Abstract: A lead for use with an implanted pulse generator which may be a pacemaker or defibrillator or combination thereof. The lead can deliver an electrical charge to cardiovert or defibrillate the ventricles of the heart via a large surface area defibrillation electrode which is passively implanted in the ventricle. The defibrillation electrode is designed to produce a uniform defibrillation charge distribution.

Abstract: Implantable leads incorporating accelerometer-based cardiac wall motion sensors, and a method of fabricating such leads, are provided. The cardiac wall motion sensors transduce accelerations of cardiac tissue to provide electrical signals indicative of cardiac wall motion to an implantable cardiac stimulating device. The implantable cardiac stimulating device may use the electrical signals indicative of cardiac wall motion to detect and discriminate among potentially malignant cardiac arrhythmias. In response to a detected abnormal cardiac rhythm, the cardiac stimulating device may deliver therapeutic electrical stimulation to selected regions of cardiac tissue.

Abstract: A micropower analog-to-digital converter (ADC) for use in an implantable medical device is disclosed. The ADC achieves a high conversion speed at micropower levels through a number of timing and circuit improvements over the conventional implementation of the successive approximation ADC architecture. The ADC includes a digital-to-analog converter (DAC) that preferably is implemented as a binary-weighted, switched capacitor array that employs top plate charging and performs bipolar conversion. The DAC provides an analog output signal representing array charge to a comparator. During a comparator latch phase, the DAC asynchronously determines a bit of the ADC digital output signal in response to the comparator output, and initiates a test of the next least significant bit during the same latch phase. Further, the DAC analog output signal is timed to settle during the latch phase in response to both the bit update and the next bit test.

Abstract: An implantable cardioversion shock therapy system is provided which delays delivery of a cardioversion shock until late in the cardiac cycle to optimize the chance for the vast majority of ventricular myocardial tissue to be non-refractory. The system in intended to increase efficacy and safety by properly synchronizing the cardioversion shock to the appropriate portion of the cardiac cycle to successfully terminate a tachycardia episode. The timing of the cardioversion shock is programmable as either a percentage of measured tachycardia cycle length or fixed delay in milliseconds.

Abstract: An implantable stimulation device has a sensing amplifier circuit for amplifying low amplitude cardiac signals, while maintaining low power, to produce an output signal having a low noise level. The sense amplifier circuit includes a two-stage amplifier, a bandpass filter, and a threshold detector. The first stage comprises a linear differential amplifier which has low gain, good common mode rejection, and a current consumption proportional to the gain. The second stage is a switched-capacitor amplifier which has a programmable gain and low current consumption. The noise content of the system is low and produced substantially entirely in the switched-capacitor amplifier.

Abstract: A low-power delta modulator analog-to-digital converter is provided that is suitable for use in a cardiac stimulating device for monitoring intracardial signals. The delta modulator consumes less power than previously available delta modulators because portions of the delta modulator circuitry are shut down when the signal to be digitized is not rapidly varying. The device uses slow clock pulses for sampling the input signal and subsequently digitizes the sampled signal using a faster clock. After a sampled signal has been digitized, the result is held until the next slow clock pulse. Power consumption is reduced since the delta modulator does not draw substantial amounts of power during this holding period. Further, the output of the delta modulator reflects the magnitude of the change in the analog input, with a separate bit for representing direction.

Abstract: An improved telemetry system for telemetering data from an implantable device such as a heart pacemaker to an external device with minimum energy consumption. The external device first sweeps its receiver across a predetermined frequency band, e.g., the fm broadcast band of 88 MHz to 108 MHz, to determine the particular frequency having the lowest ambient electromagnetic noise level, which it deems the optimum frequency for the telemetry to occur. The external device's transmitter then commands the pacemaker to telemeter a predetermined start signal at a succession of frequencies that sweep across that same frequency band, while the external device's receiver remains tuned to the optimum frequency. Eventually, the external devices receiver will receive the start signal and the external device thereupon will command the pacemaker to thereafter remain at its current frequency for the subsequent telemetry of data.

