Abstract: Devices or methods such as for stimulating excitable tissue or sensing physiologic response or other signals are described. An implantable apparatus can comprise an electrostimulation electrode assembly that can include an electrostimulation unit, at least first and second electrodes, and a fixation guide. The electrostimulation unit can generate electrostimulation for stimulating excitable tissue to achieve desired diagnostic or therapeutic effects. The first and second electrodes, coupled to the electrostimulation unit, can deliver the electrostimulation to two or more stimulation sites such as inside two or more heart chambers or on the surface of the heart. The fixation guide can engage and retain a maneuvering device used for steerably positioning and securing the first and second electrostimulation electrodes at respective stimulation site.

Abstract: A leadless implantable medical device comprises a first electrode configured to deliver electrical pacing energy, a second electrode configured to sense intrinsic electrical cardiac activity, and a third electrode configurable to both deliver electrical pacing energy and sense intrinsic electrical cardiac activity. The first and third electrodes are used for delivering electrical pacing energy and the second and third electrodes are used to sense intrinsic electrical cardiac activity. None of the first, second and third electrodes are incorporated into a lead.

Abstract: A leadless implantable medical device can include a hermetically scaled housing including a cylindrical body, a first surface at a first capped end of the cylindrical body, and a second surface at a second capped end of the cylindrical body. A first electrode can be located at the first capped end and a second electrode can be located on the second surface. The first and second electrodes include conductive portions configured for contacting one or both of tissue and fluid, and wherein the cylindrical body includes a length and the conductive portions of the first and second electrodes are separated substantially by the length of the cylindrical body. The device example also includes a therapy circuit configured to deliver electrical cardiac stimulating energy using the first and second electrodes, and a telemetry circuit configured to communicate with a second separate device.

Abstract: Various implantable device embodiments may comprise a neural stimulator configured to deliver a neurostimulation therapy with stimulation ON times and stimulation OFF times where a dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time. The neural stimulator may be configured to monitor the dose of the delivered neurostimulation therapy against dosing parameters. The neural stimulator may be configured to declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy, or may be configured to record data for the monitored dose of the delivered neurostimulation therapy, or may be configured to both record data for the monitored dose of the delivered neurostimulation therapy and declare a fault if the monitored dose does not favorably compare to a desired dose for the neurostimulation therapy.

Abstract: An ambulatory or implantable device, such as a pacer, defibrillator, or other cardiac rhythm management device, can tolerate magnetic resonance imaging (MRI) or other noise without turning on an integrated circuit diode by selectively providing a bias voltage that can overcome an expected induced voltage resulting from the MRI or other noise.

Abstract: An intra-body ultrasonic signal can be converted into a first electrical signal, a local oscillator signal can be generated in an implantable system. The first electrical signal and the local oscillator signal can be mixed in an implantable system, such as to generate a demodulated signal, processed, such as using a filter. The filtered, demodulated signal can be further processed, such as implantably determining a peak amplitude of the first portion of the demodulated signal received from the filter over a time interval, implantably generating a dynamic tracking threshold that starts at an amplitude proportional the first portion of the demodulated signal and exponentially decays over a time interval, and determining a noise floor in the absence of a received intra-body ultrasonic signal and implantably comparing the peak amplitude and the tracking threshold and generate the digital output based on the difference.

Abstract: An integrated circuit for an implantable medical device can include a substrate, a first capacitor, and an electrostatic discharge (ESD) protection circuit. The first capacitor can include an electrically conductive lower polysilicon terminal and an electrically conductive upper polysilicon terminal that can be separated from the lower polysilicon terminal by a first capacitor dielectric material. The ESD protection circuit can include an ESD shunt transistor and a second capacitor. The ESD shunt transistor can be configured to be normally off, but can be configured to turn on and conduct between first and second power supply rails in response to an ESD event exceeding a specified ESD event threshold value. The second capacitor can includes a first substrate terminal and an electrically conductive second polysilicon terminal that can be separated from the first substrate terminal by a second capacitor dielectric material.

Abstract: A neural stimulation system includes a safety control system that prevents delivery of neural stimulation pulses from causing potentially harmful effects. The neural stimulation pulses are delivered to one or more nerves to control the physiological functions regulated by the one or more nerves. Examples of such harmful effects include unintended effects in physiological functions associated with autonomic neural stimulation and nerve injuries caused by excessive delivery of the neural stimulation pulses.

Abstract: Various aspects relate to a method. In various embodiments, a therapy of a first therapy type is delivered, and it is identified whether a therapy of a second therapy type is present to affect the therapy of the first therapy type. Delivery of the therapy is controlled based on the presence of the therapy of the second therapy type. Some embodiments deliver the therapy of the first type using one set of parameters in the presence of a therapy of a second type, and deliver the therapy of the first type using another set of parameters when the therapy of the second type is not present. In various embodiments, one of the therapy types includes a cardiac rhythm management therapy, and the other includes a neural stimulation therapy. Other aspects and embodiments are provided herein.

Abstract: Various aspects of the present subject matter relate to an implantable device. Various device embodiments comprise at least one port to connect to at least one lead with at least electrode, stimulation circuitry connected to the at least one port and adapted to provide at least one neural stimulation therapy to at least one neural stimulation target using the at least one electrode, sensing circuitry connected to the at least one port and adapted to provide a sensed signal, and a controller connected to the stimulation circuitry to provide the at least one neural stimulation therapy and to the sensing circuitry to receive the sensed signal. In response to a triggering event, the controller is adapted to switch between at least two modes. Other aspects and embodiments are provided herein.

