U.S. patent number 3,683,934 [Application Number 05/074,007] was granted by the patent office on 1972-08-15 for method and apparatus for providing synchronized stimulus and coupled stimulation from an implanted heart stimulator having a constant rhythm.
Invention is credited to Bohdan A. Bukowiecki, Mariusz J. Stopczyk.
United States Patent |
3,683,934 |
Bukowiecki , et al. |
August 15, 1972 |
METHOD AND APPARATUS FOR PROVIDING SYNCHRONIZED STIMULUS AND
COUPLED STIMULATION FROM AN IMPLANTED HEART STIMULATOR HAVING A
CONSTANT RHYTHM
Abstract
An apparatus which provides an electromagnetic field in
synchronization with the occurrence of a detected heart function
potential is located outside of a patient's body in which a heart
stimulator having a constant rhythm frequency generator has been
implanted. The implanted generator is magnetically coupled within
the electromagnetic field so as to be responsive to the occurrence
thereof. An electrical heart stimulus in synchronization with the
detected potential is thereby enforced from the implanted generator
in response to the occurrence of the field. Coupled stimulation is
provided by the apparatus by routing the detected signal along an
additional branch path which includes a delay line. The delayed
signal provides a second electromagnetic field a preselected
delayed time after the provision of the synchronized field whereby
a synchronized heart stimulus and a second, coupled heart stimulus
are provided in response to a single detected heart function
potential.
Inventors: |
Bukowiecki; Bohdan A. (Warsaw
ul 23, PO), Stopczyk; Mariusz J. (Warsaw ul 23,
PO) |
Family
ID: |
26652825 |
Appl.
No.: |
05/074,007 |
Filed: |
September 21, 1970 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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853843 |
Aug 28, 1969 |
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853882 |
Aug 28, 1969 |
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Foreign Application Priority Data
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Aug 31, 1968 [PO] |
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128847 |
Aug 31, 1968 [PO] |
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128849 |
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Current U.S.
Class: |
607/9 |
Current CPC
Class: |
A61N
1/365 (20130101) |
Current International
Class: |
A61N
1/365 (20060101); A61n 001/36 () |
Field of
Search: |
;128/419P,421,422 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Cobbold et al. "Medical Electronics & Biomedical Engineering"
Vol. 3, No. 3, July, 1965, pp. 273-278.
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Primary Examiner: Kamm; William E.
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a consolidated continuation-in-part of U.S.
Pat. applications, Ser. No. 853,843, filed Aug. 28, 1969, now
abandoned, and Ser. No. 853,882, filed Aug. 28, 1969, now
abandoned.
Claims
What is claimed is:
1. A method of providing an electrical stimulus for a heart from an
implanted heart stimulator having a constant rhythm frequency
generator, said stimulus being in synchronization with an
occurrence of a heart function potential, comprising the steps
of
providing a first electromagnetic field to said generator in
response to the occurrence of said heart function potential from
said heart, and
enforcing an occurrence of said synchronized heart stimulus from
said generator in response to the occurrence of said first
electromagnetic field.
2. A method in accordance with claim 1 wherein said providing step
includes the steps of detecting the occurrence of said heart
function potential, and triggering a generation of said first
electromagnetic field in response to said detected heart function
potential.
3. A method in accordance with claim 1 wherein said providing step
includes the step of providing a refractory period during the
occurrence of said synchronized heart stimulus and a resultant
heart response thereto.
4. A method in accordance with claim 1 wherein said enforcing step
includes the step of magnetically coupling said generator within
said first electromagnetic field.
5. A method in accordance with claim 1 wherein said providing step
includes the step of providing a second electromagnetic field to
said generator in response to the occurrence of said heart function
potential from said heart.
6. A method in accordance with claim 5 wherein said providing step
further includes the step of providing said second electromagnetic
field a preselected interval after the provision of said first
electromagnetic field.
7. A method in accordance with claim 6 wherein said enforcing step
includes the step of enforcing an occurrence of a second electrical
heart stimulus from said generator in response to the occurrence of
said second electromagnetic field.
8. A method in accordance with claim 5 wherein said enforcing step
includes the step of magnetically coupling said generator within
said first and second electromagnetic fields.
9. An apparatus for providing an electrical stimulus for a heart
from an implanted stimulator having a constant rhythm frequency
generator, said stimulus being in synchronization with an
occurrence of a heart function potential of said heart,
comprising
means for providing a first electromagnetic field to said generator
in response to the occurrence of said heart function potential from
said heart, said generator including means responsive to said first
electromagnetic field for enforcing an occurrence of said
synchronized heart stimulus.
