Abstract: One system includes a stimulation device such as a vagus nerve stimulation lead, and a controller for controlling the stimulation device according to a set of stimulation parameters. A memory of the stimulation device contains a state transition model, and for each state defines a set of stimulation parameters and at least one expected response during the application of stimulation with the parameters. A matrix determines the transition rules between states based on physiological levels measured versus target levels. A state transition control unit determines, in an organized timely method, possible transitions between states according to the rules on physiological levels obtained in response to the implementation of the stimulation parameters of the current state, and a transition from a current state to a new state causes a corresponding change in the parameter set used for stimulation.

Abstract: An assembly includes a medical device provided with an anchoring member adapted to penetrate tissue of a cavity of the heart. The assembly further includes an implantation accessory including an elongated tubular element provided with a fastening mechanism for handling and guiding the medical device to an implantation site. The fastening mechanism includes an elastic deformable component cooperating with a rigid component, that is able to disconnect the medical device from the tubular element under the effect of a rotation exerted to the tubular element. The elastic deformable component cooperates with the rigid component such that the elastic deformable component exerts on the latter a radial constriction effect, and the elastic component and the rigid component being disconnected under the combined effect of a torsion torque and a traction exerted to the elastic deformable component, to thereby reduce the radial constriction until release of the rigid component.

Abstract: A cuff for use in nerve stimulation includes a sheet of elastomer having at least one electrode and being pre-stressed so as to allow its spiral self-winding to form a cuff around the nerve. The sheet is delimited by a first width defining an outer edge of the cuff after winding, a second width defining an opposite inner edge, a first length and a second opposite length. The first width is at both ends connected to the two lengths by a respective bevel edge forming an oblique angle relative to the direction of greatest dimension of the sheet.

Abstract: A medical device for stimulating the heart using biventricular stimulation. The device includes a sensor for detecting an endocardial acceleration parameter and a processing circuit configured to receive the endocardial acceleration parameter. The device further includes stimulation electronics coupled to the processing circuit. The processing circuit is configured to use the EA parameter to evaluate the biventricular stimulation. The evaluation includes comparing the value of the EA parameter in biventricular mode to the value of the EA parameter in left only mode or right only mode, and using the comparison and an assessment of the variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising: (a) normal operation, (b) a loss of RV or LV capture, (c) possible anodal stimulation. The processing circuit is further configured to conduct at least one update to operational parameters of the device based on the determined case.

Abstract: The disclosure relates to a lead including a connector for connection to a generator, a demultiplexing circuit receiving at its input on the first conductors of the electrical control signals from the control bus and whose output is connected to a plurality of second conductors contained in the lead and connected to the lead electrodes. The lead further includes a gate and connection circuit component having a body forming a support for an integrated circuit for demultiplexing and defining a set of connection cavities with the second conductor distributed at the periphery of the body around a general axis of the body, and a plurality of connecting elements embedded in the body material, and emerging at an element region and supporting the circuit at respective cavities. The gate and connection circuit component is advantageously made of ceramic-metal.

Abstract: A microlead, of an overall diameter less than 0.5 mm, includes a plurality of at least eight conductor wires individually insulated and twisted together. Each conductor wire includes an electrically conductive core microcable and an insulation layer surrounding the core microcable and having at least one exposed area to form a detection/stimulation electrode of the microlead. The microlead further includes a central support structure shaped as a surface of revolution, which may be free of conductor wires and of central lumen. The conductor wires are configured in one or more layers of twisted peripheral conductor wires carried by the central support structure and circumferentially distributed thereon.

Abstract: The disclosure relates to a device including a circuit for adjusting the energy of the stimulation pulses, independently controlling the pulse width and the voltage of each stimulation pulse. An iterative search algorithm for determining the optimum energy includes changing both the pulse width and voltage at each new pulse delivered, by setting a high energy value and a low energy value, and delivering a stimulation pulse with the low energy value. A capture test is then carried out. In the presence of a capture, a current iteration is complete and a new iteration is done with the current low energy as a new high energy value. In the absence of capture, the algorithm is terminated with selection of the last energy value that produced the capture as the value of optimum energy.

