DE3035733A1 - DEVICE FOR REGISTERING HEART RHYTHMOUS KILLS - Google Patents

Description

The invention relates to a device that can be carried by the patient outside his body for recording and subsequent recording Reproduction of information that a disturbance of the course of the heart current affect. The device is intended to be used to monitor an implanted cardiac rhythm correction device and is provided with electrodes that are assigned to the patient. Information, for example a heart rate signal, is fed teiemetrically to the recorder. A continuously working and continuously advancing run-time memory is provided. When capturing one of several Types of arrhythmias or when giving a Defibrillation current surge, the data contained in the memory are "permanently" recorded on a magnetic tape.

In the last few decades there have been diseases of the coronary arteries has become the leading cause of death in developed areas of the world. The cause of sudden death Coronary artery disease is not yet fully understood, but the facts known in medicine indicate this points out that in the majority of these cases death is due to severe disturbances in the course of the heart's current, which lead to ventricular fibrillation.

It is true that one cannot say with infallible certainty which one patient suddenly suffering from coronary artery disease will die, but it can be seen that the risk is very high in certain groups of patients. To these patients include those who have had a heart attack; even if they are in good health, is with them the risk of sudden death several times greater than the average for the general population. If now patients after a heart attack from serious ventricular arrhythmias and / or cardiac arrest or if there are signs of persistent irritability of the heart muscle it is believed that there is a very great danger of sudden death. Such patients could be greatly affected by an automatic cardiac rhythm correction device kept on standby to be helped.

An automatic heart rhythm correction device is also required for those patients who have not yet had a heart attack, but show strong symptoms of coronary artery disease For example, ventricular arrhythmias that cannot be remedied by medical treatment or angina pectoris.

Finally, there are numerous ambulatory patients who repeatedly suffer from atrial fibrillation, or atrial flutter

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Suffer from tachycardia. These supraventricular arrhythmias are not life-threatening, but can weaken and lead to complications and must therefore be treated. These Patients in need of frequent electrical or pharmacological Conversion treatment under the care of your doctor to help your hearts return to normal sinus rhythm.

Recently, a fully implantable, Great advances have been made in automatic ventricular defibrillators. The first such defibrillator is in the DE-AS 21 04 591 described. Also the reliability of Flicker detectors has been improved, for example according to US-PS 4 202 304. In the German patent application P 28 22 799.8 of May 24, 1978 is also specified how the reliability of the implanted defibrillator by the Creation of a circuit can be improved, which before the delivery of a defibrillation shock, the implanted Electronics checked for proper functionality.

Despite the significant advances made in the development of the fully implantable, automatic defibrillator and the Increasing the reliability of the measuring and defibrillation circuit achieved, it must not be overlooked that the implantable defibrillator is still in its infancy plugged. There is a need for data which will confirm the accuracy of the measurement and defibrillation circuitry or the defectiveness of which is indicated. In particular, there is a need for a device with which desired parts of a Cardiac current signal that is generated by a heart before and during the occurrence of various disturbances in the course of the cardiac current generated, recorded and then reproduced. Such a device could not only function properly of the implanted defibrillator.

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but it could also provide valuable information about the patient's heart function before and during an arrhythmia can be obtained. There is also a need for a device that can be carried by the patient for monitoring cardiac function, even if no defibrillator is implanted.

The invention has the object of satisfying the needs outlined above.

The invention relates generally to an apparatus for recording and later playback of desired portions of a cardiac output signal generated by a heart before and during the occurrence various disturbances of the course of the heart current is generated. The course of the patient's heart current is measured using a suitable Transducer detected and then converted into a typical HerStromsignal .

