Abstract: A first implantable medical device (IMD) implanted within a patient may communicate with a second IMD implanted within the patient by encoding information in an electrical stimulation signal. The delivery of the electrical stimulation signal may provide therapeutic benefits to the patient. The second IMD may sense the electrical stimulation signal, which may be presented as an artifact in a sensed cardiac signal, and process the sensed signal to retrieve the encoded information. The second IMD may modify its operation based on the received therapy information. Crosstalk between the first and second IMDs may be reduced using various techniques described herein. For example, the first IMD may generate the electrical stimulation signal to include a spread spectrum energy distribution or a predetermined signal signature. The second IMD may effectively remove a least some of the signal artifact in a sensed cardiac signal based on the predetermined signal signature.

Abstract: An implantable medical device may deliver pacing, cardioversion, and/or defibrillation stimulation to a heart of a patient via extravascular electrodes and delivers electrical stimulation to a nonmyocardial tissue site to modulate the autonomic nervous system of the patient. The implantable medical device may include a cardiac therapy module that generates and delivers at least one of pacing, cardioversion, or defibrillation therapy to a patient via an extravascular electrode, and a neurostimulation therapy module that generates and delivers a neurostimulation signal to the patient via a neurostimulation electrode. The cardiac therapy module and neurostimulation therapy module may be disposed in a common housing of the medical device. In some examples, at least one common lead may electrically couple the neurostimulation electrode and the extravascular electrode to the neurostimulation and cardiac therapy modules, respectively.

Abstract: An electrical parameter value indicative of an impedance of an electrical path between a first medical device implanted within a patient and a second medical device implanted within the patient may be determined by generating and delivering an electrical signal between electrodes connected to the first medical device and sensing the electrical signal with two or more sense electrodes connected to the second medical device. In some examples, the electrical parameter value indicative of the impedance may be used to detect a system integrity issue, such as relative movement between the first and second medical devices, such as between leads connected to the medical devices, or a lead-related condition. In other examples, the determined impedance may indicate a transthoracic impedance of the patient.

Abstract: An implantable medical device (IMD) may include a battery dedicated to providing cardiac stimulation therapy and a separate power source that provides power for electrical stimulation therapy. Such a configuration preserves the battery dedicated for providing cardiac stimulation therapy even if the second power source is depleted. As an example, the IMD may comprise a cardiac stimulation module configured to deliver at least one stimulation therapy selected from a group consisting of pacing, cardioversion and defibrillation. The IMD further comprises a electrical stimulation module configured to deliver electrical stimulation therapy, a first power source including a battery, wherein the first power source is configured to supply power to the cardiac stimulation module and not to the electrical stimulation module, and a second power source. The second power source is configured to supply power to at least the electrical stimulation module.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: Impedance, e.g. sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change. Other methods vary the AA interval to maximize impedance change over the entire cardiac cycle or during the atrial cycle.

Abstract: Automated adjustment of a pre-excitation interval (PEI) used to deliver hemodynamically efficient fusion pacing therapy.

Abstract: An implantable medical device (IMD) identifies lead performance issues and provides alternative lead configurations to continue with the programmed therapy. In the absence of an appropriate alternatively lead configuration, the IMD determines alternative mechanisms to provide a similar therapy or to determine a secondary therapy.

Abstract: The disclosure provides methods and apparatus of left ventricular pacing including automated adjustment of a atrio-ventricular (AV) pacing delay interval and intrinsic AV nodal conduction testing. It includes—upon expiration or reset of a programmable AV Evaluation Interval (AVEI)—performing the following: temporarily increasing a paced AV interval and a sensed AV interval and testing for adequate AV conduction and measuring an intrinsic atrio-ventricular (PR) interval for a right ventricular (RV) chamber. Thus, in the event that the AV conduction test reveals a physiologically acceptable intrinsic PR interval then storing the physiologically acceptable PR interval in a memory structure (e.g., a median P-R from one or more cardiac cycles). In the event that the AV conduction test reveals an AV conduction block condition or if unacceptably long PR intervals are revealed then a pacing mode-switch to a bi-ventricular (Bi-V) pacing mode occurs and the magnitude of the AVEI is increased.

Abstract: A method and system for improving or optimizing the collection of data from and the delivery of therapy to a patient by an implantable medical device (IMD) is disclosed which uses information about the patient's respiratory cycle.

