阅读说明：本技术 低功率无线通信 (Low power wireless communication ) 是由 J·K·卡内 S·E·格林哈特 J·L·库恩 J·D·瑞恩克 D·J·佩歇尔 J·W·布萨 于 2018-04-11 设计创作，主要内容包括：描述了用于在两个医疗设备之间建立通信的系统、设备以及技术。在一个示例中,植入式医疗设备包括通信电路、治疗递送电路以及处理电路,所述处理电路被配置成用于：发起通信窗口的,在该通信窗口期间植入式第二医疗设备能够接收与由第一医疗设备检测到的心脏事件有关的信息,该通信窗口是由通信调度所限定的多个通信窗口中的一个,该通信调度对应于传送调度,在该传送调度中第一医疗设备被配置成用于传送信息；控制通信电路接收来自第一医疗设备的与心脏事件有关的信息,该与心脏事件有关的信息指示了相对于传送窗口的时序的心脏事件的时序；根据与心脏事件有关的信息调度并且控制治疗的递送。(Describe the system, equipment and technology for establishing communication between two Medical Devices.In one example, implantable medical device includes telecommunication circuit, treatment delivery circuit and processing circuit, the processing circuit is configured for: initiating communication window, the second Medical Devices of implanted can receive information related with the cardiac event detected by the first Medical Devices during the communication window, the communication window is one in multiple communication windows as defined by communication scheduling, the communication scheduling corresponds to transmission scheduling, and the first Medical Devices are configured for transmission information in transmission scheduling；It controls telecommunication circuit and receives the information related with cardiac event from the first Medical Devices, be somebody's turn to do the timing that information related with cardiac event indicates the cardiac event of the timing relative to Transfer Window；According to message scheduling related with cardiac event and control the delivering for the treatment of.)

1. a kind of Medical Devices, the Medical Devices include:

Sensing circuit, the sensing circuit are configured for the cardiac event of detection patient；

Processing circuit, the processing circuit are configured for:

Determine the timing of Transfer Window, the Transfer Window is a biography in multiple Transfer Windows as defined by transmission scheduling Send window；And

The timing of the cardiac event based on the timing relative to the Transfer Window, generation have with the cardiac event The information of pass；And

Telecommunication circuit, the telecommunication circuit are configured for during the Transfer Window as defined by transmission scheduling Transmit the information related with the cardiac event.

2. equipment according to claim 1, which is characterized in that

The processing circuit is configured for generating the information related with the cardiac event by following operation:

The timing by the delivering treatment of the second Medical Devices of implanted is determined based on the cardiac event detected, and

Based on the timing for the timing and the Transfer Window for delivering the treatment, control signal, the control letter are generated It number is configured for limiting time of the implantable medical device by the treatment is delivered；And

The telecommunication circuit is configured for transmitting the control signal to second Medical Devices of implanted.

3. equipment according to claim 2, which is characterized in that it is described control signal designation described in Transfer Window it is described when Sequence and the second Medical Devices of the implanted are by the delay period between the time for delivering the treatment.

4. equipment according to claim 3, which is characterized in that the Transfer Window is the first Transfer Window, the control Signal is first control signal and the delay period is the first delay period, and wherein:

The processing circuit is further configured to:

Determine the timing of the second Transfer Window after first Transfer Window, second Transfer Window is the multiple Another Transfer Window of Transfer Window；

The timing of the timing and the delivering treatment based on second Transfer Window, generates second control signal, institute It states second control signal to be configured for limiting time of the implantable medical device by the treatment is delivered, wherein described Second control signal indicates the timing of second Transfer Window and the second Medical Devices of the implanted will be described in delivering The second delay period between the time of pacing signal；And

The telecommunication circuit is configured for during second Transfer Window defined by transmission scheduling to institute It states the second Medical Devices of implanted and transmits the second control signal.

5. the equipment according to any one of claim 2-4, further comprises:

In response to transmitting the control signal, determine to second Medical Devices of implanted by deliver the treatment it is described when Between period be less than the interphase of next Transfer Window into the multiple Transfer Window, next Transfer Window immediately institute State the Transfer Window that transmission signal is transmitted during it；And

It is less than the interphase in response to the determination period, blanking window is initiated, described first during the blanking window Medical Devices are configured for avoiding transmitting signals to second Medical Devices of implanted during the blanking window.

6. equipment according to claim 5, further comprises:

Determine the average time between the multiple cardiac events detected for including the cardiac event detected；And

The duration of the blanking window is adjusted based on the average time.

7. the equipment according to any one of claim 5-6, further comprises:

The blanking window has been pass by determination；And

In response to determination pass by the blanking window, it is described transmission scheduling the immediately described blanking window after under One or more synchronization signals are transmitted to second Medical Devices of implanted during one Transfer Window, it is one or more of same Step signal controls second Medical Devices of implanted and restarts the communication tune maintained by second Medical Devices of implanted Degree, wherein the communication scheduling be configured for it is right in time with the corresponding Transfer Window in the multiple Transfer Window Together.

8. the equipment according to any one of claim 2-7, further comprises:

By first Medical Devices, controls sensing circuit senses and indicate to have been delivered by second Medical Devices of implanted to control The signal for the treatment of；

By first Medical Devices, determine that second Medical Devices of implanted are not yet delivered by first Medical Devices The treatment of expected predetermined quantity；And

The treatment that the predetermined quantity is not yet delivered in response to determination second Medical Devices of implanted, is cured by described first Treat the rate that equipment increases the Transfer Window of the transmission scheduling.

9. equipment according to claim 1 to 8, it is characterised in that:

Generating the information related with the cardiac event includes:

By first Medical Devices and based on the cardiac event detected, the cardiac event and the biography are determined The timing between window is sent, and

By first Medical Devices, the control including the timing between the cardiac event and the Transfer Window is generated Signal processed；And

Transmitting the information related with the cardiac event includes transmitting the control to second Medical Devices of implanted Signal is based on the heart thing for second Medical Devices of implanted to allow second Medical Devices of implanted to determine The time of timing delivering treatment between part and the Transfer Window.

10. equipment according to claim 1 to 9, which is characterized in that the transmission scheduling and the implanted The communication scheduling of Medical Devices is corresponding, wherein each communication window of the communication scheduling be configured for it is described more Corresponding Transfer Window in a Transfer Window is aligned in time, and wherein second Medical Devices of implanted are configured At for enabling telecommunication circuit for being received during each communication window of the communication scheduling from first doctor It treats the signal of equipment and disables telecommunication circuit between each communication window of the communication scheduling.

11. equipment according to claim 1 to 10, further comprises:

In response to detecting the cardiac event, start the high-speed Transfer Window for the transmission scheduling, and to described Implanted the second Medical Devices send instructions are logical to start high-speed corresponding with the high-speed Transfer Window in time Believe window, the high-speed Transfer Window is with rate more higher than low rate Transfer Window appearance, the low rate Transfer Window Occur in transmission scheduling before the detection of the cardiac event；

By first Medical Devices to the implantation during each of multiple high-speed Transfer Windows Transfer Window The second Medical Devices of formula transmit synchronization signal；And

Pass through first Medical Devices and the final high-speed Transfer Window after the multiple high-speed Transfer Window Period transmission controls signal, and the second Medical Devices of implanted described in the control signal instruction are delivered to patient and treated.

12. equipment described in any one of -11 according to claim 1, further comprises, in response to transmission and the cardiac event The related information initiates blanking window, and first Medical Devices are configured for during the blanking window It avoids transmitting signal to second Medical Devices of implanted during the blanking window.

13. equipment according to claim 12, further comprises:

Determine that the blanking window is expired；And

It is expired in response to the determination blanking window, it is transmitted during synchronous window to second Medical Devices of implanted A string of synchronization signals, wherein the no-load speed of the synchronization signal in described a string is than the Transfer Window in the transmission scheduling Set rate it is bigger.

14. a kind of implantable medical device, the implantable medical device include:

Telecommunication circuit, the telecommunication circuit are configured for wirelessling receive from the second Medical Devices and cardiac event Related information；

Delivery circuit is treated, the treatment delivery circuit is configured for delivering to patient and treat；And

Processing circuit, the processing circuit are configured for:

Communication window is initiated, the implantable medical device can be received from another medical treatment during the communication window The information related with the cardiac event of equipment, the communication window are the multiple communication windows limited by communication scheduling A communication window in mouthful, the communication scheduling is corresponding with the transmission scheduling of multiple Transfer Windows is defined, described more Another Medical Devices are configured for the transmission information related with the cardiac event during a Transfer Window, Described in implantable medical device can not be received between the multiple communication window it is related with the cardiac event described Information；

Control the telecommunication circuit received during the communication window from second Medical Devices with the heart thing The related information of part, the information related with the cardiac event indicate the timing relative to the communication window The timing of the cardiac event；

According to the information related with the cardiac event, the delivering for the treatment of is dispatched；And

It controls the treatment delivery circuit and delivers the treatment to the patient.

15. equipment according to claim 14, which is characterized in that the information related with the cardiac event includes coming Define that the implantable medical device will deliver the control signal of the time of the treatment from first Medical Devices,

Wherein, the processing circuit according to it is described processing signal the time scheduling described in treatment delivering, and

Wherein, the treatment circuit delivers the treatment in the time.

16. equipment according to claim 15, which is characterized in that the control signal designation receive the control signal with And the implantable medical device is by the delay period between the time for delivering the treatment.

17. equipment described in any one of 5-16 according to claim 1, which is characterized in that the processing circuit by further by It is disposed for initiating blanking window, the implanted during the blanking window in response to receiving the control signal Medical Devices do not initiate any communication window in the multiple communication window.

18. equipment according to claim 17, which is characterized in that the processing circuit is further configured to be used for:

Determine that multiple includes multiple average times controlled between signals received of the control signal received；And

The duration of the blanking window is adjusted based on the average time.

19. equipment described in any one of 7-18 according to claim 1, which is characterized in that the processing circuit is further It is disposed for:

The blanking window has been pass by determination；And

The blanking window is pass by response to determination, next communication window is initiated according to the communication scheduling.

20. equipment described in any one of 4-19 according to claim 1, which is characterized in that the processing circuit is further matched It is set to for determining the time for delivering the treatment, described and cardiac event based on the information related with the cardiac event The related information indicates the timing of the cardiac event of the timing relative to the communication window.

21. equipment described in any one of 4-20 according to claim 1, which is characterized in that the processing circuit passes through described Start the communication window before transmitting the expected Transfer Window of scheduling to initiate the communication window, the communication window exists Continue in duration including the expected Transfer Window.

22. equipment described in any one of 4-21 according to claim 1, which is characterized in that in response to receiving the information, institute Processing circuit is stated by disabling the telecommunication circuit of the implantable medical device to terminate the communication window.

23. equipment described in any one of 4-22 according to claim 1, which is characterized in that the processing circuit extends described logical The duration of window is believed, until the information is fully received.

24. equipment described in any one of 4-23 according to claim 1, which is characterized in that the processing circuit is based on the letter Breath be when be received and at the beginning of changing subsequent communications window or when the window of the subsequent communications window continues At least one of between, for being aligned the communication scheduling with transmission scheduling to capture and be set from another medical treatment Standby follow-up.

25. equipment according to claim 24, it is characterised in that:

Wherein, it includes the pre- of one in the beginning or end to the communication window that the telecommunication circuit, which receives the information, Determine to receive the information in percentage；And

Wherein, the processing circuit changes the window duration of the subsequent communications window and includes, in response to described The information is received in one predetermined percentage in the beginning of the end of communication window, described in extension The window duration of subsequent communications window.

26. the equipment according to any one of claim 24-25, it is characterised in that:

Wherein, it includes the predetermined percentage in the expeced time for receiving the information that the communication window, which receives the information, It is interior to receive the control signal；And

Wherein, the processing circuit changes the window duration of the subsequent communications window and includes, in response to with In receiving the information in the predetermined percentage of the expeced time for receiving the information, shorten the subsequent communications window The window duration.

27. equipment described in any one of 4-26 according to claim 1, which is characterized in that the processing circuit is further It is disposed for:

Based on the information be when be received and generate clock signal correction factor, clock signal correction factor school The just described information is the difference between the expected expeced time for receiving the information when being received；And

The clock signal correction factor is applied to the clock signal of the implantable medical device to be used for the communication Scheduling is aligned in time with transmission scheduling.

28. equipment described in any one of 4-27 according to claim 1, which is characterized in that the multiple communication window has low In 2 percent average duty ratio of the communication scheduling.

Technical field

The disclosure relates generally to Medical Devices, and more particularly, to the communication technology between Medical Devices.

Background technique

Implanted pacemaker can to patient cardiac delivery pacemaker impulse and monitor the situation of patient's heart.Implanted rises Device of fighting may include impulse generator and one or more electrical leads.In some instances, impulse generator can be implanted in patient Chest in folliculus (pocket) in.The electrical lead is coupled to impulse generator, which may include life At pacemaker impulse and/or the circuit of sensing cardiac electrical activity.Electrical lead can be extended to from impulse generator target site (for example, Atrium and/or ventricle), wherein the electrode for being located at electrical lead far-end is connected to target site.Impulse generator can be via electrode Electro photoluminescence is provided to the target site and/or monitors the cardiac electrical activity of the target site.

In some instances, no lead pacemaker can be used for sensing electrical activity and/or treat signal to cardiac delivery.Nothing is drawn Line pacemaker can include one or more electrodes on its external shell to deliver treatment electric signal and/or sense the intrinsic of heart Depolarising.No lead pacemaker can be located at portion in or beyond heart, and in some instances, can be anchored to the heart via fixed mechanism Dirty wall.

Summary of the invention

Describe the system, equipment and technology for managing the communication between two or more Medical Devices.For example, Two Medical Devices are using the transmission scheduling (schedule) of multiple Transfer Windows is defined, in the multiple Transfer Window One (for example, main equipment) in period Medical Devices can send information (for example, when instruction should be in the case where delivering to patient The control signal of the time of one treatment indicates the signal of the timing between the cardiac event and Transfer Window detected). Another Medical Devices (for example, implantable medical device) can periodically open during the communication window limited by communication scheduling With or open telecommunication circuit.It is aligned in time with communication scheduling or synchronous by the way that scheduling will be transmitted, implantable medical device can (for example, being enabled or switched on telecommunication circuit) information (such as, controlling signal or other signals) only " is listened to " during communication window To limit power consumption.By this method, implantable medical device can be constructed and be had smaller using lesser battery Size and/or by except scheduled communication window for telecommunication circuit be powered to provide longer service life.

In one example, this disclosure relates to a kind of method, this method comprises: detecting patient's by the first Medical Devices Cardiac event；The timing of Transfer Window is determined by the first Medical Devices, which is more as defined by transmission scheduling A Transfer Window in a Transfer Window；By the first Medical Devices and the heart based on the timing relative to Transfer Window The timing of event generates information related with cardiac event；And it is limited by the first Medical Devices and by transmission scheduling Transfer Window during to implanted second Medical Devices different from the first Medical Devices transmit letter related with cardiac event Breath.

In another example, this disclosure relates to which a kind of method, is initiated this method comprises: passing through the second Medical Devices of implanted Communication window, the second Medical Devices of implanted can receive from the first Medical Devices and have with cardiac event during the communication window The information of pass, the communication window are a communication window in the multiple communication windows limited by communication scheduling, the communication scheduling Corresponding with transmission scheduling, transmission scheduling defines multiple Transfer Windows, and the first medical treatment is set during multiple Transfer Window Standby to be configured for transmission information related with cardiac event, wherein the second Medical Devices of implanted can not be in multiple communications Information related with cardiac event is received between window；It is received and is come from during communication window by the second Medical Devices of implanted The information related with cardiac event of first Medical Devices is somebody's turn to do information related with cardiac event and is indicated relative to Transfer Window Timing cardiac event timing；It is treated by the second Medical Devices of implanted according to message scheduling related with cardiac event Delivering；And it is delivered and is treated to patient by the second Medical Devices of implanted.

In further example, this disclosure relates to the first Medical Devices, which includes: sensing circuit, The sensing circuit is configured for the cardiac event of detection patient；And processing circuit, the processing circuit are configured for Determine the timing of Transfer Window, which is a Transfer Window in the multiple Transfer Windows limited by transmission scheduling, And by the first Medical Devices and the timing of the cardiac event based on the timing relative to Transfer Window, generate and heart thing The related information of part；And telecommunication circuit, the telecommunication circuit were configured in the Transfer Window phase limited by transmission scheduling Between to implanted second Medical Devices different from the first Medical Devices deliver information related with cardiac event.

In further example, this disclosure relates to the second Medical Devices of implanted, implanted the second Medical Devices packet Telecommunication circuit is included, which is configured for wirelessling receive from the related with cardiac event of the first Medical Devices Information；Delivery circuit is treated, which is configured for delivering to patient and treat；And processing circuit, at this Reason circuit is configured for: initiating communication window, the second Medical Devices of implanted, which can receive, during the communication window comes From the information related with cardiac event of the first Medical Devices, which is the multiple communication windows limited by communication scheduling In a communication window, the communication scheduling with transmission scheduling it is corresponding, the transmission dispatch define multiple Transfer Windows, at this The first Medical Devices are configured for transmission information related with cardiac event in multiple Transfer Windows, wherein implanted second Medical Devices can not receive information related with cardiac event between multiple communication windows；Telecommunication circuit is controlled in communication window The information related with cardiac event from the first Medical Devices is received during mouthful, is somebody's turn to do information related with cardiac event and is indicated The timing of the cardiac event of timing relative to communication window；The delivering treated according to message scheduling related with cardiac event； And control treatment delivery circuit is delivered to patient and is treated.

The content of present invention is intended to provide the general view to theme described in the disclosure.It is not intended to provide to following The exclusive or exhausted explanation for the device and method being described in detail in attached drawing and description.In following appended drawing and description In elaborate the disclosure one or more aspects details.

Detailed description of the invention

Before Fig. 1 is the example according to the patient for being implanted with example medical device systems of the one or more aspects of the disclosure View, the medical apparatus system include being implanted into the outer icd system of the indoor angiocarpy of patient's heart chamber and pacing devices (PD).

Fig. 2A is the patient for being implanted with another example medical device systems according to the one or more aspects of the disclosure Example front view, the medical apparatus system include that implantation to the outer icd system of the indoor angiocarpy of patient's heart chamber and pace-making is set Standby (PD).

Fig. 2 B is the patient according to the example medical device systems for being implanted with Fig. 2A of the one or more aspects of the disclosure Example side view.

Fig. 2 C is the patient according to the example medical device systems for being implanted with Fig. 2A of the one or more aspects of the disclosure Example transverse views.

Fig. 3 is to show the concept map of the example PD of Fig. 1 of the one or more aspects according to the disclosure.

Fig. 4 is to show the functional block diagram of the example arrangement of the ICD of Fig. 1 of the one or more aspects according to the disclosure.

Fig. 5 is to show the functional block diagram of the example arrangement of the PD of Fig. 1 of the one or more aspects according to the disclosure.

Fig. 6 is to show the function of the example arrangement of the external equipment of Fig. 1 of the one or more aspects according to the disclosure Block diagram.

Fig. 7 is to show the example network of the external equipment including Fig. 1 of the one or more aspects according to the disclosure Functional block diagram.

Fig. 8 A and Fig. 8 B are the timing diagrams of the detection of example cardiac event and control signal transmission from Medical Devices.

Fig. 9 is to show the flow chart of the instantiation procedure for dispatching transmission control signal according to transmission.

Figure 10 be by implantable medical device during the correspondence communication window of communication scheduling received example control system Timing diagram.

Figure 11 is shown for receiving control according to communication scheduling and based on the control signal delivering treatment received The flow chart of the instantiation procedure of signal.

Figure 12 A and Figure 12 B are that the example control system from Medical Devices is transmitted and connect by implantable medical device The timing diagram of the control signal of receipts.

Figure 13 A and Figure 13 B are the received timing diagrams of example of the control signal during indicating communication window.

Specific embodiment

Generally, the present disclosure describes for managing the communication between two or more Medical Devices system, set The related theme of standby and technology.During operation, Medical Devices may need to communicate.Communication can be between Medical Devices Two-way communication or the one-way communication when an equipment transmission information and another equipment reception information.In addition, equipment can be with Various modes operation, such as two-way communication mode or unidirectional mode, the operational requirements depending on equipment.Communication may expect by with The data that arrive known to the transmitting and reception, operational order, error message or with the operation of equipment and/or associated with equipment The related any other information of the state of patient.

In one example, the first Medical Devices (for example, main equipment) may be configured for sensing physiological event and Determine information (for example, the timing of physiological event and/or needing to deliver the treatment of the type based on the detected physiological event When timing).However, the second Medical Devices (for example, from (slave) equipment) may include treatment delivery components and/or phase Patient is properly positioned for delivering treatment.If two Medical Devices are not via physical connection (for example, leading Line or other conductors) connection, Medical Devices must transmit data via wireless communication, so that the first Medical Devices can It sends information (for example, control signal), and the second Medical Devices can wirelessly receive the information (for example, control signal). Since the second Medical Devices will not know when the first Medical Devices will detect physiological event or send the inspection with physiological event Survey related information, thus the second equipment " will be listened to " in the most of time (if the time if not all) of operation or Wireless communication is enabled, to avoid missing the information transmitted from the first Medical Devices.Maintain wireless communication ability consumption The power of battery, even if during this time period without receiving information.The consumption of power can reduce the service life and/or second of battery The service life of Medical Devices.In order to maintain prolonged wireless communication energy when being expected from the signal of the first Medical Devices Power, the second Medical Devices may include the rechargeable battery for needing periodically to recharge and/or with the biggish of larger capacity Battery is for supporting the radio communication system of the type.

