Abstract: Methods for performing cardiac signal analysis in an implanted medical device, and devices configured to perform illustrative methods of cardiac signal analysis. A cardiac signal is captured by an implanted device using implanted electrodes and, during at least certain conditions, the cardiac signal undergoes heuristic filtering. In some embodiments, heuristic filtering is achieved by modifying a signal or value that is used as an indicator of received signal amplitude. In an illustrative example, the heuristic filtering includes periodically incrementing or decrementing the signal or value toward a desired quiescent point, where the heuristic filter period is significantly longer than the sampling period for the signal itself. In another illustrative example, the heuristic filter frequency can be adjusted dynamically to keep the signal average near the desired quiescent point.

Abstract: A comparator is arranged to compare a series of analog voltage signal samples on a first capacitor with a voltage on a second capacitor which is linearly increased or decreased to equal the sample value. The comparator's single output freezes the count of the counter at counts which are proportional to the voltage of the respective samples. In this manner, analog to digital conversion can be accomplished using a single line between the analog and digital sides of a circuit, thereby reducing parasitic capacitance.

Abstract: An illustrative embodiment includes an implantable cardiac stimulus device comprising input circuitry configured to reduce the time required to return to small signal operation after a disturbance of small signal operation. In another illustrative embodiment, the present invention includes methods for operating an implantable cardiac stimulus device to reduce the time required to return to small signal operation after a disturbance of small signal operation. In yet additional embodiments, the initiation of small signal operation after a change in sensing vector and/or after delivery of a stimulus to the patient is improved by the inclusion of input circuitry and/or the use of methods adapted to reduce the time needed to reach small signal operation.

Abstract: Methods and devices for sensing vector analysis in an implantable cardiac stimulus system. In an illustrative example, a first sensing vector is analyzed to determine whether it is suitable, within given threshold conditions, for use in cardiac event detection and analysis. If so, the first vector may be selected for detection and analysis. Otherwise, one or more additional vectors are analyzed. A detailed example illustrates methods for analyzing sensing vectors by the use of a scoring system. Devices adapted to perform these methods are also discussed, including implantable medical devices adapted to perform these methods, and systems comprising implantable medical devices and programmers adapted to communicate with implantable medical devices, the systems also being adapted to perform these methods. Another example includes a programmer configured to perform these methods including certain steps of directing operation of an associated implanted or implantable medical device.

Abstract: The present invention is directed toward methods for inducing fibrillation in a patient using a controlled current AC signal applied via an implanted ICD. In some embodiments, the AC signal is applied as a series of alternating constant current pulses. Some embodiments make use of a specialized H-bridge circuit for applying the AC signal. A low-side current controlling portion of an ICD's circuitry may make up part of the specialized H-bridge circuit. Further embodiments include devices embodying these methods.

Abstract: A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient's heart or reside in the intrathoracic blood vessels and for providing anti-tachycardia pacing energy to the heart, comprising a capacitor subsystem for storing the anti-tachycardia pacing energy for delivery to the patient's heart; and a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-tachycardia pacing energy to the capacitor subsystem.

Abstract: Electrical circuit componentry is switchable into a defibrillator circuit to deliver a constant pacing current to a patient. The circuitry may include a constant current source inserted in a leg of the defibrillator circuit or a resistor of selected value inserted between a high voltage source and the high side of a defibrillator circuit.

Abstract: A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and using a lead system that does not directly contact a patient's heart or reside in the intrathoracic blood vessels and for providing anti-bradycardia pacing energy to the heart, comprising a capacitor subsystem for storing the anti-bradycardia pacing energy for delivery to the patient's heart; and a battery subsystem electrically coupled to the capacitor subsystem for providing the anti-bradycardia pacing energy to the capacitor subsystem.

Abstract: Methods of using a template having a template data set and template parameters to provide improved alignment of captured cardiac signal data to a stored template. More particularly, in an illustrative method, a captured cardiac signal is first configured using template parameters for a stored template. Then, once configured, the captured cardiac signal is then compared to the stored template. Other embodiments include implantable cardiac treatment devices including operational circuitry configured to perform the illustrative method. In a further embodiment, more than one stored templates may be used. Each template can have independently constructed parameters, such that a single captured cardiac signal may be configured using first parameters for comparison to a first template, and using second parameters for comparison to a second template.

Abstract: Methods and devices for cutaneous testing of a patient for the purpose of implanting and/or placing electrodes for electrical cardiac stimulation. In an example, a cutaneous electrode system is placed and used to observe cardiac signal sensing and/or simulate cardiac stimulation. The method may include identifying locations for improved sensing or simulation, and implanting a device or system such that implanted electrodes are placed to correspond to cutaneously identified locations.

