Abstract: An implantable medical device assembly includes a mounting structure, an electrode protruding from a surface of the structure, between opposing sides thereof, and tissue-penetrating fixation tines, each extending from a corresponding shoulder of the structure surface, adjacent to the opposing sides. In a relaxed condition, each tine extends away from the surface and then bends toward a proximal end of the structure and back toward the surface. In an extended condition, each tine bends toward a distal end of the structure and extends along the corresponding shoulder. A holding member of a delivery tool has opposing sidewalls defining a cavity, wherein each sidewall includes a rail-like edge that fits in sliding engagement with a corresponding shoulder, to deform a corresponding tine into the extended condition, when an operator passes the assembly into the cavity. Applying a push force, to move the assembly back out form the cavity, releases the tines.

Abstract: Techniques for systems and methods for remotely monitoring a patient are provided. The system comprises a plurality of input sources operable to acquire patient-specific information corresponding to a condition of a patient. A patient-centric threshold is computed based on relevant environmental, cultural, societal, religion, and economic data for evaluation of the acquired physiological parameters. Risk stratification is performed to determine the risk level of the patient based on the patient-centric threshold, and a recommendation is generated. The recommendation includes a treatment/care plan that can consist of prescriptions and patient education tailored to the risk stratification and patient-specific information.

Abstract: An operator advances a delivery catheter through a guiding catheter, after positioning an inflatable sleeve of the guiding catheter in proximity to a target implant site on an epicardial surface. By inflating the positioned sleeve, the operator displaces the epicardial surface to create a gap that accommodates a reach of the delivery catheter. With the delivery catheter extending distally from the guiding catheter, the operator can activate the reach of the delivery catheter within the gap, and then advance the lead out through a distal-most opening of the delivery catheter. The reach may orient a fixation member of the advanced lead relative to the epicardial surface so the operator can secure the lead to the surface. The sleeve of the guiding catheter is preferably non-compliant and has a maximum diameter of at least twice the reach of the delivery catheter, when inflated.

Abstract: In one example, a method includes determining a slope of a cardiac electrogram. The method may also include determining a threshold value based on a maximum of the slope of the cardiac electrogram. The method may further include identifying a last point of the cardiac electrogram before the slope of the cardiac electrogram crosses the threshold as one of an onset or an offset of a wave. In another example, the method further includes receiving an indication of local ventricular motion associated with a cardiac contraction, and determining an electromechanical delay between the identified onset and the local ventricular motion. Some examples include providing the electromechanical delay for configuration of cardiac resynchronization therapy.

Abstract: An implantable medical device system includes a pacemaker and an implantable cardioverter defibrillator (ICD). The pacemaker is configured to confirm a hemodynamically unstable rhythm based on an activity metric determined from an activity sensor signal after detecting a ventricular tachyarrhythmia and withhold anti-tachycardia pacing (ATP) pulses in response to confirming the hemodynamically unstable rhythm. The pacemaker may deliver ATP when a hemodynamically unstable rhythm is not confirmed based on the activity metric. The ICD is configured to detect the ATP and withhold a shock therapy in response to detecting the ATP in some examples.

Abstract: This disclosure describes an implantable medical electrical lead and an ICD system utilizing the lead. The lead includes a lead body defining a proximal end and a distal portion, wherein at least a part of the distal portion of the lead body defines an undulating configuration. The lead includes a defibrillation electrode that includes a plurality of defibrillation electrode segments disposed along the undulating configuration spaced apart from one another by a distance. The lead also includes at least one electrode disposed between adjacent sections of the plurality of defibrillation sections. The at least one electrode is configured to deliver a pacing pulse to the heart and/or sense cardiac electrical activity of the heart.

Abstract: An apparatus for guiding the placement of a subcutaneous device that includes a strap having an indentation configured for a fold of skin and fat layer to be positioned within the indentation as the subcutaneous device is advanced to a desired implantation site.

Abstract: A method and device for detecting a cardiac event that includes sensing cardiac electrical signals representative of electrical activity of a heart of a patient, detecting the cardiac event in response to the sensed cardiac signals, determining an indication of signal reliability corresponding to the sensed cardiac signals as being one of a reliable signal and a not reliable signal, and switching operation of the device between a first mode of determining whether the sensed signal is one of treatable and not treatable and a second mode of determining whether the sensed signal is one of treatable and not treatable in response to the determined indication of signal reliability.

Abstract: An implantable electrical medical system comprises a low voltage cathode electrode assembly, including a cathode surface adapted for, intimate contact with electrically active tissue, and a low voltage anode electrode assembly, including an anode surface and a porous layer extending over the anode surface. The cathode surface and the anode surface function as a bipolar pair for pacing and the porous layer extending over the anode surface allows conduction therethrough and prevents the anode surface from contacting the electrically active tissue in order to prevent anodal stimulation.

