Abstract: The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient's cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy.

Abstract: Disordered breathing events may be classified as central, obstructive or a combination of central an obstructive in origin based on patient motion associated with respiratory effort. Central disordered breathing is associated with disrupted respiration with reduced respiratory effort. Obstructive disordered breathing is associated with disrupted respiration accompanied by respiratory effort. A disordered breathing classification system includes a disordered breathing detector and a respiratory effort motion sensor. Components of the disordered breathing classification system may be fully or partially implantable.

Abstract: The presence of disordered breathing is detected using an implantable medical device. A cardiac condition is detected that is indicative of the patient's cardiac status. Based on the presence of disordered breathing and the cardiac condition, the patient is identified as suitable for a cardiac resynchronization therapy.

Abstract: Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Abstract: Devices and methods for therapy control based on electromechanical timing involve detecting electrical activation of a patient's heart, and detecting mechanical cardiac activity resulting from the electrical activation. A timing relationship is determined between the electrical activation and the mechanical activity. A therapy is controlled based on the timing relationship. The therapy may improve intraventricular dyssynchrony of the patient's heart, or treat at least one of diastolic and systolic dysfunction and/or dyssynchrony of the patient's heart, for example. Electrical activation may be detected by sensing delivery of an electrical stimulation pulse to the heart or sensing intrinsic depolarization of the patient's heart. Mechanical activity may be detected by sensing heart sounds, a change in one or more of left ventricular impedance, ventricular pressure, right ventricular pressure, left atrial pressure, right atrial pressure, systemic arterial pressure and pulmonary artery pressure.

Abstract: This patent document discusses, among other things, systems, devices, and methods for enhancing detection of pulmonary edema using, in addition to thoracic impedance, one or a combination of: physiologic information about a subject, at least one statistical parameter, a user-programmable detection level, at least one parameter associated with a previous pulmonary edema event, and patient symptom information about the subject. In one example, a (base) thoracic impedance threshold is modified to an adjusted thoracic impedance threshold. The adjusted thoracic impedance threshold provides an increased sensitivity of pulmonary edema detection as compared to the base thoracic impedance threshold. In another example, an alert is provided to a subject, a caregiver, or other user based on a pulmonary edema indication determined by the present systems, devices, and methods. In a further example, a therapy (provided to the subject) is adjusted or initiated in response to the pulmonary edema indication.

Abstract: Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Abstract: Various approaches to detecting arousals from sleep involve generating signals modulated by muscle tone, brainwave activity, and/or other nervous system activity associated with a patient's autonomic arousal response. Generating the signals and/or detecting autonomic arousals from sleep may be performed using an implantable device. Arousal information may be useful to identify sleep disorder events associated with arousals from sleep, for diagnostic purposes, and/or for therapy adjustment.

Abstract: Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Abstract: A respiration pattern of a number of respiration cycles is detected and breath intervals (BI) and tidal volume (TVOL) measurements of each of the respiration cycles are respectively determined. An unevenly sampled instantaneous minute ventilation (iMV) signal is produced using the BI and TVOL measurements, and an evenly sampled iMV signal (resampled iMV signal) is produced using the unevenly sampled iMV signal. Disordered breathing is detected based on a comparison between a baseline threshold and the resampled iMV signal.

Abstract: This patent document discusses, among other things, systems, devices, and methods for predicting an occurrence of impending thoracic fluid accumulation and in one example, invoking a responsive therapy, such as to prevent or minimize the consequences of the impending thoracic fluid accumulation. One example of the present systems, devices, and methods senses or receives at least one parameter that is statistically associated with impending thoracic fluid accumulation from a subject. Using such parameter(s), a probability of impending thoracic fluid accumulation is estimated. A list of parameters determines which values are recurrently sensed or received at various desired time intervals. Another example of the present systems, devices, and methods weights the sensed or received parameter value(s) to compute the probability estimate of impending thoracic fluid accumulation.

Abstract: Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Abstract: A system and method for determining pulmonary performance from transthoracic impedance measures is provided. Transthoracic impedance measures collected by an implantable medical device are correlated to pulmonary functional measures. The pulmonary functional measures are grouped by respiratory pattern. Pulmonary performance is evaluated. Differences are determined by comparing the pulmonary functional measures for each respiratory pattern to the pulmonary functional measures for at least one previous respiratory pattern. A trend is identified from the differences. An alert is generated upon sufficient deviation of the trend from a threshold criteria.

Abstract: A cardiac rhythm management (CRM) system includes a non-invasive hemodynamic sensing device and an implantable medical device to sense a hemodynamic signal and derive one or more cardiac performance parameters from the hemodynamic signal. The non-invasive hemodynamic sensing device includes at least a portion configured for external attachment to a body in which the implantable medical device is implanted. The one or more cardiac performance parameters are used for various diagnostic, monitoring, and therapy control purposes.

Abstract: An evaluation of heart failure status is provided based on a disordered breathing index. Patient respiration is sensed and a respiration signal is generated. Disordered breathing episodes are detected based on the respiration signal. A disordered breathing index is determined based on the disordered breathing episodes. The disordered breathing index is trended and used to evaluate heart failure status. The disordered breathing index may be combined with additional information and/or may take into account patient activity, posture, sleep stage, or other patient information.

Abstract: Vector selection is automatically achieved via a thoracic or intracardiac impedance signal collected in a cardiac function management device or other implantable medical device that includes a test mode and a diagnostic mode. During a test mode, the device cycles through various electrode configurations for collecting thoracic impedance data. At least one figure of merit is calculated from the impedance data for each such electrode configuration. In one example, only non-arrhythmic beats are used for computing the figure of merit. A particular electrode configuration is automatically selected using the figure of merit. During a diagnostic mode, the device collects impedance data using the selected electrode configuration. In one example, the figure of merit includes a ratio of a cardiac stroke amplitude and a respiration amplitude. Other examples of the figure of merit are also described.

Abstract: Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Abstract: A method and device for delivering pre-excitation pacing to prevent or reduce cardiac remodeling following a myocardial infarction is described. The pre-excitation pacing is modulated in accordance with an assessment of cardiac function in order to balance the beneficial effects of stress reduction with hemodynamic compromise.

Abstract: Various approaches to detecting arousals from sleep involve generating signals modulated by muscle tone, brainwave activity, and/or other nervous system activity associated with a patient's autonomic arousal response. Generating the signals and/or detecting autonomic arousals from sleep may be performed using an implantable device. Arousal information may be useful to identify sleep disorder events associated with arousals from sleep, for diagnostic purposes, and/or for therapy adjustment.

Abstract: An evaluation of heart failure status is provided based on a disordered breathing index. Patient respiration is sensed and a respiration signal is generated. Disordered breathing episodes are detected based on the respiration signal. A disordered breathing index is determined based on the disordered breathing episodes. The disordered breathing index is trended and used to evaluate heart failure status. The disordered breathing index may be combined with additional information and/or may take into account patient activity, posture, sleep stage, or other patient information.