Abstract: Cardiac monitoring and/or stimulation methods and systems provide monitoring, diagnosis, and defibrillation and/or pacing therapies. A signal processor receives a plurality of composite signals associated with a plurality of sources, performs a source separation, and produces one or more cardiac signal vectors associated with all or a portion of one or more cardiac activation sequences based on the source separation. A method of signal separation involves detecting a change in a characteristic of the cardiac signal vector relative to a baseline. One or more vectors and/or activation sequences may be selected, and information associated with the vectors and/or activation sequences may be stored and tracked.

Abstract: A CRM system enhances intracardiac electrogram-based arrhythmia detection using a wireless electrocardiogram (ECG), which is a signal sensed with implantable electrodes and approximating a surface ECG. In one embodiment, the wireless ECG is sensed as a substitute signal for the intracardiac electrogram when the sensing of the intracardiac electrogram becomes unreliable.

Abstract: Discrimination between different types of possible cardiac pacing responses may depend on the timing of expected features that are sensed within a temporal framework. The temporal framework may include classification intervals, blanking periods and appropriately timed back up paces. The classification intervals and blanking periods of the temporal framework are intervals of time that have time parameters that include start time, end time, and length. The relationships and timing parameters of the elements of the temporal framework, e.g., blanking periods, classification intervals, delay periods, and backup pacing, should support detection of features used to discriminate between different types of pacing responses. As the system learns the morphology of the particular patient by analyzing the waveform of the pacing response signal, the temporal framework for pacing response determination may be adjusted to accommodate the individual patient.

Abstract: Cardiac monitoring and/or stimulation methods and systems provide for monitoring, diagnosing, defibrillation and pacing therapies, or a combination of these capabilities, including cardiac systems incorporating or cooperating with neuro-stimulating devices, drug pumps, or other therapies. Embodiments of the present invention relate generally to implantable medical devices employing automated cardiac activation sequence monitoring and/or tracking for arrhythmia discrimination. Embodiments of the invention are directed to devices and methods involving sensing a plurality of composite cardiac signals using a plurality of implantable electrodes. A source separation is performed using the sensed plurality of composite cardiac signals and the separation produces one or more cardiac signal vectors associated with one or more cardiac activation sequences that is indicative of ischemia. A change of the one or more cardiac signal vectors is detected using the one or more cardiac signal vectors.

Abstract: A CRM system enhances intracardiac electrogram-based arrhythmia detection using a wireless electrocardiogram (ECG), which is a signal sensed with implantable electrodes and approximating a surface ECG. In one embodiment, an intracardiac electrogram allows for detection of an arrhythmia, and the wireless ECG allows for classification of the detected arrhythmia by locating its origin. In another embodiment, the wireless ECG is sensed as a substitute signal for the intracardiac electrogram when the sensing of the intracardiac electrogram becomes unreliable. In another embodiment, a cardiac signal needed for a particular purpose is selected from one or more intracardiac electrograms and one or more wireless ECGs based on a desirable signal quality. In another embodiment, intracardiac electrogram-based arrhythmia detection and wireless ECG-based arrhythmia detection confirm with each other before indicating a detection of arrhythmia of a certain type.

Abstract: A cardiac rhythm management (CRM) system includes an implantable medical device that senses a wireless electrocardiogram (ECG), which is a signal sensed with implantable electrodes and approximating a surface ECG. In one embodiment, the wireless ECG is sensed as a substitute signal for the intracardiac electrogram when the sensing of the intracardiac electrogram becomes unreliable.

Abstract: An implantable medical device such as an implantable pacemaker or implantable cardioverter/defibrillator includes a programmable sensing circuit providing for sensing of a signal approximating a surface electrocardiogram (ECG) through implanted electrodes. With various electrode configurations, signals approximating various standard surface ECG signals are acquired without the need for attaching electrodes with cables onto the skin. The various electrode configurations include, but are not limited to, various combinations of intracardiac pacing electrodes, portions of the implantable medical device contacting tissue, and electrodes incorporated onto the surface of the implantable medical device.

Abstract: Cardiac monitoring and/or stimulation methods and systems that provide one or more of monitoring, diagnosing, defibrillation, and pacing. Cardiac signal separation is employed for automatic capture verification using cardiac activation sequence information. Devices and methods sense composite cardiac signals using implantable electrodes. A source separation is performed using the composite signals. One or more signal vectors are produced that are associated with all or a portion of one or more cardiac activation sequences based on the source separation. A cardiac response to the pacing pulses is classified using characteristics associated with cardiac signal vectors and the signals associated with the vectors. Further embodiments may involve classifying the cardiac response as capture or non-capture, fusion or intrinsic cardiac activity. The characteristics may include an angle or an angle change of the cardiac signal vectors, such as a predetermined range of angles of the one or more cardiac signal vectors.

Abstract: This document discusses, among other things, systems and methods for automatic electrode integrity management. Interelectrode impedance is measured for various electrode combinations of an implantable cardiac function management device. The impedance data is processed, such as at an external remote server, to determine whether an electrode is failing or has failed, to select an alternate electrode configuration, to alert a physician or patient, to predict a time-to-failure such as by using population data, or to reprogram electrode configuration or other device parameters of the implantable cardiac function management device.

