WO2000013741A2 - Procede et appareil de surveillance de la syncope - Google Patents

Procede et appareil de surveillance de la syncope Download PDF

Info

Publication number
WO2000013741A2
WO2000013741A2 PCT/US1999/020565 US9920565W WO0013741A2 WO 2000013741 A2 WO2000013741 A2 WO 2000013741A2 US 9920565 W US9920565 W US 9920565W WO 0013741 A2 WO0013741 A2 WO 0013741A2
Authority
WO
WIPO (PCT)
Prior art keywords
heart
buffer
patient
monitoring
cardiac
Prior art date
Application number
PCT/US1999/020565
Other languages
English (en)
Inventor
Kai Kroll
Original Assignee
Galvani, Ltd.
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 Galvani, Ltd. filed Critical Galvani, Ltd.
Priority to AU59129/99A priority Critical patent/AU5912999A/en
Publication of WO2000013741A2 publication Critical patent/WO2000013741A2/fr

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
    • A61N1/37—Monitoring; Protecting
    • A61N1/3702—Physiological parameters

Definitions

  • This invention generally relates to cardiac arrhythmia monitoring
  • the present invention pertains to a syncope monitor.
  • the present invention pertains to a syncope monitoring device that subcutaneously measures and records information regarding syncope.
  • syncope Sudden transient loss of consciousness
  • syncope When structural heart disease is absent, a disorder of cardiovascular reflexes is the most likely cause of syncope Syncope can be associated with bodily injury due to falls or other accidents. Additionally, individuals who experience syncope may have a serious underlying cardiac condition and may run the risk of increased mortality or morbidity if the condition is left undiagnosed
  • External ambulatory monitors that record an electrocardiography (ECG) continuously or during predetermined symptoms are often prescribed Patients may wear such devices, such as halter monitors, for one day to several months However, for patients whose symptoms occur infrequently, the monitoring period may not be long enough to capture a diagnostic ECG. Additionally, patient compliance with long term use of such monitors is problematic and can limit or hinder normal activities such as swimming, bathing and even dressing. Another deficiency with external monitoring devices is that many patients being monitored for syncope will suffer fibrillation and die while being monitored.
  • ventricular fibrillation a usually fatal heart arrhythmia
  • ICD implantable cardioverter defibrillator
  • a typical ICD includes an electrical pulse generator and an arrhythmia detection circuit coupled to the heart by a series of two or more electrodes implanted in the body A power supply, and one or more charge storage capacitors are used for delivering defibrillation shocks in the form of electrical current pulses to the heart
  • ICDs work well at restoring normal function, the ICD is expensive and large in size and not practical for a truly prophylactic device.
  • ICDs are designed to furnish hundreds of high voltage defibrillation shocks over a period of years.
  • the present invention comprises a method and an apparatus for monitoring syncope.
  • the syncope monitor includes electrical cardiac output forcing (ECOF) back up
  • the present invention is an implantable device for recording the electrical activity within a human heart.
  • the device of the present invention includes ECOF back up.
  • the device includes a power supply for operating the device and for providing the necessary output forcing signals
  • a monitoring or detection device is connected to the power supply.
  • the device can monitor blood pressure (BP), and record and store blood pressure readings.
  • Electrodes electrically connect the power supply and the detection device to a patient's heart
  • a memory device is also provided which is connected to the detection device for recording electrical activity data of the patient's heart.
  • the memory device is comprised of a short term loop buffer for continuously recording the electrical data from the patient's heart and a long term storage buffer.
  • the short term loop buffer may be of a desired size, for example, capable of storing from 1-30 minutes of data before overwriting occurs.
  • a predetermined event for example, a bout of syncope
  • the data in the short term loop buffer is transferred to the long term storage buffer.
  • An output control circuit is also provided which is connected to the detection device and to the power supply and to the electrodes.
  • the output control circuit causes the delivery of an electrical cardiac output forcing signal to the patient's heart.
  • Figure 1 is a block diagram illustrating a system constructed in accordance with a first preferred embodiment of the present invention.
  • Figure 2 is a perspective view of the system of the present invention in an epicardial patch configuration.
  • Figure 3 is a perspective view of the system of the present invention using an endocardial lead.
  • Figure 4 is a flow chart illustrating the syncope monitoring portion of the present invention.
  • Figure 5 is a diagram showing a representative electrical signal of the present invention.
  • Figure 6 is a flow chart illustrating the ECOF portion of the present invention.
  • Figure 7 is a diagram showing the expected effect of a 50 volt pulse on a heart during diastole
