Communication system for intrabody communication

Abstract

A communication system for establishing intrabody communication comprises a number of implantable medical devices 1-3, each of the number of implantable medical devices 1-3 including a communication circuit 13, 23 for communicating with another of the number of implantable medical devices 1-3 using a first signaling technique. At least one external device 4, 5 includes a first communication circuit 41 for communicating with the number of implantable medical devices 1-3 using the first signaling technique and a second communication circuit 42 for communicating with a remote system 6 using a second signaling technique different from the first signaling technique.

Description

[Technical field]

[0001] The present invention relates generally to communication systems for intrabody communication and methods for operating communication systems. [Background technology]

[0002] Within the type of communication system described herein, communication is facilitated between implantable medical devices, such as cardiac stimulator devices (e.g., pacemaker devices or defibrillators), sensor devices, recording devices, or other medical devices implanted in a patient to provide therapeutic or diagnostic functions. This type of communication system may also be referred to as a Body Area Network (BAN) system.

[0003] An implantable medical device of the type concerned in this specification may be, for example, a pacemaker, an implantable cardioverter defibrillator, a sensor device such as a biosensor for measuring blood pressure, or a recording device such as a loop recorder that is implanted subcutaneously within the patient.

[0004] For example, an implantable pacemaker may be subcutaneously implanted in a patient and may include electrode-bearing leads that extend from a generator unit of the pacemaker device into the patient's heart to provide pacing function, e.g., to the right ventricle of the heart, or may be designed as a leadless pacemaker that does not include leads and is implanted directly into the patient's heart, e.g., in the right ventricle, to provide pacing function.

[0005] Defibrillators may operate to monitor and treat potentially life-threatening arrhythmias within a patient's heart. For example, this type of defibrillator may be implanted subcutaneously and may include leads that extend into the patient's heart to record signals and to inject stimulation energy into the patient's heart to deliver, for example, an electric shock (defibrillation).

[0006] For example, sensor devices such as pressure sensors, flow sensors, temperature sensors, etc. may be implanted within blood vessels, such as veins, to provide monitoring of relevant parameters under conditions of providing therapy.

[0007] For example, a loop recorder may be implanted subcutaneously and serve to continuously record information about cardiac activity, such as an ECG, etc. The loop recorder may continuously loop through its memory and store certain portions of the signal, and thus communicate the recorded signal to an external device for analysis of the signal and providing a diagnosis.

[0008] It is desirable for medical devices implanted in a patient to be able to communicate with each other to enable interaction of the medical devices. For example, signals sensed by a pacemaker device or an implanted sensor device may be transmitted to a loop recorder so that the loop recorder may record such signals. Additionally, a pacemaker device may receive signals from a sensor device implanted remotely from the pacemaker device in order to take into account the sensed signals of the sensor device for the purpose of controlling the pacing action in the patient's heart.

[0009] To establish communication, approaches exist to create an intra-body network (IBN) that links the implanted medical devices together so that signals can be exchanged between them.

[0010] For example, EP2327609B1 describes an acoustic communication link between implanted medical devices for exchanging information between the implanted medical devices, which is established to enable wireless communication between the implanted medical devices, and transmission parameters such as sensitivity and carrier frequency can be adapted to improve an existing communication link.

[0011] An implantable medical device may generally sense data that is to be communicated to another implantable medical device, and in addition, to an external device for further processing. Alternatively or in addition, an implantable medical device may receive configuration data from an external device to adapt the operation of the particular implantable medical device. To do this, it is necessary to establish communication with the external device.

[0012] In some approaches, a dedicated implantable medical device acts as a hub to provide a communication link to an external device with a dedicated communication concept different from the signaling adopted within the implantable medical device environment. This has the drawback that the implantable medical device acting as a hub exhibits increased energy consumption, since communication with an external device can be power intensive. Furthermore, communication with an external device depends on the correct functioning of the implantable medical device acting as a hub, and the hub must implement a different communication concept to be able to establish communication with the external device as well as with other implantable medical devices. Any failure of a dedicated implantable medical device acting as a hub may preclude communication with other implantable medical devices.

[0013] US Patent Application Publication No. 2006 / 0031378(A1) describes a system and method for providing digital data communication over a wireless intrabody network. A physical protocol layer is logically defined by identifiers uniquely assigned to multiple implantable devices in the intrabody network. Functions are specified within the physical protocol layer that allow for the exchange of data over the wireless interface. A slave implantable device is activated in response to an activation signal transmitted over the wireless interface by the master implantable device. A wireless communication link is established between the slave implantable device and the master implantable device when the identifiers assigned to the slave implantable devices match. Data is communicated within the body over the communication link.

