Abstract: The disclosure describes techniques for delivering vagal stimulation to decrease the ventricular rate response during an atrial tachyarrhythmia, such as atrial fibrillation. Decreasing the ventricular rate response during an atrial tachyarrhythmia may facilitate increased ventricular pacing for cardiac resynchronization therapy (CRT), and may also reduce the likelihood of inappropriately detecting a ventricular tachyarrhythmia during the atrial tachyarrhythmia. Furthermore, the vagal stimulation may augment vagal tone, which may facilitate long term left ventricular reverse remodeling and decrease atrial and ventricular arrhythmic burden in heart failure patients. An example system that delivers CRT comprises a processor that detects an atrial tachyarrhythmia in one or more atria of the heart, and monitors at least one of a ventricular rate or degree of ventricular pacing subsequent to the detected atrial arrhythmia.

Abstract: An implantable medical device system includes a medical electrical lead having a connector assembly and a connector bore for receiving the lead connector assembly. The lead includes a distal portion having a first outer diameter and a distal sealing member, an intermediate portion having a second outer diameter smaller than the first outer diameter, and a connector pin extending from the intermediate portion, the connector pin having an outer diameter corresponding to a DF-1 standard.

Abstract: Devices and methods for penetrating from a vessel lumen in which a catheter device is positioned to a target location outside of that vessel lumen. A tissue penetrator advances from a catheter positioned within the vessel lumen to the target location when properly aimed. An imaging transducer fixedly mounted on or within the catheter body provides an imaging signal from which an image of the target location can be obtained. An imageable marker may be present on the catheter to form on the image obtainable from the imaging signal to predict the path that will be followed by the tissue penetrator when the tissue penetrator exits from the catheter. Alternatively, or addition thereto, the imaging transducer may comprise a plurality of imaging elements which are located so that the penetrator path indication can be obtained electronically without use of an imageable marker on the catheter.

Abstract: A navigation system or combination of navigation systems can be used to provide two or more types of navigation or modalities of navigation to navigate a single instrument. The single instrument can be positioned within the patient and tracked. For example, both an Electromagnetic (EM) and Electropotential (EP) navigation system can be used to navigate an instrument within a patient.

Abstract: A delivery device for implanting a medical device that includes an expandable fixation member adapted to fix the position of the medical device within a lumen of a human body. The delivery device has an inner shaft rotatably disposed in a tubular outer shaft. A retention member is secured to and rotatable with the inner shaft and has a free end and a retainer portion adapted to protrude outwardly through an exit aperture in the outer shaft to extend circumferentially about the exterior of the outer shaft. The fixation member of the medical device may be retained on the tubular shaft in a low profile configuration by the outwardly protruding retainer portion and may be released to expand upon retraction of the retainer portion in response to rotation of the inner shaft.

Abstract: Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Abstract: Techniques for detecting a value of a sensed patient parameter, and automatically delivering therapy to a patient according to therapy information previously associated with the detected value, are described. In exemplary embodiments, a medical device receives a therapy adjustment from the patient. In response to the adjustment, the medical device associates a sensed value of a patient parameter with therapy information determined based on the adjustment. Whenever the parameter value is subsequently detected, the medical device delivers therapy according to the associated therapy information. In this manner, the medical device may “learn” to automatically adjust therapy in the manner desired by the patient as the sensed parameter of the patient changes. Exemplary patient parameters that may be sensed for performance of the described techniques include posture, activity, heart rate, electromyography (EMG), an electroencephalogram (EEG), an electrocardiogram (ECG), temperature, respiration rate, and pH.

Abstract: Multi-directional deflectable catheter apparatuses, systems, and methods for achieving renal neuromodulation by intravascular access are disclosed herein. One aspect of the present application, for example, is directed to apparatuses, systems, and methods that incorporate a catheter treatment device comprising an elongated shaft. The elongated shaft is sized and configured to deliver a thermal element to a renal artery via an intravascular path. Thermally or electrical renal neuromodulation may be achieved via direct and/or via indirect application of thermal and/or electrical energy to heat or cool, or otherwise electrically modulate, neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers.

Abstract: The disclosure provides monolithic electrodes including a substrate defining a walled cavity having a floor, an electrically conductive cathode layer overlaying the cavity floor, an electrically conductive contact pad overlaying the substrate, an electrically conductive via in electrical communication with the cathode layer and the contact pad, and a porous membrane layer overlaying the cavity and defining a chamber formed by the porous membrane layer, the walled cavity, and the cavity floor. The disclosure also provides pH transducers including monolithic indicator and reference electrodes, and methods of making and using monolithic pH electrodes and transducers.

