Abstract: A PPG system for determining a stroke volume of a patient includes a PPG sensor configured to be secured to an anatomical portion of the patient. The PPG sensor is configured to sense a physiological characteristic of the patient. The PPG system may include a monitor operatively connected to the PPG sensor. The monitor receives a PPG signal from the PPG sensor. The monitor includes a pulse trending module determining a slope transit time of an upslope of a primary peak of the PPG signal. The pulse trending module determines a stroke volume of the patient as a function of the slope transit time.

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: An Implantable Medical Device (IMD) configured to be implantable in a ventricle of a patient's heart may include a housing, a first electrode secured relative to the housing, a second electrode secured relative to the housing, the second electrode spaced from the first electrode, and circuitry in the housing operatively coupled to the first electrode and the second electrode. The circuitry may be configured to identify a measure of impedance between the first electrode and the second electrode at each of a plurality of times during a cardiac cycle. Each measure of impedance may represent a measure of volume of the ventricle in which the IMD is implanted. In some cases, the circuitry may generate a pacing pulse, the timing of which is based at least in part on the measure of volume of the ventricle at two or more of the plurality of times during the cardiac cycle.

Abstract: Methods and systems are described for detecting the likelihood of patent ductus arteriosus (PDA) in an infant using electrocardiogram and photoplethysmographic pulse signals obtained from the upper body and foot of the infant.

Abstract: Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. This neural fulcrum zone may be identified by monitoring a patient's response to incrementally increased intensity settings at a first frequency. If the incremental intensity increases do not result in the identification of the neural fulcrum zone, the frequency may be changed to provide finer resolution identification of the neural fulcrum zone.

Abstract: A medical device system is configured to sense a physiological signal by a first device and generate a control signal by the first device in response to the physiological signal. An acoustical emitting device is controlled by the first device to emit an acoustical trigger signal in response to the control signal. A second device detects the acoustical trigger signal and delivers an automatic therapy to a patient in response to detecting the acoustical trigger signal.

Abstract: Devices and methods for therapy control based on electromechanical timing involve detecting electrical activation of a patient's heart, and detecting mechanical cardiac activity resulting from the electrical activation. A timing relationship is determined between the electrical activation and the mechanical activity. A therapy is controlled based on the timing relationship. The therapy may improve intraventricular dyssynchrony of the patient's heart, or treat at least one of diastolic and systolic dysfunction and/or dyssynchrony of the patient's heart, for example. Electrical activation may be detected by sensing delivery of an electrical stimulation pulse to the heart or sensing intrinsic depolarization of the patient's heart. Mechanical activity may be detected by sensing heart sounds, a change in one or more of left ventricular impedance, ventricular pressure, right ventricular pressure, left atrial pressure, right atrial pressure, systemic arterial pressure and pulmonary artery pressure.

Abstract: An introducer comprise a sheath for introducing a catheter into a blood vessel, a plurality of electrodes on the sheath, and an impedance assessment unit provided on the sheath and connected to the electrodes. The impedance assessment unit fixes one of a current or voltage across a first pair of the electrodes and measures the other of the current or voltage across a second pair of electrodes.

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 medical electrical stimulator provides selective control of stimulation via a combination of two or more electrodes coupled to respective regulated current paths and one or more electrodes coupled to unregulated current paths. Constant current sources may control the current that is sourced or sunk via respective regulated current paths. An unregulated current path may sink or source current to and from an unregulated voltage source that serves as a reference voltage. Unregulated electrodes may function as unregulated anodes to source current from a reference voltage or unregulated cathodes to sink current to a reference voltage.

Abstract: Various techniques are provided for use with an implantable medical device for exploiting near-field impedance/admittance. Examples include techniques for assessing heart chamber disequilibrium, detecting chamber volumes and pressures, calibrating near-field-based left atrial pressure (LAP) estimation procedures and for assessing the recovery from injury at the electrode-tissue interface. In one particular example, the implantable device assesses the degree of concordance between the left ventricle (LV) and the right ventricle (RV) by quantifying a degree of scatter between LV and RV near-field admittance values. An increase in RV admittance is indicative of RV failure, an increase in LV admittance is indicative of LV failure, and an increase in both LV and RV admittance is indicative of biventricular failure.