[0014] US Patent Application Publication No. 2007 / 02083890(A1) describes an implanted sound sensor that communicates wirelessly with an implantable medical device or an external monitoring device. [Prior art documents] [Patent documents]

[0015] [Patent Document 1] EP2327609B1 issue [Patent Document 2] US Patent Application Publication No. 2006 / 0031378(A1) [Patent Document 3] US Patent Application Publication No. 2007 / 02083890(A1) Summary of the Invention [Problem to be solved by the invention]

[0016] It is an object of the present invention to provide a communication system and a method for operating a communication system that allows reliable and more power efficient communication between implantable medical devices as well as communication with external devices.

[0017] It is a further object of the present invention to provide intrabody communication that best supports the requirements of small, low energy implantable devices, minimizing energy consumption and maximizing system simplicity. [Means for solving the problem]

[0018] In one aspect, a communication system for establishing intrabody communications includes a number of implantable medical devices, each of the multiple implantable medical devices including a communication circuit for communicating with another of the multiple implantable medical devices using a first signaling technique, and at least one external device including a first communication circuit for communicating with the multiple implantable medical devices using the first signaling technique and a second communication circuit for communicating with a remote system using a second signaling technique different from the first signaling technique.

[0019] Furthermore, within the communication system, multiple implantable medical devices are configured to communicate with each other and with external devices using the first signaling technique, such that each of the implantable medical devices is capable of communicating with other implantable medical devices and with external devices, i.e. devices outside the patient's body.

[0020] Because external devices can communicate with any of the implantable medical devices (when implanted in the patient), there is no need for a single dedicated implantable medical device to act as a hub to relay communications. Rather, a common communication technique is used for intrabody communication between implantable medical devices as well as between implantable medical devices and external devices.

[0021] By utilizing the same signaling techniques for intrabody communication between implantable medical devices as for communication between an implantable medical device (while implanted) and one or many external devices, the implementation complexity for the communication circuitry of the intrabody devices can be minimized. Furthermore, the external device can address individual implantable medical devices without needing a specific intrabody hub to perform, for example, programming or interrogation tasks, and can provide, for example, network maintenance tasks in addition to monitoring the communication between the various medical devices.

[0022] Furthermore, by allowing the external device to communicate to any of the internal individual implantable medical devices, a depleted or failed battery in an implantable medical device will not prevent communication to other implantable medical devices.

[0023] The first communication circuitry of the at least one external device is specifically configured to communicate with each of the multiple implantable medical devices using the first signaling technique, such that any implantable medical device can communicate directly with one or multiple external devices without the need for relaying through another implantable medical device.

[0024] The first signaling technique and the second signaling technique enable wireless communication such that the communication system wirelessly extends to medical devices implanted in a patient as well as external devices using a common wireless signaling technique.

[0025] In one embodiment, the first signaling technique is based on a first physical layer signaling using modulated oscillating electric fields. For example, IntraBody Communication (IBC) techniques may be used for communication as described in the IEEE 802.15.6 WBAN protocol. Thus, the external device may be coupled to the patient using, inter alia, galvanic or capacitive coupling.

[0026] In another embodiment, the first signaling technique is based on physical layer signaling using acoustic signals, in particular ultrasonic signals. For this purpose, the communication circuitry of the implantable medical device as well as the at least one external device may be formed as an ultrasonic transducer packaged for vibrational coupling to a medium surrounding each of the implantable medical devices and the external device. The external device may be placed, for example, on the patient's skin for coupling to the patient, such that ultrasonic signals may be transmitted to and received from the patient.

[0027] In yet another embodiment, the first signaling technique is based on physical layer signaling using oscillating magnetic fields or electromagnetic wave signals, in which the implantable medical device as well as the at least one external device comprises a magnetic coil and a communication circuit using a modulated oscillating magnetic field for communication between the implantable medical devices and for communication with the external device.

[0028] In another embodiment, the first signaling technique is based on a physical layer using RF technology with a carrier frequency suitable for penetrating body tissue.

