Abstract: Various embodiments of a system are disclosed. The system includes a sensing apparatus configured to monitor cardiac electrical activity of a patient and a computing apparatus operatively coupled to the sensing apparatus and configured to monitor cardiac electrical activity using the sensing apparatus to generate a cardiac signal over time, detect a pacing artifact in the cardiac signal, and determine to account for the pacing artifact when using the cardiac signal based on at least one pacing artifact characteristic of the pacing artifact in the cardiac signal. The computing apparatus is further configured to account for the pacing artifact when using the cardiac signal if it is determined to account for the pacing artifact.

Abstract: Systems and methods are described herein for generating representative cardiac information. The representative cardiac information may be based on a plurality of electrode signals monitored, or measured, over a plurality of cardiac cycles or heart beats. The systems and methods may remove unqualified cardiac cycles, remove invalid electrode signals, remove inconsistent cardiac cycles, and removing uncorrelated cardiac cycles, and then generate representative cardiac information based on the remaining cardiac cycles and electrode signals.

Abstract: The present disclosure pertains to cardiac pacing methods and systems, and, more particularly, to cardiac resynchronization therapy (CRT). In particular, the present disclosure pertains to determining whether a patient is experiencing atrial fibrillation (AF). If the patient is experiencing AF, the efficacy of CRT is determined. A signal is sensed in response to a ventricular pacing stimulus. Through signal processing, a number of features are parsed from the signal and a determination is made as to whether the ventricular pacing stimulus evoked a response from the ventricle.

Abstract: Systems and methods are described herein for determining whether cardiac conduction system pacing therapy may be beneficial and/or determining how proximal or distal a cardiac conduction system block may be using external cardiac signals. To do so, one or more left-sided metrics of electrical heterogeneity information may be generated based on left-sided surrogate cardiac electrical measured using a plurality of left external electrodes.

Abstract: An implantable medical device system is configured to generate signals representing activity of a heart of a patient; determine, based on the signals, an intrinsic delay of the heart of the patient; determine whether the intrinsic delay is indicative of a first-degree heart block being present in the heart of the patient; determine a patient-specific timing regime for conduction system pacing based on whether the intrinsic delay is indicative of the first-degree heart block being present in the heart of the patient; and administer cardiac pacing to a native conduction system of the heart of the patient based on the timing regime.

Abstract: Systems and methods of generating atrial electrical heterogeneity using electrical activity monitored using a plurality of external electrodes are described herein. The atrial electrical heterogeneity may include P-wave electrical heterogeneity. The atrial electrical heterogeneity generated from electrical activity monitored during atrial pacing therapy may be used to evaluate and adjust atrial pacing therapy. The atrial electrical heterogeneity generated from electrical activity monitored during intrinsic activation may be used to evaluate a patient's cardiac condition.

Abstract: The present disclosure relates generally to pacing of the cardiac conduction system of a patient, and more particularly, to providing adaptive cardiac conducting system pacing therapy and to determining selective or non-selective capture of the cardiac conduction system by cardiac conduction system pacing therapy. The adaptive cardiac conduction system pacing therapy may adjust AV delay and VV delay based on various signals and metrics and may switch between cardiac conduction system pacing therapy exclusively and cardiac conduction system pacing therapy in combination with traditional left ventricular pacing therapy.

Abstract: An implantable device and associated method for delivering multi-site pacing therapy is disclosed. The device comprises a set of electrodes including a first and second left ventricular electrodes spatially separated from one another and a right ventricular electrode, all coupled to an implantable pulse generator. The processing circuit coupled to the implantable pulse generator, the processing circuit configured to determine whether a prospective heart failure condition has occurred and if so to trigger the pulse generator to switch from a first pacing mode to a second pacing mode, the first pacing mode comprising delivering only a first pacing pulse to a left ventricle (LV) and thereafter delivering an RV pacing pulse to the right ventricular electrode within a single cardiac cycle and the second pacing mode comprising delivering first and a second pacing pulses to the LV and thereafter delivering an RV pacing pulse to the right ventricular electrode within a single cardiac cycle.

Abstract: VfA cardiac therapy uses an implantable medical device or system. The implantable medical device includes a tissue-piercing electrode implanted in the basal and/or septal region of the left ventricular myocardium of the patient's heart from the triangle of Koch region of the right atrium through the right atrial endocardium and central fibrous body. The device may include a right atrial electrode, a right atrial motion detector, or both. The device may be implanted completely within the patient's heart or may use one or more leads to implant electrodes in the patient's heart. The device may be used to provide cardiac therapy, including single or multiple chamber pacing, atrioventricular synchronous pacing, asynchronous pacing, triggered pacing, cardiac resynchronization pacing, or tachycardia-related therapy. A separate medical device may be used to provide some functionality for cardiac therapy, such as sensing, pacing, or shock therapy.

