Abstract: An example of a system includes an implantable medical device (IMD) for implantation in a patient, where the IMD includes a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, and where the controller is operably connected to the cardiac pace generator to generate cardiac paces. The controller is configured to provide a trigger for conducting a PS detection procedure and perform the PS detection procedure in response to the trigger. In performing the PS detection procedure the controller is configured to receive a signal from the sensor, detect PS using the signal from the sensor, and record the PS detection in storage within the IMD.

Abstract: Systems, catheters, and methods for accessing and treating along the central nervous system are disclosed. A system for processing cerebrospinal fluid is disclosed. The system may include a catheter having a proximal subassembly and a distal subassembly. A pump and filtration system may be coupled to the catheter. An infusion lumen for infusing cerebrospinal fluid filtered by the pump and filtration system may be defined along the distal subassembly. The distal subassembly may define a plurality of infusion openings in fluid communication with the infusion lumen. The infusion openings may increase in size distally along the distal subassembly.

Abstract: Filtering cassettes, filtering systems, and methods for using the same are disclosed. An example filtering cassette may include a cassette housing. An inlet may be coupled to the cassette housing. The inlet may be configured to receive cerebrospinal fluid from a catheter. An outlet may be coupled to the cassette housing. The outlet may be configured to direct filtered cerebrospinal fluid to the catheter. One or more filters may be disposed within the cassette housing. An arcuate surface may be defined along a periphery of the cassette housing. The arcuate surface may be configured to engage a controller assembly when the cassette housing is mounted to the controller assembly.

Abstract: Systems, catheters, and methods for accessing and treating along the central nervous system are disclosed including sampling systems. An example sampling system may include a filter cassette designed to filter cerebrospinal fluid. The filter cassette may have an inlet region configured to be coupled to a catheter and configured to receive cerebrospinal fluid, one or more filters, and an outlet region configured to be coupled to an outlet of the catheter and to direct filtered cerebrospinal fluid to the catheter. A sampling port may be in fluid communication with the filter cassette. The sampling port may have a first end region configured to receive cerebrospinal fluid, a stopcock, a syringe port, and a second end region. The stopcock may be configured to shift between a first position where cerebrospinal fluid is directed from the first end region to the second end region and a second position where cerebrospinal fluid is directed from the first end region to the syringe port.

Abstract: Cardiac anodal electrostimulation detection systems and methods are described, such as for distinguishing between cathodal-only capture and at least partially anodal capture (e.g., combined anodal and cathodal capture, or between two anodes of which only one captures nearby cardiac tissue, etc.).

Abstract: Systems, catheters, and methods for accessing and treating along the central nervous system are disclosed. An example system may include a system for ameliorating a symptom of bacterial meningitis in a patient. The system may include a catheter assembly having a first lumen with a distal port and a second lumen with a proximal port, said catheter being adapted to be introduced in a CSF space and said ports being spaced axially apart. A pump may be connectable between the first and second lumens to induce a flow of CSF therebetween. A filter component may be connectable between the first and second lumens. The filter component may be configured to remove one or more meningitis causing bacterial pathogen from the CSF, to thereby condition the cerebrospinal fluid.

Abstract: An example of a system includes an implantable medical device (IMD) for implantation in a patient, where the IMD includes a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, and where the controller is operably connected to the cardiac pace generator to generate cardiac paces. The controller is configured to provide a trigger for conducting a PS detection procedure and perform the PS detection procedure in response to the trigger. In performing the PS detection procedure the controller is configured to receive a signal from the sensor, detect PS using the signal from the sensor, and record the PS detection in storage within the IMD.

Abstract: An example of a system includes an implantable medical device (IMD) for implantation in a patient, where the IMD includes a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, and where the controller is operably connected to the cardiac pace generator to generate cardiac paces. The controller is configured to provide a trigger for conducting a PS detection procedure and perform the PS detection procedure in response to the trigger. In performing the PS detection procedure the controller is configured to receive a signal from the sensor, detect PS using the signal from the sensor, and record the PS detection in storage within the IMD.