10. An apparatus in accordance with claim 9 wherein said first
electromagnetic field providing means includes means between said
first electromagnetic field providing means and said generator
means for magnetically coupling said generator within said first
electromagnetic field.
11. An apparatus in accordance with claim 9 wherein said first
electromagnetic field providing means includes means for detecting
the occurrence of said heart function potential, and means for
triggering a generation of said first electromagnetic field in
response to said detected heart function potential.
12. An apparatus in accordance with claim 11 wherein said first
electromagnetic field providing means further includes means for
providing a refractory period during the occurrence of said
synchronized heart stimulus and a resultant heart response
thereto.
13. An apparatus in accordance with claim 11 wherein said first
electromagnetic field providing means further includes a capacitive
charging means and a means for discharging said charging means,
said discharge means including electromagnetic means, said
triggering means being operatively associated with said discharge
means for causing the operation of said electromagnetic means in
synchronization with said detected heart function potential.
14. An apparatus in accordance with claim 9 wherein said first
electromagnetic field providing means includes means for providing
a second electromagnetic field to said generator in response to the
occurrence of said heart function potential from said heart, said
generator responsive means further including means responsive to
said second electromagnetic field for enforcing an occurrence of a
second heart stimulus.
15. An apparatus in accordance with claim 14 wherein said first
electromagnetic field providing means includes means for detecting
the occurrence of said heart function potential, and means for
triggering a generation of said first and second electromagnetic
fields in response to said detected heart function potential, said
second electromagnetic field providing means including delay means
operatively connected between said detecting means and said
triggering means for delaying the generation of said second
electromagnetic field due to said triggering means for a
preselected interval after the generation of said first
electromagnetic field due to said triggering means, said
synchronized heart stimulus and said second heart stimulus
providing coupled stimulation for said heart.
16. An apparatus in accordance with claim 14, wherein said first
electromagnetic field providing means includes means between said
first electromagnetic field providing means and said generator
means for magnetically coupling said generator within said first
and second electromagnetic fields whereby coupled stimulation is
provided for said heart.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a method and apparatus for
obtaining an electrical heart stimulus in synchronization with a
heart function potential from an implanted heart stimulator having
constant rhythm, and a method of obtaining coupled stimulation
thereby.
2. Description of the Prior Art
Prior art implanted heart stimulators, or as they are commonly
termed, cardiac pacers, are normally of the constant rhythm type,
having a constant rhythm frequency generator, or blocking
oscillator for emitting an electrical stimulus to the heart. In
such pacers, a single impulse signal is emitted at a preset
interval by the pacer in order to stimulate the heart. This single
impulse stimulates the heart to cardiac contraction at a constant
rhythm or frequency. If spontaneous heart function potentials,
which are the electrical manifestations which accompany cardiac
contractions, appear in a patient having a constant rhythm
pacemaker implanted in his body, the stimulator pulses can cause an
interference with the patient's own heart rhythm. This phenomenon
may bring about dangerous disturbances, such as ventricular
fibrillation, if the ventricle is the portion of the heart being
stimulated.
Prior art methods of correcting for this interference of stimulator
pulses with the patient's own, or natural heart rhythm have
involved surgical removal and exchange of the stimulator, which
must often be urgently carried out, or pharmacological treatment,
by administering drugs for the purpose of inhibiting a generation
of heart function potentials until such generation no longer
interferes with stimulator pulses. Another and more drastic prior
art solution to this problem is to provide a very large electric
shock to the heart in order to totally depolarize the heart. The
heart then totally discharges and stops, and then commences beating
again at a different rate, hopefully in step with the
stimulator.
However, these prior art solutions do not totally solve the problem
of interference since a surgical exchange of stimulators, or pacers
may cause additional complications and cannot always be
accomplished due to the condition of the patient or a lack of
facilities at the time the emergency occurs, while pharmacological
therapy does not produce reliable effects. Furthermore, electrical
shock treatment is a drastic remedy and one not normally favored if
others are available.
Coupled stimulation, that is stimulation in which a heart function
potential is detected and a delayed signal, or stimulus is emitted
to the heart sometime thereafter in order to produce a
depolarization of the heart without producing a mechanical
contraction of the heart, is well known. Such coupled stimulation
is normally provided by means of applicances provided outside the
patient's body rather than by a pacer. Moreover, for such a pacer
of the constant rhythm variety, the problems previously enumerated
such as interference, may occur. Prior art pacers are not,
therefore, able to provide stimulator pulses in synchronization
with a patient's spontaneously appearing heart function potentials
as well as a second, coupled stimulation thereafter.