  • Figure 8 is a diagram showing the expected effect of a 50 volt pulse on a heart during systole
  • Figure 9 is a diagram showing the expected effect of a 50 volt pulse on a heart during fibrillation.
  • Figure 10 illustrates a waveform useful for the electrical cardiac output forcing function.
  • Figure 11 illustrations an alternative waveform useful for the electrical cardiac output forcing function.
  • Figure 12 is a perspective view of the system of the present invention in an alternative embodiment.
  • FIG. 1 is a block diagram illustrating a system 10 constructed in accordance with the present invention.
  • System 10 is connected to a heart 12 by a series of leads including an output lead 14, an optional pressure sensing lead 16, and an ECG sensing lead 18.
  • System 10 includes a conventional ECG amplifier 20 for amplifying cardiac signals.
  • the amplified cardiac signals are analyzed by a syncope monitor 22 that includes a loop buffer 23a and a long term storage buffer 23b which will be described in greater detail below.
  • the amplified cardiac signals also are analyzed by a conventional arrhythmia detector 24 which determines if an arrhythmia is present
  • System 10 also contains an optional pressure sensing section 26 which amplifies and conditions a signal from an optional pressure sensor from within heart 12 or an artery
  • the output of pressure sensor circuit 26 is fed to a cardiac output detection circuit 28 which analyzes the data and determines an estimate of cardiac output.
  • Data from arrhythmia detector 24 and cardiac output detection circuit 28 is fed to a microprocessor 30.
  • Microprocessor 30 determines if ECOF is appropriate. If forcing is indicated, microprocessor 30 prompts an output control 32 to charge a capacitor within an output circuit 34 via a capacitor charger 36. Output control 32 directs output circuit 34 to deliver pulses to heart 12 via output leads 14.
  • microprocessor 30 may communicate with external sources via a telemetry circuit 38 within device 10.
  • the power for system 10 is supplied by an internal battery 40.
  • references to ECG throughout may be interpreted as BP as well, where appropriate, as another form of sensed signal
  • FIGs 2 and 3 illustrate various configurations of using the present invention.
  • an epicardial patch configuration is illustrated.
  • a non-thoracotomy system is illustrated using an endocardial lead Figure 2, in particular, illustrates system 10 adapted for a thoracotomy configuration wherein electrode patches 42 are attached to heart 12. Electrode patches 42 are connected to system 10 through output leads 14
  • Optional pressure sensing lead 16 passes a signal from an optional pressure transducer 46 which lies in heart 12.
  • the ECG is monitored by sense electrodes 44 which is connected to system 10 by ECG sensing lead 18.
  • Figure 3 illustrates a non-thoracotomy system wherein current passes from a coil electrode 52 in heart 12 to a housing 53 of system 10.
  • An endocardial lead 50 combines ECG sensing electrodes 44 and coil electrode 52.
  • a patient's ECG is monitored by sense electrodes 44 in heart 12 and passes the signal through endocardial lead 50
  • optional pressure transducer 46 is available which passes a signal to system 10 through lead 16.
  • syncope monitoring circuit 22 continuously monitors the heart's electrical activity and records it as a subcutaneous ECG/BP.
  • Monitoring circuit 22 records information in a loop, replacing old ECG/BP information with new ECG/BP information
  • Recording information in a loop may be accomplished in a number of ways such as with a circular, or revolving buffer 23 a.
  • the buffer used for recording ECG/BP data may be of various sizes to accommodate desired recording lengths before overwriting is necessary
  • loop buffer 23 a will be sized to record between one and thirty minutes of data, however, greater buffer sizes may be used.
  • the information that has been recorded in revolving buffer 23a is transferred to a more permanent buffer 23b in syncope monitoring circuit 22.
  • the transmission of data from revolving buffer 23a to long term storage buffer 23b may be activated by a number of protocols.
  • an external device may be used to send a command to telemetry circuit 38 instructing syncope monitoring circuit 22 to transfer the data.
  • Syncope monitoring circuit 22 may be programmed to automatically transfer data to buffer 23b after an event has been detected, or syncope monitoring circuit 22 may be equipped with a magnetically actuated switch (not shown) which causes the transfer of data from buffer 23 a to buffer 23b when a magnet is placed in proximity to the patient's chest It should be noted that these are only a few examples and this list is not meant to be exhaustive.
  • Long term buffer 23b is preferably sized larger than loop buffer 23a. By sizing long term storage buffer 23b larger than loop buffer 23a, data recording multiple syncope events can be transferred from loop buffer 23a and stored in buffer 23b before buffer 23b is full. Storing multiple syncope events may be important if the patient is not able to get to a physician immediately after the first recorded occurrence of syncope.
  • the data is available for downloading to an external device for analysis by doctors.
