EP0594620A1 - Procede et appareil de stimulation cardiaque transcutanee - Google Patents

Procede et appareil de stimulation cardiaque transcutanee

Info

Publication number
EP0594620A1
EP0594620A1 EP91915140A EP91915140A EP0594620A1 EP 0594620 A1 EP0594620 A1 EP 0594620A1 EP 91915140 A EP91915140 A EP 91915140A EP 91915140 A EP91915140 A EP 91915140A EP 0594620 A1 EP0594620 A1 EP 0594620A1
Authority
EP
European Patent Office
Prior art keywords
pulses
pacing
stimuli
amplitude
series
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP91915140A
Other languages
German (de)
English (en)
Other versions
EP0594620A4 (fr
Inventor
Gary A. Freeman
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
ZMD Corp
Original Assignee
ZMD Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by ZMD Corp filed Critical ZMD Corp
Publication of EP0594620A1 publication Critical patent/EP0594620A1/fr
Publication of EP0594620A4 publication Critical patent/EP0594620A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61N1/3625—External stimulators

Definitions

  • This invention relates to electrically pacing the heart transcutaneously.
  • transcutaneous, or external, electrical pacing of a patient's heart electrical stimuli travel from the pacing apparatus' electrodes to the heart through the patient's skin and skeletal thorax muscles to stimulate the heart.
  • the skeletal muscles may contract in response to the passage of the electrical stimuli through them.
  • the passage of the electrical pacing stimuli through the patient's skin may stimulate cutaneous nerves and muscles located near to the skin. This nerve stimulation and skeletal muscle contraction may feel uncomfortable to the patient, or even become painful enough to result in the patient's intolerance of extended transcutaneous heart pacing.
  • the invention features pacing stimuli each of which comprises a series of pulses.
  • Each of the pulses is, by itself, incapable of causing a cardiac muscle contraction, but the series of pulses making up each pacing stimulus is capable, as a group, of causing such a contraction.
  • the series of pulses tends to produce less skeletal muscle stimulation than a continuous pulse, thus making extended transcutaneous pacing more bearable for a patient.
  • each pulse averages less than 0.5 msec (preferably less than 250 microseconds, and more preferably less than 50 microseconds) ; the duty cycle of the pulses (i.e., the percentage of time the pulse is on) is at least 20%, and more preferably at least 50%; and the amplitude of the pacing stimulus in the brief intervals between each pulse is below the minimum amplitude required for skeletal muscle stimulation if one were using a continuous pulse of the same duration as the pulse train (and is preferably substantially zero) .
  • the invention features reducing skeletal muscle stimulation during pacing by including in the pacing stimuli one or more pulses that have amplitudes below the threshold for skeletal muscle stimulation.
  • Stimulation threshold is here defined as the minimum pulse amplitude required for stimulation if the pulse amplitude of a given pulse train remained constant for the duration of the pulse train.
  • the subthreshold pulses tend to reduce the reaction of skeletal muscles to the above-threshold stimulus that follows them.
  • these subthreshold pulses are the initial pulses in a pacing stimulus itself comprising a series of pulses; the pacing stimulus extends for at least 5 msec (more preferably, at least 40 msec) ; and some, possibly all, of the subthreshold pulses, and possibly some of the above- threshold pulses, each has an amplitude that is greater than the amplitudes of the preceding pulses in the pacing stimulus.
  • the reduction in skeletal muscle stimulation is believed to result because the cardiac muscle reacts to the train of pulses as if it were one continuous pulse. whereas at least some of the skeletal muscles react in a manner more akin to the way they would react to individual pulses. It is believed that this difference may result from a filtering of the pulse train as it passes through the chest wall, with the result that the cardiac muscle sees a continuous stimulus, whereas at least some of the skeletal muscles are exposed to the unfiltered, or less filtered, pulses, which, because of their short duration, produce less skeletal muscle stimulation. But whatever physiological actions are actually responsible, the result is that, at cardiac threshold (i.e. at a stimulus amplitude just high enough to cause cardiac contraction) , the skeletal muscles are stimulated less by a train of pulses than by a continuous pulse.
