Abstract: Methods and systems to modulate timing intervals for pacing therapy are described. For each cardiac cycle, one or both of an atrioventricular (A-V) timing interval and an atrial (A-A) timing interval are modulated to oppose beat-to-beat ventricular (V-V) timing variability. Pacing therapy is delivered using the modulated timing intervals.

Abstract: A neurostimulation system includes a neural stimulation lead having a proximal portion and a distal portion and including a plurality of electrodes along the distal portion. The plurality of electrodes are configured for positioning proximate a portion of the autonomic nervous system. A neural stimulation circuit, coupled to the plurality of electrodes, delivers neural stimulation pulses to the plurality of electrodes. A processor and controller is configured to control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations. Each electrode configuration includes one or more of the plurality of electrodes. The processor and controller is further configured to receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations and to identify the electrode configurations that induce the motor fiber activity.

Abstract: A pacemaker initiates and times a monitoring interval in response to an event such as a therapy delivery to a patient. The monitoring interval is specified to include a duration of an anticipated acute response to the event, such as vagal surge. One or more physiological parameters indicative of the acute response are detected during the monitoring interval for analyzing therapeutic effect of the event. In various embodiments, one or more pacing parameters are adjusted for a response interval specified to include the duration of the anticipated acute response to allow for the analysis and maximization of the therapeutic effect. In various embodiments, the event includes a session of pacing therapy delivered according to an intermittent cardiac stress augmentation pacing protocol, and the therapeutic effect is analyzed to adjust that protocol.

Abstract: Embodiments of the invention are related to medical devices and methods for delivery high-energy anti-tachycardia therapy to a subject, amongst other things. In an embodiment, the invention includes a medical device including a controller module configured to administer a plurality of electrical pulses to a patient in response to a detected tachycardia, the electrical pulses comprising an amplitude of greater than 3 Volts and less than 40 Volts, the controller configured to modulate the amplitude of the electrical pulses. In an embodiment, the invention includes a method of treating a tachyarrhythmia including administering a first series of electrical pulses to a patient with an implantable medical device, the electrical pulses including an amplitude of greater than 8 Volts and less than 40 Volts, the first series of electrical pulses having an interval of less than about 600 ms in between individual pulses. Other embodiments are also included herein.

Abstract: Cardioprotective pre-excitation pacing may be applied to stress or de-stress a particular myocardial region delivering of pacing pulses in a manner that causes a dyssynchronous contraction. Such dyssynchronous contractions are responsible for the desired cardioprotective effects of pre-excitation pacing but may also be hazardous. Described herein is a method and system that uses measures of a patient's physiological response to ventricular dyssynchrony to control the duty cycles of intermittent pre-excitation pacing.

Abstract: Some embodiments provide a system for delivering neurostimulation. Some system embodiments comprise a lead configured to be implanted in the body, a stimulation output circuit configured to deliver neurostimulation pulses to the vagus nerve through the lead, an EMG sensing circuit configured to use the lead to sense EMG signals from laryngeal muscle activity, and an evoked muscular response detection circuit configured to use the EMG signals sensed by the EMG sensing circuit to detect evoked laryngeal muscle activity evoked by the neurostimulation pulse.

Abstract: Implanted electrodes can be used to deliver electrical stimulation signals to areas near blood vessels, nerves, or other internal body locations. In an example, an electrode can be implanted in a cervical location and can be used to measure dimensional changes in an artery using impedance plethysmography. Measured artery dimensional changes can be used to determine one or more physiological parameters associated with a patient's health status, such as pulse transit time, relative pulse pressure, or aterial compliance, among others. These parameters can be used to monitor a patient health status or to modulate a patient's therapy, among other uses. In some examples, an electrode configured to deliver an electrostimulation signal to nerve tissue can be used to provide non-neurostimulating electrical stimulation plethysmography signals near a blood vessel.

Abstract: Some embodiments provide a method comprising delivering neural stimulation for a neural stimulation therapy according to a programmed schedule, detecting a swallow event, and responding to the detected swallow event by overriding the programmed schedule.

Abstract: A method and device to detect and compare changes in atrial rate and morphology can be used to identify left atrial sense and capture, such as from a quadripolar or other lead located in or around the coronary sinus.

Abstract: A method and apparatus is described for detecting and localizing areas of myocardial infarction or ischemia. By pacing sites in proximity to the infarcted or ischemic region with appropriately timed pacing pulses, the region is pre-excited in a manner that lessens the mechanical stress to which it is subjected, thus reducing the metabolic demand of the region and the stimulus for remodeling.

