Abstract: An apparatus comprising an implantable cardiac signal sensing circuit configured for sensing an intrinsic cardiac signal, a memory to store a template of a morphology of normal atrial-ventricular conduction, and a controller that includes a tachyarrhythmia detection circuit and a correlation circuit. The tachyarrhythmia detection circuit is configured for detecting a rhythm with elevated ventricular rate using the sensed intrinsic cardiac signal. The correlation circuit is configured for iteratively calculating a correlation between the sensed intrinsic cardiac signal and the template, and comparing the calculated correlation to a variable correlation threshold to determine whether the detected rhythm correlates to the template. The apparatus also includes a therapy circuit configured for inhibiting a ventricular tachycardia therapy when the detected rhythm correlates to the template. Other apparatuses and methods are described.

Abstract: A combination pacer/defibrillator is tailored for bradycardia patients. In one example, its shock-delivery specificity exceeds its sensitivity to shockable ventricular tachyarrhythmias. In another example, its specificity exceeds 95%, or 99%, or even 99.5%. Sensitivity is programmed to a high desired sensitivity value, but only if it can be done without decreasing the specificity below the desired specificity threshold value. This can be conceptualized as “avoiding at all costs” delivering false shocks, even at the expense of failing to deliver a shock to a treatable ventricular tachyarrhythmia. Specificity enhancements include, among other things, inhibiting shock delivery when the patient is breathing or not supine, using multiple channels or a high rate VT/VF detection threshold.

Abstract: An implantable cardioverter/defibrillator (ICD) delivers atrial pacing under several scenarios during a tachyarrhythmia episode that is detected using a ventricular rate. In various embodiments, the atrial pacing terminates the detected tachyarrhythmia and/or enhances the classification of the detected tachyarrhythmia, thus avoiding ineffective and/or unnecessary delivery of a ventricular anti-tachyarrhythmia therapy when the detected tachyarrhythmia has a supraventricular origin.

Abstract: A cardiac rhythm management device is configured to discriminate between ventricular and supraventricular tachycardias (referred to as SVT/VT discrimination) by utilizing a morphology criterion in which the morphology of electrogram waveforms during ventricular beats are analyzed to determine if the beats are normally conducted. After the delivery of a cardioversion/defibrillation shock, however, the intraventricular conduction system is left in a modified state which alters the subsequently generated electrogram signal. Use of the morphology criterion for SVT/VT discrimination is discontinued after delivery of such a shock and resumed after a predetermined minimum number of normally conducted ventricular beats has been detected.

Abstract: An implantable cardioverter/defibrillator (ICD) executes a rate accuracy enhancement algorithm to select measured atrial and ventricular intervals for classifying a detected tachycardia based on average atrial and ventricular rates calculated from the selected atrial and ventricular intervals. The detected tachycardia is classified as ventricular tachycardia (VT) if the average ventricular rate is substantially higher than the average atrial rate.

Abstract: A cardiac rhythm management system can be used to detect episode beats associated with cardiac events in a subject's body. These events may be monitored and depolarization morphology information can be derived for candidate arrhythmic beats in an arrhythmia episode. An arrhythmic beat morphology template may be formed from selecting at least one of the candidate arrhythmic beats based upon user's labeling according to specific morphologies of one or more candidate episodes. Methods of use are also presented.

Abstract: A combination pacer/defibrillator is tailored for bradycardia patients. In one example, its shock-delivery specificity exceeds its sensitivity to shockable ventricular tachyarrhythmias. In another example, its specificity exceeds 95%, or 99%, or even 99.5%. Sensitivity is programmed to a high desired sensitivity value, but only if it can be done without decreasing the specificity below the desired specificity threshold value. This can be conceptualized as “avoiding at all costs” delivering false shocks, even at the expense of failing to deliver a shock to a treatable ventricular tachyarrhythmia. Specificity enhancements include, among other things, inhibiting shock delivery when the patient is breathing or not supine, using multiple channels or a high rate VT/VF detection threshold.

Abstract: A cardiac rhythm management device is configured to discriminate between ventricular and supraventricular tachycardias (referred to as SVT/VT discrimination) by utilizing a morphology criterion in which the morphology of electrogram waveforms during ventricular beats are analyzed to determine if the beats are normally conducted. After the delivery of a cardioversion/defibrillation shock, however, the intraventricular conduction system is left in a modified state which alters the subsequently generated electrogram signal. Use of the morphology criterion for SVT/VT discrimination is discontinued after delivery of such a shock and resumed after a predetermined minimum number of normally conducted ventricular beats has been detected.

Abstract: An implantable cardioverter/defibrillator (ICD) executes a rate accuracy enhancement algorithm to select measured atrial and ventricular intervals for classifying a detected tachycardia based on average atrial and ventricular rates calculated from the selected atrial and ventricular intervals. The detected tachycardia is classified as ventricular tachycardia (VT) if the average ventricular rate is substantially higher than the average atrial rate.

