Abstract: An apparatus comprises a cardiac signal sensing circuit and a first implantable electrode pair. At least one electrode of the first implantable electrode pair is configured for placement at a location in a right branch of a His bundle of the subject. The apparatus can include a therapy circuit and a control circuit. The control circuit can include an AH delay calculation circuit configured to calculate an optimal paced AH delay interval. The pacing stimulation location is distal to a location of RV conduction block in a right branch of the His bundle. The control circuit initiates delivery of an electrical stimulation pulse to the stimulation location in the His bundle according to the calculated paced AH delay interval and in response to an intrinsic depolarization event sensed in an atrium of the subject.

Abstract: The present invention is directed toward a detection architecture for use in implantable cardiac rhythm devices. The detection architecture of the present invention provides methods and devices for discriminating between arrhythmias. Moreover, by exploiting the enhanced specificity in the origin of the identified arrhythmia, the detection architecture can better discriminate between rhythms appropriate for device therapy and those that are not.

Abstract: A system for measuring of cardiac blood flow balance parameter between the right chamber of the heart and the left chamber of the heart includes a sensor device for measuring one of blood pressure and blood flow rate and blood constituent concentration of a patient so as to generate an arterial pulse signal. A processing unit is responsive to the arterial pulse signal for generating a full arterial pulse signal, an arterio-venous pulse signal, and a balance parameter. A computational device is responsive to the balance parameter for further generating a set of physiological parameters. A display station device is responsive to the set of physiological parameters from the computational device for displaying meaningful information.

Abstract: A heart rate variability or heart rate variation can be identified using sensed and/or paced heart beats. One or more patient metrics, such as a variability index or a variation index, can correspond to the identified heart rate variability or heart rate variation. The patient metrics can be used to identify a need for a particular therapy, such as a rate-responsive pacing therapy. The patient metrics can be used to identify patients at an elevated risk of death. Methods and systems to identify therapy indications or at-risk patients are provided. In an example, a patient risk profile can be adjusted, such as in response to an identified patient heart rate variability or heart rate variation. In an example, a rate-responsive pacing mode can be used to adjust the patient risk profile.

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: A device includes a signal generator module, a processing module, and a housing. The signal generator module is configured to deliver pacing pulses to an atrium. The processing module is configured to detect a ventricular activation event and determine a length of an interval between the ventricular activation event and a previous atrial event that preceded the ventricular activation event. The processing module is further configured to schedule a time at which to deliver a pacing pulse to the atrium based on the length of the interval and control the signal generator module to deliver the pacing pulse at the scheduled time. The housing is configured for implantation within the atrium. The housing encloses the stimulation generator and the processing module.

Abstract: Devices and methods for providing pacing in multiple modes are provided. One device operates in a dual chamber (DDD or biventricular) mode and in a pacing mode favoring the spontaneous atrioventricular conduction such as an AAI mode (10) with a ventricular sensing or a mode with hysteresis of the atrioventricular delay. The device controls (10-18) the conditional switching from one mode to the other. The device comprises a hemodynamic sensor, including an endocardial acceleration sensor, derives a hemodynamic index representative of the hemodynamic tolerance of the patient to the spontaneous atrioventricular conduction. The device controls inhibiting or (20) forcing the conditional switching of the device to the DDD (or biventricular) mode according to the evolution of the hemodynamic index.

Abstract: Systems and methods are provided for graphically configuring leads for a medical device. According to one aspect, the system generally comprises a medical device and a processing device, such as a programmer or computer, adapted to be in communication with the medical device. The medical device has at least one lead with at least one electrode in a configuration that can be changed using the processing device. The processing device provides a graphical display of the configuration, including a representative image of a proposed electrical signal to be applied by the medical device between the at least one electrode of the medical device and at least one other electrode before the medical device applies the electrical signal between the at least one electrode and the at least one other electrode. In one embodiment, the graphical display graphically represents the lead(s), the electrode(s), a pulse polarity, and a vector.

