| 摘要 |
A multi-site pulse generator for the treatment of cardiac insufficiencies by stimulation. In such a multi-site cardiac pulse generator, electrodes are placed in a plurality of distinct respective sites, including at least two ventricular sites. The electrodes are connected to independent outputs of the pulse generator in a manner that allows the detection of a potential of depolarization as well as the application of a stimulation pulse. A sensor of contraction of at least one of the ventricles is provided, to detect an instant of beginning of valvular opening, and a research system that determines an optimal electrode configuration operates to commute successively and automatically the different ventricular electrodes according to the various possible connection configurations, and to detect a depolarization or stimulation event on the electrode in the corresponding configuration; to determine a time interval separating, for each given configuration, the depolarization or stimulation event and the instant of beginning of the valvular opening, and to select therefrom the configuration obtaining the shortest time interval. The pulse generator also is able to apply a stimulation on the electrode in the selected optimal configuration, and automatically checks the configuration from time to time to maintain the optimal configuration from among the various configurations. The pulse generator may be included in a pacemaker, cardioverter or defibrillator, and may include single, double, triple or quadruple chamber modes.
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