Abstract: Methods, devices, and systems for controlling a tissue-treatment motion by a surgical instrument are disclosed.

Abstract: Various example embodiments described herein are directed to articulating surgical instruments for treating tissue comprising an end effector and a shaft extending proximally from the end effector along a longitudinal axis. In certain embodiments, the shaft comprises a plurality of transverse spacer members as well as first and second rotatable members extending through at least a portion of the plurality of transverse spacer members. The first and second rotatable members may both be biased away from the longitudinal axis such that their respective directions of bias vary with rotation of the first rotatable member. When the respective directions of bias of the first and second rotatable members oppose one another, the shaft may be substantially straight. When the respective directions of bias of the first and second rotatable members are aligned with one another, the shaft may articulate away from the longitudinal axis in the direction of the alignment.

Abstract: A method and system for use in selecting a cardiac pacing site includes sensors for tracking wall motion (e.g., sensors coupled to the right and left ventricular heart wall). The wall motion of one or more non-paced cardiac cycles is compared to the wall motion of one or more paced cardiac cycles to determine the effectiveness of one or more pacing sites. For example, image data may be generated to notify the user as to the effectiveness of the one or more pacing sites.

Abstract: An antimicrobial accessory may include a membrane layer defining a major surface comprising a first lateral portion, a second lateral portion, and a third lateral portion. The membrane layer may comprise a first biodegradable polymer. The antimicrobial accessory may further include a first porous layer overlying the first lateral portion and a second porous layer overlying the second lateral portion. The first porous layer comprises a second biodegradable polymer and a first antimicrobial, while the second porous layer comprises a third biodegradable polymer and a second antimicrobial.

Abstract: A method and system for use in selecting a cardiac pacing site includes sensors for tracking wall motion (e.g., sensors coupled to the right and left ventricular heart wall). The wall motion of one or more non-paced cardiac cycles is compared to the wall motion of one or more paced cardiac cycles to determine the effectiveness of one or more pacing sites. For example, image data may be generated to notify the user as to the effectiveness of the one or more pacing sites.

Abstract: A method for selecting a cardiac pacing site includes steps of: securing first and second electromagnetic receiver coils at first and second positions, respectively, along a heart wall; collecting a set of non-paced heart wall motion data from each of the coils secured at the corresponding positions; applying cardiac pacing stimulation at at least one first pacing site; collecting a first set of paced heart wall motion data from each of the secured coils; comparing the non-paced heart wall motion data to the first set of paced heart wall motion data; and determining, based on the comparing, whether to maintain pacing at the at least one first cardiac pacing site or to apply pacing stimulation at a second pacing site for collection of a second set of paced heart wall motion data. The at least one first pacing site may include a right ventricular site and a left ventricular site.

Abstract: An algorithm is implemented in a circuit for sensing P-waves in a pacemaker to ensure ventricular pacing synchronization with sensed atrial depolarization waves. VDD and VDDR pacing (atrial synchronized, ventricular inhibited pacing) are implemented via a single standard ventricular pacing lead (unipolar or bipolar) and preferably a subcutaneous electrode array (SEA). Specifically, an implanted ventricular lead provides ventricular pacing and ventricular sensing while the SEA enable atrial sensing, thus eliminating the need for an implanted atrial lead or a specialized single pass VDD lead. The algorithm manages the sensed cardiac waves to effect a desired pacing regimen based on the input from the single lead and SEA.

Abstract: An algorithm is implemented in a circuit for sensing P-waves in a pacemaker to ensure ventricular pacing synchronization with sensed atrial depolarization waves. VDD and VDDR pacing (atrial synchronized, ventricular inhibited pacing) are implemented via a single standard ventricular pacing lead (unipolar or bipolar) and preferably a subcutaneous electrode array (SEA). Specifically, an implanted ventricular lead provides ventricular pacing and ventricular sensing while the SEA enable atrial sensing, thus eliminating the need for an implanted atrial lead or a specialized single pass VDD lead. The algorithm manages the sensed cardiac waves to effect a desired pacing regimen based on the input from the single lead and SEA.

Abstract: An apparatus and method for communicating acoustic telemetry data produced by an implantable medical device over a communication channel includes a signal generator, a modulator, and an acoustic transmitter each provided in the implantable medical device. The modulator modulates a carrier signal with an information signal representative of information acquired or produced by the implantable medical device so as to produce a modulated information signal. The modulated information signal may have a frequency content that is readily accommodated by a public exchange communication channel. The transmitter transmits the modulated information signal as an acoustic information signal in a form communicable over the communication channel. The acoustic information signal may constitute telephonic tones which are directly communicable over a conventional telephone connection.

Abstract: An automatic, body-implantable medical device having at least two modes of operation is disclosed. The device is provided with circuitry for automatically detecting when the device has been implanted in a patient, so that the device can automatically switch from a first mode to a second mode of operation upon implantation. In one embodiment, the first mode is a power conserving mode in which one or more non-essential sub-systems of the device are disabled. Prior to detection of implant, at least two conditions of the device known to reflect whether the device has been implanted are monitored. After implant has been detected, situations in which power to the device is disrupted and then restored will cause the device to enter a predefined "power-on-reset" mode of operation. Prior to detection of implant, however, such conditions do not result in the device entering the power-on-reset mode, or this mode is reset.

