Abstract: Described herein are implantable medical devices (IMDs), and methods for use therewith. In certain embodiments, a controller of an IMD controls when a pacing capacitor of the IMD is charged using a first voltage, when the pacing capacitor is being charged using a second voltage, and when the pacing capacitor is discharged to deliver a pacing pulse between anode and cathode electrodes of, or electrically coupled to, the IMD. By selectively charging the pacing capacitor for a portion of a charge duration using the second voltage, that is greater in magnitude than the first voltage that is used for delivering the pacing pulse, a magnitude of a polarization artifact superimposed on an evoked response within a cardiac electrical signal, sensed using a sensing circuit of the IMD, is reduced compared to if the pacing capacitor were instead charged using the first voltage for the entire charge duration.

Abstract: A biostimulator, such as a leadless cardiac pacemaker, has a header assembly that includes an antenna. A header assembly includes an antenna cap having an antenna loop embedded in a cap body. The cap body includes a dielectric material, and the antenna loop extends about a central channel of the cap body. The central channel extends along a longitudinal axis over a cap length, and the cap body has a cap width transverse to the longitudinal axis. The cap body has an aspect ratio of the cap width to the cap length greater than 1. A header assembly includes an antenna loop of the antenna encased in a header body of the header assembly. The header assembly includes a fixation element. A proximal end of the fixation element is encased in the header body. Other embodiments are also described and claimed.

Abstract: A system for determining a change in position of an implanted medical device (IMD) within an implant pocket is provided. The system includes an accelerometer configured to be implanted in a patient, the accelerometer configured to obtain accelerometer data along at least one axis. The system also includes one or more processors configured to determine the patient is engaging in a determined activity over an activity period, and obtain the accelerometer data during the activity period. The one or more processors are also configured to identify postures of the patient and corresponding posture periods during the activity period based on the accelerometer data, determine a duration related to a non-standing posture identified from the postures identified, and identify a migration of the IMD within the implant pocket based on the duration of the non-standing posture exceeding a duration threshold.

Abstract: A biostimulator delivery system having a tether cable, is described. A connector can be mounted on the tether cable to connect to a biostimulator. The connector can be a protuberance that lodges within the biostimulator, or a threaded connector that screws into the biostimulator. The tether cable has a stranded cable configuration, including several strands extending about a core strand in a helical direction. The stranded cable structure resists breaking under bending stresses typically seen during a tether mode used during delivery of the biostimulator. The tether cable reliably secures the biostimulator to the delivery system in the tether mode. Other embodiments are also described and claimed.

Abstract: A biostimulator, such as a leadless cardiac pacemaker, having a flexible circuit assembly, is described. The flexible circuit assembly is contained within an electronics compartment between a battery, a housing, and a header assembly of the biostimulator. The flexible circuit assembly includes a flexible substrate that folds into a stacked configuration in which an electrical connector and an electronic component of the flexible circuit assembly are enfolded by the flexible substrate. An aperture is located in a fold region of the flexible substrate to allow a feedthrough pin of the header assembly to pass through the folded structure into electrical contact with the electrical connector. The electronic component can be a processor to control delivery of a pacing impulse through the feedthrough pin to a pacing tip. Other embodiments are also described and claimed.

Abstract: A method for controlling an adaptive pacing therapy that includes utilizing one or more processors to perform measuring an atrial-ventricular (AV) interval corresponding to an interval between an atrial paced (Ap) event or an atrial sensed (As) event and a sensed ventricular (Vs) event, setting an AV delay based on the AV interval, and measuring an S1 heart sound characteristic of interest (COI) while utilizing the AV delay in connection with delivering a pacing therapy by the IMD. The one or more processors also perform adjusting the AV delay, repeating the measuring, and adjusting to obtain a collection of S1 heart sound COIs and corresponding AV delays, selecting one of the AV delays, that corresponds to a select one of the S1 heart sound COIs, as a resultant AV delay, and managing the pacing therapy, utilized by the IMD, based on the resultant AV delay.

Abstract: A biostimulator, such as a leadless cardiac pacemaker, including a fixation element and an electrode mounted on a resilient scaffold, is described. The fixation element and the resilient scaffold are coupled to a housing of the biostimulator. The resilient scaffold can support the electrode against a target tissue at a location that is radially offset from a location where the fixation element anchors the housing to the target tissue. A flexibility of the resilient scaffold allows the electrode to conform to a shape and movement of the target tissue when the housing is rigidly fixed to the target tissue by the fixation element. The resiliently supported electrode that is radially offset from the anchor point can reliably pace the target tissue without piercing the target tissue. Other embodiments are also described and claimed.

