Abstract: A subcutaneous implantable medical device and method (SIMD) provided. A pulse generator (PG) is configured to be positioned subcutaneously within a lateral region of a chest of a patient. The PG has a housing that includes a PG electrode. The PG has an electronics module. An elongated lead is electrically coupled to the pulse generator. The elongated lead includes a first electrode that is configured to be positioned along a first parasternal region proximate a sternum of the patient and a second electrode that is configured to be positioned at an anterior region of the patient. The first and second electrodes are coupled to be electrically common with one another. The electronics module is configured to provide electrical shocks for antiarrhythmic therapy along at least one shocking vector between the PG electrode and the first and second electrodes.

Abstract: Methods, devices and program products are provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device. Electrodes are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. A conduction different ? is determined based on i) an atrial-ventricular conduction delay (ARRV) between the A site and the RV site, and ii) an atrial-ventricular conduction delay (ARLV) between the A site and the LV site. A correction term ? is based on intrinsic inter-ventricular conduction delay (IVCD) between the LV and RV. An LV atrial-ventricular pacing (AVLV) delay is set based on the conduction difference ?, a pacing latency PL and the correction term ? and manages the LUV pacing therapy based on the AVLV delay, wherein the LUV pacing therapy lacks pacing in the RV.

Abstract: Methods for implanting a pulse generator (PG) within a pectoral region of a chest of a patient and devices having the PG. The PG has a housing that includes a PG electrode. Methods also include implanting at least one lead having first and second electrode segments with the first electrode segment positioned along an anterior of the chest of the patient and the second electrode segment positioned along at least one of a posterior of the patient or a side of the patient. The first and second electrode segments are positioned subcutaneously at or below an apex of a heart of the patient, wherein the PG electrode and the first and second electrode segments are configured to provide electrical shocks for antiarrhythmic therapy.

Abstract: Methods for implanting a puke generator (PG) within a pectoral region of a chest of a patient and devices having the PG. The PG has a housing that includes a PG electrode. Methods also include implanting at least one lead having first and second electrode segments with the first electrode segment positioned along an anterior of the chest of the patient and the second electrode segment positioned along at least one of a posterior of the patient or a side of the patient. The first and second electrode segments are positioned subcutaneously at or below an apex of a heart of the patient, wherein the PG electrode and the first and second electrode segments are configured to provide electrical shocks for antiarrhythmic therapy.

Abstract: An implantable system includes a first leadless pacemaker (LP1) implanted in or on a first chamber of a heart and a second leadless pacemaker (LP2) implanted in or on a second chamber of the heart. The LP1 is configured to time delivery of one or more pacing pulses delivered to the first chamber of the heart based on timing of cardiac activity associated with the second chamber of the heart detected by the LP1 itself. The LP1 is also configured to transmit implant-to-implant (i2i) messages to the LP2. The LP2 is configured to time delivery of one or more pacing pulses delivered to the second chamber of the heart based on timing of cardiac activity associated with the second chamber of the heart as determined based on one or more i2i messages received by the LP2 from the LP1.

Abstract: A leadless pacemaker (LP) is configured to be implanted in or on a cardiac chamber. The LP includes a first housing made of an electrically conductive material, a second housing made of an electrically conductive material, and an inter-housing insulator between the first and second housings and electrically isolating the first and second housings from one another. Electronic circuitry within the first housing includes pulse generator(s), sense amplifier(s), and a controller. A battery within the second housing provides power to the electronic circuitry via conductors that electrically couple poles of the battery to the electronic circuitry within the first housing. The LP includes two or more electrodes including at least one tip electrode and at least one ring electrode. At least two of the electrodes are selectively couplable to a pulse generator to enable delivery of pacing pulses to the cardiac chamber in or on which the LP is implanted.

Abstract: An implantable system includes a first leadless pacemaker (LP1) implanted in or on a first chamber of a heart and a second leadless pacemaker (LP2) implanted in or on a second chamber of the heart. The LP1 uses at least two of its electrodes to transmit and receive implant-to-implant (i2i) messages to and from the LP2. During one or more periods of time, the LP1 times delivery of pacing pulse(s) to the first chamber of the heart based on timing of cardiac activity associated with the second chamber of the heart detected by the LP1 itself. During one or more further periods of time, the LP1 times delivery of pacing pulse(s) to the first chamber of the heart based on timing of cardiac activity associated with the second chamber of the heart as determined based on one or more i2i messages received by the LP1 from the LP2.