Abstract: In an embodiment, an implantable medical device senses the heart rate of a patient by analyzing a cardiac signal of the patient. The device identifies an increase in the patient's sensed heart rate and determines whether noise in the cardiac signal exceeds a certain specified amount. Upon an increase in the sensed heart rate and a finding of noise in the cardiac signal, pacing is invoked in the patient at a normal rate or at a rate that is greater than an estimated intrinsic rate for that patient. The device continues to pace until the device determines that the noise in the cardiac signal has subsided.

Abstract: One aspect of this disclosure relates to an apparatus for providing a selective capacitance. An embodiment of the apparatus includes a first and second capacitor in a stack, and a switching circuit connected between the first and second capacitors. The switching circuit has at least two states, and is adapted to provide a first defibrillation capacitance in a first state and a second defibrillation capacitance in a second state. A switching circuit embodiment includes a field effect transistor (FET) adapted to have a source connected to the first capacitor and a drain connected to the second capacitor, a bipolar junction transistor (BJT) adapted to have an emitter connected to the source of the FET and a collector connected to a gate of the FET, a first current source connected to the collector of the BJT, and a second current source connected to a base of the BJT.

Abstract: An apparatus and method for delivering electrical shock therapy in order to treat atrial tachyarrhythmias such as fibrillation utilizes a dynamically varying threshold to detect R-waves and synchronously deliver a defibrillation shock.

Abstract: An improved protection mechanism to protect from unintended execution of critical tasks operates, in one example embodiment, by receiving a request to start a task by a first process. The first process informs a second process of running an algorithm to verify the legitimacy of the received request to determine the need to start the task. The second process stores the information regarding the starting the algorithm by the first process. The first process runs the algorithm to verify the legitimacy of the received request, and conveys an outcome of the verification to the second process. The second process enables the start of the task by the first process based on the outcome of the verification and a checking of the stored information and the first process starts the task.

Abstract: Multiple morphology templates for discliminating between rhythms have been used, such as supraventricular tachyarrhythmias (SVTs) and ventricular tachyarrhythmias (VTs), for delivering a countershock in response to a VT episode, but withholding delivery of such a countershock in response to an SVT episode. In certain examples, the particular morphology used for storing morphological features is selected at least in part using a sensor-indicated activity level of a subject, or a metabolic need of the subject.

Abstract: A cross-chamber refractory period with an adaptively adjusted sensing threshold for use by a cardiac pacemaker is disclosed. In response to a cross-chamber event, the sensing threshold of a sensing channel is raised to an adaptively adjusted cross-chamber maximum refractory value. The cross-chamber maximum refractory value is derived from a peak amplitude measurement of the far-field signal resulting from the cross-chamber event.

Abstract: A cross-chamber refractory period with an adaptively adjusted sensing threshold for use by a cardiac pacemaker is disclosed. In response to a cross-chamber event, the sensing threshold of a sensing channel is raised to an adaptively adjusted cross-chamber maximum refractory value. The cross-chamber maximum refractory value is derived from a peak amplitude measurement of the far-field signal resulting from the cross-chamber event.

Abstract: This document describes systems, devices, and methods that use multiple morphology templates for discriminating between rhythms, such as supraventricular tachyarrhythmias (SVTs) and ventricular tachyarrhythmias (VTs), for delivering a countershock in response to a VT episode, but withholding delivery of such a countershock in response to an SVT episode. In certain examples, the particular morphology used for storing morphological features is selected at least in part using a sensor-indicated activity level of a subject, or a metabolic need of the subject.

Abstract: An improved protection mechanism to protect from unintended execution of critical tasks operates, in one example embodiment, by receiving a request to start a task by a first process. The first process informs a second process of running an algorithm to verify the legitimacy of the received request to determine the need to start the task. The second process stores the information regarding the starting the algorithm by the first process. The first process runs the algorithm to verify the legitimacy of the received request, and conveys an outcome of the verification to the second process. The second process enables the start of the task by the first process based on the outcome of the verification and a checking of the stored information and the first process starts the task.

Abstract: An apparatus and method for delivering electrical shock therapy in order to treat atrial tachyarrhythmias such as fibrillation utilizes a dynamically varying threshold to detect R-waves and synchronously deliver a defibrillation shock.

Abstract: An improved protection mechanism to protect from unintended execution of critical tasks operates, in one example embodiment, by receiving a request to start a task by a first process. The first process informs a second process of running an algorithm to verify the legitimacy of the received request to determine the need to start the task. The second process stores the information regarding the starting the algorithm by the first process. The first process runs the algorithm to verify the legitimacy of the received request, and conveys an outcome of the verification to the second process. The second process enables the start of the task by the first process based on the outcome of the verification and a checking of the stored information and the first process starts the task.