Abstract: Embodiments of the invention are related to managing noise in sensed signals in implantable medical devices, amongst other things. In an embodiment the invention includes a method for processing electrical signals obtained from a patient including gathering a first set of electrical signals using an implantable medical device, filtering to provide a second set of electrical signals, the second set including frequencies above a threshold frequency, and estimating the amount of noise present in the first set of electrical signals based on the magnitude of the second set. In an embodiment, the invention includes a medical device configured to gather a first set of electrical signals, filter the first set to provide a second set of electrical signals including frequencies above a threshold frequency, and estimate the amount of noise present in the first set based on the magnitude of the second set. Other embodiments are also included herein.

Abstract: A system or apparatus can provide electrostimulations via an electrode configuration that can be selected from multiple electrode configurations, the electrostimulations of the type for inducing a desired heart contraction, or a neurostimulation response. The system or apparatus can allow communicating with an external device to receive an input indicating a degree of patient discomfort with an electrostimulation delivered using a first electrode configuration, and can associate information about the degree of discomfort with information about the corresponding first electrode configuration for use by a controller circuit in determining a second electrode configuration for delivering a subsequent electrostimulation.

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 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: Approaches for rate initialization and overdrive pacing used during capture threshold testing are described. Cardiac cycles are detected and the cardiac events of a cardiac chamber that occur during the cardiac cycles are monitored. The number of intrinsic beats in the cardiac events is counted. Initialization for a capture threshold test involves maintaining a pre-test pacing rate for the capture threshold test if the number of intrinsic beats in the cardiac events is less than a threshold. The pacing rate is increased for the capture threshold test if the number of intrinsic beats in the cardiac events is greater than the threshold.

Abstract: A medical system including an implantable medical device having at least first and second bores, the first bore configured to receive a first lead, the first lead configured to deliver a first therapy, the second bore configured to receive a second lead, the second lead configured to deliver a second therapy, and a lead reversal detection circuit connected to the at least first and second bores, for detecting insertion of the first or second leads into the wrong bore.

Abstract: Approaches for rate initialization and overdrive pacing used during capture threshold testing are described. Cardiac cycles are detected and the cardiac events of a cardiac chamber that occur during the cardiac cycles are monitored. The number of intrinsic beats in the cardiac events is counted. Initialization for a capture threshold test involves maintaining a pre-test pacing rate for the capture threshold test if the number of intrinsic beats in the cardiac events is less than a threshold. The pacing rate is increased for the capture threshold test if the number of intrinsic beats in the cardiac events is greater than the threshold.

Abstract: Approaches for rate initialization and overdrive pacing used during capture threshold testing are described. Cardiac cycles are detected and the cardiac events of a cardiac chamber that occur during the cardiac cycles are monitored. The number of intrinsic beats in the cardiac events is counted. Initialization for a capture threshold test involves maintaining a pre-test pacing rate for the capture threshold test if the number of intrinsic beats in the cardiac events is less than a threshold. The pacing rate is increased for the capture threshold test if the number of intrinsic beats in the cardiac events is greater than the threshold.

Abstract: A medical system including an implantable medical device having at least first and second bores, the first bore configured to receive a first lead, the first lead configured to deliver a first therapy, the second bore configured to receive a second lead, the second lead configured to deliver a second therapy, and a lead reversal detection circuit connected to the at least first and second bores, for detecting insertion of the first or second leads into the wrong bore.

Abstract: A system or apparatus can provide electrostimulations via an electrode configuration that can be selected from multiple electrode configurations, the electrostimulations of the type for inducing a desired heart contraction, or a neurostimulation response. The system or apparatus can allow communicating with an external device to receive an input indicating a degree of patient discomfort with an electrostimulation delivered using a first electrode configuration, and can associate information about the degree of discomfort with information about the corresponding first electrode configuration for use by a controller circuit in determining a second electrode configuration for delivering a subsequent electrostimulation.

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 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 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: Approaches for adjusting the pacing energy delivered by a pacemaker are provided. Adjusting the pacing energy involves performing a plurality of capture threshold tests, each capture threshold test measuring a capture threshold of the heart. One or more measured captured thresholds are selected, including at least one capture threshold that is higher relative to other measured capture thresholds acquired by the plurality of capture threshold tests. The pacing energy is adjusted based on the one or more selected capture thresholds.

Abstract: Approaches for rate initialization and overdrive pacing used during capture threshold testing are described. Cardiac cycles are detected and the cardiac events of a cardiac chamber that occur during the cardiac cycles are monitored. The number of intrinsic beats in the cardiac events is counted. Initialization for a capture threshold test involves maintaining a pre-test pacing rate for the capture threshold test if the number of intrinsic beats in the cardiac events is less than a threshold. The pacing rate is increased for the capture threshold test if the number of intrinsic beats in the cardiac events is greater than the threshold.

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: Embodiments of the invention are related to managing noise in sensed signals in implantable medical devices, amongst other things. In an embodiment the invention includes a method for processing electrical signals obtained from a patient including gathering a first set of electrical signals using an implantable medical device, filtering to provide a second set of electrical signals, the second set including frequencies above a threshold frequency, and estimating the amount of noise present in the first set of electrical signals based on the magnitude of the second set. In an embodiment, the invention includes a medical device configured to gather a first set of electrical signals, filter the first set to provide a second set of electrical signals including frequencies above a threshold frequency, and estimate the amount of noise present in the first set based on the magnitude of the second set. Other embodiments are also included herein.

Abstract: Noncaptured atrial paces can result in long-short cardiac cycles which are proarrhythmic for ventricular tachyarrhythmia. Approaches are described which are directed to avoiding proarrhythmic long-short cycles. For cardiac cycles in which the atrial pace captures the atrium, a first post ventricular refractory period (PVARP) and a first A-A interval are used. For cardiac cycles in which the atrial pace does not capture the atrium, both an extended PVARP and an extended A-A interval are used. The A-A interval following a noncaptured atrial pace is extended from an atrial depolarization sensed during the extended PVARP.

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 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.