As described herein, Medical Devices, which can utilize, reduces Medical Devices for enabling wireless communication to detect from another The time quantum of the information (such as signal or data) of equipment or the radio communication system of duty ratio.For example, Medical Devices can be same Step transmission and the scheduling for receiving data, and then each Medical Devices can independently safeguard corresponding scheduling.In fact, When second Medical Devices will be it can be anticipated that will send any signal from the first Medical Devices, and disable except the expection window Telecommunication circuit.Therefore, described herein to be configured for may not be needed to wrap using the Medical Devices of radio communication system Include the rechargeable battery for needing periodically to recharge and/or the relatively big battery with larger capacity.

In one example, communication plan may include defining the transmission scheduling of multiple Transfer Windows, in multiple transmission Signal can be transferred into the second medical treatment from the first Medical Devices (for example, implantable medical device or external equipment) during window Equipment (for example, implantable medical device), and communication scheduling defines multiple communication windows, during multiple communication window Second Medical Devices enable wireless communication for receiving the signal from the first Medical Devices.Communication window be synchronized with when Between it is upper be aligned with corresponding Transfer Window so that the signal sent during Transfer Window will be existed by the second Medical Devices Corresponding communication window receives.In some instances, Transfer Window can be the particular point in time that signal can be sent, and pass Send window that can limit some duration, the second Medical Devices can receive or detect transmitted letter within the duration Number.

By synchronous communication window and corresponding Transfer Window, both the first Medical Devices and the second Medical Devices can Reduce the time amount or duty ratio, during the amount or duty ratio of the time telecommunication circuit of each equipment be in be powered and Active state.The duty ratio of the reduction can reduce the amount that equipment maintains power needed for communication.For example, public using institute herein The technology opened, the duty ratio of the communication window of the second Medical Devices can less than 2%, or even less than 1%, simultaneously effective connect Receive the arbitrary signal that will be sent from the first Medical Devices.The duty ratio of communication window can be communication window relative to being delivered Treatment between communication scheduling time total amount average duty ratio.Second Medical Devices can be by same according to receiving Communication scheduling is moved forward or rearward to be communicated scheduling with by the first Medical Devices and send out by the timing of step signal in time The synchronization signal sent is synchronous.If the second Medical Devices miss the expection signal of predetermined quantity (for example, such as controlling signal And/or the information of synchronization signal etc), then the second Medical Devices can increase the duration of communication window and/or increase communication The rate of window, until receiving expected signal again.

First Medical Devices may be configured for information related with the physiological event detected being sent to the second doctor Treat equipment.As usually described herein, information can be or include control signal, and one treat should under the control signal designation When the time of patient is delivered to by the second Medical Devices.By this method, control signal can be relative to the control signal delivered Timing come designated delivery treatment time.It include the timing for the treatment of due to the first Medical Devices generation control signal, Second Medical Devices are not entrusted arbitrarily analyzing or determine when delivering treatment for the task for executing the cardiac time detected. However, can provide the data of alternative type by the information that the first Medical Devices transmit.For example, the information transmitted may include timing Information, the timing information indicate when the first Medical Devices detect physiological event (for example, cardiac event, such as P- wave). Timing information can indicate when physiological event is detected based on the timing of Transfer Window.Second Medical Devices then can divide It analyses the timing of event detected and the timing based on the event detected determines when delivering treatment.By this method, second Medical Devices can provide additional processing capacity with the timing for analyzing event and determine when delivering treatment.In any thing In part, the first Medical Devices can transmit any information related with the physiological event detected during the Transfer Window of scheduling, So that the second Medical Devices can receive the information during the corresponding communication window of communication scheduling.

Since the transfer rate of the first Medical Devices is constrained to the rate of Transfer Window, sent during Transfer Window Control signal may not only include " immediately delivering treatment " order.That is, Transfer Window may with should by second medical treatment The time of equipment delivering treatment is not correspond to.On the contrary, control signal may indicate that control signal is transmitted (and being therefore received) Time and treatment (for example, for pacemaker impulse of atrium or ventricle) future by the time delivered by the second Medical Devices it Between time amount or delay.For example, if Transfer Window every 50 milliseconds (ms) occurs, but signal will be controlled sending by treating Transfer Window after 40ms be delivered, then the first Medical Devices produce control signal to be used to indicate the second Medical Devices It will the 40ms delivering treatment after receiving control signal by the second Medical Devices.In some instances, the second Medical Devices can The further one or more by being kept telecommunication circuit disabling to reach communication scheduling during transmitting in no control anticipated signal Communication window (for example, blanking window) is further reduced the power consumption of telecommunication circuit.These are described in further detail herein And other examples.

Fig. 1 is the front view of example medical device systems 8A, which includes being implanted into the patient The outer icd system 30A and PD 16 of angiocarpy.In the example of fig. 1, cardiovascular outer icd system 30A includes being coupled to heart to remove Quiver the ICD 9 of lead 25A, which hypodermically extends above thoracic cavity from ICD 9.In the example of fig. 1, ICD 9 and PD 16 is the example of implantable medical device.In the example shown, body of the defibrillation lead 25A towards patient 14 Dry center extends, and in the immediate vicinity bending or turning of trunk, and subcutaneously prolongs upwards above thoracic cavity and/or breastbone 22 It stretches.Defibrillation lead 25A can lateral shift to breastbone 22 left or right side or be located at breastbone 22 on.Defibrillation lead 25A can base The extension of breastbone 22 is parallel on this, or laterally angled from breastbone in proximal end or far-end.

Defibrillation lead 25A includes the lead body of insulation, and it includes the connection for being configured to connect to ICD 9 which, which has, The proximal end of device 34, and the distal part including one or more electrodes.Defibrillation lead 25A further includes one or more conductors, The one or more conductor forms conductive path in lead body, and makes electric connector several electricity corresponding with multiple electrodes Pole interconnects.In the example of fig. 1, defibrillation lead 25A includes the distal part towards defibrillation lead 25A (for example, towards removing Quiver lead 25A along breastbone 22 extend part) single defibrillation electrode 28.Defibrillation lead 25A is placed along breastbone, is made It obtains in defibrillation electrode 28 and case electrode being formed by ICD 9 or on ICD 9 (or other second electrodes for the treatment of vector) Between treatment vector substantially cross over the ventricle of heart 26.

Defibrillation lead 25A may also include one or more sensing electrodes of the distal part positioning along defibrillation lead 25A (such as sensing electrode 32a and sensing electrode 32b).In the example shown in Figure 1, sensing electrode 32a and 32b passes through defibrillation electricity Pole 28 is separated from each other.However, in other examples, sensing electrode 32a and 32b both can defibrillation electrode 28 distal side or All in the nearside of defibrillation electrode 28.In other examples, lead 25A can defibrillation electrode 28 nearside and/or distal side it is each It include more or fewer electrodes at a position, and lead 25A may include multiple defibrillation electrodes, for example, such as Fig. 2A-C Defibrillation electrode 28a and 28b shown in example.PD 16, which may be configured for detecting, to be delivered by ICD 9 via lead 25A Electric shock.

Cardiac resynchronization therapy (CRT) is the group (such as ICD 9 and/or one or more PD 16) by IMD or IMD The treatment of one type of delivering.CRT can be exported by resynchronizing the electromechanical activity of the ventricle of heart to help to enhance the heart.The heart Room is asynchronous to be likely to occur in the patient by congestive heart failure (CHF).In a crt, to the pacemaker impulse of ventricle Delivering is timed to the specific delay (A-V time) after atrial contraction.In some instances, CRT is related to two ventricles Pacemaker impulse (" double-ventricle pacemaker ") is delivered to synchronize their contraction.In other examples, CRT is related to delivering to a ventricle Pacemaker impulse is synchronous with the contraction of another ventricle to be shunk, and such as pace-making left ventricle is to be shunk and the contraction of right ventricle It is synchronous.

One or more PD 16 can be based on the electric signal perceived in heart 26 and/or in response to controlling signal from ICD 9 are transferred into PD 16 and provide pacemaker impulse to heart 26.In some instances, PD 16 can be to provide CRT to heart 26 Mode pacemaker impulse is provided.In order to deliver CRT, ventricular contraction be at the specific time after atrial contraction it is necessary to 's.In some cases, PD 16 cannot sense atrial contraction and must be from the separated equipment for being able to detect atrial contraction Receive the control signal for indicating when delivering pacing signal.In some instances, the PD 16 being arranged in left ventricle is combinable to be set Another PD 16 on right ventricle is set to be applied in combination for CRT can be provided to patient to cardiac delivery double-ventricle pacemaker. By this method, two PD can receive the identical or different control signal from ICD 9 according to corresponding communication scheduling.CRT It can be used for conductive impairment caused by treating heart failure and/or ventricle be asynchronous.In some cases, CRT can help to restore the heart Mechanical sequence room excitement and shunk.In some instances, CRT can be related to double-ventricle pacemaker (for example, via right ventricle with And lead and/or PD in left ventricle) with the contraction for synchronizing two ventricles.In other examples, CRT may relate to the heart One pace-making (for example, via left ventricular pacing of PD 16) in room is for by its contraction and the contraction of another ventricle It is synchronous.

In one example, medical apparatus system 8A include the implantable medical device (for example, PD 16) that communicates with one another with And another Medical Devices (for example, ICD 9), wherein the operation of ICD 9 is the main equipment that control signal is transmitted to PD 16, the PD 16 Operation is the reception control signal and executes by the slave equipment of the function of the control signal command and/or triggering.For example, ICD 9 may be configured for the cardiac event of detection patient, such as atrial contraction (P- wave), and based on the cardiac event detected Determine the timing of the delivering of the treatment by the PD 16 different from ICD 9.Treatment, which can be, to be delivered from PD 16 to left ventricle Pacing signal.ICD 9 can be with: determining the timing of Transfer Window, Transfer Window is the multiple transmission windows limited by transmission scheduling A Transfer Window in mouthful；And the timing of the delivering based on treatment and the timing of Transfer Window generate control signal, the control Signal processed is configured for limiting PD 16 for the time of delivering treatment.ICD 9 then can be in the transmission limited by transmission scheduling Control signal is sent to PD 16 during window.As discussed herein, in other examples, the transmittable control signal of ICD 9 Except information (for example, the information for the timing of cardiac event that instruction detects).

Transmission scheduling with ICD 9 is consistent, and PD 16 independently can enable and disable communication electricity according to communication scheduling Road.PD 16 can initiate communication window, and PD 16 can receive the control signal from ICD 9 during the communication window, this is logical Letter window is a communication window in the multiple communication windows limited by communication scheduling corresponding with transmission scheduling.PD 16 1 As cannot be received between multiple communication windows control signal.After PD 16 receives control signal from ICD 9 and in communication window During mouthful, PD 16 then can dispatch the delivering for the treatment of at the time according to control signal and pass at the scheduled time Send treatment.By this method, PD 16 can be configured to for example according to the order provided from ICD 9 via control signal to left ventricle Pacemaker impulse is delivered, and may not be required to include the sensing circuit for sensing heart signal.However, in other examples In, in the case where the communication from ICD 9 has been lost, PD 16 can still be configured for sensing cardiac event as passing It send pacemaker impulse or the further inspection before spare pace-making is provided.Although only describing a PD 16, phase is can be used in ICD 9 As scheduling for conveying information to the additional Medical Devices of the intracorporal one or more of patient 14.In addition, ICD 9 may include One or more intracardiac leads replace lead 25A or include one or more intracardiac leads in addition to lead 25A.In other examples In, PD 16 can be communicated with the main equipment in the atrium of heart 26 or in the right ventricle of heart 26, which may be similar PD.The PD being implanted in atrium dextrum or right ventricle may be main equipment, because its size can be more greatly with bigger for accommodating Battery, sensing circuit or other any circuits and/or function that main equipment may be beneficial to.The PD 16 for being implanted in left ventricle can Be configured to from equipment, should have limited function and lesser size from equipment with meet be implanted in it is big in left ventricle Small limitation.In other examples, subcutaneous monitor can detect cardiac event and transmit signals to PD 16.

Fig. 2A, Fig. 2 B and Fig. 2 C show the implantation intracorporal another example cardiac medical devices system 8B of patient 14 The concept map of various views.With can be similar to the component of the identical label of label in Fig. 1, Fig. 2A, Fig. 2 B and Fig. 2 C Ground configures and can provide similar function.It include the outer ICD of angiocarpy being implanted in patient 14 referring to Fig. 2A, cardiac system 8B System 30B and the pacing devices being implanted in the heart 26 of patient 14 (PD).Fig. 2A is the cardiac system 8B for being implanted with Fig. 2A Patient front view.Fig. 2 B is the side view for being implanted with the patient of cardiac system 8B of Fig. 2A.Fig. 2 C is implanted with Fig. 2A The transverse views of the patient of cardiac system 8B.The medical apparatus system 8B as shown by Fig. 2A, Fig. 2 B and Fig. 2 C can be configured At one or more technologies for executing the medical apparatus system 8A described herein about Fig. 1.As described herein, Medical apparatus system 8 may refer to the 8A or 8B of Fig. 1, Fig. 2A, Fig. 2 B and Fig. 2 C, and icd system 30 may refer to Fig. 1, The icd system 30A or 30B of Fig. 2A, Fig. 2 B and Fig. 2 C.About Fig. 1, Fig. 2A, Fig. 2 B and Fig. 2 C and this paper other parts, PD 16 is described generally as in the chamber for being attached at heart 26 (that is, intracardiac pacing devices).However in other examples, PD 16 can be attached to the outer surface (for example, contacting with the external membrane of heart) of heart 26, so that PD 16 is arranged on the outer of heart 26 Face but desired chamber can be paced.Therefore, although PD 16 is described generally as setting for the pace-making of intracardiac implantation herein It is standby, but it is the outer pacing devices of the heart that PD 16, which is alternatively configured for being attached to the outer surface of heart 26 and operating,.

Referring again to Fig. 2A, icd system 30B includes the implantation for being connected at least one implantable cardiac defibrillation lead 25B Formula cardioverter defibrillators (ICD) 9.ICD 9 is configured to the cardiac delivery high energy when detecting atrium or ventricular fibrillation to patient Measure cardioversion or defibrillation pulse.When meeting fibrillation examination criteria, cardioversion shock is usually same with the R- wave that detects Step delivering.When meeting fibrillation standard, usually delivering defibrillation pulse, and R- wave cannot from the signal perceived by ICD 9 quilt It identifies.

The ICD 9 of Fig. 2A hypodermically or under flesh is implanted on the left side above 14 thoracic cavity of patient.Draw with the defibrillation of Fig. 1 Line 25A is different, and the defibrillation lead 25B of Fig. 2A can be at least partly implanted into position under the breastbone of Fig. 2A, for example, in thoracic cavity and/or Between breastbone 22 and heart.In such configuration, the portions of proximal of lead 25B is hypodermically prolonged from ICD 9 towards breastbone Stretch, and the distal part of lead 25B in anterior mediastinum 36 below breastbone 22 or lower section upwardly extends.Anterior mediastinum 36 is by pleura 39 (see Fig. 2 C) laterally, from forwardly being limited to ground, by breastbone 22 after pericardium.In some instances, the antetheca of anterior mediastinum It can be formed by musculus transversus thoracis and one or more costal cartilage.Anterior mediastinum includes a certain amount of loose connective tissue (such as honeycomb group Knit), it is some lymphatic vessels, lymph gland, musculature (such as musculus transversus thoracis) under breastbone, quiet in the branch of artery and thoracic cavity in thoracic cavity Arteries and veins.In one example, the distal part of lead 25B muscle substantially under the loose connective tissue of anterior mediastinum and/or breastbone Extend in tissue along the rear side of breastbone 22.Lead 25B can be at least partly implanted in other intrathoracic positions, such as other are non- Blood vessel, extrapericardial position, the periphery including the other parts around pericardium or heart and be adjacent to but be not attached to pericardium or The other parts of heart and the not gap above breastbone 22 or thorax, tissue or other anatomical features.

In other examples, lead 25B can be implanted at other cardiovascular external positions.For example, defibrillation lead 25B can Hypodermically extended with the trunk center above thoracic cavity from ICD 9 towards patient 14, be bent or turn in the immediate vicinity of trunk, And hypodermically upwardly extended above thoracic cavity and/or breastbone 22, it is similar to shown in Fig. 1.Defibrillation lead 25B can laterally partially It moves to the left or right side of breastbone 22 or is located on breastbone 22.Defibrillation lead 25B can be arranged essentially parallel to the extension of breastbone 22, or It is laterally angled from breastbone 22 in proximal end or far-end.In another example, defibrillation lead 25B and/or pace-making or sense lead It can by the external membrane of heart be implanted into that pericardium is intracapsular, is implanted into pericardium or in another position.

The defibrillation lead 25B of Fig. 2A includes the lead body of insulation, and it includes being configured to connect to ICD 9 which, which has, Connector proximal end, and the distal part including one or more electrodes.Defibrillation lead 25B further includes that one or more is led Body, the one or more conductor form conductive path in lead body, and make electric connector and the corresponding number in multiple electrodes A electrode interconnects.

The defibrillation lead 25B of Fig. 2A includes defibrillation electrode, which includes two parts or section 28a and 28b, system Claim (or being alternatively referred to as) defibrillation electrode 28.The defibrillation electrode 28 of Fig. 2A towards defibrillation lead 25B distal part, for example, court The part extended to defibrillation lead 25B along breastbone 22.The defibrillation lead 25B of Fig. 2A is placed on 22 lower section of breastbone or along chest Bone 22, so that in defibrillation electrode 28a or 28b and case electrode formed by ICD 9 or on ICD 9 (or treatment vector Other second electrodes) between treatment vector substantially across heart 26 ventricle.In one example, treatment vector can be regarded For the shell for extending to ICD 9 from the point (for example, one center in defibrillation electrode part 28a or 28b) on defibrillation electrode 28 The line of point on body electrode.In one example, the defibrillation electrode 28 of Fig. 2A can be elongated coil electrode.

Defibrillation lead 25B may also include one or more sensing electrodes of the distal part positioning along defibrillation lead 25B (such as sensing electrode 32a and sensing electrode 32b).In the example shown in Fig. 2A and Fig. 2 B, sensing electrode 32a and 32b pass through Defibrillation electrode 28a is separated from each other.However, in other examples, sensing electrode 32a and 32b both can be in defibrillation electrodes 28 Distal side or in the nearside of defibrillation electrode 28.In other examples, lead 25B can defibrillation electrode 28 nearside and/or It include more or fewer electrodes at each position in distal side.In identical or different example, ICD 9 may include another One or more electrodes on a lead (not shown).

Icd system 30B can feel via the one or more of the combination for the case electrode for including electrode 32a and 32b and ICD 9 Direction finding amount carrys out sensing electric signals.For example, what the available sensing vector using between electrode 32a and electrode 32b of ICD 9 was perceived Electric signal obtains the electric signal that the sensing vector between the external conductive casing electrode using electrode 32b and ICD 9 is perceived, and obtains The electric signal perceived using the sensing vector between the external conductive casing electrode of electrode 32a and ICD 9, or obtain and use them The electric signal that is perceived of combination.In some instances, ICD 9 can be used sensing vector and sense cardiac electric signals, the sense Direction finding amount includes in one in defibrillation electrode part 28a and 28b (or electrode 28 in Fig. 1) and sensing electrode 32a and 32b One or ICD 9 case electrode.

The intrinsic electric signal perceived can indicate one or more cardiac events and to include by cardiac muscle generate electricity The depolarising and repolarization of the heart 26 of the various times of signal and instruction during cardiac cycle.In addition, the electricity perceived Signal may also include the electric signal (for example, pacemaker impulse) that heart 26 is generated and delivered to by PD 16.ICD 9 is analyzed by one Or the electric signal that multiple sensing vectors are perceived, to detect tachyarrhythmia, such as Ventricular Tachycardia or ventricular fibrillation. In response to detecting that tachyarrhythmia, ICD 9 can start the storage member for making such as one group of one or more capacitor etc Part charging, and when memory element is charged, if tachyarrhythmia still has, via removing for defibrillation lead 25B Quiver the one or more defibrillation pulses of electrode 28 (for example, 28,28a, 28b) delivering.

In the example of Fig. 2A, PD 16 is implanted in the left ventricle of heart 26 for providing the pace-making for being used for CRT treatment Pulse.PD 16 can be configured in the volume available for being configured for being suitble to left ventricle and can be attached to left ventricular wall Size.The smaller size of PD 16 can also reduce the risk that thrombus is formed in heart.PD 16 can utilize the sensing energy of ICD 9 Power and does not therefore include sensing circuit and/or if you do not need to then utilize more low capacity for the conventional sense of cardiac event Battery.For example, ICD 9 may be configured for sensing heart 26 electrical activity (for example, atrial depolarization or P- wave) and really Determine when PD 16 to left ventricle should deliver one or more pacing signals (for example, pulse).ICD 9 then can believe control It number is sent to PD 16, and PD 16 can receive control signal and according to the timing delivering pace-making letter by control signal designation Number.Transmission scheduling and communication scheduling can be used to be operated for ICD 9 and PD 16, to limit PD 16 as reception control letter Number telecommunication circuit be powered time quantum.

