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: Tunneling tools and systems comprising electrodes and tunneling tool. In some examples the tunneling tools have a width that is greater than thickness, or may have enlarged portions to allow tunneling of a space. The tunneling tools may have expandable dissection portions including expandable balloons, linkages and/or springs in different examples. Systems may include tunneling tools with a lumen for receiving a lead having an electrode in a collapsed configuration, where the electrode is designed to expand once placed in a patient, with the tunneling tool designed to create a space in which the electrode can expand.

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: In some examples, cardiac cycle detection may be used as a more or less default approach to cardiac activity tracking. Additional rate measurement relying on different sources or analyses may require extra power consumption over the cycle detection methods. Therefore, new methods and devices are disclosed that selectively activate a second cardiac rate measurement when needed. In some illustrative methods and devices, decisions are made as to whether and which previously collected data, if any, is to be discarded, replaced, or corrected upon activation of the second cardiac rate measurement.

Abstract: In some examples, cardiac cycle detection may be used as an approach to cardiac activity tracking, with one or more second approaches to cardiac activity tracking also available for use. Additional rate measurement relying on different sources or analyses may require extra power consumption over the cycle detection methods. Therefore, new methods and devices are disclosed that selectively activate a second cardiac rate measurement. In some illustrative methods and devices, decisions are made as to whether and which previously collected data, if any, is to be discarded, replaced, or corrected upon activation of the second cardiac rate measurement. In some illustrative methods and devices, a cardiac cycle detection approach to cardiac activity tracking may be bypassed by a second cardiac rate measurement.

Abstract: Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. A preferred sensing configuration may be selected at a given point in time, for example under clinical conditions. Signal quality for the preferred sensing configuration is then monitored, and if the signal quality degrades under selected conditions, re-analysis may be performed to select a different sensing vector configuration for at least temporary use. If signal quality increases for the preferred sensing configuration, temporary use of the different sensing vector configuration may cease and reversion to the preferred sensing configuration takes place if certain conditions are met. The conditions for reversion may depend in part of a history of sensing signal quality for the preferred sensing configuration.

Abstract: Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. Signals from multiple vectors may be combined using weighting factors and/or by conversion to different coordinate systems than the original inputs, which may or may not be normalized to patient anatomy. Signals from multiple sensing vectors may be combined prior to or after several analytical steps or processes including before or after filtering, and before or after cardiac cycle detection. Cardiac cycle detection information may be combined across multiple sensing vectors before or after analysis of individual vectors for noise or overdetection. Cardiac cycle detection information may also be combined across multiple sensing vectors to identify noise and/or overdetection.

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: Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. Signals from multiple vectors may be combined using weighting factors and/or by conversion to different coordinate systems than the original inputs, which may or may not be normalized to patient anatomy. Signals from multiple sensing vectors may be combined prior to or after several analytical steps or processes including before or after filtering, and before or after cardiac cycle detection. Cardiac cycle detection information may be combined across multiple sensing vectors before or after analysis of individual vectors for noise or overdetection. Cardiac cycle detection information may also be combined across multiple sensing vectors to identify noise and/or overdetection.

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: A neurostimulation system measures a cardiac parameter at various cardiac intervals and analyzes its restitution, including computing a restitution slope being a rate of change of the restitution parameter with respect to change in the cardiac interval. In various embodiments, the system uses the restitution slope to provide for adaptive control of neurostimulation. In various embodiments, one or more cardiac parameters such as action potential duration (APD), conduction velocity (CV), QT interval (QT), and/or T-wave morphology (TM) parameter are measured and analyzed for restitution of each parameter, which is then used to control the delivery of the neurostimulation.

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: 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: A method of and system for collecting patient event information is described, where the system includes an implantable medical device (IMD) and an external interface device. The external interface device is remote from the IMD and includes a communication module, a display device adapted to prompt a user of the system to select a reason for a particular transmission session and a user input device adapted to accept input indicating a selected reason.

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: Ectopic cardiac activity can be detected, such as in the absence of a diagnosed tachyarrhythmia episode. In response to the detected ectopic activity, electrostimulation can be provided to a para-Hisian region, such as to activate natural cardiac contraction mechanisms or to interrupt re-entrant cardiac activity. Subsequent ectopic cardiac activity can be detected, and subsequent electrostimulation can be provided to the para-Hisian region, such as according to one or more adjustable electrostimulation parameters.

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: A neurostimulation system measures a cardiac parameter at various cardiac intervals and analyzes its restitution, including computing a restitution slope being a rate of change of the restitution parameter with respect to change in the cardiac interval. In various embodiments, the system uses the restitution slope to provide for adaptive control of neurostimulation. In various embodiments, one or more cardiac parameters such as action potential duration (APD), conduction velocity (CV), QT interval (QT), and/or T-wave morphology (TM) parameter are measured and analyzed for restitution of each parameter, which is then used to control the delivery of the neurostimulation.

Abstract: A method of and system for collecting patient event information is described, where the system includes an implantable medical (IMD) and an external interface device. The external interface device is remote from the IMD and includes a communication module, a display device adapted to prompt a user of the system to select a reason for a particular transmission session and a user input device adopted to accept input indicating a selected reason.

Abstract: A method of collecting patient event information from a cardiac rhythm management system (CRM system) is described, where the CRM system includes a cardiac rhythm management device (CRM device) and an external interface device. The method includes the steps of initiating a transmission session wherein the interface device communicates with the CRM device, prompting a user of the CRM system to select a reason for the transmission session, inputting the selected reason for the transmission session to the interface device, and storing the selected reason for the transmission session and timestamp information for the transmission session.