Abstract: According to this disclosure, a non-transvenous pacing and, optionally defibrillation, therapy device is implanted subcutaneously and oriented to provide cardiac sensing from electrodes spaced from a heart and deliver pacing and/or defibrillation from one or more non-transvenous electrodes (e.g., an epicardial or pericardial electrode or electrode patch). A subject receiving a device according to this disclosure is monitored to confirm a relatively stable bundle branch block (i.e., delayed activation) of one ventricle. The subcutaneous device has electrodes disposed on the housing and/or having an electrode on a subcutaneous medical lead is oriented so that the pacing (and sensing) vector impinges mainly upon the one ventricle, and/or optionally an epicardial or pericardial lead is deployed to a last-to-depolarize ventricle (e.g., a left ventricle) so that single-ventricular pacing is delivered to achieve fusion depolarization of both ventricles.

Abstract: This disclosure is directed to extra, intra, and transvascular medical lead placement techniques for arranging medical leads and electrical stimulation and/or sensing electrodes proximate nerve tissue within a patient.

Abstract: This disclosure is directed to extra, intra, and transvascular medical lead placement techniques for arranging medical leads and electrical stimulation and/or sensing electrodes proximate nerve tissue within a patient.

Abstract: According to this disclosure, a non-transvenous pacing and, optionally defibrillation, therapy device is implanted subcutaneously and oriented to provide cardiac sensing from electrodes spaced from a heart and deliver pacing and/or defibrillation from one or more non-transvenous electrodes (e.g., an epicardial or pericardial electrode or electrode patch). A subject receiving a device according to this disclosure is monitored to confirm a relatively stable bundle branch block (i.e., delayed activation) of one ventricle. The subcutaneous device has electrodes disposed on the housing and/or having an electrode on a subcutaneous medical lead is oriented so that the pacing (and sensing) vector impinges mainly upon the one ventricle, and/or optionally an epicardial or pericardial lead is deployed to a last-to-depolarize ventricle (e.g., a left ventricle) so that single-ventricular pacing is delivered to achieve fusion depolarization of both ventricles.

Abstract: This disclosure is directed to extra, intra, and transvascular medical lead placement techniques for arranging medical leads and electrical stimulation and/or sensing electrodes proximate nerve tissue within a patient.

Abstract: This disclosure is directed to extra, intra, and transvascular medical lead placement techniques for arranging medical leads and electrical stimulation and/or sensing electrodes proximate nerve tissue within a patient.

Abstract: This disclosure is directed to extra, intra, and transvascular medical lead placement techniques for arranging medical leads and electrical stimulation and/or sensing electrodes proximate nerve tissue within a patient.

Abstract: An implantable device is described that collects and aggregates data from non-implanted medical devices external from a body of a patient. The device may also collect and aggregate data from medical devices implanted within the body. The implantable device includes a wireless transceiver to acquire physiological data from the external medical devices, and a storage medium to store the physiological data. A processor retrieves the physiological data and communicates the physiological data to a remote patient management system. The device may collect the physiologic data from the various external data sources, possibly over an extended period of time, and stores the data for subsequent upload to a common patient management system. In addition, the implantable device may collect physiological data from other medical devices implanted within the patient. In this manner, the device provides a central point for collection and aggregation of physiological data relating to the patient.

Abstract: The present invention provides a technique for verifying pacing capture of a ventricular chamber, particularly to ensure desired delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”). The invention also provides for ventricular capture management by delivering a single ventricular pacing stimulus and checking inter-ventricular conduction during a temporal window to determine if the ventricular pacing stimulus captured the chamber. If a loss-of-capture (LOC) signal results from the capture management testing, then the characteristics of the applied pacing pulses are modified and the conduction test repeated. In the event that the LOC signal persists, a pacing mode-switch to an atrial-based pacing therapy and/or non-bi-ventricular pacing regimen can be implemented.

Abstract: The disclosure relates to systems, methods, and devices for monitoring a patient's blood and cardiac condition. Patients with diabetes oftentimes wear diabetes management equipment (e.g., a glucose monitor, an external insulin pump, or a device having dual functionality). Such patients risk silent myocardial infarction. Herein described is regular cardiac ischemia/infarction monitoring—which if not monitored can lead to (silent) myocardial infarction. Moreover herein described are combined blood monitoring functionality and cardiac condition monitoring functionality via a single device, meaning that the patient is not required to wear additional equipment. Adding this functionality to already-existing equipment is significantly less invasive than requiring a patient to wear one piece of equipment to monitor his/her blood and a second piece of equipment to monitor his/her cardiac condition.