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WO2019001478A1 - Procédé de réalisation d'une stimulation cardiaque à la demande à chambre double - Google Patents

Procédé de réalisation d'une stimulation cardiaque à la demande à chambre double Download PDF

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Publication number
WO2019001478A1
WO2019001478A1 PCT/CN2018/093158 CN2018093158W WO2019001478A1 WO 2019001478 A1 WO2019001478 A1 WO 2019001478A1 CN 2018093158 W CN2018093158 W CN 2018093158W WO 2019001478 A1 WO2019001478 A1 WO 2019001478A1
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WO
WIPO (PCT)
Prior art keywords
ventricular
atrial
pacing
control unit
event
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Ceased
Application number
PCT/CN2018/093158
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English (en)
Chinese (zh)
Inventor
熊建劬
黎贵玲
黄敏
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Micro Port Sorin Crm (shanghai) Co Ltd
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Micro Port Sorin Crm (shanghai) Co Ltd
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Publication of WO2019001478A1 publication Critical patent/WO2019001478A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36592—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by the heart rate variability
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3688—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions configured for switching the pacing mode, e.g. from AAI to DDD
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/37—Monitoring; Protecting
    • A61N1/3702—Physiological parameters

Definitions

  • the invention relates to a method for controlling a pacemaker, in particular to a double-cavity on-demand pacing implementation method.
  • Cardiac pacemaker is an electronic therapeutic device implanted in the body.
  • the pulse generator distributes the electric pulse that is powered by the battery.
  • the myocardial contacted by the electrode is stimulated, and the heart is excited and contracted. In order to achieve the purpose of treating cardiac dysfunction caused by certain arrhythmias.
  • a dual-chamber pacemaker is one of the most clinically installed pacemakers.
  • the English abbreviation is DDD.
  • the first D represents a double heart chamber that can be pacing, including the atria and ventricle.
  • the second D represents two (double) heart chambers that can be perceived, including an atrium and a ventricle.
  • the third D represents After the heartbeat senses its own heart, it can be reflected in two ways (double), one is suppression and the other is trigger, so it is also represented by D.
  • the dual-chamber pacemaker has two electrodes that are placed in the two chambers of the heart to sense and pace the atria and ventricles. Generally, one electrode is placed in the right atrium and one is placed in the apex of the right ventricle.
  • the pacemaker itself sets a time limit for the conduction of the ventricle from the atrium (the systole of the ventricle after the atrium), for example 0.20 seconds. If the atrial contraction, after 0.20 seconds, the ventricle does not shrink, then it starts from The beater sends impulses to the electrodes of the right ventricle, stimulating the myocardium and creating ventricular contractions.
  • Dual-chamber pacemakers typically operate in dual-chamber pacing modes such as DDD, DDI, DOO, ODO, and DVI, depending on user settings.
  • the various modes can be automatically converted as needed, when the atrial rate is lower than the lower limit frequency set by the pacemaker, and the PR interval (perceived interventricular interval) is greater than the AV interval set by the pacemaker (pacing) During the interventricular period, the ventricular pacing is presented.
  • the other modes of the dual-chamber pacemaker appear to suppress the release of ventricular impulses and reform the pacing frequency.
  • the DDI mode is a dual-chamber on-demand pacing mode, equivalent to AAI+VVI, suitable for patients with sick sinus with atrioventricular block, especially with paroxysmal atrial tachyarrhythmia.
  • Dual-cavity pacemakers currently on the market which operate in DDI pacing mode, are typically switched from DDD pacing mode (or other currently operating mode of operation) to DDI pacing mode.
  • DDD pacing mode or other currently operating mode of operation
  • DDI pacing mode When a pacemaker is operating in DDI mode: When an atrial event outside the refractory period is detected, the expected atrial pacing is cancelled. However, a new interventricular interval is initiated when atrial pacing is expected, and ventricular pacing is delivered at the end of the interventricular interval.
  • the technical problem to be solved by the present invention is to provide a dual-cavity on-demand pacing implementation method, which can not only improve the convenience, reliability and direct verifiability of implementing the on-demand DDI mode, but also greatly reduce the workload of verification, and Since the substantial mode conversion is not required, the mode switching is fast and smooth, physiologically good, and the patient's discomfort is reduced.
