Abstract: A medical device lead is presented. The lead includes one or more jacketed conductive elements. The jacket comprises one or more covers. A first cover of expanded polytetrafluoroethylene (ePTFE) is in direct contact with the at least one conductive element. At least one conductive element and a ePTFE cover are coiled. The coiled conductive element can substantially retain its original coiled shape.

Abstract: A method of identifying sleep disordered breathing (SDB) in a patient includes monitoring a hemodynamic pressure, deriving high, middle, and low values representative of the distribution of the hemodynamic pressure over a storage interval, measuring a ratio of a lower range to a full range of the hemodynamic pressure based on the derived high, middle, and low values, and using the ratio to determine whether the patient has experienced an SDB episode. Certain embodiments of the invention compare the ratio to a threshold value to identify the occurrence of an SDB episode, while other embodiments of the invention identify the occurrence of an SDB episode by monitoring for a simultaneous increase in both the ratio and the full range of the hemodynamic pressure. In certain other embodiments of the invention, activity level and/or duration criteria may be employed to confirm the occurrence of an SDB episode detected using the ratio.

Abstract: In some embodiments, a method for operating a cardiac rhythm management device may include one or more of the following steps: (a) sensing atrial depolarizations through an implanted atrial electrode, (b) administering a sequential CRT pacing therapy in a sequential CRT pacing mode to a left and right ventricle of a heart of a patient via implanted ventricular electrodes in a sequential bi-ventricular fashion, (c) switching from the sequential CRT pacing mode to a simultaneous CRT pacing mode, (d) administering a simultaneous CRT pacing therapy in the simultaneous CRT pacing mode to the left and right ventricle in a simultaneous bi-ventricular fashion, (e) analyzing the sensed atrial depolarizations to detect the presence of an atrial arrhythmia, (f) analyzing the sensed atrial depolarizations while in the sequential CRT pacing mode to detect the presence of atrial arrhythmia, and (g) sensing ventricular depolarizations of the left and the right ventricle.

Abstract: The medical lead delivery device combines features of a guidewire and a stylet in order to more easily and quickly deliver a lead to or through the coronary vein of a patient's heart. The medical lead delivery device includes an elongated body, a controller, a first and second spring, and a sleeve. The elongated body includes a proximal end and a distal end. The controller is disposed at the proximal end and provides enhanced control of the distal tip of the elongated body.

Abstract: A medical electrical lead includes a lead body and a connector terminal. A conductor extends from the lead body to the connector terminal along a helical path through a transition zone.

Abstract: A method of performing a medical procedure is provided. The medical procedure includes stimulation of a patient's heart while stimulating a nerve of the patient in order to modulate the patient's inflammatory process. More particularly, the medical procedure includes pacing the ventricles of the patient's heart while stimulating the vagal nerve of the patient. Systems and devices for performing the medical procedure are also provided.

Abstract: A system and method are provided for sensing cardiac electrogram (EGM) signals and ventricular pressure signals and for using the sensed EGM and sensed pressure signals for estimating stroke volume (SV). A measure of cardiac output can be computed from the estimated SV and a heart rate determined from the EGM signals. The sensed ventricular pressure signal and the sensed EGM signal are used to derive landmark points such as an estimated pulmonary diastolic pressure, a mean pulmonary artery pressure, a peak right ventricular pressure (RVP), and various time intervals used in computing an area or a pulse contour integral. The pulse contour integral is used to estimate SV. The estimated pulmonary diastolic pressure, mean pulmonary artery pressure and CO computed from the estimated SV can be used to compute a pulmonary vascular resistance.

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: An implantable medical device system and associated method are provided for measuring an excitation-physiological response delay. The method includes sensing a first signal responsive to electrical activity in a first cardiac chamber, sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and determining an excitation-physiologic response delay in response to the first signal and the second signal.

Abstract: Displacement or migration of a left ventricular lead located within the coronary sinus or coronary veins of the heart is detected by comparing an electrogram (EGM) waveform pattern from the lead with a stored baseline EGM waveform pattern. Based upon the extent of lead migration, if any, a lead displacement may produce an annunciating response. The patient may be alerted, an electrical stimulus applied through the lead may be adjusted to compensate for lead migration, or an alternative electrode on the lead may be used for EGM sensing and pacing.

Abstract: A method for determining an optimal pacing timing control parameter setting is provided for use in an implantable medical device programmed to deliver a pacing pulse in response to the timing control parameter. The method includes storing a user-selected optimization metric, iteratively adjusting the timing control parameter setting, sensing a first signal that varies in response to left ventricular wall acceleration, measuring the user-selected optimization metric in response to the sensed first signal, and determining an optimal timing control parameter value in response to the measured user-selected optimization metric.