The present invention overcomes these disadvantages of the prior
art.
SUMMARY OF THE INVENTION
An apparatus for providing an electrical stimulus for a heart from
a pacer having a constant rhythm frequency generator is provided.
The heart stimulus is provided in synchronization with an
occurrence of a heart function potential of the heart. Means are
provided to detect the occurrence of the heart function potential
and to trigger a generation of a first synchronized electromagnetic
field in response thereto. The generator is magnetically coupled
within the first electromagnetic field and the synchronized heart
stimulus is enforced therefrom in response to the occurrence of the
first field.
Additional means may also be provided, in conjunction with the
first electromagnetic field providing means, if provision of a
second electromagnetic field to the generator in response to the
occurrence of the single heart function potential is desired. This
additional means includes a delay means for delaying the triggering
of the generation of the second electromagnetic field for a
preselected interval after the generation of the first synchronized
electromagnetic field whereby coupled stimulation is provided. The
implanted generator is responsive to both the first and second
electromagnetic fields to enforce the occurrence of the coupled
heart stimuli, one in synchronization with the heart function
potential, and the other at a preselected interval thereafter.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a block diagram of the preferred embodiment of the
present invention;
FIG. 2 is a block diagram of an alternative embodiment of the
present invention;
FIG. 3 is a partial schematic diagram of the embodiment shown in
FIG. 1;
FIGS. 4-a through 4-c are graphical illustrations of signal
phenomena associated with the embodiment shown in FIG. 1; and
FIGS. 5-a through 5-c are graphical illustrations of signal
phenomena associated with the embodiment shown in FIG. 2.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the drawings in detail, and especially to FIG. 1
thereof which is a block diagram of the preferred embodiment of the
present invention. As shown and preferred, the present invention
includes an electromagnetic field providing means, generally
referred to by the reference numeral 10 having an impulse generator
portion 12 and a detection and synchronization portion 14. The
impulse generator portion 12 of the electromagnetic field providing
means 10 includes a power supply circuit 16 which is conventional
and is shown in greater detail in FIG. 3.
The power supply circuit 16 (FIG. 3) preferably includes a
step-down power transformer 18 having a primary winding 19 and a
pair of secondary windings 20 and 26, each forming a part of a
power supply source. Secondary winding 20 together with a diode 22
and an electrolytic capacitor 24, form one power supply source, and
secondary winding 26 together with a diode 28 and an electrolytic
capacitor 30 forms another power supply source which is a
low-voltage power supply source. The portion of the power supply
circuit 16 including secondary winding 20 is connected to a
charging circuit 32 which preferably is a capacitive charging
circuit consisting of a resistor-capacitor combination 34-36 (FIG.
3) for a purpose to be described in greater detail hereinafter. The
portion of the power supply circuit 16 including secondary winding
26 is connected to an amplifier 38 of the detection and
synchronization portion 14 of the electromagnetic field providing
means 10, in a manner to be described in greater detail
hereinafter.
The output of the charging circuit 32 is connected to an
electromagnetic field generator 40 which, as shown and preferred in
FIG. 3, includes an armature 42 of a relay 44, which acts as a
switch to enable or disable the electromagnetic field generator 40,
and an induction coil 46 for providing an electromagnetic field
therefrom. Preferably, during use, the induction coil 46 which is
preferably applied to the body of the patient above the location of
a conventional implanted pacer is located so as to be magnetically
coupled to a constant rhythm frequency generator 48 of the pacer
(not shown). The solenoid portion 50 of the relay 44 is connected
in a triggering circuit 52, such as a conventional Schmitt trigger
circuit configuration as shown and preferred in FIG. 3, with the
solenoid 50 of the relay 44 connected to the collector 54 of an
output transistor stage 56 of the trigger circuit 52.
