Abstract: A cardiac rhythm management device is configured to detect oscillations in cardiac rhythm by comparing electrogram signals during successive heart beats. Upon detection of electrical alternans, the device may adjust its operating behavior to compensate for the deleterious effects of the condition.

Abstract: A cardiac rhythm management system includes a lead assembly for intracardiac mapping, pacing, and drug delivery. The lead assembly includes an implantable endocardial lead having a proximal end for connection to an implantable cardiac rhythm management device and a distal end for disposal in an intracardiac region. The lead includes a pacing-sensing electrode and a drug delivery device, both located at or near the distal end. A lumen is within and extends throughout the lead, with an opening at or near the proximal end and another opening at or near the distal end. The lumen provides for access to the intracardiac region by a steerable stylet and a hollow needle, one at a time. The steerable stylet allows for electrophysiological mapping of the intracardiac region. The hollow needle allows for delivery of chemical, biochemical, and/or biological substance to the intracardiac region.

Abstract: A drug delivery system incorporated into a cardiac device for delivering a dose of a drug to a patient upon detection of a particular medical condition. The cardiac device may be, for example, an implantable cardioverter/defibrillator, cardiac pacemaker, or combination device that communicates via a radio frequency link with a drug delivery device. The drug delivery device is preferably an electrically modulated transdermal drug delivery device for delivering the drug transdermally in accordance with a signal received from the cardiac device.

Abstract: An implantable device for delivering cardiac pacing therapy in order to improve cardiac function is programmed to allow some amount of intrinsic activity to occur without otherwise the disturbing the pacing algorithm used to deliver therapy. Intrinsic cardiac cycles utilize the heart's native conduction system and thus serve to prevent the atrophy which may otherwise result from continuous pacing.

Abstract: A method for stabilizing atherosclerotic plaque with the intra-myocardial portion of a coronary artery is presented. Pacing therapy is utilized to pre-excite ventricular myocardium near the site of a plaque and thereby mechanically unload the myocardial region. Such mechanical unloading results in less deforming stress being transmitted to the plaque during ventricular systole.

Abstract: This document describes, among other things, systems, devices, and methods for predicting how the status of the patient's congestive heart failure (CHF) condition will progress in the future. In one example, a therapy is provided or adjusted at least in part in response to the prediction.

Abstract: An implantable medical device in which an electrogram is recorded and analyzed in order to detect changes indicative of cardiac ischemia. Cardiac ischemia may be detected by recording an electrogram from a sensing channel of the device and comparing the recorded electrogram with a reference electrogram. If cardiac ischemia is detected, a cardiac drug such as a thrombolytic agent is delivered.

Abstract: An apparatus and method preventing cardiac arrhythmias with pacing therapy is disclosed. Upon detection of a pre-arrhythmic condition, an implantable cardiac rhythm management device is configured to deliver pacing therapy in a manner that pre-excites particular myocardial sites that have been identified as stressed sites and likely locations for the origination of arrhythmias. Such pacing results in a reduction in myocardial wall stress at those sites during systole and reduces the probability of an arrhythmia occurring.

Abstract: An implantable system for the defibrillation of the atria of a patient's heart comprises (a) a first catheter configured for insertion into the right atrium of the heart, preferably without extending into the right ventricle of the heart; a first atrial defibrillation electrode carried by the first catheter and positioned at the atrial septum of the heart (i.e., an atrial septum electrode); (b) a second atrial defibrillation electrode which together with the first atrial defibrillation electrode provides a pair of atrial defibrillation electrodes that are configured for orientation in or about the patient's heart to effect atrial defibrillation, and (c) a pulse generator operatively associated with the pair of atrial defibrillation electrodes for delivering a first atrial defibrillation pulse to the heart of the patient. The second electrode may be configured for positioning through the coronary sinus ostium and in the coronary sinus or a vein on the surface of the left ventricle, such as the great vein.

Abstract: This invention is a passive conductor assembly for use with an implanted device having an intra-cavitarily or trans-venously disposed electrode. The assembly can include electrical components in electrical communication therewith which provide for the manipulation, and/or modification of the electrical stimulus or waveform generated by the implanted stimulus generator, which can be designed, for example, to selectively stimulate only neural tissue, not cardiac tissue or vice versa through the same passive conductor assembly.

Abstract: An apparatus and method for assessing myocardial wall stress is disclosed. The method may be used in conjunction with electro-stimulatory therapy for preventing or reversing ventricular remodeling. In such therapy, one or more stimulatory pulses are delivered to the heart such that a stressed region of the myocardium is pre-excited relative to other regions, thereby subjecting 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 rhythm management device is configured to detect oscillations in cardiac rhythm by comparing electrogram signals during successive heart beats. Upon detection of electrical alternans, the device may adjust its operating behavior to compensate for the deleterious effects of the condition.

