Abstract: A device for the active fixation of an implantable medical lead includes a housing, a tine assembly, an electrode, and a rotatable shaft. The housing includes a proximal end for connecting to the lead and a distal end opposite the proximal end. The housing defines a housing lumen extending between the proximal end and a recess adjacent to the distal end. The tine assembly is disposed within the housing lumen and includes at least one tine configured to self-bias from a linear configuration within the housing to a curved configuration outside of the housing. The electrode assembly is disposed at the distal end of the housing and includes a plurality of electrodes. The rotatable shaft extends through the housing lumen and is configured to engage the tine assembly such that rotation of the shaft transitions the at least one tine between the linear configuration and the curved configuration.

Abstract: A device for the active fixation of an implantable medical lead includes a housing, a tine assembly, an electrode, and a rotatable shaft. The housing includes a proximal end for connecting to the lead and a distal end opposite the proximal end. The housing defines a housing lumen extending between the proximal end and a recess adjacent to the distal end. The tine assembly is disposed within the housing lumen and includes at least one tine configured to self-bias from a linear configuration within the housing to a curved configuration outside of the housing. The electrode assembly is disposed at the distal end of the housing and includes a plurality of electrodes. The rotatable shaft extends through the housing lumen and is configured to engage the tine assembly such that rotation of the shaft transitions the at least one tine between the linear configuration and the curved configuration.

Abstract: This document discusses, among other things, systems and methods to receive physiologic information from a patient during different first and second pacing periods having respective, different first and second atrioventricular (AV) delays, determine first and second physiologic parameters using respective received physiologic information from the first and second pacing periods, and adjust the first AV delay using the determined first and second physiologic parameters, wherein the second AV delay is longer than the first AV delay.

Abstract: New and alternative approaches to the monitoring of cardiac signal quality for external and/or implantable cardiac devices. In one example, signal quality is monitored continuously or in response to a triggering event or condition and, upon identification of a reduction in signal quality, a device may reconfigure its sensing state. In another example, one or more trends of signal quality are monitored by a device, either continuously or in response to a triggering event or condition, and sensing reconfiguration may be performed in response to identified trends and events. In yet another example, a device may use a looping data capture mode to track sensing data in multiple vectors while primarily relying on less than all sensing vectors to make decisions and, in response to a triggering event or condition, the looped data can be analyzed automatically, without waiting for additional data capture to reconfigure sensing upon identification of the triggering event or condition.

Abstract: A medical device system has a medical device interface configured to download data from an implanted medical device. Memory stores electrode location identification rules and display definitions. Each of the display definitions correspond to possible electrode placement locations of the implanted medical device. Processing circuitry is configured to compare the downloaded data from the implanted medical device to the electrode location identification rules to identify one or more actual electrode placement locations of the possible electrode placement locations of the implanted medical device. A user output interface is in communication with the processing circuitry. The processing circuitry is configured to cause the output to display the one or more actual electrode placement locations.

Abstract: A subcutaneous implantable cardioverter-defibrillator (S-ICD) comprising shocking electrodes configured to reduce the defibrillation threshold. The S-ICD may include a canister housing a source of electrical energy, a capacitor, and operational circuitry that senses heart rhythms and an electrode and lead assembly. The electrode and lead assembly may comprise a lead, at least one sensing electrode, and at least one shocking electrode. The at least one shocking electrode may extend over a length in the range of 50 to 110 millimeters and a width in the range of 1 to 40 millimeters.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, and alternate the first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay. Physiologic information can be received from the patient, and one of the first or second pacing period for delivery to the patient can be determined using the received physiologic information.

Abstract: An example of a system and method for protecting a patient diagnosed of cancer from cardiac injury resulting from a chemotherapy treating the cancer. A sequence of cardioprotective pacing sessions may be initiated based on timing of the chemotherapy. Cardiac pacing pulses may be delivered to the patient during each session of the cardioprotective pacing sessions according to a cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from the chemotherapy. The cardioprotective pacing mode may specifying alternating non-pacing and pacing periods.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, to alternate first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, and to determine an increased pacing rate for the first pacing waveform during the first pacing period using the first AV delay, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay.

Abstract: A medical device system has a medical device interface configured to download data from an implanted medical device. Memory stores electrode location identification rules and display definitions. Each of the display definitions correspond to possible electrode placement locations of the implanted medical device. Processing circuitry is configured to compare the downloaded data from the implanted medical device to the electrode location identification rules to identify one or more actual electrode placement locations of the possible electrode placement locations of the implanted medical device. A user output interface is in communication with the processing circuitry. The processing circuitry is configured to cause the output to display the one or more actual electrode placement locations.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. A medical system includes electrostimulation circuit that may generate His-bundle pacing (HBP) pulses for delivery at or near the His bundle. A capture verification circuit may detect, from a far-field signal representing ventricular response to the HBP pulses, a His-bundle response representative of excitation of the His bundle directly resulting from the HBP pulses, and a myocardial response representative of excitation of the myocardium directly resulting from the HBP pulses. A control circuit may adjust one or more stimulation parameters based on the His-bundle response and myocardial response. The electrostimulation circuit may generate and deliver the HBP pulses according to the adjusted stimulation parameters to excite the His bundle.