The detection and synchronization portion 14 of the electromagnetic
field providing means 10 includes a heart function potential
detector 58, such as an electrode connected to the heart of the
patient in which the pacer (not shown) is implanted. Amplifier 38,
preferably, has an input thereof connected to the electrode 58,
which is either implanted in or located near the heart of the
patient in which a pacer is implanted, in order to amplify the
detected heart function potential. The amplifier 38, which is
preferably a conventional transistor amplifier, preferably has the
output thereof connected to a conventional refractory circuit 60
which, as will be explained in greater detail hereinafter, renders
the electromagnetic field providing means 10 insensitive to
external stimuli for a predetermined interval. Preferably, the
output of the refractory circuit 60 is connected to a conventional
synchronization circuit 62, the output thereof which is in turn
connected to the input of the triggering circuit 52.
OPERATION
The operation of the electromagnetic field providing circuit 10 of
the present invention is as follows. Referring now to FIGS. 4-a
through 4-c, the total electric signal detected by the electrode 58
includes a stimulator pulse portion 64 as well as a stimulated
heart function potential pulse portion 66. Spontaneous heart
function potentials such as those illustrated by 68, 70 and 72,
which are due to the abnormal operation of the heart without the
aid of the implanted pacer, are also shown in FIG. 4-a.
The electrical signal from the heart is detected by electrode 58
and amplified in the amplifier 38. The amplified signal is then
transmitted to the refractory circuit 60 which, after having passed
the detected signal, blocks the signal conduction path for a
preselected interval in a conventional manner, so as to render the
electromagnetic field providing means 10 insensitive to external
stimuli subsequently detected by electrode 58 during this blocking
interval. In this manner, the circuit 10 is protected against
excitation as a result of feedback of the pulse triggered from the
pacer or the stimulated heart function potential resulting
therefrom. This refractory period is provided during the occurrence
of the resultant synchronized heart stimulus and the resultant
heart response thereto.
The detected signal, after having passed through the refractory
circuit 60, enables the synchronization circuit 62 which, in a
conventional manner, provides a signal to the triggering circuit
52. When a signal is received by the triggering circuit 52, it in
turn causes the generation of a pulse, via output stage 56, through
the solenoid 50 of the relay 44. Relay 44 is thereby activated and
the relay armature 42 is operated to close the circuit in generator
40. This completes the circuit to the induction coil 46 of the
electromagnetic field generator 40 from the charging circuit 32.
This causes the capacitor 36, which has been charged during the
interval when the relay 44 was not activated and an open circuit to
coil 46 was thereby provided, to discharge through coil 46. The
discharge of capacitor 36 provides an impulse through coil 46 which
impulse causes a generation of an electromagnetic field thereby
providing a pulse 74, such as shown in FIG. 4-b.
The electromagnetic field which is created by the discharge through
coil 46 provides a pulse to the constant rhythm frequency generator
48 of the implanted pacer due to the magnetic coupling of the
induction coil 46 to the constant rhythm frequency generator 48.
This pulse, which is in synchronization with the detected heart
function potential in turn enforces the generation of a pulse from
the implanted generator which is in synchronization with the
detected heart function signal, such as shown in FIG. 4-c.
For purposes of illustration, we shall now describe the operation
of the circuit 10 of the present invention in the time period from
t.sub. 1 through t.sub. 6. As was previously mentioned, the
detected heart function signal at t 1 (FIG. 4-a) represents a
combination of the stimulator pulse 64 together with the stimulator
heart function potential 66. This causes a generation of a pulse 74
(FIG. 4-b) due to the electromagnetic field at coil 46 which in
turn enforces combined pulse 76 (FIG. 4-c) from the constant rhythm
frequency generator 48 in synchronization with the detected heart
function signal 64-66. Assuming the constant rhythm frequency
generator to have the period T, where T represents the time
interval between the stimulator pulses of the pacer, if no
spontaneous heart function potentials occur during this period,
such as represented by the time interval from t.sub. 1 to
t.sub.2/3.sub.2, then the previously described operations of
detection, creation of an electromagnetic field and enforcement of
a synchronized stimulating pulse represented by the signals 78, 80
and 82, respectively, occur in the manner previously described.
If a spontaneous heart function potential, such as represented by
signal 68 (FIG. 4-a) occurs during the time interval T between the
normal constant rhythm stimulator pulses generated by the implanted
generator 48, such as at t.sub. 3, this heart function potential 68
is detected by electrode 58 and as was previously described with
reference to the detected combined heart function signal 64-66
causes the generation of a trigger pulse by trigger circuit 52
which closes the relay 44. This causes the generation of an
electromagnetic field through coil 46 due to the discharge of
capacitor 36 thereby providing a pulse 84. The electromagnetic
field through coil 46 enforces the occurrence of a heart
stimulating pulse 86 from the constant rhythm frequency generator
48 in synchronization with the occurrence of heart function
potential 68 thereby correcting for the occurrence of the
spontaneous heart function potential 68 and preventing any
interference thereto.
