Abstract: A method for heart treatment includes analyzing the cardiac rhythm. The method further includes utilizing a generator to produce discharges (Si) of N pulses (I) of VNS stimulation in succession. The discharge may be synchronized to a detected R ventricular depolarization wave of each cardiac cycle. The method further includes controlling a stochastic modulation of the discharges control of the delivery of each VNS pulse of each discharge by selective inhibition or not of the generation of these VNS pulses. The number of pulses of each discharge thus randomly varies, and thus varies the VNS stimulation energy of this discharge, which is artificially induced, cycle-to-cycle variability in the RR interval. This stochastic therapy is applied if the spontaneous heart rate variability falls below a minimum level.

Abstract: A housing of an active medical device includes a metal wall having at least one feedthrough for an electrical connection through the wall. In the area of the feedthrough, the housing wall includes a contour groove extending through the thickness of wall, defining a metal islet electrically and physically isolated from the rest of the wall. The housing wall further includes an electrically insulating outer layer on the outer side of the wall extending over a region in alignment with the groove and beyond either side of the groove. The insulating outer layer includes a recess formed in alignment with the islet. The wall further includes an electrically conductive outer layer formed outside of the insulating layer and extending over the region in alignment with the groove and beyond either side of the groove. The islet is mechanically supported by the insulating and conductive outer layers.

Abstract: A sensing/pacing lead including a microcable having a diameter of at most 2 French (0.66 mm). The microcable includes an electrically conductive core cable including a plurality of strands and a composite structure formed from at least a structuring material and a radiopaque material, the radiopaque material constituting at least about 0.008 mm2 of the core cable cross section. The plurality of strands of the core cable comprises a first set of individual strands formed from the structuring material and a second set of individual strands formed from the radiopaque material, or a plurality of strands each comprising a first and second layer, one of which is the structuring material and the other the radiopaque material. The microcable further includes a polymer insulation layer at least partially surrounding the core cable and at least one electrode.

Abstract: The invention relates to an implantable capsule, particularly an autonomous capsule of cardiac stimulation, including a tubular body provided at the distal end of an anchoring element with a helical screw adapted to penetrate tissue a wall of an organ of a patient, the body housing a set of functional elements of the capsule. It includes, in an annular area surrounding the base of the screw recessed arrangements defining a set of flush tips oriented in a circumferential direction opposite to that of the screwing, to avoid the unscrewing of the capsule.

Abstract: Forming a connector head for a generator of an active implantable medical device by providing a pin (20) having alternating smooth sections (21) for receiving an electrical contact (210) and a profiled section (22); disposing the electrical contacts on the smooth sections; injecting into a first mold a flexibly resilient material around the profiled sections of the pin to produce isolation elements between the electrical contacts; injecting in a second mold a rigid material around the pin to form the connector head with the electrical contacts and isolation elements embedded therein; and withdrawing the pin from the cavity of the connector head thus formed. The material provides precise axial and radial positioning of the different elements, and good electrical insulation.

Abstract: An active implantable medical device includes digital processor circuits configured to sense right and left atrial depolarizations and deliver left atrial stimulation pulses according to a stimulation protocol. The stimulation protocol includes delivering a left atrial stimulation pulse at an inter-atrial coupling interval. The inter-atrial coupling interval is a coupling interval shorter than the sinus rhythm coupling interval, so as to deliver a premature pulse. The protocol further includes delivering a not premature left-atrial stimulation pulse during an immediately subsequent cardiac cycle, at an inter-atrial coupling interval corresponding to the sinus rhythm coupling interval. The protocol also includes assessing the right atrial coupling interval between the right atrial depolarizations and comparing the right atrial coupling interval to the sinus rhythm coupling interval. And finally, modifying an adjustable controlling parameters if necessary according to the result of the comparison.

Abstract: Apparatus and methods for communicating between an apparatus, such as a medical device, and a remote device are provided. One method includes determining a first indicator representative of a long-term availability for each of a plurality of channels for communication between a medical device and a remote device. The method further includes receiving a communication request from the remote device and, in response to the communication request, determining a second indicator representative of a short-term availability for each of the plurality of channels. The method further includes selecting a communication channel from the plurality of channels based on the first and second indicators.