  • cardiac threshold i.e. at a stimulus amplitude just high enough to cause cardiac contraction
  • the invention features providing background stimuli in the intervals between pacing stimuli to reduce discomfort during pacing.
  • the background stimuli occur only in the intervals between the pacing stimuli; the background stimuli comprise pulses; the average amplitude of the background pulses is less than the average amplitude of the pacing stimuli; the average amplitude of the background pulses is less than 20 mA (more preferably less than 10 mA) ; and the duty cycle of the background pulses is less than 80% (more preferably less than 50%) .
  • the invention features an electrode for transcutaneous pacing in which there are two skin-contacting regions each insulated and spaced laterally from the other.
  • Fig. 1 is a block diagram of a pacing stimuli signal generator according to one embodiment of the invention.
  • Fig. 2 is an illustrative example of electrical stimuli produced by the signal generator of Fig. 1.
  • Figs. 3A and 3B are illustrative examples of electrical pacing stimuli produced by the signal generator of Fig. 1.
  • Fig. 4 are plotted characteristics, one for cardiac muscle and one for skeletal muscle and cutaneous nerves, relating a stimulating pulse's strength with the pulse's duration.
  • Fig. 5 is an example of an electrode configuration for applying the electrical stimuli of Fig. 2 to a patient.
  • Figs. 6A-6C are three illustrative examples of alternative pacing stimuli produced by the signal generator of Fig. 1.
  • a signal generator 10 for generating electrical pacing stimuli 65 which are to be applied transcutaneously to a patient's heart.
  • the signal generator's timing and control circuitry 20 can accept cardiac feedback signals 12 from the patient to initiate electrical pacing stimuli, or it can operate without such feedback (asynchronous pacing) .
  • the timing and control circuitry also sets the timing characteristics of the pacing stimuli, as discussed below.
  • the timing and control circuitry 20 initiates the pacing stimuli by signaling the stimuli generating circuitry 30, which includes oscillator and drive circuitry 40, isolation circuitry 50, and waveform- shaping circuitry 60.
  • Oscillator and drive circuitry 40 generates a stream of pulses that are processed by isolation circuitry 50, which isolates the signal generator's internal voltages from the patient, thereby providing electrical hazard protection for the patient during the patient's exposure to the pacing stimuli 65.
  • Waveform-shaping circuitry 60 receives the isolation circuitry's pulse stream output and modifies signal characteristics of the pulse stream, e.g., pulse shape, polarity, and amplitude, to generate pacing stimuli 65 having user-specified signal parameters.
  • the pacing stimuli 65 are coupled to posterior and anterior electrodes 70, 72, which together externally deliver the electrical stimuli to the patient for transcutaneous pacing of the patient's heart.
  • the signal generator's electrical pacing stimuli output 65 is composed of pacing stimuli 80 and background pulse trains 90.
  • the pacing stimuli 80 comprising, for example, pacing pulse trains, are delivered to the patient to stimulate the patient's heart.
  • the background pulse trains 90 are delivered to the patient in the intervals between the pacing pulse trains, when the heart is not being stimulated.
  • pulse train stimuli provide effective transcutaneous stimulation of the heart with reduced patient discomfort.
  • the pacing pulse trains 80 each consist of a series of pulses, with each pulse having a time duration, or width, W , which may be different than the duration of the other pulses in the series.
  • characteristic curves for pulse stimuli representing the relationship between a pulse's current amplitude, or strength, i, and a pulse's duration, t, for stimulating cardiac muscle and skeletal muscle.
  • the duration, T t of each pacing pulse train 80 (Fig. 3) is chosen by considering these strength-duration curves.
  • Each curve delineates the minimum duration, t, which an electrical pulse stimulus having a given current amplitude, i, will require to stimulate a muscle. Stated another way, given a pulse amplitude, i, a muscle will not be stimulated unless the pulse duration, t, is on, or to the right of, the corresponding curve.
