U.S. patent number 3,669,120 [Application Number 05/053,557] was granted by the patent office on 1972-06-13 for device for starting or stimulating heart contractions.
This patent grant is currently assigned to Christian Rovsing A/S. Invention is credited to Lars Stig Nielsen.
United States Patent |
3,669,120 |
Nielsen |
June 13, 1972 |
DEVICE FOR STARTING OR STIMULATING HEART CONTRACTIONS
Abstract
A Pacemaker of the demand type having an output control circuit
arranged to control the produced pace impulses in such a manner
that the amplitude of each impulse is slightly less than that of
the preceding impulse. When the amplitude has decreased below the
threshold value so that a heart impulse fails to occur within a
predetermined period, a reset circuit will cause another pace
impulse to be produced having a given initial amplitude.
Inventors: |
Nielsen; Lars Stig (Copenhagen,
DK) |
Assignee: |
Christian Rovsing A/S
(Copenhagen, DK)
|
Family
ID: |
8126528 |
Appl.
No.: |
05/053,557 |
Filed: |
July 9, 1970 |
Foreign Application Priority Data
Current U.S.
Class: |
607/27 |
Current CPC
Class: |
A61N
1/365 (20130101) |
Current International
Class: |
A61N
1/365 (20060101); A61n 001/36 () |
Field of
Search: |
;128/419P,419R,421,422 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Claims
What I claim is:
1. A Pacemaker comprising a pair of electrodes adapted to be
inserted in or near the heart of a patient, a pulse generator for
producing heart stimulating pacing pulses of substantially fixed
frequency, which pulses are applied to said electrodes, and a
detector connected to the electrodes and to the pulse generator and
adapted to detect the heart pulses that trigger muscular
contractions of the heart and to control the pulse generator to
produce a pacing pulse on the absence of a heart pulse for a
predetermined period, characterized in that means are provided in
operative relationship for gradual reduction of the amplitude of
selected pacing pulses and means are operatively connected for
producing predetermined initial amplitude, after the absence of a
heart pulse for a certain period after the provision of a reduced
pacing pulse.
2. A Pacemaker according to claim 1, characterized in that the
amplitude reducing means reduces the amplitude of each pacing pulse
by a fixed or relative value with respect to the preceding pacing
pulse.
3. A Pacemaker according to claim 1, further comprising an output
circuit connected to said electrodes and containing a condenser, an
electronic switch connected in series with said condenser, and a
charging circuit operatively connected for charging the condenser
to a controllable potential.
4. A Pacemaker according to claim 3, characterized in that the
amplitude reducing means include a dosage circuit containing a
dosage condenser operatively connected so that the voltage of the
dosage condenser controls the potential to which the output
condenser is charged, and a charging circuit and a discharging
circuit connected in circuit relationship with the dosage
condenser.
5. A Pacemaker according to claim 4 and in which the pulse
generator comprises a resetable astable multivibrator,
characterized in that it comprises a first monostable multivibrator
which is activated by said astable multivibrator after each
completed cycle thereof to produce a trigger pulse, a second
monostable multivibrator in operative circuit relationship with
said first monostable multivibrator to be activated by the leading
edge of said trigger pulse and to control the electronic switch of
the output circuit, and wherein said amplitude producing means
include a restoration circuit in operative circuit relationship
with said first monostable multivibrator to be activated by the
trailing edge of said trigger pulse in the absence of a detected
heart pulse to adjust the dosage circuit to full pace pulse
amplitude.
6. A Pacemaker according to claim 5, characterized in that the
charging circuit of the dosage circuit comprises an electronic
switch connected in series with the dosage condenser and further
connected to said second monostable multivibrator so as to be
controlled by the trigger pulses.
7. A Pacemaker according to claim 5, characterized in that the
discharging circuit of the dosage circuit is connected in parallel
with the dosage condenser and includes an electronic switch
operatively connected to the restoration circuit as to be
controlled thereby.
Description
A Pacemaker is an electronic device which after surgical insertion
of electrodes in a patient is capable of emitting pulses of
sufficient magnitude to start or stimulate heart contractions. The
Pacemaker is used as a means of treatment in case of abnormal
conditions where the function of the natural centers of stimulus of
the heart is suspended spasmodically or for a prolonged period and
where no effective medical treatment is possible.
