Abstract: Multi-chamber pacing may result in capture of one chamber, capture of multiple chambers, fusion, or non-capture. Approaches for detecting various capture conditions during multi-chamber pacing are described. Pacing pulses are delivered to left and right heart chambers during a cardiac cycle. A cardiac electrogram signal is sensed following the delivery of the pacing pulses. Left chamber capture only, right chamber capture only, and bi-chamber capture may be distinguished based on characteristics of the cardiac electrogram signal. Multi-chamber capture detection may be implemented using detection windows having dimensions of time and amplitude. The detection windows are associated with expected features, such as expected signal peaks, under a particular capture condition. The cardiac electrogram signal features are compared to detection windows to determine the capture condition.

Abstract: An apparatus comprises an implantable cardiac signal sensing circuit and a controller circuit. The implantable cardiac signal sensing circuit provides a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium. The controller circuit includes a one-to-one detector circuit and a tachyarrhythmia discrimination circuit. The one-to-one detector circuit measures cardiac depolarization intervals of the atrium and the ventricle and determines whether a relationship of atrial depolarizations to ventricular depolarizations is substantially one-to-one. The tachyarrhythmia discrimination circuit increments a counter when detecting a shortening or prolonging of a V-V interval that immediately precedes the same shortening or prolonging of an A-A interval, classifies the episode as VT according to the counter, and provides the classification of the tachyarrhythmia episode to a user or process.

Abstract: An apparatus comprises an implantable cardiac signal sensing circuit and a controller circuit. The implantable cardiac signal sensing circuit provides a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium. The controller circuit includes an onset detection circuit and a classification circuit. The onset detection circuit detects an onset episode that includes fast cardiac depolarizations and identifies a depolarization that initiates the onset episode.

Abstract: A method and system for determining an optimum atrioventricular delay (AVD) interval and/or ventriculo-ventricular delay (VVD) intervals for delivering ventricular resynchronization pacing in an atrial tracking or atrial sequential pacing mode. Evoked response electrograms recorded at different AVD and VVD intervals are used to determine the extent of paced and intrinsic activation.

Abstract: This document discusses, among other things, a system and method for generating a stimulation energy to provide His-bundle stimulation for a cardiac cycle, receiving electrical information from the heart over at least a portion of the cardiac cycle, determining a characteristic of at least a portion of the received electrical information for the cardiac cycle, and classifying the cardiac cycle using the determined characteristic.

Abstract: A system evaluates the performance of an implantable medical device, such as by using a remote external server and a user interface and stored historical physiological data of a population of congestive heart failure (CHF) patients. A processor is coupled to a patient data storage device to apply multiple algorithm variations against the same implantable physiological data from the patient to produce corresponding resulting CHF indicators. The user interface includes a display that is configured to display to a user information allowing comparison between the resulting CHF indicators from the multiple algorithm variations. The display also includes a population data selector to permit the user to select physiological data from a population that includes a different set of one or more patients or physiological data collected over a period of time from the patient. This permits optimization of an algorithm parameter or selection of a best performing algorithm.

Abstract: An apparatus comprises a cardiac signal sensing circuit, a pacing therapy circuit, and a controller circuit. The controller circuit includes a safety margin calculation circuit. The controller circuit initiates delivery of pacing stimulation energy to the heart using a first energy level, changes the energy level by at least one of: a) increasing the energy from the first energy level until detecting that the pacing stimulation energy induces stable capture, or b) reducing the energy from the first energy level until detecting that the stimulation energy fails to induce capture, and continues changing the stimulation energy level until confirming stable capture or the failure of capture. The safety margin calculation circuit calculates a safety margin of pacing stimulation energy using at least one of a determined stability of a parameter associated with evoked response and a determined range of energy levels corresponding to stable capture or intermittent failure of capture.

Abstract: Systems, methods, and apparatus for identifying and classifying noise of an intracardiac electrogram of a cardiac rhythm management device to prevent inaccurate detection of a cardiac episode are disclosed. In an example, three channels are analyzed to identify and determine whether an episode or noise has been detected.

Abstract: Methods and systems involve classifying the cardiac response to pacing using a multi-channel approach. Multiple cardiac response signals are sensed via multiple sense channels. Each sense channel comprises a distinct combination of electrodes and sensing circuitry. The cardiac response to the pacing pulse is classified based on the morphology of the cardiac response signals. Classifying the cardiac response involves discriminating between capture, fusion, non-capture, and non-capture with intrinsic activity.

Abstract: An apparatus comprises a sensor circuit configured to produce a time-varying physiologic sensor signal of a subject and a pathology detection circuit communicatively coupled to the sensor. The pathology detection circuit is configured to detect a first pathological episode using the sensed physiologic sensor signal, deem that the first pathological episode has ended, detect at least one second pathological episode using the sensed physiologic sensor signal, and indicate the first and second pathological episodes as one pathological episode if the first and second episode are detected within a specified time interval.

