Abstract: The exemplary systems and methods may be configured to generate a dispersion signal from a plurality of cardiac signals and determine a QRS onset time value and a QRS offset time value from the plurality of cardiac signals. The QRS onset and offset time values may be used to measure, or capture, activation times.

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: 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: 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: A system and associated method for determining whether a signal is ambiguous, wherein the system includes a plurality of electrodes configured to be located proximate tissue of a patient. A display apparatus thereof includes a graphical user interface configured to present information to a user. A computing apparatus thereof is configured to determine maximums for beats of signals from the electrodes.

Abstract: A method and system for delivering cardiac pacing therapy that includes sensing electrical activity of tissue of a patient from a plurality of external electrodes during delivery of a non-ambulatory pacing therapy from a pacing device and determining an optimal electromechanical (EM) response time from an optimal electrical activation determined from electrical heterogeneity information obtained during non-ambulatory pacing therapy. During delivery of subsequent ambulatory pacing, the pacing sensing an EM signal from an EM sensor of the pacing device, determines a current EM response time in response to the sensed EM signal, and adjusting a pacing parameter setting of the ambulatory pacing therapy in response to comparing the current EM response time to the optimal EM response time.

Abstract: A medical device and medical device system for delivering left ventricular pacing that includes a subcutaneous sensing device having a subcutaneous electrode to sense a subcutaneous cardiac signal and an emitting device to emit a trigger signal in response to the sensed cardiac signal, an intracardiac therapy delivery device to deliver the left ventricular pacing in response to the emitted trigger signal, and a processor configured to determine whether the medical device system is in one of a VVD pacing mode and a VVI pacing mode, determine whether the delivered left ventricular pacing captures the left ventricle, determine whether to adjust a pacing parameter in response to the determination of whether the device system is in one of a VVD pacing mode and a VVI pacing mode and the determination of whether the delivered left ventricular pacing captures the left ventricle, and deliver the left ventricular pacing in response to determining whether to adjust the pacing parameter.

Abstract: The exemplary systems and methods may be configured to monitor electrical activity from a patient using a plurality of external electrodes. The exemplary systems and methods may be further configured to provide a model heart representative of the patient's heart based on at least one of a plurality of patient characteristics. The model heart can include a plurality of segments. The exemplary systems and methods may be further configured to determine a value of electrical activity for each of a plurality of anatomic regions of the model heart based on the mapped electrical activity. Each of the plurality of anatomic regions can include a subset of the plurality of segments.

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: A method and system that includes an implantable cardioverter defibrillator (ICD) determining signal characteristics of a cardiac signal within a signal evaluation window positioned along a first portion of a cardiac cycle and determining whether a P-wave occurs within the signal evaluation window associated with the first portion of the cardiac cycle. The signal evaluation window is adjusted to be positioned along a second portion of the cardiac cycle in response to the P-wave not occurring within the signal evaluation window and signal characteristics of the cardiac signal are determined within the adjusted signal evaluation window. A determination is made as to whether a P-wave occurs in response to the signal characteristics determined within the adjusted signal evaluation window, and the ICD delivers a trigger signal to a leadless pacing device instructing delivery of ventricular pacing therapy by the leadless pacing device whenever a P-wave is determined to occur.

Abstract: VfA cardiac therapy uses an implantable medical device or system. The implantable medical device includes 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 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. A separate medical device may be used to provide some functionality for cardiac therapy. The implantable medical device or separate medical device may be used to measure physiological response information, such as cardiac electrical heterogeneity information. The physiological response information may be used to calibrate and deliver adaptive pacing therapy.

Abstract: Capture management in a left ventricular leadless pacing device that includes determining an intrinsic P-wave of a sensed cardiac signal, sensing an electromechanical signal from an electromechanical sensor of the pacing device, and determining an intrinsic electromechanical atrioventricular interval of the sensed electromechanical signal in response to the sensed P-wave. Ventricular pacing is delivered via the one or more electrodes of the pacing device, and a ventricular pacing (V-pace) event is determined in response to the delivered ventricular pacing, and a V-pace to electromechanical response interval is determined in response to the V-pace event. A determination as to capture is detected is made in response to the intrinsic electromechanical atrioventricular interval and the V-pace to electromechanical response interval, and a pacing parameter is determined in response to determining whether capture is detected.

Abstract: A cardiac pacemaker is disclosed for pacing cardiac tissue to improve synchrony between the atria and ventricles and/or between the left and right ventricles. A pulse generator is configured to deliver a pacing pulse to a patient's ventricle at an atrioventricular (AV) delay following a preceding atrial event. A sensing circuitry configured to sense a signal from the patient's ventricle following delivery of a said pacing pulse. A processing circuitry coupled to the pulse generator and the sensing circuitry and configured to control the pulse generator, the processing circuitry further configured to: (1) acquire from the sensed signal a set of features; (2) determine whether the ventricular pacing pulse effectively captures the patient's ventricle using the set of features; (3) determine whether one or more tissue latency conditions are present. The one or more pacing pulse parameters are adjusted, in response to determining that tissue latency is present.

Abstract: The present disclosure relates to cardiac evoked response detection and, more particularly, reducing polarization effects in order to detect an evoked response following delivery of a stimulation pulse. An implantable medical device (IMD) is configured to deliver a ventricular pacing pulse. A signal is sensed in response to the ventricular pacing stimulus. A window is placed over the sensed signal to obtain a set of data from the signal after a paced event. The set of data extracted from the sensed signal comprises a maximum amplitude, a maximum time associated with the maximum amplitude, a minimum amplitude, and a minimum time associated with the minimum amplitude. Responsive to processing the extracted data, the window is delayed to avoid polarization effects. A determination is then made as to whether the ventricular pacing stimulus is capturing the paced ventricle in response to determining whether the maximum time is greater than the minimum time.

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: 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: 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 exemplary computer-implemented method is disclosed for detection of onset of depolarization on far-field electrograms (EGMs) or electrocardiogram (ECG)-or ECG-like signals. The method includes determining a baseline rhythm using a plurality of body-surface electrodes. The baseline rhythm includes an atrial marker and a ventricular marker. A pre-specified window is defined as being between the atrial marker and the ventricular marker. A low pass filter is applied to a signal within the window. A rectified slope of the signal within the window is determined. A determination is made as to whether a time point (t1) is present such that the rectified slope exceeds 10% of a maximum value of the rectified slope. A point of onset of a depolarization complex in the signal is determined. The point of onset occurs at a largest curvature in the signal within the window.

Abstract: The exemplary systems, methods, and interfaces may obtain and analyze electrode signals from a plurality of external electrodes. The electrode signals may include at least an anterior set of electrode signals and a posterior set of electrode signals. The anterior and posterior sets of electrode signals may be used to generate, or provide, various metrics of cardiac electrical heterogeneity and various graphical depictions that may be useful in assessing a patient's cardiac functionality.

Abstract: A method and system that includes an implantable cardioverter defibrillator (ICD) determining signal characteristics of a cardiac signal within a signal evaluation window positioned along a first portion of a cardiac cycle and determining whether a P-wave occurs within the signal evaluation window associated with the first portion of the cardiac cycle. The signal evaluation window is adjusted to be positioned along a second portion of the cardiac cycle in response to the P-wave not occurring within the signal evaluation window and signal characteristics of the cardiac signal are determined within the adjusted signal evaluation window. A determination is made as to whether a P-wave occurs in response to the signal characteristics determined within the adjusted signal evaluation window, and the ICD delivers a trigger signal to a leadless pacing device instructing delivery of ventricular pacing therapy by the leadless pacing device whenever a P-wave is determined to occur.