  • the external device (not shown) may be a portable hand held device used by the patient or a larger device used in hospitals or clinics.
  • the data may be downloaded from storage buffer 23b to the external device via telemetry circuit 38
  • Data may be downloaded upon command from the external device, or, as with the transfer from buffer 23a to buffer 23b, with the aid of a magnet switch that is activated by a separate magnet or a magnet located in the external device.
  • syncope monitoring circuit 22 only begins recording the subcutaneous ECG signals when an indicia of syncope has been detected
  • loop buffer 23a is not recording anything until such indicia of syncope is first detected. At that point, ECG data is recorded in loop buffer 23a.
  • This alternative embodiment is not as desirable as the preferred embodiment which continuously records ECG data in loop buffer 23a, because in this embodiment the ECG signals, prior to the first indicia of syncope, will not be recorded and therefore will be unavailable for comparison.
  • the present invention also includes backup ECOF functionality. If ventricular fibrillation is sensed by arrhythmia detector circuit 24, ECOF pulses will be delivered to the heart to maintain life until external defibrillation therapy is administered.
  • a forcing field is generated by applying approximately 50 V to the heart at a rate of approximately 100-180 beats per minute. These fields are applied after detection of an arrhythmia and maintained for up to several hours. This will generate a cardiac output which is a fraction of the normal maximum capacity.
  • the heart has a four or five times reserved capacity so this fraction of the normal pumping activity will maintain life and consciousness to allow a patient enough time to get to a hospital. The patient would then be a candidate for an implantable cardioverter defibrillator.
  • a series of forcing pulses 60 are shown in Figure 5
  • the pulses are approximately 50 V in amplitude with a spacing of approximately 500 ms
  • the 50 V and 500 ms pulse spacing are chosen as illustrative for an implantable device
  • the forcing pulse interval is chosen to maximize cardiac output within the limits of device circuitry and the response of the heart muscle
  • An interval of 500 ms corresponds to a heart rate of 120 beats per minute.
  • a rate of 240 beats per minute would produce a lower output due to mechanical limitations of the heart
  • a practical range is 60 to 200 beats per minute
  • the pulses could also be timed to coincide with the natural pumping of the atria, thus improving overall cardiac output.
  • the higher voltage produces greater patient discomfort and extraneous muscle twitching
  • FIG. 6 is a flow chart illustrating a method of applying ECOF pulses according to the present invention It should be noted that this chart is provided for purposes of illustration only and that one skilled in the art will recognize from the discussion that alternative methods may be employed without departing from the principles of the invention.
  • the flow chart shown in Figure 6 represents a method of automatically treating a heart which is in fibrillation, tachycardia, or asystole and thereby pumping inefficiently or not at all.
  • a series of cardiac output forcing electric pulses are automatically delivered in block 72. It should be understood that the therapy may be delivered for any output compromising cardiac arrhythmia.
  • the status of the heart is determined in block 74. If an arrhythmia is still present and there exists low pressure within the heart, more forcing pulses are delivered in block 78. If the heart is pumping at a safe level, the therapy ceases and exits at block 76. Note that this means that the ECOF successfully defibrillated the patient's heart even though this is not a primary goal of the system. For those patients who are defibrillated by ECOF pulse therapy, it is possible they could then receive ECOFs instead of the larger ICD. After the therapy in block 78 has been delivered, the pressure and ECG is again monitored in block 79.
  • the method proceeds to a continuous cardiac assist mode as in block 80.
  • This therapy may only be stopped by an external command, for example, a telemetry signal or a magnet which is applied to the chest activating a magnetic reed switch as indicated in block 82 which terminates the therapy and exits in block 76.
  • the forcing voltage could be adjusted down when sufficient pressure signals or adequate flow measured by other means were detected, for example, the pressure sense transducer could be replaced by an oxygen detector or a doppler flow measuring device.
  • the pulse rate could also be adjusted to maximize output
  • Figure 7 is a diagram showing the effect of a 50 V forcing pulse of heart 12 during electrical diastole (cells at rest).
  • the current is passed through heart 12 by electrodes 42.
  • Approximately 60% of cardiac cells 90 would be captured by a 50 V pulse if the cells were is diastole Captured cells 90 mostly lie in the direct path between electrodes 42 and near electrodes 42 where the field strengths are highest
  • these directly captured cells then propagate an activation wavefront to stimulate the rest of the heart. This so called far-field pacing is irrelevant here as the hearts, of interest, are in fibrillation and not in diastole.
