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: A cardiac device is described with the capability of detecting cardiac ischemia using multiple sensing modalities. The device may be configured to modify its behavior in delivering therapies to treat bradycardia or tachyarrhythmias in response to detection of cardiac ischemia.

Abstract: Cardiac monitoring and/or stimulation methods and systems provide monitoring, defibrillation and/or pacing therapies. A signal processor receives a plurality of composite signals associated with a plurality of sources, separates a signal using a source separation algorithm, and identifies a cardiac signal using a selected vector. The signal processor may iteratively separate signals from the plurality of composite signals until the cardiac signal is identified. The selected vector may be updated if desired or necessary. A method of signal separation involves detecting a plurality of composite signals at a plurality of locations, separating a signal using source separation, and selecting a vector that provides a cardiac signal. The separation may include a principal component analysis and/or an independent component analysis.

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: 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 provide monitoring, defibrillation and/or pacing therapies. A signal processor receives a plurality of composite signals associated with a plurality of sources, separates a signal using a source separation algorithm, and identifies a cardiac signal using a selected vector. The signal processor may iteratively separate signals from the plurality of composite signals until the cardiac signal is identified. The selected vector may be updated if desired or necessary. A method of signal separation involves detecting a plurality of composite signals at a plurality of locations, separating a signal using source separation, and selecting a vector that provides a cardiac signal. The separation may include a principal component analysis and/or an independent component analysis.

Abstract: Changes in patient status are assessed based at least in part on respiration parameters. A user can make selections regarding alert criteria options to be used in assessing patient status. Respiration is implantably sensed and respiration data is stored by an implantable device. A respiration parameter, such as respiration rate, is measured from the respiration data. The change in patient status is assessed by comparing the respiration parameter to the configured alert criteria. If the comparison of the respiration parameter and the configured alert criteria indicates a significant change in patient status, an alert signal is generated.

Abstract: A neural stimulator senses a reference signal indicative of cardiac cycles each including a predetermined type timing reference event using a sensor external to the heart and blood vessels. The delivery of the neural stimulation pulses are synchronized to that timing reference event. Examples of the timing reference event include a predetermined cardiac event such as a P-wave or an R-wave detected from a subcutaneous ECG signal, a predetermined type heart sound detected from an acoustic signal, and a peak detected from a hemodynamic signal related to blood flow or pressure.

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: Methods and systems for arranging and labeling cardiac episodes based on acquired cardiac episode data are described. Cardiac episodes are algorithmically arranged based on one or more discriminating features of the episode data. A user is presented with at least one episode selected from the arrangement of cardiac episodes. The user inputs a label that characterizes the selected episode. The label is algorithmically appended to the data of the selected episode and to other episodes of the arrangement of cardiac episodes based on the discriminating features.

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: Various embodiments provide an implantable medical device comprising a detector, a neural stimulator, and a controller. The detector is configured to detect a pathological condition indicated for an acute neural stimulation therapy. The neural stimulator is capable of delivering a chronic neural stimulation therapy and the acute neural stimulation therapy. The controller is configured to control the neural stimulator to provide the chronic neural stimulation therapy, receive an indicator from the detector that the pathological condition is detected, and control the neural stimulator to integrate the acute neural stimulation therapy with the chronic neural stimulation therapy in response to the indicator.

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: 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: An implantable cardiac rhythm management device is configured to remove pacing artifacts from recorded electrograms by a subtraction method. A template waveform representing a recorded pace without accompanying cardiac electrical activity is generated. Such a pacing pulse template is then aligned with the instant at which a pace is delivered and subtracted from the recorded electrogram in order to remove the pacing artifact.

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: A cardiac device is described with the capability of detecting cardiac ischemia using multiple sensing modalities. The device may be configured to modify its behavior in delivering therapies to treat bradycardia or tachyarrhythmias in response to detection of cardiac ischemia.

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: 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.