In some instances, ICD 9 also the electrode 32a and/or 32b of such as lead 25B can be used to provide pacing signal and make For a part of CRT treatment.In other examples, ICD 9, which can be coupled to, carries the one or more intracardiac of corresponding electrode Lead, the electrode are configured for being arranged in atrium dextrum and right ventricle and via these intracardiac leads and PD 16 A part that delivering pacemaker impulse is treated as CRT together.In other examples, additional PD similar with PD 16 can be set In atrium dextrum and/or right ventricle.The PD being placed in atrium dextrum and/or right ventricle can similarly be controlled by ICD 9, alternatively, Control signal can be provided to the PD 16 in left ventricle by one in the PD in atrium dextrum and/or right ventricle or the two.

In other examples, PD 16 may be configured for delivering pacing therapy to heart 26, and such as bradycardia paces It is paced after treatment and/or electric shock.In these cases, PD 16 can be attached via the one or more fixing elements for passing through tissue It is connected to the inner wall of the right ventricle of heart 26.PD 16 can be fixed to heart tissue by these fixing elements of PD 16, and keep electricity Pole (for example, cathode or anode) is contacted with heart tissue.However, in other examples, system 8B may include the phase in heart 26 Answer the additional pacing devices 16 in chamber (for example, atrium dextrum or atrium or atrium sinistrum and/or right ventricle).

In some instances, PD 16 may not include sensing circuit.In other examples, PD 16 can be able to use and carry Electrode on the shell of PD 16 carrys out sensing electric signals.These electric signals can be myogenetic by the heart and indicate that heart 26 exists The depolarising of each time during cardiac cycle and the electric signal of repolarization.PD 16 can analyze the electric signal of perception, with detection Tachyarrhythmia, such as Ventricular Tachycardia or ventricular fibrillation, slow arrhythmia even shock by electricity.In response to inspection These situations are measured, PD 16 can be for example depending on arrhythmia cordis or the type of electric shock, with and without from another equipment Start to pace after delivering bradycardia pacing therapy or electric shock in the case where information.In some instances, PD 16 may be in response to not It can detect that the control signal from ICD 9 only detects rhythm of the heart mistake up to the communication window of a predetermined time section or predetermined quantity Often.

Although PD 16 and ICD 9 one-way communication, heart PD 16 and icd system 30B can at least can be configured At for operating completely independently of each other.In this case, PD 16 and icd system 30B cannot establish each other telemetering or other Communication session exchanges the information about sensing and/or treatment to use one-way or bi-directional communication.The independent operation can be Meaning or as fail with one or two equipment synchronous driving and communication scheduling or other mistake and caused by.PD 16 With each of icd system 30B not shared information, but analyze via the data that their corresponding electrodes are perceived with In progress arrhythmia detection and/or Treatment decsion.Each equipment may be unaware that whether other equipment will test the heart as a result, Restrain it is not normal, it whether or when will provide treatment etc..

Although Fig. 2A is shown or describes in the situation of icd system 30 and PD 16 under breastbone, according to this public affairs The technology for the one or more aspects opened is applicable to other systems coexisted.For example, icd system may include with distal portion Point lead, the distal part by with shown in Fig. 1 in a manner of similar mode be hypodermically implanted in breastbone (or other Position), rather than be implanted under breastbone.In another example, icd system is substituted, the pace-making for being coupled to two intracardiac leads is set It is standby to be implanted patient's body.By this method, pacing devices can provide pace-making to atrium dextrum and right ventricle via intracardiac lead Pulse and control PD 16 to left ventricle provide pacemaker impulse.As a result, the example of Fig. 1, Fig. 2A, Fig. 2 B and Fig. 2 C merely for Example purpose is shown, and is not considered as limiting techniques described herein.

External equipment 21 may be configured for and one or the two in icd system 30A (Fig. 1) or icd system 30B And PD 16 (Fig. 2A) communication.External equipment 21 is described below with respect to the icd system 30B and PD 16 in Fig. 2A；However, External equipment 21 can similarly be operated about the icd system 30A of Fig. 1.In external equipment 21 only and in icd system 30B and PD 16 One of in the example of communication, non-communicating equipment can receive from the equipment that communicate with equipment 21 and instruct or communicate to equipment 21 Equipment transmission data.In some instances, equipment 21 includes that Handheld computing device, computer workstation or networking calculate Equipment.Equipment 21 may include the user interface for being configured for receiving input from the user.In other examples, user goes back It can remotely be interacted with equipment 21 via networked computing device.User can be interacted with equipment 21 with PD 16 and/or ICD System 30B communication.For example, user can be interacted with equipment 21 to send inquiry request and search treatment delivering data, update limit Surely communication between the treatment parameter treated, management PD 16 and/or icd system 30B is executed about PD 16 and/or ICD system Other any activities of system 30B.Although user is that doctor, technician, surgeon, electrophysiologist or other health cares are special Industry personnel, but user can be patient 14 in some instances.

Equipment 21 also allow for user limit PD 16 and/or icd system 30B how sensing electric signals (for example, ECG), inspection It surveys arrhythmia cordis (for example, tachyarrhythmia), delivering treatment and is exchanged with the other equipment of system 8B.For example, equipment 21 can be used for changing tachyarrhythmia detection parameters.In another example, equipment 21 can be used for management restriction treatment Treatment parameter.In the example that PD 16 and icd system 30B is communicated, equipment 21 can be used for changing PD 16 and icd system Communication protocol between 30B.For example, equipment 21 can instruct PD 16 and/or icd system 30B one-way communication and two-way communication it Between switch and/or change which of PD 16 and/or icd system 30B entrusted arrhythmia cordis initial detecting task. External equipment 21 can be for CRT treatment programming A-V and/or V-V delay.External equipment 21 can also or alternatively can be configured to use In adjustment limit communication parameter, the duration of such as window, the rate of window, the rate of synchronization signal, at one or more A equipment attempt to re-establish the past call duration time (lapse in communication) of the permission before communication and Other such parameters.

Equipment 21 can use any technology known in the art and PD 16 and/or icd system via wireless communication 30B communication.The example of the communication technology may include for example: proprietary and non-proprietary radio frequency (RF) telemetering, induction telemetering, acoustics, with And tissue conductive communication (TCC), but it is also contemplated that other technologies.During TCC, electric current is driven through the two of transmission device Tissue between a or more electrode.Propagation of electrical signals and can be raw between two electrodes of receiving device by measuring At voltage come at a certain distance from be detected.In some instances, equipment 21 may include programming head, which can be placed At the body of neighbouring patient and near PD 16 and/or icd system 30B implant site, so as to improve PD 16 and/or The quality and safety of communication between icd system 30B and equipment 21.

PD 16 may be configured for providing CRT or other pace-making pacing protocols or be based even on by the resistance to rapid of ICD 9 Property arrhythmia cordis peb treatment application adjust cardiac treatment.PD 16 knows when ICD 9 has delivered the rapidity rhythm of the heart Not normal peb treatment may be useful.In response to the delivering of electric shock, PD 16 is paced after can activating electric shock.In some instances, Such as the time after the control signal by control signal designation, the approaching or PD of the transmittable instruction electric shock of ICD 9 should be opened Begin the control signal paced.

In some instances, the appropriate detection that PD 16 and icd system 30B can participate in communicating to promote arrhythmia cordis.It is logical Letter may include one-way communication, and one of equipment is configured to transmit communication information, and another equipment is configured for According to those message of corresponding scheduled reception.Communication can include alternatively two-way communication, wherein each equipment is configured to pass Defeated and reception communication information.PD 16 and ICD 9 may be configured for based on the treatment as needed for patient in one-way communication Switch between mode and two-way communication mode.

In conjunction with or as communication between PD 16 and icd system 30B substitution, PD 16 may be configured for detecting It is delivered according to the electrical signal detection of two or more electrodes across PD 16 by icd system 30B or external defibrillator anti-fast Speed arrhythmia cordis electric shock.PD 16 can be configured to the electrical characteristics to shock by electricity based on resistance to rapid arrhythmia cordis to detect resistance to rapid Property arrhythmia cordis electric shock.Although different defibrillation devices can provide different waveforms, including different pulse duration and Amplitude, but defibrillation pulse usually has signal characteristics, so that even if not about implantation or external defibrillator The detection of resistance to rapid arrhythmia cordis can also occur in the case where the priori knowledge of resistance to rapid arrhythmia cordis shock waveform.With This mode, the delivering of 16 tunable cardiac stimulation of PD, including the delivering paced after electric shock.

In some instances, PD 16 passes through the voltage between the electrode input for the equipment that measurement is implanted into detect resistance to rapid Property arrhythmia cordis electric shock.PD 16 can detecte one or more characteristics of signals of resistance to rapid arrhythmia cordis, comprising: detection is anti- After the high amplitude level of tachyarrhythmia electric shock, the high conversion rate for detecting lead and trail edges and the electric shock that detection is big Polarization variation.Carrying out detection to more than one characteristics of signals can be improved sensitivity and/or specificity.For example, PD 16 can be tied It closes the high conversion rate for detecting lead and trail edges and detects big one or both of electric shock after-polarization variation, and detect It shocks by electricity to high-caliber resistance to rapid arrhythmia cordis.

In response to detecting that resistance to rapid arrhythmia cordis shocks by electricity, PD 16 is paced after can activating electric shock, such as, the VVI (heart Room sensing, ventricular pacemaking, pace-making when perceiving activity inhibit) it paces after electric shock.If shocked by electricity in resistance to rapid arrhythmia cordis The heart of patient does not immediately begin to normal beats later, then pace-making is supported after electric shock can be used to ensure to pace.Pace-making is set Standby (can pace relative to typical heart) after delivering is shocked by electricity higher than normal impulse amplitude and pulse width paces, to be used for The mistake after resistance to rapid arrhythmia cordis electrode is set to capture the risk minimization of (loss of capture).Due to tissue suppression (tissue stuning) (its due to from resistance to rapid arrhythmia cordis electric shock delivering cardiac muscular tissue in electric current increase) and It is likely to occur and higher captures threshold value.Since (it is due to lacking flow direction during the ventricular fibrillation (VF) for the physiological change of tissue Caused by the blood of cardiac muscle), it is also possible to there is higher threshold value.In addition, after resistance to rapid arrhythmia cordis electric shock, lead The polarization of interface can increase, and overcome lead to polarize so as to cause higher voltage is needed.

In one example, PD 16 can be delivered to heart 26 via an at least subset for the set of the electrode of PD 16 and be shocked by electricity After pace.In some instances, PD 16 can rise after delivering electric shock after pacing mode in response to detecting electric shock to enter after electric shock It fights.In some instances, timer can be used to determine when to have pass by (elapse) scheduled time, at this in PD 16 Electric shock should be delivered during the scheduled time.It is paced after having pass by predetermined time period and/or having stopped electric shock Afterwards, PD 16 is paced after can starting electric shock.

Although coordinated communication can be performed in order to provide independent pace-making or CRT, these doctors in ICD 9 and PD 16 Treating equipment transmission described herein and communication scheduling can be used to provide other treatment to patient 14.For example, ICD 9 can be inspection It surveys atrial contraction (that is, p- wave) and transmits the control for when delivering pacing signal without lead pacemaker informed in left ventricle (LV) CRT to be added under the subcutaneous of function of ICD 9, breastbone or through intravenous device by signal processed.In another example, skinny device Can be hypodermically implanted into the upper limb of patient 14 with for detect atrial contraction (p- wave) and PD 16 into left ventricle or PD transmission in two ventricles controls signal to deliver CRT.

In other examples, system may include no lead dual cavity (for example, DDD) pacemaker system, the pacemaker system The 2nd PD 16 transmission including sensing atrial contraction in atrium dextrum and into right ventricle controls signal to realize chamber (A-V) PD 16 of synchronous pacing.In some instances, ventricle PD 16 may be configured for sensing heart premature ventricular contraction (PVC) And the instruction of PVC is sent to the PD 16 in atrium.In another example, two 16 equipment of PD can be during ventricular pacemaking It is communicated with atrial sense (VDD), wherein in right ventricle a PD 16 detects P wave, pacing signal is delivered to right ventricle simultaneously And activity of the sensing from right ventricle and the PD into left ventricle 16 send TCC signal to deliver pacing signal to realize the heart Room synchronous biventricular (bi-V) pace-making.The pacing mode can avoid the pace-making that T- wave is directed to after PVC, because if between equipment TCC dropout, then PD 16 in right ventricle, which is provided, senses and also inhibits (VVI) pace-making therapy to mention using ventricular cardiac event Incense ventricular pacemaking and sensing.

Another treatment that may include communication is that equipment provides auricular pacemaking (AAI) when needed in the right heart in atrium dextrum It paces and senses in room, and the PD 16 that TCC signal is sent in right ventricle is provided to right ventricle to be used to pace. PD 16 in right ventricle may be configured for sensing cardiomotility to detect the T- wave after PVC and/or in atrium and ventricle Spare vvi mode is provided in the case where the communication disruption between equipment.In another example, have leadless device can in atrium dextrum and DDD is provided in right ventricle to pace and sense in right ventricle when needed, and TCC signal is sent to the volume in left ventricle Outer PD 16 with for realizing three chambers pace-making (for example, right ventricle sensing can avoid after PVC for T wave right ventricle and/ Or left ventricular pacing and spare vvi mode is provided).In another example, normal left ventricle lead, which is implanted to, does not lead to foot There is lead CRT equipment that may benefit from the merging that the PD 16 of left ventricle is set in the position of enough CRT responses.With this side Formula, PD 16 can provide left ventricular pacing, and wherein another lead in left ventricle is disabled.In another example, except drawing via LV Except the pace-making that line is delivered, PD 16 can be delivered to LV and be paced, to provide stimulation for two positions into LV.It is this more Point pace-making can preferably synchronize the contraction of entire LV compared with using only single pacemaker.In this example, there is lead CRT TCC signal is sent to the PD 16 in left ventricle by equipment, with order paced by PD and be achieved in three chambers pace-making and Sensing.In some instances, the lead for being not used for pacing or sensing can be used for transmitting control signal or to PD 16 to have by oneself Other signals of leadless device.The these and other example of multiple medical apparatus systems is in combination with communication plan described herein To reduce power consumption for the time quantum by the telecommunication circuit energization in limitation receiving device.

Fig. 3 is to show the concept map of the example PD 16 of Fig. 1, which may include telecommunication circuit and be configured to use In the treatment circuit for delivering pacemaker impulse and/or electric shock to patient.In some instances, PD 16 can further include sensing circuit. As shown in Figure 3, PD 16 includes shell 50, cover 58, electrode 60, electrode 52, mechanism of ammonium fixation 62, flange 54 and opening 56.Shell 50 and cover 58 can be considered as the shell of PD 16 together.By this method, shell 50 and cover 58 can be fenced And protect each electrical component in PD 16.Shell 50 can substantially fenced all electrical components, and cover 58 can be external Shell 50 is sealed and creates the gas-tight seal shell of PD 16.Although PD 16 is described generally as including one or more electricity Pole, but PD 16 usually may include at least two electrodes (for example, electrode 52 and 60) for delivering electric signal (for example, such as The treatment of pacing signal or electric shock etc) and/or at least one sensing vector is provided.

Electrode 52 and 60 carries on the shell created by shell 50 and cover 58.By this method, electrode 52 and 60 can be with It is considered as no lead electrode.In the example of fig. 3, electrode 60 is arranged on the outer surface of cover 58.Electrode 60 can be It is positioned at the circular electrode that heart tissue is contacted when implantation.Electrode 52 can be the ring being arranged on the outer surface of shell 50 Shape electrode or cylindrical electrode.Both shell 50 and cover 58 can be electrically insulated.Electrode 60 is used as cathode and electrode 52 may be used as anode (or vice versa) paced after such as CRT or electric shock for delivering pacing stimulation treatment.However, Electrode 52 and 60 can be used in any stimulation arrangement.In addition, electrode 52 and 60 can be used for detecting the intrinsic electricity from cardiac muscle Signal.In other examples, PD 16 may include three or more electrodes, and wherein each electrode can deliver treatment and/or inspection Survey intrinsic signal.Electrode 52 and 60 and it may be configured for sending and/or be connect by other any electrodes that PD 16 is carried It receives according to TCC signal disclosed herein.

PD 16 can be attached to heart tissue by mechanism of ammonium fixation 62.Mechanism of ammonium fixation 62, which can be, actively fixes pointed tooth, spiral shell Nail, pliers, adhesive member or any other type for attaching devices to tissue.As shown by example in fig. 3, fixed mechanism 62 can be constructed by maintaining the memory material of preforming shape.During implantation, mechanism of ammonium fixation 62 can to pre-buckling with It pierces through tissue and is allowed to towards 50 rearward flexure of shell.By this method, mechanism of ammonium fixation 62 can be embedded in destination organization It is interior.

Flange 54 can be set on one end of shell 50, enable to fasten or take out PD 16.For example, suture or Other equipment can surround flange 54 and/or are inserted by opening 56 and be attached to tissue.By this method, flange 54 can mention For the second attachment structure, for fastening or maintaining PD 16 in heart 26 in the case where fixed mechanism 62 fails.Once PD 16 need to be moved out of out of patient 14 body (or remove) (if this movement is considered as if necessary), flange 54 and/or Opening 56 may be utilized for taking out PD 16.

Technique described herein is generally come relative to no lead pacing devices or intracardiac pacing devices (such as PD 16) Description.Intracardiac pacing devices (such as PD 16) can be commonly configured in the chamber for being implanted into heart.Show some Example in, intracardiac pacing devices can be no lead, as in Fig. 3 shown by PD 16.In other examples, electrode is (all Such as one or more electrodes in electrode 52 and 60) it can be carried in the small lead extended at shell 50 (for example, " lead Part ") on.However, even if intracardiac pacing devices include one or more lead parts, entire intracardiac pacing devices (including this Or multiple lead parts) it is still configured as the indoor size of single chamber of implantable cardiac.PD 16 can be the example of IMD, should The example of IMD is configured for providing pace-making in the chamber of heart for example for supporting CRT to control together with another IMD It treats.However, the implantable medical device of substitution can be used for executing the function same or similar with PD 16, for example, to heart 26 deliver cardiac pacings and are communicated according to communication scheduling with icd system 30.For example, PD can be configured to outside implantation heart 26 Portion, for example, the external membrane of heart that is close or being attached to heart 26.It may be positioned so that by the electrode that the shell of PD carries and connect with the external membrane of heart Touching, and/or be coupled to the lead of PD one or more electrodes may be positioned so that be usually enough to provide treatment (such as, CRT or Cardiac pacing) position (for example, on outer surface of left ventricle and/or right ventricle) at contacted with the external membrane of heart.In some examples In, 30 system of ICD without lead or can have leadless device communication with the one or more being implanted into inside or outside heart 26. For example, icd system 30 can be configured to include detecting cardiac event and transmitting related PD to PD to deliver what which was treated The sensing circuit of order.By this method, PD may not include sensing circuit and/or not be required using the power of battery to sense heart Event, this, which may result in, does not need sensing circuit and/or biggish battery capacity for operating the lesser of sensing circuit PD。

Fig. 4 is the functional block diagram for showing the example arrangement of icd system 30 of Fig. 1.As described in connection with fig. 1, icd system 30 include the ICD 9 for being connected at least one implantable cardiac defibrillation lead 25.As shown in Figure 5, icd system 30 includes Processing circuit 70, switch module 71, memory 72, electric-shocking circuit 75, signal generating circuit 76, sensing circuit 78, telecommunication circuit 80, activity sensor 82 and power supply 84.Memory 72 includes computer-readable instruction, this is computer-readable when by processing circuit When 70 execution, so that icd system 30 and processing circuit 70 execute the icd system 30 and processing circuit 70 that can be attributed to this paper Various functions (for example, the detection of the cardiac event of such as p- wave, tachyarrhythmia etc, communicate with PD 16 and/or The delivering of resistance to rapid arrhythmia cordis peb treatment).Memory 72 may include any volatibility, non-volatile, magnetic, light or Dielectric, such as, random access memory (RAM), read-only memory (ROM), non-volatile ram (NVRAM), electric erasable can Programming ROM (EEPROM), flash memories or any other number or simulation medium.

Telecommunication circuit 80, sensing circuit 78 and signal generator 76 can be selectively coupled via switch module 71 to The conductive case electrode 31 of electrode 28 (or 28a or 28b), 32a, 32b and ICD 9.70 controllable switch module of processing circuit 71.Switch module 71 may be configured for selectively coupleeing telecommunication circuit 80, sensing circuit for any of electrode Any of 78 and signal generator 76.Switch module may be configured for selectively coupling at least one electrode To sensing circuit being used for sense physiological signals, being coupled to treatment generation circuit to treat signal for delivering or being coupled to communication Circuit 80 is for receiving and/or transmitting signal.