Abstract: An intracardiac capsule comprises a cylindrical body having an atraumatic rounded surface and a helical anchoring screw integral with the cylindrical body. The helical anchoring screw is able to penetrate tissue of a wall of the heart and is configured to provide temporary attachment, in rotation and in translation, of the capsule to an implantation site. The helical anchoring screw surrounds at least a portion of the length of the cylindrical body forming a contact region intended to come into contact with the wall of the cavity of the heart. Over the length of the contact region, the external diameter of the cylindrical body is less than the inner diameter of the helical anchoring screw, so as to leave a free gap there between. The helical anchoring screw is secured to the cylindrical body near the proximal end of the contact region, and extends freely to the opposite distal end.

Abstract: The energy harvester module of the capsule comprises: a primary oscillating structure subjected to an external low-frequency stress; a secondary oscillating structure comprising an elastic element and able to vibrate in high-frequency resonance; and an electrostatic structure with a first electrode coupled to the primary structure and a second electrode coupled to the secondary structure. The electrodes exert a mutual attraction between them driving the secondary structure away from its stable equilibrium position with tensioning of the elastic element, up to a limit beyond which the secondary structure is released by relaxation effect to vibrate at a resonance frequency. A transducer coupled to the secondary structure converts these high frequency vibration movements into electrical energy.

Abstract: Devices and methods for providing pacing in multiple modes are provided. One device operates in a dual chamber (DDD or biventricular) mode and in a pacing mode favoring the spontaneous atrioventricular conduction such as an AAI mode (10) with a ventricular sensing or a mode with hysteresis of the atrioventricular delay. The device controls (10-18) the conditional switching from one mode to the other. The device comprises a hemodynamic sensor, including an endocardial acceleration sensor, derives a hemodynamic index representative of the hemodynamic tolerance of the patient to the spontaneous atrioventricular conduction. The device controls inhibiting or (20) forcing the conditional switching of the device to the DDD (or biventricular) mode according to the evolution of the hemodynamic index.

Abstract: An active implantable medical device for cardiac resynchronization includes implantable electrodes configured to detect atrial and ventricular events and to apply electrical pulses to a plurality of stimulation sites of the right and left ventricles, where a first combination of stimulation sites define an original pacing configuration and a second combination of stimulation sites define a changed pacing configuration. A sensing device is configured to measure a peak to peak amplitude of the first peak of endocardial acceleration for each cardiac cycle. A processing circuit is configured to change the pacing configuration from the original pacing configuration to the changed pacing configuration, measure one of a set of values in the changed pacing configuration, and change the pacing configuration from the changed pacing configuration to the original pacing configuration.

Abstract: A device includes a pulse generator coupled to a neurostimulation lead placed around the nerve and a set of electrodes individually connected to the generator by a splitter circuit controlled to preferentially stimulate certain regions of the nerve relative to other regions. The device performing an iterative search of an optimal configuration operating by selection of a plurality of different stimulation configurations, storing of a cardiac physiological parameter measured for each selected stimulation configuration, and designation as optimal stimulation configuration of the one of said selected different stimulation configurations, depending on at least the stored values of the physiological parameter measured for different electrode configurations.

Abstract: An active implantable medical device (e.g., implantable pacemaker or defibrillator), for detection of QRS complexes in noisy signals. Functional units (12-16) collect, amplify, prefilter and convert from analog-to-digital an endocardial signal, and digital functional units (18) provide signal processing and analysis of the digitized signal, for delivery of an indicator corresponding to a signal peak detection representative of the presence of a QRS complex in the endocardial signal. A double threshold comparator (30) is employed, receiving as input (28) the digitized signal and outputting (40) the indicator of peak detection when, cumulatively: the amplitude (A) of the input signal exceeds a peak amplitude threshold (SA), and the peak amplitude threshold is exceeded for a period (W) greater than a peak width threshold (SW). The peak amplitude threshold (SA) is a variable adaptive threshold, according to a noise level calculated from the energy (RMS) of the input signal.