  • a minimum pulse amplitude, or rheobase (Ri c for cardiac muscle and Ri s for skeletal muscle) , defines the smallest pulse amplitude that will stimulate a muscle. Any stimulus having a current amplitude less than the rheobase will not stimulate a muscle, even if the pulse's duration is greater than the rheobase duration, called the utilization time, (Rt c for cardiac muscle and Rt s for skeletal muscle) . Comparing the strength-duration curves of Fig. 4, the cardiac muscle's utilization time, Rt c , which is greater than approximately 40 msec, is longer than that of skeletal muscle, having a utilization time Rt ⁇ which is considerably less than 40 msec.
  • a preferable range for the pacing pulse trains' durations T t is selected with the following consideration. While any stimulus point on the cardiac strength-duration curve produces effective cardiac stimulation, stimulus points having lower current amplitudes tend to produce lower skeletal muscle stimulation than stimulus points having higher current amplitudes, for a given stimulus duration. Accordingly, a pulse stimulus having the characteristics of point A (close to the cardiac utilization time Rt c ) stimulates skeletal muscle less than a pulse stimulus having the characteristics of point B, but will stimulate the heart equally effectively.
  • each pacing pulse train is therefore preferably at least 5 msec, or more preferably 20 msec, but may be of any duration sufficient to stimulate the heart.
  • the maximum preferable pacing pulse train duration is limited to approximately 150 msec because of safety considerations for inducing cardiac fibrillation.
  • the pulse width and pulse period T of each of the pulses in the pacing pulse trains are also selected based on a comparison of the strength-duration relationships for cardiac muscle and skeletal muscle (Fig. 4) .
  • a minimum pulse duration called the chronaxie (Ct_ for cardiac muscle and Ct_ for skeletal muscle)
  • Ct_ for cardiac muscle
  • Ct_ for skeletal muscle is the pulse duration corresponding to a stimulating pulse amplitude equal to twice the rheobase of a muscle.
  • the cardiac muscle's chronaxie Ct c is approximately equal to 2 msec and the skeletal muscle's chronaxie Ct s is approximately equal to 0.5 msec.
  • a pulse stimulus of a duration shorter than the skeletal muscle chronaxie Ct g having, e.g., the duration of a pulse at point C, would therefore tend not to stimulate either cardiac muscle or skeletal muscle.
  • a train of such pulses having suitably adjusted amplitudes and a pulse train duration T t which is longer than the cardiac muscle chronaxie Ct c , e.g., the stimulus duration of point A,. effectively stimulates the heart as if the pulse trains had been filtered by, e.g., the skeletal muscles, to produce a continuous pacing pulse.
  • the pulse width W of each of the pacing pulses is selected to be less, preferably much less, than the skeletal muscle chronaxie Ct g (0.5 msec). With pulses of such width, the skeletal muscles tend to be stimulated less than they would if the pacing pulse were a single continuous pulse, but the heart is stimulated as effectively as a continuous pulse.
  • the pacing pulse width for achieving this condition is preferably less than 100 microseconds, and most preferably less than 15 microseconds. Pulse widths of less than about 7 microseconds may produce a pacing pulse frequency which is high enough to cause tissue damage, and thus may need to be avoided.
  • the pacing pulse period T is selected to ensure adequate pacing stimulation, or capture, of the heart.
  • the preferred pacing pulse duty cycle is 66%, but a lower duty cycle, e.g., 20%, or a variable duty cycle may be used, provided the given duty cycle is adequate to capture the heart.
  • a lower duty cycle e.g. 20%
  • a variable duty cycle may be used, provided the given duty cycle is adequate to capture the heart.
  • the higher the duty cycle the higher will be the effective filtered amplitude of the continuous pulse that influences the cardiac muscle.
  • Fig. 3B A variation in the form of the pacing stimuli is shown in Fig. 3B.
  • the amplitude, i £ of the first pulse in each pacing pulse train has a subthreshold amplitude, i.e., the amplitude is below the minimum pulse amplitude required for stimulation if the pulse amplitude of a given pulse train remained constant for the duration of the pulse train.