The main characteristics of such diseases are disturbance in the
propagation of electric pulses from the atriums of the ventricles
of the heart, the object of which is to start coordinated
contractions of the ventricles. The pulse propagation is
characterized physiologically by a successive and coordinated
depolarization of certain cell membranes, the so-called "HIS"
bundles. Normally the pulse issues from a small cell cluster known
as the sinus node and located in the upper portion of the right
atrium at the entrance of vena cava superior. From the sinus node
the depolarization propagates through the atriums.
The depolarization means a change in the electrical potential
difference between the inner and outer muscle walls, a phenomenon
which may be compared electrically to an increasing double layer
charge. The total effect of this change of potential in all atrium
cells is shown in the electrocardiographic recordings on the
surface of the patient's body as a small peak known as the P peak
of a duration of about 0.1 second and a value of about 0.2 mV.
The peak thus corresponds to the contraction of the atriums. From
the atriums the depolarization is normally transmitted to the
ventricles through a special cell cluster, the atrio-ventricular
node, located in the partition wall immediately beside the valve
between the right atrium and ventricle. The pulse transmission is
delayed 0.07 second in the atrio-ventricular node and is then
conducted through two branches in the cardiac partition wall to the
base of the right and left ventricles. From here the depolarization
of the ventricles is initiated and is recorded on the
electrocardiogram in the form of the socalled QRS complex. The R
and S peaks are the dominant characteristics of the complex and are
of an order of about 1.0- 2.5 mV and of a duration of about
0.08-0.12 seconds. The QRS complex thus corresponds to the
contraction of the ventricles.
During the subsequent relaxation repolarization occurs which will
probably be reflected in the electrocardiogram by the T PEAK.
The proper pumping action of the heart is associated with the
ventricle contractions. It is therefore of decisive significance
that the contractions are started by the release of a QRS complex
at appropriate time intervals, for instance about 60-80 times per
minute. The release of the QRS complex, as explained above, is
effected by transmission of pulses from the atriums. Disturbances
in the transmission in the form of complete or partial blocking are
known as atrio-ventricular blockage. In patients with complete
blockage the ventricles may automatically continue to contract in
that the muscle cells contract spontaneously, but at a frequency
which is substantially lower than that produced by the sinus node.
If the natural frequency of the ventricles drops, the patient will
not be able to maintain a normal blood circulation. In cases of
acute blockage it frequently occurs that the contractions of the
ventricles do not start immediately. Such a condition is known as
an ADAM-STOKES attack and is characterized by temporary
unconsciousness. Complete failure of the natural rhythm of the
ventricles is known as heart stoppage or asystoli and will cause
certain death unless immediate action is taken. This may be done
either by external heart massage or by artificial release of a QRS
complex. In the latter case an electric pulse of short duration
(about 1.8 msec. and 10 mA) is transmitted through the ventricles,
and this is known as pacing the heart to contraction.
Heart failures of the type just described occur in spasms and
without warning and, because there is no safe prophylactic medical
treatment, research has led to the development of a pulse generator
which can be applied externally or by surgical insertion to assist
the heart permanently or temporarily. Patients who receive an
internal pulse generator are said to be undergoing permanent
pacemaker treatment.
In Pacemaker treatment the electrodes can be applied in two
different ways, viz. epicardially or endocardially. The epicardial
method requires that the thorax be opened and the electrodes
inserted into the heart muscle tissue. The Pacemaker to which the
other end of the electrodes are connected is placed in a pocket
just under the skin of the thorax or the abdomen.
Because of the great risk of complications arising from such an
operation, the epicardial method has been almost completely
abandoned in favor of the endocardial method which is carried out
as follows. One of the electrodes known as the differential
(normally the negative pole) is introduced through a neck vein and
carried via the right atrium through the tricuspid valve arriving
finally at the base of the right ventricle, where it becomes
enmeshed in the papillary muscle. The electric pulse is a
capacitive discharge between the electrodes. The value of the pulse
necessary for triggering the QRS complex depends upon the type and
placing of the electrodes. This value is known as the heart's
actual pace threshold value and the "pace security" can be defined
as the ratio between the actual pace impulse and the actual pace
threshold value. At the commencement of treatment this value is
normally between 3 and 5.