  • the technical solution adopted by the present invention to solve the above technical problem is to provide a dual-cavity on-demand pacing implementation method, comprising the steps of: setting an upper limit tracking frequency of a dual-chamber pacemaker to be equal to a lower limit frequency in advance;
  • the cavity pacemaker works according to the DDD mode.
  • the atrial pulse After sensing the atrial event, the atrial pulse is suppressed, the interventricular phase is opened, and the ventricular pacing is delivered at the end of the interventricular interval until the ventricular rate exceeds the upper limit tracking frequency; After the upper limit tracking frequency is exceeded, the atrial event is continued to be perceived; and after detecting the atrial sensing event outside the refractory period, the trigger of the atrial pulse is suppressed, and the ventricular pulse is issued to achieve the DDI mode at the end of the lower limit frequency interval.
  • the dual-chamber pacemaker comprises a microprocessor and a digital/analog module connected thereto, the microprocessor and the digital/analog module interacting through data/information The interfaces are connected.
  • the dual-cavity on-demand pacing implementation method wherein the control unit of the microprocessor acquires user setting information through the data/information interaction interface, and sets an upper limit tracking frequency interval UTRI to a lower frequency interval LRI is consistent.
  • the microprocessor comprises a main control unit and a time control unit, the digital/analog module comprising a pacing control/generation unit, a perceptual control/amplification unit, and a program control unit
  • the perceptual control/amplification unit of the digital/analog module detects an atrial sensing event, and when the main control unit of the microprocessor determines that the event is a ventricular refractory period, the dual-chamber type is controlled
  • the beater continues to operate in accordance with the mode of operation of the DDD mode, and the main control unit of the microprocessor controls the time control unit to set the atrial-aware post-ventricular pacing interval.
  • the dual-cavity on-demand pacing implementation method wherein the sensing/amplifying unit of the digital/analog module detects the atrial sensing event As and the ventricular sensing event Vs in real time, first determining the UTRI and the starting point of the above ventricular event The current atrial perception event As is the starting time of the atrial perception of the interventricular interval AsVI timing overflow sequence. If the AsVI first timed out, the atrial perception post-ventricular escape interval is overflowed at the end of UTRI; if UTRI is one step ahead Timed overflow, then set the atrial perception after the ventricular escape interval is overflowed at the end of AsVI.
  • the main control unit of the microprocessor controls the pacing control/generation unit to deliver a ventricular pacing pulse when the atrial sensing post-ventricular ventricular interval timeout occurs Vp, and controlling the time control unit to set atrial ventricular refractory period PVARP, ventricular refractory period VRP, upper limit tracking frequency interval UTRI and ventricular chamber atrial escape interval AEI.
  • the dual-chamber on-demand pacing implementation method described above wherein the perceptual control/amplification unit of the digital/analog module does not perceive any atrial or ventricular event if the atrial escape interval AEI is timed out after the ventricular event
  • the atrial pacing event is issued when the AEI is timed out; at the same time, the main control unit of the microprocessor controls the time control unit to set the ventricular escape interval ApVI after atrial pacing.
  • the above-described dual-chamber on-demand pacing implementation method wherein the atrial sensing post-interventricular interval AsVI, ventricular retroatrial refractory period PVARP, ventricular refractory period VRP and upper limit tracking frequency interval UTRI and atrial pacing
  • the dual-cavity on-demand pacing implementation method described above wherein the sensing/amplifying unit of the digital/analog module senses a ventricular event before the ApVI timing overflow, and inhibits ventricular pacing; meanwhile, the microprocessing
  • the main control unit of the device controls the time control unit to set a post-ventricular atrial refractory period PVARP, a ventricular refractory period VRP and an upper limit tracking frequency interval UTRI.
  • the invention also provides a dual-chamber type pacemaker, comprising: a microprocessor comprising a main control unit and a time control unit, the main control unit being configured to acquire user setting information through a data/information interaction interface, and to track the upper limit The frequency interval UTRI is set to be consistent with the lower limit frequency interval LRI;
  • the digital/analog module is connected to the microprocessor through a data/information interface;
  • the digital/analog module includes: a perceptual control/amplification unit, and pacing control/generation The unit;
  • the sensing control/amplifying unit is configured to detect an atrial event, and the pacing control/generating unit is configured to issue or suppress a pacing pulse;
  • the main control unit is further configured to: when the dual chamber type pacemaker operates in the DDD mode, by sensing The control/amplification unit detects the atrial event, and after detecting the atrial event, controls the pacing control/generating unit to suppress the triggering of the atrial pacing pulse, and controls
  • the sensing control/amplifying unit is further configured to detect the atrial sensing event As and the ventricular sensing event Vs in real time, and the main control unit is further configured to determine the UTRI of the previous ventricular event as the starting point and the atrium starting from the current atrial sensing event As Perceive the timed outflow sequence of the interventricular interventricular period AsVI. If the AsVI first timed out, set the atrial perception after the ventricular escape interval is overflowed at the end of UTRI. If the UTRI first timed out, set the atrial perception after ventricular escape. The blog interval overflows at the end of AsVI.
