Abstract: Systems and methods for selecting one or more sites at or within at least one heart chamber for cardiac stimulation are disclosed. The system can include a physiologic sensor circuit to sense physiologic signals at two or more candidate stimulation sites. The system can generate respective activation timing indicators corresponding to the two or more candidate stimulation sites, and detect MI indicators indicating the presence of, or spatial proximity of each of the two or more candidate stimulation sites to a MI tissue. The system can use the activation timing indicators and the MI indicators to select at least one target stimulation site or to determine an electrostimulation vector. The system can display the selected target stimulation site to a user, or deliver electrostimulation to the patient at the target stimulation site or according to the determined electrostimulation vector.

Abstract: Systems and methods for evaluating multiple candidate electrostimulation vectors for use in therapeutic cardiac stimulation are disclosed. The system can include a programmable electrostimulator circuit for delivering electrostimulation to one or more sites of a heart according to multiple candidate electrostimulation vectors. One or more physiologic sensors can detect resulting physiologic responses to the electrostimulation. A processor circuit can generate categories of indicators including therapy efficacy indicators, battery longevity indicators, or complication indicators using the sensed physiologic responses. The candidate electrostimulation vectors can be ranked according to the categories of indicators in specified orders.

Abstract: Methods and systems for use of the Q-wave to R-wave interval to guide placement of a leadless cardiac pacemaker are disclosed. An implant delivery device is equipped with sensing electrodes to sense R-wave onset in a ventricle of a patient's heart to allow placement at a location of last or latest onset of the R-wave. Guidance tools are provided to assist in determination of the Q-wave to R-wave interval during implantation. For a chronic system, a cooperative approach is disclosed in which an implantable medical device and a leadless cardiac pacemaker exchange data to determine Q-wave to R-wave intervals and enhance cardiac resynchronization therapy delivery by the leadless cardiac pacemaker.

Abstract: An apparatus comprises a cardiac signal sensing circuit configured to sense a plurality of intrinsic cardiac signals using a plurality of cardiac pacing sites, a heart sound sensing circuit, a stimulus circuit configured to provide an electrical cardiac pacing stimulus to the plurality of pacing sites, and a control circuit electrically coupled to the cardiac signal sensing circuit and the stimulus circuit. The control circuit includes a pacing site locating circuit configured to generate an indication of a preferred pacing site as one of a) a subset of the respective cardiac pacing sites selected using the intrinsic ventricular activation time interval value, from which subset the preferred pacing site is selected using the heart sound characteristic value; or b) a subset of the respective cardiac pacing sites selected using the heart sound characteristic value, from which subset the preferred pacing site is selected using the ventricular activation time interval value.

Abstract: A delivery device for delivering an implantable leadless pacing device may include a catheter shaft a distal holding section for receiving the implantable leadless pacing device. In some cases, the delivery device may include a flow-sensing device to determine a pressure or flow-rate of a fluid within the distal holding section. Also included may be a handle assembly and a deployment mechanism to deploy the implantable leadless pacing device.

Abstract: Systems and methods for providing CRT therapy to a patient with an implanted multi-site pacing medical device. In one example, an intrinsic electrical delay associated with each of two or more left ventricle electrodes may be determined. The intrinsic electrical delay associated with each of the two or more left ventricle electrodes may be compared to an electrical delay threshold. If the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, a single left ventricle electrode may be selected for use during subsequent CRT therapy. If the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, two or more of the left ventricle electrodes may be selected for use during subsequent CRT therapy.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker (LCP) and an extracardiac device (ED). The system is configured to identify atrial events to use as timing markers for the LCP to deliver CRT, and further to determine whether the timing markers are incorrectly sensed and to make adjustment or call for re-initialization as needed.

Abstract: An implantable medical device (IMD) that includes a housing, a first electrode secured relative to the housing, a second electrode secured relative to the housing, and a gyroscope secured relative to the housing. The IMD may include circuitry in the housing in communication with the first electrode, the second electrode, and the gyroscope. The circuitry may be configured to determine and store a plurality of torsion data measurements, from which a representation of a twist profile may be determined.

Abstract: A delivery and deployment device may include a handle assembly and a shaft extending distally from the handle assembly. A device containment housing may be coupled to a distal region of the shaft and may extend distally therefrom. The distal containment housing may be configured to accommodate at least a portion of the IMD therein. The IMD may, for example, be a leadless pacemaker, a lead, a neurostimulation device, a sensor or any other suitable IMD. A plurality of electrodes may be distributed about an exterior surface of the device containment housing such that at least some of the plurality of electrodes may be positioned to test a potential IMD deployment location before deploying the IMD.