Processing circuit 70 may include any one or more of the following terms: microprocessor, controller, at digital signal It is electric to manage device (DSP), specific integrated circuit (ASIC), field programmable gate array (FPGA) or equivalent discrete or analog logic Road.In some instances, processing circuit 70 may include multiple components, such as one or more microprocessors, one or more Controller, one or more DSP, one or more ASIC or one or more FPGA any combination and other it is discrete or Integrated logic circuit.Due to the function of the processing circuit 70 of this paper can be implemented as software, firmware, hardware or its any group It closes.

It is centripetal that processing circuit 70 controls signal generating circuit 76 according to the treatment parameter that can store in memory 72 Dirty 26 delivering stimulation therapy.For example, processing circuit 70 can control signal generating circuit 76, has with delivering and specified by treatment parameter Amplitude, pulse width, frequency or polarity of electrode electric pulse (for example, shock pulse).By this method, signal generating circuit 76 can deliver electric pulse to heart 26 via the conductive case electrode 31 of electrode 28 (or 28a or 28b) and ICD 9.In addition, electric Any combination of pole 28,32a, 32b and/or shell 31 can be connected to sensing circuit 78 via switch module 71.Further In example, signal generating circuit 76 can via electrode 28,32a, 32b and/or shell 31 any combination (although electrode 32a and 32b can be by more often for sensing) electric pulse is delivered to heart 26, for example, cardiac pacing.Electricity can be used in icd system 30 Any combination of pole come deliver anti-tachycardia therapy and/or detection the electric signal from patient 14.However, generally, line Circle electrode 28 and shell 31 can be used for delivering resistance to rapid arrhythmia cordis electric shock.If ICD 9 is combined one or more Cardiac lead provides, then ICD 9 can also deliver pacemaker impulse to one or more chambers of heart via the lead.Show some In example, ICD 9 can be via cardiovascular external electrode (such as, lead under tank (can) electrode and/or breastbone) delivering pacemaker impulse.

Signal generating circuit 76 may also include electric-shocking circuit 75.Electric-shocking circuit 75 may include delivering resistance to rapid arrhythmia cordis Circuit and/or capacitor needed for electric shock.For example, signal generating circuit 76 can charge for electric-shocking circuit 75 in preparation for delivering Electric shock.Electric-shocking circuit 75 then can discharge so that signal generating circuit 76 can be passed via one or more electrodes to patient 14 Power transmission is hit.In some instances, signal generating circuit 76 and electric-shocking circuit 75 can share one or more components, for example, electric Hitting circuit can be a part of signal generating circuit.In other examples, electric-shocking circuit 75 can be located in icd system 30 But it is separated with signal generating circuit 76.

Signal generating circuit 76 is electrically coupled to electrode 28,32a and 32b via switch module 71.In shown example In, signal generating circuit 76 is configured for generating and delivers reactance tachyarrhythmia peb treatment to heart 26. For example, electric-shocking circuit 75 can be used to deliver electricity to heart 26 via the subset of electrode 28,32a and 32b for signal generating circuit 76 It hits.In some instances, signal generating circuit 76 can be delivered in the form of voltage or electrical pulse of current pacing stimulation (for example, Paced after electric shock) and cardioversion or defibrillation pulse.In other examples, signal generating circuit 76 can be with other signals Form delivers one or more of stimulation or electric shock of the voltage or electric current of these types, and other signals form is such as sinusoidal Wave, square wave or other substantially continuous time signals.

Signal generating circuit 76 may include switch module, and processing circuit 70 can be used switch module for example via number It selects to deliver electric shock and/or pacemaker impulse using which of avaivable electrode according to/address bus.Switch module may include out It closes array, switch matrix, multiplexer or is suitable for for stimulation energy being selectively coupled to any of selected electrode Other kinds of switchgear.

Inductance slowdown monitoring circuit 78 may be configured for monitoring and come self-electrode 28, at least two in 32a, 32b and shell 31 A signal, so as to monitor such as cardiac event of the electrical activity of heart 26, impedance etc or other electrical phenomenas and/or other Non-cardiac relevant activity.Sensing can be finished to for identifying the event in cardiac cycle (for example, p- wave, QRS complex (complex), t- wave etc.), to determine the rhythm of the heart or heart-rate variability, or for detecting arrhythmia cordis (for example, the rapidity rhythm of the heart loses Often) or other electric signals.Sensing circuit 78 can utilize switch module 71 to be used to select suitable electrode, but alternatively, sensing Circuit 78 may include separately or independent switch module is for depending on which kind of electrode group used in presently sensed configuration It closes or which in available electrode electrode vector to select for sensing cardiomotility.In the example with several electrodes In, 70 controllable switch module 71 of processing circuit is to be chosen for use as the electrode of sensing electrode via switch module 71, i.e. selection sense It is measured and sets.Sensing module 78 may include one or more detection channels, wherein each detection channel can be coupled to selected electricity Pole configuration, for detecting heart signal via the electrode configuration.Some detection channels can be configured to detect specific heart Event, such as P wave or R wave, and the instruction that this event occurs is provided to processing circuit 70, such as on June 2nd, 1992 is announced Authorize the entitled " for monitoring device (the APPARATUS FOR MONITORING of electricity physiological signal of Keimel et al. ELECTRICAL PHYSIOLOGIC SIGNALS) " United States Patent (USP) No.5,117,824 described in.Processing circuit 70 can The function of sensing module 78 is controlled by providing signal via data/address bus.

Processing circuit 70 may include timing and control module, can be embodied as hardware, firmware, software or its is any Combination.Timing and control module may include the specialized hardware electricity separated with other 70 components of processing circuit (such as microprocessor) Road (such as ASIC) or the software module executed by the component (it can be microprocessor or ASIC) of processing circuit 70.Timing and Control module can realize programmable counter.If icd system 30 is configurable to generate and delivers pacemaker impulse to heart 26, this The counter of sample it is controllable with DDD, VVI, DVI, VDD, AAI, DDI, DDDR, VVIR, DVIR, VDDR, AAIR, DDIR and its The associated basic time interphase of his pacing mode.

It may include between atrium and ventricle pace-making escape beat by the interphase that the timing in processing circuit 70 and control module define Phase, the P wave of perception and R wave are in vain to restart the refractory period of the timing of escape interval and the pulse width of pacemaker impulse. As another example, for delivering the Time Intervals during and after electro photoluminescence to heart 26, timing and control module can press down Make the sensing of one or more channels from sensing circuit 78.It can be by processing circuit 70 in response to storing in memory 72 Data determine duration of these interphases.The timing of processing circuit 70 and control module can also determine cardiac pacing pulse Amplitude.In addition, as described herein, processing circuit 70 can determine (such as to be delivered by PD 16 by the delivering treatment of another equipment Pacing signal) time, and instruction PD 16 when will during the Transfer Window that deliver pacing signal generate be used to be sent to PD 16 control signal.

Once sensing R- wave and P- wave with the detection channel of sensing circuit 78, so that it may reset the timing by processing circuit 70 The interval counters realized with control module.When by perceiving R wave and P wave reset when be present in the counting in interval counters Value can circuit 70 processed be used to measure duration of R -- R interval, P-P interphase, P-R interphase and R-P interphase, between the R-R Phase, P-P interphase, P-R interphase and R-P interphase duration be the measurement being storable in memory 72.Processing circuit 70 can Tachyarrhythmia event is detected using the count value in interval counters, such as, auricular fibrillation (AF), room mistake aroused in interest Fast (AT), ventricular fibrillation (VF) or Ventricular Tachycardia (VT).These interphases can also be used to detect total heart rate, ventricular contraction Rate and heart rate variability.A part of memory 72 can be configured as multiple recycling buffers, can save a series of The interphase measured, can by processing circuit 70 in response to occur pace or sensing interrupt and analyze it is described it is a series of measure between Phase, to determine whether the heart 26 of patient is just showing room or ventricular tachyarrhythmias at present.

In some instances, arrhythmia detection method may include any suitable tachyarrhythmia detection algorithm. In one example, processing circuit 70 using the rule-based detection method described in following United States Patent (USP) whole or Subset: Olson et al., on August 13rd, 1996 bulletin it is entitled " for arrhythmia cordis diagnosis and treatment based on preferential The method and apparatus of rule " (" PRIORITIZED RULE BASED METHOD AND APPARATUS FOR DIAGNOSIS AND TREATMENT OF ARRHYTHMIAS ") United States Patent (USP) No.5,545,186 or Gillberg et al., 1998 Entitled " method and apparatus based on priority rule of diagnosis and treatment for arrhythmia cordis " that on May 26, in is announced (“PRIORITIZED RULE BASED METHOD AND APPARATUS FOR DIAGNOSIS AND TREATMENT OF ARRHYTHMIAS ") United States Patent (USP) No.5,755,736.It authorizes the United States Patent (USP) No.5,545,186 of Olson et al. and authorizes The United States Patent (USP) No.5,755,736 of Gillberg et al..However, in other examples, processing circuit 70 can also use other Arrhythmia detection method such as utilizes those of the timing of electrocardiogram and form method.

In some instances, processing circuit 70 can have been occurred by R-R (or P-P) interphase length that mark shortens to determine Tachyarrhythmia.In general, processing circuit 70 detects aroused in interest when interphase length drops below 220 milliseconds It overruns, and when interphase length drops below 180 milliseconds, processing circuit 70 detects fibrillation.In other examples, work as interphase When length is dropped between 330 milliseconds, Ventricular Tachycardia is can be detected in processing circuit 70, and when interphase length drops to When between 240 milliseconds, ventricular fibrillation is can be detected in processing circuit 70.These interphase length are only examples, and user can be on schedule Hope that these interphase length can be then stored in memory 72 to define interphase length.It should as an example, may need to detect Continuous cycles of the interphase length up to some quantity, some percentage up to the period in moving window, or for some quantity Detect the moving average of the cycle length cardiac cycle.

In processing circuit 70 based on the signal detection from sensing circuit 78 to room or ventricular tachyarrhythmias, and And in the case where needing resistance to rapid arrhythmia cordis pace-making scheme, the resistance to rapid rhythm of the heart is generated for controlling signal generating circuit 76 The timing interphase of not normal pacing therapy can be loaded into timing and control module by processing circuit 70, to control escape beat therein The operation of the interval counters and invalid refractory period of the detection for defining R wave and P wave is to restart to lose for the resistance to rapid rhythm of the heart The escape interval counters often paced.Other than detecting and identifying the certain types of rhythm of the heart, sensing circuit 78 can also be to inspection The intrinsic signal measured is sampled to generate other time-based instructions of electrocardiogram or cardiac event.

Activity sensor 82 can be included in the shell of icd system 30, and including one or more accelerometers or Other are able to detect the movement of icd system 30 and/or the other equipment of position.For example, activity sensor 82 may include being configured At 3 axis accelerometers for detecting the acceleration on any direction in space.The acceleration detected by activity sensor 82 Spend the potential noise that can be used for by processing circuit 70 identifying in the signal detected by sensing circuit 78 and/or for confirming the rhythm of the heart Not normal or other status of patient detections.In some instances, activity sensor 82 can detect patient activity or other organs Activity (such as, breathes).In some instances, ICD 9 may include microphone or other are configured for detecting other physiology The other sensors of event (such as, heart sound or breath sound).Processing circuit 70 can analyze these physiological events to diagnose patient Situation and/or be that patient determines suitable treat and/or the timing for the treatment of.

Power supply 84 can be any type of equipment, be configured to save the electricity of the circuit for operating icd system 30 Lotus.Power supply 84 can be used as rechargeable or non-rechargeable battery provides.In other examples, power supply 84 may also comprise energy Quantity collection system, the energy collecting system store the electric energy of the movement from the intracorporal icd system 30 of patient 14.

In some instances, telecommunication circuit 80 may be configured for detecting the signal of communication from PD 16.PD 16 can The electricity of the amplitude and/or mode with the information for indicating to be sent to icd system 30 is generated via one or more electrodes Signal.Electric signal can be carried by pacemaker impulse or the signal of communication separated, and the pacemaker impulse or separated signal of communication can be matched It is set to for being detected by icd system 30.By this method, telecommunication circuit 80 may be configured for monitoring and be perceived by sensing circuit 78 Signal and determine when from PD 16 receive communication information.These send via electrode and can quilts by the signal of patient Referred to as tissue conductive communication (TCC).

As described herein, icd system 30 also can be used one from electrode 28,32a, 32b and shell 31 or Communication information is sent to PD 16 by the electric signal of multiple transmission.In this case, telecommunication circuit 80 can be via switch module 71 And the one or more in electrode generates and receives electric signal or pulse.Processing circuit 70 can control telecommunication circuit 80 and/ Or switch module 71, to transmit and or receive communication signal.Alternatively, processing circuit 70 can be detected via sensing circuit 78 Communication and/or the communication that delivering is used for via the generation of signal generating circuit 76.Although telecommunication circuit 80 can be used for using telecommunications It number is communicated via electrode 28,32a, 32b and shell 31, but telecommunication circuit 80 alternatively or additionally uses wireless protocols, it is all As RF telemetering, induction telemetering, acoustics or TCC come and PD 16 or other medical device communications.In some instances, telecommunication circuit 80 may include the wireless communication function.

Telecommunication circuit 80 includes any for communicating with another equipment of such as PD16 and/or equipment 21 (Fig. 1) etc Appropriate hardware, firmware, software or any combination thereof.Telecommunication circuit 80 can transmit generated or received arrhythmia cordis data, Communication between treatment parameter values, icd system 30 and PD 16, as the order for another Medical Devices control signal or Any other information.For example, telecommunication circuit 80 can transmit the perceived physiological data (such as R -- R interval) of expression or can be by PD 16 make the information for being configured for determining other any data of the situation of patient 14.Telecommunication circuit 80, which may be additionally used for receiving, to be come from The updated treatment parameter of equipment 21.Under the control of processing circuit 70, telecommunication circuit 80 can be with the help of antenna from setting Uplink telemetering is simultaneously sent to equipment 21 by standby 21 reception downlink telemetry, which can be internal and/or outer Portion.Processing circuit 70 to the data of equipment 21 and will for example can be used for via address/data bus offer by uplink The control signal of telemetric circuit in telecommunication circuit 80.In some instances, telecommunication circuit 80 can will be received via multiplexer Data be provided to processing circuit 70.

Memory 72 can be configured to store various operating parameters, treatment parameter, perception data and the data that detect with And with the monitoring of patient 14, treatment and cure related any other information.Memory 72 can store between such as A-V and/or V-V Phase, the threshold value for indicating tachyarrhythmia and parameter and/or at least partially define delivered resistance to rapid arrhythmia cordis The treatment parameter values of electric shock.In some instances, memory 72 can also store be sent to PD 16 and/or from PD 16 it is received Communication.In addition, memory 72 can store the related letter of the used communication plan between ICD 9 and other Medical Devices What breath, such as Transfer Window duration, frequency, control signal attribute, communication reconstructing protocol, synchronization time and restriction communicated Other such parameters.

In some instances, 30 signal of icd system notice equipment 21 further communicates with clinician and passes through network (the Medtronic Care such as developed by the Medtronic of Minneapolis, Minnesota (Medtronic) companyNetwork) or it is some link patient 14 other networks alarm is passed into clinician.Icd system 30 can be spontaneously Or diagnostic message is sent to network in response to inquiry request from the user.

The icd system 30 including ICD 9 may be configured for using communication plan and other doctors as described herein Equipment (such as PD 16) communication is treated, communication plan limitation receiver Medical Devices need to detect for transmitted signal holding The time quantum listened.In TCC, passed for example, receiving Medical Devices and can need to be powered by the amplifier of telecommunication circuit to detect The signal sent, and the amplification needs the power of battery.Thus icd system 30 can be utilized with the communication scheduling of receiving device in the time Upper alignment or synchronous transmission scheduling, to send the signal to receiving device.Although icd system 30 is being described herein as passing Medical Devices or main equipment are sent, but icd system 30 is also operable to receiving device in some instances.

In one example, the operation of icd system 30 is will control the main equipment that signal is sent to PD 16, the PD 16 operation To receive the control signal and executing by the slave equipment of the function of the control signal command.For example, icd system 30 can be configured Pass through at the cardiac event for detecting patient, such as atrial contraction (P- wave), and based on the cardiac event determination detected The timing of the treatment delivering of PD 16 (PD 16 separated from icd system 30 and different with icd system 30).Treatment can be by The pacing signal that PD 16 is delivered to left ventricle.Icd system 30 may further determine that (Transfer Window is by transmitting for the timing of Transfer Window Dispatch a Transfer Window in the multiple Transfer Windows limited), and the timing of the delivering based on treatment and Transfer Window Timing generates control signal, which is configured for limiting PD 16 for the time of delivering treatment.Icd system 30 can Control signal is then sent to PD 16 during the Transfer Window limited by transmission scheduling.

The control signal transmitted by icd system 30 can indicate Transfer Window timing (for example, control signal transmitted when Between) and implanted equipment by delivering treatment time between delay interphase.Therefore, when receiving device receives control signal, Receiving device can dispatch treatment delivering up to the right times relative to the control signal received.The delay interphase allows control Time of the signal processed except the time that treatment will be delivered is sent, this can occur in Transfer Window only with special speed When (rate such as, such as between 10Hz and 50Hz) occurs.

The transmittable instruction of icd system 30 will be by the multiple of reception Medical Devices (for example, PD 16) identical treatment delivered Control signal.As discussed above, after detection cardiac event and determination will deliver the timing properly treated, ICD System 30 can determine the timing of the second Transfer Window after the first Transfer Window of transmission first control signal, second biography Sending window is another Transfer Window in multiple Transfer Windows.Icd system 30 then can the timing based on the second Transfer Window with And the timing of the delivering for the treatment of generates second control signal, which, which will be configured for restriction PD 16, to deliver The time for the treatment of.Second control signal indicates that the timing of the second Transfer Window and PD 16 will be between the times that deliver pacing signal Second delay interphase.Icd system 30 then can be during the corresponding Transfer Window as defined by transmission scheduling by the second control Signal processed is sent to PD 16.

By this method, multiple control signal can be transmitted during corresponding (and may be continuous) Transfer Window. Each control signal can be delivered by the delay period changing the time transmitted from each control signal for treatment Specify the identical time.For example, first control signal can indicate that treatment will be delivered after 90ms, and the biography after 50ms The second control signal for sending window to be transmitted can indicate to treat by after the transmission of second control signal 40ms be delivered.Pass through For identical upcoming treatment event transmission multiple control signal, receiving device (for example, PD 16) has increased machine It can be treated to detect at least one of signal and be delivered in the suitable time.In other words, just PD 16 does not receive control One in signal processed, PD 16 also can detect another control signal and responsively deliver in the suitable time and treats.For example, Transmission and the communication scheduling of icd system 30 and PD 16 can be limited using enough window rates, so that transmission is set Standby detection cardiac event and treatment are likely to occur multiple windows between needing to be delivered.However, between cardiac event and treatment Only one window is capable of providing the enough communication between equipment, and it includes delivering treatment that icd system 30, which is only sent, in this case One of time communication.In other examples, icd system 30 can continue the control that transmission indicates the delay period of continuous reduction Signal, as long as Transfer Window occurs before the treatment delivering ordered.

Transmission scheduling is corresponding with the communication scheduling of implantable medical device (for example, PD 16) in receiving end, wherein should Each communication window of communication scheduling is configured to Transfer Window corresponding with multiple Transfer Windows and is aligned in time.With This mode receives implantable medical device and is configured for enabling telecommunication circuit to receive to come during each communication window Telecommunication circuit is disabled from the signal of icd system 30, and between each communication window of communication scheduling.Transfer Window can be Period with some duration may occur in which the transmission of control signal during the duration.However, in other examples Middle Transfer Window can be not only time point, wherein any transmission is scheduled at the time of Transfer Window or at least It is accurately delivered in the section start of Transfer Window.Each of multiple Transfer Windows Transfer Window can be with scheduled frequency Or rate occurs, wherein each of Transfer Window is separated by scheduled interphase.For example, scheduled rate can be about 10Hz to about 50Hz (wherein, corresponding interphase arrives 20ms for 100 milliseconds (ms)).In one example, scheduled rate be from (wherein, corresponding interphase is from about 50ms to about 33ms) by about 20Hz to about 30Hz.Scheduled interphase can be with similar frequency Rate is corresponding but is expressed as the interphase of specific millisecond number, between such as about 20ms and 100ms.Interphase can be each The interphase limited between the beginning of a Transfer Window or the rate of Transfer Window, and be not necessarily a Transfer Window end and Interphase between the beginning of next Transfer Window.Alternatively, however using the interphase between window, and between window Interphase can take into account the duration of each window, to realize the desired rate for being directed to Transfer Window.

Blanking window can also be included in transmission scheduling by icd system 30, to avoid signal is sent during blanking window.Example Such as, signal is controlled in response to transmission, icd system 30 can determine implantable medical device by the period of the time of delivering treatment Less than to following next Transfer Window of the control signal in multiple Transfer Windows after the Transfer Window that period is transmitted closely Interphase.In other words, occur before the time that next Transfer Window will not be in delivering treatment.It is small in response to the determination period In the interphase, icd system 30 can initiate blanking window, and the first Medical Devices are configured to avoid during the blanking window Implantable medical device is transmitted signals to during blanking window.In some instances, icd system 30 can be during blanking window Stop being that telecommunication circuit charges, to save power for icd system 30.