In a preferred embodiment of the invention, the cardiac current curve is recorded in the form of a cardiac current signal Thoracic electrodes are provided which are placed on the anterior chest wall of the patient. The patient's cardiac output signal is transmitted telemetrically to the device according to the invention by suitable measures and recorded in this in order to to be played back later. The device is housed in a suitable container, such as a briefcase. In this embodiment, the received cardiac output signal is converted into suitable digital data. That is the heart rate signal representing digital signal is stored in a memory with a predetermined capacity, operating on the principle of the silo storage is working. A common rhythm disturbance detector, because: the received cardiac current signals are continuously monitored, generated when a disturbance in the course of the heart current occurs Logic signal indicating a rhythm disturbance. Such a one

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Disturbance can be caused, for example, by ventricular tachcardia, Bradycardia, asystole, ventricular flutter, or ventricular fibrillation ectopic strikes are caused. That the rhythm disturbance The logic signal indicating this turns on a tape recorder which now records the data output from the memory. When the disturbance has stopped and the cardiac current flow is normal again, you will hear what indicates the rhythm disturbance Logic signal on. Thereafter, the recording device continues to record the output signal during a predetermined one Period of time that corresponds, for example, to the period of time that the memory needs for a single output of all content. The recording device is then switched off. The desired part of the is now on your magnetic tape in digital form received cardiac current signal recorded, which the heart before and during the occurrence of the disturbance of the cardiac current curve s generated.

In a doctor's office or in a hospital it will Tape played by the doctor or a trained assistant and the played data are displayed with a visual display shown so that they can be evaluated.

In order to generate an EKG, electrodes are usually used to record electrical signals indicating the heart's activity placed on the body surface. Receives an electrogram on the other hand, one generally takes measurements on the surface of the heart. In the context of the invention, the Herζstrom course through each any measurement technology can be monitored.

It is an object of the invention to provide an apparatus for recording and later reproducing desired items Sharing a cardiac output signal received from a heart before the and during the occurrence of a disturbance in the course of the heart current is produced.

Another object of the invention is to provide an apparatus for storing valuable information about the downward current curve of the patient in the form of the cardiac current signal, generated before and during a flicker episode.

A further object of the invention is to create a device that can be carried by the patient outside his body, lightweight device that uses wireless telemetry to record and later play back a desired part a cardiac current signal is suitable that is generated by a heart before and during the occurrence of a disturbance in the course of the cardiac current is produced.

The invention also has the task of creating a lightweight device that can be carried by the patient outside his body, which is suitable for recording and later reproducing parts of Herstrom signals that are used during several of one Patient suffered disturbances of the cardiac current flow generated will.

Furthermore, it is an object of the invention to provide an apparatus which can be used for recording and later reproducing information which relate to a defibrillation attempt that has been carried out by means of an implanted defibrillator is.

Another object of the invention is to provide a device that makes it easier to determine whether one is suffering from a disease the coronary artery patient needs a fully implanted ventricular defibrillator, and that the treatment of Supports patients who suffer from cardiac arrhythmias.

A further object of the invention is to provide a device for checking the functionality of a implanted defibrillator.

The invention provides a device which is used for recording and later reproducing information, for example consist of desired parts of a cardiac output signal that are transmitted by a heart before and during the occurrence of a disturbance of the course of the cardiac current. You can use the device for monitor the function of an implanted automatic defibrillator use. The device carried by the patient outside of his body has electrodes that are assigned to the patient will. The cardiac current information is transmitted telemetrically to the recording device. It is a constantly working one and continuously updating runtime memory is provided. At the Detect one of several types of irregular heartbeat or when the implanted defibrillator has a defibrillation surge outputs, the data contained in the memory are "permanently" recorded on magnetic tape.

An embodiment of the invention is based on the following of the accompanying drawings. In these shows

Fig. 1 is a detailed block diagram of a

preferred embodiment of the invention and

2 shows a circuit diagram of an embodiment

a rhythm disturbance detector which is assigned to the device according to FIG.

In describing the preferred embodiment of FIG In the invention, certain devices are used for the sake of clarity, but to which the invention is not limited. Any designation of a facility also includes all technically equivalent facilities that perform a similar function and serve a similar purpose.

The device shown in FIG. 1 has two units 160 and 170. The first unit 160 is a cardiac output signal transmitter carried by the patient. The second unit 170 is a cardiac current receiving and processing device, which is shown in FIG a suitable container, such as a briefcase, is housed and at a certain distance from the Patient is located.

