Abstract: Systems and methods are described herein for generating representative cardiac information. The representative cardiac information may be based on a plurality of electrode signals monitored, or measured, over a plurality of cardiac cycles or heart beats. The systems and methods may remove unqualified cardiac cycles, remove invalid electrode signals, remove inconsistent cardiac cycles, and removing uncorrelated cardiac cycles, and then generate representative cardiac information based on the remaining cardiac cycles and electrode signals.

Abstract: Systems, devices, and techniques are described for analyzing evoked compound action potentials (ECAP) signals to assess the effect of a delivered electrical stimulation signal. In one example, a system includes a stimulation generator configured to deliver a stimulation pulse to a patient, sensing circuitry configured to sense an evoked compound action potential (ECAP) signal evoked from the stimulation pulse, and processing circuitry. The processing circuitry may be configured to determine a maximum value of a derivative of the ECAP signal, determine a minimum value of the derivative of the ECAP signal, determine, based on the maximum value of the derivative and the minimum value of the derivative, a characteristic value of the ECAP signal, and determine, based on the characteristic value of the ECAP signal, at least one parameter value at least partially defining electrical stimulation therapy to be delivered to the patient.

Abstract: Systems and methods for improved user experience with rechargers for implantable medical devices. An external charging device for providing power to a rechargeable implantable device can determine a firmware state of the external charging device during recharging of the rechargeable implantable device, display a searching indication using a light indicator when the firmware state is determined to be in a searching state, display a charging indication using the light indicator when the firmware state is determined to be a charging state, and display an error indication using the light indicator when the firmware state is determined to be an error state. An optional user device application can provide complementary graphical user interfaces according to the firmware states.

Abstract: Systems and methods for delivering and implanting heart valves are disclosed. The delivery systems can include an integrated introducer. The integrated introducer can include a sheath having an inner diameter that is smaller than the outer diameter of a delivery capsule of the delivery system and an outer diameter that is approximately equal to the outer diameter of the delivery capsule. The integrated introducer can include a hub having a hemostatic seal. The hub can have a locking mechanism configured to fix the integrated introducer in place on the delivery system.

Abstract: Methods of forming hermetically-sealed packages are disclosed. In one or more embodiments, the hermetically-sealed package can include a housing and a feedthrough assembly that forms a part of the housing. The feedthrough assembly can include a non-conductive substrate and a feedthrough. The feedthrough can include a via from an outer surface to an inner surface of the non-conductive substrate, a conductive material disposed in the via, and an external contact disposed over the via on the outer surface of the non-conductive substrate. The external contact can be electrically coupled to the conductive material disposed in the via. Further, the external contact can be hermetically sealed to the outer surface of the non-conductive substrate by a laser bond surrounding the via.

Abstract: This disclosure is directed to techniques for identifying false detection of asystole in a cardiac electrogram that include determining whether at least one of a plurality of false asystole detection criteria are satisfied. In some examples, the plurality of false asystole detection criteria includes a first false asystole detection criterion including a reduced amplitude threshold for detecting cardiac depolarizations in the cardiac electrogram, and a second false asystole detection criterion for detecting decaying noise in the cardiac electrogram.

Abstract: Methods and apparatus for holding and maneuvering a valve during preparation and attachment to patient, providing increased visibility of the prosthetic valve and the sewing ring to prevent suture entanglement. A handle attachment is spaced from the valve for improved visibility of the sewing ring and the outlet end of the valve during attachment. Commissure posts are bent inward at the tips while preventing crashing of the commissure posts into each other causing damage. A release force needed to remove the holder and unthread the holder sutures is reduced. The holder and related methods can provide a kink free holder suture path to reduce suture entanglement and prevent damage to the implanted valve during holder removal by reducing the release force needed to remove the holder sutures by up to 30%.

Abstract: Implantable medical devices include circuitry positioned adjacent to header-related structures, rather than having the header and related structures sitting atop the position of the circuitry within a device housing. A circuit board within the device housing may be positioned adjacently to a lead bore of the header. Feedthrough conductors may extend from the circuitry to conductors of the header while being positioned adjacently to the circuit board. Lead frame conductors may extend to the electrical connectors of the lead bores while also being adjacent to the upper portion of the circuitry. Device height may be reduced by having the circuitry be positioned adjacent to one or more of the various header-related structures.

Abstract: Implantable medical systems enter an exposure mode of operation, either manually via a down linked programming instruction or by automatic detection by the implantable system of exposure to a magnetic disturbance. A controller then determines the appropriate exposure mode by considering various pieces of information including the device type including whether the device has defibrillation capability, pre-exposure mode of therapy including which chambers have been paced, and pre-exposure cardiac activity that is either intrinsic or paced rates. Additional considerations may include determining whether a sensed rate during the exposure mode is physiologic or artificially produced by the magnetic disturbance. When the sensed rate is physiologic, then the controller uses the sensed rate to trigger pacing and otherwise uses asynchronous pacing at a fixed rate.

Abstract: The present disclosure pertains to cardiac pacing methods and systems, and, more particularly, to cardiac resynchronization therapy (CRT). In particular, the present disclosure pertains to determining whether a patient is experiencing atrial fibrillation (AF). If the patient is experiencing AF, the efficacy of CRT is determined. A signal is sensed in response to a ventricular pacing stimulus. Through signal processing, a number of features are parsed from the signal and a determination is made as to whether the ventricular pacing stimulus evoked a response from the ventricle.