  • Figure 8 is a diagram showing the effect of a 50 V forcing pulse on the heart during electrical systole (cells already stimulated).
  • the current is passed through heart 12 by electrodes 42.
  • Approximately 20% of cardiac cells 100 would be captured by a 50 V pulse if the cells were in systole.
  • the captured cells 100 are nearest each electrode 42 where the field strengths are highest. Capture in systolic cells means that their activation potential is extended. This capture requires significantly higher fields (10 V/cm) than those required for diastolic cell capture (1 V/cm).
  • Figure 9 is a diagram showing the effect of a 50 V forcing pulse on the heart during fibrillation During fibrillation there are always cells in systole and diastole simultaneously. But, the vast majority are in systole. This diagram assumes 50% of the cells are in diastole which applies only after several capturing pulses.
  • the current is passed through heart 12 by electrodes 42. One hundred percent of the cells 1 10 nearest electrodes 42 would be captured due to the high field strength. As shown in Figure 8, even systolic cells are captured by high field strengths Fifty percent of cells 112 in the direct path between electrodes 42 would be captured if it is assumed that 50% of all cells are in diastole.
  • the A row represents the diastolic cells that are not captured by the forcing pulse If 50% of the heart's cells are in diastole and 40% of those are not captured that is 20% of the total cells These cells will, however, shortly contract on their own (from previous wavefronts or new ones) providing a positive gain in mechanical action and therefore cardiac output
  • the B row corresponds to the diastolic cells that are captured. If 60% of the diastolic cells (50% of total) contract due to the forcing field this is 30% of the total heart cells. These cells provide the biggest gain in mechanical action and cardiac output.
  • the 30% net pumping action should be sufficient to maintain survival and consciousness, because the heart has a 4 -5 times reserve capacity.
  • Figures 10 and 11 depict examples of waveforms designed to minimize the twitching of the chest muscles which can be very uncomfortable to the patient.
  • a low harmonic pulse waveform 120 which has a very gradual "foot” 122 and a gradual peak 124 is illustrated. Such a pulse has less high frequency energy components and thus is less likely to stimulate the skeletal muscle.
  • FIG 11 shows the opposite extreme
  • each compound forcing pulse 126 is actually composed of 50 very short spikes 128 each of which is 20 ⁇ s in width with a 20 ⁇ s spacing.
  • the heart will tend to average out these thin pulses and "see" a 2 ms wide forcing pulse.
  • the skeletal muscle is not efficiently stimulated by these extremely narrow pulses. The skeletal muscle will not average out this signal either. This approach could help minimize skeletal muscle twitching and discomfort.
  • An alternative system would be to initially apply a 300 V pulse to capture many cells therefore putting those cells into diastole after a delay of 100 - 200 ms. At this point, the voltage could be lowered to 100 V and delivered every 100 ms.
  • a 3 watt DC-DC converter with a 67% efficiency could provide 100 ms interval forcing pulses assuming a 50 ohm resistance and 1 ms pulse (0.2 J). This rate is too fast for forcing cardiac output due to mechanical limitations, but is very effective for electrical capture After sufficient capture, the rate of forcing pulses could be slowed down to 100 - 170 beats per minute for optimum cardiac output
  • the Electrical Cardiac Output Forcing (ECOF) portion of the present invention could also be used to help patients with atrial fibrillation.
  • electrode coil 52 and sensing electrodes 44 could be placed in the atrium The device could then function to force atrial output. Even though atrial fibrillation is not instantly fatal like ventricular fibrillation, clots can build up in the atria which can eventually lead to strokes. Cardiac output forcing of the atria on a daily basis may limit this problem. It is also possible that after a number of forcing pulses the atria would return to a normal rhythm. There is, however, no urgency as is the case with ventricular fibrillation.
  • Figure 12 illustrates a further use for the ECOF portion of the present invention.
  • device 10 is shown connected to heart 12 via endocardial lead 50. Again, forcing coil electrode 52 and sensing electrodes 44 are in the right ventricle.
  • a large atrial coil electrode 130 and atrial sensing electrodes 132 are in the right atrium. These would be used for conventional atrial defibrillation.
  • One of the big concerns with atrial defibrillation is that in a few cases, an atrial defibrillation shock causes ventricular fibrillation. If this happens, the patient dies within minutes. In this embodiment, the present invention could maintain output in the patient for several hours and thus have enough time for transport to a hospital for external defibrillation.
  • the ECOF approach in the ventricle could provide a safety back up to atrial defibrillation.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biophysics (AREA)
  • Physiology (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Electrotherapy Devices (AREA)

