Abstract: Systems, methods, and interfaces are described herein for identification of effective electrodes to be used in sensing and/or therapy. Two or more portions of a signal monitored using an electrode may be compared to determine whether the electrode is effective. The two or more portions may correspond to the same portion or window of a cardiac cycle. Further, signals from a first electrode and from a second electrode located proximate the first electrode may be compared to determine whether one or both of the electrodes are effective.

Abstract: Systems and methods are described herein for evaluation and adjustment cardiac therapy. The systems and methods may initially evaluate a first pacing parameter while other pacing parameters are fixed to, for example, nominal values, and determine an effective setting for the first pacing parameter. Then, a second pacing parameter may be evaluated while the first pacing parameter is fixed to the previously-determined effective setting. Each evaluation may not test every possible setting for the pacing parameters, and instead, may utilize various processes to limit the settings to a subset of settings to test.

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 system for accounting for adverse pacing artifacts may include an electrode apparatus and a computing apparatus. The electrode apparatus may include one or more external electrodes to monitor electrical activity from tissue of a patient. The computing apparatus may include one or more processors and may be operatively coupled to the electrode apparatus. The computing apparatus may be configured to monitor electrical activity from the tissue of the patient using the one or more external electrodes. Such electrical activity may be used to generate one or more cardiac signals of the patient over time. The computing apparatus may detect a pacing artifact in the one or more cardiac signals and determine whether to account for, and account for, the pacing artifact based on a pacing artifact characteristic of the pacing artifact when producing electrical heterogeneity information.

Abstract: Systems, methods, and devices are described herein for evaluation, adjustment, and delivery of adaptive cardiac therapy. The systems, methods, and devices may utilize electrical heterogeneity information to determine and/or select one or more pacing settings and pacing type or configurations for a plurality of different heart rates. The adaptive cardiac therapy may deliver cardiac therapy at selected pacing settings such as, for example, A-V and/or V-V intervals, according to a presently measured heart rate and switch between left ventricular-only or biventricular cardiac pacing therapy also according to the presently measured heart rate.

Abstract: Systems and methods are described herein for evaluation and configuration cardiac therapy. The systems and methods may monitor electrical activity using a plurality of external electrodes and may utilize multiple-electrode cardiac metrics such as electrical heterogeneity information, single-electrode cardiac metrics, and vectorcardiographic metrics to determine and select one or more paced settings from a plurality of different paced settings.

Abstract: Systems and methods are described herein for selection of a cardiac cycle, or heartbeat, from a plurality of cardiac cycles monitored over time. The cardiac cycle may be selected using various metrics including a single-cycle metric and a cycle-series metric. Further, the selected cardiac cycle may be used for further cardiac analysis (for example, to generate electrical activation times).

Abstract: Systems, methods, and interfaces are described herein for assisting a user in noninvasive evaluation of patients for cardiac therapy and noninvasive evaluation of cardiac therapy being delivered. The systems, methods, and interfaces may provide graphical representations of cardiac electrical activation times about one or more portions of human anatomy and one or more cardiac health metrics.

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: 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: 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: 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: 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: 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: 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: 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: 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: Systems and methods are described herein for evaluation and adjustment of a left ventricular assist device (LVAD). The systems and methods may utilize at least a plurality of external electrodes to monitor cardiac electrical activity before and during LVAD therapy. The cardiac electrical activity as well as other information such cardiac sound information may be used to determine and adjust one or more LVAD output parameters such as pump speed.

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: 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.