[0029] Within the communication, a common physical layer signaling as well as a common communication protocol is used for communication between the implantable medical device and at least one external device. As used herein, the physical layer refers to a logical layer that defines the physical signaling between different devices using a common technology with a common communication protocol. As used herein, each implantable medical device as well as the at least one external device may be identified with a unique identifier within a communication message, such that messages sent through the patient's body are received by all devices and processed by the devices according to the identifier information contained within the message.

[0030] In one embodiment, the at least one external device is configured to contact the patient externally. For example, the at least one external device is configured to be worn on the patient's body. For example, the at least one external device may have the shape of a watch and thus be worn on the patient's wrist, with a contact surface of the at least one external device configured to be brought into contact with the patient's skin for coupling to the patient, for example for introducing electrical or acoustic signals (particularly ultrasound signals) to the patient or for receiving such signals from the patient.

[0031] Furthermore, the at least one external device implements a second signaling technique, which is based on a second physical layer signaling, for example, using RF signals. The second signaling technique may employ a standardized communication technique, such as, for example, a Bluetooth technique, in particular Bluetooth Low Energy (BLE), a Zigbee technique, a Near Field Communication (NFC) technique, or a Wi-Fi technique.

[0032] The second signaling technique implements a second (logical) physical layer for establishing communication between at least one external device and a remote system, such as a remote server accessible via a public communication network, such as the Internet. With the second signaling technique, the at least one external device may be connected to a communication device acting as a relay device, such as a local computer, a mobile device, such as a smart phone, or another local device in the vicinity of the patient, and with the second signaling technique, communication may be established, particularly within a local environment. With the communication device, data may be relayed to and from the remote system, for example using a common communication protocol scheme with the public communication network.

[0033] In one embodiment, the second signaling technique is based on a second physical layer using acoustic signals. For example, the second communication circuit of the at least one external device may include an acoustic transducer configured to generate an acoustic signal in an audible acoustic frequency band, e.g., between 50 Hz and 8 kHz, which may be transmitted using a Public Switched Telephone Network (PSTN). For example, to relay data to a remote system, a user may use a telephone to call a telephone number associated with a central server link station. The user may then place at least one external device in proximity to a microphone of the telephone, such that the acoustic signal generated by the at least one external device may be transmitted to the remote system via the telephone, thereby allowing data transmission without the need for an Internet connection or other specialized hardware.

[0034] In one embodiment, at least one of the implantable medical devices is a cardiac stimulation device, such as a pacemaker device or a defibrillator.

[0035] In one embodiment, at least one of the implantable medical devices is a leadless cardiac stimulation device, which is a cardiac stimulation device that does not have any electrodes carrying leads. This type of leadless cardiac stimulation device can be implanted directly in the patient's heart, for example in the right ventricle or right atrium.

[0036] Generally, one or multiple implantable medical devices of the communication system may be implanted subcutaneously or directly into the patient's heart. For example, in one embodiment, one implantable medical device is implanted in the right ventricle of the patient's heart and another implantable medical device is implanted in the right atrium, and communication is established between the intracardiac implantable medical devices in the communication system.

[0037] In one embodiment, at least one of the implantable medical devices is a subcutaneous cardiac loop recorder or a biosensor for measuring blood pressure.

[0038] Generally, within a communication system, different implantable medical devices, e.g., in the form of a stimulating device, a sensing device, a recording device, or a marking device, may communicate with another device and with at least one external device using a common (first) signaling technique, which requires a common physical layer as well as a common communication protocol.

[0039] In one embodiment, within the communication system, an intracardiac pacemaker is implanted in the right ventricle and an intracardiac pacemaker is implanted in the right atrium.

[0040] In one embodiment, within the communication system, an intracardiac pacemaker is implanted in the right ventricle and a loop recorder is implanted subcutaneously.

[0041] In one embodiment, within the communication system, an intracardiac pacemaker is implanted in the right ventricle and a sensor (e.g., a biosensor) for measuring blood pressure is implanted in the patient's blood vessel and / or integrated into the intracardiac pacemaker.

[0042] A communication system can be based on the optimization of energy saving using modulated oscillating electric fields for communication between devices implanted in the body. Such communication concepts utilize high frequency electric pulses modulated with either phase-shift keying (PSK) or on-off keying (OOK) to convey bit information. In both cases, the carrier frequency can be generated by a square pulse shaped signal with a 50% duty cycle. In the case of PSK modulation, the carrier frequency signal is continuous and a phase shift of the carrier frequency indicates a change in the transmitted bit value. In the case of OOK modulation, the presence of the carrier frequency for a given time represents a code for a bit value 1, and the absence of the carrier frequency, also for a given time frame, represents a code for a bit value 0. This basic principle of OOK modulation makes it a good candidate for a simple communication concept with good energy saving potential.

