Abstract: An ICD multimode system comprises a microcontroller or FPGA having a memory, a differentially driven phased array amplifier, one or more sensors, and a wireless transmitter/receiver. Based upon sensor data and demand criteria programmed into the memory, the system provides late systolic impulse (LSI) therapy to treat congestive heart failure (CHF) and ventricle level-shifting (VLS) therapy to block unwanted PVCs to prevent VT or VF dynamically and use a phased array amplifier therapy to accurately manage CRT. An external echocardiogram and ultrasound system adjusts the therapies administered based upon sensor and demand data in real time to allow a patient's heart to function at a level of improved performance and increase ejection fraction EF.

Abstract: An ICD multimode system comprises a microcontroller or FPGA having a memory, a differentially driven phased array amplifier, one or more sensors, and a wireless transmitter/receiver. Based upon sensor data and demand criteria programmed into the memory, the system provides late systolic impulse (LSI) therapy to treat congestive heart failure (CHF), ventricle level-shifting (VLS) therapy to block unwanted PVCs to prevent VT or VF, and cardiac resynchronization therapy (CRT) that adjusts LV and RV contraction synchronization based upon timing. An integrated echocardiogram and ultrasound system automatically adjusts the therapies administered based upon sensor and demand data in real time to allow a patient's heart to function at a level of improved performance and efficiency.

Abstract: Methods and systems for identifying dislodgement of an electrode, operably coupled to an implanted medical device, from fixation with the endocardium of a chamber of the heart of a patient can include obtaining a test electrogram, and measuring at least two parameters indicating a cavitary electrogram and taking an action, such as generating an electrode dislodgement alert and/or configuring the implanted medical device to disable therapy, when the cavitary electrogram is indicated. In embodiments, the two parameters include a test positive component magnitude and a test negative component magnitude. In embodiments, the test component magnitudes are compared to baseline component magnitudes determined from a baseline electrogram.

Abstract: Scientific and medical system circuitry for diagnosis of implantable cardioverter defibrillator (ICD) lead conductor anomalies, in particular conductor migration and externalization within an ICD implantable cardiac lead. The system determines an “imaginary” component of the high frequency transmission line impedance having certain spectral changes that correspond to radially outward movements or local externalization of a conductor within a lead body allowing for the detection of conductor migration and small insulation failures.

Abstract: Methods and systems for identifying dislodgement of an electrode, operably coupled to an implanted medical device, from fixation with the endocardium of a chamber of the heart of a patient can include obtaining a test electrogram, and measuring at least two parameters indicating a cavitary electrogram and taking an action, such as generating an electrode dislodgement alert and/or configuring the implanted medical device to disable therapy, when the cavitary electrogram is indicated. In embodiments, the two parameters include a test positive component magnitude and a test negative component magnitude. In embodiments, the test component magnitudes are compared to baseline component magnitudes determined from a baseline electrogram.

Abstract: A method and apparatus to detect anomalies in the conductors of leads attached to implantable medical devices based on the dynamical electrical changes these anomalies cause. In one embodiment, impedance is measured for weak input signals of different applied frequencies, and a conductor anomaly is detected based on differences in impedance measured at different frequencies. In another embodiment, a transient input signal is applied to the conductor, and an anomaly is identified based on parameters related to the time course of the voltage or current response, which is altered by anomaly-related changes in capacitance and inductance, even if resistance is unchanged. The method may be implemented in the implantable medical device or in a programmer used for testing leads.

Abstract: A method and apparatus to detect anomalies in the conductors of leads attached to implantable medical devices based on the dynamical electrical changes these anomalies cause. In one embodiment, impedance is measured for weak input signals of different applied frequencies, and a conductor anomaly is detected based on differences in impedance measured at different frequencies. In another embodiment, a transient input signal is applied to the conductor, and an anomaly is identified based on parameters related to the time course of the voltage or current response, which is altered by anomaly-related changes in capacitance and inductance, even if resistance is unchanged. The method may be implemented in the implantable medical device or in a programmer used for testing leads.

Abstract: Scientific and medical system circuitry for diagnosis of implantable cardioverter defibrillator (ICD) lead conductor anomalies, in particular conductor migration and externalization within an ICD implantable cardiac lead. The system determines an “imaginary” component of the high frequency transmission line impedance having certain spectral changes that correspond to radially outward movements or local externalization of a conductor within a lead body allowing for the detection of conductor migration and small insulation failures.

