Abstract: An implantable cardiac stimulation device, such as a pacemaker or Implantable Cardioverter Defibrillator, is configured to automatically monitor the effects of antiarrhythmic drugs on cardiac electrical signals within a patient to verify the efficacy of the drugs taken. In one example, an analysis of patient cardiac electrical signals is performed by comparing the cardiac electrical signals with values representative of the effects of different classes of antiarrhythmic drugs. If the implantable device determines that the prescribed antiarrhythmic drugs have not been effective, a warning signal is generated. The warning signal is conveyed directly to the patient via a bedside monitor and to the patient's physician via remote connection to an external programmer device so that both are notified of the drug efficacy problems.

Abstract: A combined programming wand and PSA for physician programmers. A programmer/PSA wand can be connected to known programmers and PSA application software can be installed on the programmer to provide a system with the functionality of a PSA and a programmer in a single piece of clinical equipment. The programmer/PSA wand includes electronics to sense, pace, and shock to facilitate evaluation of indwelling leads during implantation of the implantable device and leads to facilitate programming of the device. The system includes one or more displays and control inputs that can provide information to a clinician at a single point that is typically provided with separate programmer and PSA equipment. The system provides increased efficiency, reduced opportunities for errors and/or equipment malfunction, and integrated data collection.

Abstract: An implantable cardiac device and method provides for monitoring a progression or regression in heart disease during an extended time period. A sensor generates an electrogram signal representing electrical activity of a patient's heart. From the generated electrogram signal, a processor determines morphology measurements wherein the morphology measurements indicate a progression or regression in the heart disease. The morphology measurements are stored in a memory during the extended period of time. A telemetry circuit transmits the stored morphology measurements to an external receiver for retrieval or display. The morphology measurements may be of electrogram intrinsic activity or evoked response activity characteristics.

Abstract: An implantable cardiac stimulation device provides therapy for hearts having severe conduction abnormalities such as hearts suffering from congestive heart failure. The implantable cardiac stimulation device includes a pulse generator that provides pacing pulses having energies greater than about 0.1 millijoules and a lead system including a far-field electrode configuration that applies the pacing pulses to the heart. The lead system may further provide a near-field pacing electrode configuration and the device switches between the near-field pacing electrode configuration and the far-field pacing electrode configuration responsive to the measurement of a hemodynamic parameter such as QRS width.

Abstract: An implantable cardiac stimulation device is described wherein a controller of the cardiac stimulation device controls selected functions of the device based on whether the patient is at rest and further based on whether the patient is prone to vagally-mediated arrhythmias. Functions of the device that may be controlled include, for example, a pacing base rate, an AV/PV delay, and a refractory period as well as overdrive pacing parameters and diagnostic data gathering parameters. In one example, if the patient is not prone to vagally-mediated arrhythmias, the base rate is lowered while the patient is at rest. Also, overdrive pacing parameters are set to be less aggressive. As such, the operation of the cardiac stimulation device is controlled to make it easier for the patient to rest while also reducing power consumption. However, if the patient is prone to vagally-mediated arrhythmias, the base rate is not lowered while the patient is at rest.

Abstract: An implantable cardiac stimulation device is described wherein a controller of the cardiac stimulation device controls selected functions of the device based on whether the patient is at rest and further based on whether the patient is prone to vagally-mediated arrhythmias. Functions of the device that may be controlled include, for example, a pacing base rate, an AV/PV delay, and a refractory period as well as overdrive pacing parameters and diagnostic data gathering parameters. In one example, if the patient is not prone to vagally-mediated arrhythmias, the base rate is lowered while the patient is at rest. Also, overdrive pacing parameters are set to be less aggressive. As such, the operation of the cardiac stimulation device is controlled to make it easier for the patient to rest while also reducing power consumption. However, if the patient is prone to vagally-mediated arrhythmias, the base rate is not lowered while the patient is at rest.