There are three known categories of pacemakers, divided according
to their functioning:
1. Fixed-rate pacemakers
2. Demand pacemakers
3. Atrial-triggered pacemakers.
The fixed-rate Pacemaker emits continuous pulses of a preset
frequency. Thus the patient's heart is constantly paced and is
committed to a fixed rhythm. This is unsuitable for patients who
need only occasional pacing. Moreover, it appears that a
considerable number of patients (about 25 percent), after 6-12
months of Pacemaker treatment, regain their normal sinus rhythm.
This causes fluctuating pacing, which presents a serious hazard to
life due to ventricular fibrillation. The principle of the
fixed-rate Pacemaker is that of an astable multivibrator, e.g. the
Hook Circuit.
The demand Pacemaker emits pulses only when the natural rhythm of
the heart falls below a preset frequency, i.e. the Pacemaker
controls currently that the heart itself triggers QRS complexes of
adequate frequency and only when the heart frequency has dropped
below a certain value does it set in. In this manner the Pacemaker
will not compete with the natural rhythm of the heart and pacing
sets in only when required, e.g. during an ADAM-STOKES attack. The
demand Pacemaker is formed in principle as a resettable astable
multivibrator which is reset whenever a pulse trigger picks up an R
peak. If no R peak is detected the multivibrator will work
currently and emit pacing pulses of constant frequency. After each
pacing pulse emitted the pulse trigger will be blocked for about
400 msec. In a construction of this type it is difficult to obtain
a pulse trigger which is sufficiently immune to noise and which can
be relied upon to pick up only the R peaks.
The atrial-triggered Pacemaker generates an impulse in
synchronization with the atrium contractions. It is used only for
patients suffering from total atrio-ventricular blockage and having
a strong atrial sinus rhythm. If the sinus rhythm fails, the
Pacemaker is reduced to a fixed-rate Pacemaker. This pacing enables
adaptation of the pumping effect to requirement, but two
intra-cardial electrodes are needed, one in the right atrium and
one in the right ventricle. The insertion of these electrodes is
difficult and atrial-triggered pacing therefore rarely applied.
One of the most serious drawbacks of the known pacing technique is
that it is not possible to ascertain the effectiveness of the
pacing by a periodical examination without surgical operation; it
can only be ascertained that the Pacemaker's ability to trigger
pulses is intact. Nothing can be learned about the trigger
effectiveness since it depends also on the threshold value of the
heart, which cannot be ascertained without surgical operation. It
has been found that the threshold value tends to increase during
continued triggering and simultaneously the trigger ability of the
Pacemaker will decline as a result of battery discharge. Unreliable
pacing will therefore occur earlier than foreseen where the
Pacemaker's trigger ability is associated with the threshold value
ascertained at the implantation.
This invention relates to a pacemaker comprising a pulse generator
for producing heart stimulating pacing pulses of substantially
fixed frequency and a detector adapted to detect the heart pulses
that trigger muscular contractions of the heart and to activate the
pulse generator to produce a pace impulse on the absence of a heart
pulse for a predetermined period, and it is the aim of the
invention to provide a Pacemaker of this type which enables current
determination of the actual threshold value of the heart and at the
same time ensures effective pacing security.
This aim has been accomplished by providing the Pacemaker with
means for gradual reduction of the amplitude of selected pacing
pulses and means for producing a new pacing pulse of predetermined
initial amplitude after the absence of a heart pulse for a certain
period after the provision of a reduced pace impulse, the smallest
pacing pulse emitted by this Pacemaker being a measure of the
threshold value of the heart.
Where it is considered expedient the Pacemaker may be adapted to
generate pacing pulses of full amplitude, i.e. the initial
amplitude, in between the selected pacing pulses, but the simplest
construction is obtained by adapting the amplitude reducing means
to reduce the amplitude of each pacing pulse by a fixed or relative
value with respect to the preceding pacing pulse.
The QRS complex normally occurs from 30 to 40 msec. after the
triggering pacing pulse on account of physiological delay, and the
Pacemaker's inbuilt time limit may suitably be about 100 msec. As
long as the pacing pulse triggers the QRS complex within this
period of time the following pacing pulse will be reduced. But if a
QRS complex is not detected within the 100 m.sec. period a pacing
pulse of full amplitude will be generated at the end thereof, for
instance of a value five times that of the actual threshold
value.