Abstract: This accessory comprises a remotely steerable catheter (40) extended by a tip (50) comprising a base (52) to which the catheter (40) connects to and a cylindrical portion (54) defining a volume (56) suitable for housing the capsule (10). A sub-catheter (30) and the capsule are telescopically extendable with respect to the catheter between i) a retracted position and a deployed position wherein the capsule is removed from the connector and is carried by the distal end of the sub-catheter, and the distal end of sub-catheter and the proximal region (18) of the capsule being provided with disconnectable means of attachment (20, 36). The tip presents, between its base (52) and its cylindrical portion (54), a flexible portion (58) providing, between the base and the cylindrical portion, an elastic deformability in bending and compression.

Abstract: The device comprises a sealed body housing electronic circuits, and extending from said body, a microlead comprising microcables connected to remote electrodes. The device has no connector between the microlead and the electronic circuits. Each microcable is permanently connected to its pole by connection means. The connection means comprises an insulating base hermetically crossed by feedthrough pins, a support for the base, conductive connection parts each comprising a first passage for a microcable and a second passage for a feedthrough pin, an insulating guiding and holding part mounted on the support and locked thereon. The guiding and holding part having cavities for the connection parts, each cavity opening in its bottom on a passage wherein a pin projects. The device also includes a transition and protection element encapsulating the guiding and holding part, the connection parts and the adjoining regions of the microcables.

Abstract: The invention relates to an implantable capsule, particularly an autonomous capsule of cardiac stimulation, comprising a tubular body provided at the distal end of an anchoring element with a helical screw adapted to penetrate tissue a wall of an organ of a patient, the body housing a set of functional elements of the capsule. It comprises an annular support integral with the body and coaxial therewith, said support surrounding the base of the anchoring element and comprising a series of openings radially extending. The base of the anchoring element comprises a series of rods or tubes projecting in a generally radial direction, and engaged in said openings to thereby secure the anchoring element to the support.

Abstract: An epicardial screw lead for stimulation/defibrillation implantable by a guide-catheter inserted into the pericardial space is described. The lead is a monodiameter lead with a helical anchoring screw extending axially of the lead body. The guide-catheter (24) has a pre-shaped tube having, in the absence of stress, a first bend (26) for supporting the lead body on the outer wall of the pericardial space (38), and a second bend (28) for orienting the end of the guide-catheter tube in the direction of the outer wall of the myocardium (34) and keeping the axis of the anchoring screw (14) in that same direction during a combined movement of screwing and insertion of the lead head.

Abstract: An active implantable medical device for vagal stimulation with optimization of ventricular filling is disclosed. The device delivers stimulation pulses to the vagal nerve of the patient with an adjustable energy level. The device includes a hemodynamic sensor for measuring hemodynamic parameters of the patient's cardiac cycles and delivering a timing parameter representative of the ventricular filling time. The energy level of the vagal stimulation pulses is adjusted dynamically and repeatedly over several cardiac cycles. The energy level is varied during successive cardiac correlative changes in the filling time (FT1, FT2) are assessed, and the energy level is set to a level that maximizes the ventricular filling time.

Abstract: A medical device for stimulating the heart using biventricular stimulation. The device includes a sensor for detecting an endocardial acceleration parameter and a processing circuit configured to receive the endocardial acceleration parameter. The device further includes stimulation electronics coupled to the processing circuit. The processing circuit is configured to use the EA parameter to evaluate the biventricular stimulation. The evaluation includes comparing the value of the EA parameter in biventricular mode to the value of the EA parameter in left only mode or right only mode, and using the comparison and an assessment of the variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising: (a) normal operation, (b) a loss of RV or LV capture, (c) possible anodal stimulation. The processing circuit is further configured to conduct at least one update to operational parameters of the device based on the determined case.

Abstract: A device includes a pulse generator coupled to a neurostimulation lead placed around the nerve and a set of electrodes individually connected to the generator by a splitter circuit controlled to preferentially stimulate certain regions of the nerve relative to other regions. The device performing an iterative search of an optimal configuration operating by selection of a plurality of different stimulation configurations, storing of a cardiac physiological parameter measured for each selected stimulation configuration, and designation as optimal stimulation configuration of the one of said selected different stimulation configurations, depending on at least the stored values of the physiological parameter measured for different electrode configurations.