Abstract: Systems and methods for pacing cardiac conductive tissue are described. A medical system includes electrostimulation circuit that may generate His-bundle pacing (HBP) pulses for delivery at or near the His bundle. A capture verification circuit may detect, from a far-field signal representing ventricular response to the HBP pulses, a His-bundle response representative of excitation of the His bundle directly resulting from the HBP pulses, and a myocardial response representative of excitation of the myocardium directly resulting from the HBP pulses. A control circuit may adjust one or more stimulation parameters based on the His-bundle response and myocardial response. The electrostimulation circuit may generate and deliver the HBP pulses according to the adjusted stimulation parameters to excite the His bundle.

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: Atrial fibrillation information can be determined from ventricular information or a ventricular location, such as using ventricular rate variability. An ambulatory medical device can receive indications of pairs of first and second ventricular rate changes of three temporally adjacent ventricular heart beats. A first count of instances of the pairs meeting a combined rate change magnitude characteristic and a second count of instances of the pairs in which both of the first and second ventricular rate changes are negative can be used to provide atrial fibrillation information.

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 to determine P wave oversensing (PWOS) are disclosed, including identifying cardiac signal features in received cardiac electrical information, determining a first indication of PWOS using a pattern of identified cardiac signal features, and in response to the determined first indication of PWOS, determining a second indication of PWOS using a morphology of the received cardiac electrical information.

Abstract: Systems and methods for calibrating an orientation of an implantable device in a patient is described. An exemplary system includes a calibration circuit that can receive acceleration information sensed from an implantable medical device (IMD) implanted in a patient, and receive reference acceleration information sensed from a reference device associated with the patient. The acceleration information and the reference acceleration information are acquired when the patient assumes a first posture or in a first position. The calibration circuit determines a spatial relationship between an orientation of the IMD and a reference orientation of the reference device using the received acceleration information and the received reference acceleration information, and calibrate subsequent acceleration information sensed from the IMD using the determined spatial relationship to correct for the orientation of the IMD.

Abstract: An apparatus comprises an arrhythmia detection circuit configured to: detect atrial arrhythmia in a first portion of a sensed cardiac signal using a first arrhythmia detection criteria, wherein the sensed cardiac signal is representative of cardiac activity of a subject; and upon detection of the atrial arrhythmia, analyze a second portion of the cardiac signal that is prior in time to the first portion using a second different arrhythmia detection criteria to detect the presence or absence of the atrial arrhythmia in the second portion of the cardiac signal.

Abstract: An example of a system for managing pain may include a pain monitoring circuit, a pain relief device, and a control circuit. The pain monitoring circuit may include a parameter analyzer and a pain score generator. The parameter analyzer may be configured to receive and analyze at least two parameters selected from a physiological parameter indicative of a physiological function or state of a patient, a functional parameter indicative of a physical activity or state of the patient, or a patient parameter including subjective information provided by the patient. The pain score generator may be configured to compute a composite pain score using an outcome of the analysis. The composite pain score may indicate a degree of the pain. The pain relief device may be configured to deliver a pain-relief therapy. The control circuit may be configured to control the delivery of the pain-relief therapy using the composite pain score.

Abstract: This document discusses, among other things, systems and methods to receive cardiac electrical information and premature ventricular contraction (PVC) information of a subject, detect atrial fibrillation (AF) of the subject using the received cardiac electrical information, and adjust AF detection using the received PVC information.

Abstract: This document discusses, among other things, systems and methods to detect an initial arrhythmia event indication and, after a threshold amount of detection window intervals detecting the initial arrhythmia event indication, adjust a set of arrhythmia parameters or at least one of a respective set of parameter thresholds to increase sensitivity of an extended arrhythmia event indication detection.

