Abstract: Capacitor packaging according to the disclosure provides advantages particularly in connection to compact and/or complex-shaped medical devices (e.g., having limited interior volume defined by domed and/or irregular exterior surfaces). In addition, capacitors of the type shown and described herein can be utilized in relatively compact external defibrillators, such as automatic external defibrillators or clinician-grade, automated or manually-operated external defibrillators. In one form a plurality of capacitors having substantially flat exterior surfaces are placed in an abutting relationship between at least a pair of major surfaces and the major surfaces are spaced from an opposing or adjacent surface in a non-parallel configuration. In other forms, one or more exterior surface portions have a common and/or complex radius dimension (i.e., the surfaces are curved).

Abstract: An implantable medical device operates according to a ventricular pacing protocol (VPP) that precludes ventricular pacing in any cardiac cycle where a sensed ventricular event has occurred in the preceding cycle. Improved ventricular sensing, detection and classification is provided.

Abstract: The invention is directed to lead configurations for sensors that allow for less invasive sensor replacement procedures. In one configuration, a sensor lead assembly includes an outer lead body and an inner lead including a sensor such as an electrochemical glucose sensor. The inner lead can be positioned in an inner conduit of the outer lead body. The outer lead body may be substantially permanently implanted in the patient, and the inner lead can be implanted through the inner conduit of the outer lead body. Once the sensor of the inner lead has worn out or otherwise exhausted its useful life, the inner lead can be removed, and a new inner lead can be implanted in place of the old inner lead.

Abstract: Embodiments of close loop optimization of atrio-ventricular (A-V) delay interval and/or inter-ventricular (V-V) timing are disclosed. An implantable medical device includes a housing that supports a processing means adapted for implantation in a patient. There can be two or more electrodes electrically coupled to the processing means where the two or more electrodes can be used for sensing a patient's cardiac signals, which include a far-field EGM. The processing means can determine a width of a P-wave from the sensed far-field EGM. Also included can be a means for delivering an adapted cardiac pacing therapy based upon the width of the P-wave, including revised A-V delay and/or V-V temporal intervals.

Abstract: Apparatus and method for fabricating a shroud member having extra-cardiac sensing electrode. The assembly is used to provide a subcutaneous cardiac activity sensing device via at least a pair of electrodes mechanically coupled to the shroud member. In one embodiment only a major surface portion of the electrodes are exposed to body fluid and tissue. One beneficial aspect of the fabrication techniques herein involve the encapsulation of the elongated conductors and a majority of the electrode surfaces thereby reducing possibility for electrical shorting among the IMD housing and the other conductive members. The assemblies provided can be fabricated efficiently, inexpensively, quickly and easily using insert-molding techniques.

Abstract: Implantable pulse generators (IPGs) are adapted to deliver stimulation to refractory myocardial tissue. An IPG nominally delivers one to six monophasic stimulation pulses. Because monophasic stimulation tends to accumulate polarization, a programmable blanking period of between about 20 milliseconds (ms) and about 300 ms is implemented (subsequent to delivery of the last pulse in a RPS pulse train) to allow recovery from polarization. The stimulation pulse width is about 0.03 ms to about 1.6 ms and voltage amplitude of 0.5 volts to 8 volts at about 50 Hz. The amplitude of electrical current of the stimulation pulses is less than or equal to approximately 50 milliamps. The pulses are delivered to multiple sites within a cardiac chamber and device performance and/or diagnostic information can be stored within a memory structure and reviewed to confirm delivery of a desired therapy regimen.

Abstract: A floating adapter is configured to electrically couple an auxiliary lead assembly to an implantable medical device including a canister. The floating adapter comprises a connector configured to receive an end of the auxiliary lead assembly, and a conductor having a proximal end and a distal end. The distal end of the conductor is coupled to the connector, and the proximal end of the conductor is coupled to a collector. The collector, the connector, and the conductor form a current flow path between the canister and the auxiliary lead assembly when the conductive body is implanted proximate the canister.

Abstract: An implantable cardiac stimulation system and method having continuous capture management capabilities are provided. Continuous capture management is realized by continuously monitoring for secondary effects of loss of capture, thereby effectively providing continuous capture management in any heart chamber without encountering the limitations normally associated with evoked response sensing. A pacing threshold search is triggered upon detecting a secondary indicator of loss of capture. Secondary indicators of loss of capture may be lead-related changes, changes related to the occurrence of atrial sensed events, changes related related to the occurrence of ventricular sensed or paced events, and/or changes related to a monitored physiological condition.

Abstract: Embodiments of the invention provide systems and methods for an implantable medical device comprising means for selecting between an atrial chamber reset (ACR) test and an atrioventricular conduction (AVC) test to provide atrial capture management and means for switching between an atrial-based pacing mode and a dual chamber pacing mode based on detecting relatively reliable atrioventricular conduction.

Abstract: Stuttering-treatment techniques using neural stimulation and/or drug delivery. One or more electrodes and/or a catheter are implanted adjacent to sites in the brain. A signal generator and the electrode deliver stimulation to a first site. A pump and the catheter deliver one or more therapeutic drugs to a second site. The first and second sites could be: the supplementary motor area, the centromedian circuit, the dorsomedial nuclei, the lateral prefrontal circuit, or other paramedian thalamic and midbrain nuclei. The stuttering treatment could be performed via periodic transcranial magnetic stimulation. A sensor, located near the patient's vocal folds, can be used for generating a signal responsive to activity of the patient's speech-producing muscles. A controller adjusts one or more stimulation parameters in response to the signal from the sensor.

