Abstract: A system is provided for stimulating one or more cells, wherein the stimulation is sub-threshold and may alter a transmembrane potential of the one or more cells. For some populations of cells it may be possible to affect the transmembrane potential to gain a therapeutic benefit. Cells of the sino-atrial node spontaneously depolarize predominantly due to the slow depolarization of transmembrane potential. The present system may provide sino-atrial cells with a local field stimulation that while not eliciting an action potential may nonetheless alter local transmembrane potential. Such alteration of transmembrane potential may permit an increase or decrease in a rate of depolarization, and hence modify heart rate.

Abstract: A system is provided for stimulating one or more cells, wherein the stimulation is sub-threshold and may alter a transmembrane potential of the one or more cells. For some populations of cells it may be possible to affect the transmembrane potential to gain a therapeutic benefit. Cells of the sino-atrial node spontaneously depolarize predominantly due to the slow depolarization of transmembrane potential. The present system may provide sino-atrial cells with a local field stimulation that while not eliciting an action potential may nonetheless alter local transmembrane potential. Such alteration of transmembrane potential may permit an increase or decrease in a rate of depolarization, and hence modify heart rate.

Abstract: A method for monitoring a biological cardiac pacemaker is provided. The method may include stimulating a heart at a region selected for implantation of a biological pacemaker and sensing at least one electrical signal indicative of a cardiac depolarization originating in the region selected for implantation of the biological pacemaker. The method may further include sensing at least one subsequent electrical signal produced by the heart and determining if the subsequent electrical signal originated in the region selected for the biological pacemaker or another region of the heart. In an alternative embodiment, the method may include determining a template time difference between two points on cardiac complexes sensed in two or more different cardiac locations during normal sinus rhythm. The method may further include determining a time difference between two points on a subsequent cardiac complex sensed in two or more different cardiac locations.

Abstract: The present invention includes a method for controlling pacemaker therapy in a patient with an implanted biological pacemaker. The method may include pacing a heart at a predetermined rate using an electronic pacemaker and configuring the pacemaker to periodically enter a biological pacemaker weaning mode. The weaning mode may include ceasing pacing for at least a predetermined length of time and monitoring the heart to detect electrical depolarizations of a ventricle of the heart during the predetermined length of time. The weaning mode may further include determining the length of time between the cessation of pacing and the detected electrical depolarization and determining if the length of time between the cessation of pacing and the detected electrical depolarization is less than a maximum predetermined interval. The pacemaker therapy may be withheld as long as the length of time is less than the maximum predetermined interval.

Abstract: A system and method for transacting an automated patient communications session is described. A patent health condition is monitored by regularly collecting physiological measures through an implantable medical device. A patient communications session is activated through a patient communications interface, including an implantable microphone and an implantable speaker in response to a patient-provided activation code. An identification of the patient is authenticated based on pre-defined uniquely identifying patient characteristics. Spoken patient information is received through the implantable microphone and verbal system information is played through the implantable speaker. The patient communications session is terminated by closing the patient communications interface. The physiological measures and the spoken patient information are sent.

Abstract: A system and method for transacting an automated patient communications session is described. A patent health condition is monitored by regularly collecting physiological measures through an implantable medical device. A patient communications session is activated through a patient communications interface including, an implantable microphone and an implantable speaker in response to a patient-provided activation code. An identification of the patient is authenticated based on pre-defined uniquely identifying patient characteristics. Spoken patient information is received through the implantable microphone and verbal system information is played through the implantable speaker. The patient communications session is terminated by closing the patient communications interface. The physiological measures and the spoken patient information are sent.

Abstract: A system and method for transacting an automated patient communications session is described. A patent health condition is monitored by regularly collecting physiological measures through an implantable medical device. A patient communications session is activated through a patient communications interface, including an implantable microphone and an implantable speaker in response to a patient-provided activation code. An identification of the patient is authenticated based on pre-defined uniquely identifying patient characteristics. Spoken patient information is received through the implantable microphone and verbal system information is played through the implantable speaker. The patient communications session is terminated by closing the patient communications interface. The physiological measures and the spoken patient information are sent.

Abstract: A cardiac electro-stimulatory device and method for operating same in which stimulation pulses are distributed among a plurality of electrodes fixed at different sites of the myocardium in order to reduce myocardial hypertrophy brought about by repeated pacing at a single site and/or increase myocardial contractility. In order to spatially and temporally distribute the stimulation, the pulses are delivered through a switchable pulse output configuration during a single cardiac cycle, with each configuration comprising one or more electrodes fixed to different sites in the myocardium.

Abstract: A cardiac electro-stimulatory device and method for operating same in which stimulation pulses are distributed among a plurality of electrodes fixed at different sites of the myocardium in order to reduce myocardial hypertrophy brought about by repeated pacing at a single site and/or increase myocardial contractility. In order to spatially and temporally distribute the stimulation, the pulses are delivered through a switchable pulse output configuration during a single cardiac cycle, with each configuration comprising one or more electrodes fixed to different sites in the myocardium.

