Abstract: Systems and methods for resolving catheter rendering issues are provided. A system includes a catheter including a plurality of electrodes and a plurality of catheter pins, each catheter pin corresponding to an associated electrode. The system further includes a mapping system communicatively coupled to the catheter, the mapping system including a pin box including a plurality of sockets, a display device configured to render the catheter, and an electronic control unit (ECU). The ECU is configured to determine that the catheter is being rendered incorrectly on the display device, determine a number of electrodes that are being rendered incorrectly on the display device, identify at least one particular electrode of the plurality of electrodes that is being rendered incorrectly on the display device, and attempt to resolve the incorrect rendering of the catheter based on the determined number of electrodes and the at least one particular electrode.

Abstract: Methods and systems for dynamically modifying pacing timing and backup pacing delivery in cardiac stimulation devices include applying pacing impulses, measuring corresponding responses, and, based on such responses, automatically modifying timing or operational settings of the stimulation device to improve pacing functionality. Among other things, the approaches described herein reduce unnecessary backup pacing impulses in HIS bundle pacing applications, facilitate fusion in bundle branch block applications, and automatically enable or disable backup pacing in response to achieving QRS complex correction.

Abstract: Methods and systems are provided herein and include an HIS electrode configured to be located proximate to a HIS bundle and to at least partially define a HIS sensing channel. The system includes memory to store cardiac activity (CA) signals obtained over the HIS sensing channel, the memory to store program instructions; and one or more processors that, when executing the program instructions, are configured for utilizing an atrial oversensing (AO) process to analyze the CA signals, obtained over the HIS sensing channel during an AO avoidance (AOA) window, for an atrial activity (AA) component to identify AA beats. The system applies a consistency criteria to the AA beats to determine a number of the AA beats that are indicative of consistent AO. Based on the consistency criteria and the number of AA beats indicative of consistent AO, the system performs at least one of adjusting an AO parameter utilized by the AO process or disabling the AO process and manages HIS bundle pacing based on a ventricular event.

Abstract: Systems and methods for His bundle pacing and classifying response to pacing impulses include applying, using a pulse generator, an impulse through a stimulating electrode to induce a response from a patient heart. A response to the impulse is measured using at least one sensing electrode and frequency characteristics of the response are analyzed to determine whether His bundle capture has occurred and, if so, what type of capture has occurred. To facilitate analysis, the response measured from the patient heart may also be filtered to pass or stop frequencies indicative of certain capture types.

Abstract: Systems and methods for His bundle pacing and classifying response to pacing impulses include applying, using a pulse generator, an impulse through a stimulating electrode to induce a response from a patient heart. A response to the impulse is measured using at least one sensing electrode and time-domain based characteristics of the response are analyzed to determine whether His bundle capture has occurred and, if so, what type of capture has occurred.

Abstract: Cardiac activation wavefronts can be computed as one or more stream paths or stream lines from electrophysiological data collected by a multi-electrode catheter. In embodiments of the disclosure, the stream path or stream line is computed by identifying a first activating bipole from amongst the electrodes and then iteratively identifying successively later-activating, neighboring bipoles. The process can be repeated for additional bipoles and/or additional locations of the multi-electrode catheter within the subject's heart. In additional embodiments of the disclosure, stream paths or stream lines are computed from a conduction velocity vector field or mesh, distributed over a cardiac geometry, by identifying the path of one or more seed points through the conduction velocity vector field. The stream paths and/or stream lines can be graphically output, such as on a three-dimensional cardiac geometry model.

Abstract: Computer implemented methods, devices and systems for monitoring a trend in heart failure (HF) progression are provided. The method comprises sensing left ventricular (LV) activation events at multiple LV sensing sites along a multi-electrode LV lead. The activation events are generated in response to an intrinsic or paced ventricular event. The method implements program instructions on one or more processors for automatically determining a conduction pattern (CP) across the LV sensing sites based on the LV activation events, identifying morphologies (MP) for cardiac signals associated with the LV activation events and repeating the sensing, determining and identifying operations, at select intervals, to build a CP collection and an MP collection. The method calculates an HF trend based on the CP collection and MP collection and classifies a patient condition based on the HF trend to form an HF assessment.