By means of thorax electrodes 162 arranged on the front wall of the patient's thorax, the flow of the current is in the form of a Detected down current signal, which is fed to an amplifier 163 will. A pulse frequency modulation (PFM) encoder 164 converts the amplified down current signal into a PFM waveform implemented. This consists of numerous pulses of the same width, the spacing (or frequency) of which is the one to be transmitted Represents data. The PFM waveform is provided to a transmitter 166 and its output to an antenna 168. If the Patient has an implanted defibrillator contains the Unit 160 also includes a sensor 172 for detecting defibrillation current surges. This sensor 172 receives the cardiac output signal from the thorax electrodes. A normal cardiac output signal has an amplitude of about 1 mV. A defibrillation surge has an amplitude of around 10V when measured on the skin. if therefore, the implanted defibrillator generates a defibrillation surge emits, this is detected by the sensor 172, which then emits a signal to the PFM encoder that causes that the signal is encoded and then transmitted via the transmitter 166 and the antenna 168. The sensor 172 also gives the signal on line 165 so that it causes the PFM encoder 164 to deliver a special signal to the transmitter indicating the delivery of a difibrillation pulse.

The transmitted PFM-Wellonform is via an antenna 176 from a receiver 174 received, the output of which is a

Pulse Frequency Modulation (PFM) decoders 178 and a signal detector 180 is supplied. When the output of the receiver 174 drops below a certain level or If the demodulated pulses do not have the width with which they were sent, the signal detector indicates an enable signal a timer 182 and a locking signal to a portable recording and reproducing device 184, for example on a cassette recorder or the like. The timer 182 generates a signal of a desired duration, the one Sound signal generator 186 actuated. In this way the patient receives an indication when the cardiac current signals are being sent through the Unit 160 or in the reception of the core current signals by the unit 170 an interruption has occurred or the patient has reached an area with disruptive electromagnetic influences is. This indicates that the pulses are not as wide as they were sent. The patent is also granted an indication when he has brought the unit 160 outside of the reception range of the unit 170.

The PFM decoder 178 decodes the PFM waveform it received from the receiver 174, thereby providing the cardiac output signal again. The restored Hercurrent signal is fed to an analog-to-digital converter (A / D converter) 190 via lines 188 and converted into digital data there, namely in a sequence of words of eight bits each. The restored cardiac output signal is further transmitted over lines 188 a rhythm disturbance detector 192 of a known type.

Which type of arrhythmia detector is chosen depends on the type or types of cardiac dysfunction should be recorded. An embodiment of such a rhythm disturbance detector will be described in detail below. The output of the A / D converter 190 is in a Runtime memory 194 of predetermined capacity is stored.

which works on the principle of a silo memory and comprises either a random access memory (RAM) or a shift register.

In one embodiment, memory 194 comprises random access memory of 8K, which can store 1024 digital data words. These 1024 words represent the means of the thorax electrodes 162 Herζstrom curve recorded in the last ten seconds The forth current signal generated in a period of ten seconds can therefore be stored in digital form in the memory 194 get saved. You can of course also work with a larger or smaller storage capacity so that the during data generated over a longer or shorter period of time can be stored.

A clock 196 gives over the lines 198 to the A / D converter both a signal initiating the implementation and control pulses. A memory address counter (SA counter) 200 is there address codes to memory 194 via lines 202. The clock 196 is over the lines 204 clock pulses to Continuation of the SA counter. The SA counter issues address codes through which all memory locations of the memory are consecutively addressed. As long as the SA counter receives clock pulses over the lines 204, it repeats the address sequence continuously.

In operation, the output of the A / D converter 190 is in the Memories are stored in locations determined by the address codes output from the SA counter 200. In the A / D converter the conversion is initiated and carried out on the basis of the pulses coming from the clock generator 196. When the implementation is complete, the A / D converter outputs a WRITE mark on lines 191, which is followed by the data bus data output from the A / D converter is written into the memory. After the whole RAM has been addressed, the SA counter starts again with the address sequence and become

new digital data from the A / D converter is written into the memory locations of the memory 194, which is based on the principle of Silo storage works. The memory 194 has an output circuit through which the replaced digital data continuously are output on lines 206.

