Abstract: A method for operating a cardiac rhythm management device in which a clinical state vector is computed as a combination of a plurality of parameters related to a patient's heart failure status and compared to a previously computed clinical state vector to determine a clinical trajectory indicative of changes in the patient's heart failure status. Such detected changes in status can be used both as a clinical tool to evaluate treatment and to automatically adjust the operation of the device.

Abstract: A method and apparatus for delivering anti-tachycardia pacing in an adaptive manner is disclosed. A cardiac rhythm management device, such as an implantable pacemaker, having anti-tachycardia pacing capability delivers anti-tachycardia pacing therapy in accordance with a selected pacing protocol upon detection of a terminable arrhythmia. The protocol is selected from a library of available protocols. A record of the successes and failures of each available protocol in converting tachyarrhythmias is maintained in a result table for use in selecting the protocol.

Abstract: A lead having a distal end electrode assembly adapted for implantation on or about the heart or within a vein and for connection to a system for monitoring or stimulating cardiac activity. The electrode assembly includes conductive fixation features, such as conductive tines or flexible members, in combination with non-conductive fixation features. The conductive fixation features also include tines coated with a conductive material. The fixation features further include conductive tines which are retractable. A defibrillation coil is optionally disposed at the distal end of the lead in combination with the conductive tines.

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 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: An implantable medical device such as a cardiac pacemaker or implantable cardioverter/defibrillator with the capability of receiving communications in the form of speech spoken by the patient. An acoustic transducer is incorporated within the device which along with associated filtering circuitry enables the voice communication to be used to affect the operation of the device or recorded for later playback.

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: An implantable device for delivering cardiac pacing therapy in order to improve cardiac function is programmed to allow some amount of intrinsic activity to occur without otherwise the disturbing the pacing algorithm used to deliver therapy. Intrinsic cardiac cycles utilize the heart's native conduction system and thus serve to prevent the atrophy which may otherwise result from continuous pacing.

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: An implantable system includes a housing configured for subcutaneous, non-intrathoracic placement in a patient, and a plurality of electrodes coupled to the housing, each of the plurality of electrodes configured for subcutaneous, non-intrathoracic placement in the patient. Detection circuitry is provided in the housing and coupled to the plurality of electrodes. The detection circuitry is configured to detect cardiac activity necessitating a cardiac stimulation therapy. Energy delivery circuitry is provided in the housing and coupled to the plurality of electrodes. The energy delivery circuitry is configured to deliver the cardiac stimulation therapy.

Abstract: A method and apparatus for delivering anti-tachycardia pacing in an adaptive manner is disclosed. A cardiac rhythm management device, such as an implantable pacemaker, having anti-tachycardia pacing capability delivers anti-tachycardia pacing therapy in accordance with a selected pacing protocol upon detection of a terminable arrhythmia. The protocol is selected from a library of available protocols. A record of the successes and failures of each available protocol in converting tachyarrhythmias is maintained in a result table for use in selecting the protocol.

Abstract: Systems and methods for an information management system for an implantable medical device are disclosed. A preferred embodiment uses an implantable medical device that is automatically recognized by a publicly accessible information access portal. Some embodiments of a system disclosed herein also can be configured as a component of an Advanced Patient Management System that helps better monitor, predict and manage chronic diseases.

Abstract: A method and device for delivering cardiac function therapy on a demand basis. An implantable device for delivering cardiac function therapy is programmed to suspend such therapy at periodic intervals or upon command from an external programmer. Measurements related to hemodynamic performance are then taken using one or more sensing modalities incorporated into the device. Based upon these measurements, the device uses a decision algorithm to determine whether further delivery of the cardiac function therapy is warranted.

Abstract: A sleep quality assessment approach involves collecting data based on detected physiological or non-physiological patient conditions. At least one of detecting patient conditions and collecting data is performed using an implantable device. Sleep quality may be evaluated using the collected data by an imlantable or patient-external sleep quality processor. One approach to sleep quality evaluation involves computing one or more summary metrics based on occurrences of movement disorders or breathing disorders during sleep.