Abstract: Time delays between a feature of a signal indicative of electrical activity of a patient's heart and a feature of a plethysmograph signal indicative of changes in arterial blood volume are used to arrange the operation of an implantable device, such as a pacemaker. Shorter time delays between the feature of the signal indicative of electrical activity of a patient's heart and the feature of the plethysmograph signal indicative of changes in arterial blood volume are indicative of larger cardiac stroke volumes. The time delay can be used to select a pacing site or combination of pacing sites and/or to select a pacing interval set.

Abstract: A cardiac rhythm management (CRM) device can extract ventilation information from thoracic impedance or other information, and adjust a delivery rate of the CRM therapy. A tidal volume of a patient is measured and used to adjust a ventilation rate response factor. The measured tidal volume can optionally be adjusted using a ventilation rate dependent adjustment factor. The ventilation rate response factor can also be adjusted using a maximum voluntary ventilation (MVV), an age predicted maximum heart rate, a resting heart rate, and a resting ventilation determined for the patient. In various examples, a global ventilation sensor rate response factor (for a population) can be programmed into the CRM device, and automatically tailored to be appropriate for a particular patient.

Abstract: The implantable cardiac treatment system of the present invention is capable of choosing the most appropriate electrode vector to sense within a particular patient. In certain embodiments, the implantable cardiac treatment system determines the most appropriate electrode vector for continuous sensing based on which electrode vector results in the greatest signal amplitude, or some other useful metric such as signal-to-noise ratio (SNR). The electrode vector possessing the highest quality as measured using the metric is then set as the default electrode vector for sensing. Additionally, in certain embodiments of the present invention, a next alternative electrode vector is selected based on being generally orthogonal to the default electrode vector. In yet other embodiments of the present invention, the next alternative electrode vector is selected based on possessing the next highest quality metric after the default electrode vector.

Abstract: Diastolic function is monitored within a patient based on dynamic cardiogenic impedance as measured by a pacemaker or other implantable medical device. In one example, the device uses ventricular cardiogenic impedance values to detect E-wave parameters representative of passive filling of the ventricles. Atrial cardiogenic impedance values are used to detect A-wave parameters representative of active filling of the ventricles. Diastolic function is then assessed or evaluated based on the E-wave and A-wave parameters. Various functions of the implantable device are then controlled based on the assessment of diastolic function, such as by adjusting atrioventricular delay parameters to improve diastolic function. In some examples, the detection of E- and A-wave parameters is achieved by aligning impedance signals to atrial activation, and separately to ventricular activation, during asynchronous VOO pacing or while artificially inducing a 2:1 block.

Abstract: Methods, implantable medical devices and systems configured to perform analysis of captured signals from implanted electrodes to identify cardiac arrhythmias. In an illustrative embodiment, signals captured from two or more sensing vectors are analyzed, where the signals are captured with a patient in at least first and second body positions. Analysis is performed to identify primary or default sensing vectors and/or templates for event detection.

Abstract: Time delays between a feature of a signal indicative of electrical activity of a patient's heart and a feature of a plethysmograph signal indicative of changes in arterial blood volume are used to arrange the operation of an implantable device, such as a pacemaker. Shorter time delays between the feature of the signal indicative of electrical activity of a patient's heart and the feature of the plethysmograph signal indicative of changes in arterial blood volume are indicative of larger cardiac stroke volumes. The time delay can be used to select a pacing site or combination of pacing sites and/or to select a pacing interval set.

Abstract: Disclosed techniques include monitoring a physiological characteristic of a patient with a sensor that is mounted to an inner wall of a thoracic cavity of the patient, and sending a signal based on the monitored physiological characteristic from the sensor to a remote device.

Abstract: A system comprising implantable device, the implantable medical device including an intrinsic cardiac signal sensor, an impedance measurement circuit configured to apply a specified current to a transthoracic region of a subject and to sample a transthoracic voltage resulting from the specified current, and a processor coupled to the intrinsic cardiac signal sensor and the impedance measurement circuit. The processor is configured to initiate sampling of a transthoracic voltage signal in a specified time relation to a fiducial marker in a sensed intrinsic cardiac signal, wherein the sampling attenuates or removes variation with cardiac stroke volume from the transthoracic voltage signal, and determine lung respiration using the sampled transthoracic voltage signal.

Abstract: The disclosure herein relates generally to methods for treating heart conditions using vagal stimulation, and further to systems and devices for performing such treatment. Such methods may include monitoring physiological parameters of a patient, detecting cardiac conditions, and delivering vagal stimulation (e.g., electrical stimulation to the vagus nerve or neurons having parasympathetic function) to the patient to treat the detected cardiac conditions.

Abstract: Systems, methods, and graphical user interfaces are described herein for identification of optimal electrical vectors for use in assisting a user in implantation of implantable electrodes to be used in cardiac therapy. Cardiac improvement information may be generated for each pacing configuration, and one or more pacing configuration may be selected based on the cardiac improvement information. Optimal electrical vectors using the selected pacing configurations may be identified using longevity information generated for each electrical vector. Electrodes may then be implanted for use in cardiac therapy to form the optimal electrical vector.

Abstract: According to an embodiment of a method for using an implantable device to deliver a hypertension therapy to a patient, an activity level is sensed using the implantable medical device. The implantable device may be programmed with a mapping of the sensed activity level to intensity levels for the hypertension therapy. The method may determine a desired intensity for the hypertension therapy as a function of both a circadian rhythm template and the sensed activity level, and use the implantable device to deliver the hypertension therapy using the desired intensity.

Abstract: A device produces at least two distinct temporal components (Vbip, Vuni) from two separate endocardial electrogram EGM signals concurrently collected in the same cavity. A 2D non-temporal characteristic is determined from the variations of one of the temporal components (Vuni) versus the other (Vbip). The analysis of this characteristic allows detection of the possible presence of an anodal stimulation, causing a depolarization in a second cavity after stimulation delivered to a first heart chamber, opposite to the first. One possibility is to proceed by observing whether the non-temporal 2D characteristic is included or not within a predetermined domain defined in a coordinate frame corresponding to the space of the two temporal components.

Abstract: Exemplary methods are described for providing responsive vascular control with or without cardiac pacing. An implantable device with responsive vascular and cardiac controllers interprets physiological conditions and responds with an appropriate degree of vascular therapy applied as electrical pulses to a sympathetic nerve. In one implementation, an implantable device is programmed to deliver the vascular therapy in response to low blood pressure or orthostatic hypotension. The device may stimulate the greater splanchnic nerve, to effect therapeutic vasoconstriction. The vascular therapy is dynamically adjusted as the condition improves. In one implementation to benefit impaired physical mobility, vascular therapy comprises vasoconstriction and is timed to coincide with a recurring segment of the cardiac cycle. The vasoconstriction assists circulation and venous return in the lower limbs of inactive and bedridden individuals.

Abstract: An implantable medical device includes a multi-axial acceleration sensor and an evaluation unit connected thereto. The evaluation unit is configured to (1) split the accelerometer output signal into at least two signal components, one of which is associated with a right-ventricular contraction and another of which is associated with a left-ventricular contraction; (2) detect events in the signal components, and/or determine signal features therein; and (3) determine at least one characteristic value K by evaluating the signal components, and/or the events and/or signal features therein.

Abstract: A single-chamber implantable device for detecting a patient's atrial activity using a monobody lead is disclosed. The monobody lead (10) includes a ventricular coil (16), a supraventricular coil (18), a distal electrode (14) forming three electrodes for detecting depolarization signals. A generator (12) of the implantable device collects a first unipolar signal (20) between the ventricular coil and the generator housing and a second unipolar signal (22) between the supraventricular coil and the generator housing. An independent component analysis is performed to the detected depolarization signals to determine an estimated atrial activity signal from the first and second unipolar signals.