[0043] An OOK modulated oscillating electric field with a carrier frequency of a square pulse signal shape with a 50% duty cycle can have two available energy saving parameters. 1 A given time used to define a bit duration (0 or 1) 2 Duty cycle used for carrier frequency of square pulse signal

[0044] Tests have shown that demodulating an OOK modulated oscillating electric field can significantly reduce the time of the pulse width and therefore the duty cycle. Reducing the duty cycle for the active part of the pulse interval effectively produces a broadband signal. The narrower the pulse, the wider the frequency spectrum. Applying both energy saving methods to the generation of communication signals can result in significant energy savings compared to the existing state of the art in the industry. This can be seen by comparing the active signal time (AST) as used in existing technologies (e.g. ZAND communication) with test results utilizing energy optimized signal parameters. Since AST represents time and the active voltage is applied to the transmitting electrodes, reducing the AST directly reduces the energy required to generate the transmit signal.

[0045] The AST in OOK may by design only apply to bit transmissions of value 1, and a given bit time may be expressed as the number of carrier frequency intervals required for that time. Finally, for square pulse shape duty cycles that further limit the active signal time, the AST may be AST=(1 / fc)*N*DC where: fc = carrier frequency, N = number of carrier frequency intervals, and DC = carrier frequency is the duty cycle of the square pulse shape.

[0046] For communication with OOK modulation, the number of intervals may be about 60 and the duty cycle used may be 0.5 (50%). For example, with the parameter N set to 10 and the duty cycle value set to 0.1 (10%), successful communication may be achieved, resulting in a 30-fold energy reduction compared to the settings above.

[0047] The above described embodiments and any combination thereof allow the implanted device to perform communication without utilizing any complex technology and with minimal energy consumption.

[0048] In another aspect, a method for operating a communications system for intrabody communications includes establishing communications among multiple implantable medical devices, each having communications circuitry for communicating with another of the multiple implantable medical devices using a first signaling technique, establishing communications between the multiple implantable medical devices and at least one external device having a first communications circuitry for communicating with the multiple implantable medical devices using the first signaling technique, and establishing communications between the remote system and at least one external device having a second communications circuitry for communicating with the remote system using a second signaling technique, different from the first signaling technique.

[0049] The advantages and advantageous embodiments explained above for the communication system equally apply to the present method and reference is made in this respect to the same.

[0050] The various features and advantages of this invention can be more readily understood with reference to the following detailed description and the illustrative embodiments illustrated in the drawings. [Brief description of the drawings]

[0051] [Figure 1] FIG. 1 is a schematic diagram of a communication system for a medical device implanted in a patient. [Diagram 2] 1 is a schematic diagram of two medical devices between which a communication link for data communication is established; [Diagram 3] FIG. 1 is a schematic diagram of a communication system including multiple medical devices implanted in a patient and a variety of external devices. [Figure 4] FIG. 1 is a schematic diagram of physical layer signaling between an implantable medical device, an external device, and a remote system. [Diagram 5] FIG. 1 illustrates an example of data transmission between an external device and a remote system using acoustic signaling techniques. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0052] Next, embodiments of the invention will be described in detail with reference to the drawings, in which like reference numbers indicate similar structural elements, and in which:

[0053] It should be noted that the examples are not limiting of the invention but merely provide illustrative examples.

[0054] Referring to FIG. 1 , implantable medical devices 1, 2, 3 may be implanted in a patient P at different locations to provide different functions within the patient P's body. For example, medical device 1 in the form of a leadless pacemaker device may be implanted in the right ventricle RV of the patient's heart H to provide a pacing function within the heart H. Another medical device 2, for example in the form of a loop recorder, may be implanted subcutaneously in the chest, which may record signals and communicate, for example, with an external device, to monitor certain parameters within the patient P's body. Another implantable medical device 3, in the form of a sensor device, for example a pressure sensor, flow sensor, temperature sensor, etc., may be implanted, for example, in a blood vessel to sense a characteristic parameter such as blood pressure or blood flow.

