Abstract: A method for use with an implantable system including a lead having multiple electrodes implantable proximate to a patient's left ventricular (LV) chamber includes simultaneously delivering pacing pulses over corresponding pacing vectors defined by electrodes proximate to the LV chamber. The method includes recording evoked responses responsive to the pacing pulses that are measured over separate corresponding sensing channels. The method also includes comparing the evoked responses to a template that represents local capture of a local LV tissue region along one or more of the corresponding pacing vectors. The comparison is used to determine whether the pacing pulses achieved local capture along the corresponding pacing vectors. At least one of the pacing pulses or pacing vectors are updated based on the comparison of the evoked responses to the template in order to determine a local capture threshold for the corresponding pacing vectors.

Abstract: A delivery system for implanting a leadless cardiac pacemaker into a patient is provided. The cardiac pacemaker can include a docking or delivery feature having a through-hole disposed on or near a proximal end of the pacemaker for attachment to the delivery system. In some embodiments, the delivery catheter can include first and second tethers configured to engage the delivery feature of the pacemaker. The tethers, when partially aligned, can have a cross-sectional diameter larger than the through-hole of the delivery feature, and when un-aligned, can have a cross-sectional diameter smaller than the through-hole of the delivery feature. Methods of delivering the leadless cardiac pacemaker with the delivery system are also provided.

Abstract: Described herein are implantable cardiac stimulation devices, and methods for use therewith. A pacing channel of such a device includes a pace output terminal, a pulse generator and at least two pace return electrode terminals. The pace output terminal is coupleable to an electrode for use as an anode. The pulse generator is configured to selectively output an electrical stimulation pulse to the pace output terminal. Each of the pace return electrode terminals is coupleable to a separate one of at least two further electrodes for use as a cathode. Switching circuitry selectively couples any one of the pace return electrode terminals of the pacing channel to the pace return capacitor of the pacing channel at a time, thereby enabling the pace return capacitor to be shared by at least two of the pace return electrode terminals of the pacing channel. Additional embodiments are also disclosed herein.

Abstract: An implantable device and method for monitoring changes in the risk of arrhythmia induced by medications. The implantable device monitors risk of arrhythmia by analyzing an aspect of T-wave morphology to generate a metric of transmural dispersion of repolarization (“TDR”) as a proxy for the risk of arrhythmia. The implantable device generates an index of change in the risk of arrhythmia by comparing values of the metric of TDR obtained for different time periods. The implantable device generates a warning if the change in risk of arrhythmia is outside acceptable limits. The implantable device can also communicate with other devices to correlate changes in risk of arrhythmia with medications taken by the patient.

Abstract: An implantable cardiac stimulation device and method provide electrical stimulation therapy to stabilize the ventricular rate of a heart during episodes of atrial fibrillation. The stimulation therapy may be a plurality of stimulation pulses delivered to the AV node during the AV node refractory period following the sensing of an atrial event. Alternatively, the stimulation therapy may be a plurality of sub-threshold stimulation pulses delivered to capture AV node vagal innervations following the detection of atrial fibrillation.

Abstract: Systems and methods are provided wherein intracardiac electrogram (IEGM) signals are used to determine a set of preliminary optimized atrioventricular (AV/PV) and interventricular (VV) pacing delays. In one example, the preliminary optimized AV/VV pacing delays are used as a starting point for further optimization based on impedance signals such as impedance signals detected between a superior vena cava (SVC) coil electrode and a device housing electrode, which are influenced by changes in stroke volume within the patient. Ventricular pacing is thereafter delivered using the AV/VV pacing delays optimized via impedance. In another example, parameters derived from IEGM signals are used to limit the scope of an impedance-based optimization search to reduce the number of pacing tests needed during impedance-based optimization. Biventricular and multi-site left ventricular (MSLV) examples are described.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: A method for detecting potential failures by an implantable medical lead is disclosed. The method includes sensing first, second and third signals between at least first and second combinations of electrodes, on the lead; determining whether at least one of the first, second and third signals is representative of a potential failure in the lead and identifies a failure and the electrode associated with the failure based on which of the first, second and third sensed signals is representative of the potential failure. Optionally, when the first and second sensed signals are both representative of the potential failure, the method further includes determining whether the first and second sensed signals are correlated with one another. When the first and second sensed signals are correlated, the method declares an electrode common to both of the first and second combinations to be associated with the failure.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: A leadless intra-cardiac medical device (LIMD) is configured to be implanted entirely within a heart of a patient. The LIMD comprises a housing configured to be securely attached to an interior wall portion of a chamber of the heart, and a stabilizing intra-cardiac (IC) device extension connected to the housing. The stabilizing IC device extension may include a stabilizer arm, and/or an appendage arm, or an elongated body or a loop member configured to be passively secured within the heart.

