Abstract: An exemplary method includes providing a mechanical activation time (MA time) for a myocardial location, the location defined at least in part by an electrode and the mechanical activation time determined at least in part by movement of the electrode; providing an electrical activation time (EA time) for the myocardial location; and determining an electromechanical delay (EMD) for the myocardial location based on the difference between the mechanical activation time (MA time) and the electrical activation time (EA time).

Abstract: An implantable medical lead disclosed herein may include a longitudinally extending body, a helical anchor and a lead connector end. The longitudinally extending body may include a distal end, a proximal end, a braid-reinforced inner tubular layer extending between the proximal and distal ends, and an outer tubular layer extending between the proximal and distal ends. The braid-reinforced inner tubular layer may extend through the outer tubular layer in a coaxial arrangement. The helical anchor electrode may be operably coupled to a distal end of the braid-reinforced inner tubular layer. The lead connector end may be operably coupled to the proximal end of the body and include a pin contact operably coupled to a proximal end of the braid-reinforced tubular layer.

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: An implantable medical lead comprising a conductor extending along the lead and a crimp connector secured to the conductor comprising a body with an outer surface, an inner surface, proximal and distal ends, and first and second lateral edges, the lateral edges having edge features extending there from, the edge features adapted to opposingly interleave with one another. Methods of assembling a crimp connector with a cable conductor including parallel and cross-wise assembly are also encompassed.

Abstract: An introducer sheath is disclosed herein. The sheath includes a tubular body. The tubular body has a proximal zone, an intermediate zone and a distal zone. The proximal zone is generally straight. The intermediate zone extends from a distal end of the proximal zone and curves in a first direction. The distal zone extends from a distal end of the intermediate zone and curves in a second direction different from the first direction.

Abstract: A first lead provides therapeutic stimulation to the heart and includes a first mechanical sensor that measures physical contraction and relaxation of the heart. A controller induces delivery of therapeutic stimulation via the first lead. The controller receives signals from the first mechanical sensor indicative of the contraction and relaxation; develops a template signal that corresponds to the contraction and relaxation; and uses the template signal to modify the delivery of therapeutic stimulations. In another arrangement, a second lead, with a second mechanical sensor also provides signals to the controller indicative of contraction and relaxation. The first mechanical sensor is adapted to be positioned at the interventricular septal region of the heart, and the second mechanical sensor is adapted to be positioned in the lateral region of the left ventricle. The controller processes the signals from the first mechanical sensor and the second mechanical sensor to develop a dysynchrony index.

Abstract: An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a coronary sinus of a patient where the cardiac information includes electrical information and mechanical information; calculating scores based on the cardiac information where each of the scores corresponds to the coronary sinus or a tributary of the coronary sinus; and based on the scores, selecting a tributary of the coronary sinus as an optimal candidate for placement of a left ventricular lead. Accordingly, the selected tributary may be relied on during an implant procedure for the left ventricular lead. Various other methods, devices, systems, etc., are also disclosed.

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: A system and related methods for assisting a user approximate the location of a fibrillation driver within a heart. The system includes an electrode and a computer, which is coupled to the electrode. The electrode is configured to sense a signal emitted from a location in the heart. The computer is configured to calculate a standard deviation of cycle length value for the signal. The user can approximate the location of the fibrillation driver based on a comparison of the standard deviation of cycle length value to other standard deviation of cycle length values that previously have been calculated by the computer for signals emitted from other locations in the heart.

Abstract: An implantable medical device includes electrodes that are configured to be positioned within at least one of a heart and a chest wall of a patient. The device also includes an impedance measurement module, a patient position sensor, and a correction module. The impedance measurement module measures an impedance vector between a predetermined combination of the electrodes. The patient position sensor determines at least one of a posture and an activity level of the patient. The correction module adjusts the impedance vector based on the at least one of the posture and the activity level of the patient.

Abstract: Techniques are provided for assessing left atrial pressure (LAP) based on atrial electrocardiac signal parameters, particularly intra-atrial conduction delay (IACD) and P-wave duration. In one example, a pacemaker or other implantable device senses an intracardiac electrogram (IEGM) or a subcutaneous electrocardiogram (ECG), from which IACD and P-wave duration are derived. The device tracks changes, if any, in the parameters. A significant increase in either IACD or P-wave duration is associated with an increase in LAP. In some examples, conversion factors are calibrated for use with a particular patient to relate IACD and/or P-wave duration values to LAP values to provide an estimate of actual LAP. The conversion factors are pre-calibrated using LAP measurements obtained using a wedge pressure sensor. In other examples, IACD and P-wave duration are instead used to confirm the detection of an elevation in LAP initially made using impedance signals. Other confirmation parameters are described as well.

