Abstract: The control module of a first pacemaker included in an implantable medical device system including the first pacemaker and a second pacemaker is configured to set a pacing escape interval in response to a far field pacing pulse sensed by the first pacemaker. The far field pacing pulse is a pacing pulse delivered by the second pacemaker. The pacing escape interval is allowed to continue without restarting the in response to a far field intrinsic event sensed by the first pacemaker during the pacing escape interval. The first pacemaker delivers a cardiac pacing pulse to the heart upon expiration of the pacing escape interval.

Abstract: The present invention provides an implantable medical device having at least two electrodes coupled to the device housing. The electrodes may be configured for sensing physiological signals such as cardiac signals and alternatively for providing an electrical stimulation therapy such as a pacing or defibrillation therapy. In accordance with aspects of the disclosure, the device housing provides a hermetic enclosure that includes a battery case hermetically coupled to a circuit assembly case. At least one of the at least two electrodes is coupled to an exterior surface of the battery case. The battery case is electrically insulated from the cathode and anode of the battery.

Abstract: An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train.

Abstract: In situations in which an implantable medical device (IMD) (e.g., an extravascular ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the IMD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the IMD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the IMD includes a pace pulse detector that detects, based on the processing of sensed electrical signals, delivery of a pacing pulse from a second implantable medical device and blank, based on the detection of the pacing pulse, the sensed electrical signal to remove the pacing pulse from the sensed electrical signal.

Abstract: In situations in which an implantable medical device (e.g., a subcutaneous ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the subcutaneous ICD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the ICD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the ICD includes a first pace pulse detector configured to obtain a sensed electrical signal and analyze the sensed electrical signal to detect a first type of pulses having a first set of characteristics and a second pace pulse detector configured to obtain the sensed electrical signal and analyze the sensed electrical signal to detect a second type of pulses having a second set of characteristics.

Abstract: Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous implantable cardioverter defibrillator (SICD) and a leadless pacing device (LPD) are described. For example, the SICD may detect a tachyarrhythmia within a first electrical signal from a heart and determine, based on the tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia. The LPD may receive communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart and determine, based on a second electrical signal from the heart sensed by the LPD, whether to deliver anti-tachycardia pacing (ATP) to the heart. In this manner, the SICD and LPD may communicate to coordinate ATP and/or cardioversion/defibrillation therapy. In another example, the LPD may be configured to deliver post-shock pacing after detecting delivery of anti-tachyarrhythmia shock therapy.

Abstract: A device for generating a plurality of output voltages from a single input energy supply source is described. The device includes a switched capacitor voltage converter that provides each of the output voltages having different supply ratios. The supply ratio is defined as a function of the input voltage provided to the switched capacitor voltage converter by the energy supply source. The switched capacitor voltage converter includes a plurality of capacitors selectively coupled to a plurality of switches that dynamically configure the capacitors into a plurality of stacked configurations. Switching between the plurality of stacked configurations may be controlled based on predetermined criteria.

Abstract: Various techniques are described for periodically performing a calibration routine to calibrate a low-power system clock within an implantable medical device (IMD) based on a high accuracy reference clock also included in the IMD. The system clock is powered continuously, and the reference clock is only powered on during the calibration routine. The techniques include determining a clock error of the system clock based on a difference between frequencies of the system clock and the reference clock over a fixed number of clock cycles, and adjusting a trim value of the system clock to compensate for the clock error. Calibrating the system clock with a delta-sigma loop, for example, reduces the clock error over time. This allows accurate adjustment of the system clock to compensate for errors due to trim resolution, circuit noise and temperature.

Abstract: Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous implantable cardioverter defibrillator (SICD) and a leadless pacing device (LPD) are described. For example, the SICD may detect a tachyarrhythmia within a first electrical signal from a heart and determine, based on the tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the detected arrhythmia. The LPD may receive communication from the SICD requesting the LPD deliver anti-tachycardia pacing to the heart and determine, based on a second electrical signal from the heart sensed by the LPD, whether to deliver anti-tachycardia pacing (ATP) to the heart. In this manner, the SICD and LPD may communicate to coordinate ATP and/or cardioversion/defibrillation therapy. In another example, the LPD may be configured to deliver post-shock pacing after detecting delivery of anti-tachyarrhythmia shock therapy.

Abstract: A method and apparatus for determining estimated remaining longevity for an implantable stimulator. The device employs pre-calculated numbers of days for various combinations conditions of device usage parameters to determine remaining device longevity based upon identified actual conditions of device usage and employs the determined longevity to change longevity indicator states in the device. While between longevity state changes, the device the identified conditions of device usage and adjusts the determined longevity if the conditions of use change significantly. The indicator states may correspond to one or more of Recommended Replacement Time (RRT), Elective Replacement Indicator (ERI) or End of Service (EOS).

Abstract: A device for generating a plurality of output voltages from a single input energy supply source is described. The device includes a switched capacitor voltage converter that provides each of the output voltages having different supply ratios. The supply ratio is defined as a function of the input voltage provided to the switched capacitor voltage converter by the energy supply source. The switched capacitor voltage converter includes a plurality of capacitors selectively coupled to a plurality of switches that dynamically configure the capacitors into a plurality of stacked configurations. Switching between the plurality of stacked configurations may be controlled based on predetermined criteria.

