Abstract: A first lead provides therapeutic stimulation to the heart and includes a first mechanical sensor that measures physical contraction and relaxation of the heart. A controller induces delivery of therapeutic stimulation via the first lead. The controller receives signals from the first mechanical sensor indicative of the contraction and relaxation; develops a template signal that corresponds to the contraction and relaxation; and uses the template signal to modify the delivery of therapeutic stimulations. In another arrangement, a second lead, with a second mechanical sensor also provides signals to the controller indicative of contraction and relaxation. The first mechanical sensor is adapted to be positioned at the interventricular septal region of the heart, and the second mechanical sensor is adapted to be positioned in the lateral region of the left ventricle. The controller processes the signals from the first mechanical sensor and the second mechanical sensor to develop a dysynchrony index.

Abstract: An implantable therapy system including implantable stimulation and control components. The implantable components operate under a set of variable parameters that can be adjusted for improved performance for an individual patient. The implantable components are adapted to self-evaluate the patients physiologic performance and autonomously adjust an existing set of parameters to improve performance throughout an implantation period without requiring intervention of a clinician, for example with a physicians programmer. The implantable components can compare a patient's exhibited activity to a desired template of that activity to determine when adjustments are indicated. The template can be based on observations of one or more third parties exhibiting normal activity. The implantable components can adjust the operating parameters to improve synchrony of multiple heart chambers and/or to increase a peak contractility.

Abstract: This invention describes methods and algorithms for processing a plurality of relevant signals/data intrinsic to a patient and/or derived from external diagnostic equipment for management of atrial arrhythmias. The intrinsic signals are acquired from intracardiac leads/sensors and analogous extrinsic data obtained from imaging equipment and patient demographics. These data are input into software algorithms that use digital signal processing to output informational data of clinical and technical relevance after comparisons are made to patients with access to this technology whose outcome under varying treatments is known. These combined data are used to define prognosis, make treatment suggestions, direct programming of cardiac devices and digitally convert intrinsically and extrinsically derived indices into a common metric.

Abstract: Cardiac tissue motion characteristics acquired by novel cardiac sensors are analyzed and processed for the derivation of physiological indices. The indices are output to a hand held local or remote volumetric haptic display and enable an operator to obtain motion related dynamic characteristics of cardiac tissues. The ability to tactually sense the motion of cardiac tissue and the affect on such motion from inserted cardiovascular instrumentation enhances the operator's performance of procedures including the positioning and placement of implanted catheters/sensors, extraction of permanently implanted leads and delivery of cardiovascular therapies. Optimal haptic rendering is achieved by using computational techniques to reconstruct the physically and perceptually relevant aspects of acquired signals and bridge the gap between the inserted catheter and operator's hand/catheter handle.

Abstract: A system and method of adjusting therapy delivery in an implantable cardiac stimulation device including establishing a plurality of setting combinations for at least two variable parameters of the implantable cardiac stimulation device affecting delivery of therapy. At least one aspect of a patient's physiologic performance is evaluated under individual ones of the plurality of setting combinations selected such that at least one of the two variable parameters vary among the plurality of combinations. A setting combination providing more optimal patient physiologic performance is programmed for future delivery of therapy. An external device can provide measurements indicative of cardiac performance. Measurements of cardiac performance can also be obtained by an implantable device.

Abstract: An implantable therapy system including implantable stimulation and control components. The implantable components operate under a set of variable parameters that can be adjusted for improved performance for an individual patient. The implantable components are adapted to self-evaluate the patients physiologic performance and autonomously adjust an existing set of parameters to improve performance throughout an implantation period without requiring intervention of a clinician, for example with a physicians programmer. The implantable components can compare a patient's exhibited activity to a desired template of that activity to determine when adjustments are indicated. The template can be based on observations of one or more third parties exhibiting normal activity. The implantable components can adjust the operating parameters to improve synchrony of multiple heart chambers and/or to increase a peak contractility.

Abstract: A multi-channel implantable syncope monitor that monitors ECG data, myopotential data, EEG data, photoplethysmography (PPG) data, and position sensor data is used to capture physiologic data about a patient who is experiencing a syncopal event. The timing of the events within the simultaneously captured physiologic data can then be used to more accurately determine potential sources of origin of the syncopal event.