Abstract: Systems and methods described herein improve visibility of P-waves of an EGM or ECG signal segment to be displayed on a display screen. There is a determination of whether relatively small features, including the P-waves, of the ECG or EGM signal segment would be difficult to visualize if an original signal segment range of the ECG or EGM signal segment were caused to be displayed on the display screen. In response to determining that the relatively small features of the ECG or EGM signal segment would be difficult to visualize, a portion of the EGM or ECG signal segment is displayed on the display screen in a manner that magnifies the P-waves of the EGM or ECG signal segment compared to if an entirety of the EGM or ECG signal segment within the original signal segment range were instead caused to be displayed on the display screen.

Abstract: Described herein are methods, devices, and systems that use electrogram (EGM) or electrocardiogram (ECG) data for sleep apnea detection. An apparatus and method detect potential apnea events (an apnea or hypopnea event) using a signal indicative of cardiac electrical activity of a patient's heart, such as an EGM or ECG. Described herein are also methods, devices, and systems for classifying a patient as being asleep or awake, which can be used to selectively enable and disable sleep apnea detection monitoring, as well as in other manners.

Abstract: A method and device for dynamic device based AV delay adjustment are provided. The method provides electrodes that are configured to be located proximate to an atrial (A) site and a right ventricular (RV) site. The method utilizes one or more processors, in an implantable medical device (IMD), for detecting an atrial paced (Ap) event or atrial sensed (As) event. The method determines a measured AV interval corresponding to an interval between the Ap event or the As event and a ventricular sensed event and calculates a percentage-based (PB) offset based on the measured AV interval. The method automatically dynamically adjusting an AV delay, utilized by the IMD, based on the measured AV interval and the PB offset and manages a pacing therapy, utilized by the IMD, based on the AV delay after the adjusting operation.

Abstract: A method and system for managing delivery of a respiration gated defibrillation shock from a subcutaneous implantable medical device (S-IMD) having one or more extra vascular electrodes. The method and system sense cardiac events of a heart. Additionally, the method and system utilize one or more processors to declare a shockable arrhythmia based on the cardiac events, obtain a respiration proxy signal indicative of respiration, track a respiration state related (RSR) characteristic from the respiration proxy signal, gate delivery of a high voltage (HV) shock based on occurrence of a respiration-gated (RG) trigger in connection with the RSR characteristic, and deliver the HV shock along a shocking vector between extra vascular electrodes based on the RG trigger to time delivering of the HV shock to occur during the select state within the respiration cycle.

Abstract: Methods and systems are provided for a rate adaptive bi-ventricular fusion pacing. The methods and systems deliver a first pulse at a left ventricular (LV) lead and a second pulse at a right ventricular (RV) lead based on a paced atrio-ventricular (AV) delay. The first pulse timed to be delivered concurrently with an intrinsic ventricular conduction. The methods and systems further repeat the delivery of the first pulse and the second pulse for a predetermined number of cycles. Additionally, the methods and systems measure an intrinsic AV conduction interval, and adjust the paced AV delay based on the intrinsic AV conduction interval and a negative hysteresis delta.

Abstract: Described herein are apparatuses and methods to detect tachycardias and selectively reject false tachycardia detections due to T-wave oversensing or noise. An apparatus includes electrodes, a sensing circuit coupled to at least two of the electrodes and configured to sense a signal indicative of cardiac electrical activity, and a smoothing filter configured to filter to the sensed signal indicative of cardiac electrical activity to thereby produce a filtered signal indicative of cardiac electrical activity. The apparatus produces a difference signal indicative of cardiac electrical activity by determining a difference between the sensed and filtered signals indicative of cardiac electrical activity. The apparatus also includes at least one processor configured to detect a tachycardia, or to determine whether or not to reject a tachycardia detection, based on the difference signal. The smoothing filter and/or difference circuitry can be implemented by the at least one processor, and/or other circuitry.

