Abstract: The present invention relates generally to methods for implantable medical devices and more particularly to methods for optimizing stimulation of a heart of a patient. The method comprises: determining recommended pacing settings including recommended AV delays and/or recommended W delays based on IEGM data. Further, at least one hemodynamical parameter is determined based on measured at least one hemodynamical signal. Reference pacing settings are determined including reference AV delays and/or reference W delays based on said hemodynamical parameters. An AV delay correction value and a W delay correction value are calculated as a difference between recommended AV and/or VV delays and reference AV and/or W delays, respectively. The correction values are used for updating recommended AV and/or VV delays, respectively.

Abstract: An implantable medical device comprising a coronary perfusion measurement unit is adapted to measure and determine parameters related to coronary perfusion of heart tissue. The parameters include time periods and perfusion magnitudes. The coronary perfusion measurement unit is configured to determine a time period T related to a perfusion event of a coronary vessel and including includes a reperfusion time period, where a perfusion event is defined as a decrease of coronary perfusion followed by reperfusion, and to generate a time period signal in dependence thereto. The implantable medical device further comprises a coronary flow calculation unit that is adapted to receive the time period signal and that is adapted to process the time period and to generate an ischemia risk indicating index I in dependence of the time period.

Abstract: An implantable medical device, IMD, (100) conducts CRT settings searches at multiple CRT settings search periods during an optimization time period by testing different candidate CRT settings and selecting the optimal CRT setting based on output signals of a hemodynamic sensor (240). The respective optimal CRT settings determined during the optimization time period are employed in order to predict at least one future optimal CRT setting that can be used by the IMD (100) following the end of the optimization time period. The IMD (100) then generates and applies pacing pulses to a subject's (5) heart (10) according to a CRT setting of the at least one future optimal CRT setting. The embodiments therefore enable efficient cardiac resynchronization therapy without any sensor readings after the end of the optimization time period and can therefore provide cardiac resynchronization therapy even if the hemodynamic sensor (240) becomes inoperable.

Abstract: Atrial fibrillation (AF) is detected based on pulmonary artery pressure (PAP) data. In some embodiments, PAP data generated by a PAP sensor device implanted in or near the pulmonary artery of a patient is processed to determine whether the patient is suffering from AF. In some aspects, detection of AF is based on identifying cycle-to-cycle variations of one or more parameters derived from the PAP data.

Abstract: Techniques are provided for detecting pulmonary congestion based on an increase in right ventricular (RV) stroke volume over left ventricular (LV) stroke volume. In one example, the device generates an index based on accumulated differences between RV stroke volume and LV stroke volume while RV stroke volume exceeds LV stroke volume, such that the index is indicative of an ongoing imbalance between RV and LV stroke volume. The index is compared to a suitable threshold to detect a severe imbalance indicative of pulmonary edema. Additionally, techniques are described for estimating RV and LV stroke volumes based on pulmonary artery pressure, left atrial pressure, aortic pressure, LV strain or on various intracardiac or extracardiac impedance measurements.

Abstract: An implantable medical device receives at least one sensor signal representing inter-movement between a basal region of a heart ventricle and a ventricle apex during at least a portion of a systolic phase of a cardiac cycle. A parameter processor calculates a contraction status parameter value based on the at least one sensor signal. This contraction status parameter value represents an elongation of the ventricle following onset of ventricular activation during a cardiac cycle. The contraction status parameter value is stored in a memory as a diagnostic parameter representing a current contraction status of a subject's heart.

Abstract: In an implantable medical device and a method for stimulating a heart of a patient, at least one left atrial pressure (LAP) signal over a cardiac cycle is obtained. The A-wave is identified using the LAP signal and a maximum positive rate of change of the A-wave of the LAP signal is determined. The maximum positive rate of change of the A-wave corresponds to the rate which the pressure in the atrium raises as the atria contraction forces more blood into the ventricle during the very last stage of diastole. Further, AV and/or VV delay is adjusted in response to the maximum positive rate of change of the A-wave, wherein a reduction of the maximum positive rate of change of the A-wave indicates an AV and/or VV delay providing an enhanced hemodynamic performance.

Abstract: An implantable medical device has an event detector that detects a predetermined cardiac event during a heart cycle of a subject. A reference time is assigned to this detected cardiac event. An onset detector detects the onset of ventricular filling of the heart during the heart cycle. The relative time of the detected filling onset is determined based on the assigned time reference. An increased risk of heart failure of the subject is automatically determined based on the determined relative time for the filling onset. Generally, a reduction in the relative time, as determined at different points in time, indicates an increased heart failure risk or the presence of a heart failure condition.

Abstract: An implantable medical device is connectable to an epicardial left ventricular lead having at least one epicardial electrode and a myocardium penetrating catheter with at least one endocardial electrode and present in a lumen of the lead. The device comprises a pulse generator controller that controls a ventricular pulse generator to generate pulses to be applied to the epicardial and endocardial electrodes. The controller uses an endocardial-to-epicardial time interval or epicardial-to-endocardial time interval to coordinate endocardial and epicardial activation of the left ventricle to thereby achieve cardiac pacing that closely mimics the natural electrical activation pattern of a healthy heart.

Abstract: In implantable medical devices such a pacemaker or cardioverter/defibrillators (ICDs) and systems including such a device and an external programmer a measure of a hemodynamic parameter such as the cardiac output, the stroke volume, or the contractility of a patient is used to trend heart failure or in an AV/VV optimization scheme. The implantable medical device is adapted to measure the cardiac impedance and the cardiac impedance data is used to determine impedance morphology curves, which, in turn, are used to compute a measure of the hemodynamic parameter.