The constant rhythm frequency generator 48 is automatically reset
so as to thereafter provide another stimulating pulse after the
time interval T in a continuous manner from the occurrence of the
last generated pulse until this rhythm is interrupted by another
spontaneous heart function potential. If this occurs a synchronized
pulse is enforced and the constant rhythm frequency generator 48
resets once again. The occurrence of another spontaneous heart
function potential before the completion of the preset time
interval T is illustrated at t.sub. 4 by signal 70. When this
occurs, pulses 88 and 90 are subsequently produced in the manner
previously described with reference to the production of the pulses
84 and 86. Combined signal 92 (FIG. 4-a) at time interval t.sub. 5
represents the occurrence of a heart function signal after the
normal preset time interval T, and resultant pulses 94 and 96 are
produced thereby. Finally, if another spontaneous heart function
potential 72 occurs prior to the completion of the preselected time
interval T of the constant rhythm frequency generator 48, an
electromagnetic field is generated once again through coil 46
thereby providing a pulse 98 which field in turn enforces the
occurrence of a synchronized heart stimulating pulse 100, such as
illustrated at t.sub. 6.
COUPLED STIMULATION
Referring now to FIG. 2, a circuit, generally referred to by the
reference numeral 102, capable of providing coupled stimulation in
a preferred manner to be described in greater detail hereinafter is
shown. The circuit 102 includes an impulse generator portion 104
which is preferably identical with the impulse generator portion 12
previously described with reference to the embodiment of FIG. 1 and
will not be described in greater detail hereinafter. Suffice it to
say, the impulse generator portion 104 includes a power supply
circuit 16, a charging circuit 32, an electromagnetic field
generator 40 and a triggering circuit 52 connected together in the
manner previously described with reference to the embodiment shown
in FIG. 1.
The circuit 102 for providing coupled stimulation preferably also
includes a detection and synchronization portion 106 which is
preferably substantially identical with the detection and
synchronization portion 14 of the embodiment shown in FIG. 1.
However, in addition to the normal interconnection between the
refractory circuit 60 and the synchronization unit 62, an
additional interconnection through a delay circuit 108, such as a
conventional delay line, is provided for a purpose to be described
in greater detail hereinafter. The detection and synchronization
portion 106 includes a detector or electrode 58, an amplifier 38
which is connected to the power supply circuit 16, the refractory
circuit 60, a direct connection therefrom to the synchronization
circuit 62 and a connection from the refractory circuit 60 through
delay circuit 108 to the synchronization unit 62. The
synchronization unit 62 has its output in turn connected to the
triggering circuit unit 52, as in the embodiment previously
described with reference to FIG. 1.
COUPLED STIMULATION OPERATION
Referring now to FIGS. 2 and 5-a through 5-c, the operation of the
circuit 102 to provide coupled stimulation from a pacemaker having
a constant rhythm will now be described. The operation of this
circuit 102 with respect to the provision of a heart stimulating
pulse from a constant rhythm frequency generator 48 in
synchronization with the occurrence of a heart function potential
of the heart is similar to that previously described with reference
to the operation of the embodiment shown in FIG. 1. However, in
addition to the provision of the synchronized heart stimulating
pulse, a second, delayed heart stimulating pulse is produced, in a
manner to be described in greater detail hereinafter, in response
to the occurrence of the same heart function potential to which the
synchronized heart stimulating pulse is responsive.
The hart function signal, such as represented by the combined
signal 110 (FIG. 5-a) which includes a stimulator pulse portion 112
and a stimulated heart function potential 114, is detected by means
of electrode 58. This detected signal 110 is transmitted to the
amplifier 38 where it is amplified. After amplification, this
detected signal is then transmitted to the refractory unit 60 which
thereafter, for a preselected interval termed the refractory
period, blocks the signal conduction path to inhibit the response
of the circuit 102 to external stimuli, as was previously described
with reference to the embodiment shown in FIG. 1.
