Abstract: System and methods are provided for determining a stimulation threshold for closed loop spinal cord stimulation (SCS). The system and methods provide a lead coupled to an implantable pulse generator (IPG). The system and methods deliver SCS pulses from the IPG to the lead electrodes in accordance with an SCS therapy and determine an evoked compound action potential (ECAP) amplitude based on an ECAP waveform resulting from the SCS therapy. The system and methods increase the SCS therapy by increasing at least one of an amplitude, a duration, and number of the SCS pulses associated with the SCS therapy. The system and methods also include iteratively repeat the delivering, determining and increasing operations until the ECAP amplitude exhibits a downward trend divergence. The system and methods define a stimulation threshold based on the ECAP amplitude at the trend divergence.

Abstract: An exemplary method for optimizing pacing configuration includes providing distances between electrodes of a series of three or more ventricular electrodes associated with a ventricle; selecting a ventricular electrode from the series; delivering energy to the ventricle via the selected ventricular electrode, the energy sufficient to cause an evoked response; acquiring signals of cardiac electrical activity associated with the evoked response via non-selected ventricular electrodes of the series; based on signals of cardiac electrical activity acquired via the non-selected ventricular electrodes and the distances, determining conduction velocities; based on the conduction velocities, deciding if the selected ventricular electrode is an optimal electrode for delivery of a cardiac pacing therapy; and, if the selected ventricular electrode comprises an optimal electrode for delivery of the cardiac pacing therapy, calling for delivery of the cardiac pacing therapy using the selected ventricular electrode.

Abstract: Computer implemented methods and systems are provided for automatically determining capture thresholds for an implantable medical device equipped for cardiac stimulus pacing using a multi-pole left ventricular (LV) lead. The methods and systems measures a base capture threshold for a base pacing vector utilizing stimulation pulses varied over at least a portion of an outer test range. The base pacing vector is defined by a first LV electrode provided on the LV lead and a second electrode located remote from an LV chamber. The methods and systems designate a secondary pacing vector that includes the first LV electrode and a neighbor LV electrode provided on the LV lead. The methods and systems further define an inner test range having secondary limits based on the base capture threshold, wherein at least one of the limits for the inner test range differs from a corresponding limit for the outer test range.

Abstract: Methods and systems are provided for managing residual charge for multi-point pacing therapy. The method and system provide an electrode configuration that includes an atrial (A) electrode, a right ventricular (RV) electrode and multiple left ventricular (LV) electrodes. The method and system deliver pacing pulses for an MPP therapy, during a first cardiac cycle, from a pulse generator to the electrode configurations. The pacing pulses are separated by pacing pulse (PP) intervals. The method and system dynamically adjust at least one of a timing or a duration of discharge pulses for the residual charge to form a discharge sequence. The method and system activate the discharge pulses based on the discharge sequence, during the first cardiac cycle, to the multiple LV electrodes to distribute the residual charge across the PP intervals.

Abstract: System and methods are provided for determining a stimulation threshold for closed loop spinal cord stimulation (SCS). The system and methods provide a lead coupled to an implantable pulse generator (IPG). The system and methods deliver SCS pulses from the IPG to the lead electrodes in accordance with an SCS therapy, and determine an evoked compound action potential (ECAP) amplitude based on an ECAP waveform resulting from the SCS therapy. The system and methods increase the SCS therapy by increasing at least one of an amplitude, a duration, and number of the SCS pulses associated with the SCS therapy. The system and methods also include iteratively repeat the delivering, determining and increasing operations until the ECAP amplitude exhibits a downward trend divergence. The system and methods define a stimulation threshold based on the ECAP amplitude at the trend divergence.

Abstract: Computer implemented methods and systems are provided for automatically determining capture thresholds for an implantable medical device equipped for cardiac stimulus pacing using a multi-pole left ventricular (LV) lead. The methods and systems measures a base capture threshold for a base pacing vector utilizing stimulation pulses varied over at least a portion of an outer test range. The base pacing vector is defined by a first LV electrode provided on the LV lead and a second electrode located remote from an LV chamber. The methods and systems designate a secondary pacing vector that includes the first LV electrode and a neighbor LV electrode provided on the LV lead. The methods and systems further define an inner test range having secondary limits based on the base capture threshold, wherein at least one of the limits for the inner test range differs from a corresponding limit for the outer test range.

