Abstract: A method for diagnosing an implantable cardiac device including a plurality of implanted leads may include: monitoring a plurality of parameters associated with the plurality of implanted leads; detecting a change in one of the parameters; evaluating at least one of the other parameters upon detection of the change; and diagnosing a problem with the implantable cardiac device based on the detected change and the evaluation. A system for diagnosing an implantable cardiac device including a plurality of implanted leads may include an implantable pacing device and a processor. The processor may be configured to: monitor a plurality of parameters associated with the plurality of implanted leads; detect a change in one of the parameters; evaluating at least one of the other parameters upon detection of the change; and diagnose a problem with the implantable cardiac device based on the detected change and the evaluation.

Abstract: A cardiac-related signal such as a cardiogenic impedance signal is derived to obtain cardiac information such as stroke volume information that may be used to evaluate cardiac performance and/or other medical conditions. In some aspects detection of the cardiogenic impedance signal involves adaptively cancelling an unwanted component of a sensed signal. For example, in some embodiments a sensed respiratory signal may be subtracted from a thoracic impedance signal to reduce a respiratory component of the thoracic impedance signal. In this way, a more accurate cardiogenic impedance signal may be derived from the resulting signal.

Abstract: Selection of an appropriate rate programming control (RPC) setting in an implantable medical device (IMD), uses analysis of VA coupling surrogate conditions. The VA coupling surrogate conditions are derived from signals such as cardiogenic impedance, blood pressure, and the pulsatile components of PPG. By analyzing a waveform of the measured surrogate condition, the IMD estimates wall stiffness, through the slope of the waveform, and peripheral arterial pressure, through the reflection time between the main wave and reflection wave of the waveform. These values are plotted against each other on a VA coupling coordinate plane. Based on the location and orientation of the resulting VA coupling plot, the IMD selects an appropriate RPC setting.

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: A method for use in an implantable medical device comprises the steps of monitoring respiration with an amplifier having a gain, generating a moving apneic threshold based on recent respiration cycles, accumulating differences between amplitudes of respiration cycles and the moving apnea detection threshold and comparing the accumulated differences against an apnea detection threshold to detect the onset of an episode of apnea. The method further comprises measuring respiration levels upon detecting the onset of apnea, confirming the episode of apnea based upon the respiration levels measured upon detecting the onset of apnea; and adjusting one of the gain of the amplifier and the apnea detection threshold so that the time from the detection of onset of apnea to the time of confirmation of the episode of apnea is within a predetermined time range following the detection of the onset of apnea.

Abstract: An implantable cardiac stimulation device provides AV interval hysteresis to promote intrinsic conduction while providing PMT avoidance. The device comprises a pulse generator that provides atrial and ventricular pacing stimulation pulses on demand separated by an AV interval, an AV hysteresis circuit that extends the AV interval from a base AV interval to an extended AV interval to promote intrinsic heart activity, and a refractory circuit that establishes a PVARP following each provided ventricular pacing pulse including a lengthened PVARP longer in duration than a normal PVARP responsive to the AV hysteresis circuit extending the AV interval from the base AV interval to the extended AV interval.

Abstract: A method includes providing an optimal interventricular interval, determining an atrio-ventricular conduction delay for the ventricle having faster atrio-ventricular conduction, determining an interventricular conduction delay and determining an advance atrio-ventricular pacing interval, for use in pacing the ventricle having slower atrio-ventricular conduction, based at least in part on the optimal interventricular interval and the interventricular conduction delay.

Abstract: An apparatus for and method of measuring pressure through a septum in a patient's heart. A lead inserted into the right side of a heart is routed through the septum to gain access to the left side of the heart. The lead includes a mounting mechanism that secures the lead to one or both sides of the septal walls. The lead also includes one or more sensors for measuring cardiac pressure on the left side of the heart and, as necessary, the right side of the heart.

Abstract: Access to the left side of the heart is gained through a heart wall. A delivery instrument includes a guide that may include or carry a puncturing instrument that is adapted to be directed toward the heart wall. In some embodiments a distal portion of the delivery instrument may be adapted to be co-located with the coronary sinus. In addition, the guide may be located a known distance from the portion of the delivery instrument that is co-located with the coronary sinus. Access to the left side of the heart may thus be readily gained by positioning the delivery instrument relative to the coronary sinus.

Abstract: An implantable cardiac stimulation device provides measurement of intrinsic heart activity metrics while sustaining pacing of the heart. The device includes a pulse generator that delivers pacing pulses to a first chamber of corresponding chambers of a heart, and a sensing circuit that senses a conducted evoked response of a second chamber of the corresponding chambers of the heart in response to the pacing pulse to provide an electrical signal representing the conducted evoked response. The device further includes a measuring circuit that measures a metric of the electrical signal to approximate a corresponding metric of an intrinsic electrical feature of the second chamber.