Abstract: A cardiac event and arrhythmia detection system and method detects arrhythmic cardiac activity or other information from an electrogram signal of a heart. The system senses the electrogram signal through an electrogram lead, preliminarily processes the signal, and converts it to a plurality of discrete digital signals, each of which represents the magnitude of the electrogram signal at a prescribed sample time. The discrete digital signals are applied to both a cardiac event detector and a morphology detector. The morphology detector detects selected changes in the morphology (shape) of the electrogram signal, wherein such changes automatically control the sensitivity (gain and/or threshold) used to detect cardiac events. The occurrence of a prescribed amount of change in the detected morphology over time indicates the occurrence of a prescribed arrhythmic cardiac condition.

Abstract: An improved input protection circuit for use in a circuit for processing sensor signals from a piezoelectric patient activity sensor is provided. The input protection circuit includes a field-effect transistor to prevent the voltage at an input terminal of the processing circuit from rising beyond a first predetermined voltage or falling below a second predetermined voltage. The gate and drain terminals of the transistor are connected to a first of two input terminals of the processing circuit and the source and body terminals are connected to the second terminal. When the voltage at the first terminal rises or falls sufficiently, the transistor conducts current, thereby preventing the voltage from rising or falling further.

Abstract: A universal cable connector includes a plurality of different sized connectors adapted to mate with the proximal connectors of different sized implantable stimulation leads. The cable connector attaches to a system analyzer and enables the system analyzer to interface with whatever implantable stimulation leads are connected to the connector block, thereby allowing the system analyzer to perform desired tests, such as threshold-determining tests, using the implanted stimulation leads. An adapter cable and clamp is also provided that allows an electrical connection of the proper polarity to be established between an implantable stimulation device, e.g., an implantable cardioverter-defibrillator (ICD), and the connector block while the implantable stimulation device is connected to a patient and is operating, thereby permitting the system analyzer to monitor the performance of the implantable stimulation device.

Abstract: An implantable cardiac device for providing cardioversion and defibrillation therapies is provided, which forecasts time-to-therapy based on battery voltage degradation and provides an enhanced energy shock in the event a predetermined threshold time is reached. The device also monitors elapsed time-to-therapy to determine whether the predetermined threshold time is exceeded and sets the energy content of the therapeutic shock accordingly.

Abstract: An improved implantable cardiac stimulating device that performs cardiac wall motion-based automatic capture verification system is provided. Pacing pulses of varying energy content are administered to a patient's heart, and the response of the patient's heart is sensed by a cardiac wall motion sensor. The cardiac wall motion sensor provides a signal which is analyzed to determine the patient's capture threshold, defined as the minimum amount of electrical stimulation required to evoke a cardiac contraction. The device then sets the amount of electrical stimulation at a level safely above the measured capture threshold. Capture verification may be performed at predetermined time intervals, on demand, or upon the occurrence of a significant cardiac event. Capture verification can also be performed on every pacing pulse delivered by the implantable cardiac stimulating device.

Abstract: An implantable dual-chamber pacemaker programmed to operate primarily in an atrial tracking mode is provided, where the pacemaker includes an atrial rate smoothing filter for producing a filtered atrial rate from an intrinsic atrial rate, and where the pacemaker automatically switches its mode of operation from the atrial tracking mode to a non-atrial tracking mode in the event the filtered atrial rate exceeds a prescribed upper rate limit. The pacemaker switches from a primary set of operational parameter settings for the primary mode, to an alternate set of operational parameters for the alternate mode when the mode is switched from the primary mode to the alternate mode. The pacemaker also includes the capability of recording and storing mode switching events and data pertaining to the mode switching events.

Abstract: A system and method for a pacemaker are provided, for using cardiac wall motion sensor signals to provide hemodynamically optimal pacing therapy to patient at rest, and for providing rate-responsive pacing therapy. The cardiac wall motion sensor signals are provided by an implantable lead that incorporates an accelerometer for measuring cardiac mechanical activity. The cardiac wall motion sensor signals are processed to derive cardiac wall velocity signals and cardiac wall displacement signals. The derived signals are further processed to derive physiologic parameters indicative of cardiac performance, including stroke volume, contractility, pre-ejection period, and ejection time. The physiological parameters, in turn, are used by the pacemaker to provide hemodynamically optimal pacing therapy at rest, and rate-responsive pacing therapy.