Abstract: Time delays between a feature of a signal indicative of electrical activity of a patient's heart and a feature of a plethysmograph signal indicative of changes in arterial blood volume are used to arrange the operation of an implantable device, such as a pacemaker. Shorter time delays between the feature of the signal indicative of electrical activity of a patient's heart and the feature of the plethysmograph signal indicative of changes in arterial blood volume are indicative of larger cardiac stroke volumes. The time delay can be used to select a pacing site or combination of pacing sites and/or to select a pacing interval set.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: A method of manufacturing an implantable medical lead is disclosed herein. The method may include: providing a lead body including a proximal end, a distal end, and an electrode near the distal end; provide a conductor extending between the proximal and distal ends; providing a crimp including a ribbon-like member and extending the ribbon-like member around the conductor; and mechanically and electrically connecting the ribbon-like member to the electrode.

Abstract: Implantable medical devices (IMDs), and methods for use therewith, use a same coil for receiving communication and power signals. An IMD, which is configured to operate in a charge or power mode and in a communication mode, includes a coil, power circuitry and communication circuitry. The coil includes first and second terminals and an intermediate tap therebetween. The power circuitry is coupled, during the charge or power mode, to a first portion of the coil extending between the first and second terminals of the coil. The communication circuitry is coupled to a second portion of the coil extending between the first terminal and the intermediate tap of the coil. A third portion of the coil, extending between the intermediate tap and the second terminal of the coil, is decoupled from the power circuitry during the communication mode, which prevents current from flowing through the third portion of the coil.

Abstract: An exemplary method includes positioning a lead in a patient where the lead has a longitudinal axis that extends from a proximal end to a distal end and where the lead includes an electrode with an electrical center offset from the longitudinal axis of the lead body; measuring electrical potential in a three-dimensional potential field using the electrode; and based on the measuring and the offset of the electrical center, determining lead roll about the longitudinal axis of the lead body where lead roll may be used for correction of field heterogeneity, placement or navigation of the lead or physiological monitoring (e.g., cardiac function, respiration, etc.). Various other methods, devices, systems, etc., are also disclosed.

Abstract: Techniques are provided for use with implantable devices equipped with programmable voltage multipliers (including voltage dividers.) Candidate pulse widths are determined for selected voltage multipliers and stimulation vectors. Each candidate pulse width corresponds to a lowest pulse energy sufficient to achieve capture within the tissues of the patient (subject to a safety margin) using the selected vector and using the corresponding voltage multiplier. As such, a candidate pulse width represents a preferred or optimal pulse width, at least insofar as energy consumption is concerned. However, depending upon the capabilities of the device, the candidate pulse width might not be achievable. Accordingly, for each programmable vector, the system determines a lowest “operable” voltage multiplier sufficient to generate a pulse at a candidate pulse width subject to the capabilities of the device.

Abstract: Diastolic function is monitored within a patient based on dynamic cardiogenic impedance as measured by a pacemaker or other implantable medical device. In one example, the device uses ventricular cardiogenic impedance values to detect E-wave parameters representative of passive filling of the ventricles. Atrial cardiogenic impedance values are used to detect A-wave parameters representative of active filling of the ventricles. Diastolic function is then assessed or evaluated based on the E-wave and A-wave parameters. Various functions of the implantable device are then controlled based on the assessment of diastolic function, such as by adjusting atrioventricular delay parameters to improve diastolic function. In some examples, the detection of E- and A-wave parameters is achieved by aligning impedance signals to atrial activation, and separately to ventricular activation, during asynchronous VOO pacing or while artificially inducing a 2:1 block.