DE2826189A1 - METHOD OF MONITORING AND CHANGING CONTROL OF AN IMPLANTED PACEMAKER - Google Patents

Description

2826189 Andrejewski, Honke, Gesthuysen & Masch patent attorneys

- Lj- - Physicist

Dr. Walter Andrejewski Graduate engineer Dr.-lng. Manfred Honke Graduate engineer Hans Dieter Gesthuysen Physicist Dr. Karl Gerhard Masch Lawyer files: 43 Essen 1, Theaterplatz 3, Postf. 789

52 067, 'Ti' th June 10, 1978

Patent application

ESB International Corporation

2625 Concord Pike

Wilmington, Delaware I9803 / USA

Method for monitoring and variably controlling an implanted pacemaker.

Devices, so-called pacemakers, which are implanted in the body of a patient, have been known for some time can be and serve to improve the functioning of certain organs by applying electrical triggering pulses to them to control. The best known, for example, is the pacemaker, which is practically a battery-operated pulse generator and serves to transmit triggering impulses to the heart tissue of its wearer.

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

Originally, pacemakers worked with a fixed, invariable frequency. Recently, however, the so-called "demand pacemaker" type has been widely used. With this pacemaker, the trigger pulses are only generated when the natural heartbeats stop, i.e. not available. Pacemakers have developed in other ways and traditionally provide a pulse interval that which can be monitored to determine the condition of the pacemaker battery.

It is known that certain operating parameters of a pacemaker must be changed to meet the needs of the individual To adapt the carrier. For example, the minimum frequency with which pulses are generated must be matched to the individual carrier will. In addition, other factors often change, such as the duration of the trigger pulse and the Sensitivity of the pacemaker to the wearer's natural heartbeat. As a result, pacemakers have been designed which can be adjusted prior to implantation so that a physician can actually check the operating characteristics of the pacemaker can adapt precisely to a specific patient.

It has also been recognized that often some or all of the operational features of an implanted pacemaker may be required to change at will. Pacemakers have already been designed to perform this function. So became For example, in one solution, a pacemaker is provided with a movable magnetic element, which is in accordance with the Movement of one on the wearer's skin near the implanted

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

Pacemaker applied magnet can be rotated. Other systems have been designed in which sonic, ultrasonic or Radio frequency signals supplied by a signal generator are received by an antenna in a implanted pacemaker and in the same for the purpose of changing the operation of the Pacemaker are processed. Such systems are, for example, in US Patents 3,631,680, 3,718,909, 3,805,796, 3,833,005 and 3,945,387. Most of these systems have counters and decoders which indicate the number count of received signal pulses and convert them into binary numbers, which represent a desired operating mode.

For various reasons, the application of a variable number of signal pulses may not be considered satisfactory Procedures for setting the pacemaker parameters are considered. For example, it results without impractical and Sophisticated test systems are not an effective way for the pacemaker to determine if an appropriate number of pulses is being received became. The additional reception of a wrong impulse, for example due to noise, or the omission of an impulse generation, output, or detection can have serious results. For example, S-o gives in a system the reception of 16 bits after decoding the binary number 10 000. The lack of a single bit from which Reasons whatever, so that only 15 pulses or counts are received then results in the binary signal 01111. A further disadvantage in the previously known systems is that rambling counting stages or registers must be provided in order to variably control each process.

809883/0687

Andrejewski, Honlce, Gesthuysen & Masch, patent attorneys in Essen

It is also of interest to a physician or technician to monitor the operation of an implanted pacemaker to be able to. This monitoring is usually carried out by applying electrodes to the body of the wearer of a pacemaker and the effect of the pacemaker pulses on the body tissue is measured. The weakening of the pacemaker impulses, which are often thick body tissue However, having to penetrate can make it difficult to accurately identify and interpret the signals. Simultaneously is the physical connection of electrodes or other sensors with an implanted pacemaker for the purpose of achieving not practical for a more direct reading. Finally, no practically feasible method is known to date elicit specific responses from a pacemaker, thereby improving monitoring.

As a result, it would be highly desirable to provide a pacemaker which can operate without difficulty could be changed easily and extremely reliably, and the operation of the pacemaker can also be monitored directly should be.

The invention has therefore set itself the task of realizing a method by means of which the operating parameters of a implanted pacemaker can be variably controlled, with the loss or addition of signal pulses the Loading and saving of newly received data can prevent, at the same time the operation of an implanted pacemaker should be monitored better than before.

