Abstract: A system and method for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the anatomical structure. A most recent intrinsic event at a selected time is determined based on the sensed activation signals and a persistent display of relevant characteristics is generated based on the sensed activation signals of the most recent intrinsic event. The persistent display is updated upon detection of a subsequent intrinsic event.

Abstract: A method and system for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the anatomical structure. Substantially similar activation signals are binned according to a self-correlation algorithm which identifies patterns among the sensed activation signals. A template is generated for each bin and compared to a characteristic template to identify at least one bin which corresponds to a far-field activation signal.

Abstract: Systems and methods are provided for using information from a subject heart sound signal and information from a subject physiological pulsatile signal to identify subject systolic time intervals. An example system for identifying systolic time intervals includes a heart sound detector circuit, configured to detect a subject heart sound signal using an acoustic signal. The system can include a physiological signal sensing circuit configured to detect a physiological pulsatile signal, including at least one of a pulsatile cervical impedance signal or a pulsatile pulmonary artery pressure signal. A timing circuit can be configured to calculate a systolic time interval between a feature on the heart sound signal and a feature on the pulsatile signal. A subject physiologic diagnostic indication can be provided using information from the timing circuit about the systolic time interval.

Abstract: An apparatus may include an implantable therapy circuit that provides bi-ventricular pacing to a subject, a heart sound signal sensing circuit that produces a sensed heart sound signal that is representative of at least one heart sound associated with mechanical cardiac activity, a memory circuit to store one or more heart sound templates of cardiac capture, and a comparison circuit that compares a segment of the sensed heart sound signal to the one or more heart sound templates of cardiac capture to identify ventricles in which cardiac capture was induced by the bi-ventricular pacing. In some situations, an indication of the ventricles in which cardiac capture was induced may be generated according to the comparison.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can be configured to detect a heart sound signal and generate one or more heart sound metrics, detect a characteristic indicative of cannon waves, and determine a desired value for a device parameter, such as a timing parameter which can be used to control the delivery of CRT pacing to various heart chambers. The desired device parameter value can be determined using the heart sound metrics and the characteristic indicative of the cannon waves. The ambulatory medical device can program stimulation using the desired device parameter value, and deliver the programmed stimulations to one or more target sites to achieve desired therapeutic effects.

Abstract: Systems and methods are described for subject rehospitalization management. In an example, multiple physiologic signals can be obtained from a subject using multiple sensors. In response to a hospitalization event, pre-hospitalization characteristics of the multiple physiologic signals can be identified. Post-hospitalization characteristics of the multiple physiologic signals can be identified, including characteristics that differ from their corresponding pre-hospitalization characteristics. Later subsequent physiologic signals can be further monitored after the hospitalization event, such as using the same multiple sensors, and subsequent physiologic signal characteristics can be identified. In an example, a heart failure diagnostic indication can be determined using information about the pre-hospitalization characteristics, the post-hospitalization characteristics, and the subsequent characteristics.

Abstract: A system may include an external medical device (e.g., a patch) including one or more physiological sensors configured to sense one or more physiological parameters of a subject when the subject is ambulatory. The external medical device may be configured to communicate information related to the sensed one or more physiological parameters for determining and/or modifying at least one cardiac therapy parameter of an implantable medical device (e.g., pacemaker, implantable cardioverter defibrillators, or cardiac resynchronization therapy device). In some situations, an indication or notification may be generated corresponding to the determined and/modified cardiac therapy parameter.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can receive one or more physiologic signals and generate multiple signal metrics from the physiologic signals. The ambulatory medical device can determine a desired value for a device parameter, such as a timing parameter used for controlling the delivery of CRT pacing to various heart chambers, using information fusion of signal metrics that are selected based on one or more of a signal metric sensitivity to perturbations to the device parameter in response to a stimulation, a signal metric variability in response to a stimulation, or a covariability between two or more signal metrics in response to a stimulation. The ambulatory medical device can program a stimulation using the desired device parameter value, and deliver the programmed stimulation to one or more target sites to achieve desired therapeutic effects.

Abstract: An apparatus, such as a cardiac function management system can detect heart sounds following a sensed transition in physical activity level, such as from an elevated physical activity level to rest. A technique can include systems, methods, machine-readable media, or other techniques that can include identifying a physical activity level transition, receiving a heart sound signal, determining characteristics of the heart sound and subject physiologic activity to provide an indication, such as a heart failure status indication.

Abstract: Stimulation energy can be provided to stimulate synchronous ventricular contractions. Interval information obtained from a cardiac electrical heart signal and a cardiac mechanical heart signal can be used to determine a right ventricular activation time. The interval information can provide a cardiac stimulation indication.