By providing the Pacemaker with an output circuit comprising a
condenser connected in series with an electronic switch and a
charging circuit for charging the condenser to a controllable
potential, it will be possible in a simple manner to generate
relatively high energy pacing pulses by means of weak outer power
sources and at the same time to control the pulse amplitude. This
control may be accomplished by providing a dosage circuit
comprising a dosage condenser the voltage of which controls the
potential to which the output condenser is charged and which is
connected to a charging circuit and a discharging circuit.
In an embodiment of the invention the pulse generator comprises a
resetable astable multivibrator which after each completed cycle
activates a monostable multivibrator to produce a trigger pulse the
leading edge of which activates a second monostable multivibrator
to control the electronic switch of the output circuit and the
trailing edge of which in the absence of a detected heart pulse
activates a restoration circuit which adjusts the dosage circuit to
full pacing pulse amplitude, and here the said inbuilt time limit
is equal to the length of the trigger pulse.
Simple means for controlling the voltage over the dosage condenser
which determines the magnitude of the pacing pulse are provided by
inserting in the charging circuit of the dosage circuit a circuit
breaker connected in series with the dosage condenser and
controlled by the trigger pulses and connecting the discharging
circuit of the dosage circuit in parallel with the dosage condenser
and inserting therein an electronic circuit breaker which is
controlled by the restoration circuit.
All the specified members of the said Pacemaker may be combined
into a single implantable device, but the pacemaker may also be
divided into an implantation device which is able to work
independently as a conventional demand Pacemaker with fixed pulse
amplitude and a device kept at the place where the patient
undergoes treatment and connected to the implanted device by
non-galvanic, for instance magnetic or inductive means to provide a
gradual reduction of selected pacing pulses until the threshold
value is reached and then restore full impulse amplitude.
The invention will be explained in greater detail here with
reference to the drawing, in which
FIG. 1 shows typical electrocardiographic signals,
FIG. 2 shows graphs illustrating the functioning of the Pacemaker
according to the invention,
FIG. 3 is a block diagram of an embodiment of the Pacemaker
according to the invention,
FIG. 4 is a diagram showing certain circuit details of the
Pacemaker illustrated in FIG. 3, and
FIG. 5 is a corresponding diagram of a modified embodiment divided
into two devices, only one of which is intended for
implantation.
FIG. 1 shows the peaks or pulse elements P,Q,R,S and T which are
characteristic of electro-cardiographic registered signals. The
time duration is given along the abscissa and the amplitude along
the ordinate. The scales of these graph components are also shown.
Both the absolute and relative values of the different peaks as
well as their time durations and positionings may vary considerably
from patient to patient and it is the existence of these
differences that makes electro-cardiography such an important
diagnostic tool.
The Pacemaker illustrated in FIG. 3 has two input leads 1 for
receiving heart pulses and two output leads 2 for emitting pacing
pulses. The two pairs of leads may, if desired, be connected to one
another as shown by the dotted line and thus be connected to a
common set of electrodes to be inserted in the patient. The input
leads 1 are connected, through a blocking circuit B that serves to
block the receiving member when pacing pulses are emitted, to an
amplified F that amplifies the received signals and transmits them
to a detector D which is adapted to detect the QRS complexes and on
each such detection to generate an output pulse that triggers a 250
msec. monostable multivibrator MV1. The most characteristic feature
of the QRS complex being the inclination of the line RS the
detector may expediently be adapted in conventional manner to sense
this inclination. By allowing the multivibrator MV1 the relatively
long pulse period of 250 msec. the risk that after being activated
by a QRS complex it will be activated also by the subsequent T peak
has been obviated. It will be seen that the already described
portion of the Pacemaker will cause the generation of a square
pulse of a length of 250 msec. on an output lead 3 from the
multivibrator MV1 whenever a QRS complex is received. This impulse
will be referred to in the following as the starting pulse.
The starting pulses are transmitted to the reset entrance 4 of a
resetable saw-tooth oscillator with an adjustable frequency of
about 50-90 pulses per minute, but which is forced to restart its
working cycle whenever it receives a reset or starting pulse. The
oscillator 0 will thus be allowed to run through a whole working
cycle only when the pulse rhythm of the heart becomes slower than
the natural rhythm of the oscillator.