Abstract: Cardiac monitoring and/or stimulation methods and systems provide monitoring, diagnosis, and defibrillation and/or pacing therapies. A signal processor receives a plurality of composite signals associated with a plurality of sources, performs a source separation, and produces one or more cardiac signal vectors associated with all or a portion of one or more cardiac activation sequences based on the source separation. A method of signal separation involves detecting a change in a characteristic of the cardiac signal vector relative to a baseline. One or more vectors and/or activation sequences may be selected, and information associated with the vectors and/or activation sequences may be stored and tracked.

Abstract: Various aspects of the present subject matter relate to a method. According to various method embodiments, cardiac activity is detected, and neural stimulation is synchronized with a reference event in the detected cardiac activity. Neural stimulation is titrated based on a detected response to the neural stimulation. Other aspects and embodiments are provided herein.

Abstract: Cardiac monitoring and/or stimulation methods and systems that provide one or more of monitoring, diagnosing, defibrillation, and pacing. Cardiac signal separation is employed to detect, monitor, track and/or trend closed-loop cardiac resynchronization therapy using cardiac activation sequence information. Devices and methods involve sensing a plurality of composite cardiac signals using a plurality of electrodes, the electrodes configured for implantation in a patient. A source separation is performed using the sensed plurality of composite cardiac signals, producing one or more cardiac signal vectors associated with all or a portion of one or more cardiac activation sequences. A cardiac resynchronization therapy is adjusted using one or both of the one or more cardiac signal vectors and the signals associated with the one or more cardiac signal vectors.

Abstract: This document discusses, among other things, systems and methods for automatic electrode integrity management. Interelectrode impedance is measured for various electrode combinations of an implantable cardiac function management device. The impedance data is processed, such as at an external remote server, to determine whether an electrode is failing or has failed, to select an alternate electrode configuration, to alert a physician or patient, to predict a time-to-failure such as by using population data, or to reprogram electrode configuration or other device parameters of the implantable cardiac function management device.

Abstract: This document discusses, among other things, a system including an implantable medical device. The implantable medical device includes a control circuit and a motion sensing device. The motion sensing device is coupled to the control circuit, and the motion sensing device is configured to transmit signals to the control circuit. The control circuit is configured to identify one or more steps of a patient using the motion sensing device signal.

Abstract: Cardiac monitoring and/or stimulation methods and systems provide monitoring, diagnosis, and defibrillation and/or pacing therapies. A signal processor receives a plurality of composite signals associated with a plurality of sources, performs a source separation, and produces one or more cardiac signal vectors associated with all or a portion of one or more cardiac activation sequences based on the source separation. A method of signal separation involves detecting a change in a characteristic of the cardiac signal vector relative to a baseline. One or more vectors and/or activation sequences may be selected, and information associated with the vectors and/or activation sequences may be stored and tracked.

Abstract: An implantable medical device such as an implantable pacemaker or implantable cardioverter/defibrillator includes a programmable sensing circuit providing for sensing of a signal approximating a surface electrocardiogram (ECG) through implanted electrodes. With various electrode configurations, signals approximating various standard surface ECG signals are acquired without the need for attaching electrodes with cables onto the skin. The various electrode configurations include, but are not limited to, various combinations of intracardiac pacing electrodes, portions of the implantable medical device contacting tissue, and electrodes incorporated onto the surface of the implantable medical device.

Abstract: Various aspects of the present subject matter relate to a method. According to various method embodiments, cardiac activity is detected, and neural stimulation is synchronized with a reference event in the detected cardiac activity. Neural stimulation is titrated based on a detected response to the neural stimulation. Other aspects and embodiments are provided herein.

Abstract: This document discusses, among other things, a system including an implantable medical device. The implantable medical device includes a control circuit and a motion sensing device. The motion sensing device is coupled to the control circuit, and the motion sensing device is configured to transmit signals to the control circuit. The control circuit is configured to identify one or more steps of a patient using the motion sensing device signal.

Abstract: A self-diagnostic system for an implantable cardiac device such as a pacemaker, cardioverter, or resynchronization device which utilizes a subcutaneous ECG channel is described. The subcutaneous ECG channel allows the device to, in real time and independent of the standard pacing and sensing circuitry, verify the presence of pacing spikes, chamber senses, and other device outputs and hence establish and verify device integrity.

Abstract: Noncaptured atrial paces can result in long-short cardiac cycles which are proarrhythmic for ventricular tachyarrhythmia. Approaches are described which are directed to avoiding proarrhythmic long-short cycles. For cardiac cycles in which the atrial pace captures the atrium, a first post ventricular refractory period (PVARP) and a first A-A interval are used. For cardiac cycles in which the atrial pace does not capture the atrium, both an extended PVARP and an extended A-A interval are used. The A-A interval following a noncaptured atrial pace is extended from an atrial depolarization sensed during the extended PVARP.