Abstract: A cardiac rhythm management system that provides an indication of patient well-being based on the autonomic balance between the sympathetic and parasympathetic/vagal components of the autonomic nervous system, using time-domain processing of frequency components of a heart rate interval signal.

Abstract: An implantable cardiac rhythm management device capable of automatically detecting intrinsic and evoked response of a patient's heart. The device operates in an automatic capture verification mode, wherein a global accelerometer signal is utilized to identify heart sounds (S1 and S2) of the patient's heart. The presence or absence of one or more of the heart sounds S1 and S2 in the accelerometer signal indicates whether a stimulation pulse evokes a response by the patient's heart. The device may automatically adjust the stimulation output in accordance with a step down stimulation protocol, wherein the presence of a predetermined heart sound indicates capture. Also, the device may suspend the automatic capture verification sequence if the patient's physical activity level exceeds a predetermined threshold.

Abstract: A cardiac electro-stimulatory device and method for operating same in which stimulation pulses are distributed among a plurality of electrodes fixed at different sites of the myocardium in order to reduce myocardial hypertrophy brought about by repeated pacing at a single site and/or increase myocardial contractility. In order to spatially and temporally distribute the stimulation, the pulses are delivered through a switchable pulse output configuration during a single cardiac cycle, with each configuration comprising one or more electrodes fixed to different sites in the myocardium.

Abstract: A cardiac rhythm management system detects edema. In response to an episode of detected edema, it initiates or adjusts a cardiac resynchronization therapy and/or a cardiac contractility modulation (CCM) therapy.

Abstract: An apparatus and method for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Abstract: A method and apparatus for selection of one or more ventricular chambers to stimulate for ventricular resynchronization therapy. Intrinsic intracardia electrograms that include QRS complexes, are recorded from a left and right ventricle. A timing relationship between the intrinsic intracardia electrograms recorded from the left and right ventricle is then determined. In one embodiment, the timing relationship is determined using a delay between a left ventricular and a right ventricular sensed intrinsic ventricular depolarizations and a duration interval of one or more QRS complexes. In one embodiment, the duration of QRS complexes is determined from either intracardiac electrograms or from surface ECG recordings. One or more ventricular chambers in which to provide pacing pulses are then selected based on the timing relationship between intrinsic intracardia electrograms recorded from the right and left ventricle, and the duration of one or more QRS complexes.

Abstract: A system and method for measuring the capture threshold of a bipolar lead in order to determine an appropriate value for the stimulus pulse energy to be used with the lead by a cardiac rhythm management device. An appropriate bipolar stimulating configuration can also be determined. The method is particularly useful in testing bipolar leads used to excite the left ventricle such as when delivering cardiac resynchronization therapy.

Abstract: A cardiac rhythm management device in which amplitudes of electrograms from one or more cardiac sites are measured in order to ascertain the extent of hypertrophy. The device may then pace the heart by delivering pacing therapy in a manner that unloads the hypertrophied myocardium to effect reversal of undesirable remodeling.

Abstract: A cardiac rhythm management device that utilizes blanking or refractory periods to avoid misidentification of artifacts and evoked potentials, wherein the refractory periods are discontinuous and may be dependent upon sensed events, expiration of a predefined timing interval, or stimulation events in the same or other chambers of the heart. The discontinuous refractory periods enhance the ability of the device to sense intrinsic events. The present invention includes separate refractory and floating refractory periods incorporated within the sensing protocol for each selected cycle, thereby increasing the time period for normal sensing.

Abstract: A pacing system for providing optimal hemodynamic cardiac function for parameters such as ventricular synchorny or contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular pacing pulse. The system providing an option for near optimal pacing of multiple hemodynamic parameters. The system deriving the proper timing using electrical or mechanical events having a predictable relationship with an optimal ventricular pacing timing signal.

Abstract: A pacing system for providing optimal hemodynamic cardiac function for parameters such as ventricular synchorny or contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular pacing pulse. The system providing an option for near optimal pacing of multiple hemodynamic parameters. The system deriving the proper timing using electrical or mechanical events having a predictable relationship with an optimal ventricular pacing timing signal.