Abstract: An implantable device and method for monitoring S1 heart sounds with a remotely located accelerometer. The device includes a transducer that converts heart sounds into an electrical signal. A control circuit is coupled to the transducer. The control circuit is configured to receive the electrical signal, identify an S1 heart sound, and to convert the S1 heart sound into electrical information. The control circuit also generates morphological data from the electrical information. The morphological data relates to a hemodynamic metric, such as left ventricular contractility. A housing may enclose the control circuit. The housing defines a volume coextensive with an outer surface of the housing. The transducer is in or on the volume defined by the housing.

Abstract: A method for trending heart failure measures cardiogenic impedance (CI) and obtains signals representing estimates for or direct measurements of at least one of cardiac volume and pressure of the heart when the CI measurements were obtained. The method identifies correction factors based on the signals and applies the correction factors to the contractility estimates. A system for trending heart failure includes a contractility module to determine contractility estimates from CI measurements taken along at least a first vector through a heart, and a collection module to receive signals representing estimates for or direct measurements of at least one of cardiac volume and pressure of the heart when the CI measurements were obtained. The system further includes a factor module to identify correction factors based on the signals and a correction module to apply the correction factors to the contractility estimates.

Abstract: The present invention is generally directed to methods, systems, and computer program products for coordinating musculoskeletal and cardiovascular hemodynamics. In some embodiments, a heart pacing signal causes heart contractions to occur with an essentially constant time relationship with respect to rhythmic musculoskeletal activity. In other embodiments, prompts (e.g., audio, graphical, etc.) are provided to a user to assist them in timing of their rhythmic musculoskeletal activity relative to timing of their cardiovascular cycle. In further embodiments, accurately indicating a heart condition during a cardiac stress test is increased.

Abstract: A method and system for deriving effectiveness of medical treatment of a patient are provided that include collecting patient state (PS) data from at least one of an implantable medical device (IMD) or an external medical device (EMD) over a collection interval. The collected PS data relates to a physiologic characteristic (PC) of the patient. The PS data is transferred to a database that is remote from the patient to form a patient state data (PSD) history. The patient undergoes a pivotal medical event (PME) during the collection interval. The PS data within the PSD history is analyzed before and after the PME to propose a treatment therapy (TT). Following delivery of the TT, the collecting and transferring operations are repeated to obtain post-treatment PS data and form a post-treatment PSD history. An effectiveness indicator (EI) of the TT is derived based on at least the post-treatment PSD history.

Abstract: A system may include an external medical device (e.g., a patch) including one or more physiological sensors configured to sense one or more physiological parameters of a subject when the subject is ambulatory. The external medical device may be configured to communicate information related to the sensed one or more physiological parameters for determining and/or modifying at least one cardiac therapy parameter of an implantable medical device (e.g., pacemaker, implantable cardioverter defibrillators, or cardiac resynchronization therapy device). In some situations, an indication or notification may be generated corresponding to the determined and/modified cardiac therapy parameter.

Abstract: Devices and methods for improving device therapy such as cardiac resynchronization therapy (CRT) by determining a desired value for a device parameter are described. An ambulatory medical device can be configured to detect a heart sound signal and generate one or more heart sound metrics, detect a characteristic indicative of cannon waves, and determine a desired value for a device parameter, such as a timing parameter which can be used to control the delivery of CRT pacing to various heart chambers. The desired device parameter value can be determined using the heart sound metrics and the characteristic indicative of the cannon waves. The ambulatory medical device can program stimulation using the desired device parameter value, and deliver the programmed stimulations to one or more target sites to achieve desired therapeutic effects.

Abstract: Pacing parameters may be adjusted to increase the cardiac output of a patient's heart while a patient is awake and/or active and the demand placed on the heart may be greatest, and to decrease or hemodynamic efficiency while a patient is at rest so that the heart itself has time to rest before the next period of higher demand for efficiency begins. This may aid in lessening the strain placed on the heart by making the heart work hard when needed such as when the patient is active, and by permitting the heart to “rest” when the patient is relatively inactive.

