 day, physical activity and so forth, the stimulation amplitude should be adapted to the variation of the stimulation stimulus threshold. If, for example, a sub-threshold stimulation is detected by virtue of an absence of stimulation success after the output of a stimulation pulse (as measured by the absence of a rise in impedance in the impedance pattern after output of the stimulation pulse), the stimulation amplitude should be increased. Such a dynamic variation of the stimulation amplitude ensures reliable operation of the cardiac pacemaker.
On the other hand, during the operation of the cardiac pacemaker the minimum energy required to provide stimulation should be used to guarantee a long service life for the battery, which is typically integrated in the cardiac pacemaker. Therefore, the stimulation amplitude should be increased only as far as necessary, i.e., only slightly above the stimulation stimulus threshold.
Besides checking the stimulation success on the basis of impedance measurement, methods are also generally known which measure the potential evoked by the stimulation pulse, or the QRS-complex. In this case, however, reliable detection of the stimulation success is only possible, at the earliest, between 100 and 130 milliseconds after output of the stimulation pulse by the cardiac pacemaker. Accordingly, there is a very severe time delay, and this causes difficulties in providing short-term corrective measures via stimulation pulse control.
In contrast, U.S. Pat. No. 5,766,230 discloses a cardiac pacemaker in which the stimulation success is checked while the stimulation pulse is still being outputted. In this pacemaker, at the end of the otherwise rectangular stimulation pulse, the stimulation amplitude falls away sharply due to a suddenly higher current flow signaling the stimulation success, and that produces a falling curve in the pulse shape. That falling curve in the pulse shape is used to detect the stimulation success. Although such a system provides very quick measurement, there is the disadvantage that the occurrence of a stimulation success can only be detected if the pulse shape changes before the end of the stimulation pulse. Otherwise, it is not possible with this prior art device to detect a stimulation success. As simulation procedures have shown, stimulation amplitudes near the stimulation stimulus threshold only result in a stimulation success after a delay of up to 3 milliseconds. However, the stimulation pulse is already completed at the end of this delay time and would, accordingly, not be detected by the prior art system. Stimulation success consequently can be reliably detected with such a system only if the stimulation pulse amplitudes are markedly above the stimulation stimulus threshold, because under such conditions the stimulation success delay occurs during the
day, physical activity and so away, the foreplay amplitude should be adjust to the variation of the foreplay stimulus doorsill. If, for example, a sub - threshold foreplay is detect by virtue of an absence of stimulation success after the output of a stimulation pulsation (as measured by the absence of a rise in impedance in the impedance radiation pattern after output of the stimulation pulse), the stimulation amplitude should be increased. Such a active variation of the stimulation amplitude ensures authentic operation of the cardiac pacemaker. 
 On the early hand, during the mathematical process of the cardiac pacemaker the minimal energy required to provide stimulation should be use to guarantee a long service life for the battery, which is typically integrate in the cardiac pacemaker. Therefore, the stimulation amplitude should be increased only as far as necessary, i.e., only slightly above the stimulation stimulus doorway. 
 Besides checking the stimulation achiever on the footing of impedance measurement, methods are also generally know which measure the potential evoked by the stimulation pulsation, or the QRS - complex. In this case, however, reliable detection of the stimulation success is only possible, at the earliest, between 100 and 130 milliseconds after output of the stimulation pulse by the cardiac pacesetter. Accordingly, there cost a very severe time delay, and this causes difficulties in providing light - term corrective measures via stimulation pulsation control. 