[0055] Generally, it is desirable to have data communication between the different medical devices 1, 2, 3 implanted in the patient P. There are ways to establish this kind of communication in wireless form by establishing an intrabody network system linking the medical devices 1, 2, 3 together, in such a way that data can be exchanged between the medical devices 1, 2, 3. Thus, a loop recorder may record for example sensor data of a sensor device or data of a pacemaker or defibrillator and provide the data to the pacemaker or defibrillator for example to control the action of a therapy.

[0056] To enable data communication, a communication link needs to be established between the medical devices 1, 2, 3. Herein, signals are exchanged in modulated form using a particular transmission technology, such as the transmission of acoustic, electric or magnetic (inductive) signals, and a particular modulation scheme, such as PCM, FSK, PSK, QPSK, FM or AM modulation.

[0057] Referring now to FIG. 2, the medical devices 1, 2 implanted in the patient P may have a small build and may be designed to have low power consumption in order to remain within the patient P's body for an extended period of time.

[0058] A first medical device 1, e.g., in the form of a leadless pacemaker, herein may comprise a housing 10, control circuitry 11, an electrode arrangement 12 for emitting stimulation signals and receiving sensing signals, communication circuitry 13, and an energy storage unit 14, e.g., in the form of a battery.

[0059] The second medical device 2, for example in the form of an implantable sensor device such as a pressure sensor or in the form of a loop recorder, may comprise a housing 20, a control circuit 21, a communication circuit 23 and an energy storage unit 24, for example in the form of a battery.

[0060] The communication circuits 13, 23 each comprise a transmitting unit 130, 230 and a receiving unit 131, 231. The communication circuits 13, 23 are designed for a specific transmission technology, i.e. for transmitting and receiving acoustic, electric or magnetic signals, and are also designed to modulate the transmitting and receiving demodulation signals, respectively, to optimize the transmission parameters, amplify the received signals and process the signals in order to transfer the processed signals to the control circuits 11, 21 for analyzing and controlling the operation of the medical devices 1, 2.

[0061] Generally, within the communication system as shown diagrammatically in Fig. 1, communication between the implantable medical devices 1, 2, 3 is established by means of a communication link. For example, referring to Fig. 2, a communication link L is established between the medical devices 1, 2, for example upon initial power-up of one of the medical devices 1, 2 or after a sleep mode exists after a long duration of inactivity of the medical devices 1, 2. Herein, the medical device 1, 2 wishing to establish communication may emit a trigger signal, for example towards the other medical device 2, 1, indicating that the medical device 1 wishes to establish communication. The communication is then carried out by means of a common physical layer signaling, employing, for example, a signaling technique using electrical, acoustic or magnetic signals.

[0062] Referring now to FIG. 3, medical devices 1, 2, 3 implanted in a patient P are connected via a communication link L 12 , L 13 , L 23 For example, measurement data may be transmitted from a sensing device to a receiving device via such a communication link L for processing by the receiving device. 12 , L 13 , L 23 via a 32-bit oscilloscope and then transmitted to a recording device such as a loop recorder or a stimulation device.

[0063] Furthermore, the medical devices 1, 2, 3 implanted in the patient P may communicate with one or many external devices 4, 5 in order to transmit data, e.g. measurement data, from the medical devices 1, 2, 3 towards the external devices 4, 5 or to receive configuration data from the external devices 4, 5 in order to adapt the operation of the implanted medical devices 1, 2, 3. In this specification, communication is referred to as communication via a communication link L connecting the external devices 4, 5 and the implanted medical devices 1, 2, 3 to each other. 15 , L 25 , L 35 , L 34 Furthermore, the external devices 4, 5 also communicate via the communication link L 45 They can communicate with each other via

[0064] In this specification, in order to facilitate communication between the internal medical devices 1, 2, 3 and the external devices 4, 5, it is proposed to use a common communication technology for both the internal internal devices 1, 2, 3 and the external devices 4, 5, such that the medical devices 1, 2, 3 can communicate with the external devices 4, 5, as well as with each other, using the same communication technology.

[0065] A common communication technology requires, among other things, common physical layer signaling and common communication protocols.

[0066] For example, the implantable medical devices 1, 2, 3 and the external devices 4, 5 may use signaling techniques based on physical layer signaling using modulated oscillating electric fields. For example, standardized Intrabody Communication (IBC) signaling may be employed using galvanic or capacitive coupling of the external devices 4, 5 to the patient P.

