Abstract: A system and method for designating between types of activation by a pulse generator configured to deliver a left ventricular (LV) pacing pulse at an LV pacing site as part of a cardiac resynchronization therapy (CRT) are provided. The system includes a sensing channel configured to collect cardiac activity (CA) signals along at least one sensing vector extending through a septal wall between the LV and right ventricle (RV). The CA signals are indicative of one or more beats and include a pre-LV pacing segment indicative of cardiac activity preceding the LV pacing pulse and a post-LV pacing segment indicative of cardiac activity following the LV pacing pulse. The system includes memory to store program instructions. One or more processors are configured to implement the program instructions to analyze the pre-LV pacing segment to identify a first myocardium activation (MA) characteristic of interest (COI).

Abstract: Systems and methods are provided for detecting arrhythmias in cardiac activity is provided. The systems and methods include measuring conduction delays between an atria (A) and multiple left ventricular (LV) electrodes to obtain multiple intrinsic A/LV intervals, measuring conduction delays between a right ventricular (RV) and the multiple LV electrodes to obtain multiple intrinsic VV intervals. The systems and methods include calculating a first atrial ventricular (AV) delay based on at least one of the intrinsic A/LV intervals, and calculating a second AV delay based on at least one of the intrinsic VV intervals. The systems and methods include selecting a biventricular (BiV) pacing mode or an LV only pacing mode based on a relation between the first and second AV delays, and delivering a pacing therapy based on the selecting operation.

Abstract: A system and method for managing atrial-ventricular (AV) delay adjustments are provided and includes electrodes configured to be located proximate to an atrial (A) site and at least one of a left bundle branch (LBB) site or a HIS site. An IMD has a header that includes a right atrial (RA) header port, a right ventricular (RV) header port and a left ventricular (LV) header port. The system includes memory configured to store program instructions and one or more processors that, when configured to execute the program instructions measure an AV interval corresponding to an interval between an atrial paced (Ap) event or an atrial sensed (As) event and a sensed ventricular (Vs) event.

Abstract: Systems and methods are provided for detecting arrhythmias in cardiac activity is provided. The systems and methods include measuring conduction delays between an atria (A) and multiple left ventricular (LV) electrodes to obtain multiple intrinsic A/LV intervals, measuring conduction delays between a right ventricular (RV) and the multiple LV electrodes to obtain multiple intrinsic VV intervals. The systems and methods include calculating a first atrial ventricular (AV) delay based on at least one of the intrinsic A/LV intervals, and calculating a second AV delay based on at least one of the intrinsic VV intervals. The systems and methods include selecting a biventricular (BiV) pacing mode or an LV only pacing mode based on a relation between the first and second AV delays, and delivering a pacing therapy based on the selecting operation.

Abstract: A method and device for dynamic device based AV delay adjustment are provided. The method provides electrodes that are configured to be located proximate to an atrial (A) site and a right ventricular (RV) site. The method utilizes one or more processors, in an implantable medical device (IMD), for detecting an atrial paced (Ap) event or atrial sensed (As) event. The method determines a measured AV interval corresponding to an interval between the Ap event or the As event and a ventricular sensed event and calculates a percentage-based (PB) offset based on the measured AV interval. The method automatically dynamically adjusting an AV delay, utilized by the IMD, based on the measured AV interval and the PB offset and manages a pacing therapy, utilized by the IMD, based on the AV delay after the adjusting operation.

Abstract: A method and device for dynamic device based AV delay adjustment are provided. The method provides electrodes that are configured to be located proximate to an atrial (A) site and a right ventricular (RV) site. The method utilizes one or more processors, in an implantable medical device (IMD), for detecting an atrial paced (Ap) event or atrial sensed (As) event. The method determines a measured AV interval corresponding to an interval between the Ap event or the As event and a ventricular sensed event and calculates a percentage-based (PB) offset based on the measured AV interval. The method automatically dynamically adjusting an AV delay, utilized by the IMD, based on the measured AV interval and the PB offset and manages a pacing therapy, utilized by the IMD, based on the AV delay after the adjusting operation.

