Abstract: Determining an optimal atrioventricular interval is of interest for proper delivery of cardiac resynchronization therapy. Although device optimization is gradually and more frequently being performed through a referral process with which the patient undergoes an echocardiographic optimization, the decision of whether to optimize or not is still generally reserved for the implanting physician. Recent abstracts have suggested a formulaic approach for setting A-V interval based on intrinsic electrical sensing, that may possess considerable appeal to clinicians versus a patient average nominal A-V setting of 100 ms. The present invention presents a methods of setting nominal device settings based on entering patient cardiac demographics to determine what A-V setting may be appropriate. The data is based on retrospective analysis of the MIRACLE trial to determine what major factors determined baseline A-V settings.

Abstract: Automated adjustment of a pre-excitation interval (PEI) used to deliver hemodynamically efficient fusion pacing therapy.

Abstract: An implantable medical device (IMD) identifies lead performance issues and provides alternative lead configurations to continue with the programmed therapy. In the absence of an appropriate alternatively lead configuration, the IMD determines alternative mechanisms to provide a similar therapy or to determine a secondary therapy.

Abstract: Pacing parameters are provided to address cross talk and intrinsic ventricular events occurring within a predefined blanking period following an atrial event. The parameters are used in conjunction with protocol for minimizing or reducing ventricular pacing, wherein ignoring intrinsic ventricular events during the blanking period might otherwise affect the performance of the protocol.

Abstract: An implantable medical device system and associated method are provided for measuring an excitation-physiological response delay. The method includes sensing a first signal responsive to electrical activity in a first cardiac chamber, sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and determining an excitation-physiologic response delay in response to the first signal and the second signal.

Abstract: According to the present invention at least a pair of neurological stimulation electrodes are disposed in, on, about, adjacent and/or within excitable neural tissue of a subject. Cardiac activity of a patient is detected using one or more electrodes adapted for delivery of a neurological stimulation therapy (NST). Following detection of certain types of cardiac activity one or more of the plurality of stimulation electrodes deliver or withhold NST, if desired in synchrony with the cardiac activity or in response to the detected cardiac activity. The NST delivered includes without limitation subcutaneous stimulation, peripheral, TENS and/or vagal nerve stimulation therapy or the like.

Abstract: Heart-monitoring systems, apparatus, and methods adapted to detect CS, CI and/or MI. In one embodiment, a system comprising at least two first-tier sensors capable of measuring and converting into signals at least two aspects related to cardiac function, at least one second-tier sensor that is also a first-tier sensor, at least one signal processor capable of transmitting a first-tier and second-tier trigger signal when coronary syndrome, cardiac ischemia or myocardial infarction has been detected, at least one communication device capable of communicating, at least one control element adapted to produce a first-tier and second-tier trigger signal when at least one first-tier sensor exceeds its threshold signal level, to exclude the signal from the first-tier sensor that exceeded its threshold and lower at least one threshold of the at least one first-tier sensor is provided.

Abstract: A method for determining an optimal pacing timing control parameter setting is provided for use in an implantable medical device programmed to deliver a pacing pulse in response to the timing control parameter. The method includes storing a user-selected optimization metric, iteratively adjusting the timing control parameter setting, sensing a first signal that varies in response to left ventricular wall acceleration, measuring the user-selected optimization metric in response to the sensed first signal, and determining an optimal timing control parameter value in response to the measured user-selected optimization metric.

Abstract: A method and apparatus are used to provide therapy to a patient experiencing ventricular dysfunction or heart failure. At least one electrode is located in a region associated with nervous tissue, such as nerve bundles T1-T4, in a patient's body. Electrical stimulation is applied to the at least one electrode to improve the cardiac efficiency of the patient's heart. One or more predetermined physiologic parameters of the patient are monitored, and the electrical stimulation is adjusted based on the one or more predetermined physiologic parameters.

Abstract: The disclosure provides methods and apparatus of left ventricular pacing including automated adjustment of a atrio-ventricular (AV) pacing delay interval and intrinsic AV nodal conduction testing. It includes—upon expiration or reset of a programmable AV Evaluation Interval (AVEI)—performing the following: temporarily increasing a paced AV interval and a sensed AV interval and testing for adequate AV conduction and measuring an intrinsic atrio-ventricular (PR) interval for a right ventricular (RV) chamber. Thus, in the event that the AV conduction test reveals a physiologically acceptable intrinsic PR interval then storing the physiologically acceptable PR interval in a memory structure (e.g., a median P-R from one or more cardiac cycles). In the event that the AV conduction test reveals an AV conduction block condition or if unacceptably long PR intervals are revealed then a pacing mode-switch to a bi-ventricular (Bi-V) pacing mode occurs and the magnitude of the AVEI is increased.

Abstract: A method and apparatus for delivering corrective therapy through hormone regulation is provided. Inhibition of sympathetic fibers by spinal cord stimulation is used to regulate the levels of hormones such as catecholamines, renin, and calcitonin gene-related peptide. The invention utilizes a closed or open loop feedback system in which physiological parameters such as the concentrations of hormones and sympathetic indicators such as heart rate and urine production are monitored and used to determine the appropriate level of neurostimulation. The site of electrical stimulation includes, but is not limited to, the spinal cord at levels T7-L2 and the associated neural fibers within a region of the T7-L2 dermatomes.

