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: An interactive representation of electrostimulation electrodes or vectors can be provided, such as for configuring combinations of electrostimulation electrodes. In an example, electrodes or test parameters can be presented graphically or in a table. A user interface can be configured to receive user-input designating electrode combinations or vectors for test or for use in programming an implantable or ambulatory medical device. The interface can be used to indicate suggested electrode combinations or vectors in response to a first selection of an electrode. Tests can be performed on electrode combinations and vectors, and the results of the tests can be presented to a user using the interactive representation. In an example, test results can be analyzed by a processor and optionally used to program an implantable or ambulatory medical device.

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: The disclosure relates to systems and methods for cardiac rhythm management. In some cases, a system may include a pulse generator for generating pacing pulses for stimulating a heart of a patient; a memory; and a sensor configured to sense a response to an unwanted stimulation and to produce a corresponding sensor signal. A processing circuit may receive the sensor signal for a time after one or more pacing pulses, and may derive a time-frequency representation of the sensor signal based on the received sensor signal. The processing circuit may use the time-frequency representation of the sensor signal to help identify unwanted stimulation. Once unwanted stimulation is detected, the processing circuit may change the pacing pulses to help reduce or eliminate the unwanted stimulation.

Abstract: A cardiac rhythm management system includes at least one sensing component configured to obtain a first physiological parameter signal, an indication of a cardiac response to a stimulation therapy, and temporal information corresponding to the first physiological parameter signal and the cardiac response; and at least one processor configured to: receive the first physiological parameter signal, the indication of the cardiac response, and the temporal information; and to classify the cardiac response into a first cardiac response class to generate a classified cardiac response. The at least one processor also is configured to determine a correlation, based on the temporal information, between the first physiological parameter signal and the classified cardiac response.

Abstract: Systems and methods for efficiently determining one or more parameters for vectors of a multi-electrode implantable medical device, and for identifying one or more suitable vectors for sensing cardiac electrical data and/or delivering electrical stimulation therapy based on one or more of the determined parameters. Reducing the time required to determine the one or more parameters for each vector can help reduce procedure time for implanting and/or configuring an implantable medical device, which can reduce costs and/or improved patient comfort.

Abstract: A system and method for mapping an anatomical structure includes sensing activation signals of physiological activity with a plurality of mapping electrodes disposed in or near the anatomical structure. Patterns among the sensed activation signals are identified based on a similarity measure generated between each unique pair of identified patterns which are classified into groups based on a correlation between the corresponding pairs of similarity measures. A characteristic representation is determined for each group of similarity measures and displayed as a summary plot of the characteristic representations.

Abstract: Medical devices and methods for using medical devices are disclosed. An example mapping medical device may include a catheter shaft with a plurality of electrodes. The catheter shaft may be coupled to a processor. The processor may be capable of collecting a first set of signals from a first location, collecting a second set of signals from a second location, characterizing the first set of signals over a first time period, characterizing the second set of signals over a second time period, comparing the first set of signals to the second set of signals and matching a first signal from the first set of signals with a second signal from the second set of signals.

Abstract: Systems and methods may facilitate selection of a vector for delivering electrical stimulation to a patient's heart. One illustrative method may include delivering electrical stimulation at a first voltage to each vector in a first set of two or more vectors of a multi-vector medical system, determining whether the delivered electrical stimulation at the first voltage resulted in capture for each of the vectors in the first set of two or more vectors, identifying those vectors of the first set of two or more vectors that were determined to result in capture as a second set of vectors, delivering electrical stimulation at a second voltage that is lower than the first voltage to each vector in the second set of vectors, and determining whether the delivered electrical stimulation at the second voltage resulted in capture for each of the vectors in the second set of vectors.

Abstract: A method for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the anatomical structure, identifying at least one of the electrodes not in direct contact with the anatomical structure, and adjusting the activation signals sensed by each of the plurality of electrodes based on the activation signals sensed by the identified at least one of the electrodes not in direct contact with the anatomical structure.

