Abstract: Various aspects of the present subject matter relate to a device. In various embodiments, the device comprises at least one port adapted to connect at least one lead, a CRM functions module connected to the port and adapted to provide at least one CRM function using the lead, a neural function module, and a controller connected to the CRM functions module and the neural function module. The at least one CRM function includes a function to provide an electrical signal to the lead to capture cardiac tissue. The neural function module includes a signal processing module connected to the port and adapted to receive and process a nerve traffic signal from the lead into a signal indicative of the nerve traffic. The controller is adapted to implement a CRM therapy based on the signal indicative of the nerve traffic. Other aspects are provided herein.

Abstract: An implantable medical device includes a pressure input, an excitation source, a detector module, and a processor. The pressure input is configured to be joined to a pressure sensor located proximate to a cardiac chamber of the heart. The pressure input receives pressure measurements representative of a pressure in the cardiac chamber. The excitation source is configured to deliver stimulation pulses to the heart. The detector module communicates with the pressure sensor to receive and compare the pressure measurements to a pressure threshold. The processor instructs the excitation source to deliver the stimulation pulses at a pressure-based rate based on the comparison of the pressure measurements to the pressure threshold.

Abstract: A system and method for administering a therapeutic treatment to the heart, includes a pressure sensor positioned in the pulmonary artery, an implantable medical device located remotely from the sensor, and communication means for communicating pressure data from the pressure sensor to the implantable medical device. The system includes a control module operatively coupled to the implantable medical device. The control module is adapted for comparing the pulmonary arterial pressure data to a pre-programmed value, adjusting an operating parameter of the implantable medical device based on the relationship of the pulmonary arterial pressure to the pre-programmed value, and repeating this process until the relationship between the pulmonary arterial pressure data and the pre-programmed value is such that no adjustment is necessary.

Abstract: Methods and devices for treating hypotension, such as in cases of shock, including septic shock and anaphylactic shock, wherein the treatment includes providing an electrical impulse to a selected region of the vagus nerve of a patient suffering from hypotension to block and/or modulate nerve signals that regulate blood pressure.

Abstract: An implantable cardiac device has a heart stimulator for electrically stimulating the heart of a patient, detector that measures a physiologic parameter that is affected by the status of a cardiovascular disease associated with sympathetic activation, a signal processor that determines at least one of a low frequency, LF, and a very low frequency, VLF, Mayer wave component in the measured parameter, and analyzer that automatically analyzes the determined Mayer wave component in relation to a predetermined reference value to determine the status of the cardiovascular disease. The detector is a cardio-mechanical parameter detector that measures, as said physiologic parameter, a mechanical change in at least one of the four chambers of the heart. In a corresponding method for monitoring the status of a cardiovascular disease associated with sympathetic activation of a patient having an implantable electric heart stimulator a physiologic parameter affected by the cardiac disease is measured.

Abstract: In general, this disclosure describes techniques for monitoring ventricular capture of electrical stimulation based upon sensed ventricular pressures using an implantable medical device. One example method comprises obtaining a blood pressure signal for a first ventricle (e.g., right ventricle) of a patient, and determining whether stimulation captured a second, different ventricle (e.g., left ventricle) of the patient based upon the blood pressure signal for the first ventricle. Whether stimulation captured the second ventricle may be determined based on at least one value of a myocardial performance index that is determined based upon the blood pressure signal for the first ventricle. If a loss of capture is identified, the method may further comprise providing a warning signal and/or providing a therapy adjustment signal to adjust the electrical stimulation that is provided to the second ventricle.

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 physiological response to ventricular dyssynchrony to control the duty cycles of intermittent pre-excitation pacing.

Abstract: A device and method for delivering electrical stimulation to the heart in order to improve cardiac function in heart failure patients. The stimulation is delivered as high-output pacing in which the stimulation is excitatory and also of sufficient energy to augment myocardial contractility. The device may be configured to deliver high-output pacing upon detection of cardiac decompensation.