Abstract: Pacing parameters are provided to address cross talk and intrinsic ventricular events occurring within a predefined blanking period following an atrial event. The parameters are used in conjunction with protocol for minimizing or reducing ventricular pacing, wherein ignoring intrinsic ventricular events during the blanking period might otherwise affect the performance of the protocol.

Abstract: Provided herewith are methods and apparatus for optimizing ventricle-to-ventricle (V-V) pacing delay intervals based upon ECG-based optimization calculated as a linear function of P-wave duration sensed PR (intrinsic) interval sensed (or paced) QRS duration and heart rate. Since the relationship among these parameters is linear once the coefficients are solved (which can be any value, including null) with reference to a known optimized V-V interval such as from an echocardiographic study, an operating V-V interval value can be dynamically adjusted in an ambulatory subject. The various combinations of values can be loaded into a look up table or calculated automatically. And, since some of the parameters do not typically change much over time they can be determined acutely and fed into the equation while the other values can be measured more frequently. The parameter values can be measured by an implantable medical device such as a dual- or triple-chamber pacemaker.

Abstract: Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval. One manner described involves dynamically programming an AV interval in cardiac resynchronization therapy (CRT) device having a rate-adaptive AV (RAAV) feature in such a way that not less than a minimum AV interval is maintained. That is, the AV interval is not allowed to be reduced so much that the P-wave is truncated by the QRS complex. In this form of the invention, the AV interval is reduced by one millisecond per one bpm increase in heart rate (and vice versa for reducing heart rate) but maintained at a value calculated from the end of the P-wave (PWend) and the beginning of the QRS complex (QRSbeg) or delivery of a ventricular pacing stimulus or to the end of the end of the QRS complex (QRSend).

Abstract: A medical device and method for determining a parameter for delivery of a predetermined pacing therapy that includes a plurality of electrodes to deliver a pacing therapy, including the predetermined pacing therapy, and a control unit to control the timing of the delivery of the pacing therapy, including the predetermined pacing therapy, by the electrodes. A processor generates a first template in response to the pacing therapy being delivered to only one of a right ventricle and a left ventricle, and a second template in response to the pacing therapy being delivered to only the other of the right ventricle and the left ventricle, and determines the parameter in response to a comparing of subsequently delivered pacing therapy to the first template and the second template.

Abstract: Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval. One manner described involves programming an AV interval in such a way that the time interval between the end of the P-wave (PWend) and the beginning of the QRS complex (QRSbeg) or ventricular pace stimulus (Vp) is close to or no less than a certain fixed value (e.g. 40 ms). This is defined as an optimized AV interval (AVopt) herein. The foregoing can be dynamically and chronically implemented in an implantable medical device such as a dual- or triple-chamber pacemaker. The PWend value is detected using a novel technique and sensing QRSbeg and/or Vp is achieved with traditional circuitry and components. Then automatic adjustment of an operating AV interval occurs until AVopt is identified. Thereafter, periodic, continuous, or manually-triggered performance of the foregoing can be implemented.

Abstract: Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval based upon ECG-based optimization is calculated as a linear function of P-wave duration, sensed PR (intrinsic) interval, sensed or paced QRS duration and heart rate. Since the relationship among these parameters is linear, once the coefficients are solved (which can be any value, including null) with reference to a known optimized AV interval (AVopt) such as from an echocardiographic study, an AVopt value can be dynamically adjusted in an ambulatory subject. The various combinations of values can be loaded into a look up table or calculated automatically. And, since some of the parameters do not typically change much over time they can be determined acutely and fed into the equation while the other values can be measured frequently. The parameter values can be measured by an implantable medical device such as a dual- or triple-chamber pacemaker.

Abstract: A preferred atrial-based pacing method and apparatus is provided using an intelligent cardiac pacing system to having the ability to continue atrial-based pacing as long as relatively reliable AV conduction is present. In the event that such relatively reliable AV conduction is not present, mode switching to a DDD/R or a DDI/R pacing mode while continually biased to mode switch back to atrial-based pacing. The standard or relatively reliable AV conduction may be changed either automatically or manually. This increases pacing that utilizes natural AV conduction however possible so as to gain all the benefits of cardiac contractile properties resulting therefrom, while tolerating the occasional missed ventricular depolarization (i.e., non-conducted P-wave). In the event where relatively reliable AV conduction is not present, the pacing mode is switched to a DDD/R mode while detecting a return of the relatively reliable AV conduction (and resulting mode switch to preferred atrial based pacing).

Abstract: The implantable medical device (IMD) system disclosed here utilizes one or more cardiac sensors that measure mechanical characteristics of the heart, such as left ventricular acceleration or right ventricular pressure. The raw sensor data is collected and processed by the IMD, which derives one or more mechanical event marker signals from features, traits, and characteristics of the sensor data waveforms. The mechanical event marker signals are wirelessly transmitted to an external monitor device for display.

Abstract: Automated adjustment of a pre-excitation interval (PEI) used to deliver hemodynamically efficient fusion pacing therapy.