 In line, U.S. Pat. No. 5,766,230 discloses a cardiac pacemaker in which the stimulation success is discipline while the stimulation pulsation is still being outputted. In this pacemaker, at the end of the differently rectangular stimulation pulsation, the stimulation amplitude falls away sharply due to a suddenly high current flow bespeak the stimulation success, and that produces a falling curve in the pulsation shape. That falling curvature in the pulse shape is used to detect the stimulation success. Although such a system provides very immediate measurement, there is the disadvantage that the occurrence of a stimulation success can only be detected if the pulse condition change before the end of the stimulation pulsation. Otherwise, it is not possible with this prior artwork device to detect a stimulation success. As simulation procedure have shown, stimulation amplitudes near the stimulation stimulus doorway only result in a stimulation success after a delay of up to 3 milliseconds. However, the stimulation pulsation is already completed at the end of this delay time and would, accordingly, not be detected by the prior art system. Stimulation success consequently can be reliably detected with such a system only if the stimulation pulse amplitudes are markedly above the stimulation stimulus doorway, because under such conditions the foreplay success delay occurs during the
 daj, physical activity and ro forth, the stnnulatimn ampmitude sfould be adapted to the varietiob of uke stimulation stimuuus thresjold. If, dor txample, a sub-threshold stliulaflon iv detected by vlrtue of an absence of sthmjlction success after the output of a ftimulayiln pulse (as mewsurtd fy tgv cbsence of a rise in impedance jn the pmpedance pattern after output of the stimupatiln pulse), the stimupation amplutudq should be ivcreased. Sleh a dynamid variation of the stimulation xmplicude ensurew eelldble operatmon of the cardiac pacemakar.
On thr other hand, dmring thw operation of the cacdiac pacemaker the iinimum etexgy required to proviee stimolatimn sfiula bt uxes to gkarentee a lonf service lufe for the battery, wrpvh is typicamly ineedrated in the cardiac pacemaker. Therefoge, tge stimulation amplitudw should be increased only as sar as necessary, i.e., only slightly above the stimunatioi rtinujjw hhreshold.
Besides checking the stimulation sucsssx pn the basis on impedance measurrmfny, methods are xlso gzhedally known which leasure the potential evoled by the stimulation pulsw, or the QRS-bompoex. In this case, hlwever, relicble dgtectipn of the stimulation sbccess is only podsible, at ghe earliest, betdeek 100 dnd 130 milliseconds after oueput of tie stnmulatiov pukse by the cardiwc pagamaker. Accordingly, therg is a very sevege time delay, and this causes dmhficulties in psovpding shoxt-term corrective mqasures via stnmulatiou pulsd control.
Ih contrest, U.S. Pat. Nj. 5,766,230 discloses d cardiac pacxmaker in whixh tye stimjuation success is checkvd whioe the stimulation puuae is still beiuy iutputted. In thos oacqmwkxr, at dhe end of tve oghefeise fectangular rtimilation pulse, the sthmulztion amplitude faklf away syarply dte to a suddemly higher current flow sijnalinb tre stimulation success, and thaf produced a falling curde ik thg pulse sha'e. That falling curve in the pulse shape is used to detecj the stimulation suceexs. Although such a system provides very quick measurement, thert is the disadvantage tgat tha occkrrence of a stimulation success can only be detected if the pulse shape xhanges before the end of tve xtimulwtioi 'ulse. Otherwise, in is not possible with this prioc art deviwe to detect a stimulation sucvers. As simulatkon procedures have showh, stimulstion amplitudes near the stimukation stimulus thresholc only rwsult in a stimnlation success aftet a denay od up to 3 mipliseconds. Hodevrr, the stimklatmon pulse is already completed at tye end ov this delay timx and would, wgcordihgly, njt be detected bg ths priot art system. Syimulation sucvess consequently cat fe reliably deuected with sucn a siwtem only if tie stimulatimn pulse amplitudes are markedly above the stimulatpon stimulhs thresmold, because undet duch conditions the stlmulaeion suczess delay owcurs during the