After each completed cycle the oscillator 0 activates a monostable
multivibrator MV2 which at its exit 5 produces a square pulse of a
duration of 100 msec. This pulse is called a trigger pulse because
it is responsible for initiating a pacing pulse by activating with
its leading edge another monostable multivibrator MV3 which has a
pulse time of 1.8 msec. and via lead 6 activates an output circuit
U to emit an output pacing pulse to the output leads 2. The square
pulses from the multivibrator MV3 are here called control pulses
because they control the emission of pacing pulses. The control
pulses are also conducted over a lead 7 to the blocking circuit B
whereby the said blocking of the receiving member during the
emission of pacing pulses is established.
The trigger pulses from the multivibrator MV2 are also conducted
over a lead 8 to a dosage circuit C which is adapted on receipt of
a trigger pulse to activate the output circuit U over the lead 9 so
that the amplitude of the next pacing pulse is reduced by a
predetermined absolute or relative value.
Moreover the trigger pulses are transmitted over a lead 10 to a
restoration circuit R which is adapted to be activated by the
trailing edge of the said pulses and by the starting pulses
transmitted through a lead 11 to generate a restoration pulse on an
output lead 12 when and only when the trailing edge of the trigger
pulse occurs in the absence of a starting pulse, that is when no
heart pulse has been received within 100 msec. from the generation
of a pacing pulse. The restoration pulse is transmitted to the
dosage circuit C, which immediately adjusts the output circuit U so
that the next pacing pulse emitted will be of full amplitude, that
is a predetermined initial value. A slightly delayed version of the
restoration pulse is transmitted through a lead 13 to the
multivibrator MV3 and acts as an extra trigger pulse causing the
generation of a new pacing pulse of full amplitude 100 msec. after
the emission of an ineffective trigger pulse.
In the embodiment of the Pacemaker illustrated here the trigger
pulses are fed back over a lead 14 to the input of the saw tooth
oscillator 0, which is thereby prevented from starting a new
working cycle before the end of the trigger pulse.
FIG. 4 shows practically expedient embodiments of the restoration
circuit R, the dosage circuit C and the output circuit U. These
circuits are provided with electronic circuit breakers which are
illustrated here as transistors T1-T4 but could also be other types
of static electrical change-over switches.
The output circuit U contains a condenser C4 inserted in series
with the output leads 2 and the transistor T4 which is made by
conducting 1.8 msec. control pulses from the multivibrator MV3 via
lead 6 and thus causes discharge of condenser C4 through the
electrode circuit 2. The pacing pulse size is thus equivalent to
the voltage over the condenser C4 at the moment the transistor T4
is switched on. The condenser voltage is controlled by the dosage
circuit C over a voltage follower field-effect transistor T5 which
determines the potential to which C4 is recharged after each pacing
pulse. This potential depends on the voltage over condenser C3 in
the dosage circuit, which in turn is controlled by the two
transistors T2 and T3.
Every 100 msec. trigger pulse from the multivibrator MV2 makes
transistor T3 conductive and effect changing of condenser C3 so
that the voltage in the point P connected with the lead 9 drops,
resulting in a reduction of the potential to which the output
circuit condenser C4 is recharged. In this manner every pacing
pulse is reduced by a certain value relatively to the preceding
pacing pulse.
A precondition for the new reduced value of the next pacing pulse
is the detection of a heart pulse before the trailing edge of a 100
msec. trigger pulse appears. When this happens the 250 msec.
multivibrator MV1 will be activated and transmit the necessary
basic current for maintaining the transistor T2 of the restoration
circuit R in a saturated condition. If no heart pulse is detected,
the trailing edge of the 100 msec. trigger pulse will, via the
condenser C1, block the transistor T1 for a comparatively short
interval of time determined by the magnitude of the condenser C1
and of the resistors R1, R2 and R3. At the moment the transistor T1
is blocked the transistor T2 of the dosage circuit C is made
conductive and short circuits condenser C3 which is thus
discharged. Thus the voltage at the point P rises and pulls up
transistor T5's source electrode voltage so that the output circuit
condenser C4 is recharged to the starting value. When the
transistor T1 of the restoration circuit is again reset the
condenser C4 has been recharged and a pacing pulse can be produced.
This is effected by the 1.8 msec. multivibrator MV3 being activated
by the condenser C2 when the transistor T1 is short-circuited.
FIG. 2A shows some of the pacing pulses produced by the Pacemaker
described above when the heart's threshold value is e.g. 1.2 mA.