Abstract: Some embodiments provide a method, comprising performing a neural stimulation test routine for stimulating a neural target in a cervical region of a patient, wherein for each of a plurality of head positions, performing the neural stimulation test routine includes testing a plurality of electrode configurations. The method further comprises recording threshold data for each of the tested electrode configurations for the plurality of head positions, and recommending an electrode configuration based on the recorded threshold data.

Abstract: Stimulation energy can be provided to a His-bundle to activate natural cardiac contraction mechanisms. Interval information can be used to describe a cardiac response to His-bundle stimulation, and the interval information can provide cardiac stimulation diagnostic information. For example, interval information can be used to discriminate between intrinsic conduction cardiac contractions and contractions responsive to His-bundle pacing.

Abstract: A method and apparatus is described for detecting and localizing areas of myocardial infarction or ischemia. By pacing sites in proximity to the infarcted or ischemic region with appropriately timed pacing pulses, the region is pre-excited in a manner that lessens the mechanical stress to which it is subjected, thus reducing the metabolic demand of the region and the stimulus for remodeling.

Abstract: A device embodiment is configured to deliver vagal stimulation therapy (VST) to a vagus nerve of a patient. The device embodiment includes a neural stimulator, an implantable impedance sensor and an impedance analyzer. The neural stimulator is configured to deliver the VST to the vagus nerve in a cervical region of the patient. The implantable impedance sensor is configured to detect impedance changes in a cervical region of the patient caused by laryngeal vibrations. The impedance sensor is configured to generate sensed impedance values. The impedance analyzer is configured to analyze the sensed impedance values generated by the sensor. The analyzer is configured to detect laryngeal vibrations or cough from the sensed impedance values.

Abstract: A device embodiment is configured to deliver vagal stimulation therapy (VST) to a vagus nerve of a patient. The device embodiment includes a neural stimulator, an implantable pressure sensor, and a pressure analyzer. The neural stimulator is configured to deliver the VST to the vagus nerve in a cervical region of the patient. The implantable pressure sensor is configured to be implanted in the cervical region and to detect pressure changes in the cervical region caused by laryngeal vibrations. The pressure sensor is configured to generate sensed pressure values. The pressure analyzer is configured to analyze the sensed pressure values generated by the pressure sensor. The analyzer is configured to detect laryngeal vibrations or cough from the sensed pressure values.

Abstract: A device and method for delivering electrical stimulation to the heart in order to improve cardiac function in heart failure patients. The stimulation is delivered as high-output pacing in which the stimulation is excitatory and also of sufficient energy to augment myocardial contractility. In order to provide a consistent hemodynamic response, the high-output pacing is optimized by delivering it using different parameter sets, evaluating the hemodynamic response thereto as reflected by one or more measured physiological variables, and selecting the parameter set with the best hemodynamic response.

Abstract: Methods and systems to modulate timing intervals for pacing therapy are described. For each cardiac cycle, one or both of an atrioventricular (A-V) timing interval and an atrial (A-A) timing interval are modulated to oppose beat-to-beat ventricular (V-V) timing variability. Pacing therapy is delivered using the modulated timing intervals.

Abstract: An A-H delay can be specified, such as by computing the A-H delay using a measured cardiovascular physiologic parameter. The A-H delay can be used for specifying timing between a paced or sensed atrial contraction and a His-bundle pacing time.

Abstract: This document discusses, among other things, an apparatus comprising an implantable cardiac depolarization sensing circuit, an electrical stimulation circuit, and a pacing mode controller. The pacing mode controller is configured to deliver pacing therapy according to a first pacing mode that is a normal operating mode, and to deliver pacing therapy according to second and third pacing modes. The second and third pacing modes increase mechanical stress on at least a particular portion of the ventricle as compared to the pacing therapy delivered during the first pacing mode. The pacing mode controller alternates between the second and third pacing modes when switched from the normal operating mode to a stress augmentation mode and stores a statistic related to the stress augmentation mode in a stress augmentation cycle memory area.

Abstract: A neurostimulation system includes a neural stimulation lead having a proximal portion and a distal portion and including a plurality of electrodes along the distal portion. The plurality of electrodes are configured for positioning proximate a portion of the autonomic nervous system. A neural stimulation circuit, coupled to the plurality of electrodes, delivers neural stimulation pulses to the plurality of electrodes. A processor and controller is configured to control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations. Each electrode configuration includes one or more of the plurality of electrodes. The processor and controller is further configured to receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation pulses to each of the plurality of electrode configurations and to identify the electrode configurations that induce the motor fiber activity.