Abstract: A cardiac rhythm management system comprises a medical electrical lead, a pressure sensing element, and an implantable pulse generator. The lead is sized to be advanced through the right atrium and coronary sinus into a coronary vein adjacent to the left ventricle. The lead includes an opening intermediate its proximal and distal ends, and a lumen extending longitudinally within the body in communication with the opening. The pressure sensing element is movably disposed in lead lumen and is dimensioned to extend through the opening in the lead, and includes a flexible, elongated conductive member having a distal end, and a pressure transducer coupled to the distal end of the conductive member. The pulse generator is configured to receive cardiac rhythm signals from the electrode and fluid pressure signals from the pressure transducer.

Abstract: A method and apparatus are used to provide therapy to a patient experiencing ventricular dysfunction or heart failure. At least one electrode is located in a region associated with nervous tissue, such as nerve bundles T1-T4, in a patient's body. Electrical stimulation is applied to the at least one electrode to improve the cardiac efficiency of the patient's heart. One or more predetermined physiologic parameters of the patient are monitored, and the electrical stimulation is adjusted based on the one or more predetermined physiologic parameters.

Abstract: A cardiac rhythm management apparatus includes a proximal housing, a distal housing and a lead. The proximal housing includes a first energy storage device. The distal module is implantable within a patient's heart, and includes a second energy storage device, at least one electrode, and a control module. The control module controls the delivery of at least one electrical stimulus from the second energy storage device to a location in communication with the patient's heart. The lead connects the proximal housing to the distal module and is configured to communicate one or more digital signals between the proximal housing and the distal module.

Abstract: Methods and devices for delivering cardiac therapy to a patient are provided. Various implantable device embodiments comprise a plurality of leads and a controller. The leads include at least one lead to be positioned within a lead path to deliver ventricular pacing pulses and to deliver neural stimulation at a site proximate to the heart to inhibit sympathetic nerve activity. The controller controls delivery of the ventricular pacing pulses in accordance with a programmed pacing mode and controls delivery of the neural stimulation. The controller is programmed to deliver remodeling control therapy (RCT) by delivering ventricular pacing to pre-excite a ventricular myocardium region to mechanically unload that region during systole, and further is programmed to deliver anti-remodeling therapy (ART) by delivering neural stimulation to inhibit sympathetic nerve activity in conjunction with RCT. Other embodiments are provided herein.

Abstract: Disclose herein is a method of measuring pressures in a coronary sinus. In one embodiment, the method includes: introducing a distal portion of a lead or tool into the coronary sinus, wherein the distal portion includes first and second pressure sensors and at least one selectably expandable member; expanding the at least one expandable member such that the first and second sensors are isolated from each other within the coronary sinus; and taking pressure measurements with the first and second sensors when isolated from each other.

Abstract: An implantable system senses a pulmonary artery pressure (PAP) signal using an implantable sensor placed in the pulmonary artery and isolates a plurality of signals from the PAP signal for diagnostic and/or therapeutic use. Each signal is extracted from the PAP signal using its known frequency characteristics and/or timing relationship with one or more detectable events.

Abstract: A method of treating cardiovascular disease in a medical patient is provided. The method includes the steps of generating a sensor signal indicative of a fluid pressure within the left atrium of the patient's heart, and delivering an electrical stimulus to a location in the heart. The electrical stimulus is delivered based at least in part on the sensor signal. The method also includes the steps of generating a processor output indicative of a treatment to a signaling device. The processor output is based at least in part on the sensor signal. At least two treatment signals are provided to the medical patient. The treatment signals are distinguishable from one another by the patient, and are indicative of a therapeutic treatment. The treatment signals are based at least in part on the processor output.

Abstract: A neural stimulator senses a reference signal indicative of cardiac cycles each including a predetermined type timing reference event using a sensor external to the heart and blood vessels. The delivery of the neural stimulation pulses are synchronized to that timing reference event. Examples of the timing reference event include a predetermined cardiac event such as a P-wave or an R-wave detected from a subcutaneous ECG signal, a predetermined type heart sound detected from an acoustic signal, and a peak detected from a hemodynamic signal related to blood flow or pressure.

