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: A cardiac rhythm management (CRM) system includes a non-invasive hemodynamic sensing device and an implantable medical device to sense a hemodynamic signal and derive one or more cardiac performance parameters from the hemodynamic signal. The non-invasive hemodynamic sensing device includes at least a portion configured for external attachment to a body in which the implantable medical device is implanted. The one or more cardiac performance parameters are used for various diagnostic, monitoring, and therapy control purposes.

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: A method includes mounting an anchor member to a surface of a heart, the anchor member having a tension member coupled to the anchor member, advancing a lead body along the tension member, the lead body including a plurality of electrodes disposed along the lead body, identifying an MI region of the heart, positioning the plurality of electrodes at or near the MI region, affixing the tension member to the lead body to hold the electrodes in position, and delivering pulses through the plurality of electrodes to the heart.

Abstract: An ultrasonic implantable device includes an ultrasonic sensor having a plurality of transducers. The sensor is configured for mounting to a vessel wall. A first of the transducers directs sound waves in a direction at least partially upstream or downstream in the vessel. A second of the transducers directs sound waves in a radial direction through an interior of the vessel against a sidewall of the vessel. The sensor monitors a change in frequency of the sound waves from the first transducer to determine a fluid velocity in the vessel. The sensor also monitors a reflection time of the sound waves from the second transducer that return from the sidewall to determine an internal diameter of the vessel. The determined fluid velocity and vessel diameter can be used to determine a volumetric flow rate of the fluid in the vessel.

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: 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 method and device for delivering pre-excitation pacing to prevent or reduce cardiac remodeling following a myocardial infarction is described. The pre-excitation pacing is modulated in accordance with an intravascular pressure measurement in order to balance the beneficial effects of stress reduction with hemodynamic compromise.

Abstract: A gene regulatory system detects ischemia events and is capable of delivering a biologic therapy in response to the detection of an ischemic event or the reception of a command. The biologic therapy protects the heart from ischemic damage by regulating the expression of an exogenously introduced gene product. In one embodiment, the gene regulatory system includes an implantable system that emits at least one gene regulatory signal in response to the detection of the ischemic event or the reception of the command. The gene regulatory signal directly or indirectly regulates gene expression of the gene product.

Abstract: An implantable cardiac rhythm management (CRM) device delivers a chronic therapy while detecting an ischemic state. When the ischemic state indicates the occurrence of an ischemic event, the implantable CRM device delivers a post-ischemia therapy. The post-ischemia therapy and the chronic therapy are adjusted using feedback control with the ischemic state and parameters indicative of the effectiveness of the post-ischemic therapy and the effectiveness of the chronic therapy as inputs.

Abstract: A system comprising a medical device that includes an impedance measurement circuit adapted to be coupled to implantable electrodes to obtain an intracardiac impedance signal between electrodes, a therapy circuit operable to deliver a therapy to a subject, and a controller circuit coupled to the impedance measurement circuit and the therapy circuit. The controller circuit determines a time rate of change of the intracardiac impedance signal and adjusts at least one parameter related to therapy in a manner that alters the rate of change.

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: 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: A method and device for delivering pre-excitation pacing to prevent or reduce cardiac remodeling following a myocardial infarction is described. The pre-excitation pacing is modulated in accordance with an assessment of cardiac function in order to balance the beneficial effects of stress reduction with hemodynamic compromise.

Abstract: An implantable cardiac protection pacing system delivers pacing pulses to protect the heart from injuries associated with ischemia and myocardial infarction. The system includes an implantable pulse generator (PG) that delivers the pacing pulses and a coronary stent electrically connected to the implantable PG to function as a pacing electrode through which the pacing pulses are delivered. In one embodiment, an intravascular lead provides the electrical connection between the coronary stent and the implantable PG to allow the implantable PG to be implanted in the femoral region. In another embodiment, the coronary stent and the implantable PG are integrated into an intravascular pulse generator-stent.

Abstract: A method for treating patients after a myocardial infarction which includes pacing therapy is disclosed. A cardiac rhythm management device is configured to deliver pre-excitation pacing to one or more sites in proximity to an infarcted region of the ventricular myocardium. Such pacing acts to minimize the remodeling process to which the heart is especially vulnerable immediately after a myocardial infarction.

Abstract: A method and apparatus are disclosed for treating mitral or tricuspid regurgitation with electrical stimulation. By providing pacing stimulation to a selected region of the left ventricle, such as one in proximity to the mitral valve apparatus or papillary muscles in a manner that pre-excites the region during early ventricular systole, a beneficial effect is obtained which can prevent or reduce the extent of mitral regurgitation.

Abstract: A method and apparatus are disclosed for treating mitral or tricuspid regurgitation with electrical stimulation. By providing pacing stimulation to a selected region of the left ventricle, such as one in proximity to the mitral valve apparatus in a manner which pre-excites the region during early ventricular systole, a beneficial effect is obtained which can prevent or reduce the extent of mitral regurgitation.

Abstract: A cardiac rhythm management system modulates the delivery of pacing and/or autonomic neurostimulation pulses based on heart rate variability (HRV). An HRV parameter being a measure of the HRV is produced to indicate a patient's cardiac condition, based on which the delivery of pacing and/or autonomic neurostimulation pulses is started, stopped, adjusted, or optimized. In one embodiment, the HRV parameter is used to adjust a maximum tracking rate in an atrial tracking pacing mode.

Abstract: A cardiac rhythm management system modulates the delivery of pacing and/or autonomic neurostimulation pulses based on heart rate variability (HRV). An HRV parameter being a measure of the HRV is produced to indicate a patient's cardiac condition, based on which the delivery of pacing and/or autonomic neurostimulation pulses is started, stopped, adjusted, or optimized. In one embodiment, the HRV parameter is used to evaluate a plurality of parameter values for selecting an approximately optimal parameter value.