Abstract: An exemplary method includes delivering a maintenance therapy that aims to prevent occurrence of apnea, sensing information, based at least in part on the information, determining if apnea exists and, if apnea exists, delivering a termination therapy that aims to terminate the apnea. An exemplary implantable device includes an input for information pertaining to respiration and control logic to call for overdrive pacing at a first rate that aims to minimize occurrence of a respiratory condition, to analyze the information for occurrence of the respiratory condition and, upon occurrence of the respiratory condition, to call for overdrive pacing at a higher rate. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: The optimal location for delivering pacing pulses to a given cardiac chamber (such as the left ventricle) is determined by identifying the last electrically or mechanically activated site within the chamber. For example, the last site within the left ventricular myocardium to depolarize during an intrinsic ventricular contraction triggered by an initial atrial depolarization is identified as being the optimal pacing location for the left ventricle. A pacing electrode is then implanted as close as possible to that location. The technique is particularly effective for use in identifying optimal epicardial pacing locations for mounting satellite pacing devices for use in delivering cardiac resynchronization therapy. However, the techniques may also be applied to identify locations for mounting endocardial electrodes as well. Capture thresholds may also be taken into account in determining the optimal location.

Abstract: Dynamic overdrive pacing adjustment techniques are described for use in implantable cardiac stimulation devices. In a first technique, an overdrive pacing unit of a microcontroller of the implantable device operates to optimize various control parameters that affect overdrive pacing so as to achieve a desired degree of overdrive pacing for the particular patient in which the stimulation device is implanted. Parameters to be optimized include the number of overdrive beats paced once overdrive pacing is trigged, the overdrive pacing response function, the recovery rate, and various base rates. The control parameters are adjusted in a hierarchical order of priority until the desired degree of overdrive pacing is achieved. Adjustment of the number of overdrive beats, the recovery rate, and various base rates is iteratively performed by using incremental numerical adjustments.

Abstract: A cardiac stimulation device uses dynamic overdrive pacing to prevent sleep apnea. In another aspect, the device can use dynamic overdrive pacing to terminate sleep apnea after detection. An implantable cardiac stimulation device comprises a sensor and one or more pulse generators. The sensor senses intrinsic cardiac electrical phenomena. The pulse generators can generate cardiac pacing pulses with timing based on the sensed intrinsic cardiac electrical phenomena to dynamically overdrive the intrinsic cardiac electrical phenomena. The timed cardiac pacing pulses can prevent a sleep apnea condition.

Abstract: An implantable cardiac device and method provides for monitoring a progression or regression in heart disease during an extended time period. A sensor generates an electrogram signal representing electrical activity of a patient's heart. From the generated electrogram signal, a processor determines morphology measurements wherein the morphology measurements indicate a progression or regression in the heart disease. The morphology measurements are stored in a memory during the extended period of time. A telemetry circuit transmits the stored morphology measurements to an external receiver for retrieval or display. The morphology measurements may be of electrogram intrinsic activity or evoked response activity characteristics.

Abstract: An implantable cardiac stimulation device, such as a pacemaker or Implantable Cardioverter Defibrillator, is configured to automatically monitor the effects of antiarrhythmic drugs on cardiac electrical signals within a patient to verify the efficacy of the drugs taken. In one example, an analysis of patient cardiac electrical signals is performed by comparing the cardiac electrical signals with values representative of the effects of different classes of antiarrhythmic drugs. If the implantable device determines that the prescribed antiarrhythmic drugs have not been effective, a warning signal is generated. The warning signal is conveyed directly to the patient via a bedside monitor and to the patient's physician via remote connection to an external programmer device so that both are notified of the drug efficacy problems.

Abstract: A pacemaker or other cardiac stimulation device is configured to predict the onset of vasovagal syncope and administers pacing therapy to prevent the syncope from occurring. Prediction of the onset of vasovagal syncope is based upon an analysis of the contractility of the heart muscle. In an example described herein, the contractility of the heart muscle is detected and compared with the average contractility. If the current contractility exceeds the average contractility by a predetermined threshold, a high risk of vasovagal syncope is thereby detected and the heart is paced at a vasovagal syncope prevention rate which may be, for example, 20 to 40 beats per minute faster than a previous heart rate. The contractility of the heart is determined, for example, by measuring the impedance of the heart tissue, by measuring the movement of heart tissue in the wall of the heart, by pressure using an accelerometer, or based on an electrogram signal.

Abstract: An implantable cardiac stimulation system senses electrical activity of all four chambers of the heart and delivers pacing and defibrillation pulses to all four chambers of the heart. The system includes a lead system consisting of first and second leads. The first lead includes a right ventricular pacing electrode, a right ventricular defibrillation electrode, and a right atrial defibrillation lead. The second lead is implantable in the coronary sinus of the heart and includes a left ventricular pacing electrode, a left ventricular defibrillation electrode, a left atrial pacing electrode, and a left atrial defibrillation electrode. A right atrial pacing electrode is carried by one of the first and second leads.

Abstract: An implantable multi-chamber cardiac stimulation device and method are provided for accurately sensing cardiac activity from three or four heart chambers using passive sensing electrodes placed in each heart chamber. Multiple intra-chamber or inter-chamber sensing vectors are established between passive sensing electrodes. Sampled sensing vector signals are processed such that a cardiac depolarization may be accurately detected, as well as its origin and direction of propagation. Time intervals between detected depolarization signals may be used to determine conduction time or heart rate. Diagnostic indicators of heart failure condition normally obtained from a 12-lead surface ECG study, such as P-wave or R-wave duration, may also be determined from the sensing vectors. Based on precise and detailed evaluation of sensing vector signals, stimulation therapy may be provided immediately upon a detected change in heart rhythm or heart failure condition.

Abstract: A system and method for treatment of paroxysmal atrial fibrillation by destruction of conductive pathways between the pulmonary veins and the left atrium. A stent is delivered by catheter to the left atrium and to the ostium of a pulmonary vein to be treated. The stent is positioned in the pulmonary vein and is deployed to engage and support the pulmonary vein. The stent prevents stenosis of the pulmonary vein as a result of ablation of tissue. The ablation is produced by a coating of a biologically active material on the stent which destroys tissue or slows electrophyisiologic conduction through the tissue. Alternatively, ablation is performed using RF energy, cryoablation, laser energy, or other ablation techniques.

Abstract: A three lead implantable cardiac stimulation system is capable of delivering stimulation pulses to any one chamber or combination of chambers of a heart. The system includes a first lead for implant in the right ventricle and having a right ventricular defibrillation electrode, a second lead for implant in the coronary sinus and having a left ventricular defibrillation electrode, and a third lead for implant in the coronary sinus and having a left atrial defibrillation electrode. One of the leads further including a right atrial defibrillation electrode for placement in one of the right atrium and superior vena cava. The system further includes an implantable cardiac stimulation device including a programmable pulse generator that delivers defibrillation pulses to any one of the defibrillation electrodes or to any combination of the defibrillation electrodes.

Abstract: An implantable cardiac stimulation system including a single atrial dedicated lead provides sensing electrical activity of and delivering stimulation pulses to the right and left atria of the heart. The single lead is implantable in the coronary sinus of the heart and includes a distal left atrial pacing electrode, and a right atrial pacing electrode. The electrodes are spaced apart on the lead so that when the left atrial pacing electrode is in electrical contact with and adjacent the left atrium within the coronary sinus, the right atrial pacing electrode is in electrical contact with the right atrium and adjacent to the ostium of the coronary sinus within the coronary sinus. The system further includes an implantable cardiac stimulation device including a pulse generator and a sensing circuit that is coupled to the left and right pacing electrodes. They may further include one or more defibrillation coil electrodes.

Abstract: An implantable cardiac device detects a progression or regression in heart disease such as congestive heart failure. An activity sensor and a respiration sensor generate raw signals indicative of the patient's activity level and respiration level. Degradation or improvement of the patient's activity and respiration over a predetermined time corresponds to an indication of the progression or regression of the heart disease. A processor coupled to the sensors is programmed to process the raw sensor signals over the predetermined time and stores the processed sensor signals in a memory having a data storage area. A telemetry circuit coupled to the memory is configured to transmit the stored sensor signals to an external monitor for subsequent display. The processor further controls pacing of the heart, adjusts pacing therapy responsive to the process signals, and process the raw respiration signals when the patient is in a number of different active states.

Abstract: An implantable cardiac stimulation system and lead is capable of sensing electrical activity of the right and left heart and delivering stimulation pulses to the right and left heart. The system includes a single cardiac lead including a left ventricular pacing electrode, a left ventricular defibrillation electrode, a left atrial pacing electrode, a left atrial defibrillation electrode, and a right atrial pacing electrode. The system further includes a cardiac stimulation device including a pulse generator for delivering pacing pulses to any combination of the pacing electrodes, delivering defibrillation pulses to any combination of the defibrillation electrodes, and sensing electrical activity with any combination of the pacing electrodes. The lead is implantable in the coronary sinus of the heart and may further include a right atrial defibrillation coil electrode.