Abstract: Methods and/or device facilitating and selecting among multiple modes of filtering a cardiac electrical signal, in which one filtering mode includes additional high pass filtering of low frequency signals, relative to the other filtering mode. The selection filtering modes may include comparing sensed signal amplitude to one or more thresholds, using the multiple modes of filtering. In another example, an additional high pass filter is enabled, over and above a default or baseline filtering mode, and the detected cardiac signal is monitored for indications of possible undersensing, and/or for drops in amplitude toward a threshold, and the additional high pass filter may be disabled upon finding of possible undersensing or drop in signal amplitude.

Abstract: An IMD may include a housing with a controller and a power supply disposed within the housing. A distal electrode may be supported by a distal electrode support that biases the distal electrode toward an extended position in which the distal electrode extends distally from the distal end of the housing and allows the distal electrode to move proximally relative to the extended position in response to an axial force applied to the distal electrode in the proximal direction. In some cases, the distal electrode support may include a tissue ingrowth inhibiting outer sleeve that extends along the length of the distal electrode support and is configured to shorten when the distal electrode moves proximally relative to the extended position and to lengthen when the distal electrode moves back distally toward the extended position in order to accommodate movement of the distal electrode.

Abstract: Methods and/or device facilitating and selecting among multiple modes of filtering a cardiac electrical signal, in which one filtering mode includes additional high pass filtering of low frequency signals, relative to the other filtering mode. The selection filtering modes may include comparing sensed signal amplitude to one or more thresholds, using the multiple modes of filtering. In another example, an additional high pass filter is enabled, over and above a default or baseline filtering mode, and the detected cardiac signal is monitored for indications of possible undersensing, and/or for drops in amplitude toward a threshold, and the additional high pass filter may be disabled upon finding of possible undersensing or drop in signal amplitude.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker and an extracardiac device. The extracardiac device is configured to analyze one or more QRS complexes of the patient's heart, determine whether fusion pacing is taking place, and, if not, to communicate with the leadless cardiac pacemaker to adjust intervals used in the CRT in order to generate desirable fusion of the pace and intrinsic signals. The extracardiac device may take the form of a subcutaneous implantable monitor, a subcutaneous implantable defibrillator, or other devices including wearable devices.

Abstract: This document discusses, among other things, systems and methods to acclimate a patient to therapy from an implantable medical device. For instance, an implantable medical device can include pulse generation circuitry, sensing circuitry, and a controller. The pulse generation circuitry can generate electrical pulses. The sensing circuitry can be for sensing cardiac electrical activity of the patient. In an example, the controller can detect cardiac events that define pacing timing intervals and control the delivery of electrical pulses in accordance with a programmed mode. The controller can be programmed to provide instructions to the pulse generation circuitry to deliver electrical pulses to the heart of a patient. In an example, the electrical pulses can be based on a therapy parameter. The controller can be configured to adjust the therapy parameter according to an acclimation profile to acclimate the patient to a stimulation therapy.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker (LCP) and an extracardiac device (ED). The LCP is configured to deliver pacing therapy at a pacing interval. Illustratively, the ED may be configured to analyze the cardiac cycle including a portion preceding the pacing therapy delivery for one or several cardiac cycles, and determine whether an interval from the P-wave to the pace therapy in the cardiac cycle(s) is in a desired range. In an example, if the P-wave to pace interval is outside the desired range, the ED communicates to the LCP to adjust the pacing interval.

Abstract: Methods and devices for cardiac therapy. One example provides a subcutaneous anti-tachycardia pacing therapy. Another example provides a subcutaneous low energy cardioversion therapy. Yet another example provides a subcutaneous multiple pulse cardioversion therapy. In various examples, specific steps are taken to ensure synchronization of delivered therapy when provided in response to sensing and analysis of a subcutaneous signal. Some examples use a substernal device instead.

Abstract: Methods, systems and devices for providing cardiac resynchronization therapy (CRT) to a patient using a leadless cardiac pacemaker (LCP) and an extracardiac device (ED). The LCP is configured to deliver pacing therapy at a pacing interval. Illustratively, the ED may be configured to analyze the cardiac cycle including a portion preceding the pacing therapy delivery for one or several cardiac cycles, and determine whether an interval from the P-wave to the pace therapy in the cardiac cycle(s) is in a desired range. In an example, if the P-wave to pace interval is outside the desired range, the ED communicates to the LCP to adjust the pacing interval.

Abstract: A medical system includes a physiological monitoring system configured to sense a physiological signal and record physiological signal data indicative of the patient's physiological state. The physiological monitoring system including a controller, a storage device, at least one sensor operatively coupled to the controller, and a first communication component. The system includes a mobile device configured to facilitate sensor placement, the mobile device comprising a controller, a display device, and a second communication component configured to facilitate communication between the physiological monitoring system and the mobile device. The controller of the mobile device is configured to provide a graphical user interface (GUI) on the display device, the GUI including information about a proper placement of the at least one sensor, wherein the proper placement is determined based on the physiological signal data.