Abstract: Systems, interfaces, and methods are described herein related to the evaluation of a patient's cardiac conduction system and evaluation of cardiac conduction system pacing therapy being delivered to the patient's cardiac conduction system. Evaluation of the patient's cardiac conduction system may utilize a plurality of breakthrough maps to determine where a cardiac conduction system block may be located. Evaluation of cardiac conduction system pacing therapy may utilize various electrical heterogeneity information monitored before and during delivery of cardiac conduction system pacing therapy.

Abstract: Systems and methods may monitor electrical activity of a patient's heart using electrodes during delivery of cardiac conduction system pacing therapy, generate electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of cardiac conduction system pacing therapy, and determine whether the cardiac conduction system pacing therapy would benefit from supplemental cardiac pacing therapy based on the generated EHI.

Abstract: An implantable medical device system and method for delivering cardiac resynchronization therapy (CRT) pacing that includes determining capture associated with the delivered CRT pacing is ineffective in response to the delivered CRT pacing. A reason for capture being ineffective is determined and a safety margin is adjusted if the determined reason for capture being ineffective is loss of capture and a left ventricle (LV) pre-excitation is adjusted if the determined reason for capture being ineffective is delayed LV depolarization. Monitoring for a change in effective cardiac resynchronization therapy is used to confirm that the adjustment of the CRT pacing was effective in resolving the ineffective capture.

Abstract: An implantable medical device includes a plurality of electrodes to detect electrical activity, a motion detector to detect mechanical activity, and a controller to determine at least one electromechanical interval based on at least one of electrical activity and mechanical activity. The activity detected may be in response to delivering a pacing pulse according to an atrioventricular (AV) pacing interval using the second electrode. The electromechanical interval may be used to adjust the AV pacing interval. The electromechanical interval may be used to determine whether cardiac therapy is acceptable or whether atrial or ventricular remodeling is successful.

Abstract: The present disclosure relates generally to pacing of the cardiac conduction system of a patient, and more particularly, to providing adaptive cardiac conducting system pacing therapy and to determining selective or non-selective capture of the cardiac conduction system by cardiac conduction system pacing therapy. The adaptive cardiac conduction system pacing therapy may adjust AV delay and VV delay based on various signals and metrics and may switch between cardiac conduction system pacing therapy exclusively and cardiac conduction system pacing therapy in combination with traditional left ventricular pacing therapy.

Abstract: An implantable medical system may provide atrioventricular synchronous pacing using the ventricular septal wall. The system may include a ventricular electrode coupled to an intracardiac housing or a first medical lead implantable in the ventricular septal wall of the patient's heart to deliver cardiac therapy to or sense electrical activity of the left ventricle of the patient's heart and a right atrial electrode coupled to a leadlet or second medical lead to deliver cardiac therapy to or sense electrical activity of the right atrium of the patient's heart. A right ventricular electrode may be coupled to the intracardiac housing or the first medical lead and implantable in the ventricular septal wall of the patient's heart to deliver cardiac therapy to or sense electrical activity of the right ventricle of the patient's heart.

Abstract: Systems and methods may monitor electrical activity of a patient's heart using electrodes during delivery of cardiac therapy and determine a degree of posterior left bundle branch engagement based on the monitored electrical activity. The systems and methods may adjust the cardiac therapy based on the degree of posterior left bundle branch engagement.

Abstract: An implantable medical device includes a plurality of electrodes to detect electrical activity, a motion detector to detect mechanical activity, and a controller to determine at least one electromechanical interval based on at least one of electrical activity and mechanical activity. The activity detected may be in response to delivering a pacing pulse according to an atrioventricular (AV) pacing interval using the second electrode. The electromechanical interval may be used to adjust the AV pacing interval. The electromechanical interval may be used to determine whether cardiac therapy is acceptable or whether atrial or ventricular remodeling is successful.

Abstract: Systems, methods, and devices are described herein for determining cardiac conduction system capture of ventricle from atrium (VfA) therapy. VfA therapy may be delivered at a plurality of different A-V delays while electrical activity of the patient is monitored. The electrical activity may then be utilized to determine whether the cardiac conduction system of the patient has been captured by the VfA therapy.

Abstract: Determination of cardiac conduction system pacing therapy benefit may be performed by the systems, methods, devices, and interfaces described herein. For example, various metrics of activation time dispersion may be generated based on electrical activity monitored by a plurality of external electrodes such as, e.g., a left-sided metric of dispersion and a global metric of dispersion. Such various metrics of activation time dispersion may be used to determined whether cardiac conduction system pacing would be beneficial.

Abstract: Systems and methods are described herein for configuration of cardiac therapy. The systems and methods may select, or determine, a plurality of different configuration parameters based electrical activity monitored or measured using a plurality of external electrodes. For example, the systems and methods may select, or determine, a left ventricular pacing vector, adaptive or non-adaptive pacing therapy, an interventricular pacing delay, and a atrioventricular pacing delay.