[0067] In another embodiment, the implantable medical devices 1, 2, 3 and the external devices 4, 5 may use a signaling technique based on physical layer signaling using acoustic signals, in particular ultrasonic signals. In this case, the implantable medical devices 1, 2, 3 and the external devices 4, 5 employ acoustic transducers to couple with the surrounding medium. In particular, the implantable medical devices 1, 2, 3 may employ transducers in contact with tissue. The external devices 4, 5 may be placed on the patient's skin, for example when the external device 4 has the shape of a wristwatch in the embodiment of FIG. 3.

[0068] In yet another embodiment, the implantable medical devices 1, 2, 3 and the external devices 4, 5 may use a signaling technique based on physical layer signaling using modulated oscillating magnetic fields. In this case, the medical devices 1, 2, 3 and the external devices 4, 5 comprise transducers in the form of magnetic coils that induce an oscillating magnetic field.

[0069] In yet another embodiment, the implantable medical devices 1, 2, 3 and the external devices 4, 5 may use a signaling technique based on physical layer signaling using modulated electromagnetic waves, in which case the medical devices 1, 2, 3 and the external devices 4, 5 are equipped with transducers in the form of suitable antennas.

[0070] One or many of the external devices 4, 5 may be placed on the patient's skin and thus worn by the patient P, for example, in the case of the external device 4 being in the form of a wristwatch in the embodiment of FIG.

[0071] Communications between the implantable medical devices 1, 2, 3 among one another, between the implantable medical devices 1, 2, 3 and the external devices 4, 5, and between the external devices 4, 5 among one another using common signaling techniques are based on the transmission of modulated signals, which may encode identifier information that identifies and addresses the devices 1-5. Herein, each device 1-5 may be identified by a unique identifier such that messages may be exchanged between the devices 1-5.

[0072] Thus, the communication links shown in Figure 3 are established as logical links, with signals generally being transmitted using the body of the patient P as the wave-guiding medium, and in that way a signal transmitted from one device 1-5 will generally be received by all devices 1-5 coupled in the network, but can be distinguished by identifier information encoded within the signal.

[0073] In the embodiment of Fig. 3, the external devices 4, 5 are configured to communicate with a remote system 6, e.g. a remote server system in a public communications network such as the Internet. For example, data may be transmitted from one or both of the external devices 4, 5 to the remote system 6 and may be received by the external devices 4, 5 from the remote system 6. The remote system 6 communicates with the external device 4 via an external link E4 and with the external device 5 via an external link E5.

[0074] 4, each of the external devices 4, 5 comprises a first communication circuit 41 for establishing communication with the implantable medical devices 1, 2, 3 using a common physical layer signaling PHY 1. With the common physical layer signaling PHY 1, communication can be established individually between the external devices 4, 5 to any of the implantable medical devices 1, 2, 3, and in that way data can be exchanged between the external devices 4, 5 and any of the implantable medical devices 1, 2, 3.

[0075] Furthermore, the external device 4, 5 comprises a second communication circuit 42 for establishing communication with a remote system 6 using a physical layer signaling PHY2 different from the physical layer signaling PHY1. By means of the second communication circuit 42 data can be exchanged with the remote system 6.

[0076] The physical layer signaling PHY2 may utilize standard proximity communication methods such as Bluetooth, Zigbee, Near Field Communication (NFC), or Wi-Fi. In this specification, to establish communication with a remote system 6, a connection using the physical layer signaling PHY2 may be established to a local communication device 7, such as a mobile device or a local computer, which relays data and communicates with the remote server 6 via a public communication network. The remote system 6 can be a remote server 6, or vice versa.

[0077] The control unit 40 serves to control the operation of the external devices 4, 5 and processes data. For example, the control unit 40 may be configured to convert data between different communication circuits 41, 42 for transmission between the remote server 6 and the implantable medical devices 1, 2, 3.

[0078] 5, in one embodiment, the local communication device 7 may have the form of a regular telephone connected to the remote system 6 via the Public Switched Telephone Network (PSTN). The communication circuitry 42 of the external device 4, 5 may be configured to generate, for example, an acoustic signal in the audio frequency range, for example between 50 Hz and 8 kHz, which may be transmitted via regular telephone lines. To establish communication with the remote system 6, a user may, for example, call a telephone number associated with a central server link station of the remote system 6, and the user may place the external device 4, 5 in proximity to the microphone of the telephone, such that data may be transmitted to the remote system 6 via the local communication device 7 in the form of a telephone using the acoustic signal.