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: In an implantable heart monitoring device and method, particularly for monitoring diastolic dysfunction, a control circuit (a) detects the heart rate, (b) derives information correlated to the stroke volume of the heart at the detected heart rate, and (c) stores the detected heart rate and the derived information correlated to the stroke volume in a memory. The control circuit automatically implements (a), (b) and (c) at a number of different occasions for a number of different, naturally varying heart rates, so that the memory contains information indicating the stroke volume as a function of the heart rate.

Abstract: A method and device for delivering pre-excitation pacing to prevent or reduce cardiac remodeling following a myocardial infarction is described. The pre-excitation pacing is modulated in accordance with an assessment of cardiac function in order to balance the beneficial effects of stress reduction with hemodynamic compromise.

Abstract: A method for operating an implantable medical device to obtain substantially synchronized closure of the mitral and tricuspid valves based on sensed heart sounds includes sensing an acoustic energy; producing signals indicative of heart sounds of the heart of the patient over predetermined periods of a cardiac cycle during successive cardiac cycles; calculating a pulse width of such a signal; and iteratively controlling a delivery of the ventricular pacing pulses based on calculated pulse widths of successive heart sound signals to identify an RV interval or VV interval that causes a substantially synchronized closure of the mitral and tricuspid valve. A medical device for optimizing an RV interval or VV interval based on sensed heart sounds implements such a method and a computer readable medium encoded with instructions causes a computer to perform such a method.

Abstract: A new model is provided for understanding and exploiting impedance or admittance values measured by implantable medical devices, such as pacemakers or cardiac resynchronization devices (CRTs.) The device measures impedance along vectors extending through tissues of the patient between various pairs of electrodes. The device then converts the vector-based impedance measurements into near-field individual electrode-based impedance values. This is accomplished, in at least some examples, by converting the vector-based impedance measurements into a set of linear equations to be solved while ignoring far-field contributions to the impedance measurements. The device solves the linear equations to determine the near-field impedance values for the individual electrodes, which are representative of the impedance of tissues in the vicinity of the electrodes.

Abstract: A medical device is provided that comprises a lead assembly. The lead assembly includes at least one intra-cardiac (IC) electrode, an extra-cardiac (EC) electrode and a subcutaneous remote-cardiac (RC) electrode. The IC electrode is configured to be located within the heart. The EC electrode is configured to be positioned proximate to at least one of a superior vena cava (SVC) and a left ventricle (LV) of a heart. The RC electrode is configured to be located remote from the heart. An extra-cardiac impedance (ECI) module is configured to measure extra-cardiac impedance along an ECI vector between the EC and RC electrodes to obtain ECI measurements. An arrhythmia monitoring module is configured to declare a potential atrial arrhythmia to be an atrial arrhythmia based on the hemodynamic performance determined from the ECI measurements. The hemodynamic performance assessment module is further enabled to compare a current ECI pattern with a prior baseline ECI waveform.

Abstract: An implantable device monitors and treats heart failure, pulmonary edema, and hemodynamic conditions and in some cases applies therapy. In one implementation, the implantable device applies a high-frequency multi-phasic pulse waveform over multiple-vectors through tissue. The waveform has a duration less than the charging time constant of electrode-electrolyte interfaces in vivo to reduce intrusiveness while increasing sensitivity and specificity for trending parameters. The waveform can be multiplexed over multiple vectors and the results cross-correlated or subjected to probabilistic analysis or thresholding schemata to stage heart failure or pulmonary edema. In one implementation, a fractionation morphology of a sensed impedance waveform is used to trend intracardiac pressure to stage heart failure and to regulate cardiac resynchronization therapy. The waveform also provides unintrusive electrode integrity checks and 3-D impedancegrams.

Abstract: A heart stimulation system comprises an electrode lead comprising at least one stimulation electrode a stimulation pulse generator adapted to generate electric stimulation pulses and being connected to said electrode lead for delivering electric stimulation pulses to at least one chamber of a heart via said stimulation electrode, and a control unit that is connected to said stimulation pulse generator. The electrode lead is a coronary sinus lead adapted to be placed inside the coronary sinus of a human heart and comprises an ultrasonic transducer that is adapted to measure a velocity of blood flow across a mitral valve of a human heart and that is placed on said coronary sinus lead such that the ultrasonic transducer is placed in the coronary sinus or the great cardiac vein when the coronary sinus lead is in its implanted state.

