Abstract: Systems and methods for managing pain in patient are described. A system may include sensors configured to sense physiological or functional signals, and a pain analyzer to generate signal metrics from the physiological or functional signals. The pain analyzer also generates weight factors corresponding to the signal metrics. The weight factors may indicate the signal metrics reliability in representing an intensity of the pain. The pain analyzer generates a pain score using a plurality of signal metrics and a plurality of weight factors. The pain score may be output to a user or a process. The system may additionally include an electrostimulator to generate and deliver closed-loop pain therapy according to the pain score.

Abstract: This document discusses, among other things, systems and methods for managing pain of a subject. A system may include a motion sensor configured to sense at least one functional signal indicative a physical state of the subject. The at least one functional signal may include at least one motor activity signal or at least one sleep state signal. A pain analyzer circuit may extract, from the functional signal, signal metrics indicative of subject motor control or kinetics, and generate a pain score using the signal metrics. The pain score may be output to a user or a process. The system may additionally include an electrostimulator to generate and deliver a closed-loop pain therapy according to the pain score.

Abstract: An example of a system for providing a patient with pain management includes a pain monitoring circuit. The pain monitoring circuit may include parameter analyzer circuitry and pain score generator circuitry. The parameter analyzer circuitry may be configured to receive and analyze one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient. The one or more timing parameters are indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS. The pain score generator circuitry may be configured to compute a pain score using an outcome of the analysis. The pain score is a function of the BRS during the time intervals and indicative of a degree of pain of the patient.

Abstract: An apparatus comprises a stimulus circuit, a recharge circuit, a switch circuit, and a control circuit. The stimulus circuit provides electrical cardiac pacing stimulation to multiple combinations of a plurality of electrodes, and the electrical stimulation is selectively applied at the first electrode of the electrode combinations. The recharge circuit includes a recharge capacitor electrically coupled to the second electrode of the electrode combinations, and the switch circuit selectively enables electrode combinations for electrical coupling to the stimulus circuit and the recharge circuit. The control circuit includes a pacing activation sub-circuit that selectively initiates delivery of the electrical stimulation using multiple electrode combinations, and enables simultaneous delivery of pacing recharge energy from the recharge capacitor to the second electrode of multiple electrode combinations.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT.

Abstract: Systems and methods for dynamically controlling HBP delivery based on patient AV conduction status are disclosed. An exemplary medical system includes an electrostimulation circuit to generate HBP pulses to stimulate a His bundle or a bundle branch of the heart. An AV conduction monitor circuit continuously or periodically assesses AV conduction status, and detects an indication of presence or absence of AV conduction abnormality. If an AV conduction abnormality is indicated, a control circuit may control the electrostimulation circuit to deliver the HBP pulses. Ventricular backup pacing may be delivered if HBP fails to capture and elicit ventricular activation. When the AV conduction become normal, the control circuit may withhold HBP delivery and promote patient intrinsic ventricular activation.

Abstract: This document discusses, among other things, systems and methods for monitoring a patient at risk of epilepsy. A system comprises a sensor circuit that senses from the patient at least first and second physiological or functional signals. A wellness detector circuit can detect an epileptic event using the sensed physiological or functional signals, or additionally classify the epileptic event into one of epileptic seizure types. The system can generate a wellness indicator based on a trend of the physiological or functional signal during the detected epileptic event. The wellness indicator indicates an impact of the detected epileptic event on the health status of the patient. The system includes an output unit configured to output the detection of the epileptic event or the wellness indicator to a user or a process.

Abstract: Systems and methods for monitoring and treating patients with heart failure (HF) are discussed. The system may sense cardiac signals, and receives information about patient physiological or functional conditions. A stimulation parameter table that includes recommended values of atrioventricular delay (AVD) or other timing parameters maybe created at a multitude of patient physiological or functional conditions. The system may periodically reassess patient physiological or functional conditions. A therapy programmer circuit may dynamically switch between left ventricular-only pacing and biventricular pacing, or switch between single site pacing and multisite pacing based on the patient condition. The therapy programmer circuit may adjust AVD and other timing parameters using the cardiac signal input and the stored stimulation parameter table. A HF therapy may be delivered according to the determined stimulation site, stimulation mode, and the stimulation timing.

Abstract: Systems and methods for managing machine-generated medical events detected from one or more patients are described herein. A medical event management system includes an event analyzer circuit to detect a medical event using physiological data from a patient-triggered episode acquired from a medical device. The event analyzer circuit determines a confidence score of the medical event detection, and generates an alignment indicator indicating a degree of concordance between the detected medical event and the information about the patient-triggered episode. The system assigns priority information to the patient-triggered episode using the generated alignment indicator and the confidence score of the detection. An output circuit can output the received physiological information to a user or a process according to the assigned priority information.