Abstract: Embodiments of the present invention are for use with implantable cardiac devices that discriminate between ventricular tachycardia (VT) and supraventricular tachyarrhythmia (SVT). Discrimination between VT and SVT can be based on: a detected absence, presence or degree of T-wave alternans leading up to the onset of a detected tachycardia; a detected absence, presence or degree of T-wave variability leading up to the onset of the detected tachycardia; and/or a detected cardiac electrical stability leading up to the onset of the detected tachycardia.

Abstract: A method of measuring pressure through a septum in a patient's heart is provided. A lead inserted into the right side of a heart is routed through the septum to gain access to the left side of the heart. The lead includes a mounting mechanism that secures the lead to one or both sides of the septal walls. The lead also includes one or more sensors for measuring cardiac pressure on the left side of the heart and, as necessary, the right side of the heart.

Abstract: An exemplary method includes acquiring intrathoracic impedance values over one or more respiratory cycles, acquiring myocardial evoked response values and assessing cardiac condition based at least in part on the intrathoracic impedance values and the evoked response values. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: A communication device for an implantable medical device may include: an input/output interface configured to communicate with a wireless communication device; a communication interface configured to communicate with a remote system; and a processor configured to perform an analysis of data received from the wireless communication device via the input/output interface and associated with the implantable medical device. The communication device may include a user interface configured to receive data input by a user. A communication system may include a wireless communication device and the aforementioned communication device.

Abstract: Embodiments of the present invention are for use with implantable cardiac devices that have discriminator parameters that the devices use to discriminate between ventricular tachycardia (VT) and supraventricular tachyarrhythmia (SVT). A user is allowed to select a balance setting that specifies a balance between sensitivity and specificity, where an increase in sensitivity results in a decrease in specificity, and vice versa. In response to the user selecting the balance setting, a value of at least one of the discriminator parameters and/or how at least one of the discriminator parameters is used is automatically adjusted. The more the balance setting favors sensitivity, then the more likely an actual VT will be characterized as VT, but the more likely an actual SVT may be characterized as VT. The more the balance setting favors specificity, then the less likely an actual SVT will characterized as VT, but the less likely an actual VT may be characterizes as VT.

Abstract: Methods and systems are provided for performing ventricular arrhythmia monitoring using at least two sensing channels that are each associated with different sensing vectors, for example by different pairs of extracardiac remote sensing electrodes. Myopotential associated with each of the sensing channels in monitored, and a ventricular arrhythmia monitoring mode is selected based thereon (e.g., based on determined myopotential levels). Ventricular arrhythmia monitoring is then performed using the selected monitoring mode.

Abstract: New decision paradigms for ICDs are described. In one implementation, an implantable system senses cardiac output and arterial pressure parameters and shocks the heart in inverse relation to the arterial pressure, if the cardiac output is insufficient. In another implementation, the implantable system applies atrial anti-tachycardia pacing before applying ventricular anti-tachycardia pacing, if the heart rate is tachycardic.

Abstract: A hemostasis valve is disclosed herein. The hemostasis valve may include an inner bushing, a rotation sleeve, an elastomeric sleeve, and a biasing element. The rotation sleeve may extend about the inner bushing and be rotationally displaceable relative to the inner bushing. The elastomeric sleeve may include a first end operably coupled to the inner bushing, a second end operably coupled to the rotation sleeve, and an iris valve portion. Rotation of the rotation sleeve relative to the inner bushing may cause the iris valve to transition from an open state to a closed state. The biasing element may act between the rotation sleeve and inner bushing to bias the iris valve towards at least one of a closed state or an open state.

Abstract: An implantable therapy system including implantable stimulation and control components. The implantable components operate under a set of variable parameters that can be adjusted for improved performance for an individual patient. The implantable components are adapted to self-evaluate the patients physiologic performance and autonomously adjust an existing set of parameters to improve performance throughout an implantation period without requiring intervention of a clinician, for example with a physicians programmer. The implantable components can compare a patient's exhibited activity to a desired template of that activity to determine when adjustments are indicated. The template can be based on observations of one or more third parties exhibiting normal activity. The implantable components can adjust the operating parameters to improve synchrony of multiple heart chambers and/or to increase a peak contractility.

Abstract: An implantable medical lead is disclosed herein. The lead includes a first electrode and a first electrical circuit. The first electrode is near a distal portion of the lead. The first electrical circuit extends through the lead to the first electrode and includes at least one conductor and a first band stop filter coupled between the distal end of the conductor and the electrode. The first band stop filter includes a first group of inductors in parallel and a second group of inductors in parallel. The first group is in series with the second group. The first group of inductors may include a self resonant L. The first group of inductors may include a self resonant tank LC. The first group of inductors may include a miniature self resonant L or miniature self resonant tank LC. The first group of inductors may include an integrated circuit of L and C components.