Abstract: Methods, systems, and devices that are used for improving cardiac resynchronization therapy (CRT) are described herein. Such a method can include, for each set of pacing parameters, of a plurality of sets of pacing parameters, performing CRT using a set of pacing parameters and simultaneously therewith sensing a plurality of intracardiac electrograms (IEGMs) using different combinations of implanted electrodes. Additionally, for each set of pacing parameters, of the plurality of sets of pacing parameters, the method includes producing a respective reconstructed multi-lead surface electrocardiogram (ECG) based on the plurality of IEGMs that were sensed while CRT was performed using the set of pacing parameters. The method also includes analyzing the reconstructed multi-lead surface ECGs that were produced for the plurality of sets of pacing parameters, and based on results thereof, identifying a set of pacing parameters to be use for further CRT.

Abstract: Systems and methods for His bundle pacing using a stimulation device include applying an impulse to a His bundle of a patient heart using the stimulation device. The stimulation device then measures a response of the patient heart to application of the impulse that includes a response of a ventricle of the patient heart. The stimulation device calculates a ventricular delay as a time from application of the impulse to onset of the response of the ventricle and delivers, using a lead of the stimulation device, a backup impulse to the ventricle when at least the ventricular delay exceeds a delay value stored in a memory of the stimulation device. The stored delay may, for example, correspond to a previously determined value indicative of selective or other His bundle capture.

Abstract: Computer implemented methods and systems are provided that comprise, under control of one or more processors of a medical device, where the one or more processors are configured with specific executable instructions. The methods and systems obtain motion data indicative of at least one of a posture or a respiration cycle; obtain cardiac activity (CA) signals for a series of beats; identify whether a characteristic of interest (COI) from at least a first segment of the CA signals exceeds a COI limit; analyze the motion data to determine whether at least one of the posture or respiration cycle at least in part caused the COI to exceed the COI limit. Based on the analyzing operation, the methods and systems automatically adjust a CA sensing parameter utilized by the medical device to detect R-waves in subsequent CA signals; and detect an arrhythmia based on a presence or absence of one or more of the R-waves in at least a second segment of the CA signals.

Abstract: Disclosed herein is a catheter for delivering an implantable medical lead to an implantation site near an ostium leading to a proximal region of a coronary sinus. The catheter includes a distal end, a proximal end opposite the distal end, a tubular body extending between the distal and proximal ends, an atraumatic fixation structure defining a distal termination of the distal end, and a lead receiving lumen. The atraumatic fixation structure is configured to enter the ostium and passively pivotally anchor with the proximal region of the coronary sinus. The lead receiving lumen extends along the tubular body from the proximal end to an opening defined in a side of the tubular body near the distal end and proximal the atraumatic fixation structure.

Abstract: Methods and systems are provided herein and include an HIS electrode configured to be located proximate to a HIS bundle and to at least partially define a HIS sensing channel. The system includes memory to store cardiac activity (CA) signals obtained over the HIS sensing channel, the memory to store program instructions; and one or more processors that, when executing the program instructions, are configured for utilizing an atrial oversensing (AO) process to analyze the CA signals, obtained over the HIS sensing channel during an AO avoidance (AOA) window, for an atrial activity (AA) component to identify AA beats. The system applies a consistency criteria to the AA beats to determine a number of the AA beats that are indicative of consistent AO. Based on the consistency criteria and the number of AA beats indicative of consistent AO, the system performs at least one of adjusting an AO parameter utilized by the AO process or disabling the AO process and manages HIS bundle pacing based on a ventricular event.

Abstract: Methods and systems for dynamically modifying pacing timing and backup pacing delivery in cardiac stimulation devices include applying pacing impulses, measuring corresponding responses, and, based on such responses, automatically modifying timing or operational settings of the stimulation device to improve pacing functionality. Among other things, the approaches described herein reduce unnecessary backup pacing impulses in HIS bundle pacing applications, facilitate fusion in bundle branch block applications, and automatically enable or disable backup pacing in response to achieving QRS complex correction.

Abstract: Systems and methods of performing cardio resynchronization therapy (CRT) on a patient heart include the use of a stimulation system having at least one processor, at least one memory, a pulse generator, a stimulating electrode disposed in proximity to a His bundle of the patient heart, and a sensing electrode adapted to sense electrical activity of the left ventricle (LV) of the patient heart. CRT is provided by applying, using the pulse generator and through the stimulating electrode, a His bundle pacing (HBP) impulse having a first impulse energy. The sensing electrode is then used to measure an LV activation time in response to the HBP impulse. At least one setting of the pulse generator is modified based on the LV activation time such that a subsequent HBP impulse may be provided by the pulse generator via the stimulating electrode using a modified impulse energy.