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

A method for monitoring according to the invention is identified and controlling an implanted pacemaker by altering its operating characteristics essentially by a pacemaker with a detector, a data memory and a data processing device is provided in which the data processing device is coupled to the detector and the memory, that one coupled to the data memory Pulse generator is provided, in which at least one operating parameter is determined by the data memory that one Pulse sequence is generated from an invariable number of signal pulses, in which each pulse has a first or a second state represents that these pulses are fed to the detector, a die in the data processing device Internal signal representing the states of the output signals is developed and this internal signal is sent to the data memory is forwarded for the purpose of providing the operating data of the pacemaker.

Preferably, one of the received pulses is used to either trigger or prevent the charging process, and it arrangements are made to determine whether the full number of bits of data in a word have been received, whereupon the loading of the storage unit with data is released. Furthermore, a detected signal is preferably used, in order to trigger a transmitter or transmitter, which emits a signal to be monitored, which generated a pacemaker Represents impulses.

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

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A detailed explanation of the invention results from the detailed Description of a preferred embodiment of a data processing and transmission system according to the invention for an implantable pacemaker based on the accompanying drawings; it shows

Fig.l a puncture scheme of a data processing system according to the invention and implantable pacemaker delivery system;

2 shows a flow chart to illustrate the response certain elements of the system from Pig.l on an input signal; and

Pig.3 a puncture scheme of a signal generator and the Display devices for the system from Pig.l.

Pig.l shows a system that works in an implantable pacemaker and to an applied radio frequency signal or the magnetic field of a nearby implanted pacemaker arranged permanent magnets responds respectively. appeals to. The reed switch 10 is coupled to the OR gate 12 and to a second OR gate 16. The latter supplies a signal to a control stage 18 with a fixed frequency, which in turn is sent to the Pulse generator 20 of the pacemaker is coupled. As every skilled person knows, the pulse generator is powered by a miniature battery 22 driven and gives electrical triggering pulses to the appropriate tissue of the patient's body, by means of a Catheter 24, which has an implantable electrode at the end.

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

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A signal generated from the outside is received by the antenna 26 and forwarded to a detector 28. That stated The signal is then passed through the OR gate 12 to a decoder 30, a load enable flip-flop 32 and the start terminal of the encoder 13 forwarded. With the encoder 13 is a second Antenna 34 coupled to generate signals which, as follows yet to be explained, can be monitored.

The flip-flop 32 sits at the head of a shift register 36, so that it receives the signals from the flip-flop. A data storage stage 37 receives the signals from the previous ones Data processing stages and uses them to control the operation of the pulse generator 20. At the bottom of the shift register 36 is an "end of word" flip-flop 38 (end of word). Signals from this flip-flop 38 become an OR gate 16 and fed to the AND gate 4o. The AND gate triggers the charging stage 42 when a signal from the flip-flop 32 is present the end. The flip-flop 3Ö is also one with the trigger gate Reset flip-flop 44 coupled. The latter represents the shift register 36 via the OR gate 15 at the end of a signal transmission return. Pulses delivered by the pacemaker are directed to gate 14, thereby energizing the gate. details a system constructed according to Fig.l are detailed in a US parallel application with the designation "implantable Pacer Having Variable Characteristics and Signal-Actuated Data Transmitter "and in the description below recorded.

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

To explain a mode of operation of the system shown, it is assumed that the system is to be monitored and no new operating data are fed in. Accordingly, a magnet (not shown) is arranged near the reed switch 10 and through the latter a circuit with the potential V i is closed. This energizes OR gates 12 and 16, the latter generating a signal which triggers the control stage. This control stage IS in turn brings the pulse generator 20 to the introduced (not required) working method with a fixed frequency. Accordingly, the pacemaker begins Generate trigger pulses at fixed, even intervals.

The switch-on signal generated by the OR gate 12 is also passed to the decoder J> 0 , the flip-flop J> 2 and the start terminal of the encoder Ij5. However, since the decoder J> 0 and the flip-flop 32 do not respond to the fixed start signal, only the transmitter IJ) is triggered, ie started.

When a trigger pulse is generated by the pacemaker, this pulse is passed to gate I ² J-. A signal from the gate is then sent to the transmitter 1J> , whereby the latter sends a concentrated carrier signal to the output antenna;> 4. A suitable receiving antenna and a detector (not shown) can then be used to track down the emitted carrier signal and to determine the width of the clusters and the intervals between them and thus the pulse width of the pacemaker respectively. determine the pulse frequency.