Abstract: Techniques are provided for use with a pacemaker or other implantable medical device capable of sensing electrical signals along a set of programmable sensing vectors. In one example, electrical cardiac signals are sensed within a patient using a primary sensing vector connected to a primary sensing channel for use in controlling the delivery of therapy. If the device detects a significant drop in key signal parameters such as peak signal amplitude or slew rate, an assessment is made whether an alternate sensing vector provides improved cardiac signal sensing. During the assessment, the device can continue to sense signals along the primary channel for the purposes of controlling therapy while alternate vectors are assessed in the background. If it is determined that an alternate sensing vector provides improved cardiac signal sensing, the primary sensing channel can be switched to the alternate sensing vector for use in controlling further therapy.

Abstract: An implanted device is equipped with a flag that indicates to a remote monitoring unit that an event such as a patient medical emergency or device failure has occurred. The remote monitoring unit is configured in some embodiments to maintain a low power communication link with the implanted device when they are within range. When the flag indicates an event has occurred, the remote monitoring unit quickly downloads sensed data collected by the implanted device and transfers it over a network so that it can be utilized by a medical practitioner. The remote monitoring unit is further configured in some embodiments to query the implanted device at regular intervals. The remote monitoring unit may read a subset of the data stored by the implanted device and, based on that data, determine whether to complete a full or partial download.

Abstract: Embodiments of the present invention relate to implantable systems, and methods for use therewith, for assessing a patients' myocardial electrical stability. Implanted electrodes are used to obtain an electrogram (EGM) signal, which is used to identify periods when the patient experiences T-wave alternans. Additionally, the EGM signal is used to determine whether premature ventricular contractions (PVCs) cause phase reversals of the T-wave alternans. The patient's myocardial electrical stability is assessed based on whether, and in a specific embodiment the extent to which, PVCs cause phase reversals of the T-wave alternans. This abstract is not intended to be a complete description of, or limit the scope of, the invention.

Abstract: An implantable medical device that is configured to be exposed to magnetic fields includes a lead, a detection module, a field measurement sensor, and a control module. The lead includes electrodes that are positioned within a heart to sense cardiac signals of the heart. The detection module monitors the cardiac signals to identify cardiac events based on the cardiac signals. The field measurement sensor measures a magnetic field. The sensor generates a field measurement based on the measured magnetic field. The sensor remains in an unsaturated state when exposed to the magnetic field of at least 0.2 Tesla. The control module identifies a presence of the magnetic field based on the field measurement of the sensor and switches operation of the detection module to an MR safe mode based on the field measurement.

Abstract: Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, referred to herein as QuickStim, cardiac pacing configurations are optimized based on an assessment of hemodynamic benefit and device longevity. In another example, referred to herein as QuickSense, cardiac sensing configurations are optimized based on sensing profiles input by a clinician. Various virtual sensing channels are also described that provide for the multiplexing or gating of sensed signals. Anisotropic oversampling is also described.

Abstract: Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, referred to herein as QuickStim, cardiac pacing configurations are optimized based on an assessment of hemodynamic benefit and device longevity. In another example, referred to herein as QuickSense, cardiac sensing configurations are optimized based on sensing profiles input by a clinician. Various virtual sensing channels are also described that provide for the multiplexing or gating of sensed signals. Anisotropic oversampling is also described.

Abstract: Adaptively creating a table of optimal, patient-specific atrioventricular (AV) delays for a an implantable medical device (IMD) begins as the IMD detects the patient entering a target heart rates within a defined range of elevated heart rates. On detection, the device begins testing AV delays by pacing the heart at a number of different AV delays. The IMD selects the optimal AV delay based on a comparison of measurements of cardiac output obtained during each delay's test pacing period. The optimal AV delay corresponds to the one which resulted in the highest cardiac output. The device selects this optimal AV delay and stores it in an AV delay table on the device. The process continues as the device detects the patient entering the other target heart rates in order to complete the table.

Abstract: A delivery tool for the delivery of an implantable medical lead includes a longitudinally extending tubular body and a longitudinally extending skeleton. The longitudinally extending tubular body includes a distal end, a proximal end, a tubular body segment proximal the distal end, a first lumen extending between the proximal and distal ends, and a second lumen. The first lumen is configured to receive therein the implantable medical lead. The longitudinally extending skeleton is received in the second lumen and includes a distal end, a proximal end, and a portion near the distal end that biases into a non-linear shape. The portion of the skeleton causes the tubular body segment to generally assume the non-linear shape. The skeleton is withdrawable from the second lumen.

Abstract: An implantable medical lead of the invention comprises an electrically active helix electrode extendable and retractable relative to a distal tip of the lead, an electrically conductive mapping collar disposed at the lead's distal tip and a proximal end carrying an electrical connector assembly. The electrical connector assembly comprises a first terminal connected to the helix electrode and a second terminal separately connected to the mapping collar. An advantage of the independent helix electrode and mapping collar circuits is that the implanting physician can confirm from separate electrode impedance readings that the helix is in fact extended and fully embedded within the myocardium. Further, the independent mapping collar and helix electrode circuits may be used, in conjunction with a configurable or programmable switch network, to provide the implanting physician with a choice of electrode impedances.