  • the main control unit is further configured to: when the ventricular sensation is delayed, the pacing control/generation unit issues a ventricular pacing pulse, and controls the time control unit to set a post-ventricular atrial refractory period PVARP, Ventricular refractory period VRP, upper limit tracking frequency interval UTRI and ventricular escape interval AEI.
  • the main control unit is further configured to: before the ventricular escape interval AEI timing overflow, if the self-atrial or ventricular event is not sensed by the sensing control/amplification unit, then the control occurs when the AEI timing overflows
  • the beat control/generation unit issues an atrial pacing pulse and controls the time control unit to set the ventricular escape interval ApVI after atrial pacing.
  • the digital/analog module further includes a program control unit, atrial-aware posterior atrioventricular phase AsVI, post-ventricular atrial refractory period PVARP, ventricular refractory period VRP, upper-rate tracking frequency interval UTRI, and atrial pacing after ventricular escape.
  • the main control unit is further configured to: after the ApVI timing overflows, the pacing control unit generates the ventricular pacing pulse, and controls the pacing control/generation unit to suppress the ventricular pacing pulse, and controls the time control unit to set the ventricular chamber Atrial refractory period PVARP, ventricular refractory period VRP and upper limit tracking frequency interval UTRI.
  • the dual-cavity on-demand pacing implementation method provided by the present invention has the same UTRI and LRI values, and does not need to perform any special operation and state machine setting for the DDI working mode.
  • the DDI mode can be implemented according to the DDD mode, which not only improves the convenience, reliability and direct verifiability of the implementation, but also greatly reduces the workload of verification.
  • mode conversion between DDD mode and DDI mode such as room speed may be performed
  • no special mode switching operation is required, which makes the mode conversion fast, smooth, physiological, and reduces patient discomfort.
  • FIG. 1 is a schematic diagram showing a mode control flow of a dual-chamber pacemaker according to an embodiment of the present invention
  • FIG. 2 is a schematic diagram of timing control of a dual-chamber pacemaker in DDD mode according to an embodiment of the present invention
  • FIG. 3 is a schematic diagram of timing control of a dual-cavity pacemaker implementing a DDI mode in a DDD mode according to an embodiment of the present invention
  • FIG. 4 is a schematic structural view of a dual-chamber pacemaker used in an embodiment of the present invention.
  • FIG. 1 is a schematic diagram of a mode control flow of a dual-chamber pacemaker according to an embodiment of the present invention.
  • a method for implementing a dual-chamber on-demand pacing includes the following steps:
  • Step S1 setting an upper limit tracking frequency of the dual chamber type pacemaker to be equal to a lower limit frequency
  • Step S2 Control the dual-chamber pacemaker to work in DDD mode, after atrial events, suppress atrial pulse, and simultaneously open the interventricular phase (atrial perception post-interventricular interval, AsVI), and in the interventricular phase (AsVI) At the end of the ventricular pacing, until the ventricular rate exceeds the upper limit tracking frequency;
  • Step S3 After the ventricular rate exceeds the upper limit tracking frequency, continue to sense the atrial event; and after detecting the atrial sensing event outside the refractory period, suppress the trigger of the atrial pulse until the end of the lower limit frequency interval to release the ventricular pulse to implement the DDI mode.
  • the upper limit tracking frequency the lower limit frequency.
  • ventricular pacing will be issued at the end of the interventricular interval; if the ventricular rate exceeds the upper limit tracking frequency, it will end at the upper tracking frequency interval (UTRI) (also equivalent to the lower limit frequency) At the end of the interval LRI, a ventricular pulse (also called a ventricular pacing) is issued.
