Abstract: An implantable medical device includes a lead, a pulse generator, an autothreshold module and a control module. The lead includes electrodes positioned within a heart. At least one of the electrodes senses cardiac signals. The pulse generator delivers a stimulus pulse through at least one of the electrodes. The autothreshold module performs a threshold search when operating in an autothreshold mode and causes atrial stimulus pulses to be delivered in an atrium of the heart at an overdrive rate during the threshold search. The control module determines an AV conduction time and applies an overdrive AV adjustment to the AV conduction time to generate an AV delay. The autothreshold module uses the AV delay in connection with delivering ventricular stimulus pulses to a ventricle of the heart.

Abstract: Specific embodiments of the present invention use an implanted sensor, during a period of time, to measure a physiologic property when the patient's heart is not stressed, and when the patient's heart is stressed. A slope is determined, where the slope is indicative of a change in the physiologic property during the period of time. Heart disease is monitored based on a magnitude of the slope. In further embodiments of the present invention, a slope indicative of a change in a physiologic property during a period of time is determined, for each of a plurality of periods of time. Changes in the patient's heart disease are monitored based on changes in the slope.

Abstract: An implantable lead assembly includes an outer jacket, first and second coiled conductors, and first and second electrodes. The outer jacket is elongated along a center axis and includes a body that radially extends between opposite interior and exterior surfaces. The interior surface defines an elongated lumen. The coiled conductors are held within the body of the outer jacket between the interior and exterior surfaces of the outer jacket and are wrapped around the lumen and the center axis. The electrodes are coupled with the outer jacket and electrically coupled to the coiled conductors in order to at least one of deliver stimulus pulses or sense electrical activity.

Abstract: When a medical procedure is performed on a patient in whom an implantable medical device is implanted, the medical procedure may have undesired effects on the medical device, such as triggering a response that initiates therapy by the device that is unnecessary and potentially dangerous to the patient. Systems and methods may facilitate performing of such medical procedures on such patients by automatically reprogramming the medical device, monitoring for one or more detectable characteristics associated with the medical procedure to be performed, and automatically restoring normal operation of the IMD after the medical procedure is completed.

Abstract: A medical device detects certain patient activity based on a programmable activity threshold and determines the duration of detected activity. The activity threshold may be optimized by obtaining first and second duration measurements for at least one of a first activity session and second activity session. The first duration measurement is based on the activity threshold, while the second duration measurement is based on actual start and stop of the activity session. An adjustment of the activity threshold is suggested based on a correspondence between the first duration measurement and the second duration measurement of the first activity session, or a correspondence between the first duration measurement and the second duration measurement of the second activity session. One of the first and second activities is non-significant activity expected to be undetected by the device, while the other of the two activities is low-level activity expected to be detected by the device.

Abstract: Techniques are described for discriminating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) using an implantable medical device capable of multi-site ventricular sensing. In one example, ventricular depolarization events are detected within a patient by the implantable device during a tachyarrhythmia, at both a left ventricular sensing site and a right ventricular sensing site. Ventricular event timing differences are then ascertained. The device compares the ventricular event timing differences detected during the tachyarrhythmia with predetermined supraventricular event timing differences for the patient, such as event timing differences previously detected within the patient during sinus rhythm or extrapolated from sinus rhythm values. The device then distinguishes VT from SVT based on the comparison of the event timing differences detected during the tachyarrhythmia with the predetermined supraventricular event timing differences.

Abstract: Specific embodiments provided herein relate to diagnosing, with improved specificity, occurrences of episodes relating to disorders that are known to affect T-wave morphology. One or more propensity metric is obtained, each of which is indicative of a patient's propensity for a specific disorder that is known to affect T-wave morphology. T-wave variability is monitored. Additionally, there is monitoring for a specific change in T-wave morphology that is known to be indicative of episodes relating to a disorder. When the specific change in T-wave morphology is detected, a diagnosis is determined for detecting the specific change in T-wave morphology, taking into account the propensity metric(s) and the T-wave variability.

Abstract: Certain embodiments of the present invention are related to an implantable monitoring device to monitor a patient's arterial blood pressure, where the device is configured to be implanted subcutaneously. The device includes subcutaneous (SubQ) electrodes and a plethysmography sensor. Additionally, the device includes an arterial blood pressure monitor configured to determine at least one value indicative of the patient's arterial blood pressure based on at least one detected predetermined feature of a SubQ ECG and at least one detected predetermined feature of a plethysmography signal. Alternative embodiments of the present invention are directed to a non-implantable monitoring device to monitor a patient's arterial blood pressure based on features of a surface ECG and a plethysmography signal obtained from a non-implanted sensor.

Abstract: Methods and systems are presented for using an ICD to detect myocardial ischemia. One such method includes sensing via an implantable cardiac-rhythm-management device (ICRMD) a signal indicative of cardiac pressure; determining via a processor associated with the ICRMD, a derivative signal that is a first derivative of the sensed signal; measuring via the processor, a maximum positive value of the derivative signal; measuring via the processor, a maximum negative value of the derivative signal; and indicating via the processor, an ischemia based on a comparison of a ratio of the maximum positive value to the maximum negative value with a predetermined value.

Abstract: A feedthrough assembly for use with implantable medical devices having a shield structure, the feedthrough assembly engaging with the remainder of the associated implantable medical device to form a seal with the medical device to inhibit unwanted gas, liquid, or solid exchange into or from the device. One or more feedthrough wires extend through the feedthrough assembly to facilitate transceiving of the electrical signals with one or more implantable patient leads. The feedthrough assembly is connected to a mechanical support which houses one or more filtering capacitors that are configured to filter and remove undesired frequencies from the electrical signals received via the feedthrough wires before the signals reach the electrical circuitry inside the implantable medical device.