In a system modified from FIG. 1, the memory 194 comprises eight shift registers for 1024 bits each. In this Embodiment, the memory address counter 200 is not required. As indicated above, the A / D converter 190 output digital data from a sequence of words of eight bits each. Because of the lines 191 The eight bits of each word are written into the first stage of each shift register. In each shift register, the data is sequentially shifted under the control of clock 196 until it becomes the last Stage of the shift register. The data is transferred from the last stage of each shift register to one of the Lines 206 are pushed out, in which the data thus form a sequence of eight-bit words. This way be ahead of time stored digital data replaced by new digital data according to the principle of the silo memory.

When the arrhythmia detector 192 detects a disturbance in the heart's current flow is detected, it outputs two signals, one on lines 208 and the other on lines 210. Through the signal on lines 208 becomes the recorder and playback device 184 switched on. The signal in the lines 210 reaches a built-in time identifier 212, the for example a digital watch chip and that continuously desired information, e.g. B. time and date in the form of a digital signal that serves as a time indicator referred to as. The signal on lines 210 causes

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the time identifier generator 212 over the lines 214 a time identifier gives away.

The recording and playback device records on the basis of the switch-on signal 184 on magnetic tape the time stamp and the digital data applied to lines 206. if the fault has ceased and the downcurrent curve resumes is normal, the switch-on signal applied to lines 208 ceases, whereupon the recorder and playback device does the Output signal of the memory 194 continues to record during a predetermined period of time, for example the This corresponds to the time that the memory needs for the one-time output of its entire content. The receiving facility stands on it away. It now contains a digital recording of the desired part of the cardiac output signal on the magnetic tape, that of the heart before and during the onset of the disorder of the course of the heart current has been generated.

Any later disturbances of the course of the heart current are also recorded in the manner described above. In any case, due to the switch-on signal, the recording and reproducer 184 on the magnetic tape the time stamp and the digital data applied to lines 206 on. The capacity of the recording and reproducing device depends on the length of the magnetic tape and the recording speed addicted.

If the patient has an implanted defibrillator, the sensor 172 is used in the recorder to detect the defibrillation current surge. It was already above mentions that a normal cardiac output signal has an amplitude of about 10V. The sensor 172 for the defibrillation pulse receives the cardiac output signal from thoracic electrodes 162 and senses the large change in pulse amplitude that occurs

the delivery of a defibrillation shock can be attributed to it. Because of this change, the sensor 172 gives over the lines 165 a defibrillation indication signal (DA signal), this causes the PFM encoder to output a code that does not occur during the acquisition of normal cardiac output data, for example a code with a high pulse rate. When the DA signal is in that above for those delivered by thoracic electrodes 162 Herstromsignale described way encoded and decoded it is sent to the defibrillation pulse decoder 161 fed, which evaluates it as an event to be recorded and thereupon a signal for switching on the recording and reproducing device 184 via the lines 223 and via the line 210 emits a signal which causes the time identifier generator 212 to output a time identifier.

In due course, the doctor's office or hospital will use the magnetic tape in both recording and playback eeinr ich tion 184 is rewound by a doctor or a trained assistant and then played back. It is believed, that a playback device is available in the consulting room or hospital so that the patient can use his cassette for evaluation can send in by post. However, the tape can also be played with the recording and playback device itself will. The information recorded on the magnetic tape is transmitted to a display 216 via a playback decoder 218 supplied, on which the information for evaluation is visibly displayed. The playback decoder 218 includes a circuit for converting the digital data recorded on the tape into a sequence of signals for controlling the display 216. The sequence in which the output signal of the Memory 194 has been recorded by the recording and reproducing device 184.

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An embodiment of the Rhythm disturbance detector 192 described.