[0079] The implantable medical devices 1, 2, 3 in the communication system may be, for example, cardiac stimulation devices such as leadless pacemaker devices or defibrillators, sensing devices such as biosensors for sensing, for example, blood pressure, or recording devices such as loop recorders.

[0080] In general, the implantable medical devices 1, 2, 3 may be fully or partially implanted directly into the patient's heart, for example in the right ventricle or right atrium. In another embodiment, the implantable medical devices 1, 2, 3 may be fully or partially implanted subcutaneously in the patient.

[0081] Since communication between the external devices 4, 5 and the implantable medical devices 1, 2, 3 in the above embodiments can, in some cases, only be established by bringing the external devices 4, 5 into close proximity to the patient P, advantageously in contact with the patient's skin, an inherent increase in safety is achieved in that communication with the implantable medical devices 1, 2, 3 cannot easily be damaged or interrupted. [Explanation of symbols]

[0082] 1, 2, 3 Implantable Medical Devices 10, 20 Case 11, 21 Control circuit 12 Electrode device 13, 23 Communication circuits 130, 230 sending unit 131, 231 receiving unit 14, 24 Energy storage unit 4, 5 External equipment 40 Control Unit 41 Communication Circuits 42 Communication Circuits 6 Remote System (Remote Server) 7. Communications Equipment E4, E5 External link H Heart L Communication Link L 12 -L 45 Communication Links P patient PHY1, PHY2 Physical Layer Signaling RV right ventricle

Claims

1. 1. A communication system for establishing intrabody communication, comprising: a number of implantable medical devices (1-3), each of the number of implantable medical devices (1-3) including a communication circuit (13, 23) for communicating with another of the number of implantable medical devices (1-3) using a first signaling technique; at least one external device (4, 5) including a first communication circuit (41) for communicating with the multiple implantable medical devices (1-3) using the first signaling technique, and a second communication circuit (42) for communicating with a remote system (6) using a second signaling technique different from the first signaling technique; A communication system comprising:

2. 2. The communication system of claim 1, wherein the first communication circuit (41) of the at least one external device (4, 5) is configured to communicate with each of the multiple implantable medical devices (1-3) using the first signaling technique.

3. 3. The communication system according to claim 1 or 2, wherein the first signaling technique is based on a first physical layer signaling using oscillating electrical signals.

4. 3. The communication system according to claim 1 or 2, wherein the first signaling technique is based on a first physical layer signaling using ultrasound signals.

5. 3. The communication system according to claim 1 or 2, wherein the first signaling technique is based on a first physical layer signaling using oscillating magnetic or electromagnetic wave signals.

6. 3. The communication system according to claim 1 or 2, wherein the at least one external device (4, 5) is adapted for externally contacting the patient.

7. 3. The communication system according to claim 1 or 2, wherein the at least one external device (4, 5) is adapted to be worn on the body of a patient.

8. 3. The communication system of claim 1, wherein the second signaling technique is based on a second physical layer signaling using RF signals.

9. The communication system of claim 8 , wherein the second signaling technique is based on a Bluetooth technique, a Zigbee technique, an NFC technique, or a WiFi technique.

10. 3. The communication system according to claim 1 or 2, wherein the second signaling technique is based on a second physical layer using acoustic signals.

11. 3. The communication system according to claim 1 or 2, comprising a communication device (7) coupled to the at least one external device (4, 5) for establishing data transmission between the at least one external device (4, 5) and the remote system (6) using the second signaling technique.

12. The communication system according to claim 1 or 2, wherein at least one of the multiple implantable medical devices (1-3) is a cardiac stimulation device.

13. 3. The communication system of claim 1, wherein at least one of the multiple implantable medical devices (1-3) is a leadless cardiac stimulation device.

14. The communication system according to claim 1 or 2, wherein at least one of the multiple implantable medical devices (1-3) is a subcutaneous cardiac loop recorder or a biosensor for measuring blood pressure.

15. 1. A method for operating a communication system for intrabody communication, comprising: establishing communication between a number of implantable medical devices (1-3), each having a communication circuit (13, 23) for communicating with another one of the number of implantable medical devices (1-3) using a first signaling technique; establishing communication between said multiple implantable medical devices (1-3) and at least one external device (4, 5) having a first communication circuit (41) for communicating with said multiple implantable medical devices (1-3) using said first signaling technique; establishing communication between said at least one external device (4, 5) having a second communication circuit (42) for communicating with said remote system (6) using a second signaling technique different from said first signaling technique, and said remote system (6); The method includes:

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