Abstract: An implantable cardiac rhythm/function management device that automatically determines whether or not a pacing stimulus to the ventricles results in capture by detecting propagated depolarizations at stimulating and non-stimulating electrodes. The device of the present invention is suitable for use in either a single or multiple electrode pacing/sensing configuration and may be utilized to verify either atrial or ventricular capture of a heart having either normal or abnormal intrinsic AV conduction.

Abstract: A system, method, or device classifies an arrhythmia according to the temporal order in which a depolarization wave associated with a particular heart contraction is received at a plurality of electrodes. One or more antiarrhythmia therapies is mapped to each arrhythmia classification. When a particularly classified arrhythmia is detected, the correspondingly mapped therapy list is selected and an appropriate antiarrhythmia therapy delivered. In one example, the particular therapy delivered in response to an arrhythmia depends at least in part on its historical success in treating arrhythmias of that classification.

Abstract: An apparatus and method for treating ventricular tachycardia in which paces are delivered to the ventricles at multiple pacing sites in accordance with an anti-tachycardia pacing protocol. Paces are delivered at a selected offset interval in a manner that both resynchronizes ventricular contractions and increases the probability of terminating the tachycardia.

Abstract: A pacing apparatus and method for providing optimum timing for ventricular pacing without referencing atrial activities. The pacing apparatus includes a processor, at least one sensor and a pulse generator. The pacing method includes the sensing of ventricular depolarization and the identification of an early electrical event, such as a depolarization of the HIS bundle or an onset of a ventricular depolarization (Q*). The system derives the proper timing using this early electrical event which provides a predictable relationship with an optimal ventricular pacing signal.

Abstract: A method for operating a cardiac rhythm management device in which a clinical state vector is computed as a combination of a plurality of parameters related to a patient's heart failure status and compared to a previously computed clinical state vector to determine a clinical trajectory indicative of changes in the patient's heart failure status. Such detected changes in status can be used both as a clinical tool to evaluate treatment and to automatically adjust the operation of the device.

Abstract: A centralized management system for medical devices includes a network, a central server coupled to the network, and a medical device programmer coupled to the network. The central server includes at least one prescription system for prescribing at least one programmable parameter of a medical device based on at least one characteristic of a patient. The medical device programmer communicates at least one characteristic of a patient to the central server via the network, receives at least one parameter from the central server via the network, and programs the medical device using the at least one parameter. In one embodiment, the central server hosts expert prescription systems defined by multiple experts, and a user selects one of the expert prescription systems. In another embodiment, the central server hosts a custom prescription system defined by the user.

Abstract: A system and method for automatically selecting among a plurality of pacing modes based upon capture detection. Patients suffering from heart failure may be optimally treated with different resynchronization pacing modes or configurations. By detecting whether capture is being achieved by a particular configuration or mode, a device is able to automatically switch to one that is both optimal in treating the patient and is successful in capturing the heart with pacing pulses.

Abstract: A cardiac rhythm management system includes an operational mode in which ventricular pacing pulses are delivered at a rate that tracks a sinoatrial rate up to an appropriate maximum atrial tracking rate (MATR) value determined by the system. In one example, the MATR value is based on a patient activity level and a hemodynamic maximum rate (HMR) determined from a QRS-to-S2 interval, where S2 is an accelerometer-generated fiducial correlative to aortic valve closure (AVC). In a further example, a correlation between the QRS-to-S2 interval and heart rate is established, and the MATR is based on the patient activity level and heart rate. In a further example, a lower rate threshold for providing antitachyarrhythmia therapy is modified based on the MATR. For example, when the MATR exceeds a default value of the antitachyarrhythmia therapy lower rate threshold, the threshold tracks the MATR.

Abstract: A method and system for operating a cardiac pacemaker which employs pacing therapy to regularize the ventricular rhythm together with biventricular sensing. Biventricular sensing allows the ventricular rate regularization to be accomplished with greater hemodynamic stability.