Abstract: An implantable medical device for generating a cardiac pressure-volume loop, the implantable medical device comprising a pulse generator including control circuitry, a first cardiac lead including a proximal end and a distal end and coupled to the pulse generator at the proximal end, a first electrode located at the distal end of the cardiac lead and operatively coupled to the control circuitry, a sound sensor operatively coupled to the control circuitry, and a pressure sensor operatively coupled to the control circuitry, wherein the implantable medical device is adapted for measuring intracardiac impedance. A method of using the implantable medical device to optimize therapy delivered to the heart.

Abstract: Systems and methods of performing rhythm discrimination within a patient's body using sensed hemodynamic signals are disclosed. The method can include the steps of receiving an electrical activity signal from an electrode located within or near the heart, detecting an event of the heart based on the received electrical activity signal, sensing one or more mechanical measurements using a sensor located within the body, analyzing a mechanical activity signal received from the sensor, and confirming the type of event based on the mechanical and electrical activity signals. The sensor can comprise a single pressure sensor configured to sense both atrial and ventricular activity within the heart.

Abstract: Method and systems related to monitoring right ventricular function during pacing by a cardiac rhythm management device are described. One or more pacing parameters are selected to provide cardiac resynchronization therapy. For example, the one or more pacing parameters may be selected to provide an optimal or improved therapy. The heart is paced using the selected pacing parameters. While pacing with the selected parameters, pressure is sensed via a pressure sensor disposed the pulmonary artery. The sensed pressure is analyzed to determine right ventricular function achieved during the pacing using the selected pacing parameters. A signal, such as an alert signal or control signal, is generated based on the right ventricular function achieved during the pacing.

Abstract: Devices and methods to reduce the incidence of both false positive and false negative detection of rhythm anomalies. Implantable devices that measure vascular pressure, vascular blood flow, tissue perfusion, and/or intracardial pressure provide feedback directly to the therapeutic device to improve aberrant rhythm detection.

Abstract: An implantable cardiac device is used to measure one or more parameters relating to cardiac activity of a patient's heart, from which diastolic heart failure (“DHF”) may be monitored and/or detected. These parameters are used to calculate ventricular isovolumetric relaxation time or a related time value. Heart conditions possibly having an influence on the ventricular isovolumetric relaxation time, other than heart conditions due to reduced compliance, may be detected and used to prevent an incorrect calculation of the ventricular isovolumetric relaxation time. The parameters may be measured and the relaxation time calculated multiple times over a period of time, which enables monitoring of the progression of change in the relaxation time. The relaxation time and the progression of change therein are indicators of DHF.

Abstract: A medical device for implantation on an epicardial surface of the heart. The device has a transmural member providing optimal electrode locations for various therapies. The hemodynamically optimal therapy is guided by sensed left ventricular pressure and electrical activity. The device may be used alone or with a companion implanted cardiac rhythm management device.

Abstract: A cardiac rhythm management device is configured to deliver pre-excitation pacing to one or more sites in proximity to an infarcted region of the ventricular myocardium. The pre-excitation pacing in conjunction with counterpulsation therapy serves to either prevent or minimize post-infarct remodeling.

Abstract: Implantable systems, and methods for use therewith, for monitoring arterial blood pressure on a chronic basis are provided herein. A first signal indicative of electrical activity of a patient's heart, and a second signal indicative of mechanical activity of the patient's heart, are obtained using implanted electrodes and an implanted sensor. By measuring the times between various features of the first signal relative to features of the second signal, values indicative of systolic pressure and diastolic pressure can be determined. In specific embodiments, such features are used to determine a peak pulse arrival time (PPAT), which is used to determine the value indicative of systolic pressure. Additionally, a peak-to-peak amplitude at the maximum peak of the second signal, and the value indicative of systolic pressure, can be used to determine the value indicative of diastolic pressure.

Abstract: Optimizing cardiac preload based on measured pulmonary artery pressure involves varying, for each repetition of an acute burst protocol, a parameter of pacing applied to a patient's heart during the acute burst protocol. Pulmonary artery pressure is measured during the repetitions of the acute burst protocol. An optimum ventricular preload is determined based on the measured pulmonary artery pressure. Pacing therapy is provided using a value of the parameter that is selected based on the determination of optimum ventricular preload.