Abstract: A system includes an implantable medical device configured to sense a sync signal and sense physiological parameters to obtain a physiological signal. In response to sensing the sync signal, the implantable medical device is configured to generate a sync-stamped physiological signal. In certain embodiments, a method includes receiving a first physiological signal coupled with a sync signal; receiving a second physiological signal coupled with the sync signal; and, using the sync signal, synchronizing in time the first and second physiological signals.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. A medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses. A sensing circuit senses a physiologic signal, and detect a local His-bundle activation discrete from a pacing artifact of the HBP pulse. A control circuit verifies capture status in response to the HBP pulses. Based on the capture status, the control circuit determines one or more pacing thresholds including a selective HBP threshold representing a threshold strength to capture only the His bundle but not the local myocardium, and a non-selective HBP threshold representing a threshold strength to capture both the His bundle and the local myocardium. The electrostimulation circuit may deliver HBP pulses based on the selective and non-selective HBP thresholds.

Abstract: Systems and methods for monitoring and treating patients with heart failure (HF) are discussed. The system may sense cardiac signals, and receives information about patient physiological or functional conditions. A stimulation parameter table that includes recommended values of atrioventricular delay (AVD) or other timing parameters maybe created at a multitude of patient physiological or functional conditions. The system may periodically reassess patient physiological or functional conditions. A therapy programmer circuit may dynamically switch between left ventricular-only pacing and biventricular pacing, or switch between single site pacing and multisite pacing based on the patient condition. The therapy programmer circuit may adjust AVD and other timing parameters using the cardiac signal input and the stored stimulation parameter table. A HF therapy may be delivered according to the determined stimulation site, stimulation mode, and the stimulation timing.

Abstract: This document discusses, among other things, systems and methods to receive physiologic information of a patient, to receive pulse pressure information from the patient different than the received physiologic information, and to determine an indication of atrial fibrillation (AF) using the received physiologic information and the received pulse pressure information.

Abstract: A cardiac rhythm management system includes at least one sensing component configured to obtain a first physiological parameter signal, an indication of a cardiac response to a stimulation therapy, and temporal information corresponding to the first physiological parameter signal and the cardiac response; and at least one processor configured to: receive the first physiological parameter signal, the indication of the cardiac response, and the temporal information; and to classify the cardiac response into a first cardiac response class to generate a classified cardiac response. The at least one processor also is configured to determine a correlation, based on the temporal information, between the first physiological parameter signal and the classified cardiac response.

Abstract: A neurostimulation system provides for capture verification and stimulation intensity adjustment to ensure effectiveness of vagus nerve stimulation in modulating one or more target functions in a patient. In various embodiments, stimulation is applied to the vagus nerve, and evoked responses are detected to verify that the stimulation captures the vagus nerve and to adjust one or more stimulation parameters that control the stimulation intensity.

Abstract: An apparatus includes a posture sensing circuit configured to detect a change in posture of a subject; a cardiac signal sensing circuit configured to generate a sensed cardiac signal, wherein the sensed cardiac signal includes heart rate information of the subject; a physiologic sensing circuit configured to generate a sensed physiologic signal, wherein the physiologic signal includes information related to blood pressure of the subject; a storage buffer; and a control circuit operatively coupled to the posture sensing circuit and the storage buffer. The control circuit is configured to initiate storage of the heart rate information and the information related to blood pressure in response to a detected change in posture of the subject.

Abstract: An implantable antibacterial barrier device for an elongated medical device, the elongated medical device configured to extend from a first site, through a second site, to a third site. The implantable antibacterial barrier device includes a housing configured to be disposed at the first site, a working electrode configured to be disposed at the second site, and a reference electrode configured to be disposed at the first site. The housing includes barrier circuitry. The working electrode electrically is coupled to the barrier circuitry. The reference electrode is electrically coupled to the barrier circuitry. The barrier circuitry is configured to selectively maintain the working electrode at a negative electrical potential relative to the reference electrode to form an antibacterial barrier.

Abstract: A neurostimulation system provides for capture verification and stimulation intensity adjustment to ensure effectiveness of vagus nerve stimulation in modulating one or more target functions in a patient. In various embodiments, stimulation is applied to the vagus nerve, and evoked responses are detected to verify that the stimulation captures the vagus nerve and to adjust one or more stimulation parameters that control the stimulation intensity.

Abstract: Methods and systems for selecting electrical stimulation parameters for an electrical stimulation device implanted in a patient can use an iterative process for identifying electrodes for stimulation, as well as suitable stimulation parameters. The process begins with an initial set of electrode combinations to identify regions of the nerve or other tissue for stimulation. This leads to selection of other electrode combinations to test, followed by the selection of multiple electrode groups (which can include three or more electrodes) for stimulation.

Abstract: Various implantable device embodiments may comprise a neural stimulator configured to deliver a neurostimulation therapy with stimulation ON times and stimulation OFF times where a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time. The neural stimulator may be configured to monitor the dose of the delivered neurostimulation therapy against dosing parameters. The neural stimulator may be configured to declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy, or may be configured to record data for the monitored dose of the delivered neurostimulation therapy, or may be configured to both record data for the monitored dose of the delivered neurostimulation therapy and declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy.