Abstract: An apparatus comprises an implantable cardiac signal sensing circuit configured to provide a sensed depolarization signal from a ventricle and a processor. The processor includes a signal analyzer module and a tachyarrhythmia discrimination module. The signal analyzer module is configured to determine a measure of stability of ventricular (V-V) depolarization intervals using the depolarization signal, and determine a rate of change of the measure of stability. The tachyarrhythmia discrimination module is configured to detect an episode of tachyarrhythmia using the depolarization signal, determine whether the detected tachyarrhythmia is indicative of atrial tachyarrhythmia using the determined rate of change, and provide the determination to a user or process.

Abstract: Cardiac resynchronization therapy is delivered to a heart using an extended bipolar electrode configuration in accordance with programmed pacing parameters including a non-zero intraventricular delay. The extended bipolar electrode configuration comprises a left ventricular electrode defining a cathode of the extended bipolar electrode configuration and a right ventricular electrode defining an anode of the extended bipolar electrode configuration. A pace pulse is delivered to the left ventricular electrode and anodal stimulation of the right ventricle is detected based on the sensed response to the pace pulse.

Abstract: Methods and systems for detecting noise in cardiac pacing response classification processes involve determining that a cardiac response classification is possibly erroneous if unexpected signal content is detected. The unexpected signal content may comprise signal peaks that have polarity opposite to the polarity of peaks used to determine the cardiac response to pacing. Fusion/noise management processes include pacing at a relatively high energy level until capture is detected after a fusion, indeterminate, or possibly erroneous pacing response classification is made. The relatively high energy pacing pulses may be delivered until capture is detected or until a predetermined number of paces are delivered.

Abstract: Methods and devices for classifying a cardiac response to pacing involve establishing a retriggerable cardiac response classification window. A first cardiac response classification window is established subsequent to delivery of a pacing pulse. A cardiac signal following the pacing stimulation is sensed in the first classification window. A second cardiac response classification may be triggered if a trigger characteristic is detected in the first classification window. The cardiac signal is sensed in the second classification window if the second classification window is established. The cardiac response to the pacing stimulation is determined based on characteristics of the cardiac signal. The cardiac response may be determined to be one of a captured response, a non-captured response, a non-captured response added to an intrinsic beat, and a fusion/pseudofusion beat, for example.

Abstract: Systems and methods provide for coordinated cardiac pacing with delivery of cardiopulmonary resuscitation (CPR) to a patient. Managing cardiac pacing in a patient during a cardiac arrhythmia involves detecting a cardiac arrhythmia using a patient implantable medical device, prompting a cardiopulmonary resuscitation compression, and delivering, using the patient implantable medical device, a pacing pulse to a heart chamber in coordination with the compression prompt.

Abstract: Methods and devices for classifying a cardiac response to pacing involve establishing a retriggerable cardiac response classification window. A first cardiac response classification window is established subsequent to delivery of a pacing pulse. A cardiac signal following the pacing stimulation is sensed in the first classification window. A second cardiac response classification may be triggered if a trigger characteristic is detected in the first classification window. The cardiac signal is sensed in the second classification window if the second classification window is established. The cardiac response to the pacing stimulation is determined based on characteristics of the cardiac signal. The cardiac response may be determined to be one of a captured response, a non-captured response; a non-captured response added to an intrinsic beat, and a fusion/pseudofusion beat, for example.

Abstract: Methods and systems for detecting noise in cardiac pacing response classification processes involve determining that a cardiac response classification is possibly erroneous if unexpected signal content is detected. The unexpected signal content may comprise signal peaks that have polarity opposite to the polarity of peaks used to determine the cardiac response to pacing. Fusion/noise management processes include pacing at a relatively high energy level until capture is detected after a fusion, indeterminate, or possibly erroneous pacing response classification is made. The relatively high energy pacing pulses may be delivered until capture is detected or until a predetermined number of paces are delivered.

Abstract: Approaches to automatically classifying a cardiac response to pacing involve discriminating between a captured response and non-capture with intrinsic activation. A capture detection system senses for morphological characteristics of a cardiac signal associated with the pacing pulse. The cardiac signal may be sensed using a defibrillation electrode during one or more time intervals following delivery of the pacing pulse. If a first characteristic of the cardiac signal achieves a threshold value, the system continues to sense the cardiac signal and detects a second characteristic. The cardiac pacing response is determined based on at least one of the first and the second cardiac signal characteristics.

Abstract: Systems and methods provide for coordinated cardiac pacing with delivery of cardiopulmonary resuscitation (CPR) to a patient. Managing cardiac pacing in a patient during a cardiac arrhythmia involves detecting a cardiac arrhythmia using a patient implantable medical device, prompting a cardiopulmonary resuscitation compression, and delivering, using the patient implantable medical device, a pacing pulse to a heart chamber in coordination with the compression prompt.