Abstract: A monitoring and/or stimulation device to receive a signal from a lead sensor positioned in the heart of patient. The monitoring and/or stimulation device processes the blood pressure data received from the sensor to determine an augmentation pressure for each heart beat. The augmentation pressure may be tracked over time or compared to a template to determine the circadian state of the patient. The augmentation pressure may be tracked or analyzed over a longer time period to detect other heart conditions such as hypertension.

Abstract: The current invention is an intracardiac pressure guided pacemaker. It has a sensor in pacemaker lead to sense intracardiac pressure, which is used to find the best pacing location in the cardiac chamber and to adjust the timing of pacing signal. It will optimize pacing location and pacing timing and, therefore, optimize resychronization of the contraction of myocardium and interaction between different cardiac chambers. This will improve cardiac function at the same working condition without increase in oxygen demand from myocardium. The pacemaker has a computer program, which, based on intracardiac pressure, can adjust pacing parameters of the pacemaker to optimize resynchronization of the myocardium and interaction between different cardiac chambers automatically at different heart rate and in certain time interval specified by care provider. This also can be achieved by using an interrogator manually.

Abstract: An implantable medical apparatus for detecting diastolic heart failure, DHF, has a DHF determining device for determining at least one blood pressure parameter for detecting a DHF state of the heart of a patient. The DHF determining device includes a pressure measuring unit for measuring pulse pressure in a cardiac cycle for a predetermined workload situation of the patient as the blood pressure parameter, and a comparator compares the measured pulse pressure with a predetermined reference value. A pacemaker includes such an apparatus and a control unit that optimizes pacing therapy depending on the result of the comparison of the measured pulse pressures with the predetermined reference values.

Abstract: Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

Abstract: Techniques for pacing the heart of a patient as a function of a pressure value make use of a pressure monitor that receives a signal from a pressure sensor in the heart. The pressure monitor measures a pressure value. The pressure monitor may, for example, estimate the pulmonary artery diastolic pressure if the pressure sensor is located in the right ventricle, or calculate the mean central venous pressure if pressure sensor is located in the right atrium. The energy level of the pacing pulses delivered to the patient's heart by a pacemaker is modulated as a function of the pressure value. Modulating the energy level of the pacing pulses modulates the cardiac output of the patient's heart.

Abstract: The invention provides a system and method for cardiovascular treatment or training of an individual. One or more venous return devices are used to alter the venous return in an individual, and one or more heart rate devices are used to alter the individual's heart rate.

Abstract: A method for detecting a condition of a heart of a patient using an implantable medical device including the steps of sensing acoustic signals indicative of heart sounds of the heart of the patient; extracting signals corresponding to a first heart sound (S1) and a second heart sound (S2) from sensed signals; calculating an energy value corresponding to a signal corresponding to the first heart sound (S1) and an energy value corresponding to the second heart sound (S2); calculating a relation between the energy value corresponding to the first heart sound and the energy value corresponding to the second heart sound for successive cardiac cycles; and using at least one relation to detect the condition or a change of the condition. A medical device for determining the posture of a patient and a computer readable medium encoded with instructions are used to perform the inventive method.

Abstract: An exemplary method includes providing a filling pressure parameter, providing a perfusion parameter, determining a hemodynamic profile based at least in part on the filling pressure parameter and the perfusion parameter and adjusting a stimulation parameter of an implantable cardiac therapy device based at least in part on the hemodynamic profile. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: Devices, methods, and systems for determining a systolic pulmonary artery pressure index (PAPi) corresponding to pulmonary artery pressure (PAP) and/or right ventricular systolic pressure (RVSP) use lead-based electronic sensors detecting right heart valvular events. Suitable sensors include impedance sensors, accelerometers, cardiomechanical electric sensors, and sonomicrometers.

Abstract: Pressure measurement device (2) including a pressure sensor (6) adapted to perform pressure measurements in the left ventricle of a heart (8). The sensor is connected to a measurement unit (10) to receive pressure measurement values obtained from the sensor, and to a processing means (12) for determining a set of pressure values, said processing means then determines a set of first order time derivative values determined from the set of pressure values.

