Abstract: An apparatus includes a cardiac signal sensing circuit configured to generate a sensed cardiac signal representative of electrical cardiac activity of a subject, a buffer memory and a pause detection circuit. The pause detection circuit is configured to: identify ventricular depolarization in the cardiac signal or the sampled cardiac signal; detect a candidate pause episode using the cardiac signal in which delay in ventricular depolarization exceeds a specified delay threshold; identify noise events in a stored cardiac signal; and discard the cardiac signal of the candidate pause episode when a number of noise events satisfies a specified noise event number threshold, otherwise store the cardiac signal of the candidate pause episode as a bradycardia pause episode.

Abstract: An anatomical mapping system including a plurality of mapping electrodes disposed in or near an anatomical structure and configured to detect activation signals of physiological activity, each of the plurality of mapping electrodes having an electrode location, and a processing system associated with the plurality of mapping electrodes, and configured to record the detected activation signals and associate one of the plurality of mapping electrodes with each recorded activation signal. The processing system further configured to determine a dominant frequency at each electrode location, and determine a wavefront vector at each electrode location based on a difference between the dominant frequency at a first electrode location and the dominant frequency at neighboring electrode locations.

Abstract: Systems and methods for detecting atrial tachyarrhythmia are discussed. An exemplary atrial tachyarrhythmia detection system includes an arrhythmia detector circuit configured to receive physiologic information of a patient, generate a morphological similarity metric between the received physiologic information and a sinus rhythm (SR) template representing a morphology of conducted sinus beats during normal SR, and generate a morphological variability metric indicative of a variability in morphology between heart beats in the received physiologic information. The arrhythmia detector circuit may detect an atrial tachyarrhythmia episode the morphological similarity and morphological variability metrics.

Abstract: A method and system for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of mapping electrodes disposed in or near the anatomical structure, each of the plurality of mapping electrodes having an electrode location. A vector field map which represents a direction of propagation of the activation signals at each electrode location is generated to identify a signature pattern and a location in the vector field map according to at least one vector field template. A target location of the identified signature pattern is identified according to a corresponding electrode location.

Abstract: Systems and methods for presenting physiologic data to a user are discussed. An exemplary system includes a presentation control circuit configured to generate signal metrics from data subsets of a physiologic signal corresponding to a device-detected presence of a physiologic event. The signal metrics represent characteristics of the physiologic event. The presentation control circuit may determine, from the plurality of data subsets, a target subset of clinical significance, which has the corresponding signal metric satisfying a specific condition. The presentation control circuit may present the recognized target subset over other subsets of the physiologic data. A user may adjudicate the device detection of the physiologic event or adjust device parameters.

Abstract: Systems and methods for detecting physiologic events in a patient are described herein. An embodiment of a medical system includes a memory circuit to store physiologic event episodes detected and recorded by a medical device. The system includes a control circuit to analyze the stored physiologic event episodes, and determine a presence of a target cardiac event under a plurality of detection settings. Using the determined presence of the target cardiac event from the stored physiologic event episodes, and user adjudication of the stored event episodes, the control circuit may select, from the plurality of detection settings, a detection setting to detect a subsequent target cardiac event. The control circuit may also prioritize the physiologic event episodes for storage in the memory circuit.

Abstract: Some method examples may include pacing a heart with cardiac paces, sensing a physiological signal for use in detecting pace-induced phrenic nerve stimulation, performing a baseline level determination process to identify a baseline level for the sensed physiological signal, and detecting pace-induced phrenic nerve stimulation using the sensed physiological signal and the calculated baseline level. Detecting pace-induced phrenic nerve stimulation may include sampling the sensed physiological signal during each of a plurality of cardiac cycles to provide sampled signals and calculating the baseline level for the physiological signal using the sampled signals. Sampling the sensed physiological signal may include sampling the signal during a time window defined using a pace time with each of the cardiac cycles to avoid cardiac components and phrenic nerve stimulation components in the sampled signal.