Abstract: A system and method of treating an adverse cardiac condition, such as cardiac arrhythmia or a non-arrhythmic event, involves producing, by use of a patient actuatable non-implanted activator, an activation signal in response to a patient sensing a perceived adverse cardiac condition. The method further involves confirming, by an implantable medical device provided within the patient, that the patient is experiencing an actual adverse cardiac condition. A perceivable initiating signal instructing the patient or a physician to commence with a drug delivery regimen to treat the actual cardiac adverse condition is generated by the non-implanted activator. In one approach, the implantable medical device operates in a safe mode of pacing during drug treatment of the actual adverse cardiac condition. In another approach, an appropriate pacing, cardioversion or defibrillation regimen is initiated to treat the actual adverse cardiac condition.

Abstract: A method and device for delivering defibrillation shock therapy in patients having an inter-ventricular conduction disorder is presented. Ventricular resynchronization therapy is employed to reduce the dispersion of ventricular depolarization which takes place due to the conduction disorder and reduces the safety 10 margin of shocks delivered synchronously with ventricular beats. The method may be employed in the treatment of atrial or ventricular tachyarrhythmias.

Abstract: An implantable system for the defibrillation of the atria of a patient's heart comprises (a) a first catheter configured for insertion into the right atrium of the heart; a first atrial defibrillation electrode carried by the first catheter and positioned to stimulate Bachmann's bundle, or positioned at the atrial septum of the heart (i.e., an atrial septum electrode); (b) a second atrial defibrillation electrode which together with the first atrial defibrillation electrode provides a pair of atrial defibrillation electrodes that are configured for orientation in or about the patient's heart to effect atrial defibrillation, and (c) a pulse generator operatively associated with the pair of atrial defibrillation electrodes for delivering a first atrial defibrillation pulse to the heart of the patient. The second electrode may be configured for positioning through the coronary sinus ostium and in the coronary sinus or a vein on the surface of the left ventricle, such as the great vein.

Abstract: A method for cell and electrical therapy of living tissue including administration of exogenous cells into a region of injured tissue and application of electrical energy. In one application the exogenous cells are conditioned in vitro before their administration into tissue. In one application the combined cell and electrical therapy is applied in vivo to damaged heart tissue. In such applications, minimally invasive procedures are used to apply the cell therapy and the electrical therapy is provided via an implantable pulse generator. In one application an implantable pacemaker is used in the VDD or DDD mode with an atrioventricular delay kept relatively short when compared to the intrinsic atrioventricular delay.

Abstract: A method for cell and electrical therapy of living tissue including administration of exogenous cells into a region of injured tissue and application of electrical energy. In one application the combined cell and electrical therapy is applied in vivo to damaged heart tissue. In such applications, minimally invasive procedures are used to apply the cell therapy and the electrical therapy is provided via an implantable pulse generator. In one application an implantable pacemaker is used in the VDD mode with an atrioventricular delay kept relatively short when compared to the intrinsic atrioventricular delay.

Abstract: A method and system for delivering anti-tachycardia pacing is disclosed. A cardiac rhythm management device, such as an implantable pacemaker having anti-tachycardia pacing capability, delivers anti-tachycardia pacing therapy in accordance with an anti-tachycardia pacing protocol upon detection of a terminable arrhythmia. The anti-tachycardia pacing is delivered as a burst of one or more pacing pulses at a specified coupling interval after a sensed ventricular polarization. By sensing if an evoked potential occurs, the device can determine whether or not the anti-tachycardia pacing burst has captured the ventricle and can adjust the coupling interval and/or other parameters accordingly.

Abstract: A method for stabilizing atherosclerotic plaque with the intra-myocardial portion of a coronary artery is presented. Pacing therapy is utilized to pre-excite ventricular myocardium near the site of a plaque and thereby mechanically unload the myocardial region. Such mechanical unloading results in less deforming stress being transmitted to the plaque during ventricular systole.

Abstract: An apparatus and method preventing cardiac arrhythmias with pacing therapy is disclosed. Upon detection of a pre-arrhythmic condition, an implantable cardiac rhythm management device is configured to deliver pacing therapy in a manner that pre-excites particular myocardial sites that have been identified as stressed sites and likely locations for the origination of arrhythmias. Such pacing results in a reduction in myocardial wall stress at those sites during systole and reduces the probability of an arrhythmia occurring.