Abstract: A method and system are provided for trending variation in coronary burden across multiple heart rate ranges. The method and system include obtaining cardiac signals having a segment of interest over a period of time where each cardiac signal has an associated heart rate that falls within at least one heart rate range. Segment variations of the segment of interest are determined and grouped based on the associated heart rates to produce distributions of segment variations that are associated with the heart rate ranges. Trending information is produced by automatically comparing the distributions of segment variations between different heart rate ranges.

Abstract: A subcutaneous implantable cardiac device system applies defibrillation currents in pathways aligned with the heart's own electrical system to decrease defibrillation thresholds. In one implementation, one or more subcutaneous sensors detect ventricular fibrillation. Positioning of subcutaneous sensors and filtering result in improved sensing with reduced noise. A subcutaneous patch component of the system that is in communication with a subcutaneous pacemaker or cardioverter-defibrillator may perform the sensing and apply the defibrillation. The subcutaneous patch may include one or more electrodes that perform both sensing and defibrillation. Variations of the subcutaneous patch may include battery and capacitor for generating onboard defibrillation current and may also include a microprocessor for advanced programmable operation.

Abstract: A medical device is provided that comprises a lead assembly configured to be at least partially located proximate to the heart. The lead assembly includes an extra-cardiac (EC) electrode to be positioned proximate to at least one of a superior vena cava (SVC) and a left ventricle (LV) of a heart. The lead assembly includes a subcutaneous remote-cardiac (RC) electrode configured to be located remote from the heart such that at least a portion of the greater vessels are interposed between the RC electrode and the EC electrode to establish an extra-cardiac impedance (ECI) vector. The processor module measures extra-cardiac impedance along the ECI vector to obtain ECI measurements. The processor module assesses a hemodynamic performance based on the ECI measurements.

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 fixation section and a rim form a myocardial patch for implant in the pericardial space. The fixation section is adapted to promote fibrosis to secure the patch in place. The rim is secured to and surrounds at least a portion of the fixation section and has a lumen. The patch is adapted to transition between a collapsed state and an expanded state. A stylet is passed through the lumen to force the patch into a collapsed state and is removed when the patch is positioned to allow the patch to expand and engage the epicardial surface.

Abstract: In an implantable cardiac device data is processed and stored to conserve storage space and computational resources thereby saving energy expended on these operations. The data being processed may be associated with signals with known and/or predictable patterns. A set of key elements are identified for the signal that allow the signal to be reconstructed without saving a complete time series of data for the signal.

Abstract: An exemplary device includes control logic to determine a paced atrial activation time using a predictive model and an intrinsic atrial activation time and to determine an atrioventricular delay based at least in part on the paced atrial activation time. Such a device may be an implantable device configured to deliver cardiac therapy that uses atrial pacing and ventricular pacing. Such a device may be a programmer configured to program an implantable device configured to deliver cardiac therapy that uses atrial pacing and ventricular pacing. Various other exemplary technologies are also disclosed.

Abstract: An implantable medical device calculates cardiac output on a repeated basis based on acquired cardiac information that relates to one or more parameters of the Fick equation, including venous oxygen saturation, arterial oxygen saturation, estimated oxygen consumption and hemoglobin information. In some aspects, the estimated oxygen consumption may be based on the activity of a patient. For example, respiratory-related information and/or temperature related information may be used to determine the activity level of the patient. In addition, trends relating to heart function may be identified based on cardiac output calculations that are generated over time.

Abstract: A system and method for determining a patient's degree of cardiac vascular blockage or, equivalently, a patient's risk of cardiac ischemia, based on the time interval between the onset of exercise activity and the onset of an episode of cardiac ischemia. In one embodiment, an implantable cardiac device may obtain an EGM and possibly other measures of patient physiologic activity. These measures are used to determine when the patient has initiated exercise activity. Analysis of the EGM then detects an elevated or depressed ST segment, which typically indicates an episode of cardiac ischemia. The time interval between the onset of exercise and the onset of ischemia is a metric reflecting the patient's degree of vascular blockage or, equivalently, the patient's risk of ischemia. Other metrics may be derived, such as a substantially workload-level invariant measure determined as the product of the exercise workload level and the ischemia onset time interval.

Abstract: An implantable lead is provided that includes a lead body configured to be implanted in a patient. The lead body has a distal end and a proximal end, and a lumen extending between the distal and proximal ends and includes a connector assembly provided at the proximal end of the lead body. The connector assembly is configured to connect to an implantable medical device and includes an electrode provided proximate to the distal end of the lead body with the electrode configured to at least one of deliver stimulating pulses and sense electrical activity. A multi-layer coil is located within the lumen and extends at least partially along a length of the lead body. The coil includes a first winding formed with multiple winding turns, the winding turns being segmented in an alternating pattern of insulated segments and non-insulated segments along the length of the lead body.

