pacing module from delivering an atrial pacing event when the expected atrial pacing event occurs at time T2 as determined by the start identifier of time T2.
8. The pulse stimulation device effective to avoid atrial vulnerable period pacing according to claim 6, wherein the pacing control module controls the atrial pacing module to normally deliver an atrial pacing event when the expected atrial pacing event occurs at time T1 as determined by the timing expiration information of time T1.
9. The pulse stimulation device effective to avoid atrial vulnerable period pacing according to claim 1, wherein the pacing control module, upon identifying the atrial intrinsic activity signal, identifies an atrial sense event within the refractory period if atrial intrinsic activity occurs within the atrial refractory period and identifies all atrial intrinsic activity as an atrial sense event within the refractory period if atrial intrinsic activity does not affect pacing timing.
10. A pulse stimulation device effective to avoid atrial vulnerable period pacing according to any one of claims 1 to 9, wherein the pulse stimulation device is adapted for use in a mono-or bi-luminal mode with atrial pacing.
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