Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. When a cardiac rate exceeds a predetermined threshold, the implantable medical device modifies the pacing protocol parameters to promote AV synchrony.

Abstract: Techniques for estimating a cardiac chamber or vascular pressure based upon impedance are described. A device or system may measure an impedance between at least two electrodes implanted within or proximate to a cardiovascular system. The device or system may estimate a pressure of an element of the cardiovascular system based on a relationship between impedance and volume of the element, and based on a empirical relationship between the volume and the pressure. The device or system may also estimate the dimension of the element based on the impedance-volume relationship, or other characteristics based on the impedance. Because the impedance measurements may be obtained, in some examples, by using electrodes and leads implanted within the cardiovascular system and coupled to an implantable medical device, a practical estimation of a cardiovascular pressure can be obtained on a chronic basis without requiring the use other invasive sensors, such as micronanometer transducers.

Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. When a cardiac rate exceeds a predetermined threshold, the implantable medical device modifies the pacing protocol parameters to promote AV synchrony.

Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. When a cardiac rate exceeds a predetermined threshold, the implantable medical device modifies the pacing protocol parameters to promote AV synchrony.

Abstract: This disclosure relates to monitoring intracardiac or vascular impedance to determine a change in hemodynamic status by detecting changes in an impedance parameter over cardiac cycles. An example method includes measuring a plurality of impedance values of a path within a patient over time, wherein the path includes at least one blood vessel or cardiac chamber of the patient, and wherein the impedance values vary as a function of blood pressure within the at least one vessel or chamber, determining a plurality of values of an impedance parameter over time based on the measured impedance values, wherein each of the impedance parameter values is determined based on a respective sub-plurality of the impedance values, comparing at least one of the impedance parameter values to at least one prior impedance parameter value, and identifying a change in a cardiovascular parameter related to the blood pressure based on the comparison.

Abstract: A method and system for detecting T-wave alternans for use in an implanted medical device uses wave transformation of QT intervals to obtain a reliable measure of TWA. In one embodiment, an array provides alternating sign multiplication factors which are applied respectively to n consecutive QT values. Each successive QT value is high pass filtered and moved sequentially through a queue so that each cycle each of the n QT values is multiplied by one of the factors; the products are summed and made absolute to provide an alternans match value. The alternans match is compared with a noise threshold signal, and alternans is declared when the match exceeds the threshold by a predetermined amount. The array is programmable and can be varied, providing a high degree of flexibility to optimize the test for the patient.

Abstract: Waveform analysis is used to identify and distinguish components of a sensed input signal, such as P-wave and Far Field R-wave signal components present in a sensed cardiac signal, even when the components are so closely spaced in time that the overlap to create a distorted input signal. A set of composite waveforms are generated by superimposing waveform templates of the signal components with different time delays or degree of overlap. Form parameters for each composite waveform are derived and mapped in a multidimensional map, from which form parameter boundaries are derived. Waveform data is collected from an input signal during a sensed event time window, and form parameters for the input signal waveform are derived. An output identifying the signal component of interest (e.g., a P-wave) and its location within the sensed event time window is produced based upon the set of form parameters of the input signal waveform and the form parameter boundaries.

Abstract: An implantable medical device having a prioritized multiplexor sensing circuit used for monitoring the condition or status of a patient. The device includes patient parameter sensors, such as electrodes, that are monitored for indications of significant events. Sensors indicating the presence of significant events may then be monitored more often than the other sensors.

Abstract: A method and system for detecting T-wave alternans for use in an implanted medical device uses wave transformation of QT intervals to obtain a reliable measure of TWA. In one embodiment, an array provides alternating sign multiplication factors which are applied respectively to n consecutive QT values. Each successive QT value is high pass filtered and moved sequentially through a queue so that each cycle each of the n QT values is multiplied by one of the factors; the products are summed and made absolute to provide an alternans match value. The alternans match is compared with a noise threshold signal, and alternans is declared when the match exceeds the threshold by a predetermined amount. The array is programmable and can be varied, providing a high degree of flexibility to optimize the test for the patient.

Abstract: A method and system for detecting T-wave alternans for use in an implanted medical device uses wave transformation of QT intervals to obtain a reliable measure of TWA. In one embodiment, an array provides alternating sign multiplication factors which are applied respectively to n consecutive QT values. Each successive QT value is high pass filtered and moved sequentially through a queue so that each cycle each of the n QT values is multiplied by one of the factors; the products are summed and made absolute to provide an alternans match value. The alternans match is compared with a noise threshold signal, and alternans is declared when the match exceeds the threshold by a predetermined amount. The array is programmable and can be varied, providing a high degree of flexibility to optimize the test for the patient.