Abstract: Atrial lock interval pacing increases stroke volume and optimizes cardiac output by providing a modified P-wave tracking mode that tracks P-waves up to a maximum instantaneous tracking rate only for short periods of time, to provide a maximum instantaneous ventricular heart rate, yet limits the maximal mean (or average) ventricular rate over a longer period of time, to provide a safe target maximal average rate. Two main types or embodiments of modified P-wave tracking modes may be used. A first provides a sequence of timed intervals that begins upon sensing each P-wave. Such sequence may include, e.g.: (1) a PV interval; (2) a PVARP; (3) a Wenkebach interval; (4) an atrial lock interval; and (4) a P-track interval. P-waves are not tracked during the PV interval or PVARP. P-waves that occur during the Wenkebach or Atrial lock interval are tracked, but not in a conventional manner. P-waves that occur during the P-track interval are tracked in a conventional manner.

Abstract: A cardiac event and arrhythmia detection system and method detects arrhythmic cardiac activity or other information from an electrogram signal of a heart. The system senses the electrogram signal through an electrogram lead, preliminarily processes the signal, and converts it to a plurality of discrete digital signals, each of which represents the magnitude of the electrogram signal at a prescribed sample time. The discrete digital signals are applied to both a cardiac event detector and a morphology detector. The morphology detector detects selected changes in the morphology (shape) of the electrogram signal, wherein such changes automatically control the sensitivity (gain and/or threshold) used to detect cardiac events. The occurrence of a prescribed amount of change in the detected morphology over time indicates the occurrence of a prescribed arrhythmic cardiac condition.

Abstract: A multi-conductor lead having a lead body including at least two conductors and at least one electrode at a distal end for delivering an electrical stimulus, the multi-conductor lead also including a connector assembly at a proximal end, the connector assembly including a pair of electrical contacts each connected to one of the two conductors of the multi-conductor lead and a rigid insulator interlocking and electrically separating the pair of electrical contacts.

Abstract: A cathode material is fabricated using two binder compounds, polyethylene oxide and acrylic resin, which react during processing to achieve enhanced bonding. The cathode material is formed by dissolving acrylonitril resin within the acetonitrile solvent. Polyethylene oxide powder is added yielding a homogenous solution. A powder mix containing a carbon material, such as high surface area carbon powder, and an active cathode compound, such as polycarbon monoflouride, is added to the binder mixture to produce a slurry. In one embodiment, the slurry is heated to evaporate the solvents, yielding a thin flexible cathode material for mounting to an expanded screen current collector. In an alternative embodiment, the slurry is spread directly onto a foil current collector. The solvents thereafter evaporate from the slurry yielding excellent mechanical and electrical coupling between the active cathode compound and the current collector.

Abstract: A rate-responsive pacemaker measures a patient's level of activity and stores the results in an activity level histogram. The patient's average level of activity is maintained as a running average. Based on a prescribed base pacing rate, a prescribed maximum pacing rate, the average level of activity, and the measured levels of activity stored in the activity level histogram, the rate-responsive pacemaker automatically calculates the slope of the pacemaker transfer function. An activity deviation histogram is also maintained. Analysis of the activity deviation histogram allows the pacemaker to determine if the patient was usually inactive for an extended period of time, and to inhibit an automatic slope calculation under such conditions. If a patient desires to reach a prescribed target heart rate during exercise, the slope may be calculated using the target heart rate and a prescribed fraction of time each week that the patient devotes to exercise.

Abstract: A pyroelectric suppressor circuit for preventing undesirable thermally induced signals generated by a piezoelectric physical activity sensor from reaching processor circuitry within an implantable medical device is provided. The thermally induced signals typically have frequencies below a frequency in the range from about 0.1 mHz to about 10 mHz. The suppressor circuit provides a high-pass filter that rejects signals that have frequencies associated with thermally induced signals. Signals having frequencies greater than a frequency in the range from about 0.1 mHz to about 10 mHz, which correspond to patient activity, are passed on to processing circuitry of the implantable medical device.