Abstract: A system and method are provided for sensing cardiac electrogram (EGM) signals and ventricular pressure signals and for using the sensed EGM and sensed pressure signals for estimating stroke volume (SV). A measure of cardiac output can be computed from the estimated SV and a heart rate determined from the EGM signals. The sensed ventricular pressure signal and the sensed EGM signal are used to derive landmark points such as an estimated pulmonary diastolic pressure, a mean pulmonary artery pressure, a peak right ventricular pressure (RVP), and various time intervals used in computing an area or a pulse contour integral. The pulse contour integral is used to estimate SV. The estimated pulmonary diastolic pressure, mean pulmonary artery pressure and CO computed from the estimated SV can be used to compute a pulmonary vascular resistance.

Abstract: A method of identifying sleep disordered breathing (SDB) in a patient includes monitoring a hemodynamic pressure, deriving high, middle, and low values representative of the distribution of the hemodynamic pressure over a storage interval, measuring a ratio of a lower range to a full range of the hemodynamic pressure based on the derived high, middle, and low values, and using the ratio to determine whether the patient has experienced an SDB episode. Certain embodiments of the invention compare the ratio to a threshold value to identify the occurrence of an SDB episode, while other embodiments of the invention identify the occurrence of an SDB episode by monitoring for a simultaneous increase in both the ratio and the full range of the hemodynamic pressure. In certain other embodiments of the invention, activity level and/or duration criteria may be employed to confirm the occurrence of an SDB episode detected using the ratio.

Abstract: A vascular prosthesis is constructed from a well-defined pore structure to allow uninterrupted ingrowth of connective tissue into a wall of the prosthesis. Several different methods can be used to produce the prosthesis, including a vacuum impregnation technique, a paste molding technique, a paste extrusion technique, a dip coating technique, and a melt extrusion technique. Furthermore, mechanical properties of the prosthesis are matched with mechanical properties of the host vessel, thereby overcoming problems of compliance mismatch.

Abstract: A vascular prosthesis is constructed from a well-defined pore structure to allow uninterrupted ingrowth of connective tissue into a wall of the prosthesis. Several different methods can be used to produce the prosthesis, including a vacuum impregnation technique, a paste molding technique, a paste extrusion technique, a dip coating technique, and a melt extrusion technique. Furthermore, mechanical properties of the prosthesis are matched with mechanical properties of the host vessel, thereby overcoming problems of compliance mismatch.

Abstract: An impedance monitor for discerning edema through evaluation of respiratory rate. Preferred embodiment includes edema monitor and trigger to initiate diagnostic reporting or corrective action when activated. Recording of Long Term Average and Short Term Average values for secondary edema measure based on DC signal level are described as are methods and apparatus for removing unwanted recurring noise.

Abstract: In using electrogram signals to determine physiologic conditions like ischemia, the bad cardiac cycle information due to noise, axis shifts in the cardiac electrical axis, and the like must be removed if the electrogram signal can be made to be a good indicator. If this is accomplished through the adaptive filtering techniques shown here, the signal can be used to drive a closed loop therapy system responsive to those physiologic conditions discernible from good cardiac cycle electrocardiogram signals.

Abstract: A medical electrical lead having an elongated insulative sheath carrying an elongated electrical conductor therein and having a drug-dispensing electrode assembly coupled to a distal end of the elongated conductor. The electrode assembly takes the form of a conductive electrode member having a distal electrode portion exposed exterior to the elongated sheath and a shank portion extending proximally from the distal portion and coupled to the elongated conductor. A drug release device is mounted around the shank proximal to the distal portion of the electrode member and the electrode member is provided with at least one bore extending from a surface of the release device to a surface of the distal portion of the electrode member.

Abstract: A medical device implant, monitoring and adjustment are enhanced by the telepresence of a remote expert (31) having a screen display (30) that mirrors the display at the patient location. Pointers (51), whether they can activate subprograms at the patient location or not, are moved identically at both locations at the same time. Also, the ECG and any features thereof are updated in real time, while other communication operations occur.

Abstract: Clinical studies of heart patients have demonstrated that ventricular tachyarrhythmia often is preceded by a foreshortened cardiac cycle length followed by a relatively long compensatory pause, thus producing in an abrupt short-to-long cycle length change. An implantable apparatus for preventing tachyarrhythmia measures the cardiac cycle length and detects the occurrence of a foreshortened cardiac cycle length more than a predefined amount between consecutive cycles. When a normal heart beat does not occur within a predefined period of time after such an abrupt change in cycle length, the resulting compensatory pause is eliminated by a cardiac pacer applying an appropriately timed electrical pulse to produce a contraction of the heart. The apparatus also includes a defibrillator to shock the heart in the event that the preventive pacing is not effective.