Abstract: The present invention provides an implantable medical device having at least two electrodes coupled to the device housing. The electrodes may be configured for sensing physiological signals such as cardiac signals and alternatively for providing an electrical stimulation therapy such as a pacing or defibrillation therapy. In accordance with aspects of the disclosure, the device housing provides a hermetic enclosure that includes a first housing section that is hermetically coupled to a second housing section. At least one of the at least two electrodes is coupled to an exterior surface of the first housing section that encloses the battery components of the device. The first housing section is electrically insulated from the cathode and anode of the battery.

Abstract: The present invention provides an implantable medical device having at least two electrodes coupled to the device housing. The electrodes may be configured for sensing physiological signals such as cardiac signals and alternatively for providing an electrical stimulation therapy such as a pacing or defibrillation therapy. In accordance with aspects of the disclosure, the device housing provides a hermetic enclosure that includes a battery case hermetically coupled to a circuit assembly case. At least one of the at least two electrodes is coupled to an exterior surface of the battery case. The battery case is electrically insulated from the cathode and anode of the battery.

Abstract: A method of generating at least one recommended replacement time signal for a battery is provided. The method includes measuring a plurality of associated unloaded and loaded battery voltages. A delta voltage for each associated unloaded and loaded battery voltage is then determined. A select number of delta voltages are averaged. A minimum delta voltage is determined from a plurality of the averaged delta voltages. At least one recommended replacement time signal for the battery is generated with the use of the minimum delta voltage when at least one averaged delta voltage is detected that has at least reached a replacement threshold.

Abstract: The present invention provides an implantable medical device having at least two electrodes coupled to the device housing. The electrodes may be configured for sensing physiological signals such as cardiac signals and alternatively for providing an electrical stimulation therapy such as a pacing or defibrillation therapy. In accordance with aspects of the disclosure, the device housing provides a hermetic enclosure that includes a first housing section that is hermetically coupled to a second housing section. At least one of the at least two electrodes is coupled to an exterior surface of the first housing section that encloses the battery components of the device. The first housing section is electrically insulated from the cathode and anode of the battery.

Abstract: Various techniques are described for periodically performing a calibration routine to calibrate a low-power system clock within an implantable medical device (IMD) based on a high accuracy reference clock also included in the IMD. The system clock is powered continuously, and the reference clock is only powered on during the calibration routine. The techniques include determining a clock error of the system clock based on a difference between frequencies of the system clock and the reference clock over a fixed number of clock cycles, and adjusting a trim value of the system clock to compensate for the clock error. Calibrating the system clock with a delta-sigma loop, for example, reduces the clock error over time. This allows accurate adjustment of the system clock to compensate for errors due to trim resolution, circuit noise and temperature.

Abstract: Techniques are disclosed for generating a plurality of output voltages from a single input power source. The techniques include implementing a switched capacitor voltage converter to provide at least two output voltages having different supply ratios. The supply ratio is defined as a function of the input voltage provided to the switched capacitor voltage converter by the power source. The switched capacitor voltage converter includes a plurality of capacitors selectively coupled to a plurality of switches to define at least a first and a second mode with each of the modes having a plurality of configurations. In accordance with aspects of the disclosure, the techniques include coupling the plurality of capacitors to define the first or second mode based on predetermined criteria.

Abstract: A device for generating a plurality of output voltages from a single input energy supply source is described. The device includes a switched capacitor voltage converter that provides each of the output voltages having different supply ratios. The supply ratio is defined as a function of the input voltage provided to the switched capacitor voltage converter by the energy supply source. The switched capacitor voltage converter includes a plurality of capacitors selectively coupled to a plurality of switches that dynamically configure the capacitors into a plurality of stacked configurations. Switching between the plurality of stacked configurations may be controlled based on predetermined criteria.

Abstract: Apparatus and methods configured to perform power regulation for an implantable device are presented. In an aspect, an implantable device can include a substrate that forms at least part of a body of the implantable device and a circuit disposed on or within the substrate. The circuit can include a high load power regulator configured to provide a first current level to components of the implantable device and a low load power regulator configured to provide a second current level to components of the implantable device, wherein the second current level is lower that the first current level. The circuit can also include a regulator switch configured to enable or disable current draw from the high load power regulator and the low load power regulator as a function of power state and associated power requirement of the components of the implantable device.

Abstract: Various techniques are described for periodically performing a calibration routine to calibrate a low-power system clock within an implantable medical device (IMD) based on a high accuracy reference clock also included in the IMD. The system clock is powered continuously, and the reference clock is only powered on during the calibration routine. The techniques include determining a clock error of the system clock based on a difference between frequencies of the system clock and the reference clock over a fixed number of clock cycles, and adjusting a trim value of the system clock to compensate for the clock error. Calibrating the system clock with a delta-sigma loop, for example, reduces the clock error over time. This allows accurate adjustment of the system clock to compensate for errors due to trim resolution, circuit noise and temperature.