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, Pafenfanwahe in Essen

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In order to change the operating characteristics of the pacemaker, a coded signal is generated and fed to the receiving antenna 26. In the present case, the coded signal consists of a pulse train with five pulses. Each pulse represents one of two states, the states of the pulses being distinguished by the width in the exemplary embodiment shown. Such a signal (shown as "coded date" in Pig.2) can be generated by using suitable coding techniques so that, for example, a short pulse can be interpreted as a digital "o", while a longer pulse is used to represent a digital "o". "l" to represent. Correspondingly, pulse # 1, or P ^, is a "θ" pulse, so is pulse P ₂ . The pulses P ^ and P ^ show a longer duration and are accordingly interpreted to represent digital "1". The final pulse P ₁ - again is short and therefore represents the digital "θ".

While the pulse width is controllably changed, the periods t 1 to t ^ are identical. Accordingly, the duration of a data word with five bits does not change. Of course, more than five bits or pulses can be used depending on the particular design of the system and its intended performance. In a successfully tested embodiment, however, a data word with five bits was found to be perfectly adequate.

The third line of FIG. 2 with the designation “modulated carrier ^11” shows a type of modulation of a carrier frequency of, for example, 10 kHz with the coded information

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

Waveform is a pulse caused by an interruption in the carrier frequency shown. It will be apparent to a person skilled in the art that in order to distinguish a digital "1" from digital pulses "θ" other solutions can also be pursued. Also can Naturally, a carrier frequency can also be modulated in the most varied of ways in order to detect the presence of the one type of pulse or to reflect on the other. As a result, the particular pulse width modulation carrier interrupt illustrated is merely to be regarded as an example.

The modulated carrier signal picked up by the antenna 26 is passed into the detector 2δ, which emits a pulse train which corresponds closely to the "coded data" line of FIG. These pulses are fed directly to the CLK terminal of the flip-flop 32 and also to the decoder 30. This decoder J> 0, which may have a monostable circuit, is used to establish a reference period of time in order to determine whether the received pulses are "long "or" short ". Of course, the specific type of decoder selected depends on the type of signal modulation used.

The demodulated and decoded information is then fed to the charge release flip-flop 32 with one pulse after the other. This flip-flop 32 forms the first stage of a shift register 36. In the embodiment shown, this shift register 36 has four signal transmitter stages, the outputs of which are shown in FIG. 2 by the wavy lines SR ₁ to SR ^. These output signals are fed to the memory 37. The "end of word" flip-flop 38 forms the final stage of the composite

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

Shift register and finally contains the first signal which is transmitted by the flip-flop J> 2. The flip-float 32 emits a "1" signal in its rest position. After the data has been received and forwarded to the flip-flop 32, this initial signal state is shifted through the register 36 through each individual stage with each subsequent receive pulse. Since the shift register 56 has four signal transmission stages, the number "1", which was originally in the flip-flop 32, is advanced to the flip-flop 38 when a fifth data pulse is received. If no further signals are received, the flip-flop 3 & remains in the "1" state, while the four output lines of the shift register 36 _{reflect the type of pulses P 1} to P ^. The last received pulse (P ₁ -) remains in the flip-flop 32. If the fifth pulse is a digit "O", the flip-flop 32 sends a signal to the AND gate 40, which corresponds to that in the flip-flop Flop 30 remaining digit "1" enables or triggers the charging stage. As a result, loading can only take place if flip-flop 3 & contains a signal indicating that five bits have been received and if pulse P ₁ -, which remains in flip-flop 38, is of the type which allows loading . In addition to enabling the charging stage 42, the flip-flop 38 also supplies a signal to the controller 18 with a fixed frequency. As already mentioned at the beginning, this causes the pacemaker to work at a fixed frequency.

Even if the received and decoded data are now in the shift register 36, they are actually not loaded into memory 37 unless a load command pulse is received from load stage 42. Such an instruction

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Andreiewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

pulse is generated by gate 14 in response to the arrival of a pacemaker pulse. This ensures that Data can only be entered into the pacemaker in an intermediate pulse period, so that the data can be correctly classified is possible. In addition, the trailing edge of the pacing pulse from gate 14 can be used to actuate reset gate 46 are used, whereby the flip-flop 32 and the signal transmitter stages of the shift register 36 can be reset.