  • UTRI upper tracking frequency interval
  • the dual-chamber pacemaker of the embodiment of the present invention When the dual-chamber pacemaker of the embodiment of the present invention operates in the DDI mode, the atrium and the ventricle can be sensed or paced.
  • the working mode is the same as the DDD mode.
  • the user or system automatically sets the UTRI (upper limit tracking frequency interval) and LRI (lower limit frequency interval) values to be consistent on the DDD mode. It can be understood that the values of UTRI and LRI are the same, which is equivalent to setting the upper limit tracking frequency equal to the lower limit frequency.
  • the embodiment of the present invention has the same UTRI and LRI values, and does not need to perform any special operation and state machine setting for the DDI working mode, and can implement the DDI mode according to the DDD mode, thereby improving the convenience of the implementation manner. , reliability and direct verifiability, reducing the amount of verification work.
  • mode conversion between DDD mode and DDI mode such as room speed may be performed
  • no special mode switching operation is required, which makes the mode conversion fast, smooth, physiological, and reduces patient discomfort.
  • the operation of the two modes of the dual chamber pacemaker of the present invention is given below.
  • DDD pacing mode synchronous dual-chamber pacing mode
  • the atrium and the ventricle can be sensed or pacing, and the ventricular pacing can follow the atrial event after the interventricular interval, thereby achieving the synchronization of the atrioventricular, as shown in FIG. 2
  • the specific timing is as follows:
  • the ventricular pacing time point set for the escape interval is shorter than the upper limit tracking frequency interval (previous ventricular time point, 3 sequence time), that is, 4 sequences
  • the AsVI at the beginning of the time expires before the UTRI starting at the 3rd sequence (AsVI expires at the 5th sequence, and UTRI expires at the 6th sequence). Therefore, the upper limit tracking interval (3 sequence time) is used to adjust the most recent Vp occurrence time and count into the ventricular pacing escape counter, and the pacing chamber is set as the ventricle.
  • Ventricular pacing Vp (6 sequence time) is issued when the ventricular pacing escape counter expires (also UTRI expires).
  • DDI pacing mode dual cavity on-demand pacing mode
  • the dual-chamber pacemaker of the embodiment of the present invention operates in the DDI mode, the atrium and the ventricle can be sensed or paced.
  • the working mode is the same as the DDD mode. Only the DDD mode needs to be set by the user or the system to automatically match the values of UTRI and LRI (lower frequency interval). Therefore, UTRI in Figure 3 can be regarded as Equivalent to LRI. As shown in Figure 3, the specific timing control is as follows:
  • Vp Ventricular pacing Vp (2 sequence moment) when the interventricular interval is equal to LRI.
  • Atrial pacing (3 sequence moments) after AEI expires.
  • AEI LRI–ApVI (ApVI is the atrioventricular phase after atrial pacing).
  • Vp appears (6 sequence time).
  • a dual-chamber pacemaker includes a microprocessor 8 and a digital/analog module 9 connected thereto, and the perception of the atrial ventricle is always on, in any mode.
  • the selection and implementation manner of the microprocessor 8 and the like are not limited.
  • the digital/analog module 9 needs to realize the perception of external signals, needs to be able to issue signals to the outside, and needs to be able to interact with external data information.
  • the microprocessor 8 includes a main control unit 1, a time control unit 2, and a data/information interaction interface 3.
  • the main control unit 1 controls the occurrence of an event, an event to be generated, and the like.
  • the main control unit 1 can select, through the time control unit 2, a time-related control function such as timing, timing, etc., for example, the time control unit 2 can capture and record the time when the event occurs, and can also control the event to be generated. Accurate time, etc.
  • the data/information interface 3 implements interaction of data or information between the device and other modules.
  • the data/information interface 3 can be a normal I/O interface or a serial or parallel data transmission module. In this embodiment, the data/information interface 3 can receive the perceived event information, issue a pacing event request, serial data interaction, clock data interaction, and the like.
  • the digital/analog module 9 includes a data/information interaction interface 4, a pacing control/generation unit 5, a perceptual control/amplification unit 6, and a program control unit 7.
  • the data/information interface 4 can interact with the corresponding data/information interface 3, although its implementation can be different.
  • the pacing control/generating unit 5 receives the pacing request of the microprocessor 8 and generates a signal of required intensity to act on the outside, and at the same time bears a small part of the control function, depending on the difference of the affected object, the strength and type of the signal, etc. The difference.