Abstract: Methods and devices are is provided for controlling a pacing therapy utilizing left ventricular multi-point pacing (MPP). The method and device provide electrodes configured to be located proximate to an atrial (A) site, a right ventricular (RV) site and multiple left ventricular (LV) sites of the heart. The method and device utilizes one or more processors. The processors determine atrial-ventricular conduction delays (AVCD) between the A site and multiple corresponding LV sites and determines pacing latencies at the LV sites. The processors adjusts the AVCDs, based on the pacing latency at the corresponding LV sites, to form atrial-ventricular latency adjusted (ARPL) conduction delays for the corresponding LV sites, calculates interventricular pacing (VV) delays for combinations of the LV sites based on the corresponding ARPL conduction delays and manages pacing therapy, that utilizes left ventricular MPP, based on the VV delays for the corresponding LV sites.

Abstract: Methods, devices and program products are provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device. Electrodes are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. A conduction different ? is determined based on i) an atrial-ventricular conduction delay (ARRV) between the A site and the RV site, and ii) an atrial-ventricular conduction delay (ARLV) between the A site and the LV site. A correction term ? is based on intrinsic inter-ventricular conduction delay (IVCD) between the LV and RV. An LV atrial-ventricular pacing (AVLV) delay is set based on the conduction difference ?, a pacing latency PL and the correction term ? and manages the LUV pacing therapy based on the AVLV delay, wherein the LUV pacing therapy lacks pacing in the RV.

Abstract: Methods, devices and program products are provided for determining an early battery depletion condition for a battery powered device. The method determines a charge consumption drawn externally from a battery cell by the device for a select period of time, obtains a measured cell voltage for the battery cell of the medical device, calculates a projected cell voltage based on the charge consumption and usage conditions, and declares an early depletion condition based on a relation between the measured and projected cell voltages.

Abstract: A method and system is provided for calculating a strain from characterization motion data. The method and system utilize an intravascular mapping tool configured to be inserted into at least one of the endocardial or epicardial space. The mapping tool is maneuvered to select locations proximate to surfaces of the heart, while collecting map points at the select locations to form a point cloud data set during at least one cardiac cycle. The method and system further include automatically assigning segment identifiers (IDs) to the map points based on a position of the map point within the point cloud data set. The method and system further select a first and second reference from a group of map points. Further, the method and system calculate a linear strain based on an instantaneous distance and a reference distance between the first and second references.

Abstract: A device to inhibit entanglement of catheter cables comprises a slip ring or a combined slip ring and fluid rotary joint. The device can include a servomechanism configured to power rotation of at least one of the slip ring and the fluid rotary joint. A detangling device for a cable plug configured to connect to a catheter handle comprises an outer cylinder configured to rotate relative to an inner cylinder while electrical connections between the inner and outer cylinders remain intact. A free rotary irrigation channel for a catheter handle inhibits entanglement of irrigation tubing.

Abstract: System and methods are provided for determining a stimulation threshold for closed loop spinal cord stimulation (SCS). The system and methods provide a lead coupled to an implantable pulse generator (IPG). The system and methods deliver SCS pulses from the IPG to the lead electrodes in accordance with an SCS therapy, and determine an evoked compound action potential (ECAP) amplitude based on an ECAP waveform resulting from the SCS therapy. The system and methods increase the SCS therapy by increasing at least one of an amplitude, a duration, and number of the SCS pulses associated with the SCS therapy. The system and methods also include iteratively repeat the delivering, determining and increasing operations until the ECAP amplitude exhibits a downward trend divergence. The system and methods define a stimulation threshold based on the ECAP amplitude at the trend divergence.

Abstract: The present disclosure provides apparatuses and methods for navigating a medical device into the body of a patient during an intracoronary or other medical procedure. In many embodiments, the present disclosure includes the use of a guidewire managing assembly that may be used in combination with a guidewire that includes a medical positioning system sensor. This guidewire managing assembly and sensor enabled guidewire are used in combination with a medical positioning system to determine the position of a medical device, such as a catheter or catheter sheath, and specifically the tip of the catheter or catheter sheath, that is threaded over the guidewire during a procedure. The present disclosure further relates to methods of tracking a medical device, such as a catheter tip, inside the body of a subject during a procedure.

Abstract: Computer implemented methods and systems are provided for automatically determining capture thresholds for an implantable medical device equipped for cardiac stimulus pacing using a multi-pole left ventricular (LV) lead. The methods and systems measures a base capture threshold for a base pacing vector utilizing stimulation pulses varied over at least a portion of an outer test range. The base pacing vector is defined by a first LV electrode provided on the LV lead and a second electrode located remote from an LV chamber. The methods and systems designate a secondary pacing vector that includes the first LV electrode and a neighbor LV electrode provided on the LV lead. The methods and systems further define an inner test range having secondary limits based on the base capture threshold, wherein at least one of the limits for the inner test range differs from a corresponding limit for the outer test range.