Abstract: An automatic, body-implantable medical device having at least two modes of operation is disclosed. The device is provided with circuitry for automatically detecting when the device has been implanted in a patient, so that the device can automatically switch from a first mode to a second mode of operation upon implantation. In one embodiment, the first mode is a power conserving mode in which one or more non-essential sub-systems of the device are disabled. Prior to detection of implant, at least two conditions of the device known to reflect whether the device has been implanted are monitored. After implant has been detected, situations in which power to the device is disrupted and then restored will cause the device to enter a predefined "power-on-reset" mode of operation. Prior to detection of implant, however, such conditions do not result in the device entering the power-on-reset mode, or this mode is reset.

Abstract: An implantable medical device and corresponding system and method are disclosed having programmable operating functions for monitoring a patient condition or delivering a therapy. The device has a primary operating function and a trial operating function. Those functions are enabled or disabled in a time dependent manner to permit their comparison and evaluation in a patient. The device may include a telemetry transceiver for receiving external programmable sequences of operating instructions and for transmitting data externally to a programmer. The device may further include a memory for storing the sequence of operating instructions and for storing data related to the delivery of the therapy or the monitoring function.

Abstract: A method and apparatus of cardiac pacing, in which pacing at an increased rate is provided in response to a detected rapid drop in detected heart rate, to a stable rate below a defined threshold rate.

Abstract: There is provided a dual chamber pacemaker system and method for ventricular pacing to provide therapy for a patient with cardiomyopathy, this system being characterized by automatically adjusting the AV escape interval so that ventricular pace pulses are delivered at an AV delay which is optimized for HOCM and/or dialated cardiomyopathy therapy. The pacemaker system continually obtains and stores representations of a QRS wave characteristic such as duration, derived either directly from the QRS signal or from an FFRS signal, and compares duration data from one or more cycles to prior stored duration data. The system then adjusts the AV interval as a function of the duration comparison, and the direction of the last adjustment of AV escape interval. By this means, the AV escape interval is maintained at or just short of the onset of fusion, thereby automatically providing for optimally lengthened AV escape intervals consistent with full capture by the delivered ventricular pace pulse.

Abstract: A rate-responsive cardiac pacemaker implements a novel scheme which detects incipient vasovagal syncope (or other episodes caused by a vasodepressive or cardioinhibitory disorder) when a) the heart rate drops below a programmable minimum size, and b) the rate after said drop is below a programmable maximum drop ending rate. The pacemaker implements a stability and intervention procedure upon the detection of an episode, in which it ignores transient drops in rate, and paces at a predetermined high rate if the drops are stable. The pacemaker then gradually reduces the pacing rate over a predetermined time to the pre-episodic level. A sleep disable feature disables the vasovagal syncope detection and therapy features during the patient's sleeping hours to reduce or eliminate false positive responses.

Abstract: A pacemaker having a fault-tolerant elective replacement indicator (ERI) triggering scheme in which transient excursions of parameters used as criteria for triggering ERI are rejected as triggering events. Periodic assessments of certain indicia of battery depletion are made, and subjected to a long-term low-pass filtering operation in order to reduce the effects of transient excursions of the indicia which result from non-ERI conditions. Over a long period of time (e.g., a day) predetermined threshold values of the indicia of interest must be exceeded a predetermined number of times in order for the device to issue an ERI. In one disclosed embodiment of the invention, the battery's loaded terminal voltage and internal impedance are used as indicators of the battery's depletion level. Periodically, these values are measured and converted to digital values.

Abstract: An implantable cardiac pacemaker having programmable stimulating pulse amplitudes selectable by means of an external programming unit. The pacemaker includes charge pump circuitry for developing a stimulating pulse voltage on an output capacitor. The output capacitor is charged to a selected level identified by a multiple-bit amplitude value communicated to the implanted device from the external programmer. The pacemaker is also provided with circuitry for monitoring the depletion level of its battery and for generating an indicator signal when the battery has depleted beyond a predetermined level. Associated with the charge pump circuitry is a selectively activated comparator circuit for controlling the charging of the output capacitor. Prior to generation of the indicator signal, the charge pump circuitry remains deactivated for some programmed output amplitudes, the level of output capacitor charging being proportional to the battery voltage.

Abstract: A pacemaker having a fault-tolerant elective replacement indicator (ERI) triggering scheme in which transient excursions of parameters used as criteria for triggering ERI are rejected as triggering events. Periodic assessments of certain indicia of battery depletion are made, and subjected to a long-term low-pass filtering operation in order to reduce the effects of transient excursions of the indicia which result from non-ERI conditions. Over a long period of time (e.g., a day) predetermined threshold values of the indicia of interest must be exceeded a predetermined number of times in order for the device to issue an ERI. In one disclosed embodiment of the invention, the battery's loaded terminal voltage and internal impedance are used as indicators of the battery's depletion level. Periodically, these values are measured and converted to digital values.

Abstract: A rate-responsive cardiac pacemaker in which deceleration of the pacing rate is modulated according to recent patient activity or "work". Based on signals provided from an activity sensor in the pacemaker, the pacemaker maintains and periodically recomputes a work value corresponding to the amount of patient activity detected over time. In response to a decrease in or cessation of detected patient activity, the pacemaker reduces the pacing rate, first at a more rapid deceleration rate, then at a lower deceleration rate, and then once again at a more rapid deceleration rate. The length of time during which the pacing rate is reduced at the lower deceleration rate is modulated according to the work value maintained by the pacemaker.