Abstract: Techniques are described for delivering inotropic electrical therapy to myocardial tissue using an implantable cardiac stimulation device such as a pacemaker. In one example, electrical stimulation is applied by a pacemaker to the heart of a patient while taking into account dynamic trans-cardiac impedance waveforms measured within the patient. In another example, a series of subthreshold inotropic stimulation pulses are delivered just prior to delivery of a suprathreshold depolarizing pulse that triggers systole. Additional subthreshold inotropic stimulation pulses can also be delivered following the suprathreshold pulse. Preferably, the magnitudes of the inotropic pulses are incrementally increased prior to systole then decremented thereafter, thereby gradually recruiting myocardium that has differing thresholds for depolarization. Both techniques seek to improve myocardial contractility of diseased tissue by improving calcium flux.

Abstract: An implantable therapy system including implantable stimulation and control components. The implantable components operate under a set of variable parameters that can be adjusted for improved performance for an individual patient. The implantable components are adapted to self-evaluate the patients physiologic performance and autonomously adjust an existing set of parameters to improve performance throughout an implantation period without requiring intervention of a clinician, for example with a physicians programmer. The implantable components can compare a patient's exhibited activity to a desired template of that activity to determine when adjustments are indicated. The template can be based on observations of one or more third parties exhibiting normal activity. The implantable components can adjust the operating parameters to improve synchrony of multiple heart chambers and/or to increase a peak contractility.

Abstract: A system with an implantable cardiac stimulation device having an implantable stimulation generator, at least one implantable lead adapted for connection to the implantable stimulation generator and further adapted for at least one of sensing physiologic activity and delivery of therapy, memory, and a controller in communication with the memory and with the at least one implantable lead and stimulation generator. The controller is configured to automatically evaluate a patient's physiologic status and selectively induce delivery of therapeutic stimulation under variable timing parameters. The system also has a measurement system adapted to measure at least one of strain and velocity of myocardial tissue and is adapted to evaluate strain and/or velocity measures and adjust the variable timing parameters of the implantable stimulation device to increase mechanical synchrony of the myocardial tissue.

Abstract: Implantable stimulation devices can provide intracardiac electrograms (EGMs) and impedance measurements to detect changes in electrical, mechanical, and electromechanical activation of the heart. Many patients with congestive heart failure have conventional intracardiac devices implanted that are not capable of resynchronization therapy and these patients could benefit from resynchronization, but are not candidates based on current criteria. These patient populations can be identified through analyses of intracardiac electrogram data that is available through implantable stimulation devices comprising at least one lead for providing electrical stimulation to the heart of a patient, at least one sensor that detects electrical signals indicative of the depolarization of the heart of the patient, and a controller that is adapted to be implanted within the patient.

Abstract: A control system for an implantable cardiac therapy device, the device defining a plurality of sensing vectors including at least one impedance sensing vector and operating under a set of a plurality of variable operating parameters that define conditions for delivery of therapy and wherein the control system evaluates signal quality from the at least one impedance sensing vector and, if the quality is sufficient to discern valvular events, the control system adjusts the set of operating parameters to dynamically improve cardiac performance, including synchrony with valvular events, and if the quality is insufficient to discern valvular events, but sufficient to discern peaks, the control system adjusts the set of operating parameters to dynamically improve cardiac performance independent of valvular events, and if the quality is insufficient to discern peaks, the control system adjusts the set of operating parameters to induce cardiac performance towards a defined performance goal.

Abstract: An exemplary method includes delivering stimulation energy via a right ventricular site; sensing an evoked response caused by the delivered stimulation energy at the right ventricular site; calculating a paced propagation delay for the right ventricular site (PPDRV); delivering stimulation energy via a left ventricular site; sensing an evoked response caused by the delivered stimulation energy at the left ventricular site; calculating a paced propagation delay for the left ventricular site (PPDLV); and determining an interventricular delay time (VV) for delivery of a bi-ventricular pacing therapy based in part on the paced propagation delay for the right ventricular site (PPDRV) and the paced propagation delay for the left ventricular site (PPDLV). Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: An implantable cardiac therapy device and methods of using a device including an implantable stimulation pulse generator, one or more implantable leads defining sensing and stimulation circuits adapted to sense and deliver therapy in at least one right side heart chamber, and an implantable controller in communication with the stimulation pulse generator and the one or more patient leads so as to receive sensed signals indicative of a patient's physiologic activity and deliver indicated therapy. The controller is adapted to monitor at least one indicator of cardiac dysynchrony and to compare the at least one indicator to a determined dysynchrony threshold. The threshold is determined for indications that the patient be further evaluated for cardiac resynchronization therapy. The controller is further adapted to set an alert when the at least one indicator exceeds the threshold to indicate to a clinician that evaluation for bi-ventricular pacing might be indicated.