  • Each of the pulses following the initial pulse has an amplitude greater than that of the previous pulses, with some number of trailing pulses all having a maximum current amplitude, i M .
  • the value of this maximum current amplitude i M is selected, along with other pulse train characteristics, e.g., pulse train duration, to ensure capture of the heart. For example, a pulse train with a given number of pulses having a maximum current amplitude i M may require a shorter duration to capture the heart than a pulse train with fewer pulses having a maximum current amplitude that is greater than i M
  • initial, subthreshold pulses, followed by a series of pulses each having an amplitude that is greater than the amplitudes of the preceding pulses is intended to induce accommodation of the skeletal muscles to the pacing pulse train stimuli.
  • Accommodation of a muscle is a physiological phenomenon which can be induced by gradually, rather than abruptly, exposing a muscle to a stimulus amplitude, whereby the stimulating threshold of the muscle is increased beyond the magnitude of the applied stimulus.
  • An accommodated muscle or nerve requires a higher than normal stimulus magnitude to be effectively stimulated, and may even reject stimulation altogether for any magnitude of stimulus increase.
  • the amplitudes of the pulses in the pacing pulse train are selected to cause accommodation of skeletal muscles but not to cause accommodation of cardiac muscle.
  • the pacing pulse trains effectively stimulate the heart but tend to decrease the skeletal muscle stimulation typically associated with the transcutaneous cardiac muscle stimulation.
  • the background pulse trains 90 are provided during the intervals between the pacing stimuli.
  • Each background pulse train comprises a series of pulses, with the amplitudes of the pulses alternating between a positive amplitude, i B , and a negative amplitude, -i B , in a biphasic fashion. While Fig. 2 shows each of the background pulses having the same amplitude magnitude, each of the pulses may have differing amplitudes.
  • the magnitude of the alternating amplitudes, [i B i is preferably below the minimum current amplitude which a pulse, having the width W B , would require to stimulate the skeletal muscles.
  • the background pulse train has an amplitude, e.g., zero amplitude, that is below the current amplitude required to stimulate skeletal muscle.
  • the pulse width W ⁇ and period T B of the background pulses are chosen to fulfill two criteria: 1.
  • the duty cycle (100 x 2W ⁇ /T B ) of the background pulses is preferably less than 80%, or more preferably less than 50%, for providing a low average current; and 2.
  • the average current (i B x duty cycle) is preferably less than 20 mA, and more preferably less than 10 mA.
  • the subthreshold stimulus from the background pulse trains 90 tends to reduce the pacing pulse trains' stimulation of the skeletal muscles, possibly through accommodation of those muscles. That is, by adding the background pulse trains, the discomfort from stimulation of skeletal muscle during cardiac pacing is less than it would be without the background pulses (when the pacing stimuli are at threshold) .
  • the background pulse characteristics are accordingly selected to enhance accommodation of the skeletal muscles while discouraging accommodation of the cardiac muscle.
  • the background pulse characteristics are selected to induce a level of skeletal muscle accommodation which increases - li ⁇ the muscle stimulation threshold above the largest pacing pulse train stimuli amplitude.
  • the background pulse trains and pacing pulse trains also decrease the cutaneous nerve stimulation associated with transcutaneous cardiac pacing. Because the skeletal muscles and cutaneous nerves have similar chronaxies (Fig. 4) , the cutaneous nerves, like skeletal muscles, tend to be stimulated less by the pulses in the pacing pulse trains than they would if the pacing pulse were a single continuous pulse. Furthermore, the background pulse train characteristics selected to produce accommodation of skeletal muscles accordingly produce accommodation of cutaneous nerves.
  • the signal generator's waveform-shaping circuitry 60 modifies the stream of pulses generated by the oscillator circuitry 40 to create and distinguish the pacing and background pulse trains in the pacing stimuli 65. This modification may require amplitude or polarity adjustment for the particular electrodes used with the signal generator, as discussed below.