Abstract: An implantable medical device or some other ambulatory medical device, such as a pacer, defibrillator, or other cardiac rhythm management device can include an electrical energy delivery circuit, such as including an integrated circuit comprising a first electrostimulation output terminal, a can terminal, and a switch control output. The ambulatory or implantable device can include at least two switches in series, each including a respective substrate electrically separate from the integrated circuit, and from each other, the switches configured to controllably isolate a conductive housing of the implantable medical device from the can terminal of the integrated circuit, such as in response to the switch control output.

Abstract: An implantable cardiac rhythm management (CRM) device includes a sensing and detection circuit that senses at least one cardiac signal and detects cardiac electrical events from the sensed cardiac signal using a detection threshold that is adjusted based on a dynamic noise estimation. The sensed cardiac signal is filtered to produce a filtered cardiac signal having a signal frequency band and a noise signal having a noise frequency band. The noise frequency band is substantially different from the signal frequency band. A dynamic noise floor is produced based on the noise signal and used as the minimum value for the detection threshold. A cardiac electrical is detected when the amplitude of the filtered cardiac signal exceeds the detection threshold.

Abstract: An ambulatory or implantable device, such as a pacer, defibrillator, or other cardiac rhythm management device, can tolerate magnetic resonance imaging (MRI) or other noise without turning on an integrated circuit diode by selectively providing a bias voltage that can overcome an expected induced voltage resulting from the MRI or other noise.

Abstract: Various aspects of the present subject matter relate to a system. Various embodiments of the system comprise at least one port to connect to at least one lead with at least one electrode, at least one stimulator circuit and at least one controller. The at least one stimulator circuit is connected to the at least one port and is adapted to deliver neural stimulation to a neural stimulation target using the at least one electrode. The at least one controller is adapted to determine when another energy discharge other than the neural stimulation to the neural stimulation target is occurring and to prevent delivery of the neural stimulation simultaneously with the other energy discharge. Other aspects and embodiments are provided herein.

Abstract: Various aspects relate to a method. In various embodiments, a therapy of a first therapy type is delivered, and it is identified whether a therapy of a second therapy type is present to affect the therapy of the first therapy type. Delivery of the therapy is controlled based on the presence of the therapy of the second therapy type. Some embodiments deliver the therapy of the first type using one set of parameters in the presence of a therapy of a second type, and deliver the therapy of the first type using another set of parameters when the therapy of the second type is not present. In various embodiments, one of the therapy types includes a cardiac rhythm management therapy, and the other includes a neural stimulation therapy. Other aspects and embodiments are provided herein.

Abstract: An implantable cardiac rhythm management (CRM) device includes a sensing and detection circuit that senses at least one cardiac signal and detects cardiac electrical events from the sensed cardiac signal using a detection threshold that is adjusted based on a dynamic noise estimation. The sensed cardiac signal is filtered to produce a filtered cardiac signal having a signal frequency band and a noise signal having a noise frequency band. The noise frequency band is substantially different from the signal frequency band. A dynamic noise floor is produced based on the noise signal and used as the minimum value for the detection threshold. A cardiac electrical is detected when the amplitude of the filtered cardiac signal exceeds the detection threshold.

Abstract: One aspect of this disclosure relates to a system for dynamic battery management in implantable medical devices. An embodiment of the system includes two or more devices for measuring battery capacity for an implantable medical device battery. The embodiment also includes a controller connected to the measuring devices. The controller is adapted to combine the measurements from the measuring devices using a weighted average to determine battery capacity consumed. According to various embodiments, at least one of the measuring devices includes a coulometer. At least one of the measuring devices includes a capacity-by-voltage device, according to an embodiment. The system further includes a display in communication with the controller in various embodiments. The display is adapted to provide a depiction of battery longevity in units of time remaining in the life of the implantable medical device battery, according to various embodiments. Other aspects and embodiments are provided herein.

Abstract: An apparatus comprises an electrostimulation energy storage capacitor, a circuit path communicatively coupled to the electrostimulation energy storage capacitor and configured to provide quasi-constant current neural stimulation through a load from the electrostimulation energy storage capacitor, a current measuring circuit communicatively coupled to the circuit path and configured to obtain a measure of quasi-constant current delivered to the load, and a control circuit communicatively coupled to the current measuring circuit, wherein the control circuit is configured to initiate adjustment of the voltage level of the storage capacitor for a subsequent delivery of quasi-constant current according to a comparison of the measured load current to a specified load current value.

Abstract: Various aspects of the present subject matter relate to an implantable device. Various device embodiments comprise at least one port to connect to at least one lead with at least electrode, stimulation circuitry connected to the at least one port and adapted to provide at least one neural stimulation therapy to at least one neural stimulation target using the at least one electrode, sensing circuitry connected to the at least one port and adapted to provide a sensed signal, and a controller connected to the stimulation circuitry to provide the at least one neural stimulation therapy and to the sensing circuitry to receive the sensed signal. In response to a triggering event, the controller is adapted to switch between at least two modes. Other aspects and embodiments are provided herein.

Abstract: An ambulatory or implantable device, such as a pacer, defibrillator, or other cardiac rhythm management device, can tolerate magnetic resonance imaging (MRI) or other noise without turning on an integrated circuit diode by selectively providing a bias voltage that can overcome an expected induced voltage resulting from the MRI or other noise.