After passing through the refractory circuit 60, the detected
signal 110 is then passed directly to the synchronization unit 62
and, over a separate signal conduction path to the delay circuit
108. The detected signal which was passed directly to the
synchronization unit 62 in turn is passed to the triggering circuit
52 where it in turn causes the generation of a pulse at the output
stage 56 thereof. The pulse from output stage 56 operates relay 44
to close the circuit between the induction coil 46 of the
electromagnetic field generator 40 and the charging circuit 32
thereby discharging the capacitor 36. This provides a pulse through
the induction coil 46 to create an electromagnetic field which
causes the generation of a pulse 116 (FIG. 5-c). The constant
rhythm frequency generator 48 which is magnetically coupled to the
induction coil 46, as was previously mentioned with reference to
the embodiment shown in FIG. 1, thereby enforces a generation of a
heart stimulating pulse 118 (FIG. 5-c) in synchronization with the
detected heart function signal 110 due to the occurrence of the
electromagnetic field through coil 46.
Simultaneously, the delay unit 108 delays the detected heart
function signal 110 passing thereto over the separate conduction
path for a preselected interval represented by T.sub.d. The delayed
signal is then passed to the synchronization unit 62 and in turn to
the triggering unit 52 where it functions similarly to the
undelayed detected signal previously described to cause the
generation of a trigger pulse at the output stage 56 of the
triggering circuit 52. This trigger pulse operates the relay 44
once again to close the circuit to coil 46 and discharge capacitor
36 therethrough thereby creating a second electromagnetic field and
causing the generation of another pulse 120 (FIG. 5-b). This second
electromagnetic field results in the enforcement of another heart
stimulating pulse 122 from the constant rhythm frequency generator
48 at the end of the delay interval T.sub.d.
In this manner, the synchronization unit 62 and in consequence, the
triggering unit 52 are controlled twice in a time interval equal to
the delay time T.sub.d thereby causing the generation of two
successive electromagnetic fields through coil 46 in this time
interval T.sub.d. Coupled stimulation is thereby provided from the
constant rhythm frequency generator 48 with one stimulating pulse
being enforced in synchronization with the detected heart function
signal and the second pulse being enforced at a delayed time
thereafter.
For purposes of illustration, we shall now describe the operation
of the circuit 102 to provide coupled stimulation during the time
interval from t.sub. 1 to t.sub. 8 as shown in FIGS. 5-a through
5-c. Assuming the period of the constant rhythm frequency generator
48 to be T, then if no spontaneous heart function potential occurs
during this period T, then the combined heart function signal
represented by 124 (FIG. 5-a) is detected in the circuit 102 which
thereby operates as was previously described to provide successive
electromagnetic fields in the delay period T.sub.d. This produces
associated pulses 126 and 128, respectively, and resultant coupled
heart stimulating pulses 130 and 132, as is illustrated at t.sub. 3
and t.sub. 4.
If as illustrated at t.sub. 5, a spontaneous heart function
potential 134 occurs prior to the completion of the preset constant
rhythm period T, then the circuit 102 operates to cause the
generation of a first electromagnetic field in synchronization with
the occurrence of the spontaneous heart function potential 134
resulting in a pulse 136 and a synchronized heart stimulating pulse
138 from the constant rhythm frequency generator 48. Furthermore, a
second electromagnetic field will be generated through coil 46 due
to operation of the delay circuit 108 to provide resultant pulses
140 and heart stimulating pulse 142 within the delay interval
T.sub.d thereby providing coupled stimulation from the pacer due to
pulses 138 and 142. The constant rhythm frequency generator 48 will
reset after the occurrence of the last stimulating pulse 142
therefrom so as to commence generating a stimulating pulse after
the time interval T measured from the generation of the last pulse
142. Thereafter, as is illustrated at t.sub.7, when a combined
heart function signal 144 occurs, a pair of successive
electromagnetic fields resulting in pulses 146 and 148 respectively
and coupled heart stimulating pulses 150 and 152 within the delay
interval T.sub.d occurs, as is illustrated at t.sub. 7 and t.sub.
8.
By utilizing the method and apparatus of the present invention,
interference from the rhythm of the heart with the rhythm of the
stimulator due to an occurrence of spontaneous heart function
potentials is minimized. Furthermore, by utilizing the method and
apparatus of the present invention to provide coupled stimilation,
the force of the heart systole can be increased and the heart
rhythm frequency may be lessened such as by depolarizing the heart
with the second heart stimulating signal of the coupled stimulating
pair of signals so as to render the heart refractory to the next
successive spontaneous generated heart function potential.
It is to be understood that the above described embodiments of the
present invention are merely illustrative of the principles thereof
and numerous modifications and embodiments of the invention may be
derived within the spirit and scope thereof.
* * * * *