The down current signal is transmitted via line 188 and an A / D converter 219 is introduced into a phase-locked loop 220, for example under the designation RCA 4046 of by RCA Corporation, Solid State Division, Somerville, New Jersey (USA). The phase synchronized Loop contains an amplifier 222, the output of which with one input of an EXCLUSIVE-OR gate 224 and one input of a Phase comparator 226 is connected. With the other input of the EXCLUSIVE-OR gate 224 and the other input of the Phase comparator 226 is the output of a voltage controlled Oscillator (VCO) 228 connected to which an external capacitor C1 and two external resistors R1 and R2 are assigned. Of the Resistor R1 and capacitor C1 determine the frequency range of the VCO. Thanks to the resistor R2, the VCO can one Frequency shift work. The output signal of the EXCLUSIVE-OR gate is fed to one input of a NOR gate 230, at the other input of which the phase comparator 226 phase pulses gives away. The output signal of the NOR gate 230 is via a resistor R3 connected in series with a diode D1 applied to the input of a NOT element 232, between which Input and output a capacitor C2 is connected. One end of the resistor R4 is connected to the input of the NOT member 232 connected and grounded at the other end. The output of the NOT gate 232 is through a resistor R5 fed to the input of a NOT element 234, the output signal of which is fed to the input of a NOT element 236 and the input a three input OR gate 244. Between the input of the NOT gate 234 and the output of the NOT element 236, a resistor R7 is connected. At the input of the NOT element 234 is via a resistor R6 a voltage Vcc of 6 V is applied.

Between the output of phase comparator 226 and the input of the VCO 228, a resistor R8 is connected. The input of the VCO is through a capacitor C3, which has a resistor R9 is connected in series, grounded. The capacitor C3 and the two resistors R8 and R9 form a two-pole low-pass filter, which improves the frequency capture range and phase lock speed. Between the input of the VCO 228 and the plus input of an operational amplifier (OV) 238, two resistors R10 and R11 are connected in series. The plus input of the OV 238 is also grounded through capacitor C5. The capacitor C4 is on its one plate with the connection between the Resistors R10 and R11 and on its other surface with the Output of OV 238 connected. A resistor R1.2 is connected between the output and the negative input of the OV 238. That The output signal of the OV 238 is dem. Via a resistor R15 The positive input of an OV 240 is fed to the negative input of which a voltage VDD of 15V = is applied. The minus input of the OV 240 is also grounded through a resistor R14. Between A resistor R16 is connected to the output and the negative input of the OV 240. The output of the OV 242 becomes the third Input of OR gate 244 supplied. The OR gate 244 applies its output signal indicative of the rhythm disturbance lines 208 and 210 on.

The phase-locked loop fed by the voltage Vcc consists of a linear low power VCO 228 and two different phase comparators 224 and 226 that make up an amplifier 222 with a common signal input and a common comparator input 221. The output of the VCO is fed directly to the comparator input 221. The phase comparator 224 is an Exclusive-OR gate and has one typical triangular phase response. If there is no Signal or noise level, the average output voltage of the phase comparator is 224 Vcc / 2. The phase

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comparator 226 is an edge-controlled storage network, that on the Af rising edges at the signal input and the comparator input responds and via the two-pole low-pass filter formed by the capacitor C3 and the resistors R8 and R9 Input voltage of the VCO continuously for frequency and phase equality of the signal input and the comparator input adjusts. If there is no input signal, the phase locked loop 220 adjusts using the comparator 226 set the VCO 228 to the lowest possible frequency. Of the The output of the phase comparator can assume three states. When the output of the phase comparator current to the low-pass emits or subtracts from it, the phase pulse output corresponds to a logic zero. When the output is in the high state Impedance, the phase pulse output corresponds to a logic one.