Abstract: An apparatus comprises a cardiac signal sensing circuit configured to sense a plurality of intrinsic cardiac signals using a plurality of cardiac pacing sites, a heart sound sensing circuit, a stimulus circuit configured to provide an electrical cardiac pacing stimulus to the plurality of pacing sites, and a control circuit electrically coupled to the cardiac signal sensing circuit and the stimulus circuit. The control circuit includes a pacing site locating circuit configured to generate an indication of a preferred pacing site as one of a) a subset of the respective cardiac pacing sites selected using the intrinsic ventricular activation time interval, from which subset the preferred pacing site is selected using the heart sound characteristic; or b) a subset of the respective cardiac pacing sites selected using the heart sound characteristic, from which subset the preferred pacing site is selected using the ventricular activation time interval.

Abstract: A medical system for sensing and regulating cardiac activity of a patient may include a cardioverter that is configured to generate and deliver shocks to cardiac tissue and a leadless cardiac pacemaker (LCP) that is configured to sense cardiac activity and to communicate with the cardioverter. The cardioverter may be configured to detect a possible arrhythmia and, upon detecting the possible arrhythmia, may send a verification request to the LCP to help conform that the possible arrhythmia is occurring. The LCP, upon receiving the verification request from the cardioverter, may be configured to activate one or more of a plurality of sensors to attempt to help confirm that the possible arrhythmia is occurring.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker (LCP) and an extracardiac device (ED). The system is configured to have available for use a plurality of modes for managing the timing of the CRT pacing delivery by the LCP acting in cooperation with the ED. The system is further configured to use various metrics to determine whether and when to switch from one of the CRT timing modes to another of the timing modes.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker and an extracardiac device. The extracardiac device is configured to analyze one or more QRS complexes of the patient's heart, determine whether fusion pacing is taking place, and, if not, to communicate with the leadless cardiac pacemaker to adjust intervals used in the CRT in order to generate desirable fusion of the pace and intrinsic signals. The extracardiac device may take the form of a subcutaneous implantable monitor, a subcutaneous implantable defibrillator, or other devices including wearable devices.

Abstract: Systems and methods for providing CRT therapy to a patient with an implanted multi-site pacing medical device. In one example, an intrinsic electrical delay associated with each of two or more left ventricle electrodes may be determined. The intrinsic electrical delay associated with each of the two or more left ventricle electrodes may be compared to an electrical delay threshold. If the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, a single left ventricle electrode may be selected for use during subsequent CRT therapy. If the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, two or more of the left ventricle electrodes may be selected for use during subsequent CRT therapy.

Abstract: A leadless cardiac pacemaker (LCP) is configured to sense cardiac activity and to pace a patient's heart and is disposable within a ventricle of the patient's heart. The LCP MAY include a housing, a first electrode and a second electrode that are secured relative to the housing and are spaced apart. A controller is disposed within the housing and is operably coupled to the first electrode and the second electrode such that the controller is capable of receiving, via the first electrode and the second electrode, electrical cardiac signals of the heart. The LCP may include a pressure sensor and/or an accelerometer. The controller may determine a pace time within a cardiac cycle based at least in part upon an indication of metabolic demand.

Abstract: This document discusses, among other things, using a pressure sensor to detect body sound information of a patient, such as cardiac murmurs, respiratory sounds, etc.

Abstract: This document discusses, among other things, systems and methods to estimate an arterial diastolic pressure of a patient using ventricular pressure information of a heart of the patient and heart sound information of the heart of the patient, such as a timing of at least one of a first heart sound (S1) or a second heat sound (S2), in certain examples, adjusted by a respective correction factor.

Abstract: A leadless cardiac pacemaker (LCP) is configured to sense cardiac activity and to pace a patient's heart and is disposable within a ventricle of the patient's heart. The LCP may include a housing, a first electrode and a second electrode that are secured relative to the housing and are spaced apart. A controller is disposed within the housing and is operably coupled to the first electrode and the second electrode such that the controller is capable of receiving, via the first electrode and the second electrode, electrical cardiac signals of the heart. The LCP may include a pressure sensor and/or an accelerometer. The controller may determine an atrial contraction timing fiducial based at least in part upon two or more of a signal from the pressure sensor, a signal from the accelerometer representing, and an electrical cardiac signal.

Abstract: A leadless cardiac pacemaker (LCP) configured to sense cardiac activity and to pace a patient's heart. The LCP may include a housing, a first electrode secured relative to the housing, a second electrode secured relative to the housing, and a pressure sensor secured relative to the housing and coupled to the environment outside of the housing. The LCP may further include circuitry in the housing in communication with the first electrode, the second electrode, and the pressure sensor. The circuitry may be configured to determine and store a plurality of impedance-pressure data pairs, from which a representation of a pressure-volume loop may be determined.

Abstract: A leadless cardiac pacemaker (LCP) is configured to sense cardiac activity and to pace a patient's heart and is disposable within a ventricle of the patient's heart. The LCP may include a housing, a first electrode and a second electrode that are secured relative to the housing and are spaced apart. A controller is disposed within the housing and is operably coupled to the first electrode and the second electrode such that the controller is capable of receiving, via the first electrode and the second electrode, electrical cardiac signals of the heart. The LCP may include a pressure sensor and/or an accelerometer. The controller may determine a pace time for a cardiac cycle based at least in part upon a signal from the pressure sensor.