Abstract: Systems, methods, and graphical user interfaces are described herein for non-invasively detecting phrenic nerve stimulation during cardiac pacing therapy. Phrenic nerve stimulation information may be generated for one or more electrical pacing vectors at one or more power configurations. The phrenic nerve stimulation information may be displayed to a user for use in configuring and/or evaluating cardiac pacing therapy.

Abstract: Systems, methods, and graphical user interfaces are described herein for non-invasively detecting phrenic nerve stimulation during cardiac pacing therapy. Phrenic nerve stimulation information may be generated for one or more electrical pacing vectors at one or more power configurations. The phrenic nerve stimulation information may be displayed to a user for use in configuring and/or evaluating cardiac pacing therapy.

Abstract: The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.

Abstract: A method comprising sensing a blood pressure signal, deriving a hemodynamic measure from the sensed blood pressure signal, adjusting an extra systolic stimulation control parameter in response to the hemodynamic measure, and delivering extra systolic stimulation pulses according to the adjusted control parameter. The sensed blood pressure signal may be a ventricular or arterial blood pressure signal from which an estimated cardiac output, end diastolic pressure, mean pressure or any other hemodynamic measure is derived. Adjusting the extra systolic stimulation control parameter may include adjusting a pacing rate, a pacing interval, an extra systolic stimulation ratio, an extra systolic stimulation interval or enabling or terminating the extra systolic stimulation.

Abstract: The present invention provides an apparatus and method for monitoring muscle function based on an index derived from a pressure or force signal. The muscle function index is derived from an instantaneous muscle stiffness ratio computed as the ratio of the first time derivative of the pressure or force waveform to the corresponding instantaneous pressure or force. The instantaneous stiffness ratio, {dot over (E)}/E(t), is in units of 1/sec and relates to the rate of strong bond formation and will be influenced by calcium handling properties of the muscle fibers and the intracellular calcium concentration. As such, an index derived from {dot over (E)}/E(t) provides a measure of the inotropic status of the muscle.

Abstract: A method and an apparatus for a hardware/firmware trap. At least one set of a firmware code is executed for operation of the device. Modification to the operation of the device is performed. The modification to the operation comprises: receiving a patch code; creating a firmware trap; generating an interrupt in response to the firmware trap; and executing the patch code in response to the interrupt.

Abstract: An extra-systolic stimulation (ESS) therapy addresses cardiac dysfunction including heart failure. ESS therapy employs atrial and/or ventricular extra-systoles via pacing-level stimulation to a heart. These extra-systoles must be timed correctly to achieve beneficial effects on myocardial mechanics (efficacy) while maintaining an extremely low level of risk of arrhythmia induction and excellent ICD-like arrhythmia sensing and detection (security). The present invention relates to therapy delivery guidance and options for improved ESS therapy delivery. These methods may be employed individually or in combinations in an external or implantable ESS therapy delivery device.

Abstract: The present invention relates to the secure delivery of an extra-systolic stimulation (ESS) therapy to treat cardiac dysfunction that employs atrial and/or ventricular extra-systoles via pacing-like stimulation of the heart. These extra-systoles must be timed correctly to achieve beneficial effects on myocardial mechanics (benefit) while maintaining an extremely low level of risk of arrhythmia induction and excellent ICD-like arrhythmia sensing and detection (security). Further experience with ESS has led to improved implementation methods that depend on better blanking, ESS stimulation timing (of an “extra-systolic interval” or ESI), and ESS therapy delivery options and guidance. These methods may be employed individually or in combinations in an external or implantable ESS therapy delivery device.

Abstract: Techniques for estimating the temporal refractory period of a heart, for adjusting a parameter for delivery of extra-systolic stimulation (ESS) therapy and for detecting an arrhythmia during delivery of ESS therapy are disclosed. In some embodiments, probe pulses are periodically delivered to estimate the location of the end boundary of the refractory period, and accordingly estimate its length. In some embodiments, the parameter is adjusted based on estimated length of the refractory period. For example, an extra-systolic interval (ESI) for delivery of ESS is adjusted to be a fixed interval longer than estimated lengths of the refractory period. In other embodiments, the parameter is adjusted based on a measured delay (or latency) between delivery of an ESS pulse and detection of an evoked response resulting from the pulse. In some embodiments, delays between delivery of an ESS pulse and detection of a subsequent depolarization are monitored to detect an arrhythmia.