Abstract: An external defibrillator having a battery; a capacitor electrically communicable with the battery; at least two electrodes electrically communicable with the capacitor and with the skin of a patient; a controller configured to charge the capacitor from the battery and to discharge the capacitor through the electrodes; and a support supporting the battery, capacitor, electrodes and controller in a deployment configuration, the defibrillator having a maximum weight per unit area in the deployment configuration of 0.1 lb/in2 and/or a maximum thickness of 1 inch. The support may be a waterproof housing.

Abstract: The surgical operation system includes a treatment section for treating a living tissue of a treatment target; an ultrasound generation section for providing ultrasound to the treatment section; an ultrasound drive power supply section for supplying ultrasound drive power to generate ultrasound to the ultrasound generation section; a high-frequency power supply section for supplying high-frequency power to the treatment section; an impedance detection section for detecting the impedance of the ultrasound provided to the living tissue and the impedance of the high-frequency power supplied to the living tissue; and a control section for controlling the ultrasound energy amount and the amount of high-frequency power or a crest factor value thereof in response to the detected impedance values of ultrasound and high-frequency wave.

Abstract: A method is provided for trending heart failure based on heart contractility information comprises measuring cardiogenic impedance (CI) measurements along at least a first vector through a heart over a period of time. The method determines contractility estimates from the CI measurements, the contractility estimates relating to contractility of the heart. The method further obtains physiologic and/or surrogate 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 physiologic and/or surrogate signals and applies the correction factors to the contractility estimates to produce contractility trend values over the period of time.

Abstract: Techniques are provided for use with an implantable medical device for assessing stroke volume or related cardiac function parameters such as cardiac output based on impedance signals obtained using hybrid impedance configurations that exploit a multi-pole cardiac pacing/sensing lead implanted near the left ventricle. In one example, current is injected between a large and stable reference electrode and a ring electrode in the RV. The reference electrode may be, e.g., a coil electrode implanted within the superior vena cava (SVC). Impedance values are measured along a set of different sensing vectors between the reference electrode and each of the electrodes of the multi-pole LV lead. Stroke volume is then estimated and tracked within the patient using the impedance values. In this manner, a hybrid impedance detection configuration is exploited whereby one vector is used to inject current and other vectors are used to measure impedance.

Abstract: For cardiac rhythm management, a combination of cardiac pacing and a noninvasive heart monitoring is proposed for the determination of a set of programmable pacing parameters hemodynamically beneficial to the patient. The apparatus incorporates a cardiac pacemaker and a thoracic electrical bioimpedance (TEB) heart monitor. This combination allows the creation of a closed-loop system that obtains pacing parameter settings providing hemodynamically beneficial pacing therapy to the patient as determined by measuring and recording of stroke volume (SV), cardiac output (CO), and other indices of ventricular performance by the heart monitor during an optimization cycle automatically employing different permutations of values of pacing parameters such as atrioventricular delays, inter-atrial delay, inter-ventricular delay, or heart rate, that are sequentially programmed to the pacemaker.

Abstract: Apparatus for diastole trimming including a controller for producing a diastole ending signal, and one or more leads connected to the controller, for carrying the signal to lead connections to a heart, characterized by the controller detecting when a left ventricle (LV) of the heart is mostly full, and producing the diastole ending signal such that the diastole duration is trimmed. Apparatus for diastole trimming including a controller for producing a diastole ending signal, and a connection to a pacemaker, characterized by the controller having decision rules for indicating to the pacemaker when to fire and end the diastole. A method of programming a pacemaker characterized by increasing cardiac output by trimming duration of diastole. A method for increasing cardiac output including producing a signal to trim diastole duration, thereby increasing heart rate (HR) and increasing a product of stroke volume (SV) times HR. Related apparatus and methods are also described.

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. In order to provide a consistent hemodynamic response, the high-output pacing is optimized by delivering it using different parameter sets, evaluating the hemodynamic response thereto as reflected by one or more measured physiological variables, and selecting the parameter set with the best hemodynamic response.

Abstract: Methods and systems to modulate timing intervals for pacing therapy are described. For each cardiac cycle, one or both of an atrioventricular (A-V) timing interval and an atrial (A-A) timing interval are modulated to oppose beat-to-beat ventricular (V-V) timing variability. Pacing therapy is delivered using the modulated timing intervals.