In a preferred embodiment, the flip-flop is not reset by a pacemaker pulse, but rather Rather, it remains in its enabled state until a sixth partial jerk pulse is received. Like line 2 in Figure 2 shows, the final pulse Pg only follows a considerable period of time after the end of the transferred word. This time should be longer than the period between the pulses of the Pacemaker at its minimum pulse rate, so that the occurrence of a pacemaker pulse for charging is guaranteed. The flip-flop becomes the flip-flop through the backlash pulse 38 and the rest of the shift register 36 through the OR gate 15 deferred to it for further data reception provide. The system remains in the deferred state until the trailing edge of the next pacemaker pulse appears, which initializes all registers.

While all detected data pulses are fed to the reset flip-flop, the five pulses of the data word have no effect on the reset flip-flop because it has not yet been released. A release of the return

809883/0687

Andrejewski, Honlce, Gesthuysen & Masch, patent attorneys in Essen

- Manufactured flip-flops only takes place when the last data pulse has been received and the flip-flop 38 is brought ^to change its state. The next detected data pulse then operates the reset flip-flop 44 and causes the data processing system to be completely reset.

The operation of the load enable flip-flop 32, the shift register 36, the "end of word" flip-flop 3δ and the transfer stage the circuit shown is shown in Fig.2. Initially, the flip-flop 32 is in the idle state "1". On the back flank of the pulse P i, which represents a digit "θ" the flip-flop 32 is clocked to a corresponding "low" state. At the same time, the four signal transmitter stages SR, to SRh of the shift register 36 clocked. As a result of the previously dated Flip-flop 32 supplied digital signal "1" switches the first Level SR-, the shift register on high output.

When a second pulse P _{2 is} received, the flip-flop 32 is clocked again. However, since it is already in a "low" state, it simply stays in the same and reflects the "θ" state of the pulse Pp. The shift register SR., Which is however in a higher state, now goes low clocked, which reflects the previous output of the flip-flop 32. At the same time, the second shift register stage SRp is clocked to the high state, which reflects the previously output value of the shift register SR.

In the same way as each pulse is received, the initial state "1" of the flip-flop 32 is set by the shift

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

register clocked through, so that the fifth final pulse P ₁ - clocks the original state of the flip-flop j52 in the "end of word" flip-flop 38. Therefore, when the five pulses 00110 have been received, the signal transmitter and charge enable outputs reflect the same state, ie 00110, in the order of the output lines from bottom to top in Fig.l.

The system described above can also transmit signals which represent the operation of the pacemaker, specifically in accordance with a determined receiver carrier frequency, regardless of whether it is modulated or unmodulated. The proportion of the interrupted time span of the received modulated carrier frequency is relatively small and does not affect the release of the transmitter stage I3 by the detected signal, which represents the presence of the carrier frequency. As soon as a carrier signal is detected by the antenna 2.6 , regardless of whether it is carrying data or not, the transmitter I3 is automatically enabled and begins to emit signals which indicate the characteristics of the pacemaker pulses.

The operation of the system shown in Fig.l is summarized in the following table.

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen Table I.

Auslb'se impulse Magnetic field only

Carrier data word with five bits only

Data word received with five bits, fifth bit equal to zero

Pacemaker pulse (leading edge)

Pacemaker pulse (trailing edge) Sixth data bit

answer

Delivery of the pulse information of a pulse train with a fixed Sequence.

Delivery of the impulse information.

Delivery of the pulse information, collection of the data in the shift register.

Triggering of the storage charging circuit pulse train with a fixed frequency.

Data entry into memory.

Resetting the shift register.

Resetting the system.

It follows from the foregoing that if more bits are received than a common data word contains, the system is deferred and the incorrect information is ignored. If less than a full word length of bits is received, the circuit for loading the system's memory is not released and the stored information is not replaced, when the next pacemaker pulse arrives. Once the shift register has received a suitable data word, can

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

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this data word can only be loaded from the shift register into the memory when a pacemaker pulse occurs. Subsequent pacemaker pulses only reset the system and have no influence on the stored information. As a result, an extremely high level of data integrity is guaranteed.

Fig.3 shows a system for generating data signals for the purpose of Transmission to the pacemaker of Fig.l as well as for determining and displaying the pulse-related transmitted by the pacemaker Information. An exemplary embodiment of this system according to FIG. 3 is described in detail in the US parallel application under the designation "Control Signal Transmitter and Monitor for Implanted Pacer", reference being made to this description. An oscillator 50 is connected to a suitable encoder 52 coupled, the state of which is determined by the states of a group of program switches 5 ^. The data from the encoder 52 are modulated in a modulator stage 56, in which they are mixed with a 10 kHz carrier signal, which is preferably derived from the oscillator 50. That modulated Signal is amplified by an amplifier 5 &, which drives an output antenna βθ.