Abstract: Systems and methods are provided for adjusting atrioventricular timing of a cardiac resynchronization therapy device, based upon multi-modal sensory data. In one particular embodiment, one or more acoustic signals are processed and categorized into certain cardiac-related mechanical events. Impedance waveforms are obtained from implanted electrodes and analyzed to identify certain valvular events. The acoustic and impedance data is analyzed to optimize AV timing and improve cardiac performance.

Abstract: Provided herein are implantable systems that include an implantable photoplethysmography (PPG) sensor, which can be used to obtain an arterial PPG waveform. In an embodiment, a metric of a terminal portion of an arterial PPG waveform is determined, and a metric of an initial portion of the arterial PPG waveform is determined, and a surrogate of mean arterial pressure is determined based on the metric of the terminal portion and the metric of the initial portion. In another embodiment, a surrogate of diastolic pressure is determined based on a metric of a terminal portion of an arterial PPG waveform. In a further embodiment, a surrogate of cardiac afterload is determined based on a metric of a terminal portion of an arterial PPG waveform.

Abstract: The present invention is related to implantable cardiac devices such as pacemakers and defibrillators that deliver cardiac resynchronization therapy (CRT), and to a method of optimizing acquisition of impedance signals between electrodes present on implanted lead systems. This system then automatically determines which electrodes or electrode combinations acquire impedance waveforms that have the best signal to noise ratio (highest fidelity) and characterize data most representative of dysynchronous electro-mechanical events. Using closed loop algorithms which provide electrograms and a variety of impedance data reflective of the patient's clinical status, the system autonomously modifies interval timing within the CRT device.

Abstract: A first lead provides therapeutic stimulation to the heart and includes a first mechanical sensor that measures physical contraction and relaxation of the heart. A controller induces delivery of therapeutic stimulation via the first lead. The controller receives signals from the first mechanical sensor indicative of the contraction and relaxation; develops a template signal that corresponds to the contraction and relaxation; and uses the template signal to modify the delivery of therapeutic stimulations. In another arrangement, a second lead, with a second mechanical sensor also provides signals to the controller indicative of contraction and relaxation. The first mechanical sensor is adapted to be positioned at the interventricular septal region of the heart, and the second mechanical sensor is adapted to be positioned in the lateral region of the left ventricle. The controller processes the signals from the first mechanical sensor and the second mechanical sensor to develop a dysynchrony index.

Abstract: Systems and methods for providing high voltage confirmation are disclosed. In various embodiments, impedance data can be used as a basis for determining the operation of a high voltage confirmation system. In some embodiments, measurements of impedance associated with the high voltage lead(s) can provide indication as to the condition of the lead(s). In some embodiments, faulty leads can yield impedance values that exceed a known threshold value. In some embodiments, such threshold value can be determined from a laboratory study of the leads under conditions that are similar to the operating conditions of implantable cardiac devices.

Abstract: A plurality of sensor data acquired from the heart using novel microfabricated sensors is compared to analogous data derived by conventional imaging modalities extrinsic to the heart. The cross-correlation of corresponding signals facilitates the development of sensor nanotechnologies including a catheter for performing ablation of cardiac arrhythmias and a biocompatible electrical interface with monitoring capabilities. Cross-correlation of data acquired with differing techniques enables system calibration and design, as well as, validation of the data acquired with next generation sensors. In a preferred mode of the invention, novel cardiac nanosensors enable an operator to differentiate one individual patient's cardiac tissue mechanical properties from others by using a sense of touch much as clinicians today use auditory cues with a stethoscope.