Abstract: In some examples, an implantable medical device delivery catheter comprises a handle and an elongated member disposed within the handle, the elongated member comprising an elongated member lumen configured to receive an inner tool that is configured to extend through a lumen of the delivery catheter, including the elongated member lumen, and interface with an implantable medical device. The handle further comprises a clamping assembly comprising a button configured to be actuated toward a longitudinal axis of the elongated member in a direction transverse to the longitudinal axis to compress the elongated member against the inner tool to restrain movement of the inner tool through the elongated member lumen.

Abstract: Apparatus for securing a therapy delivery device relative to a burr hole and method for making same. In one embodiment, the apparatus includes a base for seating in or near the burr hole. The apparatus may further include a stabilizer that may be engaged with the therapy delivery device. The stabilizer may include a surface coating or treatment operable to enhance frictional engagement with the therapy delivery device.

Abstract: Evoked compound action potentials (ECAPs) may be used to determine therapy. For example, a medical device includes stimulation generation circuitry and processing circuitry. The processing circuitry is configured to determine if a characteristic of a first ECAP is greater than a threshold ECAP characteristic value. Based on the characteristic of the first ECAP being greater than the threshold ECAP characteristic value, the processing circuitry is configured to decrease a parameter of a first set of pulses delivered by the stimulation generation circuitry after the first ECAP. Additionally, the processing circuitry is configured to determine if a characteristic of a second ECAP is less than the threshold ECAP characteristic value and based on the characteristic of the second ECAP being less than the threshold ECAP characteristic value, increase a parameter of a second set of pulses delivered by the stimulation generation circuitry after the second ECAP.

Abstract: In some examples, a tether head assembly of a delivery system includes an inner retainer and an outer retainer that defines an aperture comprising a receptacle configured to receive an attachment member of a medical device, a passageway, and a groove. The inner retainer is movable within the groove between a second position in which the passageway is dimensioned to receive the attachment member and a first position in which the passageway is dimensioned to prevent passage of the attachment member. In some examples, a tether handle assembly defines a channel, a force transmitter within the channel, a slidable member partially received within a first end of the channel and a button partially received within a second end of the channel. Distally-directed force applied to the button may cause the force transmitter to apply proximally-directed force to the slidable member, moving the slidable member and an attached pull wire proximally.

Abstract: A lead delivery apparatus and a method of delivering a medical lead to an anatomic target site. The method includes inserting a hydraulic plug into an internal delivery lumen of a delivery shaft, and coupling a medical lead to the hydraulic plug. Hydraulic pressure is applied to the hydraulic plug through the delivery lumen, thereby moving the hydraulic plug toward an anatomic target site, and advancing the medical lead toward the target site.

Abstract: Systems, devices, and techniques for establishing communication between two medical devices are described. In one example, an implantable medical device comprises communication circuitry, therapy delivery circuitry, and processing circuitry configured to initiate a communication window during which the implantable second medical device is capable of receiving the information related to a cardiac event detected by a first medical device, the communication window being one of a plurality of communication windows defined by a communication schedule that corresponds to a transmission schedule in which the first medical device is configured to transmit the information, control the communication circuitry to receive, from the first medical device, the information related to the cardiac event that is indicative of a timing of the cardiac event with respect to a timing of the communication window, schedule and control delivery of a therapy according to the information related to the cardiac event.

Abstract: Aspects of the disclosure relate to devices and methods for preparing an existing, implanted prosthetic aortic valve for subsequent prosthetic aortic valve implantation. To prepare the existing valve, a valve preparation device is delivered to the valve and valve leaflets are severed either via mechanical cutting or electrodes so that the leaflets cannot obstruct a blood flow path once a prosthetic valve is subsequently implanted within the valve. Similarly, in alternate embodiments, devices and methods of the disclosure can be used for preparing a native aortic valve for delivery and implantation of a prosthetic valve.

Abstract: A controller for an implantable blood pump, includes an accelerometer configured to measure at least one from the group consisting of position and movement of the controller. Processing circuitry is configured to control operation of the implantable blood pump, the processing circuitry being in communication with the accelerometer, the processing circuitry being configured to adjust a speed of the implantable blood pump if the measured at least one from the group consisting of position and movement deviates from a respective predetermined threshold.

Abstract: In some examples, a system may include a plurality of electrodes, electrical stimulation circuitry, and a controller. The controller may be configured to select one or more parameters of therapy to be delivered to a brain of a patient and to control the electrical stimulation circuitry to deliver the therapy to the brain of the patient based on the selected parameters and via a first one or more electrodes of the plurality of electrodes. The parameters may be defined based on a first plurality of electrical signals sensed at a plurality of different positions within the brain of the patient when electrical stimulation is not delivered at each of the positions and a second plurality of electrical signals sensed at each of the plurality of different positions within the brain of the patient in response to electrical stimulation delivered at each of the positions at a plurality of different intensities.

Abstract: A medical device is configured to detect an alternating pattern of signal features determined from consecutive segments of a cardiac electrical signal and determine a gross morphology metric from at least one segment of the cardiac electrical signal. The device is configured to detect cardiac event oversensing in response to detecting the alternating pattern and the gross morphology metric not meeting tachyarrhythmia morphology criteria. The medical device may withhold detecting an arrhythmia in response to detecting the cardiac event oversensing.