The also transmittable synchronization signal of icd system 30 to receiving Medical Devices, so as to maintain the transmission of icd system 30 dispatch with Synchronism between the communication scheduling of PD 16.Since each Medical Devices independently tracks corresponding Transfer Window and leads to Believe the timing of window, the clock signal for being accordingly used in the timing can be different between both devices.For example, PD 16 can be wrapped Include clock less more accurate than icd system 30, with for save power and/or reduce cost and/or reduce PD 16 relative to The size of ICD 9.Even if the clock of each equipment is different, the synchronization signal sent from icd system 30 can assist PD 16 to maintain The communication scheduling being aligned with transmission scheduling.For example, icd system 30 can be determined whether to have pass by blanking window, and in response to Blanking window has been pass by determination, will synchronous letter during the next Transfer Window of transmission scheduling followed closely after blanking window Number it is sent to PD 16.The synchronization signal transmitted by icd system 30 can control implantable medical device (for example, PD 16) to open again Begin the communication scheduling maintained by implantable medical device.For example, it is earlier than pre- that PD 16 can be detected the time based on synchronization signal Phase is still later than expection, is moved forward or rearward communication scheduling in time.Although synchronization signal can be in each cardiac cycle Primary (for example, after blanking window) is sent, but synchronization signal can more frequent or less frequently in other examples It sends.PD 16 can based on control signal be when be received and communication window is synchronous with Transfer Window.

In some instances, icd system 30 can monitor the operation of PD 16, as checking to ensure that PD 16 receiving biography The control signal sent.For example, 30 controllable sensing circuit 78 of icd system with sense instruction treatment by PD 16 delivering (for example, Sensing pacing signal or the other treatment ordered by icd system 30) signal.Based on expected or from the generation of PD 16 from PD 16 The signal of sensing, ICD can take suitably correction to act.Specifically, not detecting the movable associated letter with PD 16 It number can indicate that PD 16 does not receive the control signal sent from icd system 30.Icd system 30 can be based on the control letter transmitted Number determine that PD 16 not yet delivers the treatment of the predetermined quantity as desired by icd system 30 (for example, one, two, three or more It is multiple).In response to determining that PD 16 not yet delivers the treatment of predetermined quantity, icd system 30 can increase the Transfer Window of transmission scheduling Rate.The increase of this rate can increase the possibility that icd system 30 transmits control signal during the communication window of PD 16 Property.Icd system 30 can iteratively increase the rate of Transfer Window according to the quantity of the omission treatment identified.Alternatively or this Outside, the transmittable triggering PD 16 of icd system 30 changes into the letter of starting or search pattern from treatment mode (for example, pacing mode) Number, in starting or search pattern, icd system 30 and PD 16 being capable of re-synchronization Transfer Window and communication windows.

By this method, icd system 30 can change transmission scheduling as needed.In some instances, transmission is dispatched and is led to Letter scheduling can change according to the physiological activity of patient.These can be carried out to change with same for reducing the communication activity between equipment When maintain efficient communication.For example, icd system 30 can be based on A-V Interval or alteration in heart rate transmission scheduling.For example, between longer A-V Phase can support Transfer Window less frequently, at the same maintain one or more Transfer Windows and treatment will time for being delivered it Between suitable delay.If icd system 30 changes Transfer Window, PD 16 or receiving device can detect modified transmission It dispatches and communication window and/or communication scheduling is adjusted correspondingly to remain synchronous.Alternatively, icd system 30 can Send request to PD 16 to enter start-up mode or synchronous mode, so as to using with PD 16 it is additional it is one-way or bi-directional communicate it is heavy It is new to establish scheduling.

In one example, icd system 30 (and PD 16) can increase or decrease the treatment through delivering (for example, by PD 16 delivering pacemaker impulses) and synchronization signal between blanking window.For example, blanking window can extend for lower heart rate. If standard blanking window is 400ms, blanking window can be increased to such as 500ms or even 600ms by icd system 30, To be further reduced the quantity of telecommunication circuit is drawn from each equipment during it Transfer Window and communication window.In In other examples, icd system 30 can determine blanking window, to maintain the transmission of predetermined quantity before the detection of cardiac event Window (for example, three Transfer Windows).Icd system 30 can monitor the quantity of the Transfer Window in preceding cardiac cycles, and If occurring less or more Transfer Window between Transfer Window and the cardiac event of subsequent detection, blanking is adjusted Window.For example, if continuous two cardiac cycle, only there are two Transfer Windows before the determining cardiac event of icd system 30, still Three Transfer Windows are the number of targets of Transfer Window, then the duration of subsequent blanking window can be reduced and be passed by icd system 30 Send the duration of an interphase between window.Therefore, icd system 30 can increase or decrease next blanking window it is lasting when Between, with the quantity of length and desired predetermined Transfer Window before next cardiac event detected to blanking window into Row balance.Similarly, PD 16 may be configured for based on the Transfer Window counted before receiving the first pacing control signal Quantity adjust the length of blanking window.For example, if occurring more transmission than expected before pacing control signal Window, then PD 16 can extend blanking window, or if occurring ratio before the received pacing control signal of icd system 30 It is expected that less Transfer Window, then shorten blanking window.

Icd system 30 can using clearly order instruct PD 16 change blanking window, or when PD 16 blanking window it When one or more communication windows afterwards pass by but do not detect synchronization signal, PD 16 can speculate that blanking window has prolonged It is long.In other words, PD 16 can be operated using the instruction that the first Transfer Window of the synchronization signal after blanking window is transmitted. If icd system 30 needs to reduce blanking window, icd system 30 is transmittable, and that there is instruction PD 16 should be directed to is next aroused in interest Blanking window is reduced the information of special time amount or the synchronization signal of code by the period.

As described herein, it transmits the main equipment (for example, icd system 30) of information and receives the slave equipment of information (for example, PD 16) can be operated in different modes." treatment mode " can be icd system 30 and PD 16 when most of Between operation with for provides treat mode.In treatment mode, main equipment one-way communication to needed for sending treatment from equipment, Such as (if providing pacemaker impulse from equipment) is sent in each cardiac cycle.It is dispatched using transmission described herein And this treatment mode of communication scheduling allows ultra low power consumption communication, it is more harsh especially for that may have The slave equipment (for example, lesser equipment with smaller batteries) of power capacity limit.Medical Devices can also be with other modes Operation, such as " starts " or " search " mode and " programming " mode.These startings and programming mode can need additional power, But these modes may only need once in a while.

It is synchronous with the transmission main equipment of information from equipment during start-up mode or search pattern.It can be in initial implantation Afterwards, start-up mode is executed after the programming session for main equipment or when if losing synchronous from equipment.In start-up mode or During search pattern, main equipment can provide the more frequent and/or stronger signal compared with during treatment mode, and from equipment It can more frequently or constantly be powered for telecommunication circuit, to detect the data transmitted by main equipment.In some instances, from Equipment may be configured for separately detect cardiac event to be used to independently pace chamber (for example, ventricle), until with master Equipment has re-established communication.Although this sensing can draw more power, patient is in relatively short phase period Between continue to treatment may be advantageous.

During programming mode, main equipment can widely be communicated with one-way communication or two-way traffic with from equipment.For example, Programming mode may include capturing from device battery state, electrode by the threshold search from equipment, and/or inquiry, treating circuit Impedance or TCC signal strength.By this method, when answering these inquiries, data can be provided back to main equipment from equipment.Program mould Formula can be used infrequently, such as once a day or more infrequently.Programming mode can by main equipment, from equipment or should be such as The request of the external equipment of external equipment 21 (Fig. 1) etc is desirably dispatched or is executed.In some instances, it treats parameter, pass Send scheduling and/or the change of communication scheduling or other any operation changes that can occur during programming mode.

Fig. 5 is to show the functional block diagram of the example arrangement of PD 16 of Fig. 1.In shown example, PD 16 includes Processing circuit 90, signal generating circuit 96, sensing circuit 98, electric shock detection circuit 99, activity sensor 100, leads to memory 92 Believe circuit 94 and power supply 102.In some instances, PD 16 may include component more more or fewer than these components.Memory 92 include computer-readable instruction, and when being executed by processing circuit 90, described instruction returns PD 16 and the execution of processing circuit 90 Because in this paper PD 16 and processing circuit 90 various functions (for example, detection arrhythmia cordis, communicate with icd system 30 and Delivering treatment (such as, pace-making and the slow pacing therapy of tradition after anti-tachyarrhythmia pacemaker, electric shock)).Memory 92 may include Any volatibility, non-volatile, magnetic, light or dielectric, such as, random access memory (RAM), read-only memory (ROM), non-volatile ram (NVRAM), electrically erasable ROM (EEPROM), flash memories or any other number Or simulation medium.

Telecommunication circuit 94, sensing circuit 98 and signal generating circuit 96 can selectively be coupled via switch module 91 To electrode 52 and 60.90 controllable switch module 91 of processing circuit.Switch module 91 may be configured for selectively to Any of electrode is coupled to any of telecommunication circuit 94, sensing circuit 98 and signal generator 96.Switch module It may be configured for selectively coupleeing sensing circuit at least one electrode to be used for sense physiological signals, be coupled to and control It treats and circuit occurs for delivering treatment signal or being coupled to telecommunication circuit 80 for receiving and/or transmitting signal.

Processing circuit 90 may include any one or more of the following terms: microprocessor, controller, at digital signal It is electric to manage device (DSP), specific integrated circuit (ASIC), field programmable gate array (FPGA) or equivalent discrete or analog logic Road.In some instances, processing circuit 90 may include multiple components, such as one or more microprocessors, one or more Controller, one or more DSP, one or more ASIC or one or more FPGA any combination and other it is discrete or Integrated logic circuit.Due to the function of the processing circuit 90 of this paper can be implemented as software, firmware, hardware or its any group It closes.

It is centripetal that processing circuit 90 controls signal generating circuit 96 according to the treatment parameter that can store in memory 92 Dirty 26 delivering stimulation therapy.For example, processing circuit 90 can control signal generating circuit 96 delivering have specified by treatment parameter Amplitude, pulse width, frequency or polarity of electrode electric pulse.By this method, signal generating circuit 96 can be via 52 He of electrode 60 and switch module 91 to heart 26 deliver pacemaker impulse (for example, pacing therapy, CRT pacemaker impulse or traditional heart after electric shock Move too slow pacemaker impulse).Although PD 16 can only include two electrodes (such as electrode 52 and 60), in other examples, PD 16 can use three or more electrodes.Any combination of electrode can be used to deliver treatment and/or detection and come from PD 16 The electric signal of patient 14.

Signal generating circuit 96 be electrically coupled to via switch module 91 carry electrode 52 on the shell of PD 16 and 60.In shown example, signal generating circuit 96 is configured for generating and delivers electronic stimulation to heart 26.Example Such as, signal generating circuit 96 can be controlled via a part delivering electro photoluminescence of cardiac muscle of the electrode 52 and 60 into heart 26 It treats.In some instances, circuit 96 occurs for treatment can deliver pacing stimulation in the form of voltage or electrical pulse of current, such as It is paced after CRT treatment or electric shock.In other examples, signal generating circuit 96 can deliver these types in the form of other signals One of stimulation or a variety of, other signals form such as sine wave, square wave or other substantially continuous time signals.Although PD 16 is commonly described as delivering pacemaker impulse, but PD 16 can deliver cardioversion or defibrillation pulse in other examples.

The treatment signal delivered from PD 16 can at least partly provide CRT treatment, bradycardia treatment or for other The treatment of such imbalance (disorder).Each of these signals can be limited by one group of parameter being stored in memory 92 It is fixed, and may include continuing for such as pulse interphase, pulse width, electric current and/or voltage amplitude and each pulse mode The parameter of time etc.These parameters may include pulse interphase, pulse width, electric current and/or voltage amplitude and each The duration for mode of fighting.PD 16 can store these parameter values to be used to treat signal, but in some instances by PD 16 Received pacing therapy order can encode various parameters value.

Limit the changeable parameters paced after electric shock.In one example, pacing therapy can be each after monophasic shocks Pulse width of the phase with about 1 millisecond and the pulse amplitude with about 5 volts.Paced rates can be set to often 30-60 heartbeat of minute (0.5-1 hertz).After each electric shock pace session duration can between 10 seconds and 60 seconds, Or it is even longer in other examples.In other examples, what is paced after pulse width, impulse amplitude and/or electric shock continues Time can be greater or lesser.

The monitoring of inductance slowdown monitoring circuit 98 carrys out the signal of self-electrode 52 and 60, so as to monitor the electrical activity of heart 26, impedance or its His electrical phenomena.It can be sensed to determine heart rate or heart rate variability, or detection arrhythmia cordis (for example, tachyarrhythmia Or bradycardia) or other electric signals.Sensing circuit 98 may also include switch module, to depend on making in presently sensed configuration Electrode combination or electrode vectors are living to select to sense heart using which electrode (or polarity of electrode) in avaivable electrode It is dynamic.In the example with several electrodes, processing circuit 90 can be chosen for use as sensing via the switch module in sensing circuit 98 The electrode of electrode, the i.e. configuration of selection sensing.Sensing circuit 98 may include one or more detection channels, and each detection channel can coupling It is bonded to selected electrode configuration, for detecting heart signal via the electrode configuration.Some detection channels can be configured to Cardiac event, such as P wave or R wave are detected, and the instruction that this event occurs is provided to processing circuit 90, such as such as 1992 6 What the moon 2 was announced authorizes the entitled " for monitoring device (the APPARATUS FOR of electricity physiological signal of Keimel et al. MONITORING ELECTRICAL PHYSIOLOGIC SIGNALS) " United States Patent (USP) No.5,117,824 described in. Processing circuit 90 can control the function of sensing circuit 98 by providing signal via data/address bus.In some instances, PD 16 can during treatment (for example, when providing pace-making based on the order for carrying out autonomous device) unfavorable electricity consumption sensing circuit 98.

Processing circuit 90 may include timing and control module, can be embodied as hardware, firmware, software or its is any Combination.Timing and control module may include the specialized hardware electricity separated with other 90 components of processing circuit (such as microprocessor) Road (such as ASIC) or the software module executed by the component (it can be microprocessor or ASIC) of processing circuit 90.Timing and Control module can realize programmable counter.If PD 16 is configured for generating and deliver pacemaker impulse to heart 26, this The counter of sample it is controllable with DDD, VVI, DVI, VDD, AAI, DDI, DDDR, VVIR, DVIR, VDDR, AAIR, DDIR and its The associated basic time interphase of his pacing mode.Entitled " the nothing submitted Bonner's et al. and on October 31st, 2012 In the U.S. Patent Application No. 13/665,492 of lead pacemaker system (LEADLESS PACEMAKER SYSTEM) " or Bonner's et al. and entitled " no lead pacemaker system (LEADLESS PACEMAKER for being submitted on October 31st, 2012 SYSTEM it is described in U.S. Patent Application No. 13/665,601) " and this mode can be used to deliver the example PD of pace-making. It authorizes the United States Patent (USP) No.13/665,492 of Bonner et al. and authorizes the United States Patent (USP) No.13/665,601 of Bonner et al..

By the interphase that the timing in processing circuit 90 and control module define may include atrium and ventricle pace-making escape beat between Phase, the P wave of perception and R wave are in vain to restart the refractory period of the timing of escape interval and the pulse width of pacemaker impulse. As another example, for delivering the Time Intervals during and after electro photoluminescence to heart 26, timing and control module can press down Make the sensing of one or more channels from sensing circuit 98.It can be by processing circuit 90 in response to storing in memory 92 Data determine duration of these interphases.The timing of processing circuit 90 and control module can also determine cardiac pacing pulse Amplitude.In other examples, interphase can be by from the received control signal designation of main equipment (such as, icd system 30).

Once sensing R- wave and P- wave with the detection channel of sensing circuit 98, so that it may reset the timing by processing circuit 90 The interval counters realized with control module.In the example that PD 16 provides pace-making, signal generating circuit 96 may include for example It is coupled to the pacemaker output circuit of electrode 52 and 60 via switch module 91, is suitable for passing bipolar or monopole pacemaker impulse One be sent in the chamber of heart 26.In such an example, processing circuit 90 can be generated in signal generating circuit 96 Fight pulse when reset interval counters, and thus control heart pace-making function and (including paced after electric shock, provided that such If function) basic timing.However, as described herein, in other examples, PD 16 may not include sensing circuit 98.

When by perceiving R wave and P wave reset when be present in the value of the counting in interval counters can circuit 90 processed For measuring the duration of R -- R interval, P-P interphase, P-R interphase and R-P interphase, the R -- R interval, P-P interphase, P-R interphase Duration with R-P interphase is the measurement being storable in memory 92.Processing circuit 90 can be used in interval counters should It counts for detecting tachyarrhythmia event, such as atrial fibrillation (AF), atrial tachycardia (AT), VF or VT.This A little interphases may be alternatively used for detecting total heart rate, ventricular contraction rate and heart rate variability.The a part of of memory 92 can be matched Multiple recycling buffers are set to, a series of interphases measured can be saved, it can be by processing circuit 90 in response to occurring It fights or senses interruption and analyze a series of interphases measured, to determine whether the heart 26 of patient just shows room at present Or ventricular tachyarrhythmias.

Other than detecting and identifying the certain types of rhythm of the heart, sensing circuit 98 can also to the intrinsic signal detected into Row is sampled to generate other time-based instructions of electrocardiogram or cardiac event.Processing circuit 90 can also tunable from implantation The delivering of the pacemaker impulse of different PD in the different chambers of heart 26, the PD being such as implanted in atrium and/or plant Enter the PD in left ventricle.For example, processing circuit 90 can identify the pulse delivered from other PD via sensing circuit 98 And pulse timing is updated for completing selected pacing protocol.The detection can be on the basis of Pulse by Pulse or by the heart On the basis of jump, or as the time carries out small modification to pulse rate on the basis of less frequently.In other examples, PD can instruction via telecommunication circuit 94 and/or on carrier wave (such as stimulus waveform) with communicate with each other.By this method, may be used Coordinate the pacing therapy from multiple PD.

Electric shock detection circuit 99 can be used for detecting the resistance to rapid arrhythmia cordis electricity by icd system 30 or the delivering of another equipment It hits.For example, processing circuit 90 may be in response to detect tachyarrhythmia or receive instruction have detected that arrhythmia cordis or The communication that will shock by electricity and enable electric shock detection circuit 99.Processing circuit 90 can also pass by predetermined amount of time Later or in other ways will not (or no longer) expect electric shock when disabling electric shock detection circuit 99.It is detected when enabling electric shock When circuit 99, electric shock detection circuit 99 can identify when the electric signal received by sensing circuit 98 indicates cardioversion or remove Running pulse punching.

Although dividually showing in Fig. 5, electric shock detection circuit 99 can be included as processing circuit in some instances 90 a part.In some instances, due to the electric shock detection function of electric shock detection circuit 99 can be by processing circuit 90 The functional module of execution.Similar to electric shock detection, other sensing functions may include for detecting specific cardiac event or other letters Number special circuit.It is received for example, can be used as a part of sensing circuit 98 or be provided separately with sensing circuit for detecting ventricle The circuit of contracting.In other examples, telecommunication circuit 94 can be coupled directly to sensing circuit 98, so as to via as described herein TCC detect transmitted signal.

Memory 92 may be configured for storing various operating parameters, treatment parameter, perception data and the number detected According to, communication instruction and with the treatment of patient 14 and cure any other related information.In the example of hgure 5, memory 92 The ECG perceived, the arrhythmia cordis detected, the communication from icd system 30 and the treatment for limiting pacing protocol can be stored Parameter.In other examples, memory 92 can serve as temporary buffer for storing data, until the data can be uploaded To icd system 30, another implantation equipment or equipment 21.Memory 92 can also area definition communication plan parameter, such as communicate Scheduling and communication window, for the conversion (translation), logical provided by different control signals and/or synchronization signal Letter mistake transfers (handing) instruction etc..

Activity sensor 100 can be included in the shell of PD 16 and including one or more accelerometers or other It is able to detect the movement of PD 16 and/or the other equipment of position.For example, activity sensor 100 may include being configured for examining Survey 3 axis accelerometers of the acceleration on any direction in space.Specifically, 3 axis accelerometer can be used for detection can It can indicate that the PD 16 of cardiac event and/or noise is moved.For example, processing circuit 90 can monitor adding from activity sensor 100 Speed is for confirming or detecting arrhythmia cordis.Since PD 16 can be moved together with the chamber wall of heart 26, the acceleration detected The change of degree may further indicate that contraction.Therefore, PD 16 may be configured for mark heart rate and confirmation via 98 institute of sensing circuit The arrhythmia cordis of perception, such as tachycardia.

In some instances, 16 signal of PD notice equipment 21 further communicates with clinician and passes through network (such as The Medtronic Care developed by Medtronic (Medtronic) company of Minneapolis, MinnesotaNet Network) or it is some link patient 14 other networks alarm is passed into clinician.PD 16 can be spontaneously or in response to coming from The inquiry request of user transfers information to network.

Power supply 102 can be any kind of equipment, be configured to save the charge of the circuit for operating PD 16. Power supply 102 can be used as rechargeable or non-rechargeable battery provides.In other examples, power supply 102 may include energy Quantity collection system, the energy collecting system store the electric energy of the movement from the intracorporal PD 16 of patient 14.

