Abstract: Disclosed herein is a disposable enclosure for use with a trial neurostimulation device configured to electrically couple with a neurostimulation lead for implant within a patient. The trial neurostimulation device includes a pulse generator portion. The disposable enclosure includes a first wall structure, a second wall structure opposite the first wall structure, a volume between the first and second wall structures, and a header. The volume is configured to receive therein the pulse generator portion. The header is configured to electrically couple with the neurostimulation lead. The header is supported in the disposable enclosure adjacent the volume and configured to electrically couple with the pulse generator portion when the pulse generator portion is located in the volume.

Abstract: Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead and a right ventricular (RV) lead for identifying suitable pacing vectors. In one example, RV-LV delay times are measured while using different electrodes of the LV lead as cathodes for sensing. The LV electrode having the longest RV-LV delay time is identified and LV capture thresholds and diaphragmatic stimulation thresholds are measured for pacing vectors that employ that LV electrode as a cathode. Assuming at least one vector employing the selected LV electrode is found to have acceptable thresholds, the vector is selected for use in delivering pacing therapy with the selected LV electrode. If none of the pacing vectors employing the selected LV electrode has acceptable thresholds, another LV electrode is selected and the procedure is repeated. Examples with a multi-pole RV lead are also described.

Abstract: Systems and methods are provided for initiating a bi-directional communication link with an implantable medical device. The systems and methods configure an implantable medical device (IMD) to detect activation fields from a triggering device when the triggering device is positioned proximate to the IMD, and to identify a field characterization of the activation field. The systems and methods further configure the IMD to establish a bi-directional communication link with an external device through a select communication initialization mode form a plurality of communication initialization modes defined by a wireless protocol in response to the field characterization of the activation field.

Abstract: Disclosed herein is a disposable enclosure for use with a trial neurostimulation device configured to electrically couple with a neurostimulation lead for implant within a patient. The trial neurostimulation device includes a pulse generator portion. The disposable enclosure includes a first wall structure, a second wall structure opposite the first wall structure, a volume between the first and second wall structures, and a header. The volume is configured to receive therein the pulse generator portion. The header is configured to electrically couple with the neurostimulation lead. The header is supported in the disposable enclosure adjacent the volume and configured to electrically couple with the pulse generator portion when the pulse generator portion is located in the volume.

Abstract: A protective patch or bandage is provided for use with an implantable trial neurostimulation lead for implant within a patient. In one example, the lead is routed through the patch to a trial neurostimulation generator. In another example, the patch includes an internal electrical connector for connecting the trial neurostimulation lead to a connection line from the trial neurostimulation generator. In either case, the patch is sealed over an implant site to protect and hygienically isolate the site. A central chamber of the patch is provided to hold medical gauze and to further hold a coiled portion of the neurostimulation lead. In some examples, the patient can shower while wearing the protective patch.

Abstract: Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described.

Abstract: Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

Abstract: Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead and a right ventricular (RV) lead for identifying suitable pacing vectors. In one example, RV-LV delay times are measured while using different electrodes of the LV lead as cathodes for sensing. The LV electrode having the longest RV-LV delay time is identified and LV capture thresholds and diaphragmatic stimulation thresholds are measured for pacing vectors that employ that LV electrode as a cathode. Assuming at least one vector employing the selected LV electrode is found to have acceptable thresholds, the vector is selected for use in delivering pacing therapy with the selected LV electrode. If none of the pacing vectors employing the selected LV electrode has acceptable thresholds, another LV electrode is selected and the procedure is repeated. Examples with a multi-pole RV lead are also described.

Abstract: Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described.

Abstract: Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to single-site LV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish organized atrial tachycardias (such as atrial flutter) from sinus tachycardia.

Abstract: Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. Sequential MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, sequential MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to either single-site LV pacing or simultaneous MSLV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish OATs (such as atrial flutter) from sinus tachycardia.

Abstract: Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

Abstract: Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to single-site LV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish organized atrial tachycardias (such as atrial flutter) from sinus tachycardia.

Abstract: Systems and methods are provided for use by implantable medical devices equipped to deliver multi-site left ventricular (MSLV) pacing. Sequential MSLV is associated with a relatively long post-ventricular atrial blanking (PVAB) period that might limit the detection of pathologic rapid organized atrial tachycardias (OAT). In one example, sequential MSLV cardiac resynchronization therapy (CRT) pacing is delivered within a tracking mode. A possible atrial tachycardia is detected based on the atrial rate exceeding an atrial tachycardia assessment rate (ATAR) threshold. The device then switches to either single-site LV pacing or simultaneous MSLV pacing, thereby effectively shortening the PVAB to detect additional atrial events that might otherwise be obscured, and thereby permitting the device to more reliably distinguish OATs (such as atrial flutter) from sinus tachycardia.

Abstract: An exemplary method includes delivering a pacing pulse to a heart, acquiring a cardiac electrogram, comparing the cardiac electrogram to a template and, based on the comparing, deciding if the pacing pulse caused an evoked response. In such a method, the comparing may compare morphology of the cardiac electrogram to the template. Other exemplary methods, devices, systems, etc., are also disclosed.