A monostable circuit 6K is enabled by means of a transmission switch 62, which can be operated manually. Signals transmitted by the implanted pacemaker are picked up by the input antenna 66 and demodulated by the detector 68. The detected or captured signals are used to trigger the monostable line 64 which controls the coding

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

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direction 52 starts, prompting the previously selected data corresponding signals are fed to the modulator 56 and that 10 kHz carrier signal receives the data imprinted.

The pulse information, which can take the form of a modulated carrier signal, is demodulated by the detector 68. The resulting signal is fed to a first counter / decoder 70 which controls a pulse interval display 72 to indicate the time interval between pacemaker pulses. The information is also passed to a second counter / decoder Jk which controls a pulse width display J6 . The latter provides a visual indication of the width or duration of each previous pacemaker pulse.

When the system according to FIG. 5 is put into operation, the oscillator 50 is supplied with current, as a result of which a 10 kHz signal is fed to the modulator 56. The unmodulated carrier signal is processed by the amplifier 58 and emitted by the antenna 60, which is fixed near the implanted pacemaker. Signals emitted by this antenna 60 are picked up by the pacemaker and are used to excite certain elements of the same, as was explained in connection with FIG. In particular, the transmitter stage of the pacemaker is started, which outputs clusters of a carrier signal at a suitable frequency during the occurrence of pacemaker pulses. The pacemaker signal modulated in this way is picked up by the antenna 66 and demodulated by the detector 68. The captured signal is fed to an integral counter decoder 70, which responds to the input signal in this way.

809883/0687

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

Words that he is counting or measuring the time interval from one pacemaker pulse to the next. Correspondingly, a count representing the pulse interval is carried out within the counter / decoder 70 and the counts collected in this way are decoded and fed to the display 72. In the same way, the determined and received pacemaker signal is fed to the counter / decoder 7 · ^. The latter only responds to a signal which indicates the presence of a pacemaker pulse, for example a continuous concentration of carrier signals, the duration of which coincides in time with the pacemaker pulse. As a result, the counter / decoder 7 ^ can collect a number of counts indicative of the duration or width of the pacemaker pulse and transform or decode the count thus collected into an appropriate signal for actuation of the pulse width display J6. The decoder is designed in such a way that it can distinguish between pacemaker pulses which originate from natural heartbeats and those which represent pacemaker trigger pulses. This information is used to indicate whether the patient's heart is paced or operating in its normal sinus rhythm.

The pulse interval display 72 and the pulse width display can consist of four-digit, seven-line displays of a commercially available type. Conventional decoders can be used to transform the collected count into signals to excite appropriate displayed digits and appropriate Seven-line elements of each ad. In this way two multi-digit numbers are displayed, which one depends on the das

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

Are visually perceptible to the person monitoring the system. Preferably the pulse interval display 72 sets the pulse interval in milliseconds, in which case only three digits are normally required. The pulse width indicator 76 can also represent the pulse width in three identifying digits. However, since a pulse width is usually less than 10 milliseconds requires, the pulse widths are expediently resolved in 0.01 milliseconds.

As already mentioned, the output of the detector 68 is also applied to the monostable circuit 64 for the purpose of triggering the decoder 52. By closing the transmitter switch 62, the monostable circuit 64 is released, but not triggered. In this way, the 10 kHz carrier signal can only be modulated by coded data pulses immediately after a pacemaker pulse has been received. This ensures that the data is only output during the time periods between the pulses. By closing a suitable switch of the switch group 54, each of which corresponds to a specific data bit, the coding device 52 emits a sequence of η pulses, the widths of which are modulated in accordance with the state of the η switches 54. In the illustrated embodiment, closing a switch produces a digit ¹¹ "or a" short "pulse. To obtain additional pulses whose widths are modulated to correspond to digits 00110, the first, second and fifth switches Since each switch indicates the state of a pulse from a number of modulation pulses generated in series

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

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controls the 10 kHz output of modulator 56 for one interrupted for a long or short time.

The monostable circuit 64, once triggered, holds an enable signal for the decoder 52 long enough that a full data word can be generated. Unintentional reopening of the transmitter switch 42 therefore does not negate the transmission the message. The last reset bit (here the pulse Pg) occurs according to the opening of the control switch 62. So therefore, as long as the switch remains closed, the pacemaker can cannot be fully reset even after the encoded data has been received and stored in the Pacemaker have been charged.