Abstract: In some examples, a method of adjusting a cardiovascular medication administration protocol for a subject includes receiving heart contractility surrogate information, obtained from a sensor configured to sense information about a heart of the subject, during a specified acute time period following an initiation or change in medication administration to the subject, determining, using a comparator circuit, whether the heart contractility surrogate information indicates an occurrence of at least a specified change in heart contractility during the specified acute time period following the initiation or change in medication administration to the subject, and adjusting the medication administration protocol using the determination of whether the heart contractility surrogate information indicates the occurrence of at least the specified change in heart contractility during the specified acute time period following the initiation or change in medication administration to the subject.

Abstract: Various techniques are disclosed for quickly and efficiently determining cardiac pacing vectors that minimize phrenic nerve stimulation.

Abstract: An apparatus comprises a stimulus circuit, a cardiac signal sensing circuit, and a control circuit. The stimulus circuit provides electrical pulse energy to a first pacing channel that includes a first left ventricular (LV) electrode as a cathode and a second pacing channel that includes a second LV electrode as a cathode. The cardiac signal sensing circuit senses cardiac signals using a first sensing channel that includes one of the first LV electrode or the second LV electrode. The control circuit includes a capture detection sub-circuit configured to: initiate delivery of electrical pulse energy to both the first pacing channel and the second pacing channel; sense cardiac depolarization of a ventricle using the first sensing channel; determine first and second cardiac capture pulse energy level thresholds for the first and second pacing channels respectively; and provide indications of the cardiac capture pulse energy level thresholds to a user or process.

Abstract: A system and method for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the anatomical structure. A most recent intrinsic event at a selected time is determined based on the sensed activation signals and a persistent display of relevant characteristics is generated based on the sensed activation signals of the most recent intrinsic event. The persistent display is updated upon detection of a subsequent intrinsic event.

Abstract: The disclosure relates to systems and methods for cardiac rhythm management. In some cases, a system may include a pulse generator for generating pacing pulses for stimulating a heart of a patient; a memory; and a sensor configured to sense a response to a unwanted stimulation and to produce a corresponding sensor signal. A processing circuit may receive the sensor signal for a time after one or more pacing pulses, and may derive a time-frequency representation of the sensor signal based on the received sensor signal. The processing circuit may use the time-frequency representation of the sensor signal to help identify unwanted stimulation. Once unwanted stimulation is detected, the processing circuit may change the pacing pulses to help reduce or eliminate the unwanted stimulation.

Abstract: Systems and methods may facilitate selection of a vector for delivering electrical stimulation to a patient's heart. One illustrative method may include delivering electrical stimulation at a first voltage to each vector in a first set of two or more vectors of a multi-vector medical system, determining whether the delivered electrical stimulation at the first voltage resulted in capture for each of the vectors in the first set of two or more vectors, identifying those vectors of the first set of two or more vectors that were determined to result in capture as a second set of vectors, delivering electrical stimulation at a second voltage that is lower than the first voltage to each vector in the second set of vectors, and determining whether the delivered electrical stimulation at the second voltage resulted in capture for each of the vectors in the second set of vectors.

Abstract: The disclosure relates to systems and methods for cardiac rhythm management. In some cases, a system may include a pulse generator for generating pacing pulses for stimulating a heart of a patient; a memory; and a sensor configured to sense a response to an unwanted stimulation and to produce a corresponding sensor signal. A processing circuit may receive the sensor signal for a time after one or more pacing pulses, and may derive a time-frequency representation of the sensor signal based on the received sensor signal. The processing circuit may use the time-frequency representation of the sensor signal to help identify unwanted stimulation. Once unwanted stimulation is detected, the processing circuit may change the pacing pulses to help reduce or eliminate the unwanted stimulation.

Abstract: An anatomical mapping system and method includes mapping electrodes configured to detect activation signals of cardiac activity. A processing system is configured to record the detected activation signals and generate a vector field for each sensed activation signal during each instance of the physiological activity. The processing system determines an onset time and alternative onset time candidates, identifies an initial vector field template based on a degree of similarity between the initial vector field and a vector field template from a bank of templates, then determines an optimized onset time for each activation signal based on a degree similarity between the onset time candidates and initial vector field template.

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: 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.