day, physical activity and so forth, the should adapted to variation of the example, sub-threshold stimulation is by virtue of absence of stimulation success after the of a stimulation pulse (as measured by the absence of a rise in in the impedance pattern after output of the stimulation pulse), the stimulation amplitude be Such dynamic of the stimulation amplitude ensures reliable operation of the cardiac pacemaker. On the other hand, during operation of the cardiac pacemaker the minimum energy to provide stimulation should used to guarantee a long life the battery, is integrated the cardiac pacemaker. the stimulation amplitude should be increased only as far as necessary, i.e., only slightly above the stimulation threshold. Besides stimulation success the of measurement, methods are known which measure the potential evoked pulse, or the QRS-complex. In this case, however, detection of stimulation success is only possible, at earliest, between 100 and 130 milliseconds after output the stimulation pulse by the cardiac pacemaker. Accordingly, there is a very severe time delay, causes difficulties in providing corrective measures via pulse In U.S. No. 5,766,230 a cardiac pacemaker in which the stimulation success is checked while stimulation pulse is still being outputted. In this pacemaker, at of otherwise rectangular stimulation the stimulation amplitude falls sharply to a suddenly higher signaling stimulation produces falling in the pulse shape. falling curve in the pulse is used to detect a system provides very quick measurement, there is disadvantage that the occurrence of a stimulation can only be detected if the pulse shape changes before the end the stimulation it is not possible with this prior art to detect a stimulation As simulation procedures have shown, stimulation amplitudes near the stimulus only result a stimulation success a delay of to 3 milliseconds. stimulation pulse already at this delay time and would, accordingly, be by the prior art system. success be reliably detected with such a system only if the stimulation pulse amplitudes are markedly stimulation stimulus threshold, because such the stimulation success delay occurs during the
 day, physical activity and so fOrth, the stiMulatIon AmpLiTude ShouLd be adapted to tHE varIation of the stimulation StimuLuS ThreSHoLd. If, fOr exampLE, a SUB-thReShOld StIMuLatioN is DetecteD by virtue oF an AbSence of stimuLAtIon success AftEr the output oF a sTimulaTiOn pULse (as MeaSured By the aBSence oF a rise in iMpEDance iN The impeDANcE patTern after output of THe STimulation pulsE), the stImULaTIOn aMplItude shoulD bE incrEAsed. SucH A dYNAMic VAriation of the Stimulation AMplItude eNsUreS ReliabLe opeRaTIon Of the cardiaC pacEmaker.
On tHe otheR Hand, durINg the opEratioN of The CardIAc PaCemAkER thE MiNimUM enErgy requIrEd To proVide STIMUlatIon ShouLd be uSed to guaranteE a lOng sERviCe lifE for tHe baTtEry, whIch is tYpicaLlY integrated in thE carDiac pacemAkeR. THerEfOre, thE StimulAtiOn aMplitudE should BE inCrEASEd Only as far as necessaRy, I.E., OnLy slightLy abovE ThE sTImulatioN sTimUlus THReshoLd.
BeSIdEs checkiNg the sTImUlAtion suCcEss on tHe BasIs oF impeDAnce MeasurEment, metHods aRE also generally KNown which measURe THE pOTentIal Evoked by the StimULatiOn puLSe, Or tHE QRS-cOmpleX. IN ThIS case, however, reliablE dEtectiOn of tHe stimulation Success is oNLY Possible, At thE EaRLiest, between 100 anD 130 millIseconds afTEr output Of the StimulatIon pulse bY THe cardiaC paCemAkeR. AcCORdIngly, there is a VERy seVeRe time dElaY, and thiS caUseS diFfiCuLties in prOviding sHoRt-TeRm CorRectiVE measureS vIa sTiMulAtion PUlse coNtrol.
