Abstract: Devices and methods for therapy control based on electromechanical timing involve detecting electrical activation of a patient's heart, and detecting mechanical cardiac activity resulting from the electrical activation. A timing relationship is determined between the electrical activation and the mechanical activity. A therapy is controlled based on the timing relationship. The therapy may improve intraventricular dyssynchrony of the patient's heart, or treat at least one of diastolic and systolic dysfunction and/or dyssynchrony of the patient's heart, for example. Electrical activation may be detected by sensing delivery of an electrical stimulation pulse to the heart or sensing intrinsic depolarization of the patient's heart. Mechanical activity may be detected by sensing heart sounds, a change in one or more of left ventricular impedance, ventricular pressure, right ventricular pressure, left atrial pressure, right atrial pressure, systemic arterial pressure and pulmonary artery pressure.

Abstract: Devices and methods for improving cardiac efficiency involve measuring, patient-internally, an oxygen saturation parameter indicative of oxygen usage of myocardial tissue of the heart. A cardiac electrical therapy is adjusted to cause a change of the measured oxygen saturation parameter, and the adjusted cardiac electrical therapy is selected for delivery based on a changed oxygen saturation parameter indicative of an increase in cardiac efficiency.

Abstract: Pacing left and right ventricles of the heart for delivery of heart failure therapy involves measuring right ventricular (RV) pressure and a left ventricular (LV) pressure, and computing a parameter developed from one or both of the RV and LV pressure measurements. The parameter is indicative of a degree of left and right ventricular synchronization. At least one parameter of a heart failure pacing therapy is adjusted based on the parameter to improve synchronization of the right and left ventricles.

Abstract: A guiding catheter for use in medical procedures includes a flexible shaft with one or more audio transducers and a distal tip. An audio signal may be sent to one or more of the transducers and a reflected signal is received at one or more transducers. The reflected signal is used to detect the presence of an anatomical structure to assist in navigating the catheter to its destination. In another arrangement, the transducer can be used passively to detect physical characteristics of the heart such as sound, subsonic energy or temperature, that indicate relative proximity of a destination vessel.

Abstract: A system and method for administering a therapeutic treatment to the heart includes a pressure sensor positioned in the pulmonary artery, an implantable medical device located remotely from the sensor, and communication means for communicating pressure data from the pressure sensor to the implantable medical device. The system includes a control module operatively coupled to the implantable medical device. The control module is adapted for comparing the pulmonary arterial pressure data to a pre-programmed value, adjusting an operating parameter of the implantable medical device based on the relationship of the pulmonary arterial pressure to the pre-programmed value, and repeating this process until the relationship between the pulmonary arterial pressure data and the pre-programmed value is such that no adjustment is necessary.

Abstract: A system and method for administering a therapeutic treatment to the heart, includes a pressure sensor positioned in the pulmonary artery, an implantable medical device located remotely from the sensor, and communication means for communicating pressure data from the pressure sensor to the implantable medical device. The system includes a control module operatively coupled to the implantable medical device. The control module is adapted for comparing the pulmonary arterial pressure data to a pre-programmed value, adjusting an operating parameter of the implantable medical device based on the relationship of the pulmonary arterial pressure to the pre-programmed value, and repeating this process until the relationship between the pulmonary arterial pressure data and the pre-programmed value is such that no adjustment is necessary.

Abstract: Methods of cardiac pacing involve sensing left ventricular electrical rhythms, sensing left ventricular blood flow rate, and sensing a coronary vein blood temperature. The methods further involve modifying delivery of synchronized electrical signals to the patient's heart based at least in part on the sensed coronary vein blood temperature and sensed left ventricular flow rate.

Abstract: An apparatus and method for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Abstract: Pacing left and right ventricles of the heart for delivery of heart failure therapy involves measuring right ventricular (RV) pressure and a left ventricular (LV) pressure, and computing a parameter developed from one or both of the RV and LV pressure measurements. The parameter is indicative of a degree of left and right ventricular synchronization. At least one parameter of a heart failure pacing therapy is adjusted based on the parameter to improve synchronization of the right and left ventricles.

Abstract: A method and apparatus for pacing left and right ventricles of the heart involve measuring one or both of a right ventricular (RV) pressure and a left ventricular (LV) pressure, and computing a parameter developed from one or both of the RV and LV pressure measurements. The parameter is indicative of a degree of left and right ventricular synchronization. The parameter is assessed, and an interventricular (V-V) delay is adjusted in response to the parameter assessment. The V-V delay is adjusted to effect a change in the parameter that improves synchronization of the right and left ventricles. The computed parameter is a parameter indicative of hemodyamic state, such as a PP Loop or a pre-ejection period.