Abstract: Implantable heart stimulator comprising a control unit including a memory, a sensing unit, a pulse stimulation unit adapted to generate stimulation pulses separated by a variable predetermined pacing interval (PI), and also a method in a heart stimulator. The heart stimulator is adapted to be connected to one or many heart electrode leads provided with stimulating and sensing electrodes in order to stimulate heart tissue by said stimulation pulses and sense electrical heart events. The heart stimulator comprises a control parameter measurement unit adapted to derive a control parameter value indicative of end-diastolic pressure (EDP).

Abstract: Implantable heart stimulator connectable to an electrode arrangement has a pulse generator adapted to deliver stimulation pulses to a heart of a subject; an impedance measurement unit adapted monitor at least one heart chamber of the heart of the subject to measure the impedance in the at least one monitored heart chamber for generating an impedance signal corresponding to the measured impedance. The impedance signal is applied to a processor where the signal is processed, according to specified criteria, and a fractionation index value is determined represented by the curve length of the impedance signal during a predetermined measurement period. The fractionation index value is a measure of different degrees of mechanical dyssynchrony of the heart.

Abstract: An implantable medical system for detecting incipient edema has an implantable medical lead including an optical sensor having a light source and a light detector. The medical system further has an edema detection circuit that activates the light source to emit light, the light being directed into lung tissue of a patient and that obtains a light intensity value corresponding to an intensity of light received by the light detector, and that evaluates the light intensity value to detect a consistency with incipient edema.

Abstract: In a method and implantable medical device for ventricular tachyarrhythmia detection and classification, upon detection of a ventricular tachyarrhythmia based on an electrocardiogram signal, cardiogenic impedance data representative of ventricular volume dynamics are collected and used for classifying the detected tachyarrhythmia as stable or unstable. In the latter case but typically not in the former case, defibrillation shocks or other forms of therapy are applied to combat the unstable ventricular tachyarrhythmia.

Abstract: An implantable cardiac device has a heart stimulator for electrically stimulating the heart of a patient, detector that measures a physiologic parameter that is affected by the status of a cardiovascular disease associated with sympathetic activation, a signal processor that determines at least one of a low frequency, LF, and a very low frequency, VLF, Mayer wave component in the measured parameter, and analyzer that automatically analyzes the determined Mayer wave component in relation to a predetermined reference value to determine the status of the cardiovascular disease. The detector is a cardio-mechanical parameter detector that measures, as said physiologic parameter, a mechanical change in at least one of the four chambers of the heart. In a corresponding method for monitoring the status of a cardiovascular disease associated with sympathetic activation of a patient having an implantable electric heart stimulator a physiologic parameter affected by the cardiac disease is measured.

Abstract: In an implantable medical device, such as a cardiac stimulator such as a pacemaker, and method for predicting patient responses to physical exertion, the patient response is monitored over time to evaluate disease progression and pacing therapies of cardiac stimulators are adapted based on the predicted patient response. A current cardiac status indicator for the patient is created indicating a response of the patient to an increased physical activity as a primarily heart rate response or as a primarily a stroke volume response. The pacing parameters of the cardiac stimulator can thereafter be adapted depending on the current cardiac status indicator, wherein the adapted pacing parameters include a first pacing setting if the current cardiac status indicator indicates a primarily heart rate response or a second pacing setting if the current cardiac status indicator indicates a primarily stroke volume response.

Abstract: A late potential detecting system has an implantable medical device connected to at least one cardiac lead having implantable electrodes positioned at different sites of a ventricle myocardium. A sampling unit of the implantable medical device records electrogram samples for the different implantable electrodes to get different sample sets. The electrogram samples of the sample sets are time synchronized and magnitude potential representations of the potential data of the electrogram samples are determined. The magnitude potential representations of the time synchronized electrogram samples are then co-processed and used for determining a parameter that is indicative of any late potentials of the monitored ventricle.

Abstract: An implantable coronary perfusion monitoring device for in-vivo determination of a coronary perfusion index (CPI) indicative of the coronary perfusion of a heart has a time measurement unit to determine a blood pressure reflection wave measure t indicating the timely position in the heart cycle of the maximum of a reflected blood pressure wave and in a time period starting at a preset point of time in systole and ending at a local maximum of blood pressure following aortic valve closure and, a diastolic peak pressure measurement unit adapted to determine a diastolic peak blood pressure measure DPP related to diastolic aortic peak pressure and a systolic arterial pressure measurement unit adapted to determine a systolic arterial blood pressure measure SAP related to systolic arterial pressure, and a coronary perfusion index calculating unit adapted to determine said coronary perfusion index CPI as (t·DPP)/SAP.

Abstract: A cardiac stimulator is connected to a hemodynamic sensor to sense hemodynamic signals. An optimization module determines recommended AV and VV delays based on IEGM signals. A data processing module determines a delay control parameter for each preset AV delay and VV delay based on the collected hemodynamic signals for respective preset AV delay and VV delay, determines the AV delay setting that corresponds to the maximum delay control parameter and the VV delay setting that corresponds to the maximum delay control parameter, determines an AV delay error correction value as a difference between the AV delay corresponding to the maximum delay control parameter and a recommended AV delay, and determines a VV delay error correction value as a difference between the VV delay corresponding to the maximum delay control parameter and a recommended VV delay.

Abstract: In an implantable medical device, such as a bi-ventricular pacemaker and a method for detecting and monitoring mechanical dyssynchronicity of the heart, a dyssynchronicity measure indicating a degree of mechanical dyssynchronicity of a heart of a patient is calculated. A first intracardiac impedance set is measured using electrodes placed such that the first intracardiac impedance set substantially reflects a mechanical activity of the left side of the heart and a second intracardiac impedance set is measure using electrodes placed such that the second intracardiac impedance set substantially reflects a mechanical activity of the right side of the heart.