  • the timing and control circuitry 20 provides further fine adjustment of the pacing pulse train characteristics, for example, pulse shape. Both the waveform-shaping circuitry 60 and the timing and control circuitry 20 may be programmed to include or omit any or more of the electrical signal characteristics discussed above.
  • a variety of electrode structures may be used to deliver the pacing stimuli.
  • the pacing stimuli are passed through the patient's thorax from the posterior electrode to the anterior electrode.
  • the contribution of the electrode configuration to stimulation reduction may be less important.
  • conventional noninvasive pacing electrodes with non etallic skin-contacting members such as those disclosed in U.S. Patent No. 4,349,030, or as sold by R-2, of Morton Grove, Illinois, Physio-Control Corporation, of Redmond, Washington, or ZMI Corporation, of Woburn, Massachusetts, are suitable for delivering the pacing pulse trains.
  • electrodes having metallic skin-contacting members may be adapted to deliver the pacing stimuli.
  • the anterior electrode 72 and posterior electrode 70 are adapted to deliver the pacing stimuli 65 from the signal generator 10 to a patient.
  • a variety of electrode structures may be adequately used to achieve this function.
  • the electrodes are configured so that pacing pulse trains are delivered through the skin and skeletal muscles to the heart, whereas background pulse trains, if existent, are delivered only to the skin and skeletal muscles, and not to the heart. This electrode configuration ensures that cardiac fibrillation will not be induced by the background pulse trains.
  • the electrodes 70, 72 are divided into central, isolated regions 70a, 72a, and surrounding annular regions 70b, 72b.
  • Each of the central regions is separated from its corresponding annular region by a distance which is adequate to provide electrical isolation between the two regions, e.g., at least one-quarter inch.
  • the lateral region within this separating distance may be filled with an adhesive to act as an insulating material between the inner and outer electrode regions.
  • the stimuli are passed through the patient's thorax from the posterior electrode's central region 70a to the anterior electrode's central region 72a.
  • the pacing stimuli never pass through the patient, but instead pass between the central and annular regions of each electrode, as shown in Fig. 5.
  • the polarity of, or direction in which, the background stimuli are applied to the patient through the electrodes may be suitably altered without decreasing the effectiveness of the pacing stimuli for pacing the patient's heart. If no background pulse trains are present, the entire stimuli may pass through the patient's thorax from one central region 70a (anode) to the other central region 72a (cathode) .
  • the pacing pulse train could have an initial pulse 81 with a maximum amplitude i M , followed by a series of pulses which each has an amplitude that is less than the amplitudes of all preceding pulses.
  • the pacing pulse train could have an initial portion 100 of subthreshold pulses, all of an equal amplitude, followed by a portion 105 of above-threshold pulses, all of an equal amplitude.
  • the initial portion 100 of subthreshold pulses may include a second portion of subthreshold pulses, all of a second, equal amplitude.
  • the pacing pulse train could have alternating subthreshold pulses 110 and above threshold pulses 120.
  • Another variation for achieving the subthreshold pulses is to vary the duration of the pulses, using shorter durations for the subthreshold pulses, and longer durations for the above-threshold pulses.
  • the pulses in a train could have non-rectangular shapes, e.g., triangular, exponential, or rounded.
  • the duty cycle and duration of pulses can be varied within the pulse train (e.g., there could be brief gaps in the sequence of pulses) .
  • the background pulses could also be used with conventional continuous pacing pulses, and could be applied continuously (even during the pacing stimuli) .
  • the background pulses could be monophasic. Individual background pulses could have non-rectangular shapes, e.g., triangular, exponential, or rounded.
  • the amplitude, duration, and duty cycle of the background pulses could vary over time. Gaps could be present in the train of background pulses. What is claimed is:

