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: 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: An apparatus includes a sensing circuit configured to generate a sensed physiological signal representative of cardiac activity of a subject, and an arrhythmia detection circuit. The arrhythmia detection circuit is configured to monitor information corresponding to ventricular depolarization (V-V) intervals using the sensed physiological signal; determine a V-V interval distribution; determine a heart rate density index (HRDI) as a portion of samples of the V-V interval distribution corresponding to a V-V interval occurring most often in the distribution; and generate an indication of atrial fibrillation (AF) using the HRDI.

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 cardiac signal sensing circuit configured to sense a plurality of intrinsic cardiac signals using a plurality of cardiac pacing sites, a heart sound sensing circuit, a stimulus circuit configured to provide an electrical cardiac pacing stimulus to the plurality of pacing sites, and a control circuit electrically coupled to the cardiac signal sensing circuit and the stimulus circuit. The control circuit includes a pacing site locating circuit configured to generate an indication of a preferred pacing site as one of a) a subset of the respective cardiac pacing sites selected using the intrinsic ventricular activation time interval, from which subset the preferred pacing site is selected using the heart sound characteristic; or b) a subset of the respective cardiac pacing sites selected using the heart sound characteristic, from which subset the preferred pacing site is selected using the ventricular activation time interval.

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: 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: 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: An example of a pain management system may include a heart sound sensor, a heart sound sensing circuit, a heart sound detector, a parameter generator, and a pain analyzer. The heart sound sensor may be configured to sense a heart sound signal. The heart sound sensing circuit may be configured to process the heart sound signal. The heart sound detector may be configured to detect heart sounds using the processed heart sound signal. The parameter generator may be configured to generate parameter(s) using the detected heart sounds. The pain analyzer may be configured to analyze the parameter(s) for a quantitative indication of pain, and include a signal metric generator that may be configured to generate a signal metric using the one or more parameters and a pain score generator that may be configured to generate a pain score indicative of a degree of pain using the signal metric.

Abstract: An apparatus includes a cardiac signal sensing circuit configured to generate a sensed cardiac signal representative of electrical cardiac activity of a subject, a buffer memory and a pause detection circuit. The pause detection circuit is configured to: identify ventricular depolarization in the cardiac signal or the sampled cardiac signal; detect a candidate pause episode using the cardiac signal in which delay in ventricular depolarization exceeds a specified delay threshold; identify noise events in a stored cardiac signal; and discard the cardiac signal of the candidate pause episode when a number of noise events satisfies a specified noise event number threshold, otherwise store the cardiac signal of the candidate pause episode as a bradycardia pause episode.

Abstract: Embodiments of the invention are related to medical systems and methods that can be used to control features of implanted medical devices, amongst other things. In an embodiment, the invention includes a medical system including an external medical device. The external medical device including a video output and a processor in communication with the video output. The system can be configured to display information through the video output as a graph, the graph comprising data representing pacing rates of an implantable device as a function of activity level over time. The system can further be configured to accept user input through direct manipulation of the graph. Other embodiments are also included herein.

Abstract: Systems and methods for multi-site cardiac stimulation are disclosed. The system includes an electrostimulation circuit to deliver electrostimulation to one or more candidate sites of at least one heart chamber. The system may sense a physiological signal including during electrostimulation of the heart, use the physiological signal to determine a first stimulation vector for electrostimulation at a first left ventricular (LV) site and a second stimulation vector for electrostimulation at a different second LV site, and determine a therapy mode including a first chronological order and a first timing offset between stimulations delivered according to the first and second stimulation vectors. The electrostimulation circuit may deliver electrostimulation to the heart in accordance with the first and second stimulation vectors and the therapy mode.

Abstract: A system for monitoring a subject for an arrhythmia includes an external monitoring device (EMD) configured to be disposed outside of a subject's body. The EMD includes a first communication component configured to receive, from a medical device, a first physiological parameter signal and an indication of a detected trigger event associated with a first portion of the first physiological parameter signal. The trigger event is indicative of a potential arrhythmia. The EMD also includes an analysis component configured to (1) identify a second portion of the first physiological parameter signal, where the second portion satisfies a discard criterion, (2) discard the second portion, and (3) perform an arrhythmia confirmation evaluation using a third portion of the first physiological parameter signal.

Abstract: Systems and methods for detecting an arrhythmic event and storing physiological information associated with the detected arrhythmic event are described. A system may include a first detector to detect an arrhythmic event from a physiological signal sensed from a subject, and generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event. If the confidence indicator indicates a relatively high confidence of arrhythmia detection, the system may provide the detected arrhythmic event to a first process for storing the detected arrhythmic event or generating an alert. If the confidence indicator indicates a relatively low confidence of arrhythmia detection, the system may provide the detected arrhythmic event to at least a second process including confirming or rejecting the detected arrhythmic event.

Abstract: Implanted medical device data is received, where the data was sensed by a first lead portion and a sensor over a time period. The number of detected noise events sensed by the first lead portion is counted based on applying first noise detection criteria to the data sensed by the first lead portion. The number of detected noise events over the sensor is counted based on applying second noise detection criteria to the data sensed by the sensor. The mean number of detected noise events is calculated for the first lead portion and sensor based on the number of noise events sensed by the first lead portion and the number of noise events sensed by the sensor. Potential lead failure in the first lead is recorded if the number of detected noise events over the first lead is greater than the mean number of noise events by at least 5%.

Abstract: An apparatus comprises a cardiac signal sensing circuit configured to sense a plurality of intrinsic cardiac signals using a plurality of cardiac pacing sites, a heart sound sensing circuit, a stimulus circuit configured to provide an electrical cardiac pacing stimulus to the plurality of pacing sites, and a control circuit electrically coupled to the cardiac signal sensing circuit and the stimulus circuit. The control circuit includes a pacing site locating circuit configured to generate an indication of a preferred pacing site as one of a) a subset of the respective cardiac pacing sites selected using the intrinsic ventricular activation time interval value, from which subset the preferred pacing site is selected using the heart sound characteristic value; or b) a subset of the respective cardiac pacing sites selected using the heart sound characteristic value, from which subset the preferred pacing site is selected using the ventricular activation time interval value.

Abstract: Embodiments of the disclosure include systems and methods for reducing false positives in detection of pauses. For example, embodiments include a sensing component configured to obtain values of a first physiological parameter and determine a cardiac pause based on the values of the first physiological parameter. Furthermore, embodiments include performing a validation check of the determined cardiac pause using at least one of: the values of the first physiological parameter or values of a second physiological parameter.

Abstract: Systems and methods for detecting a target physiologic event and storing physiologic information associated with the detected physiologic event are disclosed. A system can receive a physiologic signal obtained from a subject, and detect the target physiologic event using a first portion of the received physiologic signal. The system can confirm the target physiologic event using a second portion of the received physiologic signal. If the target physiologic event is confirmed, the system can store physiologic information associated with the confirmed target physiologic event in a memory.

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: An apparatus comprises an implantable cardiac signal sensing circuit configured to provide a sensed depolarization signal from a ventricle and a processor. The processor includes a signal analyzer module and a tachyarrhythmia discrimination module. The signal analyzer module is configured to determine a measure of stability of ventricular (V-V) depolarization intervals using the depolarization signal, and determine a rate of change of the measure of stability. The tachyarrhythmia discrimination module is configured to detect an episode of tachyarrhythmia using the depolarization signal, determine whether the detected tachyarrhythmia is indicative of atrial tachyarrhythmia using the determined rate of change, and provide the determination to a user or process.