Abstract: The invention relates to the use of atrial pacing therapies to treat atrial tachycardia (AT). When an AT episode is detected, an implantable medical device applies an ATP therapy. If the AT episode persists, the ATP therapy may be automatically reapplied at a later time during the course of the same AT episode. In particular, previously used ATP therapies are reapplied when episodic conditions, such as cycle length or cycle regularity, change. Although a particular ATP therapy initially may be unsuccessful in terminating the AT, it may prove successful when the cycle length or regularity of the atrial rhythm changes. As the rhythm slows down, the AT may be more responsive to ATP therapies that were previously unsuccessful. As a result, potentially efficacious ATP therapies can be reapplied to terminate AT episodes, and reduce the number of episodes that require more aggressive termination by painful, atrial shocks.

Abstract: Implantable medical devices and methods of tachycardia detection that provide adjustable detection criteria based upon a hemodynamic parameter. In some embodiments, the apparatus and methods provide for detection and delivery of therapy for hemodynamically stable and hemodynamically unstable tachycardias by varying a number of intervals detected (NID) threshold based on hemodynamic measurements.

Abstract: A method and apparatus for optimizing cardiac resynchronization therapy are provided. An iterative optimization procedure is performed to test the systolic hemodynamic effects of varying A-V-V timing schemes. The hemodynamic effect is assessed based on a surrogate of stroke volume. The stroke volume surrogate is derived from a sensor signal proportional to the blood pressure in the aorta or a major artery. The A-V-V timing scheme corresponding to the greatest stroke volume, as indicated by the stroke volume surrogate, is identified and automatically programmed to maintain optimal A-V-V settings acutely and chronically.

Abstract: A feedthrough arrangement includes a titanium alloy terminal for conducting electrical current between a first environment within a housing and a second environment outside of the housing. An insulating member is positioned around a portion of the terminal. A sleeve member is positioned around the insulating member. The terminal, insulating member, and insulating member all being in sealing engagement therewith to environmentally isolate the first and second environments.

Abstract: A feed-through assembly for an IMD and a method for fabricating the same are provided. The feed-through assembly has a ferrule having a first aperture disposed therethrough. An insulating member is disposed at least partially within the first aperture. The insulating member has a second aperture, an inside surface and an outside surface. A metallization region overlies at least a portion of the inside surface and at least a portion of the outside surface of the insulating member. The metallization region is formed of a first layer of titanium and a second layer of niobium. A portion of a terminal pin of platinum is disposed through the second aperture. A first brazing seal is disposed between the insulating member and the ferrule and a second brazing seal is disposed between the insulating member and the terminal pin. The first and second brazing seals are formed of gold.

Abstract: Techniques are presented for providing adjustable cardiac resynchronization with an implanted medical device such as a pacemaker. For example, cardiac resynchronization may be provided during some time periods but not during other time periods, or cardiac resynchronization may be provided in response to selected sensed events. Adjustable cardiac resynchronization is applicable to therapy such as bi-ventricular pacing, in which both ventricles of the heart are paced in response to sensed atrial events.

Abstract: A closed loop system for monitoring drug dose, intake and effectiveness includes a pill dispenser in data communications with at least one implantable medical device. The system is preferably implemented in a web-enabled environment in which a remote data center communicates with the implantable devices (IMDs) in a patient via a programmer or the pill dispenser. Th data center includes high speed computers and databases relating to patient history and device information. A physician or clinician may access the remote data center to review and monitor the IMDs remotely. More specifically, the IMDs are adapted to chronically monitor the pill dispenser to thereby log and document drug dose, patient compliance with prescriptive regimens and as well to monitor drug efficacy in the patient.

Abstract: A capacitor structure having a shallow drawn encasement includes first and second major sides and a peripheral wall coupled to first and second major sides. First and second anodes are positioned within the encasement proximate the interior surfaces of the first and second major sides respectively. A cathode is positioned within the encasement intermediate the first and second anodes.

Abstract: The present invention provides a medical device that includes a carrier and a polynucleotide, where the carrier has a surface that includes a polymer with which the polynucleotide is associated. In another aspect, the present invention provides a medical device that includes a carrier and a cell that expresses an antimicrobial peptide, where the carrier has a surface that includes a polymer with which the cell is associated. The present invention further provides methods of making and using medical devices that include a carrier and a polynucleotide or a cell.

Abstract: Feed through assemblies and methods for their manufacture are provided. The feedthrough assemblies include a ferrule, an insulating material contacting the ferrule, and a terminal extending through the ferrule and having first and second areas separated by an area contacting the insulating material. A brazing material contacts the insulating material and the terminal's first area, and a conductive material covers the terminal's second area. The presence of the conductive material causes current density to be dispersed away from the brazing material.

Abstract: In one embodiment, a testing regimen is implemented to reduce test time. Specifically, a structure and method to power up and stabilize all die on the wafer prior to testing each die is implemented. More specifically, parallel powering schemes including die stabilization procedures are used to ready the wafer for testing. A wafer probe tester is indexed from one die to the next for an uninterrupted testing of all die in the wafer subsequent to all die power up and stabilization.