Abstract: A medical electrical electrode includes an elongated conductive coil located over a lead body, and a conductive polymer material in contact with the lead body and located between individual coils of the elongated conductive coil. In certain embodiments, the conductive polymer is a polymer (e.g., silicone) implanted with a conductive filler (e.g., carbon black). In certain embodiments, the conductive polymer material is generally isodiametric with an outer diameter of the individual coils of the elongated conductive coil. A medical electrical electrode is fabricated by sliding an elongated conductive coil over a length of a lead body, dispersing a conductive polymer on the helical coil, inserting a tubing over the elongated conductive coil, distributing the polymer material between individual turns of the elongated conductive coil, heating the tubing so the tubing shrinks around the elongated conductive coil, and removing the tubing.

Abstract: In one example, a method includes determining a slope of a cardiac electrogram. The method may also include determining a threshold value based on a maximum of the slope of the cardiac electrogram. The method may further include identifying a last point of the cardiac electrogram before the slope of the cardiac electrogram crosses the threshold as one of an onset or an offset of a wave. In another example, the method further includes receiving an indication of local ventricular motion associated with a cardiac contraction, and determining an electromechanical delay between the identified onset and the local ventricular motion. Some examples include providing the electromechanical delay for configuration of cardiac resynchronization therapy.

Abstract: Pulseless electrical activity (PEA) is reduced or eliminated. A medical electrical lead is implanted to deliver high voltage therapy to a fibrillating heart. Another medical electrical lead delivers electrical stimulation through an electrode proximate phrenic nerve tissue in response to the delivery of high voltage therapy to the fibrillating heart.

Abstract: Techniques for reducing inappropriate tachyarrhythmia therapy and associated medical device systems are described. In some examples a processor is enabled to receive a cardiac electrical signal representative of electrical activity of a heart of a patient and provide an indication of cardiac electrical signal reliability. A heart sound analyzing module is enabled to receive the indication of cardiac electrical signal reliability and a heart sound signal representing sounds generated by the heart of the patient and generated by a heart sound sensor. The heart sound analyzing module selectively determines an ensemble averaged heart sound signal or detects a plurality of heart sounds from the heart sound signal in response to the indication of cardiac electrical signal reliability.

Abstract: A method and device for detecting a cardiac event that includes sensing cardiac electrical signals representative of electrical activity of a heart of a patient, detecting the cardiac event in response to the sensed cardiac signals, determining an indication of signal reliability corresponding to the sensed cardiac signals as being one of a reliable signal and a not reliable signal, and switching operation of the device between a first mode of determining whether the sensed signal is one of treatable and not treatable and a second mode of determining whether the sensed signal is one of treatable and not treatable in response to the determined indication of signal reliability.

Abstract: A medical device and associated method obtaining cardiac event intervals corresponding to a tachycardia interval. Evidence of a rhythm breaking point is obtained in response to sensing a cardiac event having a morphology corresponding to a supraventricular beat. A non-treatable rhythm is detected in response to the plurality of cardiac event intervals and the evidence of the rhythm breaking point.

Abstract: A medical device and associated method for detecting arrhythmias that includes electrodes for sensing cardiac electrical signals and a hemodynamic sensor for sensing a hemodynamic signal. An episode of cardiac electrical event intervals meeting cardiac arrhythmia detection criteria is detected from the sensed electrical signals. Cardiac mechanical events and/or cardiac mechanical event intervals are measured from the hemodynamic signal and used to withhold or confirm a cardiac arrhythmia detection of the episode.

Abstract: A medical device and associated method for detecting arrhythmias that includes sensing cardiac electrical signals and cardiac hemodynamic signals, determining a long-term baseline hemodynamic measurement in response to a plurality of the sensed cardiac hemodynaic signals, detecting a period of increased metabolic demand in response to the sensed cardiac electrical signals, determining a sinus tachycardia baseline hemodynamic measurement in response sensing of cardiac hemododynamic signals during the detected period of increased metabolic demand, and detecting the arrhythmia and delivering therapy in response to one of only the sensed cardiac electrical signals and the sensed cardiac electrical signals in combination with one or both of the determined long-term baseline hemodynamic measurement and the sinus tachycardia baseline hemodynamic measurement.

Abstract: An implantable medical lead includes an adaptor coupled to a body of the lead. The adaptor holds a sensor capsule between a first portion and a second portion of the lead body.

Abstract: A medical device and associated method obtaining cardiac event intervals corresponding to a tachycardia interval. Evidence of a rhythm breaking point is obtained in response to sensing a cardiac event having a morphology corresponding to a supraventricular beat. A non-treatable rhythm is detected in response to the plurality of cardiac event intervals and the evidence of the rhythm breaking point.

Abstract: A method and apparatus for sensing improvement using pressure data. The method and apparatus may be used in an implantable medical device to confirm that an EGM event signifies a true mechanical cardiac activity and not just electrical oversensing. The mechanical activity may be used to create a mechanical marker channel in the implantable medical device.