Abstract: Systems, devices, and methods may be used to deliver and provide cardiac pacing therapy to a patient. Leads or leadlets carrying one or more left ventricular electrodes may be positioned in or near the interventricular septum to sense and pace left ventricular signals of the patient's heart. In one example, a leadlet including one or more left ventricular electrodes may extend in the coronary sinus from a leadless implantable medical device located in the right atrium.

Abstract: Implantable apparatus includes two or more alignable marker elements, and systems and methods for manufacturing such implantable apparatus, and methods to utilize such implantable apparatus. For example, the implantable apparatus may include a first alignable marker element and a second alignable marker element that may be used to ensure proper alignment with a target site.

Abstract: A method includes locating the triangle of Koch region in the right atrium of a patient's heart; securing at least one electrode of an implantable lead or device to cardiac tissue from the triangle of Koch region to deliver ventricle-from-atrium (VfA) cardiac therapy; and testing the location or depth of the at least one electrode to configure VfA cardiac therapy. Locating the target implant region in the triangle of Koch region may include detecting an atrial slow pathway potential (ASP) or atrial pacing output.

Abstract: A method and device for detecting phrenic nerve stimulation (PNS) in, or using, a cardiac medical device. A test signal sensitive to contraction of a diaphragm of a patient may be sensed and signal artifacts of the test signal within each of a first window of the test signal prior to a predetermined cardiac signal and a second window of the test signal subsequent to the predetermined cardiac signal may be determined. The PNS beat criteria may be evaluated, for example, using the test signal, which may be a heart sounds signal.

Abstract: In some examples, controlling delivery of cardiac resynchronization therapy (CRT) includes storing, in a memory of an implantable medical device system and in association with each of a plurality of heart rates, at least one respective value for an interval between an atrial event and a ventricular event. Processing circuitry of the implantable medical device system may determine a heart rate of a patient and select one of the stored values for the interval between the atrial event and the ventricular event associated with the determined heart rate. The processing circuitry may further determine whether to control therapy delivery circuitry of the implantable medical device system to deliver fusion pacing or biventricular pacing, based on the selected one of the stored values for the interval between the atrial event and the ventricular event.

Abstract: A method and device for detecting phrenic nerve stimulation (PNS) in, or using, a cardiac medical device. A test signal sensitive to contraction of a diaphragm of a patient may be sensed and signal artifacts of the test signal within each of a first window of the test signal prior to a predetermined cardiac signal and a second window of the test signal subsequent to the predetermined cardiac signal may be determined. The PNS beat criteria may be evaluated, for example, using the test signal, which may be a heart sounds signal.

Abstract: In some examples, controlling delivery of cardiac resynchronization therapy (CRT) includes storing, in a memory of an implantable medical device system and in association with each of a plurality of heart rates, at least one respective value for an interval between an atrial event and a ventricular event. Processing circuitry of the implantable medical device system may determine a heart rate of a patient and select one of the stored values for the interval between the atrial event and the ventricular event associated with the determined heart rate. The processing circuitry may further determine whether to control therapy delivery circuitry of the implantable medical device system to deliver fusion pacing or biventricular pacing, based on the selected one of the stored values for the interval between the atrial event and the ventricular event.

Abstract: Systems, devices, and methods may be used to deliver and provide cardiac pacing therapy to a patient. Leads or leadlets carrying one or more left ventricular electrodes may be positioned in or near the interventricular septum to sense and pace left ventricular signals of the patient's heart. In one example, a leadlet including one or more left ventricular electrodes may extend in the coronary sinus from a leadless implantable medical device located in the right atrium.

Abstract: A method includes locating the triangle of Koch region in the right atrium of a patient's heart; securing at least one electrode of an implantable lead or device to cardiac tissue from the triangle of Koch region to deliver ventricle-from-atrium (VfA) cardiac therapy; and testing the location or depth of the at least one electrode to configure VfA cardiac therapy. Locating the target implant region in the triangle of Koch region may include detecting an atrial slow pathway potential (ASP) or atrial pacing output.

Abstract: A method of delivering a pacing lead may include locating a potential implantation site adjacent to or within the triangle of Koch region of a patient's heart. The method may include advancing a pacing lead to the potential implantation site. The pacing lead has an elongate body and a fixation element coupled to a distal portion and attachable to the right-atrial endocardium adjacent to or within the triangle of Koch region. The method may include implanting the pacing lead at the potential implantation site to or sense electrical activity of the left ventricle in the basal and/or septal region of the left ventricular myocardium of the patient's heart. The pacing lead may include a lumen configured to receive a guide wire. A sheath of a delivery system used to deliver the pacing lead may include two or more curves to facilitate implanting the pacing lead at the implantation site.

