Abstract: Implantable systems, and methods for use therewith, enable the monitoring of a patient's electromechanical delay (EMD) and arterial blood pressure. Paced cardiac events are caused by delivering sufficient pacing stimulation to cause capture. A cardiogenic impedance (CI) signal, indicative of cardiac contractile activity in response to the pacing stimulation being delivered, is obtained. One or more predetermined features of the CI signal are detected, and a value indicative of the patient's EMD is determined by determining a time between a delivered pacing stimulation and at least one of the detected one or more features of the CI signal. The value indicative of EMD can be used to more accurately determine metrics indicative of pulse arrival time (PAT), which can be used to estimate arterial blood pressure.

Abstract: A method for operating an implantable medical device includes delivering a plurality of pacing pulses to an atria of a patient's heart and monitoring intrinsic atrial activity to detect intrinsic atrial contractions between one or more of the plurality of pacing pulses. The method further includes detecting atrial undersensing as a function of the detection of intrinsic atrial contractions.

Abstract: A method for reducing occurrences of atrial arrhythmias includes obtaining measures indicative of atrial pressure of a patient, and monitoring for a change in the measures indicative of atrial pressure that is indicative of an increased vulnerability to an atrial arrhythmia. In response to detecting the change in the measures indicative of atrial pressure that is indicative of the increased vulnerability to an atrial arrhythmia, pacing therapy that is adapted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia is selectively delivered. Additionally, or alternatively, pacing therapy is adjusted to reduce atrial pressure and thereby reduce vulnerability to an atrial arrhythmia.

Abstract: A delivery apparatus for accessing the pericardial space of a heart including an elongated body defining a lumen and a piercing member that extends from a distal portion of the elongated body for piercing tissue of the heart. A spring expands from a distal end of the piercing member in response to the distal end of the piercing member passing through the tissue and into the pericardial space. An electrode located on the spring in order to sense signals indicative of a distal end of the spring passing through the tissue and into the pericardial space.

Abstract: A cardio electrotherapy lead is disclosed herein. In one embodiment, the lead includes a tubular body, a conductor cable and an electrode. The conductor cable longitudinally extends through the tubular body and includes a distal end. The electrode is located on the tubular body and includes an attachment mechanism mechanically coupling the lead distal end to the electrode.

Abstract: A lead assembly of an implantable medical device includes an elongated body, electrodes on the body, and a tracking sensor located in the body. The body extends between a connector end and a leading end and has conductors disposed in the body. The connector end of the body includes terminals coupled with the conductors. The electrodes disposed on the body can be located at or near an anatomy of interest in a patient and are conductively coupled with the terminals of the body by the conductors. The electrodes are configured to sense electric activity of the anatomy of interest and/or deliver stimulus pulses to the anatomy of interest. The tracking sensor is conductively coupled with the terminals of the body by the conductors. The tracking sensor generates an electric position signal representative of a position of the tracking sensor in the heart when the body is in the patient.

Abstract: An implantable system acquires intracardiac impedance with an implantable lead system. In one implementation, the system generates frequency-rich, low energy, multi-phasic waveforms that provide a net-zero charge and a net-zero voltage. When applied to bodily tissues, current pulses or voltage pulses having the multi-phasic waveform provide increased specificity and sensitivity in probing tissue. The effects of the applied pulses are sensed as a corresponding waveform. The waveforms of the applied and sensed pulses can be integrated to obtain corresponding area values that represent the current and voltage across a spectrum of frequencies. These areas can be compared to obtain a reliable impedance value for the tissue. Frequency response, phase delay, and response to modulated pulse width can also be measured to determine a relative capacitance of the tissue, indicative of infarcted tissue, blood to tissue ratio, degree of edema, and other physiological parameters.

Abstract: This invention relates generally to systems and methods for optimizing the performance and minimizing complications related to implanted sensors, such as pressure sensors, for the purposes of detecting, diagnosing and treating cardiovascular disease in a medical patient. Systems and methods for anchoring implanted sensors to various body structures are also provided.

Abstract: Systems and methods are provided for reducing heating within pacing/sensing leads of a pacemaker or implantable cardioverter-defibrillator that occurs due to induced radio frequency (RF) currents during a magnetic resonance imaging (MRI) procedure, or in the presence of other sources of strong RF fields. For example, bipolar coaxial leads are described wherein the ring conductor of the lead is disconnected from the ring electrode via a switch in response to detection of MRI fields to convert the ring conductor into an RF shield for shielding the inner tip conductor of the lead so as to reduce the strength of RF currents induced therein and hence reduce tip heating. Other exemplary leads are described wherein a band stop filter is instead used to block RF signals to likewise convert the ring conductor into an RF shield. The switches and band stop filters also help to prevent MRI-induced stimulation.

Abstract: A method is disclosed that includes selecting an electrode configuration from a plurality of electrode configurations associated with electrodes of an implantable lead, sensing activity of the right ventricle and the left ventricle, determining an interval between sensed activity of the right ventricle and sensed activity of the left ventricle and determining whether the selected electrode configuration is suitable based at least in part on the interval. In one embodiment, an implantable device performs such a method to improve patient response to the CRT therapy, for example, by selecting a different electrode configuration if the current configuration is not suitable. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: Techniques are provided for use with implantable medical devices for addressing encapsulation effects, particularly in the detection of cardiac decompensation events such as heart failure (HF) or cardiogenic pulmonary edema (PE.) In one example, during an acute interval following device implant, cardiac decompensation is detected using heart rate variability (HRV), ventricular evoked response (ER) or various other non-impedance-based parameters that are insensitive to component encapsulation effects. During the subsequent chronic interval, decompensation is detected using intracardiac or transthoracic impedance signals. In another example, the degree of maturation of encapsulation of implanted components is assessed using impedance frequency-response measurements or based on the frequency bandwidth of heart sounds or other physiological signals.