Abstract: Systems and methods for His bundle pacing using a stimulation device include applying an impulse to a His bundle of a patient heart using the stimulation device. The stimulation device then measures a response of the patient heart to application of the impulse that includes a response of a ventricle of the patient heart. The stimulation device calculates a ventricular delay as a time from application of the impulse to onset of the response of the ventricle and delivers, using a lead of the stimulation device, a backup impulse to the ventricle when at least the ventricular delay exceeds a delay value stored in a memory of the stimulation device. The stored delay may, for example, correspond to a previously determined value indicative of selective or other His bundle capture.

Abstract: A method and device for dynamic device based AV delay adjustment are provided. The method provides electrodes that are configured to be located proximate to an atrial (A) site and a right ventricular (RV) site. The method utilizes one or more processors, in an implantable medical device (IMD), for detecting an atrial paced (Ap) event or atrial sensed (As) event. The method determines a measured AV interval corresponding to an interval between the Ap event or the As event and a ventricular sensed event and calculates a percentage-based (PB) offset based on the measured AV interval. The method automatically dynamically adjusting an AV delay, utilized by the IMD, based on the measured AV interval and the PB offset and manages a pacing therapy, utilized by the IMD, based on the AV delay after the adjusting operation.

Abstract: Computer implemented methods, devices and systems for monitoring a trend in heart failure (HF) progression are provided. The method comprises sensing left ventricular (LV) activation events at multiple LV sensing sites along a multi-electrode LV lead. The activation events are generated in response to an intrinsic or paced ventricular event. The method implements program instructions on one or more processors for automatically determining a conduction pattern (CP) across the LV sensing sites based on the LV activation events, identifying morphologies (MP) for cardiac signals associated with the LV activation events and repeating the sensing, determining and identifying operations, at select intervals, to build a CP collection and an MP collection. The method calculates an HF trend based on the CP collection and MP collection and classifies a patient condition based on the HF trend to form an HF assessment.

Abstract: Computer implemented methods, devices and systems for monitoring a trend in heart failure (HF) progression are provided. The method comprises sensing left ventricular (LV) activation events at multiple LV sensing sites along a multi-electrode LV lead. The activation events are generated in response to an intrinsic or paced ventricular event. The method implements program instructions on one or more processors for automatically determining a conduction pattern (CP) across the LV sensing sites based on the LV activation events, identifying morphologies (MP) for cardiac signals associated with the LV activation events and repeating the sensing, determining and identifying operations, at select intervals, to build a CP collection and an MP collection. The method calculates an HF trend based on the CP collection and MP collection and classifies a patient condition based on the HF trend to form an HF assessment.

Abstract: An irrigated ablation system with retrograde flow includes one or more medical devices (e.g., an ablation catheter and sheath) encompassing an irrigation lumen that terminates distally at an irrigation orifice and a drainage lumen that terminates distally at a drainage orifice. One or more pumps are coupled to the irrigation lumen and to the drainage lumen to deliver irrigant through the irrigation lumen and to extract fluid through the at least one drainage lumen. For example, a peristaltic pump can be used to simultaneously deliver irrigant through the irrigation lumen and to extract an equivalent volume of fluid through the drainage lumen. Alternatively, a feedback controller can be used to monitor parameters, such as impedance, pressure, ablation time, and/or irrigant volume, and control based thereon the rate at which the pump extracts fluid.

Abstract: Parameters for cardiac ablation can be determined using a map of one or more biological properties of a tissue to be ablated, such as tissue thickness. The biological properties are used to compute a transmurality index map. In turn, the transmurality index map can be used to determine one or more of ablation energy level, ablation time, and ablation contact force to achieve a transmural lesion. Graphical representations of the biological property maps, the transmural index map, and/or the ablation parameters can be output, for example on geometric models of the heart and/or the ablation catheter.

Abstract: Methods, apparatuses, and systems to differentiate adipose tissue from scar tissue are disclosed. One or more electrophysiology data points, each of which includes an electrophysiological signal associated with a tissue location that possesses certain signal characteristics, can be collected. An adipose tissue probability and/or a scar tissue probability can be computed using the characteristics of the electrophysiological signal, such as signal duration, signal amplitude, signal fractionation, and/or late potentials. The probability computation can also utilize dielectric properties, such as tissue impedance, tissue conductivity, and/or tissue permittivity, measured at the tissue location. Graphical representations of the adipose tissue probability and/or scar tissue probability can also be output.