Abstract: A method and system are provided for controlling an adaptive pacing therapy using an implantable medical device (IMD). The method provides electrodes that are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. The method utilizes one or more processors to perform obtaining an intra-atrial conduction interval (IACI-LVPROX) between an atrial event and intrinsic conduction at an LV site that is proximal to a sinoatrial (SA) node and obtaining timing of a first heart sound S1. The processors determine whether the S1 occurs after the IACI-LVPROX, and calculates an S1-conduction lag ?S1_C between the IACI-LVPROX and the first heart sound S1. The processors set an atrial-ventricular pacing (AV) delay based on the IACI-LVPROX and the ?S1_C. The processors deliver a pacing therapy based on the AV delay.

Abstract: A method and system are provided. The method and system sense cardiac events of a heart. The method and system utilizes one or more processors. The processors detect a ventricular fibrillation (VF) episode based on the cardiac events and identify a pace-assisted VF therapy based on the ventricular fibrillation episode. The pace assisted VF therapy includes a burst pacing therapy and a high voltage (HV) shock. The method and system deliver the burst pacing therapy at one or more pacing sites in a coordinated manner before or during the HV shock. The one or more pacing sites includes at least one of a left ventricular (LV) site or a right ventricular (RV) site. The method and system deliver the HV shock along a shocking vector between shocking electrodes.

Abstract: Embodiments described herein relate to implantable medical devices (IMDs) and methods for use therewith. Such a method includes using an accelerometer of an IMD (e.g., a leadless pacemaker) to produce one or more accelerometer outputs indicative of the orientation of the IMD. The method can also include controlling communication pulse parameter(s) of one or more communication pulses (produced by pulse generator(s)) based on accelerator output(s) indicative of the orientation of the IMD. The communication pulse parameter(s) that is/are controlled can be, e.g., communication pulse amplitude, communication pulse width, communication pulse timing, and/or communication pulse morphology. Such embodiments can be used to improve conductive communications between IMDs whose orientation relative to one another may change over time, e.g., due to changes in posture and/or due to cardiac motion over a cardiac cycle.

Abstract: Methods and devices are is provided for controlling a pacing therapy utilizing left ventricular multi-point pacing (MPP). The method and device provide electrodes configured to be located proximate to an atrial (A) site, a right ventricular (RV) site and multiple left ventricular (LV) sites of the heart. The method and device utilizes one or more processors. The processors determine atrial-ventricular conduction delays (AVCD) between the A site and multiple corresponding LV sites and determines pacing latencies at the LV sites. The processors adjusts the AVCDs, based on the pacing latency at the corresponding LV sites, to form atrial-ventricular latency adjusted (ARPL) conduction delays for the corresponding LV sites, calculates interventricular pacing (VV) delays for combinations of the LV sites based on the corresponding ARPL conduction delays and manages pacing therapy, that utilizes left ventricular MPP, based on the VV delays for the corresponding LV sites.

Abstract: Systems and methods are provided for detecting arrhythmias in cardiac activity is provided. The systems and methods include measuring conduction delays between an atria (A) and multiple left ventricular (LV) electrodes to obtain multiple intrinsic A/LV intervals, measuring conduction delays between a right ventricular (RV) and the multiple LV electrodes to obtain multiple intrinsic VV intervals. The systems and methods include calculating a first atrial ventricular (AV) delay based on at least one of the intrinsic A/LV intervals, and calculating a second AV delay based on at least one of the intrinsic VV intervals. The systems and methods include selecting a biventricular (BiV) pacing mode or an LV only pacing mode based on a relation between the first and second AV delays, and delivering a pacing therapy based on the selecting operation.

Abstract: A computer implemented method and system for detecting arrhythmias in cardiac activity are provided. The method is under control of one or more processors configured with specific executable instructions. The method obtains cardiac activity (CA) signals at the electrodes of an implantable medical device (IMD) in connection multiple cardiac beats and with different IMD orientations relative to gravitational force. The method obtains acceleration signatures at a sensor of the IMD that are indicative of heart sounds generated during the cardiac beats. The method obtains device location information at the IMD, with respect to the gravitational force during the cardiac beats. The method groups the acceleration signatures associated with the first and second set of cardiac beats into the corresponding one of first and second posture bins based on the device location information.