Abstract: This system includes a conductor microcable and an insulating microcatheter, including a hollow tube housing the microcable with the possibility of relative axial translation therebetween. The microcatheter is suitable for permanent implantation. The microcatheter, in its distal portion, includes at least one lateral window formed by a through orifice formed on the wall of the hollow tube. The window forms a stimulation site defined on the wall of the target vein facing the window of the microcatheter, and provides for a region of the microcable surface located at the window to form a stimulation electrode. In its distal portion, the microcable is not isolated at least in the region of the window of the microcatheter. The microcatheter is telescopically moveable on the microcable, so as to modify the position of the stimulation site of the target vein.

Abstract: An assembly including an autonomous capsule having an anchoring member adapted to penetrate tissue of the heart and an accessory for implantation of the capsule. The accessory includes a steerable catheter with an inner lumen, having at its distal end a tubular protection tip defining a volume for housing the capsule. The accessory also includes a disconnectable attachment mechanism for supporting and guiding the capsule to an implantation site and a sub-catheter housed within the lumen of the steerable catheter, moveable in translation and in rotation relative to the steerable catheter. The sub-catheter and the capsule are movable between a refracted position and a position wherein the capsule is deployed out of the protection tip. The sub-catheter and the capsule are provided with a first fastening mechanism for fastening the two in translation and in mutual rotation, which is disconnectable under a rotation applied to the sub-catheter.

Abstract: The invention relates to an active implantable pacemaker. The device analyzes a ventricular electrogram signal (EGM) and is able to recognize, in a search window, an EA4 component of endocardial acceleration (EA) associated with atrial activity. In the presence of atrioventricular conduction, the search window is determined based on the temporal position of the EA1 and/or EA2 components of the EA signal. In the absence of atrioventricular conduction, a delay is counted from a paced ventricular event and applied to mask the EA1 and/or EA2 components in the EA signal, and the window for research of the EA4 component follows the masking delay. In the presence of a confirmed EA4 component, an atrioventricular delay is applied, counted from the EA4 component, and in the opposite case a predetermined escape interval is applied, counted from the last stimulated ventricular event.

Abstract: On a channel of an implantable cardiac generator, a cardiac lead is replaced by a vagus nerve stimulation VNS lead. The control circuit controlling the stimulation circuit of this channel of the generator is configured to generate sequences of VNS neurostimulation bursts according to a specific profile, synchronized or not with the heart rate. The control circuit dynamically controls the initial load voltage of the reservoir capacitor so as to adjust to a constant target value the electrical charge delivered to the nerve by each stimulating pulse, from a pulse to the next one and from a burst to the next one. This improves the consistency of the physiological effects of neurostimulation despite significant variations that may occur in impedance at the electrode/vagus nerve interface.

Abstract: An intracardiac capsule comprises a cylindrical body having an atraumatic rounded surface and a helical anchoring screw integral with the cylindrical body. The helical anchoring screw is able to penetrate tissue of a wall of the heart and is configured to provide temporary attachment, in rotation and in translation, of the capsule to an implantation site. The helical anchoring screw surrounds at least a portion of the length of the cylindrical body forming a contact region intended to come into contact with the wall of the cavity of the heart. Over the length of the contact region, the external diameter of the cylindrical body is less than the inner diameter of the helical anchoring screw, so as to leave a free gap there between. The helical anchoring screw is secured to the cylindrical body near the proximal end of the contact region, and extends freely to the opposite distal end.

Abstract: A device includes a pulse generator coupled to a neurostimulation lead placed around the nerve and a set of electrodes individually connected to the generator by a splitter circuit controlled to preferentially stimulate certain regions of the nerve relative to other regions. The device performing an iterative search of an optimal configuration operating by selection of a plurality of different stimulation configurations, storing of a cardiac physiological parameter measured for each selected stimulation configuration, and designation as optimal stimulation configuration of the one of said selected different stimulation configurations, depending on at least the stored values of the physiological parameter measured for different electrode configurations.

