| 摘要 |
An active implantable medical device, in particular a pacemaker, defibrillator, cardioverter, or multisite device, having an improved cycle to cycle adjustment of the stimulation amplitude. The device stimulates the ventricle, adjusts the stimulation amplitude, periodically evaluates a capture threshold and defines a safety amplitude (Vs), and determines the detection or the loss of a capture on each cardiac cycle after stimulation with a given stimulation amplitude (V). Preferably, the device defines a capture amplitude (Vc) that is higher or equal to the capture threshold, but lower than the safety amplitude. The adjustment includes temporarily reducing the amplitude of stimulation below the safety amplitude toward the value of amplitude capture (Vc); checking, immediately after a stimulation at the reduced amplitude, the detection or the loss of capture (steps 12,14); in the event of a detection of capture, establishing for the next cardiac cycle the stimulation amplitude at the value of the capture amplitude (step 16); and, in the event of loss of capture, defining a new value, higher than the current capture amplitude (steps 44, 46).
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