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: An interactive representation of electrostimulation electrodes or vectors can be provided, such as for configuring combinations of electrostimulation electrodes. In an example, electrodes or test parameters can be presented graphically or in a table. A user interface can be configured to receive user-input designating electrode combinations or vectors for test or for use in programming an implantable or ambulatory medical device. The interface can be used to indicate suggested electrode combinations or vectors in response to a first selection of an electrode. Tests can be performed on electrode combinations and vectors, and the results of the tests can be presented to a user using the interactive representation. In an example, test results can be analyzed by a processor and optionally used to program an implantable or ambulatory medical device.

Abstract: An example of a system includes an implantable medical device (IMD) for implantation in a patient, where the IMD includes a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, and where the controller is operably connected to the cardiac pace generator to generate cardiac paces. The controller is configured to provide a trigger for conducting a PS detection procedure and perform the PS detection procedure in response to the trigger. In performing the PS detection procedure the controller is configured to receive a signal from the sensor, detect PS using the signal from the sensor, and record the PS detection in storage within the IMD.

Abstract: An example of a system includes an implantable medical device (IMD) for implantation in a patient, where the IMD includes a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, and where the controller is operably connected to the cardiac pace generator to generate cardiac paces. The controller is configured to provide a trigger for conducting a PS detection procedure and perform the PS detection procedure in response to the trigger. In performing the PS detection procedure the controller is configured to receive a signal from the sensor, detect PS using the signal from the sensor, and record the PS detection in storage within the IMD.

Abstract: An implantable cardiac device includes a sensor for sensing patient activity and detecting phrenic nerve activation. A first filter channel attenuates first frequencies of the sensor signal to produce a first filtered output. A second filter channel attenuates second frequencies of the accelerometer signal to produce a second filtered output. Patient activity is evaluated using the first filtered output and phrenic nerve activation caused by cardiac pacing is detected using the second filtered output.

Abstract: Systems and methods for determining pacing timing intervals based on the temporal relationship between the timing of local and non-local cardiac signal features are described. A device includes a plurality of implantable electrodes electrically coupled to the heart and configured to sense local and non-local cardiac signals. Sense circuitry coupled to first and second electrode pairs senses a local cardiac signal via a first electrode pair and a non-local cardiac signal via a second electrode pair. Detection circuitry is used to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber. A control processor times delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature.

Abstract: A system or apparatus can provide electrostimulations via an electrode configuration that can be selected from multiple electrode configurations, the electrostimulations of the type for inducing a desired heart contraction, or a neurostimulation response. The system or apparatus can allow communicating with an external device to receive an input indicating a degree of patient discomfort with an electrostimulation delivered using a first electrode configuration, and can associate information about the degree of discomfort with information about the corresponding first electrode configuration for use by a controller circuit in determining a second electrode configuration for delivering a subsequent electrostimulation.

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: An example of a system comprises a cardiac pulse generator configured to generate cardiac paces to pace the heart, a sensor configured to sense a physiological signal for use in detecting pace-induced phrenic nerve stimulation (PS), a storage, and a phrenic nerve stimulation detector. The storage is configured for use to store patient-specific PS features for PS beats with a desirably large signal-to-noise ratio. The phrenic nerve stimulation detector may be configured to detect PS features for the patient by analyzing a PS beat with a desirably large signal-to-noise ratio induced using a pacing pulse with a large energy output and store patient-specific PS features in the storage, and use the patient-specific PS features stored in the memory to detect PS beats when the heart is paced heart using cardiac pacing pulses with a smaller energy output.

Abstract: An interactive representation of electrostimulation electrodes or vectors can be provided, such as for configuring combinations of electrostimulation electrodes. In an example, electrodes or test parameters can be presented graphically or in a table. A user interface can be configured to receive user-input designating electrode combinations or vectors for test or for use in programming an implantable or ambulatory medical device. The interface can be used to indicate suggested electrode combinations or vectors in response to a first selection of an electrode. Tests can be performed on electrode combinations and vectors, and the results of the tests can be presented to a user using the interactive representation. In an example, test results can be analyzed by a processor and optionally used to program an implantable or ambulatory medical device.

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: 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.