Abstract: Systems and methods for correlating biometric trends with a related temporal event are disclosed. A preferred embodiment utilizes an implantable medical device comprising at least one sensor in electronic communication with a patient management system adapted to temporally analyze and correlate biometric data. Some embodiments of a system disclosed herein also can be configured as an Advanced Patient Management system that helps better monitor, predict and manage chronic diseases.

Abstract: A cardiac rhythm management device is configured to detect oscillations in cardiac rhythm by comparing electrogram signals during successive heart beats. Upon detection of electrical alternans, the device may adjust its operating behavior to compensate for the deleterious effects of the condition.

Abstract: A method and device for delivering ventricular resynchronization pacing therapy in conjunction with electrical stimulation of nerves which alter the activity of the autonomic nervous system is disclosed. Such therapies may be delivered by an implantable device and are useful in preventing the deleterious ventricular remodeling which occurs as a result of a heart attack or heart failure. The device may perform an assessment of cardiac function in order to individually modulate the delivery of the two types of therapy.

Abstract: A system and method for providing closely-followed cardiac therapy management through automated patient care is presented. A patient under remote care is enrolled in a monitoring program following commencement of a cardiac therapy regimen to be undertaken by the patient. A wearable monitor, including one or more patient physiology sensors and a wireless interface providing enabling bi-directional data exchange, is provided to the patient. Patient physiometry, including quantitative physiological measures, is periodically collected from the wearable monitor over the wireless interface concomitant to performance of the cardiac therapy regimen. The patient physiometry is evaluated to determine a trend indicating an onset, progression, regression, absence of, and status quo of patient health status.

Abstract: A method or system for computing and/or setting optimal cardiac resynchronization pacing parameters as derived from intrinsic conduction data is presented. The intrinsic conduction data includes intrinsic atrio-ventricular and interventricular delay intervals which may be collected via the sensing channels of an implantable cardiac device. Among the parameters which may be optimized in this manner are an atrio-ventricular delay interval and a biventricular offset interval. In one of its aspects, the invention provides for computing optimum pacing parameters for patients having some degree of AV block or with atrial conduction deficits. Another aspect of the invention relates to a pacing mode and configuration for providing cardiac resynchronization therapy to patients with a right ventricular conduction disorder.

Abstract: A medical system includes a housing configured for implantation within a patient's subclavicular region. Detection circuitry provided in the housing is configured to detect cardiac electrical activity. Energy delivery circuitry provided in the housing is configured to deliver therapy to treat a detected tachycardia or fibrillation episode. A lead is coupled to the housing, detection circuitry, and energy delivery circuitry. The lead is configured for subcutaneous, non-intrathoracic placement within the patient, and extends from the subclavicular region to just below the patient's ribs or the subxiphoid process. A defibrillation electrode is provided at a distal end of the lead body. A pair of sensing electrodes is provided on the lead body at locations consistent with positions V2-V5 of surface electrocardiogram electrodes.

Abstract: An apparatus and method for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Abstract: Systems and methods for evaluating a patient condition using autonomic balance information involve providing an implantable cardiac device that acquires a cardiac waveform from a patient. One or more characteristics associated with autonomic balance of the patient are detected and used to evaluate a patient condition, such as sleep onset, sleep stage, cardiac vulnerability over a predetermined duration, and sleep disordered breathing. Patient activity levels may be sensed and used to evaluate the patient's condition, such as for determining a level of systemic stress. Characteristics associated with the autonomic balance include calculating an LF/HF ratio waveform and/or determining one or more morphological features of the LF/HF ratio waveform. Coordination with a patient-external device may facilitate transmission of information about one or more of the cardiac waveform, the one or more characteristics associated with the autonomic balance, and a marked cardiac waveform.

Abstract: Methods and devices for delivering cardiac therapy to a patient are provided. Various implantable device embodiments comprise a plurality of leads and a controller. The leads include at least one lead to be positioned within a lead path to deliver ventricular pacing pulses and to deliver neural stimulation at a site proximate to the heart to inhibit sympathetic nerve activity. The controller controls delivery of the ventricular pacing pulses in accordance with a programmed pacing mode and controls delivery of the neural stimulation. The controller is programmed to deliver remodeling control therapy (RCT) by delivering ventricular pacing to pre-excite a ventricular myocardium region to mechanically unload that region during systole, and further is programmed to deliver anti-remodeling therapy (ART) by delivering neural stimulation to inhibit sympathetic nerve activity in conjunction with RCT. Other embodiments are provided herein.

Abstract: An apparatus and method for adjusting the performance of an implanted device based on data including contextual information. Contextual information, including operational and performance data concerning the implanted device as well as the patient with the implanted device, is stored by a portable electronic device. In one embodiment, the portable electronic device is adapted for battery operation and includes a personal digital assistant (PDA). The portable electronic device is adapted for use as an interface to conduct wireless communications with the implanted device. In one embodiment, the portable electronic device interfaces with a clinical programmer for use by a physician.

Abstract: Described is an implantable pulse generator housing for enclosing and containing pulse generator circuitry. The housing is formed of electrically conductive metal defining an electrically conductive outer surface which may be connected to the pulse generator circuitry for delivering electrical energy to the heart. A programmable switch operable by the pulse generator circuitry is provided to discharge electrical pulses between selected electrodes and the conductive pulse generator housing in accordance with whether a first or second cardiac condition is detected.