Abstract: Implantable device systems include an electrical lead with one or more electrodes and a shield. The shield is attached to the electrical lead with the shield covering a first side of the electrode and extending laterally away from the electrode. The shield directs energy from at least one of the electrodes of the the electrical lead in a direction away from the shield.

Abstract: An implantable medical device (IMD) with a receiver having a higher power mode and a lower power mode. In the higher power mode, the receiver can receive a communication from an external device and pass the received communication to a controller, and in the lower power mode the receiver may not receive the communication from the external device and pass the received communication to the controller. In some cases, the IMD may include a physiological sensor providing an output to the controller, and the controller may control whether the receiver is in the higher power mode or the lower power mode based at least in part on the output of the physiological sensor.

Abstract: Systems and methods for monitoring and treating patients with heart failure are discussed. The system can store in a memory stimulation parameters, including stimulation timing parameters for a plurality of heart rate ranges. The system includes a plurality of timers with respective durations for the plurality of heart rate ranges. A stimulation control circuit can identify a target heart range in which a detected heart rate falls, and measure an atrioventricular (AV) conduction characteristic value in response to the timer for the target heart range being expired at the detected heart rate. The stimulation control circuit can update a stimulation parameter corresponding to the target heart rate range using the measured AV conduction characteristic. The updated stimulation parameter can be used in cardiac stimulation.

Abstract: An implantable leadless pacing device and delivery system may comprise an implantable leadless pacing device and a catheter configured to deliver the implantable leadless packing device to a target location. The implantable device may comprise a power source, circuitry operatively coupled to the power source, a housing at least partially enclosing the circuitry, a first electrode secured relative to and offset from a longitudinal axis of the housing and exposed exterior to the housing, and a fixation mechanism secured relative to the housing. The fixation mechanism may comprise at least one tine configured to move between an elongated delivery configuration and a curved deployed configuration and radially offset from the first electrode. The catheter may comprise a distal holding section defining a cavity configured to receive the implantable leadless pacing device.

Abstract: Systems and methods for treating arrhythmias are disclosed. In one embodiment an LCP comprises a housing, a plurality of electrodes for sensing electrical signals emanating from outside of the housing, an energy storage module disposed within the housing, and a control module disposed within the housing and operatively coupled to the plurality of electrodes. The control module may be configured to receive electrical signals via two or more of the plurality of electrodes and determine if the received electrical signals are indicative of a command for the LCP to deliver ATP therapy. If the received electrical signals are indicative of a command for the LCP to deliver ATP therapy, the control module may additionally determine whether a triggered ATP therapy mode of the LCP is enabled. If the triggered ATP therapy mode is enabled, the control module may cause the LCP to deliver ATP therapy via the plurality of electrodes.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. In an embodiment, a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses. A sensing circuit senses an atrial activation. A control circuit detects a retrograde atrial conduction timing, such as a His-to-atrial interval between the HBP pulse and the sensed atrial activation in response to the HBP pulse, and verifies capture status using the determined retrograded atrial conduction timing. Based on the capture status, the control circuit determines a HBP threshold, and the electrostimulation circuit delivers HBP pulses in accordance with the determined HBP threshold.

Abstract: Retention devices for use with an implantable medical device (IMD) are disclosed. An illustrative retention device may comprise an elongate body including a hollow lumen configured to receive a lead of the IMD and an outer surface configured to receive a suture. The retention device may also include a securing mechanism configured to push against tissue of a patient.

Abstract: Systems and methods for detecting atrial tachyarrhythmia are discussed. An exemplary atrial tachyarrhythmia detection system includes an arrhythmia detector circuit configured to receive physiologic information of a patient, generate a morphological similarity metric between the received physiologic information and a sinus rhythm (SR) template representing a morphology of conducted sinus beats during normal SR, and generate a morphological variability metric indicative of a variability in morphology between heart beats in the received physiologic information. The arrhythmia detector circuit may detect an atrial tachyarrhythmia episode the morphological similarity and morphological variability metrics.

Abstract: A subcutaneous implantable cardioverter-defibrillator (S-ICD) comprising shocking electrodes configured to reduce the defibrillation threshold. The S-ICD may include a canister housing a source of electrical energy, a capacitor, and operational circuitry that senses heart rhythms and an electrode and lead assembly. The electrode and lead assembly may comprise a lead, at least one sensing electrode, and at least one shocking electrode. The at least one shocking electrode may extend over a length in the range of 50 to 110 millimeters and a width in the range of 1 to 40 millimeters.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT.