Abstract: Stimulation energy can be provided to stimulate synchronous ventricular contractions. Interval information obtained from a cardiac electrical heart signal and a cardiac mechanical heart signal can be used to determine a right ventricular activation time. The interval information can provide a cardiac stimulation indication.

Abstract: A method and system are provided for characterizing cardiac function. The method and system comprise collecting cardiac signals associated with electrical or mechanical behavior of a heart over at least one cardiac cycle; identifying a timing feature of interest (FOI) from the cardiac signals; collecting dynamic impedance (DI) data over at least one cardiac cycle (CC), designated by the timing FOI, along at least one of i) a venous return (VR) vector or ii) a right ventricular function (RVF) vector; and analyzing at least one morphologic characteristic from the DI data based on at least one of i) a VR-DI correlation metric to obtain a VR indicator associated with the CC or ii) a RVF-DI correlation metric to obtain a RVF indicator associated with CC.

Abstract: A system for the detection of cardiac events occurring in a human patient. At least two electrodes are included in the system for obtaining an electrical signal from a patient's heart. An electrical signal processor is electrically coupled to the electrodes for processing the electrical signal. The system receives data regarding the patient's state (e.g. asleep, exercising). Patient state information is stored in a patient state array, thereby enabling the system to track the patient's state over time, and to select an appropriate test for detecting a cardiac event based on both past and present data regarding the patient's state.

Abstract: A method of counterpulsation therapy is provided, the method comprising use of a combination of cardiac electrical activity and acoustic signals in such a manner that initially R wave on a cardiogram and then II (aortic) sound are determined, and, after the II sound has been determined, stimulation of muscles by means of electric impulses is initiated. A device for performing the above described method comprises a sensor of the signal of cardiac electrical activity and a sensor of cardiac acoustic signal; a unit for blocking the cardiac electrical activity signal; a unit for blocking the acoustic signal; and a control device coupled with muscle stimulating devices.

Abstract: Disclosed are certain methods, apparatus, and processor-readable mediums that may be used to treat a conduction abnormality of the heart. In one example, the apparatus includes an implantable pacing profile generator configured to generate a specified pacing electrostimulation profile for delivery to a heart via electrodes located near a septal region of the right ventricle of the heart near the His bundle, the pacing profile including a first pulse for delivery via a first electrode; and a second pulse for delivery via a second electrode; and wherein the first and second pulses are at least partially concurrent in time and opposite in polarity to each other.

Abstract: An apparatus comprises a cardiac signal sensing circuit configured to sense an electrical cardiac signal from at least one of an atrium or ventricle of a heart of a subject, a therapy circuit configured to provide electrical pacing therapy and electrical neural stimulation therapy to the subject, and a control circuit. The control circuit is configured to initiate delivery of the electrical pacing therapy, initiate a blanking period in a time relationship to the delivery of electrical pacing therapy, and initiate delivery of the electrical neural stimulation therapy to the subject during the blanking period. At least one sense amplifier of the cardiac signal sensing circuit is disabled during the blanking period.

Abstract: A system for determining a functional property of a moving object includes a tag contactable to the object such that the tag follows the movement of the object. The system further includes a movement determination device configured to determine the movement of the tag. The system also includes a functional property determination device configured to determine a functional property of the object from the determined movement of the tag.

Abstract: Aspects of the invention are directed to advanced monitoring and control of medium voltage therapy (MVT) in implantable and external devices. Apparatus and methods are disclosed that facilitate dynamic adjustment of MVT parameter values in response to new and changing circumstances such as the patient's condition before, during, and after administration of MVT. Administration of MVT is automatically and dynamically adjusted to achieve specific treatment or life-support objectives, such as prolongation of the body's ability to endure and respond to MVT, specifically addressing the type of arrhythmia or other pathologic state of the patient with targeted treatment, a tiered-intensity MVT treatment strategy, and supporting patients in non life-critical conditions where the heart may nevertheless benefit from a certain level of assistance.