Abstract: A method for accurately determining timing points for T-wave shocks is particularly useful in a system for determining a cardiac shock strength in an implantable cardioverter defibrillator (ICD. The method involves acquiring at least one first signal, acquiring at least a second signal, comparing the signals, and selecting a timing point with the T-wave of the signal. The first and second signals may be two different aspects of a single electrogram, first and second electrograms, or a combination thereof. Comparison preferably involves signal alignment and qualitative analysis.

Abstract: A method and apparatus to detect anomalies in the conductors of leads attached to implantable medical devices based on the dynamical electrical changes these anomalies cause. In one embodiment, impedance is measured for weak input signals of different applied frequencies, and a conductor anomaly is detected based on differences in impedance measured at different frequencies. In another embodiment, a transient input signal is applied to the conductor, and an anomaly is identified based on parameters related to the time course of the voltage or current response, which is altered by anomaly-related changes in capacitance and inductance, even if resistance is unchanged. The method may be implemented in the implantable medical device or in a programmer used for testing leads.

Abstract: A method for accurately determining timing points for T-wave shocks is particularly useful in a system for determining a cardiac shock strength in an implantable cardioverter defibrillator (ICD. The method involves acquiring at least one first signal, acquiring at least a second signal, comparing the signals, and selecting a timing point with the T-wave of the signal. The first and second signals may be two different aspects of a single electrogram, first and second electrograms, or a combination thereof. Comparison preferably involves signal alignment and qualitative analysis.

Abstract: A method for accurately determining timing points for T-wave shocks is particularly useful in a system for determining a cardiac shock strength in an implantable cardioverter defibrillator (ICD. The method involves acquiring at least one first signal, acquiring at least a second signal, comparing the signals, and selecting a timing point with the T-wave of the signal. The first and second signals may be two different aspects of a single electrogram, first and second electrograms, or a combination thereof. Comparison preferably involves signal alignment and qualitative analysis.

Abstract: A method and apparatus to detect anomalies in the conductors of leads attached to implantable medical devices based on the dynamical electrical changes these anomalies cause. In one embodiment, impedance is measured for weak input signals of different applied frequencies, and a conductor anomaly is detected based on differences in impedance measured at different frequencies. In another embodiment, a transient input signal is applied to the conductor, and an anomaly is identified based on parameters related to the time course of the voltage or current response, which is altered by anomaly-related changes in capacitance and inductance, even if resistance is unchanged. The method may be implemented in the implantable medical device or in a programmer used for testing leads.

Abstract: A method for determining a cardiac shock strength, for example the programmed first-therapeutic shock strength of an implantable cardioverter defibrillator (ICD), including the steps of sensing a change in a T-wave of an electrogram with respect to time such as the maximum of the first derivative of a T-wave of an electrogram; delivering a test shock by (i) delivering a test shock at a test-shock strength and at a test-shock time relating to the maximum of the first derivative of the T-wave with respect to time; and (ii) sensing for cardiac fibrillation. If fibrillation is not sensed, test-shock delivery is repeated at the same test-shock strength and at specific, different test-shock times relating to the maximum of the first derivative of the T-wave. If fibrillation is still not sensed, the shock strength is decreased and test shocks are repeated at the same specific test shock times relative to the maximum of the first derivative of the T-wave.

Abstract: A method for accurately determining timing points for T-wave shocks is particularly useful in a system for determining a cardiac shock strength in an implantable cardioverter defibrillator (ICD. The method involves acquiring at least one first signal, acquiring at least a second signal, comparing the signals, and selecting a timing point with the T-wave of the signal. The first and second signals may be two different aspects of a single electrogram, first and second electrograms, or a combination thereof. Comparison preferably involves signal alignment and qualitative analysis.

Abstract: A method and apparatus for validating a cardiac pacing pulse train preceding a T-shock. Validation of the pacing pulse train includes verifying capture of at least the last pacing pulse of the pulse train and verifying that intrinsic ventricular events are not sensed during a pacing train interval that includes at least the interval between the last pacing pulse and a scheduled T-shock delivery. Capture verification may include sensing an event during an ER sensing window, morphological analysis of a sensed event, and analysis of the temporal relationship between sensed events occurring on different EGM sources. The scheduled T-shock is delivered in response to a valid pacing pulse train. A response to an invalid pacing pulse train may include any of an invalid pacing train notification, withholding a scheduled T-shock, extension of the pacing train, repeating the pacing train, or adjusting the pacing pulse train parameters.