Abstract: Methods and systems are directed to selecting from a variety of capture verification modes. A plurality of capture verification modes, including a beat by beat capture detection mode and a capture threshold testing mode without intervening beat by beat capture detection is provided. An efficacy of at least one of the capture verification modes is evaluated and, based on the evaluation, a capture verification mode is selected.

Abstract: Atrial capture threshold testing is performed in accordance with an atrial capture threshold testing schedule. Monitoring for retrograde P-waves occurs at least during times other than times during which scheduled atrial capture threshold testing is performed. In response to detecting a retrograde P-wave indicative of sub-threshold atrial pacing during monitoring, an unscheduled atrial capture threshold test is performed and pacing of the atrium is adjusted based on the unscheduled atrial capture threshold test.

Abstract: Atrial capture threshold testing is performed in accordance with an atrial capture threshold testing schedule. Monitoring for retrograde P-waves occurs at least during times other than times during which scheduled atrial capture threshold testing is performed. In response to detecting a retrograde P-wave indicative of sub-threshold atrial pacing during monitoring, an unscheduled atrial capture threshold test is performed and pacing of the atrium is adjusted based on the unscheduled atrial capture threshold test.

Abstract: Cardiac devices and methods provide adaptation of detection windows used to determine a cardiac response to pacing. Adapting a detection window involves sensing a cardiac signal indicative of a particular type of cardiac pacing response, and detecting a feature of the sensed cardiac signal. The cardiac response detection window associated with the type of cardiac pacing response is preferentially adjusted based on the location of the detected cardiac feature. Preferential adjustment of the detection window may involve determining a direction of change between the detection window and the detected feature. The detection window may be adapted more aggressively in a more preferred direction and less aggressively in a less preferred direction.

Abstract: This document discusses, among other things, systems and methods for automatic electrode integrity management. Interelectrode impedance is measured for various electrode combinations of an implantable cardiac function management device. The impedance data is processed, such as at an external remote server, to determine whether an electrode is failing or has failed, to select an alternate electrode configuration, to alert a physician or patient, to predict a time-to-failure such as by using population data, or to reprogram electrode configuration or other device parameters of the implantable cardiac function management device.

Abstract: This document discusses, among other things, systems and methods for automatic electrode integrity management. Interelectrode impedance is measured for various electrode combinations of an implantable cardiac function management device. The impedance data is processed, such as at an external remote server, to determine whether an electrode is failing or has failed, to select an alternate electrode configuration, to alert a physician or patient, to predict a time-to-failure such as by using population data, or to reprogram electrode configuration or other device parameters of the implantable cardiac function management device.

Abstract: Methods and systems for classifying cardiac responses to pacing stimulation and managing retrograde conduction and pacemaker mediated tachyarrhythmia are described. An atrial pacing pulse and a ventricular pacing pulse are delivered during a paced cardiac cycle. A post ventricular atrial refractory period (PVARP) is timed following the ventricular pacing pulse. The system determines if the atrial pacing pulse captures the atrium. An atrial depolarization occurring after the paced cardiac cycle is sensed. Retrograde management is initiated if the atrial pacing pulse did not capture the atrium and the atrial depolarization occurred during the PVARP. Pacemaker mediated tachyarrhythmia (PMT) is initiated if the atrial pacing pulse did not capture the atrium and the atrial depolarization did not occur during the PVARP.

Abstract: Methods and systems are directed to selecting from a variety of capture verification modes. A plurality of capture verification modes, including a beat by beat capture detection mode and a capture threshold testing mode without intervening beat by beat capture detection is provided. An efficacy of at least one of the capture verification modes is evaluated and, based on the evaluation, a capture verification mode is selected.

Abstract: Methods and systems are directed to selecting from a variety of capture verification modes. A plurality of capture verification modes, including a beat by beat capture detection mode and a capture threshold testing mode without intervening beat by beat capture detection is provided. An efficacy of at least one of the capture verification modes is evaluated and, based on the evaluation, a capture verification mode is selected.

Abstract: Atrial capture threshold testing is performed in accordance with an atrial capture threshold testing schedule. Monitoring for retrograde P-waves occurs at least during times other than times during which scheduled atrial capture threshold testing is performed. In response to detecting a retrograde P-wave indicative of sub-threshold atrial pacing during monitoring, an unscheduled atrial capture threshold test is performed and pacing of the atrium is adjusted based on the unscheduled atrial capture threshold test.

Abstract: Methods and systems for delivering a pacing pulse to an atrium during a cardiac cycle. A retrograde P-wave may be identified during the cardiac cycle, indicative of sub-threshold atrial pacing. Delivery of the pacing pulse to the atrium may be adjusted in a subsequent cardiac cycle in response to identifying the retrograde P-wave. Adjusting delivery of the pacing pulse may involve initiating an atrial capture threshold test, temporarily increasing one or both of the pacing pulse amplitude and pulse width, and/or re-evaluating one or both of the pacing pulse amplitude and pulse width. Adjusting delivery of the pacing pulse may also involve altering the timing of a scheduled atrial capture threshold test. During an atrial capture threshold test, a retrograde P-wave template may be generated in response to atrial non-capture sensed during the atrial capture threshold test, and used to identify subsequent retrograde P-waves.

Abstract: Methods and systems for performing capture threshold tests are described. During an initialization procedure a capture detection interval and capture detection threshold are determined based on peak values of cardiac signals sensed following the supracapture threshold initialization pulses. Following initialization, a plurality of pacing pulses to the atrium are delivered and the peak values of the cardiac signals sensed following each of the plurality of pacing pulses are determined. The peak values are compared to the pacing artifact threshold and the capture detection threshold. A timing of each of the peak values is compared to the capture detection interval. For each pacing pulse, discrimination between a captured response, a noncaptured response, and a fusion response is based on the peak value and timing comparisons.

Abstract: Methods and systems for classifying cardiac responses to pacing stimulation and managing retrograde conduction and pacemaker mediated tachyarrhythmia are described. An atrial pacing pulse and a ventricular pacing pulse are delivered during a paced cardiac cycle. A post ventricular atrial refractory period (PVARP) is timed following the ventricular pacing pulse. The system determines if the atrial pacing pulse captures the atrium. An atrial depolarization occurring after the paced cardiac cycle is sensed. Retrograde management is initiated if the atrial pacing pulse did not capture the atrium and the atrial depolarization occurred during the PVARP. Pacemaker mediated tachyarrhythmia (PMT) is initiated if the atrial pacing pulse did not capture the atrium and the atrial depolarization did not occur during the PVARP.

Abstract: This document discusses, among other things, systems and methods for automatic electrode integrity management. Interelectrode impedance is measured for various electrode combinations of an implantable cardiac function management device. The impedance data is processed, such as at an external remote server, to determine whether an electrode is failing or has failed, to select an alternate electrode configuration, to alert a physician or patient, to predict a time-to-failure such as by using population data, or to reprogram electrode configuration or other device parameters of the implantable cardiac function management device.