The above explanations show that the invention is a pacemaker system and provides a method of actuating it which avoids many of the disadvantages of previously known assemblies. For example, the length of a data word can be extended by simply adding the appropriate number of stages in shift register J56 and in memory J57. The data processing system in general does not need to be changed. The change in the shift register and the Memory can be achieved simply by adding another flip-flop for each additional bit in a data word. As a result, the data reception and storage capacity of the system and thus the number of pacemaker process variables, which can be influenced, largely increase without reducing the size of the data processing system would have to be increased proportionally. It also shows that,

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Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen

mainly because a fixed, unchangeable number of data bits is always transmitted and also because of the nature and coding the information, adding false bits or not including real bits renders the system incapable of reprogram the memory elements of the pacemaker. Finally, a signal generated by the pacemaker is read directly from the pacemaker rather than after it has been transmitted through a relatively large mass of body tissues to be scanned. The integrity of the information generated in this way is much greater and clearer defined as data recorded by electrodes or the like placed on the body of the pacemaker wearer. In addition, the data is only available on request generated, i.e. when the encoder system is activated by receiving a specific carrier signal.

Needless to say, the invention is in no way limited to the specific details of the above Examples described is limited and that modifications or other applications are readily possible.

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Claims (13)

Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen Patent claims: 1 / Method of monitoring and controlling a planted Pacemaker by changing its working characteristics, characterized in that a pacemaker with a detector (68), a data memory (37), and a data processing device is provided in which the Data processing device is coupled to the detector and the memory, that one coupled to the data memory Pulse generator (20) is provided, in which at least one operating parameter is determined by the data memory that a Pulse sequence is generated from an invariable number of signal pulses, in which each pulse has a first or a second state represents that these pulses are fed to the detector, a die in the data processing device Internal signal representing the states of the output signals is developed and this internal signal is sent to the data memory is forwarded for the purpose of providing the operating data of the pacemaker. 2. The method according to claim 1, characterized in that the state of one of the pulses emitted by the pulse duration is determined. 3. The method according to claim 1, characterized in that for Changing the operating data of the pulse generator (20) of the implanted pacemaker a carrier signal with a predetermined Frequency is generated during this carrier signal ORIGINAL INSPECTED 809883/0887 Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen modulated a predetermined number of times over a fixed period of time where each modulation occurs within a given sub-interval and each sub-interval a predetermined one Operating parameters of the pacemaker represents that the carrier signal is detected and the modulations of the carrier signal corresponding internal signal is generated that this internal signal of a memory stage (37) with a predetermined Number of outputs is fed and these outputs are coupled to the pulse generator (20), whereby at least one Operating parameters of the pulse generator can be changed. 4. The method according to claim 3 *, characterized in that the Carrier signal is modulated for a first, longer period or a second, shorter period. 5 · The method according to claim 4, characterized in that the Modulations consist of interruptions in the carrier signal. 6. The method according to claim 4, characterized in that a Pacemaker pulse is detected and the internal signal to the memory stage in accordance with the position of the pacemaker pulse is forwarded. 7 · The method according to claim 4, characterized in that the Forwarding of the internal signals is blocked until a specified number of modulations is detected. 8. The method according to claim 1, characterized in that for Monitoring the operation of an implanted pacemaker 809883/0687 Andrejewski, Honke, Gesthuysen & Masch, patent attorneys in Essen an oscillator (50) is provided in the pacemaker and an output antenna (60) is coupled to it, that the oscillator is started according to the pulses generated by the pacemaker, making its output antenna one for pacemaker operation emits representative signal, and that this emitted signal is detected. 9. The method according to claim 8, characterized in that the Radiation of the signals is blocked in the absence of an input signal. 10. The method according to claim 9 *, characterized in that the Input signal consists of a magnetic field. 11. The method of claim 9 * wherein the pacemaker is designed as a "demand pacemaker", characterized in that the pacemaker is activated by an input signal a fixed frequency mode is established. 12. The method according to claim S, characterized in that a detector (68) for triggering the oscillator (50) is provided in the pacemaker and the detector is acted upon by an oscillation signal from outside the body of the pacemaker wearer. 13. The method according to claim 12, characterized in that the The vibration signal and the transmission signal consist of radio frequency vibrations. 809883/0687