Abstract: Systems and methods for multi-site cardiac stimulation are disclosed. The system includes an electrostimulation circuit to deliver electrostimulation to one or more candidate sites of at least one heart chamber. The system may sense a physiological signal including during electrostimulation of the heart, use the physiological signal to determine a first stimulation vector for electrostimulation at a first left ventricular (LV) site and a second stimulation vector for electrostimulation at a different second LV site, and determine a therapy mode including a first chronological order and a first timing offset between stimulations delivered according to the first and second stimulation vectors. The electrostimulation circuit may deliver electrostimulation to the heart in accordance with the first and second stimulation vectors and the therapy mode.

Abstract: Some systems and methods may facilitate selection of a vector for delivering electrical stimulation to a patient's heart. One method may include displaying a plurality of vectors on a display screen wherein each vector represents a different combination of three or more electro-stimulation electrodes, determining an electrical impedance for each of the plurality of vectors, displaying on the display screen the electrical impedance for each of the plurality of vectors, receiving a selection of a set of the plurality of vectors, determining, for each of the vectors in the set of vectors, a capture threshold, displaying on the display screen the capture threshold for each of the vectors in the set of vectors, receiving a selection of a vector from the set of vectors for delivery of electrical stimulation to the patient's heart, and programming the electro-stimulation device electrical stimulation to the patient's heart via the selected vector.

Abstract: Systems and methods for ambulatory detection of medical events such as cardiac arrhythmia are described herein. An embodiment of an arrhythmia detection system may include a detection criterion circuit that determines a patient-specific detection criterion using a baseline cardiac characteristic when the patient is free of cardiac arrhythmias. The detection criterion circuit generates a patient-specific threshold of a signal metric by adjusting a population-based threshold of the signal metric, where the manner and the amount of adjustment is based on information about patient baseline cardiac characteristic. The arrhythmia detection system detects an arrhythmia episode using a physiologic signal sensed from the patient and the patient-specific arrhythmia detection threshold.

Abstract: Systems and methods for providing CRT therapy to a patient with an implanted multi-site pacing medical device. In one example, an intrinsic electrical delay associated with each of two or more left ventricle electrodes may be determined. The intrinsic electrical delay associated with each of the two or more left ventricle electrodes may be compared to an electrical delay threshold. If the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, a single left ventricle electrode may be selected for use during subsequent CRT therapy. If the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, two or more of the left ventricle electrodes may be selected for use during subsequent CRT therapy.

Abstract: Some systems and methods may facilitate selection of a vector for delivering electrical stimulation to a patient's heart. One method may include displaying a plurality of vectors on a display screen wherein each vector represents a different combination of three or more electro-stimulation electrodes, determining an electrical impedance for each of the plurality of vectors, displaying on the display screen the electrical impedance for each of the plurality of vectors, receiving a selection of a set of the plurality of vectors, determining, for each of the vectors in the set of vectors, a capture threshold, displaying on the display screen the capture threshold for each of the vectors in the set of vectors, receiving a selection of a vector from the set of vectors for delivery of electrical stimulation to the patient's heart, and programming the electro-stimulation device electrical stimulation to the patient's heart via the selected vector.

Abstract: Some method examples may include pacing a heart with cardiac paces, sensing a physiological signal for use in detecting pace-induced phrenic nerve stimulation, performing a baseline level determination process to identify a baseline level for the sensed physiological signal, and detecting pace-induced phrenic nerve stimulation using the sensed physiological signal and the calculated baseline level. Detecting pace-induced phrenic nerve stimulation may include sampling the sensed physiological signal during each of a plurality of cardiac cycles to provide sampled signals and calculating the baseline level for the physiological signal using the sampled signals. Sampling the sensed physiological signal may include sampling the signal during a time window defined using a pace time with each of the cardiac cycles to avoid cardiac components and phrenic nerve stimulation components in the sampled signal.