Telecommunication circuit 94 includes appointing for what is communicated with another equipment of such as equipment 21 or icd system 30 (Fig. 1) etc What appropriate hardware, firmware, software or any combination thereof.Under the control of processing circuit 90, telecommunication circuit 94 can be in the side of antenna It helps down and receives downlink telemetry from equipment 21 and uplink telemetering is sent to equipment 21, which can be internal And/or external.Processing circuit 90 can for example via address/data bus provide by by the data of uplink to equipment 21 with And the control signal for the telemetric circuit in telecommunication circuit 94.In some instances, telecommunication circuit 94 can be incited somebody to action via multiplexer The data received are provided to processing circuit 90.

Telecommunication circuit 94 may include making it possible to and another medical device communication (such as TCC or other kinds of communication) Circuit.Telecommunication circuit 94 can be used to via switch module 91 and the transmission of electrode 52 and/or 60 and/or receive signal.When When with reception or " listening to " pattern configurations, telecommunication circuit can be energized or be enabled to allow signal to be detected or receive.For example, Telecommunication circuit can be powered for one or more amplifiers, to detect the signal for the relative weak that may occur in TCC.For this A little amplifiers are powered or otherwise operate telecommunication circuit for detecting transmitted signal losses power.Therefore, lead to The communication plan described herein for coordinating to communicate with transmission equipment can be used in letter circuit 94, logical in order to limit telecommunication circuit 94 The time quantum of electricity.

In one example, PD 16 can in passive mode or slave pattern operation, with main transmission equipment (such as, ICD System 30) communication.Transmission scheduling with ICD 9 is consistent, and PD 16 independently can enable and disable according to communication scheduling logical Believe circuit 94.PD 16 can initiate communication window, and PD 16 can receive the letter of the control from ICD 9 during the communication window Number, which is a communication window in the multiple communication windows limited by communication scheduling corresponding with transmission scheduling. PD 16 cannot generally receive control signal between multiple communication windows.PD 16 from ICD 9 receive control signal after and During communication window, PD 16 then can dispatch the delivering for the treatment of and at the time at the time according to control signal Delivering treatment.By this method, PD 16 can be configured to for example be paced according to the order provided by ICD 9 via control signal Pulse is delivered to left ventricle.By this method, PD 16 can not be required to include the sensing circuit for sensing heart signal.However, In other examples, in the case where the communication from ICD 9 has been lost, PD 16 can still be configured for sensing heart thing Part is as the further inspection in delivering pacemaker impulse or before providing spare pace-making.PD 16 can also be with main ability (capacity) or from ability and other medical device communications.

From the perspective of PD 16, related when deliver to patient provided and treats (for example, pacing signal) for control signal Information.For example, control signal can indicate to receive control signal and PD 16 for prolonging between the time for delivering treatment to patient The slow period.The delay can be used to dispatch or program treatment delivering in PD 16, such as how to when pacing signal progress is delivered Timing.By this method, control signal can provide information with code, and PD 16 converts the code using look-up table or formula.Such as Fruit control signal be it is digital, then PD 16 can be used control signal a part with for be successive treatment timing.For example, such as Fruit exemplary control signal includes seven positions, then PD 16 can be in last position of signal to treatment end timing.

As a part of communication scheduling, it is expected not from transmission main equipment to work as that PD 16 can be included in blanking window The unnecessary energization of telecommunication circuit 94 is reduced when signal.For example, the control signal of delivering treatment is indicated when in response to receiving, PD 16 can initiate blanking window, and PD 16 will not initiate any communication window in multiple communication windows during the blanking window Mouthful.PD 16 can continue the communication window that tracking may otherwise occur during blanking window.In other examples, PD 16 tracks communication window during can stopping at blanking window.Once blanking window has been pass by the determination of PD 16, in response to It determines and has pass by blanking window, PD 16 can initiate next communication window according to communication scheduling.Blanking window, which can be, to be based on The heart rate of patient is adaptive, so that blanking window increases when heart rate declines and blanking window is reduced when heart rate rises. Any variation in blanking window can origin autonomous device signal specific instruction come instruct, by from equipment in response to detecting Variation in heart rate based on when detects synchronization signal from main equipment to make.

It is longer that communication window usually can receive transmission the spent duration from main equipment than PD 16.In addition, PD 16 Communication scheduling can be dispatched with the transmission of main equipment and is aligned or synchronous, so that each Transfer Window will be in corresponding communication The intermediate of window occurs.By this method, the possibility between the transmission scheduling and communication scheduling of independent control is due to such as clock The difference of signal and caused by little deviation can not prevent each transmission that from being still captured during corresponding communication window.Example Such as, PD 16 can initiate communication window by starting communication window before the expection Transfer Window of transmission scheduling, the communication window Mouth continues within the duration for including expected Transfer Window.

In some instances, in response to receiving control signal, PD 16 can be terminated immediately by disabling telecommunication circuit 94 Communication window.Although communication window can be scheduled for continuing after the reception of control signal, telecommunication circuit 94 is not necessarily to It is powered, because further signal will not be received.Therefore, PD 16 can be by terminating communication window and being transmitted It is powered off immediately for telecommunication circuit 94 to be further reduced power consumption after the reception of signal.Further, PD 16 can be based on Control signal when is had received during communication window to be aligned communication scheduling or synchronous with Transfer Window.For example, PD 16 can base In controlling signal when is received come at the beginning of changing subsequent communications window or when the window of subsequent communications window continues At least one of between, for being aligned communication scheduling with transmission scheduling to capture subsequent control signal.

In other words, PD 16 forward or can move backward communication scheduling, so that expected transmission will fall into PD The centre of 16 corresponding communication window.These adjustment can be made with the when clock rate for adapting to occur between communicating medical devices Difference or unstable clock speed in degree.Mobile communication scheduling is substituted, if PD 16 attempts the clock speed with main equipment Matching, then PD 16 also produces the clock signal correction factor accelerated (increase) or slow down (reduction) clock signal.For example, when Clock signal can be multiplied by the clock signal correction factor with clock signal correction factor, attempt to replicate transmission equipment (example to generate Such as, ICD 9) clock clock so that transmission scheduling and communication scheduling be aligned in time.By this method, PD 16 can It is when to receive and generate clock signal correction factor based on control signal, the clock signal correction factor correcting controlling signal quilt Difference between received time and the expeced time for receiving the control signal from ICD 9.PD 16 then can be by clock signal Correction factor is applied to the clock signal of PD 16, and communication scheduling is aligned with transmission scheduling time.

PD 16 can also increase or decrease the duration of each communication window, to attempt to ensure that transmitted signal It is captured by PD 16.In one example, in one scheduled percentage of the PD 16 in the beginning or end of communication window Control signal is received, and in response to receiving control in one in the beginning or end of communication window scheduled percentage Signal processed, PD 16 can extend the window duration of subsequent communications window.In other words, if receiving transmitted signal distance The beginning of communication window terminated closely, then PD 16 can increase the length of communication window.

In some instances, when communication window can be smaller, PD 16 can reduce the length and telecommunication circuit of communication window 94 initiatively listen to the length of the time of signal.For example, PD 16 can be in the scheduled percentage for the expeced time for receiving control signal Than receiving control signal in (centre of such as communication window), and in response to receiving the predetermined of the expeced time of control signal Percentage in receive control signal, shorten the window duration of subsequent communications window.The extension or shortening of communication window Amount can be relatively small, the length of communication window is such as changed 5% or 10% or changes specific period, such as 1ms Or 2ms.However, the process can be iteratively performed.In addition, the amount of the variation of the duration of communication window can be based on instruction master The transmission of equipment is dispatched and rolling average or other historical informations from the degree arbitrarily changed between the communication scheduling of equipment To determine.

Each of multiple communication windows communication window can occur with set rate or predetermined interval.For example, communication The set rate of window can be about 10Hz to about 50Hz.Predetermined interval corresponding from the rate can be in different examples Middle use.It can be measured between the beginning of each window or since the end to next window of a window scheduled Interphase.In one example, communication window may have about the rate or interphase corresponding with the rate of 20Hz.However, can Different frequencies is used in other examples.In some instances, multiple communication windows go out with a rate and with a duration Existing: the rate or duration make communication window or the active time of telecommunication circuit 94 be less than the duty ratio of entire communication scheduling 2 percent.In other words, for 1 second period, telecommunication circuit 94 may be only active or be powered less than about 20ms.

As discussed herein, PD 16 can provide different types for the treatment of.In some instances, PD 16 is configured to use In in the left ventricle of the heart of implantation patient, but PD 16 can also be alternatively placed in other chambers.PD 16 can be matched It is set to and provides pacing signal individually to left ventricle, or the chamber different from what it is to heart or structure provide the other equipment of pace-making Pacing signal is provided to left ventricle in combination.

In some cases, main equipment (for example, icd system 30) and between equipment (for example, PD 16) communicate may It is insecure.For example, may be mentioned in the environment with many other physiology and/or artificial electric signal in the case where TCC For the electric signal transmitted, many other physiology and/or artificial electric signal create the environment of very noisy (noisy), should Noisy environment is prevented by PD 16 for the lasting detection of the signal transmitted.In other examples, icd system 30 and The clock of PD 16 may be largely different, or due to some other errors, so that PD 16 misses request treatment and passs The control signal sent.After lacking synchronous (for example, from 1 second to 6 second or more) up to a predetermined time section, PD 16 can be true Surely communication loss has been had already appeared.In these cases, PD 16 can initiate the test of independent physiology so as to detect cardiac event and Treatment is provided in the case where not carrying out the instruction of autonomous device.For example, PD 16 can provide spare VVI when communication has been lost Pace-making.After the communication resynchronisation with main equipment (such as, icd system 30), PD 16 can stop the spare pace-making.

When communication has been lost, PD 16 can attempt adjustment communication scheduling, to detect the signal for carrying out autonomous device again. In one example, PD 16 can iteratively increase the duration of communication window, until PD 16 detects synchronization signal or control Signal processed.When re-establishing communication, PD 16 can be returned to previous communication scheduling.In other examples, PD 16 is sustainable Ground open communication circuit 94 communicates until can re-establish with main equipment.

Fig. 6 is the functional block diagram of the example arrangement of external equipment 21.In the example of fig. 6, external equipment 21 includes processing Circuit 140, memory 142, user interface (UI) 144 and telemetric circuit 146.External equipment 21, which can be, to be had for heart The specialized hardware of the special-purpose software of programming and/or the inquiry of one or more equipment (including PD 16 or IMD 30) in system 8 Equipment.Alternatively, external equipment 21, which can be for example to run, enables external equipment 21 to carry out the equipment in cardiac system 8 The ready-made calculating equipment of the application program of programming and/or inquiry.

In some instances, clinician or user select using external equipment 21 or program setting in cardiac system 8 The value of standby operating parameter, such as heart sensing, treatment delivering and disabling and/or enabling PD 16.Show some In example, clinician receives the data collected by the equipment in system 8 using external equipment 21, such as in relation to icd system 30 The information of situation, including information related with the remaining power service life.External equipment 21 also can receive the data from PD 16, packet Include whether its delivering treatment is currently activated.External equipment 21 also can receive cardiac system 8 in equipment other operation and Performance data.

User can interact via UI 144 and external equipment 21, which may include for figure to be presented to user The display of user interface and for from user receive input keyboard or another mechanism.External equipment 21 can be used distant Slowdown monitoring circuit 146 is wirelessly communicated with one or more equipment in system 8, which may be configured for and PD 16 telecommunication circuit 94 or the telecommunication circuit 80 of ICD 30 carry out RF communication.In addition to RF communication, also it can be used any appropriate Communication protocol.

Processing circuit 140 may include any combination of integrated circuit, discrete logic circuitry, analog circuit, such as, one Or multi-microprocessor, digital signal processor (DSP), specific integrated circuit (ASIC) or field programmable gate array (FPGA).In some instances, processing circuit 106 may include multiple components, any combination of such as the following terms: one or more A microprocessor, one or more DSP, one or more ASIC or one or more FPGA and other are discrete or integrated patrol Collect circuit, and/or analog circuit.

Memory 142 can store program instruction, such as communication instruction 110, which may include can be by handling One or more program modules that circuit 140 executes.When being executed by processing circuit 140, this program instruction may cause to locate Reason circuit 140 and external equipment 21 provide the function of being attributed to them herein.Program instruction may be implemented in software, firmware And/or in RAM device.Memory 142 may include any volatibility, non-volatile, magnetic, light or electric medium, such as with Machine accesses memory (RAM), read-only memory (ROM), non-volatile ram (NVRAM), electrically erasable ROM (EEPROM), flash memories or any other digital media.

The external equipment 21 in Fig. 6 can be used to communicate with PD 16 and/or ICD 9 for clinician, and thus according to this Disclosed one or more aspects enable or the delivering of disabling treatment.In addition, external equipment 21 can be with PD 16 and/or ICD 9 Communication, to program or update communication scheduling.RF can be used directly to communicate with various equipment for external equipment 21, and in some examples In, provide via RF to equipment (for example, ICD 9) instruct and instruct the equipment will instruct relayed to via TCC it is another Equipment (for example, PD 16).As described below, clinician can also execute assessment to the equipment in cardiac system 8, and It is modified or is updated storage using external equipment 21 in the other equipment (such as, ICD 9) in PD 16 or in cardiac system 8 Parameter.Communication instruction 110 may include by various transmission and/or the communication plans that use of receiving device, the various transmission and/or Receiving device is communicated as described herein using TCC or other any mode.For example, communication instruction 110 may include being directed to The related transmission of each transmission equipment (for example, main equipment) and receiving device (for example, from equipment) and the finger of communication scheduling It enables, the transmission and communication scheduling such as window rate, telecommunication circuit active duration, blanking window, mistake transfer or all Other any aspects of communication as discussed in this article.In some instances, external equipment 21 can provide use via UI 144 The selectable parameter in family, and based on via UI144 from user it is received input come one of more new communication instruction 110 or more A aspect.

Fig. 7 is to show equipment (including PD 16 and icd system including being coupled in cardiac system 8 via network 162 30) and the external computing device of external equipment 21 (such as, server 164 and one or more other calculate equipment 170A- The functional block diagram of example system 170N).In this example, telecommunication circuit 94 can be used in PD 16, such as in different time It place and/or is wirelessly connected in different location or environment via first and communicates with external equipment 21 and wirelessly connect via second It connects and is communicated with access point 160.Similarly, telecommunication circuit 80 can be used in icd system 30, with for example at different time and/or It is wirelessly connected in different location or environment via first and is communicated with external equipment 21 and be wirelessly connected and access via second 160 communication of point.In the example in figure 7, access point 160, external equipment 21, server 164 and calculating equipment 170A-170N Interconnection, and can be communicated with one another by network 162.

Access point 160 may include via various connections (such as dialing, digital subscriber line (DSL) or cable modulation Demodulator connection) any one of be connected to network 162 equipment.In other examples, access point 160 can pass through different form Connection (including wired or be wirelessly connected) be coupled to network 162.In some instances, access point 160 can be with patient 14 It co-locates.Access point 160 for example can inquire cardiac system periodically or in response to the order from patient 14 or network 162 Equipment in 8, for searching information (such as, operation data) from the equipment in cardiac system 8.Access point 160 can be via net Network 164 provides the data seized to server 162.According to the one or more aspects of the disclosure, Fig. 7 is can be used in clinician In external equipment 21 communicated with PD 16, and thus enable or disable the delivering for the treatment of, and in some instances, repair Change or update storage the parameter in the other equipment in PD 16 or in cardiac system 8, the communication such as used by these equipment Scheduling and transmission scheduling.

In some cases, server 164 is configured for for from the one or more in cardiac system 8 The data collected at equipment and/or external equipment 21 provide the storage site of safety, such as internet.In some cases, it takes Data can be compiled in webpage or alternative document by business device 164, to be passed through by the professional trained (such as clinician) It is checked by calculating equipment 170A-170N.Using the Medtronic Care with Medtronic Inc.'s exploitation by Dublin, IrelandPopular network technology provided by network and functionally similar popular network technology and function are come real in certain aspects The shown system of existing Fig. 7.

Fig. 8 A and Fig. 8 B are the timing diagrams of the detection of example cardiac event and control signal transmission from Medical Devices. Fig. 8 A and Fig. 8 B will be described relative to main equipment (for example, icd system 30) and from equipment (for example, PD 16), but at it Other equipment can also be used in his example.Going out as shown in Figure 8 A, timing diagram 200 shows the example detection of cardiac event, Such as P- wave 204A and 204B.Each of P- wave 204A and 204B carry out self-corresponding cardiac cycle and indicate atrium It shrinks.Interphase A indicates the Time Intervals between each Transfer Window of Transfer Window 202.Transfer Window 202 is when scheduled Between occur, P- the wave 204A and 204B thus perceived can not be consistent with any Transfer Window.However, this has no effect on Communication between icd system 30 and PD 16.Each P- wave 204A and 204B can be detected as heart thing by icd system 30 Part, and then for example determine when PD 16 should deliver corresponding pacing signal based on these cardiac events detected.

As shown in the timing diagram 206 of Fig. 8 B, icd system 30 based on the P- wave 208A detected in Fig. 8 A with And 208B corresponding cardiac event 208A and 208B generate control signal 210A-D.Icd system 30 determines cardiac event The time that 208A occurs, and also determine that corresponding pacing signal should be delivered to patient in later time.Icd system 30 Determine that next Transfer Window occurs and the timing based on Transfer Window and treatment should generate control by the time that PD 16 is delivered Signal 210A processed.For example, controlling signal if pacing signal should be delivered 90ms after control signal 210A is transmitted Instruction should be delivered pacing signal by 210A after 90ms.If interphase A is less than the delay to treatment, i.e., if interphase A is 50ms, then icd system 30 generates the second control signal 210B for transmitting in next Transfer Window, the second control signal 210B instruction should deliver treatment after 40ms now.Since the Transfer Window after control signal 210B is later than controlling of being delivered It treats, icd system 30 can not be again for the corresponding pacing signal transmission control signal.Therefore, icd system 30 can start blanking Window B, the blanking window B operation are up to the scheduled time and usually cover multiple Transfer Windows.During blanking window B, ICD System 30 will avoid transmitting any signal to PD 16.

When blanking window B is terminated, the back to back next Transfer Window phase after blanking window B termination of icd system 30 Between transmit synchronization signal 212.As discussed in Figure 11, PD 16 may be in response to receive that synchronization signal 212 starts or adjustment is logical Letter scheduling.Equally, after icd system 30 detects heart signal 208B, icd system 30 will be before the time for the treatment of delivering Generating has the control signal 210C and 210D of different delay periods for transmitting during corresponding Transfer Window.Example Such as, occur earlier on the time related with transmission scheduling than cardiac event 208A due to cardiac event 208B, control The delay of signal 210C and 210D can be respectively it is corresponding control signal transmission and treatment delivering between 70ms and 20ms.Interphase provided in this example and rate are merely to illustrate, and the value of substitution can be used in other examples.

In some instances, once blanking window B has been terminated or expired, synchronization signal 212 may include a string of (burst) two A or more synchronization signal.The string synchronization signal can occur during synchronous window and allow receiving device (for example, PD 16) at least one of the synchronization signal after blanking window B is detected, even if transmission equipment (icd system 30) and reception are set The clock signal of standby (PD 16), which exists, slightly deviates (for example, each clock signal does not keep the identical time).Example Such as, icd system 30 is produced and transmits being separated by predetermined interval (for example, 2ms) or divided with set rate (for example, 500Hz) Five synchronization signals (rather than a synchronization signal) opened, wherein the scheduled termination of intermediate synchronization signal in blanking window B Time transmission.In other examples, which may include two transmitted during the standard Transfer Window of transmission scheduling A or more synchronization signal.However, in other examples, which can be in window longer than standard Transfer Window Transmission in mouthful, to accommodate all synchronization signals in the string.The no-load speed for limiting the rate of the synchronization signal in the string can It is bigger with the rate than the Transfer Window in transmission scheduling.By this method, synchronization signal will be in the expected termination of blanking window B It is sent during preceding and error period later, PD 16 receives synchronization signal for expected at this time.

It is such as independently tracked by PD 16, is terminated in response to blanking window B, PD 16 can initiate communication window, in the communication PD 16 is able to detect the signal from icd system 30 during window.If the clock signal of PD 16 is slow, PD 16 can be still Start communication window early enough to capture at least one of the synchronization signal transmitted from icd system 30.If PD 16 when Clock signal is fast, and PD 16 can initiate communication window and the open communication circuit before the first synchronization signal.PD 16 can be kept Communication window is opened until detecting synchronization signal, and be subsequently responsive to detect the first signal of communication, termination communication window. PD 16 then can find by be the synchronization signal transmitted at the end of blanking window B a part subsequent synchronisation signal.Once PD 16 does not detect any further synchronization signal expected short for receiving synchronization signal is interim, then PD 16 is then extensive Multiple normal communication scheduling is to find the signal for example transmitted during Transfer Window 202.PD 16 can be by finally detected synchronization Signal is used as the starting point of the transmission schedule synchronization by communication scheduling and icd system 30.