Abstract: This disclosure relates to monitoring intracardiac or vascular impedance to determine a change in hemodynamic status by detecting changes in an impedance parameter over cardiac cycles. An example method includes measuring a plurality of impedance values of a path within a patient over time, wherein the path includes at least one blood vessel or cardiac chamber of the patient, and wherein the impedance values vary as a function of blood pressure within the at least one vessel or chamber, determining a plurality of values of an impedance parameter over time based on the measured impedance values, wherein each of the impedance parameter values is determined based on a respective sub-plurality of the impedance values, comparing at least one of the impedance parameter values to at least one prior impedance parameter value, and identifying a change in a cardiovascular parameter related to the blood pressure based on the comparison.

Abstract: Techniques for estimating a cardiac chamber or vascular pressure based upon impedance are described. A device or system may measure an impedance between at least two electrodes implanted within or proximate to a cardiovascular system. The device or system may estimate a pressure of an element of the cardiovascular system based on a relationship between impedance and volume of the element, and based on a empirical relationship between the volume and the pressure. The device or system may also estimate the dimension of the element based on the impedance-volume relationship, or other characteristics based on the impedance. Because the impedance measurements may be obtained, in some examples, by using electrodes and leads implanted within the cardiovascular system and coupled to an implantable medical device, a practical estimation of a cardiovascular pressure can be obtained on a chronic basis without requiring the use other invasive sensors, such as micronanometer transducers.

Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. The medical device operates to promote intrinsic conduction by providing elongated AV intervals or operating in an atrial based pacing mode. Conduction checks to determine if AV conduction is present are performed on a graduated or progressive scale to facilitate intrinsic emergence.

Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. The medical device determines a course of action based upon the presence or absence of sensed ventricular activity. The device further determines whether that activity is properly conducted or the result of a PVC or nodal rhythm.

Abstract: Waveform analysis is used to identify and distinguish components of a sensed input signal, such as P-wave and Far Field R-wave signal components present in a sensed cardiac signal, even when the components are so closely spaced in time that the overlap to create a distorted input signal. A set of composite waveforms are generated by superimposing waveform templates of the signal components with different time delays or degree of overlap. Form parameters for each composite waveform are derived and mapped in a multidimensional map, from which form parameter boundaries are derived. Waveform data is collected from an input signal during a sensed event time window, and form parameters for the input signal waveform are derived. An output identifying the signal component of interest (e.g., a P-wave) and its location within the sensed event time window is produced based upon the set of form parameters of the input signal waveform and the form parameter boundaries.

Abstract: An implantable medical device having a prioritized multiplexor sensing circuit used for monitoring the condition or status of a patient. The device includes patient parameter sensors, such as electrodes, that are monitored for indications of significant events. Sensors indicating the presence of significant events may then be monitored more often than the other sensors.

Abstract: A method and system nodal rhythm detection and treatment is provided. Detecting consecutive atrial events within a nodal activity window around ventricular events identifies nodal rhythm. Nodal rhythm is treated by calculating and applying a new atrial escape interval adjusted by the interval between the atrial and ventricular events.

Abstract: The invention is directed to methods and apparatus for automatically changing from bi-ventricular pacing, in which an implantable medical device (IMD) applies pacing stimuli to both ventricles of a heart during a cardiac cycle, to single-ventricle pacing, in which the IMD paces one ventricle and inhibits pacing of the other. An IMD applying the techniques of the invention automatically changes from bi-ventricular pacing to single-ventricle pacing, or vice versa, as a function of the reliability of left ventricular pacing. Exemplary techniques for determining the reliability of left ventricular pacing include impedance measurement, capture testing, capture threshold testing, or any combination thereof.

Abstract: A system and method are provided for monitoring cardiac wall motion. A cardiac lead is provided with a motion sensor that is responsive to an excitation signal. The motion sensor signal induced by the excitation signal varies in time due to motion caused by myocardial wall motion. The time-varying motion sensor signal is obtained by sensing circuitry and provided to a processor for use in computing a wall motion parameter useful in assessing ventricular function. The processor provides wall motion parameter output for display or storage. Pacing parameters may be optimized according to wall motion parameter measurements obtained during iterative procedures using the lead-mounted motion sensor.

Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. When a cardiac rate exceeds a predetermined threshold, the implantable medical device modifies the pacing protocol parameters to promote AV synchrony.