Abstract: Cardiac monitoring and/or stimulation methods and systems employing dyspnea measurement. An implantable cardiac device may sense transthoracic impedance and determine a patient activity level. An index indicative of pulmonary function is implantably computed to detect an episode of dyspnea based on a change, trend, and/or value exceeding a threshold at a determined patient activity level. Trending one or more pulmonary function index values may be done to determine a patient's pulmonary function index profile, which may be used to adapt a cardiac therapy. A physician may be automatically alerted in response to a pulmonary function index value and/or a trend of the patient's pulmonary index being beyond a threshold. Computed pulmonary function index values and their associated patient's activity levels may be stored periodically in a memory and/or transmitted to a patient-external device.

Abstract: A system comprising an implantable electrical cardiac signal sensing circuit, an implantable sinoatrial cardiac action potential detector circuit, and an implantable electrical stimulation circuit in electrical communication with the electrical cardiac signal sensing circuit and the sinoatrial cardiac action potential detector circuit. The electrical cardiac signal sensing circuit is configured to receive one or more intrinsic heart signals from one or more respective electrodes configured for placement in a vicinity of a sinoatrial node of a subject. The implantable electrical stimulation circuit is configured to initiate delivery of at least one inhibitory electrical stimulation pulse in a vicinity of the sinoatrial node in a timed relationship to a sensed sinoatrial cardiac action potential. Other systems and methods are disclosed.

Abstract: Improving cardiac response in terms of pressure, ejected volume, and filling and ejection times by cardiac reverse remodelling, including temporary, occasionally harmful stimulation sequences. An original pacing configuration (a) is switched to a modified pacing configuration (b) in a direction opposite to that of an optimization of the hemodynamic parameters, to cause an immediate change in the response to controlled stimulation of the myocardium. This response is assessed based on: the maximum value (P (b, a)) achieved by the peak-to-peak (PEA (i)) of the first peak of endocardial acceleration (PEA) after a pacing configuration change, the mean PEA value (A (b, a)) after stabilization, the PEA variability (V (b, a)) around this average value, and the duration (T (b, a)) of stabilization after the pacing configuration change.

Abstract: An active implantable medical device or pacing, resynchronization defibrillation and/or cardioversion, and/or a device for diagnosing patient conditions, having a predictive diagnosis of the patient's status. The device measures a physiologic parameter, notably the minute ventilation; measures a physical parameter, notably the acceleration; discriminates between phases of activity and rest of the patient; and includes a memory containing a plurality of fields selectively updated by statistical processing. These fields are comprising one first set containing data related to the patient's activity phases, and one second set containing data related to the patient's rest phases. The statistical processing is updating in a dissociated manner the first and second sets of fields, selectively as a function of the value taken by the status indicator, and the analysis evaluates at least one clinical status index based upon the data contained in the fields of both first and second sets.

Abstract: Methods, systems and devices efficiently identify cardiac resynchronization therapy (CRT) pacing parameter set(s) that provide improved hemodynamic response relative to an initial CRT pacing parameter set, wherein each CRT pacing parameter set includes at least two CRT pacing parameters. User input(s) are accepted that specify a maximum amount of time and/or parameter sets that can be used to perform testing, and specify relative importance of parameters within the sets. Based on the accepted user input(s), there is a determination of how many different variations of each of the CRT pacing parameters can be tested, and based on this determination different CRT pacing parameter sets are selected and tested to obtain a hemodynamic response measure corresponding to each of the different sets tested. Additionally, one or more of the tested CRT pacing parameter sets, if any, that provide improved hemodynamic response relative to the initial CRT pacing parameter set is/are identified.

Abstract: Methods and devices are disclosed for employing mechanical measurements to synchronize contractions of ventricular wall locations. Accelerometers that may be placed within electrode leads are positioned at ventricular wall locations, such as the left ventricle free wall, right ventricle free wall, and the anterior wall/septum wall. The accelerometers produce signals in response to the motion of the ventricular wall locations. A processor may then compare the signals to determine a difference in the synchronization of the ventricular wall location contractions. The difference in synchronization can be determined in various ways such as computing a phase difference and/or amplitude difference between the accelerometer signals. One or more stimulation pulses may be provided per cardiac cycle to resynchronize the contractions as measured by the accelerometers to thereby constantly and automatically optimize the cardiac resynchronization therapy.