Abstract

L'invention concerne un procédé et un appareil de surveillance de la syncope, qui offre la possibilité de mettre en oeuvre un appareil d'appoint pour le forçage électrique du débit cardiaque (ECOF). L'objet de l'invention est un dispositif implantable qui enregistre l'activité électrique à l'intérieur du coeur humain. Ce dispositif inclut l'appareil d'appoint ECOF, une source d'énergie pour faire fonctionner l'appareil et pour générer les signaux de forçage du débit nécessaires. Un appareil de surveillance et de détection est relié à la source d'énergie. Des électrodes relient électriquement la source d'énergie et l'appareil de détection au coeur d'un patient. Un dispositif à mémoire est également relié à l'appareil de détection pour enregistrer des données relatives à l'activité électrique et/ou à la pression sanguine dans le coeur du patient. Dans une forme de réalisation préférée, le dispositif à mémoire est constitué d'un tampon en boucle à court terme qui enregistre en continu les données électriques émises par le coeur du patient, et un tampon à long terme. Le tampon en boucle à court terme peut présenter une taille désirée pouvant, par exemple, stocker de 1 à 30 minutes de données avant un éventuel écrasement. Dans le cas où un événement prédéterminé (une crise de syncope, par exemple) survient, les données contenues dans le tampon en boucle à court terme sont transférées vers le tampon à long terme. Un circuit de régulation du débit est également relié à l'appareil de détection, à la source d'énergie et aux électrodes. Dans le cas où un deuxième événement prédéterminé (fibrillation du coeur, par exemple) survient, le circuit de régulation du débit provoque l'émission d'un signal électrique de forçage du débit cardiaque à destination du coeur du patient.
PCT/US1999/020565 1998-09-08 1999-09-08 Procede et appareil de surveillance de la syncope WO2000013741A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU59129/99A AU5912999A (en) 1998-09-08 1999-09-08 Method and apparatus for monitoring syncope

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US9945898P 1998-09-08 1998-09-08
US60/099,458 1998-09-08

