Abstract: A method and apparatus for optimizing and assessing the response to extra-systolic stimulation (ESS) are provided. An optimization/monitoring parameter is calculated as a function of potentiation ratio, PR, and recirculation fraction, RF, derived from measurements of myocardial contractile function during and after ESS. PR may be computed as the ratio of the contractile function on post-extra-systolic beats during ESS to baseline contractile function. RF may be computed as the slope of a linear regression performed on a plot of the contractile function for a post-extra-systolic beat versus the contractile function for the previous post-extra-systolic beat after ESS is ceased. The ESI resulting in a maximum optimization/monitoring parameter, preferably computed as the product of PR and RF, is determined as the optimal ESI. The operating ESI may be automatically adjusted, and/or PR and RF data may be stored for monitoring purposes.

Abstract: Detection of volume depletion, particularly after an incidence of volume overload is disclosed. Various methods, systems, and devices are disclosed that sense and analyze a physiological parameter related to a patient's fluid level in order to warn patients of potentially dangerous volume depletion conditions while minimizing false notifications.

Abstract: A preferred atrial-based pacing method and apparatus is provided using an intelligent cardiac pacing system to having the ability to continue atrial-based pacing as long as relatively reliable AV conduction is present. In the event that such relatively reliable AV conduction is not present, mode switching to a DDD/R or a DDI/R pacing mode while continually biased to mode switch back to atrial-based pacing. The standard or relatively reliable AV conduction may be changed either automatically or manually. This increases pacing that utilizes natural AV conduction however possible so as to gain all the benefits of cardiac contractile properties resulting therefrom, while tolerating the occasional missed ventricular depolarization (i.e., non-conducted P-wave). In the event where relatively reliable AV conduction is not present, the pacing mode is switched to a DDD/R mode while detecting a return of the relatively reliable AV conduction (and resulting mode switch to preferred atrial based pacing).

Abstract: An external cardiac medical device for delivering Cardiac Potentiation Therapy (CPT). Techniques used with the device include initial diagnosis of the patient, delivery of the CPT, and configuration of the external device, so that CPT can be effectively and efficiently provided. In particular, these techniques include initially determining whether a patient should receive CPT, how to set the coupling interval for delivering CPT, how to configure the external medical device to deliver CPT stimulation pulses while not adversely affecting the device's ability to sense a patient's cardiac parameters and/or signals.

Abstract: A lead coupling device adapted for coupling to a lead and methods for using the coupling devices are provided. The coupling device includes a housing assembly having a proximal opening and a distal opening. The coupling device also has a lead receiving channel that is disposed between the two openings to receive a lead therethrough. Various electronics components may also included in the coupling device that enable operations such as sensing, delivery of electrical energy and wireless communication between the coupling device and an external device.

Abstract: During diastolic coronary perfusion, blood perfuses through the heart via the coronary arteries. Delivery of a therapeutic and/or diagnostic agent to the heart during diastolic coronary perfusion allows the therapeutic and/or diagnostic agent to efficiently perfuse through the heart. A medical device according to the invention detects closure of the aortic valve of a heart, and initiates delivery of a therapeutic and/or diagnostic agent upon detection of aortic valve closure. The medical device detects aortic valve closure by processing a signal.

Abstract: Waveforms are digitally sampled and compressed for storage in memory. The compression of the data includes generating a truncated entropy encoding map and using the values within the map to obtain good compression. An encoder further sub-selects values to be encoded and values to remain unencoded to provide an overall compression of the data.

Abstract: Methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval based upon ECG-based optimization is calculated as a linear function of P-wave duration, sensed PR (intrinsic) interval, sensed or paced QRS duration and heart rate. Since the relationship among these parameters is linear, once the coefficients are solved (which can be any value, including null) with reference to a known optimized AV interval (AVopt) such as from an echocardiographic study, an AVopt value can be dynamically adjusted in an ambulatory subject. The various combinations of values can be loaded into a look up table or calculated automatically. And, since some of the parameters do not typically change much over time they can be determined acutely and fed into the equation while the other values can be measured frequently. The parameter values can be measured by an implantable medical device such as a dual- or triple-chamber pacemaker.

Abstract: A medical device lead is presented. The medical device lead includes a lead body, an electrode shaft, and a tip electrode. A magnetostrictive element is coupled to the electrode shaft. The magnetostrictive element comprises either terfenol-D and/or galfenol or any material with sufficient magnetostrictive properties. The magnetostrictive element expands when exposed to magnetic resonance imaging.