Abstract: According to a system or method, information indicative of a cardiac depolarization signal can be obtained. Information indicative of an acoustic signal from an implantable acoustic sensor included as a portion of an implantable therapy device can be obtained. A feature indicative of an R wave can be identified from the information indicative of the cardiac depolarization signal, and a feature indicative of an S2 heart sound can be identified from the information indicative of the acoustic signal. A time interval between an instant corresponding to the feature indicative of the R wave and an instant corresponding to the feature indicative of the S2 heart sound can be determined. Using information about the determined time interval, an adjusted pacing therapy parameter can be provided for use in a pacing therapy to be provided by the implantable therapy device.

Abstract: Embodiments of the invention provide methods for the detection and treatment of atrial fibrillation (AF) and related conditions. One embodiment provides a method comprising measuring electrical activity of the heart using electrodes arranged on the heart surface to define an area for detecting aberrant electrical activity (AEA) and then using the measured electrical activity (MEA) to detect foci of AEA causing AF. A pacing signal may then be sent to the foci to prevent AF onset. Atrial wall motion characteristics (WMC) may be sensed using an accelerometer placed on the heart and used with MEA to detect AF. The WMC may be used to monitor effectiveness of the pacing signal in preventing AF and/or returning the heart to normal sinus rhythm (NSR). Also, upon AF detection, a cardioversion signal may be sent to the atria using the electrodes to depolorize an atrial area causing AF and return the heart to NSR.

Abstract: In specific embodiments, a method to monitor pulmonary edema of a patient, comprises (a) detecting, using an implanted posture sensor, when a posture of the patient changes from a first predetermined posture to a second predetermined posture, (b) determining an amount of time it takes an impedance signal to achieve a steady state after the posture of the patient changes from the first predetermined posture to the second predetermined posture, where the impedance signal is obtained using implanted electrodes and is indicative of left atrial pressure and/or intra-thoracic fluid volume of the patient, and (c) monitoring the pulmonary edema of the patient based on the determined amount of time it takes the impedance signal to achieve the steady state after the posture of the patient changes from the first predetermined posture to the second pre-determined posture.

Abstract: The disclosure herein relates generally to methods for treating heart conditions using vagal stimulation, and further to systems and devices for performing such treatment. Such methods may include monitoring physiological parameters of a patient, detecting cardiac conditions, and delivering vagal stimulation (e.g., electrical stimulation to the vagus nerve or neurons having parasympathetic function) to the patient to treat the detected cardiac conditions.

Abstract: Pacemaker for the stimulation of the human heart having three electrodes or two electrodes, with the first electrode connected to the right atrium, the second electrode connected to the right ventricle and the third electrode connected to the said right ventricle. The pacemaker is programmed so that there is first stimulation of the right atrium by means of the first electrode, then there is second stimulation of the right ventricle by means of the second electrode with an interval function of the programmed AV delay (50-400 msec) and with a voltage not exceeding 80-90% of the threshold potential, and finally there is third stimulation, again of the right ventricle by means of the third electrode with a voltage that conforms with Safety Margin rules and at a second stimulation time interval comprised between 50 msec and 300 msec.

Abstract: A method to optimize CRT therapy using ventricular lead motion analysis, either radiographically or with three dimensional electromagnetic mapping, to determine whether focal dyssynchrony is present at baseline, and whether biventricular pacing improves synchronicity and fractional shortening, and if no improvement is evidenced, changing the timing offset, pacing configuration and/or repositioning the ventricular leads to optimize effectiveness of CRT therapy. Various uses of this method include: diagnostic, with temporary leads to determine presence or absence of dyssynchrony and response to pacing; and therapeutic, to guide lead placement and programming during implant of CRT, and to optimize reprogramming of CRT during follow-up.