Abstract: The present invention is direction toward a detection architecture for use in implantable cardiac rhythm devices. The detection architecture of the present invention provides methods and devices for discriminating between arrhythmais. Moreover, by exploiting the enhanced specificity in the origin of the identified arrhythmia, the detection architecture can better discriminate between rhythms appropriate for device therapy and those that are not.

Abstract: One embodiment of the present invention provides an implantable cardioverter defibrillator for subcutaneous positioning between the third rib and the twelfth rib within a patient, the implantable cardioverter-defibrillator including a housing; having a first surface and a second surface, wherein the first surface comprises an electrically insulated material and the second surface comprises an electrically conductive material; and an electrical circuit located within the housing, wherein the electrical circuit is electrically coupled to the second surface of the housing.

Abstract: Methods, implantable medical devices and systems configured to perform analysis of captured signals from implanted electrodes to identify cardiac arrhythmias. In an illustrative embodiment, signals captured from two or more sensing vectors are analyzed, where the signals are captured with a patient in at least first and second body positions. Analysis is performed to identify primary or default sensing vectors and/or templates for event detection.

Abstract: One embodiment of the present invention provides an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib within a patient, the implantable cardioverter-defibrillator including a housing including a first electrode; a telescoping lead assembly including a second electrode, wherein the telescoping lead assembly is electrically and mechanically coupled to the housing; and an electrical circuit located within and electrically coupled to the housing.

Abstract: Methods and devices configured for analyzing sensing vectors in an implantable cardiac stimulus system. In an illustrative example, a first sensing vector is analyzed to determine whether it is suitable, within given threshold conditions, for use in cardiac event detection and analysis. If so, the first sensing vector may be selected for detection and analysis. Otherwise, and in other examples, one or more additional sensing vectors are analyzed. A polynomial may be used during analysis to generate a metric indicating the suitability of the sensing vector for use in cardiac event detection and analysis. Additional illustrative examples include systems and devices adapted to perform at least these methods, including implantable medical devices, and/or programmers for implantable medical devices, and/or systems having both programmers and implantable medical devices that cooperatively analyze sensing vectors.

Abstract: An illustrative embodiment includes an implantable cardiac stimulus device comprising input circuitry configured to reduce the time required to return to small signal operation after a disturbance of small signal operation. In another illustrative embodiment, the present invention includes methods for operating an implantable cardiac stimulus device to reduce the time required to return to small signal operation after a disturbance of small signal operation. In yet additional embodiments, the initiation of small signal operation after a change in sensing vector and/or after delivery of a stimulus to the patient is improved by the inclusion of input circuitry and/or the use of methods adapted to reduce the time needed to reach small signal operation.

Abstract: The implantable cardiac treatment system of the present invention is capable of choosing the most appropriate electrode vector to sense within a particular patient. In certain embodiments, the implantable cardiac treatment system determines the most appropriate electrode vector for continuous sensing based on which electrode vector results in the greatest signal amplitude, or some other useful metric such as signal-to-noise ratio (SNR). The electrode vector possessing the highest quality as measured using the metric is then set as the default electrode vector for sensing. Additionally, in certain embodiments of the present invention, a next alternative electrode vector is selected based on being generally orthogonal to the default electrode vector. In yet other embodiments of the present invention, the next alternative electrode vector is selected based on possessing the next highest quality metric after the default electrode vector.

Abstract: High side driver circuitry for a defibrillator circuit employs respective capacitors connected to respective gates of silicon controlled rectifiers serving as high side switches. Applying a voltage pulse to a selected capacitor turns on the associated SCR. Positive turn-on of the high side SCRs is insured by inserting a constant current source into the low side activation current path at start-up.

Abstract: In a subcutaneous implantable cardioverter/defibrillator, cardiac arrhythmias are detected to determine necessary therapeutic action. Cardiac signal information is sensed from far field electrodes implanted in a patient. The sensed cardiac signal information is then amplified and filtered. Parameters such as rate, QRS pulse width, cardiac QRS slew rate, amplitude and stability measures of these parameters from the filtered cardiac signal information are measured, processed and integrated to determine if the cardioverter/defibrillator needs to initiate therapeutic action.

Abstract: Template formation methods for use in implantable cardiac rhythm management devices. In an illustrative method, a signal is captured signal an implanted cardiac rhythm management device, and parameters for analysis of the captured signal are then defined. Then, in the example, additional signals can be captured and used to either verify or discard the captured signal defined parameters. The template formation methods provide for creating a robust template to compare with sensed cardiac complexes. Devices and systems configured to perform template formation and verification methods are also shown.