Abstract: Systems and methods for sleep state classification involve detecting conditions related to sleep, including at least one condition associated with rapid eye movement (REM) sleep. Additionally, a condition modulated by the sleep-wake status of the patient may be detected. A medical system that is partially or fully implantable incorporates sensors and circuitry for detecting and processing the sleep-related signals. A sleep state processor classifies the patient's sleep state based on the sleep-related signals. Sleep state classification may be used in connection with the delivery of sleep state appropriate therapy, diagnostic testing, or patient monitoring.

Abstract: An ablation catheter stores a platelet inhibitor substance within a plurality of pockets or recesses of its shaft. The substance is adapted to elute upon contact with biological fluid. In the pocket configuration, the platelet inhibitor substance is in a capsule positioned within the pocket. In the recess configuration, the platelet inhibitor substance is in a hydrogel or silicone-based porous/semi-porous matrix positioned within the recess. Elution of the platelet inhibitor substance prevents or at least substantially minimizes the adhesion of blood platelets on the catheter surface during ablation. In another configuration, the catheter includes an internal lumen network having apertures terminating at the surface of the shaft. The lumen communicates with a source of platelet inhibitor fluid that is forced through the lumen by a variable pump.

Abstract: An apparatus for delivering energy to a biological site includes a catheter having an ablation electrode and a plurality of backplates distributed at various locations proximal the biological site. The backplates are coupled to a switching device for selecting which backplate to utilize as a return electrode to complete the circuit with the ablation electrode in order to obtain deeper, larger lesions for a given amount of energy. The backplate selection is made by determining which return electrode most closely places the biological site between the ablation electrode and the backplate. Backplate selection may be made automatically based on impedance measurements or conduction time measurements. Alternatively, the backplate selection can be made manually.

Abstract: Information indicative of the flow rate of fluid through a biological organ is provided to a processor. Using this information the processor assesses whether the fluid-flow rate is high or low and controls a generator such that the generator provides energy to an electrode positioned within the organ to effect tissue ablation. Energy of a first level is provided during periods of high fluid-flow and energy of a second level, less than the first level, during periods of low fluid-flow. The flow rate information may be provided by an electrocardiograph (ECG) device or a flow sensor. A temperature sensor provides temperature signals to the processor indicative of the electrode temperature. The processor further controls the generator based on the electrode temperature to maintain the temperature at or near a target temperature and below a maximum threshold temperature.

Abstract: A method of presenting information for evaluating the condition of chronically impaired cardiac patients based on long-term assessment of activity trends, using a memoried implanted cardiac rhythm management device having a plurality of programmable parameters and one or more sensors for sensing one or more parameters related to an activity level of the patient. The method includes acquiring sensor signal data indicative of the activity level of the patient, accumulating sensor signal data in memory and using the accumulated sensor signal data to determine the activity level of the patient during a predetermined period of time, recording the activity level during a plurality of sequential time periods, adding contemporary annotation information to the activity data and producing a data record of the activity level with the annotation information during sequential time periods sufficient to indicate trends in a patient's activity level.

Abstract: An ablation catheter stores a platelet inhibitor substance within a plurality of pockets or recesses of its shaft. The substance is adapted to elute upon contact with biological fluid. In the pocket configuration, the platelet inhibitor substance is in a capsule positioned within the pocket. In the recess configuration, the platelet inhibitor substance is in a hydrogel or silicone-based porous/semi-porous matrix positioned within the recess. Elution of the platelet inhibitor substance prevents or at least substantially minimizes the adhesion of blood platelets on the catheter surface during ablation. In another configuration, the catheter includes an internal lumen network having apertures terminating at the surface of the shaft. The lumen communicates with a source of platelet inhibitor fluid that is forced through the lumen by a variable pump.