Abstract: Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

Abstract: A cardiac rhythm management (CRM) system includes a non-invasive hemodynamic sensing device and an implantable medical device to sense a hemodynamic signal and derive one or more cardiac performance parameters from the hemodynamic signal. The non-invasive hemodynamic sensing device includes at least a portion configured for external attachment to a body in which the implantable medical device is implanted. The one or more cardiac performance parameters are used for various diagnostic, monitoring, and therapy control purposes.

Abstract: A cardiac electro-stimulatory device and method for operating same in which stimulation pulses are distributed among a plurality of electrodes fixed at different sites of the myocardium in order to reduce myocardial hypertrophy brought about by repeated pacing at a single site and/or increase myocardial contractility. In order to spatially and temporally distribute the stimulation, the pulses are delivered through a switchable pulse output configuration during a single cardiac cycle, with each configuration comprising one or more electrodes fixed to different sites in the myocardium.

Abstract: A first lead provides therapeutic stimulation to the heart and includes a first mechanical sensor that measures physical contraction and relaxation of the heart. A controller induces delivery of therapeutic stimulation via the first lead. The controller receives signals from the first mechanical sensor indicative of the contraction and relaxation; develops a template signal that corresponds to the contraction and relaxation; and uses the template signal to modify the delivery of therapeutic stimulations. In another arrangement, a second lead, with a second mechanical sensor also provides signals to the controller indicative of contraction and relaxation. The first mechanical sensor is adapted to be positioned at the interventricular septal region of the heart, and the second mechanical sensor is adapted to be positioned in the lateral region of the left ventricle. The controller processes the signals from the first mechanical sensor and the second mechanical sensor to develop a dysynchrony index.

Abstract: An implantable heart stimulating device has a stimulation pulse generator that emits stimulation pulses at an adjustable stimulation rate, an activity sensor that emits an activity signal in response to detected activity of the patient, and a physiological parameter sensor that generates a physiological sensor signal in response to a detected physiological parameter. The activity and physiological sensor signals are supplied to a control arrangement that sets the stimulation rate for the stimulation pulse generator by executing a stimulation rate algorithm dependent on those signals. In the stimulation rate algorithm, if the physiological signal indicates an emotional stress on the part of the patient, the stimulation rate is increased to an adjustable emotional stress rate level, and if no increase in the activity signal occurs during a predetermined time period following the stimulation rate increase, the stimulation rate is decreased.

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: This document discusses, among other things, systems, devices, and methods for measuring cardiac impedances and producing one or more resynchronization index parameters each indicative of a cardiac synchrony or asynchrony using the measured cardiac impedances. In one example, the one or more resynchronization index parameters are used to adjust one or more pacing parameters of a cardiac resynchronization therapy.

Abstract: A method and system for calculating an atrio-ventricular delay interval based upon an inter-atrial delay exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may optimize the stroke volume exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may be blended with another atrio-ventricular delay interval that may optimize another performance characteristic, such as left ventricular contractility. Such blending may include finding an arithmetic mean, geometric mean, or weighted mean of two or more proposed atrio-ventricular delay intervals.

Abstract: New decision paradigms for ICDs are described. In one implementation, an implantable system senses cardiac output and arterial pressure parameters and shocks the heart in inverse relation to the arterial pressure, if the cardiac output is insufficient. In another implementation, the implantable system applies atrial anti-tachycardia pacing before applying ventricular anti-tachycardia pacing, if the heart rate is tachycardic.

Abstract: An external cardiac medical device for delivering Cardiac Potentiation Therapy (CPT). Techniques used with the device include initial diagnosis of the patient, delivery of the CPT, and configuration of the external device, so that CPT can be effectively and efficiently provided. In particular, these techniques include initially determining whether a patient should receive CPT, how to set the coupling interval for delivering CPT, how to configure the external medical device to deliver CPT stimulation pulses while not adversely affecting the device's ability to sense a patient's cardiac parameters and/or signals.

Abstract: A device for monitoring cardiac pacing rate having a measuring unit for receiving an electrical signal representing the patient's cardiac demand, and a computing unit for determining the myocardial energy balance by calculating energy consumed by the myocardium for both an external dynamic work for pumping blood into a vascular system, and an internal static work of the myocardium. Volume and time based measurements are used, and in one embodiment, volumes are estimated and volume ratios are calculated from volume estimates. In another embodiment, volumes are estimated from bioimpedance measurements. A further aspect is a rate adaptive pacemaker, wherein the maximum pacing rate is determined from the myocardial energy balance such that the energy supplied to the myocardium approximately equals the energy consumed by the myocardium for both an external dynamic work for pumping blood into a vascular system and an internal static work of the myocardium.