Abstract: Systems and methods for detecting atrial arrhythmias such as atrial tachyarrhythmia (AT) are described herein. An AT detection system may include a heart rate detector circuit configured to detect, from a physiological signal, representative ventricular heart rates within heart rate analysis windows. An atrial tachyarrhythmia detector circuit may perform an initial rate detection using a first ventricular heart rate statistic generated from the representative ventricular heart rates, and to perform a sustained arrhythmia detection using one or more second ventricular heart rate statistics generated within a second plurality of heart rate analysis windows during a specific duration. An AT event is detected if the second ventricular heart rate statistics satisfy a specific condition throughout the specific duration. The AT detection system may include an output unit that may output the detected AT to a user or a process.

Abstract: Systems and methods for managing machine-generated medical alerts associated with physiological events detected from one or more patients are described herein. An alert management system may receive medical events detected from a patient and physiological data associated with patient historical medical alerts. The system comprises an alert prioritizer circuit to generate an event priority indicator for the detected medical event, using a comparison between the detected medical event and the physiological data associated with patient historical medical alerts. The system can identify prolific alert patients using the information about the historical medical alerts. The alert prioritizer circuit can adjust a priority of the detected medical event, and an output circuit can present a priority to a user or a process using the event priority indicator and the identification of prolific alert patient.

Abstract: An example of a system for managing pain may include a pain monitoring circuit, a pain relief device, and a control circuit. The pain monitoring circuit may include a parameter analyzer and a pain score generator. The parameter analyzer may be configured to receive and analyze at least two parameters selected from a physiological parameter indicative of a physiological function or state of a patient, a functional parameter indicative of a physical activity or state of the patient, or a patient parameter including subjective information provided by the patient. The pain score generator may be configured to compute a composite pain score using an outcome of the analysis. The composite pain score may indicate a degree of the pain. The pain relief device may be configured to deliver a pain-relief therapy. The control circuit may be configured to control the delivery of the pain-relief therapy using the composite pain score.

Abstract: Systems and methods for detecting cardiac arrhythmias such as an atrial fibrillation (AF) are described herein. The AF detection system includes a sensor circuit to sense a physiological signal, a heartbeat processor to recognize a plurality of beat patterns using cycle length of two more consecutive cardiac cycles. The beat patterns can be indicative of temporal relationship between the consecutive cardiac cycles. The heartbeat processor may generate a repetitiveness indictor based on a statistical measurement of various beat patterns. The AF detection system includes an arrhythmia detector to detect an episode of AF based on the repetitiveness indictor, and to discriminate the AF from other arrhythmias of atrio-ventricular conduction abnormalities.

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 example of a system may include a sensing circuit and an atrial fibrillation (AF) detection circuit. The sensing circuit may be configured to sense a cardiac signal indicative of atrial and ventricular depolarizations. The AF detection circuit may be configured to detect AF using the cardiac signal and may include a detector and a detection enhancer. The detector may be configured to detect the ventricular depolarizations using the cardiac signal, to measure ventricular intervals each between two successively detected ventricular depolarizations, and to detect the AF using the ventricular intervals. The detection enhancer may include a respiratory sinus arrhythmia (RSA) detector configured to detect RSA using the cardiac signal and may be configured to verify each detection of the AF based on whether the RSA is detected.

Abstract: This document discusses, among other things, apparatus, systems, and methods to determine a first atrial fibrillation (AF) indication using received information about a heart over a first period, to cluster depolarization information about the heart over the first period, and to discriminate between an atrial fibrillation (AF) event and a non-AF event in the first period using the determined first AF indication the clustered depolarization information.

Abstract: An apparatus includes a sensing circuit configured to generate a sensed physiological signal that includes physiological information of a subject, a detection circuit, and a control circuit. The detection circuit detects a physiological condition of a subject using the physiological signal. The control circuit stores sampled values of a segment of the physiological signal in temporary memory storage; and stores the sampled values in non-temporary storage in response to receiving an indication of continued detection of the physiological condition.

Abstract: This document discusses, among other things, systems and methods to adjust arrhythmia detection using physiological information of a patient, including detecting a candidate cardiac event about a threshold, displaying the detected candidate cardiac event to a user, receiving user information about the detected candidate cardiac event, and adjusting an arrhythmia detection threshold based upon the received user information.

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.