The starting pulse is set to five times 1.2 mA., i.e. 6 mA., and
for every pacing pulse the amplitude is reduced by 5 percent of 1.2
mA., i.e. by 0.06 mA., so that the threshold value is determined
with an accuracy of 5 percent. With the said pulse reduction the
threshold value is reached after (6.0-1.2)/0.06 = 80 pulses. The
threshold value can thus be registered at any time as the lowest
pulse amplitude, and the pacing security can be calculated as the
ratio of this amplitude to the starting amplitude.
FIG. 2B shows besides the pacing pulses, also the heart pulses
triggered by the pacing pulses. FIG. 2C shows on a greater time
scale a smaller section of the pacing pulses and the pertaining 100
msec. triggering pulses.
The embodiment of the Pacemaker according to the invention
illustrated in FIG. 5 is divided into two separate sections, of
which only the section located to the right of the line I--I is
intended for implantation while the section located to the left of
this line is to be kept at the place where the patient is treated,
for instance at the hospital where the patient is subjected to
regular control and, if necessary, treatment. This Pacemaker
comprises similar circuits R, C, U and MV3 as indicated in FIG. 4,
and in FIG. 5 the designations are the same as used in FIG. 4 for
identical parts.
In the Pacemaker shown in FIG. 5 the monostable multivibrator MV3
is activated to emit 1.8 msec. control pulses by a circuit DPM,
which may be the detector and pulse generator of a conventional
demand Pacemaker. In the dosage circuit C the condenser C3 is
connected in series with a resistor R4 in lieu of the
pulse-controlled field-effect transistor T3, and in the restoration
circuit R the base of the transistor T1 is connected over the
resistor R3 to the positive pole of the battery through a normally
open reed contact RE1 which can be activated from without by a
relay coil RE when the latter is magnetized by a device A which
together with the relay coil forms the permanent equipment and
which comprises the same chain of circuits F, D and MV1 as shown in
FIG. 3 and explained in the foregoing.
When the contact RE 1 is open, as shown in the drawing, the
transistor T1 will be blocked and the transistor T2 in the dosage
circuit C will be connected. Consequently the dosage condenser C3
will be short-circuited and the point P will continually be at
maximum potential so that all the pacing pulses emitted by the
output circuit U will have full amplitude. Under these conditions
the Pacemaker will therefore work as an ordinary demand
Pacemaker.
When the implanted section of the Pacemaker is connected at the
place of treatment to the permanent equipment by placing the relay
coil RE opposite the reed contact RE1 and connecting the contact by
magnetization of the coil by means of the device A, the transistor
T1 is made conductive while the transistor T2 is blocked. The
charging of the dosage condenser C3 is now commenced through the
resistor R4 whereby the potential in the point P is gradually
reduced with the result that the pacing pulses emitted by the
output circuit U will get a correspondingly decaying amplitude.
When the amplitude reaches a value that is insufficient to effect
heart contraction it is registered in conventional manner by the
device A, which may for instance include a cardiograph and which is
further adapted on failing activation within a certain period of
time of the multivibrator corresponding to MV1 in FIG. 3 to cause
demagnetization of the relay coil RE over such a period, for
instance 20 msec., that the dosage condenser C3 will be discharged
through the transistor T2, which has been made conductive by the
connection of the reed contact RE 1, and the output condenser C4
can be charged to full potential. When the transistor T1 after the
said period is made conductive again by connection of the contact
RE1 an activating pulse will be transmitted, as in the embodiment
first described, to the control pulse multivibrator MV3 over the
condenser C2 and the lead 13, whereby a pacing pulse of full
amplitude will be generated. After this restoration the pacing
pulse amplitude will again decay in step with the charging of the
dosage condenser C3.
The connection of the implanted section of the Pacemaker to the
permanent equipment may also be provided in other ways than by
means of a reed relay as shown in FIG. 5, for instance by means of
a tuned high frequency transformer whose secondary circuit in the
implanted section is connected through a rectifier to an RC
combination whose voltage controls the transistor T1.
Other structural details of the Pacemaker according to the
invention may likewise be adapted and arranged in other ways than
illustrated in the drawing and described in the foregoing. For
instance may other types of time metering circuits than monostable
multivibrators be employed, and the functions performed by the
circuits shown in FIGS. 4 and 5 may be performed by other types of
logical circuits.
* * * * *