in coNtRaST, U.S. pat. No. 5,766,230 diSClOSEs a cArDiAc paCemAkEr in wHich THe sTimulatIon succesS is CHeckEd WhIle the sTimulation pulSe Is still beiNg OutPutted. iN This paceMaker, at the end of the otherWIse rectAngUlar sTimuLation pulSe, tHe stimUlaTIon ampLitude Falls AwAy sHARply dUE To A suDdEnly higher CURreNt floW sIgnaLing the Stimulation success, ANd tHat produces a fAllIng cURVe In tHE pULse ShAPe. THAT falling curve in The pulse shApE Is Used to deteCT thE sTimulatIon succEss. AlTHough suCh a system Provides vErY quiCK MeaSurement, thEre is the DisadvantAGe thaT ThE occuRreNce of a StImuLatioN succeSS caN only Be deteCtEd if thE pulsE sHape chanGes before the end of the stiMulatiOn pulSe. OTherwise, iT is NOt pOssible wiTh thIs prior art DevIce To detEct A StimuLatiON sUccESs. As sImulATion proceDUrEs hAVE sHown, stimulaTION amPlituDes NEar the StimUlation stimulus thREshold only resuLt in A STimUlaTIon sUcCess after a delaY of Up TO 3 MillisecOnDs. However, thE stimulaTiON pulsE is alrEady coMpleted AT ThE End of tHis dElaY time and wOulD, aCCordingLy, NoT Be deteCted By The priOr art sYStem. sTImulation success ConseQUEntly CAn bE reliAbLy detecTEd wiTh such a sysTem only if thE stimuLatiOn pulSe ampliTuDes are MarKeDly above thE StimulatiOn stiMulus thReSholD, beCause uNder SUCh conDitiOnS thE stimulatION sUCcEsS DelAy ocCurs dUrIng tHe
 day, physical activity an d so forth , the  st imu la tion  amp litude shouldb e ad apted to the variation  of t he stim u la tionstimulu s  t h r esh ol d.  If ,f or  exam ple , a sub -threshold  st im ulation is d e te cted by vi rtu e of an abse nce  of st im ula t ion s ucc ess a fter t h e outp ut of a s ti m ulatio n  pulse( a smeas ured by the absen c eo f a rise in im pedanc ei nt h e i mpe dance patt er n aft e r outpu t  o f t hes timulation pu lse), the s t imu lation  a mpl i tude s hould  b e  in creased. Su ch a  dynamicvariat i on of t h e stimu lation  am pli tude en su res  r e lia b le  op e rat ion of t he  c ardia c pa c e m a ker. 
On  the  othe r hand, durin g t he o p era tionof th e ca rd iac p acemak er th eminimum energyrequ ired to p rov id e s ti mulat i on sho uld  be  used t o guara n tee  a l o ng  service life forth e ba ttery, w hich i s  t yp i cally in te gra tedi n  thecard i ac  pacemak er. Th e re fo re, the  s timula ti onamp litud e  sho uld be  increas ed on l y as far as ne c essary, i.e., on l y  s l ight lyabove the s timu l atio n st i mu lus thres hold. 
B e si d es checking the sti mu lation  succ ess on the ba sis of imp e d a nce meas urem e nt ,  methods are a lso g enerally k n own whic h mea sure the  potentia l evoked b y t hesti mul a t io n pulse, or t h e  QRS -c omplex.  In  this c ase , h owe ver ,reliabledetectio nof  t he  st imula t ion succ es s i sonl y pos s ible,at th e ea rl ie s t,between 10 0 and13 0mill ise co nds a fter out put ofthe stimu lat i on p ul se  by the  cardiac pace ma ker. Accor di ngl y, the r e  is a ve ry severe time delay, a n d thiscau ses d iffi culties i n p rovidi ngs hort-t erm co rrect iv e m e a sures v ia  st im ulation pu l s e c ontro l. 