Abstract: An exemplary method includes receiving a signal of cardiac electrical activity after delivery of electrical energy to the heart, rectifying the signal to produce a rectified signal, comparing the rectified signal to the signal and, based at least in part on the comparing, deciding whether the delivered electrical energy resulted in non-capture, capture or fusion. Various other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: An epicardial lead is passively fixed in a pericardial space by a passive fixation member. The passive fixation member extends from a distal portion of an epicardial lead and acts against a pericardial layer and an epicardial layer to hold the lead in place. The epicardial lead may include an electrode that is connected to a conductor that extends from a distal portion of the lead. In some embodiments the epicardial lead includes a material that promotes fibrosis to fix the lead to heart tissue. The passive fixation member may include a shocking coil.

Abstract: Provided herein are implantable systems, and methods for use therewith, for estimating a level of noise in a signal produced by an implantable sensor that is sensitive to motion induced noise. Sample data is obtained that is representative of a signal produced by the implantable sensor that is sensitive to motion induced noise. Such a sensor signal has a corresponding morphology. The morphology of a portion of the sensor signal is compared to a template, and a level of motion induced noise in the sensor signal is estimated, based on results of the morphology comparison.

Abstract: Provided herein are implantable systems, and methods for use therewith, that increase the accuracy of measurements produced using an implanted sensor, where the measurements are affected by cycles of a cyclical body function (e.g., heart beat and/or respiration). In accordance with specific embodiments of system, a measurement that is presumed to be accurate is obtained. The measurement can be of a physiologic property, such as, but not limited to, blood oxygen saturation, hematocrit, or blood glucose concentration. Additionally, the implanted is used to produce a plurality of measurements of the physiologic property. Such measurements, produced using the implanted sensor, are compared to the measurement presumed to be accurate to thereby identify when the measurements produced using the implanted sensor are most accurate. Thereafter, the implanted system is configured to use the implanted sensor to produce measurements when the measurements produced using the implanted sensor are most accurate.

Abstract: Tachyarrhythmia is treated by applying anti-tachycardia pacing through at least one multi-site electrode set located on, in or around the heart. The electrode set is arranged and located such that an electrical activation pattern having a wave-front between substantially flat and concave is generated through a reentrant circuit associated with the tachyarrhythmia. The electrode set may be one of a plurality of predefined, multi-site electrode sets located on, in or around the atria. Alternatively, the electrode set may be formed using at least two selectable electrodes located on, in or around the atria.

Abstract: Conditions resulting from acute decompensation such as pulmonary edema may be indicated based on analysis of respiration signals. In some embodiments a respiration signal is derived from an intracardiac electrogram (“IEGM”) signal. In some embodiments one or more non-rate-based parameters are derived from a detected respiration signal to identify a pulmonary edema condition. In some embodiments a warning may be generated or therapy administered to a patient in response to an indication of pulmonary edema.

Abstract: Methods and systems of identifying an electrode or combination of electrodes of a multi-electrode device for pacing include selecting a first electrode or electrode combination as a first candidate; delivering a pacing pulse through the first candidate and determining a measurement based on sensed cardiac electrical activity resulting from the first candidate pacing; selecting a second candidate; delivering a pacing pulse through the second candidate and determining a measurement based on sensed cardiac electrical activity resulting from the second candidate pacing; comparing the measurement for the first and second candidates; and identifying the first or second candidate for pacing based on the comparison. The measurement may be one or more of activation time ?Tact, activation recovery interval (ARI), a fractioned electrogram width, and a standard deviation of a fractioned electrogram feature.

Abstract: A device, such as an implantable cardiac device, and methods for determining exercise diagnostic parameters of a patient are disclosed. Specifically, a maximum observed heart rate of a patient during exercise can be identified when an activity level and a heart rate measurement of the patient exceed predetermined thresholds. Included are methods for filtering out premature heartbeats or noise from the maximum heart rate determination. Methods of determining other exercise parameters, such as workload are also disclosed. The device includes hardware and/or software for performing the described methods.

Abstract: An implantable medical lead is disclosed herein. The lead may include a longitudinally extending body, an electrical conductor, a tube and an electrical component, such as, for example, an electrode for sensing or pacing, a defibrillation coil, a strain gage, a pressure sensor, a piezoelectric sensor, an integrated chip, an inductor, etc. The body may include a distal end and a proximal end. The electrical conductor may extend through the body between the proximal end and the distal end. The tube may be swaged about an outer circumferential portion of the electrical conductor. The electrical component may be on the body and electrically connected to the tube.

Abstract: An exemplary method includes detecting a QRS complex using cutaneous electrodes, during the QRS complex, detecting an R-wave of a ventricle using an intracardiac electrode, determining if the R-wave occurred during a first, predetermined percentage of the QRS complex width and, based at least in part on the determining, deciding whether a patient is likely to respond to cardiac resynchronization therapy. Such a method may set the predetermined percentage to approximately 50%. An exemplary model includes a parameter for a percentage for the timing of an EGM R-wave with respect to the total width of an ECG QRS complex. Various other exemplary methods, devices, systems, etc. are also disclosed.