In operation, the cardiac output signal from the output of A / D converter 219 becomes the signal input of the phase locked loop which is responsive to the QRS group of the HerζStromsignal and runs in phase with regular QRS groups, but cannot run in phase with irregular QRS groups. At the Output of the NOR gate 230 appears the small signal when the loop 220 is running in phase, and the large signal appears when the loop is running out of phase. The NOT link 232, the capacitor C2, the diode D1 and the resistors R3 and R4 form an integrator 231, which the output signal of the NOR gate 230 synchronized. The capacitor C1 causes a Delay. By the resistors R3 and R4 the Aufstiegsbzw. Fall time of the output signal of the NOT gate 232 certainly. The NOT gates 234 and 236 and the resistors R5 to R7 form a Schmitt trigger 233 with two switching thresholds, one of which is near ground potential and the other is near Vcc. The outcome of the Schmitt-Triggers applies the small signal to line 235,

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when the loop 220 is out of phase and the large signal when the loop is out of phase.

The OV 238, the capacitors C4 and C5 and the resistors R10 to R12 form an active filter 229. The OV 240 and the Resistors R15 and R16 form a comparator 237. The OV and the resistors R19 and R20 form a comparator 239. The input signal of the VCO is applied to the filter 229, which emits a direct voltage directly proportional to the heart rate, which is applied to the pulse input of the comparator 237 will. The voltage divider formed by resistors R13 and R14 applies a reference voltage to the minus input of the comparator 237. At the output of the comparator 237 appears with normal heart rate the small signal and with higher than normal heart rate the large signal. The output signal of the Filter 229 is also fed to the minus input of the comparator 239, at whose plus input the one from the resistors R17 and R18 formed voltage divider applies a reference voltage. At the output of the comparator 239, the small signal appears at a normal heart rate and at a higher than normal heart rate the big signal.

The small signal appears at the output of the OR gate 244 if at all the outputs of the Schmitt trigger 233 and the comparator 237 and 239 the small signal lies, and that appears Large signal · if the large signal appears at one of the outputs mentioned. One from OR gate 244 via line 208 emitted large signal represents a switch-on signal for the Recording and playback device 184 and is also supplied via line 210 to time identifier 212, so that this gives a time indicator.

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Based on the above information, the illustrated embodiment be modified variously within the scope of the inventive concept. Hence the invention is based on this Embodiment not restricted.

Claims (20)