Abstract: The disclosure relates to a device including a plurality of electrodes for stimulation of both ventricles with application of an atrioventricular delay and of an interventricular delay, a processor configured to multidimensionally measure an interventricular conduction delay, and monitor the evolution of a patient's condition. For the multidimensional measurement of the interventricular conduction delay, the device produces stimulation of one of the ventricles and collects, in the other ventricle, two endocardial electrogram signals on separate respective channels, giving two respective temporal components. Both temporal components are combined in one single parametric 2D characteristic representative of the cardiac cycle, and a comparison is made with reference descriptors for deriving an index representative of the evolution of the patient's condition.

Abstract: According to some embodiments, a device operates by comparative morphological analysis of depolarization signals collected in spontaneous rhythm on separate respective channels, with two temporal components combined into a single 2D parametric VGM vectogram characteristic. Similarity quantification methods evaluate a variation over time of a descriptor parameter of a current VGM compared to a stored previous reference VGM. This variation is compared with predetermined thresholds to diagnose an occurrence of remodeling or reverse remodeling in a patient, and/or to detect a lead failure or an occurrence of ischemia. The descriptor parameter is a function of a velocity vector of the VGM, a comparison relating to a correlation coefficient between respective magnitudes of a current VGM velocity vector and of a reference VGM velocity vector, and an average angle between these respective velocity vectors.

Abstract: A system implantable in the coronary venous system, including a pacing lead with an anchoring screw is disclosed. The system includes a stimulation lead (10) for stimulating a left heart cavity of a patient, and a removable catheter (26) for implanting the lead. The lead (10) has at least one stimulation electrode having an anchoring screw (14) that penetrates into the epicardial tissue of the patient. The catheter tube (26) is a pre-shaped tube with two curvatures in the absence of stress. The two curvatures are inscribed in two separate surfaces (38, 40) for self-orientating the distal end of the catheter tube into the target vein and maintaining the axis of the anchoring screw towards the epicardial wall during the screwing of the lead head.

Abstract: An autonomous intracorporeal capsule comprises a body containing electronic circuits and an energy harvesting module. The energy harvesting module comprises a moveable surface on the body of the capsule, subjected to pressure variations and to produce a mechanical stress under the effect of the pressure variations, and a transducer comprising a deformable piezoelectric component configured as a beam adapted to be forced to bend. The piezoelectric component has a recessed end integral with the capsule and a free end. A mechanical connection couples the free end of the piezoelectric component to the actuator. The mechanical connection may provide a degree of freedom in rotation between a main direction of the beam and the direction of application of the mechanical stress.

Abstract: A microlead has a distal active portion formed by a microcable including an electrically conductive core coated with an insulation layer, with a plurality of exposed areas forming the stimulation electrodes. The microcable has a three-dimensional preshape inscribed in a cylindrical envelope volume so as to match the target vessel wall. The microcable includes a plurality of exposed areas regularly distributed over the circumference of the cylindrical envelope volume considered in axial projection, the exposed zones extending only over an angular sector of the microcable considered in cross section, said angular sector facing the outside of the envelope volume of the preshape.

Abstract: A microlead includes a conductive cable formed by a strand of microcables, each microcable being formed of a strand of individual metallic wires. The microlead also includes an insulation layer sheathing the cable. The microlead further includes at least one exposed area formed in the insulation layer so as to form a corresponding electrode of the microlead. The microlead further includes a pharmacologically active agent (e.g., an anti-inflammatory agent) configured to gradually be released into the environment of the microlead after implantation of the microlead. The pharmacologically active agent may be a soluble material. An interstitial space, delimited by the inner wall of the insulation layer and existing in the remainder between the wires of each microcable, is filled with the pharmacologically active agent.

Abstract: The device includes a cardiac therapy circuit with a first terminal, and a peripheral therapy circuit with a second terminal. These terminals can either receive a cardiac detection/stimulation lead or a peripheral detection/stimulation lead of an organ. The device is configured to recognize the leads and automatically configure the connection terminals according to the type of lead received by the terminal. This includes discrimination methods for identifying the terminal on which a cardiac signal is detected, and selectively activating the cardiac therapy circuit and the peripheral therapy circuit based on the detection of the cardiac signal on a lead.