Fig. 9 is to show the flow chart of the instantiation procedure for dispatching transmission control signal according to transmission.For explanation Purpose, the situation of the telecommunication circuit 80 of the icd system 30 of the operation and Fig. 1 and Fig. 4 that are hereinafter executed by processing circuit 70 Fig. 9 is inside described, but the operation as shown by the example of Fig. 9 can be that the master in one-way communication sets by being configured for operation Standby any Medical Devices execute.Also about Fig. 8 A and Fig. 8 B and P- wave is being sensed as cardiac event and is being requested with from setting The pacing signal of standby (for example, PD 16) delivering describes Fig. 9 in the situation for the treatment of form.

As shown in Figure 9, processing circuit 70 can commencing signal timer (220), the timer by transmission scheduling limit Determine and timing is carried out to the interphase between each Transfer Window.If processing circuit 70 and be not detected P- wave (frame 222 "No" branch), then processing circuit 70 determines whether that the time for having pass by signal timer, (it was indicated between Transfer Window Interphase is over) (224).If not yet passing by the time (the "No" branch of frame 224) of signal timer, processing circuit 70 It continues to determine whether to have detected that P- wave (222).If processing circuit 70 determines the time (frame for having pass by signal timer 224 "Yes" branch), then processing circuit 70 can restart signal timing (220).

If the determination of processing circuit 70 has detected that P- wave (the "Yes" branch of frame 222) that processing circuit 70 determines under The next control signal (226) to be sent during one Transfer Window.For example, processing circuit 70 can will control the delay of signal instruction The time between expected time that period is set as next Transfer Window and treatment should deliver.Next processing circuit 70 waited Having gone the time (228) of signal timer and then generated via telecommunication circuit 80 and transmit instruction PD 16 should be when The control signal (230) of delivering treatment (for example, pacing signal).If next treatment (for example, pace-making) is than signal timer Farther time duration there is (the "Yes" branch of frame 232), then processing circuit 70 can again determination to be sent it is next It controls signal (226).

If treatment (the "No" branch of frame 232) will occur in the expired time earlier than next timer, electricity is handled Road 70 starts blanking window (234).During blanking window, processing circuit 70 not to PD 16 transmit any control signal or Synchronization signal.If having already been through blanking window (the "Yes" branch of frame 236), processing circuit 70 can be via telecommunication circuit 80 Synchronization signal is generated and transmitted to IPG 16, it is synchronous with communication scheduling in order to promote the transmission of two equipment to dispatch (238).Processing circuit 70 then can start again at signal timer, between the signal timer is between each Transfer Window Phase timing (220).

The signal for being generated and being transmitted by main equipment (for example, icd system 30) can be the control of the delivering of request treatment Signal, for by communication scheduling and the transmission synchronization signal that is aligned in time of scheduling and with PD 16 relative to icd system Other relevant signals of 30 operation.Each signal transmitted from icd system 30 can indicate generation corresponding with particular message Code.As shown in the table 1 of lower section, the transmission and treatment delivering that different codes can provide indication signal are (for example, pace-making Signal) timing between different delays message.Signal can be encoded to for other tasks, such as synchronous communication, again If blanking window even changes between different modes of operation.

Table 1.

Different types of signal can be used to encode the message in table 1, such as analog or digital signal.Show at one In example, each signal can be number and include multiple and different positions for various purposes.Control signal can compare Synchronization message is more complicated.The message of control signal can be encoded with 4 information, will provide 16 it is different possible Message (as shown in table 1 above).More positions can be used for encoding greater number of message.However, 7 codes can be used So as to for one error of 4 infomation detections up to two errors or correction.These can be followed for various functions Multiple series.Since receiving device cannot know when expected transmission, therefore determine that the edge of position will wherein occur being not It is possible.Therefore, First Series position will be sent as " waking up series " position.For example, each message can be with position series " 101010 " start.

Since receiver (for example, PD 16) will likely omit the several positions waken up in series, therefore will be after waking up series It is inserted into multiple marks.The mark can be such as 3 bit flags, and provide measurement mesh for the timing of transmitted signal 's.It is serial " 011 " that example landmark can be position.In one example, last position of mark can be made to be configured for by PD 16 with The timing for the signal that track is transmitted.Message code then can follow the mark.Therefore, example control system can be " 101010011 " add 7 of message.Synchronization signal can only include waking up series and mark, because not needing message.Herein The code of these types discussed and the quantity of position are merely illustrative, and other codes, position, the position for being directed to " waking up series " Arrangement, mark and message can be to use in other consistent examples of communication as described herein.

The duration of each control signal may depend on the frequency and used encoding scheme of communication protocol.Example Such as, frequency shift keying (FSK) agreement or phase-shift keying (PSK) (PSK) agreement or amplitude modulation protocol (AM) can be used for setting from master The preparation number of delivering letters.FSK can more tolerate timing differential compared with other encoding schemes.FSK system and other encoding scheme phases Than permissible receiver quickly with message start it is synchronous.FSK agreement also may not request long locking associated with PSK agreement Time, and can realize noise suppressed more better than AM agreement, this may make FSK agreement for relatively short between equipment Message is preferred.If using operating frequency in the case where long about 80 microseconds in place, 16 message will as discussed above Spend about 1.28ms.Therefore, for detecting the communication window of the message, will to need to be set to long enough whole to be used to capture A signal.

Although the process of Fig. 9 is related to determining and transmits control signal to PD 16, icd system 30 can also be transmitted usually Information related with the cardiac event detected.The information may include control signal and/or other information, the heart such as detected Timing between dirty event and Transfer Window.Information may specify when cardiac event is detected with when Transfer Window is adjusted Time quantum between degree.Timing between cardiac event and Transfer Window may be configured for that PD 16 is allowed to be based on heart thing When part, which is detected to arrive, determines the time of delivering treatment.For example, processing circuit 70 can be determined in frame 226 cardiac event when Sequence and then transmit the information rather than control signal.PD 16 then can receive the information and the inspection based on cardiac event Overpast time quantum is treated to determine when to deliver between survey and the transmission of information.In a particular example, PD 16 The time between the cardiac event and Transfer Window detected can be subtracted, from A-V Interval to determine before delivering pacing signal By the time quantum of waiting.In other examples, icd system 30 can determine in an identical manner and transmit other to PD 16 Information.

Figure 10 be by implantable medical device during the corresponding communication window of communication scheduling received example signal Timing diagram.Figure 10 will be described relative to main equipment (for example, icd system 30) and from equipment (for example, PD 16), but at other Other equipment can also be used in example.As shown in Figure 10, timing diagram 240 show by from equipment PD 16 to Lai autonomous The example detection of the signal of equipment.Similar to Fig. 8 A and Fig. 8 B, interphase A indicates each communication window of communication window 242 Between Time Intervals.Communication window 242 occurs with the predetermined time corresponding with the expection Transfer Window of icd system 30.

Control signal 246A and 246B be during corresponding window 242 receive and with discussed in Fig. 8 B by Control the signal 210A and 210B that icd system 30 transmits are corresponding.Each of signal 246A and 246B is controlled to limit The correspondence for the time that pacing signal 248A should be delivered to such as left ventricle from time of each control signal to PD 16 be prolonged Late.As discussed in Fig. 8 B, if pacing signal 248A should be delivered 90ms after receiving control signal 246A, control Instruction should be delivered pacing signal by signal 246A after 90ms.If interphase A is more shorter than the delay to treatment, i.e. hypothesis interphase A For 50ms, then second control signal 246B instruction should deliver treatment after 40ms now.As long as PD 16 detects the two controls One in signal 246A or 246B processed, PD 16 should can be generated and be delivered pacing signal 248A in the suitable time.One Denier PD 16 determines and can be received before the treatment of delivering without further control signal that PD 16 can start blanking window B, the blanking window B operation are up to a predetermined time and usually cover multiple communication windows.During blanking window B, PD 16 It will avoid being powered for telecommunication circuit 94, so that in no signal power consumption will be reduced during the time being received.Communication window 244 be the window that will occur in communication scheduling in the case where no blanking window B.

When blanking window B is terminated, PD 16 will be powered again for telecommunication circuit 94, to detect and from icd system 30 The corresponding synchronization signal 250 of synchronization signal 212 of transmission.PD 16 then can be telecommunication circuit 94 in communication window again Power-up, with the corresponding subsequent control signal of control signal 210C and 210D for detecting with being transmitted by icd system 30 246C and 246D.In response to detecting at least one of control signal 246C and 246D, IPG 16 can be according to by controlling Timing specified by each of signal 246C and 246D delivers pacing signal 258B.PD 16 and icd system 30 can Continue to deliver to patient by this method as needed and treat.In another example, the duration of blanking window B can be according to average Heart rate adjustment.That is, with heart rate rise and continuous p- wave between time (204A to 204B) reduction, icd system 30 and/or Blanking window B can be shortened one or more interphase A (or some other duration) by PD 16.Similarly, if under heart rate Blanking window B can be increased one or more interphase A (or other a certain duration) by drop, icd system 30 and/or PD 16.In In some examples, heart rate can be determined by both PD 16 and icd system 30.In another example, icd system 30 can be complete It eliminates synchronization signal 250 and the time of delivering treatment is set by control signal 246A and 246B and by PD 16 in ground Clock be adjusted to it is synchronous with icd system 30.In this example, icd system 30 can not utilize blanking window, but PD 16 can be still Using blanking window for reducing power consumption.Time value and rate value are merely to illustrate between provided in this example, In The value of substitution can be used in other examples.

Figure 11 is shown for receiving control signal according to communication scheduling and being delivered based on the control signal received The flow chart of the instantiation procedure for the treatment of.The signal that Figure 11 can be generated with the result as the process of Fig. 9 is related, and for saying Bright purpose, the situation of the operation executed below in the processing circuit 90 and telecommunication circuit 94 of the PD 16 by Fig. 1 and Fig. 5 Inside describe Figure 11.However, by the operation shown in the example of Figure 11 can by be configured for operation in one-way communication with And any Medical Devices of the main equipment of possible two-way communication execute.Also it is relevant to Figure 10 and in response to based on by main equipment Order that the cardiac event of such as P- wave that (for example, icd system 30) detects etc generates and by PD 16 (for example, from setting It is standby) delivering ventricular pacemaking signal situation in describe Figure 11.Processing circuit 90 is described generally as executing the most of of Figure 11 Process, but these features can be executed by processing circuit 90, telecommunication circuit 94, other circuits of PD 16 or any combination thereof.

As shown in Figure 11, processing circuit 90 starts communication timer (260), and the communications counter is to from communication The interphase of one communication window of scheduling to next communication window carries out timing.Processing circuit 90 may wait for until have passed through communication The time (the "No" branch of frame 262) of timer.Pass by communication window (the "Yes" branch of frame 262) in response to determination, When processing circuit 90 can control the initiation of telecommunication circuit 94 receiver (or amplifier circuit) to expire for starting from communication timer Communication window (264).Initiation to receiver may include that processing circuit 90 turns off the switch or otherwise guides power To the receiver amplifying circuit of telecommunication circuit 94, which allows the detection of PD 16 to carry out autonomous device (for example, ICD System 30) signal.Processing circuit 90 can control telecommunication circuit 94 to remain powered on the duration up to communication window.

If processing circuit 90 and the control signal (the "No" branch of frame 266) that order treatment delivering is not detected, locate Reason circuit 90 determines whether synchronization signal has been detected (274).If synchronization signal is detected the ("Yes" of frame 274 point Branch), then processing circuit 90 start communication timer with by communication timer and communication scheduling with it is received same from main equipment It walks signal alignment (260).In some instances, processing circuit 90 can be used the synchronization signal that receives by communication timer Start to be scheduling to carry out in later time, as the instruction being stored in memory 92 is instructed.If processing circuit 90 is simultaneously Synchronization signal (the "No" branch of frame 274) is not detected, then processing circuit 90 is checked to determine blanking timer whether just in needle Blanking window is run, telecommunication circuit 94 should remain powered off (276) in the blanking window.If blanking timer is without just In operation (the "No" branch of frame 276), then processing circuit 90 will start communication timer, or if blanking window is currently running (the "Yes" branch of frame 276) then checks to check whether blanking timer is expired.

Frame 266 is returned to, if processing circuit 90 detects the control signal ("Yes" of frame 266 point during communication window Branch), processing circuit 90 paces timer (268) according to the message setting of control signal.In some instances, processor circuit 90 The duration of extending communication window is until control signal is fully received.When phase of the beginning in communication window for controlling signal Between be received, but control signal duration will otherwise be more than communication window the scheduled duration when, this Kind situation is likely to occur.When detecting control signal, processing circuit 90 can automatically extend communication window one period, The period includes the expected duration for controlling signal.In other examples, processing circuit 90 may be configured for controlling The reception period of signal processed maintains the operation of receiver, and have passed through a period of time that any further signal is not detected Disabled or off receiver afterwards.By this method, even if control signal terminate may scheduled communication window end it After occur, processing circuit 90 or other circuits, which also ensure that, receives complete control signal.

As discussed herein, control signal can indicate control signal transmission and treatment delivering expected time it Between delay.Processing circuit 90 can dispatch pacing signal not carrying out the duration by the delay of control signal designation, but handle Circuit 90 can consider correction or offset applications to handle the time to the delay or will otherwise move treatment far from by controlling Other dispatch delays of the expected time of signal designation processed.When processing circuit 90 is then according to will deliver pacing signal and open Beginning blanking timer (270).Blanking timer prevents PD 16 from opening logical when the no signal of expection will be transmitted from icd system 30 Believe circuit.Processing circuit 90 then waits for pace-making timer expired (the "No" branch of frame 272) and control signal generator 96 is raw At and by pacing therapy delivery to patient (for example, left ventricle) (278).

Duration timing of the blanking timer to blanking window, and blanking timer may be in response to starting pace-making timing Device (268) or (step 278) is immediately begun to after pacing therapy is delivered in other examples.It is stood after setting paces timer I.e. starting blanking timer can lead to PD 16 and omit any additional control that receives and may be sent before treatment is delivered Signal (because PD 16 does not open telecommunication circuit during blanking window), such as if communication window interphase is compared with timing of fighting If the device duration is shorter.When second and redundancy control signal be not required when, this for save power may be to have Benefit.However, in some instances, blanking window can be arranged to start after treatment is delivered, with allow PD 16 using come The accuracy of first control signal is confirmed from the message of another control signal for the delivering for controlling same treatment.In addition, connecing It receives and when is delivered closer extra control signals with pacing therapy in time and can reduce icd system 30 and PD 16 Any timing variation between clock.Once blanking timer starts, processing circuit 90 is waited until blanking timer expires (the "No" branch of frame 280).Blanking timer it is expired when (the "Yes" branch of frame 280), processing circuit 90 starting communication meter When device (260).In other examples, processing circuit 90 can initiate immediately the reception of telecommunication circuit 94 when blanking timer expires Device (264).

Relative to the Transfer Window of Fig. 8 A, Fig. 8 B and Figure 10 description and the process of communication window and Fig. 9 and Figure 11 With the window for usually maintaining constant interphase.In other examples, Transfer Window and communication window can come from expection It advances the speed in the case where " delivering treatment now " signal of main equipment.For example, icd system 30 and PD 16 can be usually with rule Then interphase (for example, 50ms) operates corresponding window.However, the rate may be too slow or excessively infrequently so that can not support Instruction PD 16 delivers the suitable treatment delivering order for the treatment of immediately.On the contrary, in response to detecting cardiac event (such as P- Wave), icd system 30 transmits signals to PD 16 during the regular Transfer Window of the last one rule that treatment should be delivered, Signal instruction PD 16 by telecommunication circuit starts high rate communication window or than occurring during regular communication window dispatch More frequent or longer " listening to " duration.In some instances, icd system 30 can start high-speed Transfer Window (it can Respectively including one or more synchronization signals) so as to the maintenance synchronization during the process for the control signal for leading to treatment delivering. It may be in response to detect cardiac event and start high-speed Transfer Window.It delivers and treats in 30 expectation instruction PD 16 of icd system When, icd system 30 will transmit the control signal of " delivering treatment now " to PD 16.Signal, icd system are controlled in response to transmission 30 can start blanking window.In addition, PD 16 can be after receiving control signal and delivering treatment (for example, pacing signal) Start blanking window.

The process of Figure 11, but the class when reception in addition to controlling signal are described despite signal is controlled relative to reception When the information of type, similar process can also be executed by PD 16.For example, information may include when instruction icd system 30 detects the heart The clocking information of dirty event (for example, P- wave).Since the clocking information may specify that cardiac event is the timing when being detected, Rather than the timing for the treatment of when is delivered, therefore processing circuit 90 can analyze clocking information and determine when delivering treatment.Really Determining step can occur after frame 266.Once processing circuit 90 determines when delivering treatment, remaining process can be according to determining Continuation.By this method, PD 16 may be configured for processing information rather than only execute by the movement of control signal instruction.

Figure 12 A and Figure 12 B are that the example control system from Medical Devices is transmitted and connect by implantable medical device The timing diagram of the control signal of receipts.It will be relative to main equipment (for example, icd system 30) and from equipment (for example, PD 16) Figure 12 A and Figure 12 B is described, but other equipment can also be used in other examples.Figure 12 A can be with the letter as described in Fig. 8 B Number transmission it is similar, and Figure 12 B can be similar to the reception of the signal described in Figure 10.However, the biography of Figure 12 A and Figure 12 B Scheduling and communication scheduling is sent to adjust the rate of Transfer Window and communication window, so that when control signal may not go out The current transmission period less frequently, and when control signal more may be must when (for example, such as just PD 16 by Before delivering pacing signal) it is more frequent.

As shown in the timing diagram 290 of Figure 12 A, icd system 30 detects such as cardiac event 300 (can be P- wave) Etc cardiac event.Icd system 30 can also be generated based on corresponding cardiac event corresponding with the P- wave detected and be controlled Signal 296A and 296B.Icd system 30 determines the time that cardiac event 300 occurs, and also determines corresponding pacing signal Should after the cardiac event detected the specific time be delivered to patient.Icd system 30 may be configured for passing Transmission synchronization signal 298 during window 292 is sent, which occurs at a relatively slow rate (for example, 20Hz), and And the synchronization signal 302 of higher rate is sent during Transfer Window 294.By this method, communication can be limited in by icd system 30 PD 16 those of will be delivered before pacing signal in the period.Figure 12 B shows right in time with the timing diagram 290 of Figure 12 A Neat timing diagram 310, and indicate by the received control signal of PD 16 and synchronization signal and passed according to the control signal The pacing signal 318A and 318B sent.

For example, icd system 30, which can deliver instruction PD 16, should deliver the control letter of pacing signal (for example, pacemaker impulse) Number 296A.In some instances, control signal 296A can instruct PD 16 and deliver pacing signal as early as possible or control signal 296A's Pacing signal is delivered at a certain predetermined delay after transmission.Timing diagram 310, which shows the reception control of PD 16 signal 316A, (to be come From the signal 296A of icd system 30) and then deliver pacing signal 318A.Transfer Window (the example of interphase A instruction icd system 30 Such as, Transfer Window 292) each of time between the communication window (for example, communication window 312) of PD 16.Immediately in After transmission control signal 296A, and after receiving control signal 316A, each corresponding equipment initiates blanking window B, The blanking window B operation is up to the scheduled time and usually covers multiple Transfer Windows and communication window.In the blanking window B phase Between, icd system 30 will avoid transmitting any signal to PD 16.The example duration of blanking window B can be such as 500ms, But other blanking windows can be shorter or longer.In some instances, blanking window B can be adaptive and be based on The length of the cardiac cycle of the patient detected, so that longer blanking window can be used for slower heart rate.

When blanking window B is terminated, next Transfer Window immediately of the icd system 30 after the termination of blanking window B Period starts to transmit synchronization signal 298.PD 16 then can receive the first corresponding synchronization signal 320 and in response to receiving First synchronization signal 320 and start or adjustment communication scheduling.In order to maintain synchronous scheduling, icd system 30 can be right at each Continue to transmit synchronization signal 298 during the Transfer Window 292 answered, and PD 16 will continue to open telecommunication circuit 94 to receive Each of synchronization signal 320.Alternatively, icd system 30 can only deliver the first synchronization signal of synchronization signal 298, but PD 16 can still open telecommunication circuit 94 during each of communication window 312.

During this period, icd system 30 can sense heart signal, such as P- wave.In response to detecting cardiac event 300, ICD System 30 can increase the rate of transmission scheduling to include more frequent Transfer Window 294, and control PD 16 and similarly increase The rate of communication scheduling.It is higher that the first synchronization signal of synchronization signal .02 can indicate that 16 communication scheduling of PD should be changed to Rate.First synchronization signal of the synchronization signal 322 in timing diagram 310 is to be received by PD 16, and PD 16 changes communication and adjusts Degree is to include more frequent communication window 314.For example, Transfer Window 294 and communication window 314 can be with 100Hz (10ms Interphase) or the rate of 200Hz (5ms interphase) occur, but also contemplate lower or higher frequency.Alternatively, icd system 30 can Only deliver the first synchronization signal of synchronization signal 302, but PD 16 can still open during each of communication window 314 it is logical Circuit 94 is believed, until control signal 316B is received during communication window 314.In some instances, PD 16 can be used to Time-out (time out) period of higher rate communication window 314, so that if not received in predetermined time period To control signal, then PD 16 is back to communication window less frequently.By this method, if arriving the communication disruption of icd system 30 Or icd system 30 does not transmit control signal, then PD 16 can save power.