25 293 (the) Mieczyslaw Mirowski,
Owings Mills, Md. (USA) Device for registering cardiac arrhythmias Patent claims: Device dedicated to monitoring a single patient the function of an automatic cardiac rhythm correction device implanted in the patient by: a first detector due to the delivery of cardiac rhythm correction energy by the implanted Cardiac rhythm correction device initiates the storage of the data, which the said delivery of cardiac rhythm correction energy affect, a storage device for the permanent storage of said data, an external receiving device for receiving said data, a transmission device for telemetric Transmission of the data from the patient to the external receiving device. 2. Apparatus according to claim 1, characterized in that the Data relate to disturbances in the course of the cardiac current, cardiac rhythm correction current surges, cardiac current signals and / or time indicators. 3. Apparatus according to claim 1, characterized in that the transmission device from the patient outside of his Body is carried along and outside of the patient's body electrodes for detecting the heart current includes. 4. Apparatus according to claim 1, characterized in that the transmission device with the heart rhythm correction device is implanted. 5. Apparatus according to claim 1, characterized by a device for permanent recording of the to the external receiving device transferred data. 6. Apparatus according to claim 1, characterized in that the storage device has a first storage part, which has a predetermined small capacity and for temporarily storing and updating a small one Part of the mentioned data is used, and a second memory part is used to permanently store the according to the specification of Heart rhythm correction energy occurring part of the data. 7. Apparatus according to claim 6, characterized in that the Receiving means comprises a tape receiving device with a tape which is used for permanent storage of the in the first Storage part and the data stored in the second storage part is used. ou35 / 33 - 3 - 8. Apparatus according to claim 1, characterized in that a device for monitoring of the heart current course concerned Data is provided that due to the delivery of cardiac rhythm correction energy, the first detector the Storage of the data relating to the course of the lerz current initiates that the external receiving device the Receives data relating to the course of the heart current and that the transmission device receives the data relating to the course of the heart current Data transmitted from the patient to the external receiving device. 9 * Device according to claim 8, characterized by a device to format the received data, which the cardiac current curve and the delivery of cardiac arrhythmia correction concern, and for the delivery of information that indicates whether the delivery of the heart rhythm correction energy due to the Detection of a fibrillation condition by the implanted cardiac rhythm correction device is done or not. 10. Apparatus according to claim 9, characterized by a second detector, the events for a possible Flicker episode are characteristic by initiating the Storage of the data relating to the cardiac current response. 11. Device dedicated to monitoring a single patient the function of an automatic cardiac rhythm correction device implanted in the patient by: A first unit which can be carried along by the patient and which has a sensor for emitting a first signal which represents the heart current of the patient, as well as a transmitter for transmitting de :; first signal, and BATH ORIGINAL an easily carried and movable second unit, which has a receiving device for receiving the transmitted, first Signal, furthermore a detector which is circuit-connected to the receiving device and which reacts to an attempt to correct the heart rhythm responds by introducing data pertaining to this experiment, and a storage device for permanent storage of the data relating to the experiment. 12. Apparatus according to claim 11, characterized in that the detector is a rhythm disturbance detector. 13. Apparatus according to claim 11, characterized in that the second unit further comprises means for retrieving the data relating to said experiment, which are permanently stored in the memory device, as well as a visual display for the visible representation of the recovered Data. 14. Apparatus according to claim 11, characterized in that the first unit has a time identifier for delivering a Time identifier and a device which, on the basis of the output signal of the detector, causes the Time identifier is permanently stored in the storage device. 15. Apparatus according to claim 11, characterized in that the Storage device comprises a cassette recorder having a magnetic tape. 16. Apparatus according to claim 11, characterized in that the the second unit has a device which generates a second signal on the basis of the reception of the first signal, when the amplitude of the received first signal is below BATH ORIGINAL is a predetermined value, as well as a device that generates a sound signal on the basis of the second signal which indicates to the patient that the second unit is not properly receiving the first signal. 17. Apparatus according to claim 11, characterized in that the the second unit has a device which generates a second signal on the basis of the reception of the first signal, when the amplitude of the received first signal is below a predetermined value, and due to the second signal turns off the memory device. 18. Device dedicated to monitoring a single patient a cardiac rhythm correction device implanted in the patient, characterized by: A first detector which, based on events characteristic of a possible flicker episode, initiates the storage of data relating to the possible flicker episode, a second detector due to the discharge of heart rhythm correction energy initiates the storage of data by the implanted heart rhythm correction device, which concern the delivery of heart rhythm correction energy, a storage device for permanent storage of the possible flicker episode and the delivery of heart rhythm correction energy relevant data, an external receiving device for receiving the the possible flicker episode and the delivery of cardiac rhythm correction energy data, and a transmission device for telemetric transmission of the possible flicker episode and the delivery of cardiac rhythm correction energy related data from the patient to the external receiving device. 19. Implantable automatic cardiac rhythm correction device with devices for checking the functionality, marked by: A sensor for sensing the heart rate of a wearer, a detector which receives the heart current from the sensor and for detecting cardiac arrhythmias, among others. a flicker, is suitable a signal generator for generating signals based on the detection of a cardiac arrhythmia by the detector, a storage and discharge device for storing and subsequent automatic delivery of heart rhythm correction energy into the heart of the wearer, a charging device for charging the storage and discharge device with the heart rhythm correction energy, a transmission device for establishing an electrical connection between the signal transmitter and the Charging device such that due to the detection of a Flicker condition by the detector the charger is activated, a memory device for permanent storage of data relating to the heart current detected by the sensor, and ' a transmission device for producing a electrical connection between the signal transmitter and the memory device and for activating the memory device due to the detection of a rhythm disturbance the detector. 20. Heart rhythm correction device according to claim 19, characterized in that that the storage and discharge device and the charging device simultaneously due to a single activated by the signal generated by the signal generator.