Abstract: A cardiac rhythm management apparatus includes a proximal housing, a distal housing and a lead. The proximal housing includes a first energy storage device. The distal module is implantable within a patient's heart, and includes a second energy storage device, at least one electrode, and a control module. The control module controls the delivery of at least one electrical stimulus from the second energy storage device to a location in communication with the patient's heart. The lead connects the proximal housing to the distal module and is configured to communicate one or more digital signals between the proximal housing and the distal module.

Abstract: An exemplary method includes delivering a cardiac pacing therapy using an electrode configuration for left ventricular, single site pacing or left ventricular, multi-site pacing, measuring a series of interventricular conduction delays using the left ventricular pacing and right ventricular sensing (IVCD-LR), comparing the interventricular conduction delay values to a limit and, based on the comparison, deciding whether to change the electrode configuration for the left ventricular pacing. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: An implantable cardiac stimulation device provides stimulation therapy from within the left ventricle of a heart. The device includes a pulse generator adapted to be coupled to an implantable cardiac stimulation electrode and a power supply that provides the stimulation electrode with a positive voltage. The positive voltage promotes coating of the electrode through a body coating process. The coating serves to repel formation of clots on the electrode.

Abstract: A medical device is provided that comprises a lead assembly. The lead assembly includes at least one intra-cardiac (IC) electrode, an extra-cardiac (EC) electrode and a subcutaneous remote-cardiac (RC) electrode. The IC electrode is configured to be located within the heart. The EC electrode is configured to be positioned proximate to at least one of a superior vena cava (SVC) and a left ventricle (LV) of a heart. The RC electrode is configured to be located remote from the heart. An arrhythmia monitoring module is configured to analyze intra-cardiac electrogram (IEGM) signals from the at least one IC electrode to identify a potential atrial arrhythmia. An extra-cardiac impedance (ECI) module is configured to measure extra-cardiac impedance along an ECI vector between the EC and RC electrodes to obtain ECI measurements. The hemodynamic performance (HDP) assessment module is configured to determine a hemodynamic performance based on the ECI measurements.

Abstract: Therapy optimization includes tracking electrode motion using an electroanatomic mapping system and generating, based on tracked electrode motion, one or more mechanical dyssynchrony metrics to thereby guide a clinician in therapy optimization (e.g., via optimal electrode sites, optimal therapy parameters, etc.). Such a method may include a vector analysis of electrode motion with respect to factors such as times in cardiac cycle, phases of a cardiac cycle, and therapy conditions, e.g., pacing sites, pacing parameters and pacing or no pacing. Differences in position-with-respect-to-time data for electrodes may also be used to provide measurements of mechanical dyssynchrony.

Abstract: Disclosed herein is an implantable pulse generator feedthru configured to make generally planar electrical contact with an electrical component housed within a can of an implantable pulse generator. The feedthru may include a feedthru housing including a header side and a can side, a core within the feedthru housing, a generally planar electrically conductive interface adjacent the can side, and a feedthru wire extending through the core. The feedthru wire may include an interface end and a header end, wherein the header end extends from the header side and the interface end is at least one of generally flush with the generally planar interface and generally recessed relative to the generally planar interface.

Abstract: An exemplary method includes use of a multielectrode device that can help position a cardiac stimulation lead to an optimal site in the heart based at least in part on cardiac motion information acquired via the multielectrode device and one or more pairs of current delivery electrodes that establish potential fields (e.g., for use as a coordinate system). An exemplary multielectrode device may be a multielectrode catheter or a multifilar, electrode-bearing guidewire. Various other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: Techniques are described for detecting changes in posture; detecting cardiac ischemia while accounting for changes in posture; and delivering therapy or warning signals in response thereto using the implantable medical device. In one example, the device detects variations in the electrical cardiac signals indicative of a possible episode of cardiac ischemia. Changes in patient posture are detected as well using an accelerometer or similar device. Then, an episode of cardiac ischemia is detected based on the variations in the cardiac signals while distinguishing variations due to changes in posture. In another example, the device instead detects changes in posture based on transient changes in morphological features of electrical cardiac signals.

Abstract: When a medical procedure is performed on a patient in whom an implantable medical device is implanted, the medical procedure may have undesired effects on the medical device, such as triggering a response that initiates therapy by the device that is unnecessary and potentially dangerous to the patient. Systems and methods may facilitate performing of such medical procedures on such patients by temporarily reprogramming the medical device, monitoring for one or more detectable characteristics associated with the medical procedure to be performed, and restoring normal programming of the device based on detection and/or lack of detection of the detectable characteristic(s).

Abstract: An enhanced intraluminal flow measurement system and method is conducive for a low-power ultrasonic system that can use continuous-wave (CW) Doppler sensing and wireless RF telemetry. Applications include measurement of blood flow in situ in living organisms. Implementations include an extraluminal component located outside of a body, such as a human or animal body, containing a lumen. The extraluminal component can be wirelessly coupled via an RF magnetic field or other RF field to an implantable intraluminal component. The intraluminal component (i.e. implant) is implanted inside of the lumen of the body such as a heart or elsewhere in a vasculature (such as in a dialysis shunt). The intraluminal component can telemeter, via RF electromagnetic signals, flow data directly out of the body housing the intraluminal component to be received by the extraluminal component.