Abstract: A cardiac monitoring system includes a communication subsystem, a comparison module, and a display module. The communication subsystem receives literal data from a cardiac medical device. The literal data includes cardiac signals and marker data. The cardiac signals represent electrical activity of a heart that is sensed by the medical device. The marker data represents one or more algorithms running on the medical device. The comparison module compares the cardiac signals and marker data to one or more heuristic rules to derive heuristic information about the cardiac signals and the marker data. The heuristic information represents a relationship among the cardiac signals and the marker data. The display module directs a display device to visually present the cardiac signals and a visual indicator representative of the heuristic information. The heuristic information can assist an operator, such as a physician, in changing one or more algorithms running on the medical device.

Abstract: Exemplary techniques and systems for interpolating left ventricular pressures are described. One technique interpolates pressures within the left ventricle from blood pressures gathered without directly sensing blood pressure in the left ventricle.

Abstract: Disclose herein is a method of measuring pressures in a coronary sinus. In one embodiment, the method includes: introducing a distal portion of a lead or tool into the coronary sinus, wherein the distal portion includes first and second pressure sensors and at least one selectably expandable member; expanding the at least one expandable member such that the first and second sensors are isolated from each other within the coronary sinus; and taking pressure measurements with the first and second sensors when isolated from each other.

Abstract: Techniques are provided for use by a pacemaker or other implantable medical device for detecting and tracking trends in cardiopulmonary fluid transfer rates—such as heart-to-lung fluid perfusion rates and lung-to-lymphatic system fluid excretion rates—and for detecting heart failure, dyspnea or other cardiopulmonary conditions. In one example, the device periodically measures transthoracic admittance values. A first exponential time-constant (k1) is determined using curve-fitting from admittance values obtained while the patient is in a sleep posture. Time-constant k1 is representative of the fluid perfusion rate. A second exponential time-constant (k2) is determined based on admittance values obtained while the patient is standing/walking/sitting. The second exponential time-constant (k2) is representative of the fluid excretion rate from the lungs.

Abstract: An exemplary method generates a map of a pacing parameter, a sensing parameter or one or more other parameters based in part on location information acquired using a localization system configured to locate electrodes in vivo (i.e., within a patient's body). Various examples map capture thresholds, qualification criteria for algorithms, undesirable conditions and sensing capabilities. Various other methods, devices, systems, etc., are also disclosed.

Abstract: Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead having a proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient. A left atrial (LA) cardioelectrical event is sensed using the proximal electrode of the LV lead and a corresponding LA cardiomechanical event is also detected, either using an implantable sensor or an external detection system. The electromechanical activation delay between the LA cardioelectrical event and the corresponding LA cardiomechanical event is determined and then pacing delays are set based on the electromechanical activation delay for use in controlling pacing. The pacing delays can include, e.g., AV delays for use with biventricular cardiac resynchronization therapy (CRT) pacing. Other techniques described herein are directed to exploiting right atrial (RA) cardioelectrical events detected via an RA lead for the purposes of setting pacing delays.

Abstract: Disclosed herein is a method of optimizing the implantation of an implantable medical lead into a patient to optimize electrotherapy administered via the lead. The method includes: inserting the lead into the patient, the lead including a first electrode; providing a second electrode in the patient, wherein the second electrode is not part of the lead; generating an electrical vector between the first electrode and second electrode, the electrical vector being generated as the lead is being implanted; analyzing the electrical vector as the lead is being implanted; and optimizing the implantation of the lead based off of the analysis of the electrical vector to optimize electrotherapy administered via the lead.

Abstract: Diastolic function is monitored within a patient using a pacemaker or other implantable medical device. In one example, the implantable device uses morphological parameters derived from the T-wave evoked response waveform as proxies for ventricular relaxation rate and ventricular compliance. In particular, the magnitude of the peak of the T-wave evoked response is employed as a proxy for ventricular compliance. The maximum slew rate of the T-wave evoked response following its peak is employed as a proxy for ventricular relaxation. A metric is derived from these proxy values to represent diastolic function. The metric is tracked over time to evaluate changes in diastolic function. In other examples, specific values for ventricular compliance and ventricular relaxation are derived for the patient based on the T-wave evoked response parameters.

Abstract: Techniques are provided for detecting heart failure or other medical conditions within a patient using an implantable medical device, such as pacemaker or implantable cardioverter/defibrillator, or external system. In one example, physiological signals, such as immittance-based signals, are sensed within the patient along a plurality of different vectors, and the amount of independent informational content among the physiological signals of the different vectors is determined. Heart failure is then detected by the implantable device based on a significant increase in the amount of independent informational content among the physiological signals. In response, therapy may be controlled, diagnostic information stored, and/or warning signals generated. In other examples, at least some of these functions are performed by an external system.