Abstract: Cardioprotective pre-excitation pacing may be applied to stress or de-stress a particular myocardial region delivering of pacing pulses in a manner that causes a dyssynchronous contraction. Such dyssynchronous contractions are responsible for the desired cardioprotective effects of pre-excitation pacing. A method and device for applying reverse hysteresis and mode switching to the delivery of such cardioprotective pacing are described.

Abstract: Cardiac devices and methods involve the detection of cardiac signals features in adjacent classification intervals. Portions of the cardiac signal features detected in adjacent classification intervals are associated and are used to classify the cardiac response to a pacing pulse. Associating the portions of the cardiac signal features may be based on expected signal morphology.

Abstract: A system and method for presenting arrhythmia episode information to a user are described. An episode database has episode data regarding a plurality of different arrhythmia episodes generated from a plurality of data-generating devices. A user interface is configured to display the episode data for one of the arrhythmia episodes and receive characterization data from the user characterizing the displayed episode data. An adjudication database has adjudication conclusions associated with the arrhythmia episodes in the episode database. The system further includes an adjudication processor, configured to process characterization data relative to the adjudication database.

Abstract: Cardioprotective pre-excitation pacing may be applied to stress or de-stress a particular myocardial region delivering of pacing pulses in a manner that causes a dyssynchronous contraction. Such dyssynchronous contractions are responsible for the desired cardioprotective effects of pre-excitation pacing but may also be hazardous. Described herein is a method and system that uses measures of a patient's heart rate or exertion level to control the duty cycles of intermittent pre-excitation pacing.

Abstract: Cardiac devices and methods provide adaptation of detection windows used to determine a cardiac response to pacing. Adapting a detection window involves sensing a cardiac signal indicative of a particular type of cardiac pacing response, and detecting a feature of the sensed cardiac signal. The cardiac response detection window associated with the type of cardiac pacing response is preferentially adjusted based on the location of the detected cardiac feature. Preferential adjustment of the detection window may involve determining a direction of change between the detection window and the detected feature. The detection window may be adapted more aggressively in a more preferred direction and less aggressively in a less preferred direction.

Abstract: Systems and methods involve determination of CRT parameters using a number of CRT optimization processes. Each CRT optimization process attempts to return recommended parameters. The CRT parameters are determined based on the recommended parameters returned by one or more of the CRT optimization processes. The CRT optimization processes may be sequentially implemented and the CRT parameters may be determined based on the recommended parameters returned by a first CRT optimization process to return recommended parameters. The CRT parameters may be determined based on a combination of the recommended parameters returned. The CRT optimization processes implemented may be selected from available CRT optimization processes based on patient conditions.

Abstract: An apparatus comprises an implantable sensor, which provides a plurality of physiologic sensor signals of a subject, and a processor. The processor includes a feature module and a detection module. The feature module is configured to identify a feature in the sensor signals and to determine a measure of quality of the feature in the sensor signals. The detection module is configured to perform a morphology analysis of a subsequent portion of at least one of the sensor signals using the feature when the measure of quality of the feature satisfies a quality measure threshold.

Abstract: A method of and system for collecting patient event information from a cardiac rhythm management system (CRM system) is described, where the CRM system includes a cardiac rhythm management device (CRM device) and an external interface device. The method includes the steps of initiating a transmission session wherein the interface device communicates with the CRM device, prompting a user of the CRM system to select a reason for the transmission session, inputting the selected reason for the transmission session to the interface device, and storing the selected reason for the transmission session and timestamp information for the transmission session.

Abstract: Adaptive rate pacing for improving heart rate kinetics in heart failure patients involves determining onset and sustaining of patient activity. The patient's heart rate response to the sustained activity is evaluated during a time window defined between onset of the activity and a steady-state exercise level. If the patient's heart rate response to the sustained activity is determined to be slow, a pacing therapy is delivered at a rate greater than the patient's intrinsic heart rate based on a profile of the patient's heart rate response to varying workloads. If determined not to be slow, the pacing therapy is withheld. Monitoring-only configurations provide for acquisition and organization of physiological data for heart failure patients. These data can be acquired on a per-patient basis and used to assess the HF status of the patient.

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: Adaptive rate pacing for improving heart rate kinetics in heart failure patients involves determining onset and sustaining of patient activity. The patient's heart rate response to the sustained activity is evaluated during a time window defined between onset of the activity and a steady-state exercise level. If the patient's heart rate response to the sustained activity is determined to be slow, a pacing therapy is delivered at a rate greater than the patient's intrinsic heart rate based on a profile of the patient's heart rate response to varying workloads. If determined not to be slow, the pacing therapy is withheld. Monitoring-only configurations provide for acquisition and organization of physiological data for heart failure patients. These data can be acquired on a per-patient basis and used to assess the HF status of the patient.