Abstract: A radiation-based timer for use in an implantable medical device (IMD) includes a radiation source and a radiation detection circuit. The radiation source emits radiation particles during a process referred to as radioactive decay. The radiation detection circuit detects the radiation particles emitted during the decay process and tracks the number of radiation particles detected. When the number of radiation particles detected reaches a threshold value, a timer signal is generated. In this manner, the radiation-based timer generates a timer signal as a function of the radioactive decay of the radiation source. The timer signal may be used by one or more components of the IMD for any of a number of functions, including as a wakeup trigger for a communications and/or a sensor event.

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.

Abstract: An apparatus and method for the cancellation of third order derivative distortion for ultra low power (ULP) applications are disclosed involving a first amplifier connected in parallel with a second amplifier for amplifying a received signal. The first amplifier includes at least one transistor operating in the sub-threshold region such that the first amplifier possesses a positive third derivative of a transfer function of the first amplifier, which generates a first amplified signal having in phase third order distortions. The second amplifier includes at least one differential pair of transistors operating in the sub-threshold region such that the second amplifier possesses a negative third derivative of a transfer function of the second amplifier, which generates a second amplified signal having in opposite phase third order distortions. The first and second amplified output signals are combined resulting in cancellation of third order distortions in the combined amplified signal.

Abstract: Apparatus using one or more modes of statistical analysis with one or more monitored parameters of a patient's heart to identify and/or assess arrhythmias. Through use of the one or more modes of statistical analysis, a medical professional can be aided during evaluation of patient data for diagnosis of the patient. At least one of the monitored parameters may include one or more values used representatively for storage intervals of a selected length. As such, for each storage interval, a value may be determined for the one monitored parameter occurring at an upper percentile and a lower percentile. In addition, a median value may be determined for the one monitored parameter for each storage interval. Over a plurality of the storage intervals, these determined values can be used in one or more modes of statistical analysis to better identify and assess the arrhythmias.

Abstract: A coiled member of a medical device extends along a length of an elongate body of the device. A surface of the coiled member extends at an angle, with respect to a longitudinal axis of the body, from a first edge to a second edge, toward the proximal end of the body, such that the first edge of the surface is disposed in close proximity to the body and the second edge of the surface is spaced apart from the body.

Abstract: A medical electrical lead includes an inductance augmenter assembly. The assembly includes an inductor coil formed of an insulated wire, which is wound about a non-conductive core and is electrically coupled in series between a conductor coil of the lead and an electrode of the lead.

Abstract: Waveforms are digitally sampled and compressed for storage in memory. The compression of the data includes generating a truncated entropy encoding map and using the values within the map to obtain good compression. An encoder further sub-selects values to be encoded and values to remain unencoded to provide an overall compression of the data.

Abstract: A medical device system and method for delivering mechanically fused left ventricular cardiac stimulation. A sensor monitors left ventricular acceleration while left ventricular cardiac stimulation is provided at an AV interval. The left ventricular acceleration is used to calculate a mechanical response interval and the mechanical response interval is compared to a desired mechanical response interval. The AV interval is adjusted until the mechanical response interval is equal to the desired mechanical response interval.

Abstract: An implantable medical device identifies onset and/or progression of left ventricular dysfunction (LVD). The implantable medical device receives a signal that represents electrical activity within a heart, e.g., an electrogram signal, and digitally processes the signal to assess left ventricular function. In particular, the implantable medical device measures at least one characteristic of QRS complexes within the signal, and assesses left ventricular function based on measurements. The implantable medical device may, for example, measure the width of the QRS complexes and/or the amplitude of the R-waves within the QRS complexes. The implantable medical device may alert a patient or clinician of the onset or progression of LVD, and may control delivery of therapies, such as rate-responsive pacing and cardiac resynchronization pacing, based on the measurements. The implantable medical device may also control delivery of a drug by an implanted drug delivery device, e.g., drug pump, based on the measurements.

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: Apparatus and method according to the disclosure relate to promoting flow of body fluids in and around and between a substantially planar cardiac-sensing electrode and a shroud member utilizing spacing therebetween and/or one or more apertures, notches, slots and the like. For example, a relatively recessed area or aperture formed in an exemplary resin-based shroud member includes apertures that cooperate to promote flow of body fluids therearound.