Abstract: Techniques are provided for detecting left ventricular end diastolic pressure (LV EDP) using a pressure sensor implanted within the heart of a patient and for detecting and evaluating heart failure and pulmonary edema based on LV EDP. Briefly, the peak of the R-wave of an intracardiac electrogram (IEGM) is used to trigger the measurement of a pressure value within the left ventricle. This pressure value is deemed to be representative of LV EDP. In this manner, LV EDP is easily detected merely by measuring pressure at one point within the heartbeat—thereby eliminating any need to track ventricular pressure throughout the heartbeat. Techniques for detecting and evaluating heart failure and pulmonary edema based on the R-wave triggered LV EDP measurements are also set forth herein.

Abstract: An implantable medical apparatus for detecting diastolic heart failure, DHF, has a DHF determining device for determining at least one blood pressure parameter for detecting a DHF state of the heart of a patient. The DHF determining device has a pressure measuring unit for measuring the absolute value of left atrial pressure during the diastasis phase just before atrial contraction, or the absolute value of the pressure in the pulmonary vein when the pulmonary valve is closed, for a predetermined workload situation and a rest situation of the patient. A comparator compares the difference between left atrial pressure or pulmonary vein pressure, in the workload and rest situations, with a predetermined pressure difference reference value. A pacemaker includes such an apparatus and a control unit that optimizes pacing therapy depending on the result of the comparisons with the reference values.

Abstract: Systems and methods are provided for determining the pressure-volume relationship for one or more chambers of a heart. An implantable device includes a catheter including a distal end sized for introduction into a chamber of a heart, a pressure sensor for measuring pressure within the chamber, and a resistance sensor for measuring fluid resistance within the chamber. A processor coupled to the catheter obtains pressure data from the pressure sensor and fluid resistance data from the resistance sensor. The processor approximates fluid volume within the chamber as a function of time and determines one or more pressure-volume loops based upon the pressure data and the fluid volume. In one embodiment, the catheter is a lead including a pacing electrode and a controller including the processor delivers pulses to the pacing electrode based upon the pressure-volume loops to deliver electrical therapy to the heart.

Abstract: An active implantable medical device having a function for monitoring the sympathico-vagal activity by an analysis of endocardiac acceleration. The device collects at least one physiological parameter of the patient, analyzes that collected parameter and delivers at an output data representative of the sympathico-vagal activity of the patient. The physiological parameter is an endocardiac acceleration (EA), and the representative data include at least one value function of the endocardiac acceleration, in particular a function of a first peak (PEA I) at the time of the phase of isovolumic ventricular contraction and/or of a second peak (PEA II) at the time of the phase of isovolumic ventricular relieving.

Abstract: A method and apparatus for pacing left and right ventricles of the heart involve measuring one or both of a right ventricular (RV) pressure and a left ventricular (LV) pressure, and computing a parameter developed from one or both of the RV and LV pressure measurements. The parameter is indicative of a degree of left and right ventricular synchronization. The parameter is assessed, and an interventricular (V-V) delay is adjusted in response to the parameter assessment. The V-V delay is adjusted to effect a change in the parameter that improves synchronization of the right and left ventricles. The computed parameter is a parameter indicative of hemodyamic state, such as a PP Loop or a pre-ejection period.

Abstract: A method and device for delivering cardiac function therapy on a demand basis. An implantable device for delivering cardiac function therapy is programmed to suspend such therapy at periodic intervals or upon command from an external programmer. Measurements related to hemodynamic performance are then taken using one or more sensing modalities incorporated into the device. Based upon these measurements, the device uses a decision algorithm to determine whether further delivery of the cardiac function therapy is warranted.

Abstract: Described herein are methods and apparatus for treating hypertension with electrical pre-excitation pacing therapy. Electrical pre-excitation of a hypertrophic region advances the timing of the regional contraction and reduces its contribution to the overall contraction. Such pre-excitation pacing therapy may be beneficial to hypertensive patients with an abnormal distribution of ventricular wall stress/strain.