Abstract: Described herein are methods, devices, and systems that enable a remote non-implantable device (RNID) to send commands to a leadless pacemaker (LP) implanted within a patient. The RNID provide commands to a local non-implantable device (LNID) over one or more communication networks, and the LNID sends the commands to a second implantable device (SID) by transmitting radio frequency (RF) communication signals, which include the commands, using an antenna of the LNID. After receiving the commands from the LNID, by receiving RF communication signals that include the commands using an antenna of the SID, the SID transmits conductive communication signals, which include the commands, using electrodes of the SID. The LP receives the commands from the SID by receiving the conductive communication signals, which include the commands, using electrodes of the LP, and the LP performs command responses based on the commands that originated from the RNID.

Abstract: A system for verifying a candidate pathologic episode of a patient is provided that includes an accelerometer configured to be implanted in the patient. The accelerometer is configured to obtain accelerometer data along at least one axis. The system also includes a memory configured to store program instructions, and one or more processors that, when executing the program instructions, are configured to obtain accelerometer data. The one or more processors are also configured to determine a plurality of control three-dimensional point vectors related to the accelerometer data, and obtain a biological signal and identify a candidate pathologic episode based on the biological signal. The one or more processors are also configured to analyze the plurality of control three-dimensional point vectors to identify a physical action experienced by the patient, and verify the candidate pathologic episode based on the physical action.

Abstract: Systems, methods, and devices are provided for determining an early battery depletion (EBD) condition of an implantable medical device that includes a memory storing program instructions and a processor executing the program instructions. Circuitry is electrically coupled to the processor, and the circuitry and processor perform one or more tasks related to at least one of collecting signals indictive of physiologic activity, analyzing collected signals, delivering therapy, or communicating with an external device. A battery supplies energy to the circuitry and processor. A monitoring circuit coupled to the battery measures actual energy usage from the battery representing at least one of a current draw from the battery during corresponding tasks or a voltage measurement across the battery. Circuitry and processor calculate projected energy usage from the battery in connection with the corresponding tasks, and determine when an EBD condition exists based on projected energy usage and actual energy usage.

Abstract: A system and method for use during an implant procedure during which a delivery system is being used to implant a leadless pacemaker (LP) within a patient may, while the delivery system is being used to position the LP at a potential implant site within the patient: receive, from the LP, data comprising one or more pacing impedance measurements and at least one measurement obtained by the LP other than pacing impedance; provide the data to a model that is produced prior to the implant procedure based on data collected from other patients; and use the model to output an indication of whether the LP should be chronically implanted at the potential implant site.

Abstract: Described herein are apparatuses and methods for classifying a patient as being asleep or awake. Such an apparatus can include an accelerometer and a processor. The accelerometer, alone or in combination with the processor, is used to determine an activity level of the patient and a posture of the patient. The processor is configured to classify the patient as being asleep in response to both (i) the posture of the patient being recumbent or reclined for at least a sleep latency duration, and (ii) the activity level of the patient not exceeding an activity threshold for at least the sleep latency duration; and classify the patient as being awake in response to at least one of (iii) the posture of the patient being upright for at least an awake latency duration, or (iv) the activity level of the patient exceeding the activity threshold for at least the awake latency duration.

Abstract: Described herein is an ED configured to wirelessly communicate with an IMD, a method for use by the ED, a system including the ED and the IMD, and a method for use by such a system. While a wireless connection is being established between the ED and the IMD, the ED receive an IMD anchor point transmitted by the IMD, and the ED stores the IMD anchor point and an ED anchor point. Thereafter, time stamps of signal data and the stored anchor points are used to synchronize the display of different physiologic signals, at least one of which is displayed based on signal data obtained from the IMD via the wireless connection, and another of which is obtained by the ED not using the wireless connection. Such embodiments enable the synchronized co-display of such physiologic signals even in noisy environments where the wireless connection is relatively poor.

Abstract: Systems and methods described herein improve visibility of features (e.g., P-waves) of a physiologic signal segment (e.g., an EGM or ECG signal segment) to be displayed within a display band having a specified height between an upper and a lower boundary of the display band. The physiologic signal segment is divided into sub-segments, for each of which a sub-segment minimum peak amplitude and maximum peak amplitude are determined. Based thereon, a new minimum peak amplitude and a new maximum peak amplitude are determined and used to determine a new display range. A portion of the physiologic signal segment that is within the new display range is caused to be display, within the display band having the specified height, such that the upper boundary of the display band corresponds to the new maximum peak amplitude, and the lower boundary of the display band corresponds to the new minimum peak amplitude.