Abstract: A method and device for detecting phrenic nerve stimulation (PNS) in, or using, a cardiac medical device. A test signal sensitive to contraction of a diaphragm of a patient may be sensed and signal artifacts of the test signal within each of a first window of the test signal prior to a predetermined cardiac signal and a second window of the test signal subsequent to the predetermined cardiac signal may be determined. The PNS beat criteria may be evaluated, for example, using the test signal, which may be a heart sounds signal.

Abstract: In some examples, controlling delivery of cardiac resynchronization therapy (CRT) includes storing, in a memory of an implantable medical device system and in association with each of a plurality of heart rates, at least one respective value for an interval between an atrial event and a ventricular event. Processing circuitry of the implantable medical device system may determine a heart rate of a patient and select one of the stored values for the interval between the atrial event and the ventricular event associated with the determined heart rate. The processing circuitry may further determine whether to control therapy delivery circuitry of the implantable medical device system to deliver fusion pacing or biventricular pacing, based on the selected one of the stored values for the interval between the atrial event and the ventricular event.

Abstract: A delivery tool of a system for deploying medical diagnostics and/or therapy includes a deployment member and a sheath. An elastic cantilever element secured to a tubular sidewall of the deployment member, in proximity to a distal opening of a lumen formed by the sidewall, is spring biased to extend outward from the sidewall. When the cantilever element is received within the sheath, a sheath sidewall pushes the cantilever element inward, against the spring bias thereof, and a radius of curvature of the cantilever element approximately conforms to that of an outer surface of the deployment member sidewall. A helical track for receiving passage of a medical device helix fixation element therein may extend around a perimeter of the deployment member lumen, wherein a distal terminal end of the track is located in close proximity to the distal opening and generally opposite a free end of the cantilever element.

Abstract: Systems, methods, and interfaces are described herein for assisting in a user in configuring cardiac therapy. A projection of a phrenic nerve stimulation map may be projected on a graphical depiction of a portion of a patient's heart. The phrenic nerve stimulation map may indicate to a user the regions of the patient's heart that may have a likelihood of stimulating the patient's phrenic nerve.

Abstract: A medical device and associated method determine a signal amplitude of a sensor signal produced by a MEMS sensor, compare the signal amplitude to a stiction detection condition, detect stiction of the MEMS sensor in response to the signal amplitude meeting the stiction detection condition, and automatically provide a corrective action in response to detecting the stiction.

Abstract: A method and medical device for monitoring patient medication compliance that includes a plurality of electrodes to deliver a pacing therapy and a processor configured to determine a pacing threshold in response to the delivered pacing therapy, determine whether there is a change in the pacing threshold, and determine patient medication compliance in response to the determined changes.

Abstract: A medical device and associated method determine a signal amplitude of a sensor signal produced by a MEMS sensor, compare the signal amplitude to a stiction detection condition, detect stiction of the MEMS sensor in response to the signal amplitude meeting the stiction detection condition, and automatically provide a corrective action in response to detecting the stiction.

Abstract: A delivery tool of a system for deploying medical diagnostics and/or therapy includes a deployment member and a sheath. An elastic cantilever element secured to a tubular sidewall of the deployment member, in proximity to a distal opening of a lumen formed by the sidewall, is spring biased to extend outward from the sidewall. When the cantilever element is received within the sheath, a sheath sidewall pushes the cantilever element inward, against the spring bias thereof, and a radius of curvature of the cantilever element approximately conforms to that of an outer surface of the deployment member sidewall. A helical track for receiving passage of a medical device helix fixation element therein may extend around a perimeter of the deployment member lumen, wherein a distal terminal end of the track is located in close proximity to the distal opening and generally opposite a free end of the cantilever element.

Abstract: Techniques for identifying abnormal cardiac substrate, e.g., scar substrate, may be implemented, as an example, during implantation of a left-ventricular (LV) lead, e.g., for cardiac resynchronization therapy (CRT), which may enable placement of the LV lead to avoid the abnormal cardiac substrate. An example system for identifying abnormal cardiac substrate comprises at least one implantable LV lead comprising at least one bipolar electrode pair configured to sense a LV bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair. The system delivers cardiac pacing pulses to a left ventricle via at least one electrodes of the LV lead, which may be different then the electrodes of the bipolar pair, and which may be spaced at least a threshold distance from the bipolar pair of electrodes. The amplitude of paced depolarizations in the bipolar electrogram indicates whether tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate.

Abstract: Systems, methods, and interfaces are described herein for assisting in a user in configuring cardiac therapy. A projection of a phrenic nerve stimulation map may be projected on a graphical depiction of a portion of a patient's heart. The phrenic nerve stimulation map may indicate to a user the regions of the patient's heart that may have a likelihood of stimulating the patient's phrenic nerve.