Publications (1)

Publication Number Publication Date
WO2000013741A2 true WO2000013741A2 (fr) 2000-03-16

Family

ID=22275101

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1999/020565 WO2000013741A2 (fr) 1998-09-08 1999-09-08 Procede et appareil de surveillance de la syncope

Country Status (2)

Country Link
AU (1) AU5912999A (fr)
WO (1) WO2000013741A2 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7043301B1 (en) 2002-10-11 2006-05-09 Pacesetter, Inc. Implantable cardiac stimulation system providing high output far-field pacing and method
US10925677B2 (en) 2015-06-25 2021-02-23 Koninklijke Philips N.V. Medical interventional imaging device

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7043301B1 (en) 2002-10-11 2006-05-09 Pacesetter, Inc. Implantable cardiac stimulation system providing high output far-field pacing and method
US10925677B2 (en) 2015-06-25 2021-02-23 Koninklijke Philips N.V. Medical interventional imaging device
US11478309B2 (en) 2015-06-25 2022-10-25 Koninklijke Philips N.V. Medical interventional imaging device

Also Published As

Publication number Publication date
AU5912999A (en) 2000-03-27

Similar Documents

Publication Publication Date Title
US6351670B1 (en) Electrical cardiac assist for an implantable syncope monitor
US6567697B1 (en) External defibrillator with electrical CPR assist
US6560484B1 (en) Method and apparatus for electrically forcing cardiac output in an arrhythmia patient
US5782883A (en) Suboptimal output device to manage cardiac tachyarrhythmias
US6556865B2 (en) Method for improving cardiac function following delivery of a defibrillation shock
JP4827143B2 (ja) 心室性不整脈を検出しかつ治療するための装置
US7392081B2 (en) Subcutaneous cardiac stimulator employing post-shock transthoracic asystole prevention pacing
US5156148A (en) System for treating a malfunctioning heart
US5464432A (en) Implantable atrial defibrillator having an intermittently activated fibrillation detector
US6038476A (en) System and method for analyzing the efficacy of cardiac stimulation therapy
US20070293895A1 (en) Acoustically-powered wireless defibrillator
US6230056B1 (en) Method and apparatus for preventing clotting during a trial fibrillation
EP2364639B1 (fr) Dispositif médical implantable pour la discrimination de l'accident vasculaire cérébral et l'ischémie cardiaque avec des signaux électrocardiaques et des paramètres hémodynamiques
US20040220628A1 (en) Subcutaneous defibrillation timing correlated with induced skeletal muscle contraction
JP2008538989A (ja) 皮下信号又は体表面信号内の雑音、洞調律、及び心室細動を検出するレベル交差検出器
US5871510A (en) Method and apparatus for temporarily electrically forcing cardiac output as a backup for tachycardia patients
EP2257337B1 (fr) Défibrillation atriale utilisant un système de défibrillation implantable
US20050197676A1 (en) Electrical cardiac output forcer
US6167306A (en) Method and apparatus for electrically forcing cardiac output in an arrhythmia patient
EP0868206B1 (fr) Appareil permettant temporairement de forcer electriquement le debit cardiaque, comme solution d'appoint destinee aux malades souffrant de tachycardie
WO2000013741A2 (fr) Procede et appareil de surveillance de la syncope
US10004912B1 (en) System and method for diagnosing and treating cardiac arrhythmia
WO2000013748A1 (fr) Procede et appareil de prevention de coagulation lors d"une fibrillation auriculaire
EP1614446A2 (fr) Ejection cardiaque temporaire forcée electriquement pour les patients souffrant de tachycardie
US20040059390A1 (en) Device wtih redetection therapy thereshold

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A2

Designated state(s): AE AL AM AT AU AZ BA BB BG BR BY CA CH CN CU CZ DE DK EE ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT UA UG UZ VN YU ZA ZW

AL Designated countries for regional patents

Kind code of ref document: A2

Designated state(s): GH GM KE LS MW SD SL SZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
WA Withdrawal of international application
REG Reference to national code

Ref country code: DE

Ref legal event code: 8642