Abstract: An implantable medical device system and associated method select subcutaneous sensing electrodes for use in monitoring the heart rhythm. A subset of multiple sensing vectors is selected from a number of electrodes positioned at a first subcutaneous location and one electrode positioned at a second subcutaneous location. The subset of sensing vectors includes one vector that includes the electrode positioned at the second location. A signal quality parameter corresponding to each of the sensing vectors of the subset is determined.

Abstract: Method and apparatus for sensing improvement using pressure data. The method and apparatus may be used in an implantable medical device to confirm that an EGM event signifies a true mechanical cardiac activity and not just electrical oversensing. The mechanical activity may be used to create a mechanical marker channel in the implantable medical device.

Abstract: A medical device and associated method for detecting arrhythmias that includes sensing cardiac electrical signals and cardiac hemodynamic signals, determining a long-term baseline hemodynamic measurement in response to a plurality of the sensed cardiac hemodynaic signals, detecting a period of increased metabolic demand in response to the sensed cardiac electrical signals, determining a sinus tachycardia baseline hemodynamic measurement in response sensing of cardiac hemododynamic signals during the detected period of increased metabolic demand, and detecting the arrhythmia and delivering therapy in response to one of only the sensed cardiac electrical signals and the sensed cardiac electrical signals in combination with one or both of the determined long-term baseline hemodynamic measurement and the sinus tachycardia baseline hemodynamic measurement

Abstract: A medical device and associated method for detecting arrhythmias that includes electrodes for sensing cardiac electrical signals and a hemodynamic sensor for sensing a hemodynamic signal. An episode of cardiac electrical event intervals meeting cardiac arrhythmia detection criteria is detected from the sensed electrical signals. Cardiac mechanical events and/or cardiac mechanical event intervals are measured from the hemodynamic signal and used to withhold or confirm a cardiac arrhythmia detection of the episode.

Abstract: A method and apparatus for determining oversensing of cardiac signals that includes a housing containing electronic circuitry, an electrode coupled to the electronic circuitry to sense cardiac signals, and a processor, positioned within the housing, to determine an oversensing characteristic associated with the cardiac signals sensed over a predetermined sensing window, and to identify oversensing in response to the determined oversensing characteristic.

Abstract: A method of detecting a cardiac event in a medical device that includes sensing cardiac signals from a plurality of electrodes forming a first sensing vector and a second sensing vector, determining whether the first sensing vector and the second sensing vector is corrupted by noise, and determining, in response to one of the first sensing vector and the second sensing vector being corrupted by noise, whether the other of the first sensing vector and the second sensing vector is one of a first cardiac event and a second cardiac event different from the first cardiac event.

Abstract: The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.

Abstract: A cardiac rhythm management system includes an implantable medical device capable of delivering cardiac therapy and sensing an EGM. The implantable medical device undergoes threshold testing and transmits testing data to a computer via a remote monitor.

Abstract: The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).

Abstract: An implantable medical device and associated method monitor a physiological signal for sensing physiological events and detecting a physiological condition in response to the sensed physiological events. The device senses a first event from the physiological signal, senses a noise signal in the physiological signal and senses a next event from the physiological signal wherein the first event and the next event define a signal interval. The signal interval is declared as a noisy interval in response to the sensed noise signal.

Abstract: An apparatus for determining a respiration parameter in a medical device in which a pressure sensor senses pressure signals, and a signal processor, coupled to the pressure sensor, receives the sensed pressure signals and generates corresponding sample points.

Abstract: A medical device for determining a respiratory effort having a pressure sensor to sense pressure signals, a housing having system components positioned therein, and a microprocessor positioned within the housing, wherein the microprocessor detects an inspiration and an expiration in response to the pressure signals, detects a breath in response to the detected inspiration and the detected expiration, and determines the respiratory effort in response to the detected breath.

Abstract: A method of determining a respiration parameter in a medical device in which pressure signals are sensed to generate corresponding sample points, and a breath detection threshold is continuously adjusted in response to the generated sample points to generate a current adjusted breath detection threshold. A current generated sample point is compared to the current adjusted breath detection threshold, and the continuous adjusting of the breath detection threshold is suspended and the breath detection threshold is equal to the most current adjusted breath detection threshold generated prior to the suspending in response to the comparing. A next sample point, generated subsequent to the suspending, is compared to the set breath detection threshold, and the respiration parameter is determined in response to the comparing of a next sample point to the set breath detection threshold.

Abstract: A system and method for filtering a pressure signal in a medical device in which a sensor terminal senses the pressure signal, an electrode terminal receives cardiac electrical signals, a signal filtering system filters the sensed pressure signal in response to a determined heart rate to generate a heart-rate dependent frequency response, and a microprocessor derives a respiration signal in response to the heart rate dependent frequency response, and determines metrics of hemodynamic function in response to the derived respiration signal.

Abstract: A method of determining respiratory effort in a medical device in which pressure signals are sensed to generate corresponding sample points, an inspiration and an expiration are detected in response to the sensed pressure signals, a breath is detected in response to the detected inspiration and the detected expiration, and the respiratory effort is determined in response to the detected breath.

Abstract: The invention provides methods and apparatus for determining in a non-tracking pacing mode (e.g., DDI/R, VVI/R) whether a ventricular pacing stimulus is capturing a paced ventricle, including some or all of the following aspects. For example, increasing a ventricular pacing rate a nominal amount to an overdrive pacing rate higher than a most recent heart rate and evaluating a conduction interval from a first pacing ventricle to a second sensing ventricle and then continuing to monitor the underlying rate to ensure that a threshold testing pacing rate will not exceed a predetermined minimum interval and providing pacing stimulation to the first ventricle and sensing the second ventricle to determine whether the pacing stimulation to the first ventricle was one of sub-threshold and supra-threshold. The methods and apparatus are especially useful in conjunction with ensuring actual delivery of a ventricular pacing regime (e.g., cardiac resynchronization therapy or “CRT”).

Abstract: Techniques for storing electrograms (EGMS) that are associated with sensed episodes or events that may be non-physiological and, instead, associated with a sensing integrity condition are described. In some examples, a device or system identifies suspected non-physiological NSTs, and stores an EGM for the suspected non-physiological NSTs within an episode log. In some examples, a device or system determines whether to store an EGM for a suspected non-physiological episode or event based on whether an impedance integrity criterion has been satisfied. For example, a device or system may store an EGM for a detected short interval if the impedance integrity criterion has been met. In some examples, a device or system determines whether to buffer EGM data based on whether an impedance integrity criterion or other sensing integrity criterion has been met.

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: An implantable medical device and associated method monitor a physiological signal for sensing physiological events and detecting a physiological condition in response to the sensed physiological events. The device senses a first event from the physiological signal, senses a noise signal in the physiological signal and senses a next event from the physiological signal wherein the first event and the next event define a signal interval. The signal interval is declared as a noisy interval in response to the sensed noise signal.

Abstract: A method and apparatus for determining oversensing in a medical device that includes sensing cardiac signals, determining an oversensing characteristic associated with cardiac signals sensed during a predetermined sensing window, identifying oversensing in response to the oversensing characteristic, determining, in response to oversensing being identified, an adjusting characteristic associated with cardiac signals sensed during the predetermined sensing window, and updating a sensing parameter in response to the determined adjusting characteristic.