Abstract: The present disclosure provides systems and methods for applying anti-tachycardia pacing (ATP) using subcutaneous implantable cardioverter-defibrillators (SICDs). An SICD implantable in a subject includes a case including a controller, and at least one conductive lead extending from the case. The at least one conductive lead includes a plurality of coil electrodes, wherein the SICD is configured, via the controller, to apply anti-tachycardia pacing (ATP) to the subject using the at least one conductive lead.

Abstract: Methods and implantable medical devices (IMDs) are provided for monitoring a cardiac function of a heart. A heart sound sensor is configured to sense heart sound signals of the subject. The IMD includes a memory to store program instructions. The IMD includes a processor that, when executing the program instructions, is configured to identify S2 signal segment from the heart sound signals, analyze the S2 signal segment to identify a pulmonary valve signal (P2 signal) and an aortic valve signal (A2 signal) within an S2 signal segment of the heart sound signals. The processor is configured to determine a time interval between the A2 and P2 signals, characterize the S2 signal segment to exhibit a first type of S2 split based on the time interval, and identify a cardiac condition based on a comparison of the first type of S2 split and a cardiac condition matrix.

Abstract: A method and system are provided for controlling an adaptive pacing therapy using an implantable medical device (MD). The method provides electrodes that are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. The method utilizes one or more processors to perform obtaining an intra-atrial conduction interval (IACI-LVPROX) between an atrial event and intrinsic conduction at an LV site that is proximal to a sinoatrial (SA) node and obtaining timing of a first heart sound S1. The processors determine whether the S1 occurs after the IACI-LVPROX, and calculates an S1-conduction lag ?S1_C between the IACI-LVPROX and the first heart sound S1. The processors set an atrial-ventricular pacing (AV) delay based on the IACI-LVPROX and the ?S1_C. The processors deliver a pacing therapy based on the AV delay.

Abstract: An apparatus for providing therapy to tissue comprising a flexible shaft with distal and proximal ends, and a planar therapy structure, where the planar therapy structure is coupled with the distal end of the flexible shaft, where the planar therapy structure comprises an inlet to receive a pressurized coolant from a supply line, a plurality of openings to provide the pressurized coolant to an expansion chamber, and an outlet to receive a de-pressurized coolant from the expansion chamber. A system comprising a coolant source, a coolant control, a catheter, and a planar therapy structure. A method for cooling tissue comprising circulating a coolant through a portion of the catheter, inputting the coolant through an inlet, dispensing the coolant from the inlet through a plurality of openings into an expansion chamber, cooling a tissue proximate the distal end portion of the catheter, and outputting the coolant from the expansion chamber.

Abstract: Methods and devices include making an incision at a single site of a patient. The single site located at an anterior of a chest or abdomen. The method also includes inserting a tunneling tool through the incision at the single site and preparing a first tunnel to a subcutaneous posterior location. A path of the first tunnel at least one of i) extends over a plurality of Intercostal gaps of the chest or ii) extends along and within one of the intercostal gaps. The method also includes positioning a first lead having an electrode within the first tunnel and preparing a second tunnel to a subcutaneous parasternal location along the chest. The method also includes positioning a second lead having an electrode within the second tunnel and positioning a pulse generator within a subcutaneous pocket and operatively coupling the first and second leads to the pulse generator.

Abstract: Methods for implanting a puke generator (PG) within a pectoral region of a chest of a patient and devices having the PG. The PG has a housing that includes a PG electrode. Methods also include implanting at least one lead having first and second electrode segments with the first electrode segment positioned along an anterior of the chest of the patient and the second electrode segment positioned along at least one of a posterior of the patient or a side of the patient. The first and second electrode segments are positioned subcutaneously at or below an apex of a heart of the patient, wherein the PG electrode and the first and second electrode segments are configured to provide electrical shocks for antiarrhythmic therapy.

Abstract: A subcutaneous implantable medical device and method (SIMD) provided. A pulse generator (PG) is configured to be positioned subcutaneously within a lateral region of a chest of a patient. The PG has a housing that includes a PG electrode. The PG has an electronics module. An elongated lead is electrically coupled to the pulse generator. The elongated lead includes a first electrode that is configured to be positioned along a first parasternal region proximate a sternum of the patient and a second electrode that is configured to be positioned at an anterior region of the patient. The first and second electrodes are coupled to be electrically common with one another. The electronics module is configured to provide electrical shocks for antiarrhythmic therapy along at least one shocking vector between the PG electrode and the first and second electrodes.