Abstract: An implantable pacemaker that uses impedance cardiography to measure intrathoracic impedance and then transmit impedance data to an external PC based analyzer for accurate calculation of cardiac output, and a method for optimizing cardiac resynchronization therapy using the pacemaker are disclosed.

Abstract: A method and apparatus permit sensing one or more forces exerted by one or more portions of a heart. A force transducer and displacement sensor are disclosed. A movement of one or more portions of a heart can be translated into one or more signals indicative of force. These signals can be used to provide information such as to diagnose or treat one or more conditions.

Abstract: A cardiac rhythm management (CRM) system includes an implantable medical device that delivers anti-tachyarrhythmia therapies including anti-tachyarrhythmia pacing (ATP) and at least one hemodynamic sensor that senses a hemodynamic signal. When a tachyarrhythmia episode is detected, the CRM system analyzes the hemodynamic signal to determine whether and/or when to deliver an ATP. In one embodiment, a hemodynamic parameter extracted from the hemodynamic signal is used to predict the potential effectiveness of ATP in terminating the detected tachyarrhythmia episode. In another embodiment, a characteristic feature detected from the hemodynamic signal is used to determine an ATP window during which a delivery of ATP is initiated.

Abstract: A method and apparatus are disclosed for treating mitral regurgitation with electrical stimulation. By providing pacing stimulation to a region of the left ventricle in proximity to the mitral valve apparatus in a manner which pre-excites the region during early ventricular systole, a beneficial effect is obtained which can prevent or reduce the extent of mitral regurgitation.

Abstract: Methods, apparatus and systems for enhancing cardiac pacing generally provide for measuring at least one cardiac characteristic, calculating at least one cardiac performance parameter based on the measured characteristic(s), and adjusting at least one functional parameter of a cardiac pacing device. Devices may include at least one catheter (such as a multiplexed catheter with one or more sensors and/or actuators), at least one implant (such as a sensor implantable in a heart wall), or a combination of both. Various cardiac performance parameters and/or pacing device performance parameters may be weighted, and the parameters and their respective weights may be used to determine one or more adjustments to be made to the pacing device. In some instances, the adjustments are made automatically.

Abstract: A method and device for delivering pre-excitation pacing to prevent or reduce cardiac remodeling following a myocardial infarction is described. The pre-excitation pacing is modulated in accordance with an assessment of cardiac function in order to balance the beneficial effects of stress reduction with hemodynamic compromise.

Abstract: Techniques are provided for improving cardiac output and also suppressing certain forms of apnea/hypopnea within a patient using an implantable medical device, such as a pacemaker or ICD. In one example, a selected pacing parameter—usually the pacing rate—is temporarily altered by an amount sufficient to elevate cardiac output, the elevation in cardiac output being eventually reduced by intrinsic compensatory mechanisms within the patient. The pacing parameter is then temporarily reset for a duration sufficient to allow the compensatory mechanisms to return toward a previous state so as to permit a subsequent alteration in the pacing parameter to again elevate cardiac output. The pacing parameter is repeatedly altered and reset so as to achieve an overall increase in cardiac output despite the intrinsic compensatory mechanisms. The increase in cardiac output is often sufficient to suppress certain forms of apnea/hypopnea, particularly apnea/hypopnea arising from Cheyne-Stokes Respiration (CSR).

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 method and system for calculating an atrio-ventricular delay interval based upon an inter-atrial delay exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may optimize the stroke volume exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may be blended with another atrio-ventricular delay interval that may optimize another performance characteristic, such as left ventricular contractility. Such blending may include finding an arithmetic mean, geometric mean, or weighted mean of two or more proposed atrio-ventricular delay intervals.

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: A method of tuning a cardiac prosthetic pacing device includes (a) monitoring the flow output from the heart, and (b) adjusting the timing of pacing events by the cardiac prosthetic pacing device so as to optimise the flow from the heart under operational conditions.

Abstract: A method and system for calculating an atrio-ventricular delay interval based upon an inter-atrial delay exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may optimize the stroke volume exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may be blended with another atrio-ventricular delay interval that may optimize another performance characteristic, such as left ventricular contractility. Such blending may include finding an arithmetic mean, geometric mean, or weighted mean of two or more proposed atrio-ventricular delay intervals.