Abstract

Procédé et appareil de stimulation transcutanée du coeur à l'aide de stimuli de stimulation composés chacun d'une série d'impulsions individuelles. Le coeur réagit à la série d'impulsions comme si la série était une seule impulsion continue, tandis que la série d'impulsions produit des réactions des muscles squelettiques similaires à celles que l'on attendrait d'impulsions individuelles. Il en résulte une réduction de la stimulation des muscles squelettiques et des nerfs, et moins de gêne pour le patient. Une nouvelle réduction de la stimulation des muscles squelettiques et des nerfs peut être obtenue en émettant une série d'impulsions initiales d'amplitude inférieure au seuil de stimulation des muscles squelettiques dans chaque stimulus de stimulation et en émettant des stimuli de fond qui surviennent dans les intervalles entre les stimuli de stimulation. Ledit appareil comporte un circuit de minutage et de commande (20) et un circuit générateur de stimuli (30) connecté à des électrodes (70, 72).
EP9191915140A 1991-07-15 1991-07-15 Procede et appareil de stimulation cardiaque transcutanee. Withdrawn EP0594620A4 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1991/004972 WO1993001861A1 (fr) 1991-07-15 1991-07-15 Procede et appareil de stimulation cardiaque transcutanee

Publications (2)

Publication Number Publication Date
EP0594620A1 true EP0594620A1 (fr) 1994-05-04
EP0594620A4 EP0594620A4 (fr) 1994-11-02

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP9191915140A Withdrawn EP0594620A4 (fr) 1991-07-15 1991-07-15 Procede et appareil de stimulation cardiaque transcutanee.

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EP (1) EP0594620A4 (fr)
WO (1) WO1993001861A1 (fr)

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US6141587A (en) * 1996-08-19 2000-10-31 Mower Family Chf Treatment Irrevocable Trust Augmentation of muscle contractility by biphasic stimulation
US6136019A (en) * 1996-08-19 2000-10-24 Mower Family Chf Treatment Irrevocable Trust Augmentation of electrical conduction and contractility by biphasic cardiac pacing administered via the cardiac blood pool
US5431688A (en) * 1990-06-12 1995-07-11 Zmd Corporation Method and apparatus for transcutaneous electrical cardiac pacing
US5792187A (en) 1993-02-22 1998-08-11 Angeion Corporation Neuro-stimulation to control pain during cardioversion defibrillation
US6185457B1 (en) 1994-05-31 2001-02-06 Galvani, Ltd. Method and apparatus for electrically forcing cardiac output in an arrhythmia patient
US8447399B2 (en) 1996-08-19 2013-05-21 Mr3 Medical, Llc System and method for managing detrimental cardiac remodeling
US6178351B1 (en) 1996-08-19 2001-01-23 The Mower Family Chf Treatment Irrevocable Trust Atrial sensing and multiple site stimulation as intervention means for atrial fibrillation
US6141586A (en) * 1996-08-19 2000-10-31 Mower Family Chf Treatment Irrevocable Trust Method and apparatus to allow cyclic pacing at an average rate just above the intrinsic heart rate so as to maximize inotropic pacing effects at minimal heart rates
US6295470B1 (en) 1996-08-19 2001-09-25 The Mower Family Chf Treatment Irrevocable Trust Antitachycardial pacing
US6148233A (en) 1997-03-07 2000-11-14 Cardiac Science, Inc. Defibrillation system having segmented electrodes
US6067470A (en) * 1998-03-05 2000-05-23 Mower Family Chf Treatment Irrevocable Trust System and method for multiple site biphasic stimulation to revert ventricular arrhythmias
US6539255B1 (en) 1998-07-16 2003-03-25 Cardiac Science, Inc. Full-tilt exponential defibrillation waveform
KR100451227B1 (ko) * 2002-02-05 2004-10-02 엘지전자 주식회사 동기릴럭턴스 모터의 센서리스 속도제어방법
US20050107833A1 (en) 2003-11-13 2005-05-19 Freeman Gary A. Multi-path transthoracic defibrillation and cardioversion
US7457662B2 (en) 2005-09-09 2008-11-25 Cardiac Science Corporation Method and apparatus for variable capacitance defibrillation
US8483822B1 (en) 2009-07-02 2013-07-09 Galvani, Ltd. Adaptive medium voltage therapy for cardiac arrhythmias
US8750990B1 (en) 2012-12-12 2014-06-10 Galvani, Ltd. Coordinated medium voltage therapy for improving effectiveness of defibrillation therapy
GB2522717A (en) * 2014-02-04 2015-08-05 Team Turquoise Ltd A wearable heart entrainment device
CN106170244B (zh) 2014-02-04 2019-06-21 蒂姆土库尔斯有限公司 可穿戴设备

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Also Published As

Publication number Publication date
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