Implantable pulse generator for two-stage therapy

1 . An implantable medical device for generating electrical stimulations, wherein the medical device is embodied to generate and emit, a first therapy treatment via a first stimulation phase, wherein at least one first stimulation that has a first amplitude is generated by means of energy from an energy storage element, and a second therapy treatment via a second stimulation phase following the first stimulation phase when it is determined that the at least one first stimulation does not result in a therapy treatment success, wherein at least one second stimulation that has a second amplitude is generated by means of energy from the energy storage element, wherein the energy storage element is charged prior to the generation of the at least one first stimulation and after the generation of the at least one first stimulation but before generation of the at least one second stimulation, wherein the medical device is embodied not to completely discharge the energy storage element by generating the at least one first stimulation, wherein the energy of the at least one first stimulation is less than the energy of the at least one second stimulation, or the total energy of a plurality of first stimulations in the first stimulation phase is less than the total energy of a plurality of second stimulations in the second stimulation phase, and wherein the implantable medical device includes a control unit configured for terminating the first stimulation phase and continuing with the second stimulation phase when a predefined quantity of energy of the at least one first stimulation has been used without therapy success and/or when the first stimulation phase has not demonstrated any therapy success over a predefined or programmed period, wherein the first stimulation phase is divided into subphases with a parameter set for a highest therapy success in a first subphase followed by additional subphases with parameters sets in the sequence of decreasing chances of success.

2 . The implantable medical device according to claim 1 , wherein the second amplitude is greater than the first amplitude.

3 . The implantable medical device according to claim 1 , wherein the implantable medical device has an energy source and a charging circuit, the charging circuit being configured to charge the energy storage element up to a target energy level (E z ) by means of the energy source.

4 . The implantable medical device according to claim 3 , wherein the control unit is configured to initiate the generation and emission of the at least one first stimulation when charging the energy storage element before an energy level (E c ) of the energy storage element has achieved the target energy level (E z ).

5 . The implantable medical device according to claim 4 , wherein the control device is configured to initiate the generation and emission of the at least one second stimulation only if the target energy level (E z ) has been achieved during charging of the energy storage element.

6 . The implantable medical device according to claim 1 , wherein the implantable medical device has a detection unit that is embodied to detect events from a tissue stimulated by means of the stimulations.

7 . The implantable medical device according to claim 6 , wherein the control unit is configured to initiate the generation and emission of the at least one second stimulation when one or a plurality of detected events satisfy a predefined criterion.

8 . The implantable medical device according to claim 1 , wherein the at least one second stimulation is designed for defibrillation of a patient's heart.

9 . A method for controlling an implantable medical device, in particular an implantable medical device according to claim 1 , comprising the steps:

Emitting, via a first therapy treatment, at least one first stimulation from an energy storage element of the device during a first stimulation phase, the at least one first stimulation having a first amplitude, wherein the at least one first stimulation phase is divided into subphases with a parameter set for a highest therapy success in a first subphase followed by additional subphases with parameters sets in the sequence of decreasing chances of success,

Emitting, via a second therapy treatment, at least one second stimulation from the same energy storage element during a second stimulation phase following the first stimulation phase when it is determined that the at least one first stimulation does not result in a therapy treatment success, the at least one second stimulation having a second amplitude, wherein the energy storage element is charged prior to and following the emission of the at least one first stimulation but before the emission of the at least one second stimulation, and wherein the energy storage element is not completely discharged by the at least one first stimulation, and

Terminating the first stimulation phase and continuing with the second stimulation phase when a predefined quantity of energy of the at least one first stimulation has been used without therapy success and/or when the first stimulation phase has not demonstrated any therapy success over a predefined or programmed period.

10 . The method according to claim 9 , wherein the second amplitude is greater than the first amplitude.

11 . The method according to claim 9 , wherein the energy storage element is charged up to a target energy level (E z ).

12 . The method according to claim 11 , wherein the at least one first stimulation is emitted before an energy level (E c ) of the energy storage element has achieved the target energy level (E z ).

13 . The method according to claim 12 , wherein the at least one second stimulation is not emitted until the target energy level (E z ) has been achieved during charging of the energy storage element.

14 . The method according to claim 9 , wherein events from tissue to be stimulated by means of the stimulations are detected by means of the device, the at least one second stimulation being emitted when at least one detected event satisfies a predefined criterion.