Abstract: Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Abstract: Bioelectrical signals may be sensed within a brain of a patient with a plurality of sense electrode combinations. A stimulation electrode combination for delivering stimulation to the patient to manage a patient condition may be selected based on the frequency band characteristics of the sensed signals. In some examples, a stimulation electrode combination associated with the sense electrode combination that sensed a bioelectrical brain signal having a relatively highest relative beta band power level may be selected to deliver stimulation therapy to the patient. Other frequency bands characteristics may also be used to select the stimulation electrode combination.

Abstract: Bioelectrical signals may be sensed within a brain of a patient with a plurality of sense electrode combinations. A stimulation electrode combination for delivering stimulation to the patient to manage a patient condition may be selected based on the frequency band characteristics of the sensed signals. In some examples, a stimulation electrode combination associated with the sense electrode combination that sensed a bioelectrical brain signal having a relatively highest relative beta band power level may be selected to deliver stimulation therapy to the patient. Other frequency bands characteristics may also be used to select the stimulation electrode combination.

Abstract: In some embodiments, a medical device delivery system includes a catheter and a retainer. The retainer can be engaged with the medical device to restrain relative movement of the medical device in one or more axial and/or radial directions. A variety of retainers and retainer systems are disclosed, many of which can reliably disengage the medical device from the retainer. Methods for using the medical device delivery system are also described.

Abstract: A method and apparatus for determining, calculating, and/or viewing a trajectory. The trajectory can be displayed on a display relative to image data of a patient. A user can use the system to determine relationships between two or more trajectories that have been determined. The relationships can be within two dimensional, three-dimensional, or four dimensional space. The relationships can include distance, angle, etc. The relationships can also be determined between real time trajectories and stored trajectories, or combinations thereof.

Abstract: A method is provided for initializing an analyte sensor, such as a glucose sensor. Where a sensor has been disconnected and reconnected, a disconnection time is determined and a sensor initialization protocol is selected based upon the disconnection time. The sensor initialization protocol may include applying a first series of voltage pulses to the sensor. A method for detecting hydration of a sensor is also provided.

Abstract: A user may modify a stimulation parameter in a plurality of stimulation programs with a single adjustment. During stimulation therapy, the user, such as a patient, may desire to change a parameter of the plurality of stimulation programs. The patient may press a single button on an external programmer to make the parameter change, or global adjustment, to all of the plurality of stimulation programs. This global adjustment eliminates the need for the patient to navigate through each of the plurality of stimulation programs separately and adjust the parameter. Additionally, changing the plurality of stimulation programs may be desirable for uniform stimulation therapy between programs used by the patient. The external programmer may calculate an appropriate parameter change for each stimulation program to keep parameter ratios equal between the plurality of stimulation programs.

Abstract: A method for treating a brain tumor includes providing a surgical instrument having an inner member and an outer member. The outer member has a distal region forming a cutting window. The inner member is rotatably received within the outer member, and has a cutting tip that is exposed at the window. The cutting tip and the distal region of the outer member combine to define a cutting implement. An opening is created through the patient's skull to provide access to a brain tumor target site. The cutting implement is delivered through the opening to the target site. The cutting tip is placed into contact with the tumor and operated to cut the tumor. The target site is selectively aspirated to remove cut tumor tissue.

Abstract: A method and system for identifying a portion of an image data is disclosed. The image data can include image data of an anatomy, such as a brain of a patient. The identified portion can be used for planning a procedure. The identified portions can include anatomical landmarks that can be used to determine anatomical targets of the patient. The plan can include a path or trajectory to reach the anatomical target.

Abstract: A system for percutaneously inserting a prosthesis containing a biological replacement for a defective valve into an implantation site through a body lumen. The system contains a balloon catheter upon which a collapsable stent containing a venous valvular replacement is mounted. A protective shield is slidably mounted upon the catheter that is movable between a closed position over the balloon and an open position wherein the balloon can be inflated to expand the stent. A central lumen runs through the catheter that is formed of stainless steel. The central lumen provides a one to one torque ratio between the proximal end of the catheter and the distal end to enhance the steerability of the catheter. The vein of the replacement is reduced in thickness between 50% and 90% of its original size thereby considerably reducing the size of the replacement package when the stem is collapsed upon the balloon of the catheter.