Abstract: Methods and system are provided that identify motion data associated with consistent electrical and mechanical behavior for a region of interest of the heart. The methods and systems acquire electrical cardiac signals indicative of physiologic behavior of at least a portion of the heart over a plurality of cardiac cycles. The methods and systems acquires motion data indicative of mechanical behavior of a motion sensor over the plurality of cardiac cycles to form a motion data collection, the motion data indicative of mechanical behavior of the region of interest when the motion sensor is in contact with the region of interest. The designating ectopic beats within the cardiac cycles may be based on the electrical cardiac signals, the ectopic beats producing electrically inconsistent (EI) data within the motion data collection. The methods and systems identify mechanically inconsistent (MI) data within the motion data collection based on irregular changes in the motion data.

Abstract: Methods, devices and systems are provided for selecting one or more left ventricular multi-electrode pacing site(s). The methods, devices and systems measure arrival times of LV activation events for corresponding LV sensing sites, where the arrival times each correspond to a conduction time from an intrinsic ventricular event or delivery of a pacing pulse until sensing of the corresponding LV activation event. Site-to-site (STS) relative delays are calculated as differences between the arrival times associated with adjacent LV sensing sites. The STS relative delays represent STS arrival delays for corresponding combinations of the adjacent LV sensing sites. An LV electrode combination is identified that is associated with at least one of the STS relative delays that satisfy selection criteria, where the LV electrode combination corresponds to a target tissue region exhibiting a select degree of non-uniformity.

Abstract: A system and method for treating an arrhythmia in a heart are provided. The system includes an electronic control unit configured to monitor movement of one or more position sensor over a period of time. The position sensors may, for example, comprise electrodes or coils configured to generate induced voltages and currents in the presence of electromagnetic fields, The positions sensors are in contact with portions of heart tissue and changes in position are representative of motion of that tissue. The electronic control unit is further configured to generate an indicator, responsive to the movements of the sensors over the period of time, of a characteristic of the heart affected by delivery of ablation energy to heart tissue. In this manner, the effectiveness and safety of cardiac tissue ablation for treatment of the arrhythmia can be assessed and a post-ablation therapy regimen determined.

Abstract: A system and method for treating an arrhythmia in a heart are provided. The system includes an electronic control unit configured to monitor movement of one or more position sensor over a period of time. The position sensors may, for example, comprise electrodes or coils configured to generate induced voltages and currents in the presence of electromagnetic fields. The positions sensors are in contact with portions of heart tissue and changes in position are representative of motion of that tissue. The electronic control unit is further configured to generate an indicator, responsive to the movements of the sensors over the period of time, of a characteristic of the heart affected by delivery of ablation energy to heart tissue. In this manner, the effectiveness and safety of cardiac tissue ablation for treatment of the arrhythmia can be assessed and a post-ablation therapy regimen determined.

Abstract: Described herein are implantable systems and devices, and methods for use therewith, that can be used to monitor and treat heart failure (HF). Such implantable systems preferably includes a lead having at least two electrodes implantable in a patient's left ventricular (LV) chamber. A plurality of different sensing vectors are used to obtain a plurality of IEGMs each of which is indicative of an evoked response at a corresponding different region of the LV chamber. For each of the IEGMs, there is a determination of one or more evoked response metrics indicative of a localized cardiac function at the corresponding region of the LV chamber. The evoke response metrics can be, e.g., paced depolarization integral (PDI) and/or maximum upward slope of an R-wave, but are not limited thereto.

Abstract: Methods, devices and systems are provided for selecting one or more left ventricular multi-electrode pacing site(s). The methods, devices and systems measure arrival times of LV activation events for corresponding LV sensing sites, where the arrival times each correspond to a conduction time from an intrinsic ventricular event or delivery of a pacing pulse until sensing of the corresponding LV activation event. Site-to-site (STS) relative delays are calculated as differences between the arrival times associated with adjacent LV sensing sites. The STS relative delays represent STS arrival delays for corresponding combinations of the adjacent LV sensing sites. An LV electrode combination is identified that is associated with at least one of the STS relative delays that satisfy selection criteria, where the LV electrode combination corresponds to a target tissue region exhibiting a select degree of non-uniformity.