Abstract: An anode-limited battery and method of assembly are provided in which a lithium anode subassembly is constructed from two pieces of lithium foil. An elongated thicker piece of lithium foil is cohesively bonded at one end to a shorter, thinner piece of lithium foil. An optional current collector stabilizes the area of the cohesive bond. The thicker lithium foil forms the inner windings of a coiled electrode, which face reactive cathode material on both sides. The thinner foil forms the outermost winding, which faces reactive cathode material on only one side. Thus, an appropriate amount of lithium is available for cathode discharge. The method of electrode assembly allows a narrow tolerance of the lithium anode such that the benefits of an anode-limited cell may be realized.

Abstract: A capacitor structure comprises a shallow drawn encasement having first and second major sides and a peripheral wall coupled to the first and second sides. A cathode is disposed within the encasement proximate the first and second major sides, the cathode having a cathode lead. A central anode a having an anode lead is disposed within the encasement, and a bipolar, insulative feedthrough extends through the encasement through which electrical coupling may be made to the anode lead and the cathode lead.

Abstract: Methods for anodizing sintered valve metal anodes for use in wet electrolytic capacitors implemented in implantable medical devices (IMDs). The methods generally include immersing a pressed valve metal anode in an anodizing electrolyte and developing an anode-electrolyte system. Subsequently, subjecting the anode-electrolyte system to a potential that is ramped up to a target voltage in a pulsed fashion and delivering voltage potential pulses to the anode. The pulses are preferably decreased in pulse width as the potential increases. The pulse width of the applied pulses is preferably defined by means of a duty, such that the applied pulse duty cycle is substantially 100% initially and declines over the formation time as the formation voltage increases to the target potential to substantially 1.0% or less. The pulses are preferably applied for a hold time following achievement of the target formation potential, as the pulse current declines toward zero current flow.

Abstract: A patient-controlled system for temporarily disabling an electrical cardioverting therapy in order to prepare the patient psychologically and physiologically for the pain associated with electrical cardioversion therapy. In an example embodiment, the system includes a capacitive circuit capable of charging and discharging in order to apply the electrical therapy. The implanted medical device automatically causes the capacitive circuit to charge and discharge at least once within a selected period. The system includes a patient activator device that communicates with the implanted device. A disabling circuit is also included within the implanted medical device that temporarily disables the electrical therapy application in response to the patient activator device. The system further includes an alerting arrangement that alerts the patient activator device in response to the disabling circuit.

Abstract: Bi-Ventricular or AV synchronous cardiac pacing systems that pace and sense in at least one atrial heart chamber and deliver ventricular pacing pulses to right ventricular (RV) and left ventricular (LV) sites separated by a V—V delay for treatment of heart failure are disclosed that optimize one or more of the AV delay and V—V delay to enhance left ventricular filling and cardiac output as a function of QRS duration. A system and method for monitoring the QRS duration, processing such signals to provide data from which the onset or progression of heart failure is determined, and adjusting synchronous pacing delay parameters including SAV delay and/or PAV delay and/or V—V delay to enhance cardiac output as a function of QRS duration is provided. The SAV, PAV, and/or the V—V delays can be varied from the prevailing delays as a function of measured QRS duration so as to minimize the width of the QRS complex.

Abstract: A method and system to guide a medical device within a patient using image data, e.g., chemical image data, includes acquiring image data of a view region within the patient. A movable element of the medical device is guided, e.g., self-guided, based on the image data. For example, the image data may be analyzed to detect a target area within the view region, e.g., the target area having at least one characteristic that is different from other portions within the view region. The movable element may then be guided based on the detected target area.

Abstract: An ADI/R mode is implemented using an intelligent pacing system to continually monitor ventricular response. This ensures AV conduction whenever possible so as to gain all the benefits of cardiac contractile properties resulting from native R-waves. In the event where AV conduction is blocked, the pacing mode is switched to a DDD/R mode to ensure a paced R-wave. Thereafter, subsequent to a completed interval of a p-wave, ADI/R pacing resumes to monitor ventricular response.

Abstract: The present invention relates to medical devices; in particular, the present invention provides devices and methods for sensing thickness of cardiac tissue and the like so that medical procedures may be efficiently performed through and/or upon a discrete location having suitable tissue thickness. The invention includes an elongated resilient dilator apparatus having an ultrasound transceiver coupled thereto. When the ultrasound transceiver is disposed proximate a region of relatively thin tissue, such as a latent Fossa Ovalis valve, a clinician receives a signal. The clinician may then proceed with enhanced confidence to pierce the relatively thin tissue. Thus, in the case of a transseptal procedure, the clinician gains access to the left atrial chamber from the right atrial chamber.

Abstract: Implantable medical device telemetry is provided between an implantable medical device and an external communication device. The implantable medical device includes a device transmitter and/or a device receiver. The external communication device includes a moveable communication head including an antenna therein connected to at least one of an external transmitter and/or an external receiver for communication with the device transmitter and/or the device receiver of the implantable medical device. A user moves the moveable head apparatus relative to the implantable medical device. Tactile feedback is provided to the user via the moveable head apparatus upon movement of the moveable head apparatus to a position where valid telemetry can be performed.