Abstract: An example of a system may include a sensing circuit and an atrial fibrillation (AF) detection circuit. The sensing circuit may be configured to sense a cardiac signal indicative of atrial and ventricular depolarizations. The AF detection circuit may be configured to detect AF using the cardiac signal and may include a detector and a detection enhancer. The detector may be configured to detect the ventricular depolarizations using the cardiac signal, to measure ventricular intervals each between two successively detected ventricular depolarizations, and to detect the AF using the ventricular intervals. The detection enhancer may include a respiratory sinus arrhythmia (RSA) detector configured to detect RSA using the cardiac signal and may be configured to verify each detection of the AF based on whether the RSA is detected.

Abstract: Systems and methods for dynamically controlling HBP delivery based on patient AV conduction status are disclosed. An exemplary medical system includes an electrostimulation circuit to generate HBP pulses to stimulate a His bundle or a bundle branch of the heart. An AV conduction monitor circuit continuously or periodically assesses AV conduction status, and detects an indication of presence or absence of AV conduction abnormality. If an AV conduction abnormality is indicated, a control circuit may control the electrostimulation circuit to deliver the HBP pulses. Ventricular backup pacing may be delivered if HBP fails to capture and elicit ventricular activation. When the AV conduction become normal, the control circuit may withhold HBP delivery and promote patient intrinsic ventricular activation.

Abstract: The present subject matter includes an implantable medical device with a capture feature at or near the proximal end. In some cases, the capture feature includes a hold that is configured to facilitate a releasable connection with a delivery device that is used to deliver the implantable medical device to a target implant site.

Abstract: Method and system for determining an atrial contraction timing fiducial in a leadless cardiac pacemaker system is disclosed. An electrical cardiac signal associated with an atrial contraction of the patient's heart and a mechanical response to the atrial contraction of a patient's heart are used to determine an atrial contraction timing fiducial. A ventricle pacing pulse may then be generated an A-V delay after the atrial contraction timing fiducial.

Abstract: Methods and systems in which a first medical device provides patient status details to a second medical device. Patient status details may include one or more of patient posture and/or patient activity level, or other indications of patient status. The second medical device, in response to information about patient status and changes in patient status, uses a sensing configuration management function to respond to and accommodate the change in patient status. In an example, a first medical device monitors patient posture and communicates information related to patient posture to a second medical device, which then tailors sensing configurations to the patient posture.

Abstract: A retention device for use with an implantable medical device (IMD) are disclosed. An illustrative retention device may comprise an elongate body including a configured to receive the lead of the IMD. The retention device may also include securing mechanisms coupled to the elongate body and configured to push against tissue of a patient. The securing mechanisms may also include linking elements coupled to the elongate body and a portion of the securing mechanisms.

Abstract: This document discusses, among other things, systems and methods for monitoring a patient at risk of epilepsy. A system comprises a sensor circuit that senses from the patient at least first and second physiological or functional signals. A wellness detector circuit can detect an epileptic event using the sensed physiological or functional signals, or additionally classify the epileptic event into one of epileptic seizure types. The system can generate a wellness indicator based on a trend of the physiological or functional signal during the detected epileptic event. The wellness indicator indicates an impact of the detected epileptic event on the health status of the patient. The system includes an output unit configured to output the detection of the epileptic event or the wellness indicator to a user or a process.

Abstract: Systems and methods for ambulatory detection of medical events such as cardiac arrhythmia are described herein. An embodiment of an arrhythmia detection system may include a detection criterion circuit that determines a patient-specific detection criterion using a baseline cardiac characteristic when the patient is free of cardiac arrhythmias. The detection criterion circuit generates a patient-specific threshold of a signal metric by adjusting a population-based threshold of the signal metric, where the manner and the amount of adjustment is based on information about patient baseline cardiac characteristic. The arrhythmia detection system detects an arrhythmia episode using a physiologic signal sensed from the patient and the patient-specific arrhythmia detection threshold.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, and alternate the first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay. Physiologic information can be received from the patient, and one of the first or second pacing period for delivery to the patient can be determined using the received physiologic information.

Abstract: Catheter and implantable leadless pacing devices, systems, and methods utilizing catheters and implantable leadless pacing devices are disclosed. An example catheter system may include a holding structure extending distally from a tubular member. An implantable device, such a leadless pacing device, may be located within a cavity of the holding structure and an electrical barrier may be located within the holding structure at a location between a proximal electrode and a distal electrode of the implantable device. The electrical barrier may inhibit electrical signals of the implantable device from traveling within the holding structure between the proximal electrode and the distal electrode of the implantable device. The holding structure may include one or more electrical ports adjacent the proximal end of the holding structure and adjacent or proximal of the proximal electrode of the implantable device.