In some instances, each of synchronization signal 302 is provided for maintaining icd system 30 and PD respectively Transfer Window between 16 is synchronous with communication window.When icd system 30 determines that pacing signal should be in next communication window 294 When delivering later, icd system 30 can deliver the control signal 296B that instruction PD 16 will deliver pacing signal.In response to receiving Corresponding control signal 316B, PD 16 from icd system 30 can deliver pacing signal 318B.The control transmitted by icd system 30 Signal 296B processed can instruct PD 16 and deliver pacing signal immediately or be identified before pacing signal should be delivered from control signal Delay.In other examples, it can indicate from some or all of the synchronization signal 302 that icd system 30 transmits to will deliver The corresponding delay of the time of pacing signal.By this method, synchronization signal 302 can be that PD 16 provides countdown for being to pass Pacing signal is sent to prepare.In addition, if one or more control signals are not detected by PD 16, then instruction PD 16 is provided The multiple signals for the time for delivering pacing signal are allowed for into redundancy.After controlling signal 296B and 316B, icd system 30 with And each of PD 16 can be again introduced into blanking window (for example, blanking window B).

Figure 13 A and 13B are that instruction controls signal during the communication window determined by receiving device (such as, PD 16) The received timing diagram of example.In the example shown by Figure 13 A, it is contemplated that Transfer Window between example interphase be about 50ms.In other words, if receiving transmitted signal 392 (at the beginning of signal 392 transmitted) in " 0 " time, Next expected signal transmitted will occur after the time of the beginning about 50ms away from the signal 392 transmitted.However, The control signal or other any signals transmitted as main equipment (for example, icd system 30) may not be always as desired by PD 16 Time at be accurately received.For example, the clock signal of PD 16 may slightly change with the time, than icd system 30 when Clock is slightly fast or slightly slow, or may occur in which other transmission and receive delay.Therefore, communication window 394 can have and be configured for Receive the duration for the signal that may deviate from expeced time.In addition, communication window 394 can receive any transmitted providing Time of main chance of signal start.

In general, communication window 394 can be timed so that the centre of communication window 394, which is fallen in, receives any transmitted Signal expeced time at.At the beginning of the expected time of the transmitted signal of reception can be transmitted signal, The expected time of the centre of the signal transmitted is based on the expected duration of the signal transmitted or expected transmitted The end time of signal.Therefore, the centre of communication window 394, which can be timed into, falls in interphase or communication scheduling and transmission scheduling Rate.The result is that the interphase X between the beginning of the signal and communication window 394 of transmission.It is transmitted if be not received by Signal, interphase X can indicate the time between the centre of earlier communication window, or in some cases, indicate that the last one is logical Believe the time between the end of window.Interphase X can be by communication timer timing.Interphase X is also by the desired width of communication window 394 W setting.Telecommunication circuit 94 is activated and " listening to " signal during communication window 394.Therefore, communication window 394 can have Width W, width W long enough are but short enough so that when not having to transmit signal will be sent to detect transmitted signal Telecommunication circuit 94 is not energized.Width W can be arranged to longer than interphase X or predetermined time or short particular percentile it is lasting when Between, and width W can also be set to ensure the duration that width W includes expected control signal 398.For example, width W can quilt It is set as 3ms, will indicate that communication window W other than the expection 1ms duration of expected control signal 398, is passed expected 1ms is respectively opened before and after the number of delivering letters.The duration of window W is merely illustrative, and width W and control signal 398 Actual duration in other examples can be shorter or longer.In some instances, width W is arranged to the letter of the following terms Number: expection difference between transmission equipment and the clock of receiving device, the signal elapsed time received from upper one and The length of signal transmission.

However, go out as shown in Figure 13 B, the control signal 398 transmitted can not be at the expected time by accurately It receives.If the width W of communication 394 is sufficiently large, telecommunication circuit 94 will still detect control signal 398.Processing circuit 90 can make With the control signal 398 detected to synchronize next communication window.Since Transfer Window should be dispatched with the interphase of 50ms, Processing circuit 90 can start communication timer, the communication timer the control time that is received of signal 398 to next interphase into Row timing.By this method, interphase X runs the time being received from control signal 398, to mitigate from transmission equipment and connect Error between the clock signal of receiving unit.

Width W can with from the duration for receiving the signal (signal 392 transmitted) that the last one is configured and Increase.For example, and if be not detected transmitted signal, receiving device can increase width W with will come from transmission equipment and Including increased potential error between the clock signal of receiving device is included in.In addition, after blanking window expires, width W It can be arranged to the longer duration with for clock variability possible during adapting to blanking window.In receiving device (example Such as, PD 16) determine that it is no longer synchronous with transmission equipment (for example, PD 16 not yet detect certain amount of expected signal or Pass by predetermined time period but be not received by signal) some examples in, width W can ad infinitum extend until detection Determine that transmission equipment does not retransmit signal to signal or receiving device.By this method, width W can have the limited duration, The limited duration by it is longer than any expeced time between continuous signal (for example, one second, two seconds or it is any other Such period).Width W is to detect signal for substitution adjustment, and transmission equipment (for example, icd system 30) can identify PD 16 and not yet pass Treatment is sent, and increases the transfer rate of signal in response to attempt to increase a possibility that receiving device will receive signal.

In some instances, in response to receiving control signal 398, processing circuit 90 can terminate communication window 394, because Telecommunication circuit no longer needs to be powered.Processing circuit 90 can also be based on when receive control signal 398 to adjust communication window Width X.For example, processing circuit 90 can be reduced if receiving control signal 398 very close to the expeced time of Transfer Window The width W of communication window is further to save power.On the contrary, if control signal 398 is beginning or the knot in communication window 394 Received near beam, then subsequent control signal may not be captured in communication window.Therefore, processing circuit 90 can extend subsequent The width W of communication window, so that the signal for ensuring transmitted is received.The width W or in addition to this of substitution change communication window, Processing circuit 90 can change interphase X to attempt to control signal center's positioning (center) in communication window.Processing circuit 90 By monitoring moving average, weighted average or it can be appointed based on received single control signal at any time or multiple control signal Anticipating, other are measured and make these changes to width W and/or interphase X, for adjusting communication scheduling with the transmission with main equipment Scheduling alignment.

In some instances, the operation for showing or describing in flow charts can be executed in different order or with different Sequence is presented, but still according to the one or more aspects of the disclosure.Moreover, although specific operation can be in specific sequence It is existing, but in other examples, operation can be parallel or be basically executed in parallel, and also in accordance with the one or more side of the disclosure Face.Further, it can use according to the process of the one or more aspects of the disclosure or technology than shown or described It operates less operation to realize, and in other examples, this process can utilize more more than shown or described operation Operation is realized.

Any appropriate modification can be made to procedures described herein, and any appropriate equipment, processing can be used Circuit, treatment delivery circuit, and/or electrode are for the step of executing approach described herein.Any appropriate number can be passed through The equipment of amount is come the step of executing method.For example, it is some in the executable step of the processing circuit of an equipment, and another equipment Treatment delivery circuit and/or sensing circuit executing method other steps, while telecommunication circuit allow processing circuit connect Communication needed for receiving the information from other equipment.The coordination can execute in any suitable manner according to specific needs.

The disclosure conceives computer readable storage medium comprising for causing processor to execute function described herein It can be with the instruction of any of technology.Computer readable storage medium can take any Volatile media, non-volatile media, The exemplary forms of magnetic medium, optical medium or electronic media (such as, RAM, ROM, NVRAM, EEPROM or flash memory).Computer can Reading storage medium is referred to alternatively as non-transient.Programmable device (such as patient programmer or clinician's programmable device) or other calculating are set Standby also may include more portable removable memory type so that simple data transmission or off line data analysis.

Technology described in the disclosure is (including being attributed to the various composition components of icd system 16,16 external equipment 21 of PD Technology) it can at least partly realize in hardware, software, firmware, or any combination thereof.For example, can be handled in one or more Realize the various aspects of the technology in device, the one or more processors include one or more microprocessors, DSP, ASIC, FPGA or any other equivalent integrated or discrete logic circuitry, and realize in programmable device (such as, doctor or patient's programming Device, stimulator, remote server or other equipment) in this component any combination.Term " processor " or " processing electricity Road " can usually refer in combination in logic circuit above-mentioned individually or with other logic circuits or any other equivalent circuit It is any.

As used herein, term " circuit " refers to specific integrated circuit (ASIC), electronic circuit, executes one or more Described in the processor (shared, dedicated or group) and memory of a software or firmware program, combinational logic circuit or offer Other appropriate components of function.

This hardware, software, firmware can be implemented in identical equipment, or be implemented in separated equipment to support Various operations and functions described in present disclosure.For example, techniques described herein or either one or two of in the process can be one It executes in a equipment or is at least partly distributed in two or more equipment, such as in icd system 30, PD 16 and/or outside Between equipment 21.In addition, any of described unit, module or component can be implemented together, or dividually it is embodied as Discrete but interoperable logical device.Different features is portrayed as module or unit is intended to emphasize different function aspects, And do not necessarily imply that this module or unit must be realized by the hardware that separates or component software.But with one or more A module or the associated function of unit can be executed by the hardware that separates or component software, or can be integrated in common or separated In hardware or component software.

Technology described in the disclosure be can also be achieved or be encoded in the non-transient calculating encoded including the use of instruction In the product of machine readable storage medium storing program for executing.It is embedded into or is coded in the system of the non-transient computer-readable storage media including coding Instruction in product can be with, such as when the instruction for being included or being coded in non-transient computer-readable storage media by one or When multiple processors execute, one or more programmable processors or other processors is caused to realize skill described herein It is one or more in art.Example non-transient computer-readable storage media may include random access memory (RAM), read-only deposit Reservoir (ROM), programmable read only memory (PROM), Erasable Programmable Read Only Memory EPROM (EPROM), electric erazable programmable are only Read memory (EEPROM), flash memory, hard disk, CD ROM (CD-ROM), floppy disk, cassette, magnetic medium, optical medium or it is any its His computer readable storage medium or visible computer readable medium.

In some instances, computer readable storage medium includes non-transitory media.Term " non-transient " can indicate to store Medium is not implemented in carrier wave or transmitting signal.In some examples, can store can be at any time for non-transitory storage media The data (for example, in RAM or cache) of variation.

Describe the various examples of the operation for delivering cardiac stimulation therapies and the coordination various equipment of patient's body.Structure Any combination of described operation or function is thought.These and other example can be in the range of following claims.

A kind of method of example 1., comprising: the cardiac event of patient is detected by the first Medical Devices；It is set by the first medical treatment The standby timing for determining Transfer Window, the Transfer Window are a transmission windows in multiple Transfer Windows as defined by transmission scheduling Mouthful；By the first Medical Devices and the timing of the cardiac event based on the timing relative to Transfer Window generates and cardiac event Related information；And it is cured by the first Medical Devices and during the Transfer Window defined by transmission scheduling to first It treats different the second Medical Devices of implanted of equipment and transmits information related with cardiac event.

Example 2. is according to the method for example 1, wherein generating information related with cardiac event includes: to be set by the first medical treatment Timing standby and that the delivering for the treatment by the second Medical Devices of implanted is determined based on the cardiac event detected, with And by the first Medical Devices and the timing based on the delivering for treatment and the timing of Transfer Window generate control signal, The control signal is configured for limiting implantable medical device for the time of delivering treatment；And transmitting has with cardiac event The information of pass includes that will control signal to be sent to the second Medical Devices of implanted.

Example 3. is according to the method for example 2, wherein the timing and implantable medical device of control signal designation Transfer Window By the delay period between the time of delivering treatment.

Example 4. is according to the method for example 3, and wherein Transfer Window is the first Transfer Window, and controlling signal is the first control Signal, and delay period is the first delay period, and wherein this method further comprises: it is determined by the first Medical Devices The timing of the second Transfer Window after the first Transfer Window, second Transfer Window are another biographies in multiple Transfer Windows Send window；By the first Medical Devices and the timing based on the second Transfer Window and the timing of delivering treatment generate the second control Signal processed, the second control signal be configured for limiting implantable medical device will delivering treatment time, wherein this The timing of two control the second Transfer Windows of signal designations and implanted the second Medical Devices by deliver pacing signal time it Between the second delay period；And pass through the first Medical Devices during the second Transfer Window defined by transmission scheduling to plant Enter the second Medical Devices of formula transmission second control signal.

Example 5. further comprises according to the method for any of example 2 to 4: controlling signal in response to transmission, determines The period of the time of delivering treatment is less than next transmission window into multiple Transfer Windows to the second Medical Devices of implanted The interphase of mouth, next Transfer Window immediately after the Transfer Window, control signal during the Transfer Window and are transmitted；With And in response to determining that the period is less than the interphase, blanking window is initiated, the first Medical Devices are matched during the blanking window It is set to for avoiding transmitting signal to the second Medical Devices of implanted during blanking window.

Example 6. further comprises according to the method for example 5: determining that the multiple of cardiac event for including to detect detect Cardiac event between average time；And the duration based on average time adjustment blanking window.

Example 7. further comprises according to the method for any of example 5 to 6: blanking window has been pass by determination； And blanking window is pass by response to determination, next Transfer Window after immediately blanking window of transmission scheduling Period transmits one or more synchronization signals to the second Medical Devices of implanted, which controls implanted Second Medical Devices restart the communication scheduling maintained by the second Medical Devices of implanted, and wherein communication scheduling is configured to use It is aligned in time in corresponding Transfer Window in multiple Transfer Windows.

Example 8. further comprises according to the method for any of example 2 to 7: being controlled and is felt by the first Medical Devices Slowdown monitoring circuit is to sense the signal that instruction treatment has been delivered by the second Medical Devices of implanted；It is determined and is implanted by the first Medical Devices The second Medical Devices of formula not yet deliver the treatment of the predetermined quantity as desired by the first Medical Devices；And it is implanted into response to determining The second Medical Devices of formula not yet deliver the treatment of predetermined quantity, increase the Transfer Window of transmission scheduling by the first Medical Devices Rate.

Example 9. is according to the method for any of example 1-8, in which: it includes: logical for generating information related with cardiac event It crosses the first Medical Devices and the timing between cardiac event and Transfer Window, Yi Jitong is determined based on the cardiac event detected It crosses the first Medical Devices and generates the control signal including the timing between cardiac event and Transfer Window；And it transmits and heart thing The related information of part includes that will control signal to be sent to the second Medical Devices of implanted to allow implanted the second Medical Devices base Timing between cardiac event and Transfer Window determines the time of the second Medical Devices of implanted delivering treatment.

Example 10. is according to the method for any of example 1-9, wherein the communication tune of transmission scheduling and implantable medical device Spend corresponding, wherein each communication window of communication scheduling is configured for and the corresponding transmission in multiple Transfer Windows Window is aligned in time, and wherein the second Medical Devices of implanted are configured to enable telecommunication circuit in each communication The signal from the first Medical Devices is received between window phase and communication is disabled between each communication window of communication scheduling Circuit.

Method of the example 11. according to any of example 1-10, each of plurality of Transfer Window Transfer Window Occur at a predetermined rate.

Example 12. is according to the method for example 11, wherein from about 20 millis between scheduled rate and adjacent Transfer Window The interphase of second (ms) to about 100ms are corresponding.

Example 13. is according to the method for any of example 11-12, wherein between scheduled rate and adjacent Transfer Window Interphase from about 33ms to about 50ms is corresponding.

Example 14. is according to the method for any of example 1-13, wherein the first Medical Devices are configured for being implanted in Patient's body.

Example 15. is according to the method for any one of example 1-14, wherein treatment includes left ventricular pacing signal.

Example 16. is according to the method for any of example 1-15, and wherein implantable medical device is configured for being implanted into In the left ventricle of the heart of patient.

Example 17. further comprises according to the method for any of example 1 to 16: in response to detecting cardiac event, Start the high-speed Transfer Window for transmitting scheduling, and to implanted the second Medical Devices send instructions to start and high-speed Transfer Window corresponding high rate communication window in time, the high-speed Transfer Window with before the detection of cardiac event Transmission scheduling in the low rate Transfer Window that occurs compare with the appearance of higher rate；By the first Medical Devices multiple high Synchronization signal is transmitted to the second Medical Devices of implanted during each of rate Transfer Window Transfer Window；And pass through the One Medical Devices and the send instructions implanted during the final high-speed Transfer Window after multiple high-speed Transfer Windows Second Medical Devices deliver the control signal for the treatment of to patient.

Example 18. further comprises according to the method for any of example 1-17, related with cardiac event in response to transmitting Information, initiate blanking window, the first Medical Devices are configured for keeping away during blanking window during the blanking window Exempt to transmit signal to the second Medical Devices of implanted.

Example 19. further comprises according to the method for example 18: determining that blanking window is expired；And in response to true It is expired to determine blanking window, transmits a string of synchronization signals to the second Medical Devices of implanted during synchronous window, wherein should The no-load speed of synchronization signal in string is bigger than the set rate of the Transfer Window in transmission scheduling.

A kind of method of example 20., comprising: communication window is initiated by implantable medical device, during the communication window Implantable medical device can receive information related with cardiac event from another Medical Devices, which adjusted by communication A communication window in the multiple communication windows limited is spent, which dispatches with the transmission for defining multiple Transfer Windows It is corresponding, wherein another Medical Devices are configured for transmission information related with cardiac event, wherein implantable medical is set It is standby that information related with cardiac event can not be received between multiple Transfer Windows；By implantable medical device in communication window The information related with cardiac event from another Medical Devices is received during mouthful, is somebody's turn to do information related with cardiac event and is indicated The timing of the cardiac event of timing relative to Transfer Window；By implantable medical device according to letter related with cardiac event The delivering of breath scheduling treatment；And it is delivered and is treated to patient by implantable medical device.

Example 21. is according to the method for example 20, wherein information related with cardiac event includes coming from the first Medical Devices Control signal, control signal limiting implantable medical device will delivering treatment time, wherein dispatch the delivering for the treatment of Including the delivering by implantable medical device scheduling scheduling treatment at the time according to control signal, and wherein delivering is controlled Treat includes delivering to treat in the time by implanted equipment.

Example 22. is according to the method for example 21, wherein controlling, signal designation receives control signal and implantable medical is set Delay period between the standby time that will deliver treatment.

Example 23. further comprises according to the method for any of example 21-22, in response to receiving control signal Blanking window is initiated, implantable medical device does not initiate any communication window in multiple communication windows during the blanking window Mouthful.

Example 24. further comprises according to the method for example 23: determining to include the multiple receptions for controlling signal received The average time between control signal arrived；And the duration based on average time adjustment blanking window.

Example 25. further comprises according to the method for any of example 23 to 24: blanking window has been pass by determination Mouthful；And blanking window is pass by response to determination, next communication window is initiated according to communication scheduling.

Example 26. is according to the method for any one of example 20-25, and wherein implantable medical device is configured for being based on The time of information determination delivering treatment related with cardiac event, related information indicates cardiac event phase with cardiac event for this For the timing of the timing of communication window.

Example 27. is according to the method for any of example 20-26, wherein initiating communication window includes in the pre- of transmission scheduling Start communication window before the Transfer Window of phase, which continues within the duration, which includes the expection Transfer Window.

Example 28. further comprises, in response to receiving information, passing through taboo according to the method for any of example 20-27 Communication window is terminated with the telecommunication circuit of implantable medical device.

Example 29. further comprises that the duration of extension communication window is straight according to the method for any of example 20-28 It is fully received to information.

Example 30. further comprises when being received based on information according to the method for any of example 20-29, At the beginning of changing subsequent communications window or at least one of the window duration of subsequent communications window, for that will lead to Letter scheduling is aligned with transmission scheduling to capture the follow-up from another Medical Devices.

Example 31. is according to the method for example 30, wherein receiving information includes to one in the beginning or end of communication window The inscribed breath of collecting mail of a predetermined percentage；And the window duration for changing subsequent communications window includes in response in communication window The information is received in one predetermined percentage in the beginning or end of mouth, the window for extending subsequent communications window continues Time.

Example 32. is according to the method for any of example 30-31, in which: receiving information includes for receiving information Control signal is received in the predetermined percentage of expeced time；And the window duration for changing subsequent communications window includes response In receiving the information in the predetermined percentage in the expeced time for receiving information, shorten the window of subsequent communications window Duration.

Example 33. further comprises according to the method for any of example 20 to 32: being when to receive based on information And generate clock signal correction factor, which is when the receive and expected expection for receiving information to information Difference between time is corrected；And apply the clock correction factor to the clock signal of implantable medical device to be used for Communication scheduling and transmission scheduling are aligned in time.

Method of the example 34. according to any of example 20-33, each of plurality of communication window communication window Occur at a predetermined rate.

Example 35. is according to the method for example 34, wherein from about 20 millis between scheduled rate and adjacent Transfer Window The interphase of second (ms) to about 100ms are corresponding.

For example 36. according to the method for any of example 20-35, plurality of communication window, which has, is lower than communication scheduling 2 percent average duty ratio.

Example 37. is according to the method for any one of example 20-36, wherein treatment is left ventricular pacing signal.

Example 38. is according to the method for any of example 20-37, and wherein implantable medical device is configured for being implanted into In the left ventricle of the heart of patient.