Abstract: A method and device to detect and compare changes in atrial rate and morphology can be used to identify left atrial sense and capture, such as from a quadripolar or other lead located in or around the coronary sinus.

Abstract: In an example, a medical device includes a physiological data monitor (PDM), a memory, and a processor. The PDM is configured to monitor a physiological data parameter. The memory circuit is configured to store data collected by the PDM. The processor is configured to detect a data capture event and capture a first segment of physiological data associated with the data capture event. The processor is also configured to determine an amount of memory storage space available and determine a first priority level for the first segment of physiological data. The processor is further configured to determine a second priority level for a second segment of physiological data stored previously and select a processing scheme using the first and second priority levels. Finally, the processor is configured to process, using the processing scheme, the first and second segments of physiological data and store the first segment of physiological data.

Abstract: A system and method for automatically analyzing a cardiac signal, including the step of providing an episode database on a computer storage medium including a plurality of episode data records of one or more patients. Each episode data record includes a cardiac signal from at least one data-generating device. The method also includes the step of selecting one or more of the N beats to be one or more beat templates, for at least a first cardiac signal having N beats. Another step is determining a value K for the cardiac signal using a computer system where K beat templates can represent all the N beats in the cardiac signal.

Abstract: In a graphical user interface displayed in an electronic display of a computing device, a first device profile and second device profile are presented, the first and second device profiles each comprising at least one device parameter used to configure a medical device of a subject. A user input control is presented to select one of the first or second device profiles to provide a selected device profile. A probabilistic outcome of the subject corresponding to the selected device profile is then presented.

Abstract: A system including at least one implantable sensor circuit adapted to produce an electrical sensor signal related to one or more physiologic cardiovascular events of a subject, a therapy circuit configured to provide anti-tachycardia pacing (ATP) therapy, and a controller. The controller includes a tachyarrhythmia detection circuit and an efficacy circuit. The tachyarrhythmia detection circuit is configured to detect a tachyarrhythmia episode in the subject using the electrical sensor signal, and to determine whether the tachyarrhythmia episode is of a type that is treatable with ATP. The efficacy circuit is configured to estimate an efficacy of a currently configured ATP therapy for the subject, and the controller is configured to alter a delivery regimen of the currently configured ATP therapy when the estimated ATP therapy efficacy is deemed insufficient. Other systems and methods are described.

Abstract: Embodiments of the invention are directed to systems and methods for programming implantable medical devices, amongst other things. In an embodiment, the invention includes a method of programming an implantable medical device. The method can include gathering parameter data representing a set of previously programmed parameter values from a plurality of implanted medical devices. The method can further include performing association analysis on the parameter data to form a set of association rules. The method can further include suggesting parameter choices to a system user regarding a specific patient based on the set of association rules. In an embodiment, the invention can include a medical system including a server configured to perform association analysis on a set of data representing previously programmed parameter values from a plurality of implanted medical devices to derive a set of association rules. Other embodiments are also included herein.

Abstract: In an example, a cardiac rhythm management system includes an implantable physiological data monitor, a processor, a memory, and a display. The implantable physiological data monitor can be configured to monitor a plurality of cardiac responses. The processor can be configured to classify the cardiac response into one of at least three classes including pace-dominant, fusion, and pseudo-fusion. The processor can also be configured to calculate statistical information regarding the classified cardiac responses. In this example, the pace-dominant, fusion, and pseudo-fusion classes correspond to a cardiac response resulting from a corresponding electrostimulation. The memory is configured to store the classified cardiac responses and calculated statistical information for future use by the processor or for display. The display is configured to display the statistical information stored in the memory for diagnostic and device programming purposes.

Abstract: Monitoring physiological parameter using an implantable physiological monitor in order to detect a condition predictive of a possible future pathological episode and collecting additional physiological data associated with the condition predictive of a possible future pathological episode. Monitoring another physiological parameter in order to detect a condition indicative of the beginning of a present pathological episode and collecting additional pathological data in response to the condition. Determining that the condition predictive of a future episode and the condition indicative of a present episode are associated and, in response thereto, storing all the collected physiological data.

Abstract: Noncaptured atrial paces can result in long-short cardiac cycles which are proarrhythmic for ventricular tachyarrhythmia. Approaches are described which are directed to avoiding proarrhythmic long-short cycles. For cardiac cycles in which the atrial pace captures the atrium, a first post ventricular refractory period (PVARP) and a first A-A interval are used. For cardiac cycles in which the atrial pace does not capture the atrium, both an extended PVARP and an extended A-A interval are used. The A-A interval following a noncaptured atrial pace is extended from an atrial depolarization sensed during the extended PVARP.

Abstract: A system and method for automatically adjudicating arrhythmia episode information is described, and includes an episode database having episode data regarding a plurality of different arrhythmia episodes and an adjudication processor configured to output characterization data characterizing the input episode data. The characterization data includes an arrhythmia classification. The system further includes an episode processor configured to process the characterization data and episode data, provide at least one report on the characterization data related to a plurality of the different arrhythmia episodes, and provide at least one programming recommendation or at least one alert.