Abstract: A method and device, such as an implantable cardiac device, for motion and noise immunity in hemodynamic measurement is presented. The method includes obtaining a template waveform representing hemodynamic performance of a heart during a first hemodynamic state and obtaining an autocharacterization measure from an autocharacterization (e.g., autocorrelation) of the template waveform. The method further includes obtaining a test waveform during a second hemodynamic state, performing a cross-characterization (e.g., cross-correlation) of the template waveform and test waveform to identify a cross-characterization measure, and comparing the autocharacterization measure with the cross-characterization measure as a measurement of hemodynamic status of the second hemodynamic state. The device includes hardware and/or software for performing the described method.

Abstract: A plethysmogram signal is sensed from a patient and provided to a programmer device for monitoring the condition of the patient and for optimizing pacing parameters of a cardiac device implanted in the patient. The programmer device analyzes the plethysmogram signal for cardiac performance associated with different pacing parameters. The cardiac performance is indicated by, for example, a pulse amplitude response, a degree of pulsus alternans, or irregularity in the pressure pulses detected in an atrial fibrillation patient. The pacing parameters resulting in the best cardiac performance are selected as the optimum pacing parameters. In one embodiment, the programmer device monitors a Valsalva maneuver performed by a patient. Optimum pacing parameters are derived by analysis of the plethysmogram signals obtained during performance of the Valsalva maneuver while the patient is paced using different pacing parameters.

Abstract: A method of treating a heart with an implantable cardiac stimulation device involves transiently disturbing the steady state hemodynamic parameters by altering a cardiac cycle timing interval sufficient to reduce end diastolic volume for that cycle. The cardiac cycle timing interval is then adaptively controlled for successive cardiac cycles to achieve a second set of hemodynamic parameters.

Abstract: A method and apparatus for determining a metric of cardiac ventricular synchronization and optimizing a cardiac therapy based on the ventricular synchronization metric are provided. A ventricular synchronization metric is determined by: monitoring right and left ventricular pressure; plotting right ventricular pressure as a function of left ventricular pressure to form an RVP-LVP loop; and integrating with respect to direction to determine an area of the RVP-LVP loop which, according to one convention, is mathematically negative during left ventricular led pressure development and is mathematically positive during right ventricular led pressure development. Timing parameters used to control the delivery of cardiac resynchronization therapy or ventricular assist device therapy are adjusted as needed according to the ventricular synchronization metric.

Abstract: A method and device for delivering ventricular resynchronization pacing therapy in conjunction with electrical stimulation of nerves which alter the activity of the autonomic nervous system is disclosed. Such therapies may be delivered by an implantable device and are useful in preventing the deleterious ventricular remodeling which occurs as a result of a heart attack or heart failure. The device may perform an assessment of cardiac function in order to individually modulate the delivery of the two types of therapy.

Abstract: A method of data management for optimizing the patient outcome from the provision of cardiac resynchronization therapy (CRT) is described. This method describes a process by which sets of dynamic cardiopulmonary dependent variables are measured during steady-state conditions, displayed, and translated into quantitative and qualitative measurements while the independent variables of CRT, device lead placement and atrial-ventricular and interventricular delay settings of bi-ventricular pacemaker systems, are altered by a physician. In combination with visual observation and computer-assisted ranking of the dependent variables, a physician can utilize the resulting information to render decisions on the optimal choice of the independent variables.

Abstract: A signal indicative of cardiac contractions of a patient's heart is produced, as the patient's heart is paced using different sets of pacing interval parameters. Measures of pulse amplitude are obtained from the signal. Pacing interval optimization is performed based on the measures of pulse amplitude.

Abstract: In an implantable medical device a real-time left atrial pressure (“LAP”) signal obtained from a patient's heart is used as a feedback control mechanism to adjust one or more device parameters. In one example the device identifies specific characteristics and attributes of the LAP signal that correlate to hemodynamic performance, and adjusts the device parameters to optimize the LAP characteristics and attributes. In a dual-chamber pacing system, the controlled operating parameter may include the atrioventricular pacing delay, and LAP attribute suitable for controlling the atrioventricular pacing delay time intervals of v-wave, a-wave, and/or c-wave characteristics of the LAP signal.