Abstract: Systems and methods for managing cardiac arrhythmias are discussed. A data management system receives a first detection algorithm including a detection criterion for detecting a cardiac arrhythmia. An arrhythmia detector detects arrhythmia episodes from a physiologic signal using a second detection algorithm that is different from and has a higher sensitivity for detecting the cardiac arrhythmia than the first detection algorithm. The arrhythmia detector assigns a detection indicator to each of the detected arrhythmia episodes. The detection indicator indicates a likelihood that the detected arrhythmia episode satisfies the detection criterion of the first detection algorithm. The system prioritizes the detected arrhythmia episodes according to the assigned detection indicators, and outputs the arrhythmia episodes to a user or a process according to the episode prioritization.

Abstract: Systems and methods for monitoring chronic over-pacing (COP) to the heart are discussed herein. In an embodiment, a system includes a receiver circuit to receive information about pacing rates of a plurality of paced heart beats, and a pacing analyzer circuit to generate a pacing rate distribution using pacing rates of the plurality of the paced heart beats. The pacing rate distribution includes a pacing rate histogram. The pacing analyzer circuit may recognize a morphological pattern from the pacing rate distribution, and detect a COP indication using the extracted feature. A programmer circuit adjusts one or more therapy parameters in response to the detected. COP indication.

Abstract: Systems and methods for managing machine-generated alert notifications of medical events detected from one or more patients are described herein. An embodiment of a data management system may receive an adjudication of a medical event episode including an episode characterization. A storage unit stores an association between one or more episode characterizations and corresponding detection algorithms for detecting a medical event having respective episode characterizations. An episode management circuit may detect from a subsequent episode, using the stored association, a medical event having an episode characterization of at least one medical event episode presented for adjudication, and schedule presenting at least a portion of the subsequent episode based on the detection.

Abstract: Systems and methods for evaluating multiple candidate sensing vectors for use in sensing electrical activity of a heart are disclosed. The system can sense physiologic signals using each of a plurality of candidate sensing vectors, and generate respective signal intensity indicators and interference indicators using the physiologic signals sensed by using the respective sensing vectors. The system can also receive electrode information of each of the candidate sensing vectors, including information about sensing electrodes that are also used for delivering cardiac electrostimulation. The system can rank at least some of the plurality of candidate sensing vectors according to the signal intensity indicators, the interference indicators, and the electrode information. The system can also include a user interface for displaying the ranked sensing vectors, and allowing the user to select at least one sensing vector for use in sensing the cardiac electrical activity.

Abstract: Systems and methods for detecting slow and persistent rhythms, such as indicative of ventricular response to atrial tachyarrhythmia (AT), are described herein. An arrhythmia detection system monitors patient ventricular heart rate, and identifies slow heart beats with corresponding heart rates falling below a rate threshold during a detection period. The system identifies one or more sustained slow beat (SSB) sequences each including two or more slow heart beats. The system determines a first prevalence indicator of the identified slow heart beats, and a second prevalence indicator of the identified SSB sequences during the detection period. An arrhythmia detector circuit detects a slow and persistent rhythm using the first and second prevalence indicators.

Abstract: Described herein are systems and methods for classifying clinical episodes in order to more accurately generate alerts for those episodes that warrant them. In some embodiments, alerts are only generated for those episodes that are new or different from previous episodes, where the previous episodes have been found to be not significant enough to warrant an alert.

Abstract: An example of a system includes an implantable medical device (IMD) for implantation in a patient, where the IMD includes a cardiac pace generator, phrenic nerve stimulation (PS) sensor, a memory, and a controller, and where the controller is operably connected to the cardiac pace generator to generate cardiac paces. The controller is configured to provide a trigger for conducting a PS detection procedure and perform the PS detection procedure in response to the trigger. In performing the PS detection procedure the controller is configured to receive a signal from the sensor, detect PS using the signal from the sensor, and record the PS detection in storage within the IMD.