  • the perceptual control/amplification unit 6 is capable of capturing and distinguishing external real signals and notifying the microprocessor 8, such as a heart signal, and the need to be able to amplify the signal according to user settings.
  • the program control unit 7 is capable of information interaction with the outside world, such as a user.
  • the user transmits DDI working mode information to the pacemaker through the program control unit, and the main control unit of the microprocessor acquires user setting information through the data/information interaction interface, and UTRI (upper limit tracking)
  • the frequency interval is set to be consistent with the LRI.
  • the sensing control/amplification unit 6 of the digital/analog module 9 continues to operate in the DDD mode when the ventricle is not expected to be outside the atrial sensing event, the main body of the microprocessor 8.
  • the control unit 1 controls the time control unit 2 to set the atrial-aware post-ventricular pacing interval:
  • the main control unit of the microprocessor controls the pacing control/generation unit to issue the ventricular pacing Vp, and controls the time control unit to set the PVARP, the ventricle, when the ventricular systolic interval is timed out.
  • the refractory period VRP, the upper limit tracking frequency interval UTRI and the ventricular escape interval AEI as shown in Figure 3, the above-mentioned PVARP, VRP, UTRI and AEI.
  • Atrial pacing is dispensed when the AEI timing overflow occurs if the perceptual control/amplification unit of the digital/analog module does not perceive any atrial or ventricular events before the ventricular escape interval (AEI) timeout
  • the event Ap is as shown in the sequence of 3 sequences in FIG.
  • the main control unit 1 of the microprocessor 8 controls the time control unit 2 to set the ventricular escape interval (ApVI) after atrial pacing.
  • the ApVI is programmed by the user through the program control unit.
  • the perceptual control/amplification unit of the digital/analog module senses its own ventricular event and ventricular pacing is suppressed.
  • the main control unit of the microprocessor controls the time control unit to set a post-ventricular atrial refractory period PVARP, a ventricular refractory period VRP and an upper limit tracking frequency interval UTRI. As shown in the sequence of 4 in Figure 3.
  • the DDI mode can be implemented according to the DDD mode, which not only improves the convenience of the implementation mode, but also is reliable. Sexuality and direct verifiability, and greatly reduce the amount of verification work.

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Abstract

La présente invention concerne un procédé de réalisation d'une stimulation cardiaque à la demande à chambre double, comprenant les étapes suivantes : régler à l'avance la fréquence de suivi de limite supérieure d'un stimulateur cardiaque à chambre double pour qu'elle soit égale à la fréquence limite inférieure ; commander le stimulateur cardiaque à chambre double pour qu'il fonctionne en un mode DDD, supprimer une impulsion auriculaire après avoir détecté un évènement auriculaire, simultanément démarrer un intervalle atrioventriculaire et exciter, lorsque l'intervalle atrioventriculaire se termine, la stimulation ventriculaire jusqu'à ce que le rythme ventriculaire excède la fréquence de suivi de limite supérieure ; continuer à détecter l'évènement auriculaire une fois que le rythme ventriculaire excède la fréquence de suivi de limite supérieure ; et supprimer, lorsqu'un évènement de perception auriculaire hors de la période réfractaire est détecté, le déclenchement d'une impulsion auriculaire et l'excitation d'une impulsion ventriculaire jusqu'à ce que l'intervalle de fréquence limite inférieure se termine, afin de réaliser un mode DDI. La présente invention définit les valeurs afin que l'UTRI et LRI soient cohérentes, afin d'atteindre le mode DDI selon le mode DDD, ce qui non seulement permet d'améliorer la commodité, la fiabilité et la possibilité de vérification directe d'obtention du mode DDI et de réduire considérablement la charge de travail de vérification, mais aussi permet que la conversion de mode soit rapide et facile de sorte qu'il n'est pas nécessaire d'effectuer la conversion substantielle de mode, obtenant ainsi une bonne performance physiologique et réduisant l'inconfort du patient.
PCT/CN2018/093158 2017-06-27 2018-06-27 Procédé de réalisation d'une stimulation cardiaque à la demande à chambre double Ceased WO2019001478A1 (fr)

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CN108175941B (zh) * 2017-12-29 2021-10-22 创领心律管理医疗器械（上海）有限公司 基于无心室起搏的双腔起搏模式的存储介质及医疗设备

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