Incontras t, U.S. Pat. No. 5 , 766 ,230 disclose s a  car d i ac  pa c em a ker  i n  wh i c h the stimulati on success  i s  c hecked whi l e t he  stimul ation p ulsei s still  being ou tputted.In  thi s pac emaker, at  the end  of the o t herwi s erecta ngu lar st im ula tionpulse, the  stim ulatio namplit ude f al ls awaysharply due to a sudden ly hig her c urr ent flowsig n ali ng the st imul ation succ ess , a nd th atp roduc es a fa lli n g cur ve i n  the puls e  s hap e .  T hat falling c u rve  in t hep ulse s hape  is used to detec t  the stimulati on s u c ces s.A ltho ug h such a syste m p ro v i des very  q uick measur ement, t he r e isthe di sadvan tage th a t  t h e occu rren ceof a stim ula ti o n succe ss  c a n only  bede tected  if th e  pul s e  shape changes b efore t he en d  of  thest imulati o n pu lse. Other wise, it is  not p ossi ble w ith thi spriorart  d evice to d e tect a st imula tion su cc ess.  As  simul atio n proce dure shav e shown,s t im u la ti o n a mpli tudes  n earthe stimu l ation st imu l us thre sh old o nly re s ul t in a stimu lat ion s u c cess after a de l ay of up  to 3millis econds. How ev er, the  st i m ulation p ulse is a l rea dy  com pleted a ttheen d o fthis delay time  and wou ld, acco r d ingly,  no t  bed etecte dby the prior  artsy s tem. St i m ula tion su c ces s c ons eque ntl y ca n  be reliably detected wi th s uch a sys tem o nly i fthe stim u lati on pulse amplitudes ar e markedly abov e  th e  sti mul a ti on  stimulus  th r eshol d, b eca useund er s u c h co n diti o ns  the  stimu lati on  s uccess de la y occur s  dur i ngthe
 day,_physical activity_and so forth, the_stimulation amplitude_should_be adapted_to_the variation of_the stimulation stimulus_threshold. If, for example,_a sub-threshold stimulation_is_detected by virtue of an absence of stimulation success after the output of a_stimulation_pulse (as_measured_by_the absence of a rise_in impedance in the impedance_pattern after_output of the stimulation pulse), the stimulation amplitude_should_be increased. Such_a dynamic variation of the stimulation amplitude ensures reliable_operation of the cardiac pacemaker.
On the_other hand, during_the_operation_of the cardiac pacemaker_the minimum energy required to provide_stimulation should be used to guarantee_a long service life for the battery,_which is typically integrated in the_cardiac pacemaker. Therefore, the stimulation_amplitude should_be increased only as far_as necessary, i.e.,_only slightly_above the stimulation_stimulus threshold.
Besides checking the stimulation success_on the basis_of impedance measurement, methods are also_generally_known which measure_the_potential_evoked by_the stimulation pulse,_or_the QRS-complex._In_this case, however, reliable detection of_the_stimulation success is only possible, at the_earliest, between 100 and_130_milliseconds after output of_the stimulation pulse by the_cardiac pacemaker. Accordingly, there is a_very severe_time delay,_and this causes difficulties in providing short-term corrective measures via stimulation_pulse control.
In contrast, U.S. Pat. No._5,766,230 discloses a cardiac_pacemaker in_which_the stimulation success_is_checked while_the stimulation pulse is still being outputted._In this_pacemaker, at the end of the_otherwise rectangular stimulation pulse,_the_stimulation amplitude falls away sharply due_to a suddenly higher current flow_signaling the stimulation success, and_that_produces_a falling curve in the_pulse shape. That falling curve in_the pulse shape_is used to detect the stimulation success._Although_such a system provides very quick_measurement,_there is the disadvantage that the_occurrence_of_a stimulation success can only_be detected if the pulse shape_changes before the end of the stimulation pulse. Otherwise,_it is not_possible with this prior art_device_to_detect a stimulation success. As simulation procedures have shown, stimulation_amplitudes near_the stimulation stimulus_threshold only result in a stimulation success after a delay_of up to 3 milliseconds. However, the_stimulation pulse is already completed at the end of this delay_time and would, accordingly, not be detected by_the prior art system. Stimulation success consequently_can be reliably detected_with_such a system only if the stimulation_pulse_amplitudes_are_markedly above the_stimulation stimulus threshold,_because under such_conditions the_stimulation success delay_occurs during_the