Abstract: An apparatus and method for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Abstract: A cardiac electro-stimulatory device and method for operating same in which stimulation pulses are distributed among a plurality of electrodes fixed at different sites of the myocardium in order to reduce myocardial hypertrophy brought about by repeated pacing at a single site and/or increase myocardial contractility. In order to spatially and temporally distribute the stimulation, the pulses are delivered through a switchable pulse output configuration during a single cardiac cycle, with each configuration comprising one or more electrodes fixed to different sites in the myocardium.

Abstract: A cardiac electro-stimulatory device and method for operating same in which stimulation pulses are distributed among a plurality of electrodes fixed at different sites of the myocardium in order to reduce myocardial hypertrophy brought about by repeated pacing at a single site and/or increase myocardial contractility. In order to spatially and temporally distribute the stimulation, the pulses are delivered through a switchable pulse output configuration during a single cardiac cycle, with each configuration comprising one or more electrodes fixed to different sites in the myocardium.

Abstract: A drug delivery system detects a cardiac condition indicative of a need for increasing a cardiac metabolic level and, in response, releases a drug into tissue or blood to shift a source of metabolically synthesized energy fueling cardiac contraction from fatty acid to glucose. One example of such a system includes an implantable device detecting an ischemia and a transdermal drug delivery device delivering a drug when an ischemic condition is detected. Another example of such a system includes one or more implantable devices detecting a predefined change in cardiac metabolic level and delivering a drug when the change is detected. Such systems are applied to treat, for example, patients suffering ischemia and/or heart failure and patients having suffered myocardial infarction.

Abstract: An apparatus and method for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Abstract: Various system embodiments comprise a neural stimulator, a pulse generator, and a controller. The neural stimulator is adapted to generate a neural stimulation signal. The pulse generator is adapted to generate a pacing signal to provide myocardium pacing. The controller is adapted to control the neural stimulator and the pulse generator to provide a cardioprotective conditioning therapy. The conditioning therapy includes neural stimulation to elicit a parasympathetic response and myocardium pacing. Other aspects and embodiments are provided herein.

Abstract: Described herein are methods and systems for delivering pacing therapy to HF patients who do not exhibit a reduced EF. Such patients do not have systolic dysfunction and generally do not benefit from established HF therapies that either augment contractile function or counteract conduction abnormalities. In one embodiment, a HF patient with a normal EF is tested for the adequacy of heart rate response during exercise. If the patient is found to be chronotropically incompetent, a rate-adaptive pacing mode is employed in order improve functional capacity.

Abstract: Various aspects relate to a device. Various device embodiments include at least a first and a second transducer, and a controller. The first transducer is adapted to be positioned to direct a first energy wave toward a neural target, and the second transducer is adapted to be positioned to direct a second energy wave toward the neural target. The controller is connected to the transducers to generate the first energy wave with a first predetermined phase and a first predetermined amplitude from the first transducer and to generate the second energy wave with a second predetermined phase and a second predetermined amplitude from the second transducer. The amplitudes are selected so that a neural stimulation threshold is reached only during constructive wave interference. The phases are selected so that the first and second energy waves constructively interfere at the neural target. Other aspects and embodiments are provided herein.

Abstract: A system and methods for enhancing non-invasive imaging and tracking by providing an internal marker detectable by an external imaging system is disclosed. The marker may be active or passive by either generating or reflecting energy. The imaging system may be utilized to optimize imaging parameters to compensate for aberrations in the detected energy based on a known location of the marker, thereby correcting the acquired image. The system may also track the marker automatically, thereby tracking the desired image. This permits, for example, continuous ultrasonic imaging of the heart without requiring constant operator attention.

Abstract: A method of optimizing inter-site delay is disclosed for a cardiac rhythm management device that includes a dual chamber pacemaker, especially designed for treating congestive heart failure by pacing a plurality of sites. A microcontroller is operative to adjust the pacing mode and inter-site delay of the pacemaker so as to achieve optimum hemodynamic performance. Atrial cycle lengths measured during transient (immediate) time intervals following a change in the mode inter-site delay are signal processed and a determination can then be made as to which particular configuration yields the optimum performance. Performance is optimized when the patient is at rest and when the patient exercises so that a rate-adapted dynamic value of the optimum performance can be applied.