Abstract: Pacing parameters may be adjusted to increase the cardiac output of a patient's heart while a patient is awake and/or active and the demand placed on the heart may be greatest, and to decrease or hemodynamic efficiency while a patient is at rest so that the heart itself has time to rest before the next period of higher demand for efficiency begins. This may aid in lessening the strain placed on the heart by making the heart work hard when needed such as when the patient is active, and by permitting the heart to “rest” when the patient is relatively inactive.

Abstract: A system and method for detecting and treating symptoms of early decompensation utilizing a cardiac rhythm management. The system applies an electrical stimulus to the patient's heart at a first set of pacing parameters including a lower rate limit (LRL) setting, and acquires a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient. An average coronary venous end diastolic pressure (CV-EDP) value is calculated from the CVP signal. The system monitors the average CV-EDP value over a predetermined interval, and dynamically adjusts the LRL setting responsive to the detection of a first or a second predetermined event based on the average CV-EDP value.

Abstract: A system comprising an implantable electrical cardiac signal sensing circuit, an implantable sinoatrial cardiac action potential detector circuit, and an implantable electrical stimulation circuit in electrical communication with the electrical cardiac signal sensing circuit and the sinoatrial cardiac action potential detector circuit. The electrical cardiac signal sensing circuit is configured to receive one or more intrinsic heart signals from one or more respective electrodes configured for placement in a vicinity of a sinoatrial node of a subject. The implantable electrical stimulation circuit is configured to initiate delivery of at least one inhibitory electrical stimulation pulse in a vicinity of the sinoatrial node in a timed relationship to a sensed sinoatrial cardiac action potential. Other systems and methods are disclosed.

Abstract: An anatomical mapping system includes a plurality of mapping electrodes, a plurality of mechanical sensors, and a mapping processor associated with the plurality of mapping electrodes and mechanical sensors. The mapping electrodes are configured to detect electrical activation signals of intrinsic physiological activity within an anatomical structure. The mechanical sensors are configured to detect mechanical activity associated with the intrinsic physiological activity. The mapping processor is configured to record the detected activation signals and associate one of the plurality of mapping electrodes and mechanical sensors with each recorded activation signal. The mapping processor is further configured to determine activation times of the intrinsic physiological activity based on a correlation of corresponding electrical activation signals and mechanical activity.

Abstract: A method for mapping an anatomical structure includes sensing activation signals of physiological activity with a plurality of electrodes disposed in or near the anatomical structure, each activation signal having an associated cycle length, estimating an action potential duration and diastolic interval for each cycle length, generating a restitution curve based on the estimated action potential duration and diastolic interval from a preceding cycle length, iteratively optimizing each estimated action potential duration and corresponding diastolic interval to maximize a functional relationship between the estimated action potential duration and estimated diastolic interval from preceding cycle length, and generating an action potential duration restitution curve based on the optimized action potential durations and diastolic intervals.

Abstract: A method for mapping a cardiac chamber includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the cardiac chamber, the activation signals including a near-field activation signal component and a far-field activation signal component, isolating R-wave events in the activation signals, generating a far-field activation template representative of the far-field activation signal component based on the R-wave events, and filtering the far-field activation template from the activation signals to identify the near-field activation signal components in the activation signals.

Abstract: In an example, a pacing therapy can be optimized using information indicative of an offset duration between an intrinsic first atrioventricular delay of a subject at rest and a second atrioventricular delay specified to enhance a cardiac output of the subject heart when the subject is at rest. Optimizing the therapy can include receiving information about a heart rate of the subject and receiving information about an intrinsic, heart rate dependent atrioventricular delay. In an example, a therapy parameter, such as a therapy atrioventricular delay, can be adjusted using information about the received heart rate of the subject, the heart-rate-dependent third AV delay, or the offset duration.

Abstract: A catheter system includes a mapping catheter including a plurality of mapping electrodes, each mapping electrode configured to sense signals associated with an anatomical structure. The catheter system further includes a processor operatively coupled to the plurality of mapping electrodes and configured to receive the signals sensed by the plurality of mapping electrodes, characterize the signals sensed by the plurality of mapping electrodes based on amplitudes of the sensed signals, and generate an output of a quality of contact of the plurality of mapping electrodes with the anatomical structure based on the signal characterization.

Abstract: A method for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the anatomical structure, identifying at least one of the electrodes not in direct contact with the anatomical structure, and adjusting the activation signals sensed by each of the plurality of electrodes based on the activation signals sensed by the identified at least one of the electrodes not in direct contact with the anatomical structure.

Abstract: A catheter system includes a mapping catheter having a plurality of splines, each of the plurality of splines including a plurality of mapping electrodes. The system further includes a processor operatively coupled to the plurality of mapping electrodes and configured to receive signals sensed by the plurality of mapping electrodes. The processor is further configured to estimate an interspline distance between adjacent splines in the plurality of splines based on the signals sensed by the mapping electrodes on the adjacent splines.