Abstract: AV synchronous, dual chamber pacing systems are disclosed having improved sensing of ectopic ventricular depolarizations or PVCs coincidentally occurring at or shortly following delivery of an A-PACE pulse. A first ventricular sense amplifier that is blanked during and following delivery of an A-PACE pulse is coupled to active and indifferent ventricular pace/sense electrodes defining a ventricular sense vector for sensing natural ventricular depolarizations and declaring a V-EVENT. A far field PVC sense amplifier coupled to a far field PVC sense electrode pair defining a PVC sense vector detects such PVCs while the ventricular sense amplifier is blanked. A PVC declared during the ventricular blanking period by the far field PVC sense amplifier is employed to deliver a VSP pulse upon time-out of a VSP delay, if the VSP function is provided and programmed ON, and/or to halt time-out of an AV delay.

Abstract: A medical electrical lead having an elongated lead body extending from a proximal end to a distal end, a first electrode positioned at the distal end of the lead body, a second electrode spaced proximally from the first electrode, the second electrode being a flexible conductive coil and having a distal end. A first electrode sleeve is coupled to the first electrode, and a second electrode sleeve is coupled to the second electrode and positioned within the proximal end of the lead body and proximal the distal end of the second electrode to provide flexibility in a distal lead body portion.

Abstract: Methods and systems for treating patients with diastolic heart failure (DHF) are disclosed which include slowing a patient's heart rate below its intrinsic rate, and controlling the rate using cardiac pacing therapy to improve LV filling and cardiac output. In certain embodiments, a pacing treatment rate may be determined by adjusting an adaptive rate by an amount determined by evaluating one or more patient parameters.

Abstract: Implantable medical devices having two or more leads can utilize digital signal processing to sample and filter the acquired data. The processed data is utilized to identify electrical activity in cardiac tissue remote from the lead location. An atrial lead and a ventricular lead are used to acquire data and the data is processed to indicated electrical timing within the HIS bundle.

Abstract: A biological pacemaker composition for implantation into cardiac tissue includes an effective amount of interstitial cells of Cajal (ICC) to produce or conduct pacing stimuli and thereby modulate cardiac contraction. The biological pacemaker may be included as part of a heart pacing system that includes an implantable electric pacemaker for producing backup pacing stimuli if the at least one biological pacemaker is unable to modulate cardiac contraction at a predetermined pacing rate. Methods for preventing cardiac pacing or conduction dysfunction in a heart include implanting the biological pacemaker or the heart pacing system into the heart.

Abstract: A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of a refractory period stimulation (RPS) therapy to determine if the desired non-capture (i.e., lack of ventricular mechanical capture due to refractory period stimulation) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture due to pacing stimulus delivery, non-capture due to RPS therapy delivery, and/or contractile status based on the qualities of evoked response to pacing stimulation.

Abstract: Mechanical activity of a heart is sensed by a cardiac lead that carries a triboelectric sensor. The triboelectric sensor produces a triboelectric signal in response to cardiac contractions. A lead fabricated according to the invention can be used for a variety of purposes, including without limitation, pacing capture verification, electromechanical conductivity status of the myocardium (including detecting relatively reduced myocardial activity indicative of ischemia, myocyte necrosis, arterial stenosis and the like). The sensor allows detection of mechanical activity without signal blanking traditionally utilized to stimulate and sense cardiac activity. Traditional circuitry can be employed to stimulate/sense while a triboelectric sensor unit(s) detect evoked and/or intrinsic mechanical cardiac activity.

Abstract: An atrial based pacing protocol promotes intrinsic conduction. An entire cardiac cycle is monitored for ventricular activity and permitted to lapse with ventricular activity. Ventricular pacing is available in a cardiac cycle immediately subsequent to such a skipped beat. When monitoring for intrinsic ventricular events, an event is expected within a given window. If no such event is detected, the cardiac cycle in truncated, leading to a shorter cycle that is devoid of ventricular activity. The subsequent cycle has a high likelihood of a ventricular sensed event and a greater than normal AV interval is provided prior to pacing.

Abstract: A cardiac stimulation system and associated capture management method are provided in which a safety factor, used in setting pacing pulse output energy, is automatically adjusted in response to the detection of indicators of a likely increase in pacing threshold. The method includes monitoring for increased pacing threshold indicators, which may also be associated with a compromised ability to perform a pacing threshold search. Such indicators may include, but are not limited to, the presence of arrhythmias, arrhythmia episode duration, pacing mode switches, refractory sensed events, and/or lead impedance changes. In response to the detection of a selected indicator of increased pacing threshold, the safety factor is automatically increased. After an increased pacing threshold indicator has not be detected for an interval of time, or if a pacing threshold search yields a result, the safety factor may be restored to a programmed value.

Abstract: Heart pacing systems include at least one electronic or biological pacemaker as a primary pacemaker, and at least one electronic or biological pacemaker as a backup pacemaker. When implanted, the primary pacemaker(s) produce primary pacing stimuli that modulate cardiac function. The backup pacemaker(s) provide backup pacing stimuli when the electronic pacemaker is unable to modulate cardiac function at the predetermined pacing rate. The heart pacing systems are implemented by implantation in regions where they can provide pacing stimuli to cardiac tissue.