Abstract: Systems and methods for His bundle pacing and classifying response to pacing impulses include applying, using a pulse generator, an impulse through a stimulating electrode to induce a response from a patient heart. A response to the impulse is measured using at least one sensing electrode and time-domain based characteristics of the response are analyzed to determine whether His bundle capture has occurred and, if so, what type of capture has occurred.

Abstract: Systems and methods for His bundle pacing and classifying response to pacing impulses include applying, using a pulse generator, an impulse through a stimulating electrode to induce a response from a patient heart. A response to the impulse is measured using at least one sensing electrode and frequency characteristics of the response are analyzed to determine whether His bundle capture has occurred and, if so, what type of capture has occurred. To facilitate analysis, the response measured from the patient heart may also be filtered to pass or stop frequencies indicative of certain capture types.

Abstract: Computer implemented methods, devices and systems for monitoring a trend in heart failure (HF) progression are provided. The method comprises sensing left ventricular (LV) activation events at multiple LV sensing sites along a multi-electrode LV lead. The activation events are generated in response to an intrinsic or paced ventricular event. The method implements program instructions on one or more processors for automatically determining a conduction pattern (CP) across the LV sensing sites based on the LV activation events, identifying morphologies (MP) for cardiac signals associated with the LV activation events and repeating the sensing, determining and identifying operations, at select intervals, to build a CP collection and an MP collection. The method calculates an HF trend based on the CP collection and MP collection and classifies a patient condition based on the HF trend to form an HF assessment.

Abstract: Systems and methods of performing cardio resynchronization therapy (CRT) on a patient heart include the use of a stimulation system having at least one processor, at least one memory, a pulse generator, a stimulating electrode disposed in proximity to a His bundle of the patient heart, and a sensing electrode adapted to sense electrical activity of the left ventricle (LV) of the patient heart. CRT is provided by applying, using the pulse generator and through the stimulating electrode, a His bundle pacing (HBP) impulse having a first impulse energy. The sensing electrode is then used to measure an LV activation time in response to the HBP impulse. At least one setting of the pulse generator is modified based on the LV activation time such that a subsequent HBP impulse may be provided by the pulse generator via the stimulating electrode using a modified impulse energy.

Abstract: A method and device for dynamic device based AV delay adjustment are provided. The method provides electrodes that are configured to be located proximate to an atrial (A) site and a right ventricular (RV) site. The method utilizes one or more processors, in an implantable medical device (IMD), for detecting an atrial paced (Ap) event or atrial sensed (As) event. The method determines a measured AV interval corresponding to an interval between the Ap event or the As event and a ventricular sensed event and calculates a percentage-based (PB) offset based on the measured AV interval. The method automatically dynamically adjusting an AV delay, utilized by the IMD, based on the measured AV interval and the PB offset and manages a pacing therapy, utilized by the IMD, based on the AV delay after the adjusting operation.

Abstract: Systems and methods for His bundle pacing using a stimulation device include applying an impulse to a His bundle of a patient heart using the stimulation device. The stimulation device then measures a response of the patient heart to application of the impulse that includes a response of a ventricle of the patient heart. The stimulation device calculates a ventricular delay as a time from application of the impulse to onset of the response of the ventricle and delivers, using a lead of the stimulation device, a backup impulse to the ventricle when at least the ventricular delay exceeds a delay value stored in a memory of the stimulation device. The stored delay may, for example, correspond to a previously determined value indicative of selective or other His bundle capture.

Abstract: Computer implemented methods, devices and systems for monitoring a trend in heart failure (HF) progression are provided. The method comprises sensing left ventricular (LV) activation events at multiple LV sensing sites along a multi-electrode LV lead. The activation events are generated in response to an intrinsic or paced ventricular event. The method implements program instructions on one or more processors for automatically determining a conduction pattern (CP) across the LV sensing sites based on the LV activation events, identifying morphologies (MP) for cardiac signals associated with the LV activation events and repeating the sensing, determining and identifying operations, at select intervals, to build a CP collection and an MP collection. The method calculates an HF trend based on the CP collection and MP collection and classifies a patient condition based on the HF trend to form an HF assessment.