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: A method includes determining whether electrical activity is indicative of atrial fibrillation, determining whether mechanical activity is indicative of atrial fibrillation, and adjusting a pacing parameter or mode based on whether the electrical activity and the mechanical activity are indicative of atrial fibrillation. The electrical activity may be detected based on a far-field measurement. The method may be performed using a leadless implantable medical device.

Abstract: Adaptive cardiac conduction system pacing therapy may monitor electrical activity of a patient's heart and select a cardiac conduction system pacing therapy pacing mode based on the monitored electrical activity. For instance, one or more metrics such as P-wave-to-R-wave interval and QRS complex width may be determined based on the monitored electrical activity, and one of an inhibited pacing mode, a ventricular fusion pacing mode, an atrioventricular synchronous pacing mode, and an atrial fibrillation pacing mode may be selected based on the determined one or more metrics.

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: Electrical activity from tissue of a patient is monitored using a plurality of external electrodes to generate a plurality of electrical signals over time. The plurality of electrical signals are filtered using a first filter having a first frequency range to generate a plurality of first filtered signals. The plurality of electrical signals are filtered using a second filter having a second frequency range different than the first frequency range to generate a plurality of second filtered signals. At least one QRS complex is detected based on the plurality of first filtered signals. A QRS peak of the at least one QRS complex is detected based on the plurality of second filtered signals and the detected at least one QRS complex.

Abstract: Systems and methods are described herein for detecting efficiency of pacing using external cardiac signals. A representative electrical signal morphology of the cardiac signals may be determined based on the plurality of electrical signals, and an efficacy of left bundle branch (LBB) engagement determined based on the representative electrical signal morphology.

Abstract: A method includes determining whether electrical activity is indicative of atrial fibrillation, determining whether mechanical activity is indicative of atrial fibrillation, and adjusting a pacing parameter or mode based on whether the electrical activity and the mechanical activity are indicative of atrial fibrillation. The electrical activity may be detected based on a far-field measurement. The method may be performed using a leadless implantable medical device.

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: A cardiac pacemaker that delivers cardiac pacing therapy that includes delivering the cardiac pacing therapy from a cardiac pacing device, sensing a pacing event from a plurality of electrodes of the pacing device, and sensing an electromechanical signal from an electromechanical sensor of the pacing device. A pre-ejection period is determined in response to the sensed electromechanical signal, and a left ventricular ejection time is determined in response to the sensed electromechanical signal. The pacemaker device performs one or both of adjusting a pacing parameter setting and generating an alert in response to the determined pre-ejection period and the determined left ventricular ejection time.

Abstract: Systems and methods are described herein for detecting disturbances in cardiac signals. An electrode apparatus includes a plurality of external electrodes to be disposed proximate a patient's skin. A computing apparatus includes processing circuitry. The computing apparatus is operably coupled to the electrode apparatus. The computing apparatus is configured to monitor electrical activity from tissue of a patient using a plurality of external electrodes to generate a plurality of electrical signals. At least one of the electrical signals of the plurality of electrical signals is filtered. At least one disturbance in the at least one electrical signal is detected using the at least one filtered signal. A temporal location of the at least one disturbance in the at least one electrical signal is determined based on a time that the at least one filtered signal crosses a predetermined threshold.

Abstract: Methods and related systems and devices for cardiac therapy use pseudo-electric vectors (PEVs) for characterizing and representing the electrical forces generated by a patient's heart in a three-dimensional (3D) manner. PEVs may be used to predict whether a patient will respond to pacing therapy prior to implant, during implant, or in the follow-up after implant. Various cardiac therapy systems and devices, such as an electrocardiogram (ECG) belt or vest, which may include a plurality of external electrodes, may be used to obtain electrical activity information to generate the PEVs. One or more spatio-temporal PEVs may be determined using one or more sensors at one or more points in time. Spatial representation data may be determined based on the PEVs.

Abstract: Systems, interfaces, and methods are described herein for evaluation and adjustment cardiac therapy. The systems, interfaces, and methods may utilize, or include, a graphical user interface to display various information with respect to a plurality of external electrodes and electrical activity monitored using such external electrodes and to allow a user to adjust what information to display.

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: In a medical device system, a computer apparatus is configured to receive body surface electrical signals from an electrode apparatus including multiple external electrodes. The computing apparatus generates electrical dyssynchrony data from the body surface electrical signals during delivery of His bundle pacing pulses and identifies effective His bundle capture based on the electrical dyssynchrony data. The computing apparatus generates an indication of His bundle capture in response to identifying the effective His bundle 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: Systems and methods are described herein related to the evaluation and adjustment of left bundle branch (LBB) pacing therapy. Evaluation of the LBB pacing therapy may utilize electrical activity monitored from a plurality of external electrodes. The electrical activity may be used to provided one or more metrics of dispersion of surrogate cardiac electrical activation times, which may then be used to evaluate, and potentially adjust the LBB pacing therapy.

Abstract: Ventricle-from-atrium (VfA) cardiac therapy may utilize a tissue-piercing electrode implanted in the left ventricular myocardium of the patient's heart from the right atrium through the right atrial endocardium and central fibrous body. The exemplary devices and methods may determine whether the tissue-piercing electrode is achieving effective left ventricular capture. Additionally, one or more pacing parameters, or paced settings, may be adjusted in view of the effective left ventricular capture determination.

Abstract: In a medical device system, a computer apparatus is configured to receive body surface electrical signals from an electrode apparatus including multiple external electrodes. The computing apparatus generates electrical dyssynchrony data from the body surface electrical signals during delivery of His bundle pacing pulses and identifies effective His bundle capture based on the electrical dyssynchrony data. The computing apparatus generates an indication of His bundle capture in response to identifying the effective His bundle 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: Systems and methods are described herein for use in synchronizing electrical activity monitored by a plurality of external electrodes with supplemental cardiac data for use in evaluating a patient's cardiac condition and configuring cardiac therapy. The supplemental cardiac data may include one or more markers indicative of the occurrence of cardiac events and/or data representative of representative of at least one of cardiac electrical signals, cardiac sounds, cardiac pressures, blood flow, and an estimated instantaneous flow waveform provided by a left ventricular assist device.