Abstract: A system for providing temporary therapy, such as cardiac resynchronization therapy, to a patient suffering a decompensation event. The system can include a device having an external module for generating electrical stimuli, a first lead coupled to the module and implanted into an atrial region of a patient's heart, and a second lead coupled to the module and implanted into a ventricular region of the patient's heart. The device can also include a storage module coupled to the external module to store data associated with physiological data measured by the device. The external module is configured to temporarily generate electrical stimuli that are delivered by at least one of the first and second leads to provide therapy cardiac resynchronization therapy to the heart. A network can be coupled to the device to allow data stored in the device to be downloaded through the network to a central repository.

Abstract: A system comprising an implantable medical device that comprises at least one electrical input to receive sensed electrical activity of a heart of a patient, a memory, and a controller circuit. The controller circuit is coupled to the electrical input and memory and is operable to enter a memory scrubbing mode that increases a rate of detecting and correcting single bit errors in the memory when the controller circuit determines the implantable device is in a high-energy radiation environment.

Abstract: A method and system for delivering anti-tachycardia pacing is disclosed. A cardiac rhythm management device, such as an implantable pacemaker having anti-tachycardia pacing capability, delivers anti-tachycardia pacing therapy in accordance with an anti-tachycardia pacing protocol upon detection of a terminable arrhythmia. The anti-tachycardia pacing is delivered as a burst of one or more pacing pulses at a specified coupling interval after a sensed ventricular polarization. By sensing if an evoked potential occurs, the device can determine whether or not the anti-tachycardia pacing burst has captured the ventricle and can adjust the coupling interval and/or other parameters accordingly.

Abstract: A cardiac rhythm management system recognizes patterns of interval durations, distinguishing between events in different heart chambers even though signals associated with those different heart chambers are processed using a commonly shared sensing circuit. A therapy delivery algorithm ignores intervals between cardiac events occurring in different heart chambers when determining a cardiac rate upon which the delivery of therapy is based. This reduces the risk of inappropriate delivery of therapy to the patient. Delayed conduction left ventricular beats are not erroneously recognized as a subsequent right ventricular beat, preventing such short intervals from inappropriately triggering a defibrillation countershock.

Abstract: A system and method is disclosed by which an implantable cardiac device may deliver tachyarrhythmia therapy in the event of a system fault. A hardware-based safety core provides the logic circuitry for detecting tachyarrhythmias and delivering shock therapy in the event of a fault which disables operation of the device's primary control circuitry. The safety core defibrillator eliminates common mode failure of the primary control circuits used in the primary defibrillator system. Failures in the primary controller memory or execution will activate the safety core defibrillator.

Abstract: A method for delivering therapy in a medical device that includes a two-tiered approach of determining the presence of a lead-related condition, and determining, in response to a lead-related condition being present, the presence of oversensing. Deliver of therapy by the medical device is controlled in response to determining that both the lead-related condition and oversensing are present.

Abstract: A method and system facilitates the access by a patient of implanted medical device related data for patient participation in their own clinical care and therapy. In an example embodiment, the method includes establishing a communications link between an implanted medical device and a data processor via an implanted medical device interface. Access to a secured database is obtained via the implanted device data processor using a set of patient identification data. A query is then submitted via the data processor to the secured database in response to input patient diagnostic data. Data received from the secured database is then displayed for use in a patient evaluation.

Abstract: At least one system and at least one method permit a clinician to view or hear power consumption data during a Spinal Cord Stimulation (SCS) system fitting procedure. For example, a clinician's programming computer includes a display of power consumption for each effective stimulation configuration under evaluation during fitting. A clinician performing the fitting procedure uses a programming computer to select various stimulation configurations. The power consumption of the SCS configuration(s) presently and/or previously exercised is displayed for the clinician. By comparing the power consumption for each configuration, the clinician may select a configuration consuming less power while providing effective therapy. Suggestions for low power configurations may be provided by the programming computer.

Abstract: A system and method is disclosed by which an implantable cardiac device may deliver bradycardia therapy in the event of a system fault. A hardware-based safety core provides the logic circuitry for delivering bradycardia therapy in the form of synchronous pacing in the event of a fault which disables operation of the device's primary control circuitry. The safety core pacemaker eliminates common mode failure of the primary control circuits used in the primary pacing system. Failures in the primary controller memory or execution will activate the safety core pacemaker.

Abstract: Polarization signals, which represent voltages measured at a pacemaker electrode, are not constant and may drift. Polarization signal drift, which often precedes undesirable pace polarization artifacts, is more significant when the pacemaker is inhibited from providing an electrical stimulation to the patient's heart. The present invention provides an implantable system and methods for stabilization of a polarization signal. Electrical pulses may be applied to stabilize a polarization signal. In one implementation of the invention, polarization signal stabilization may be used as part of process to terminate tachycardia.

Abstract: Disclosed are systems and methods which provide an external clinician interface, such as through the use of a laptop computer or a personal digital assistant (PDA). The foregoing clinician interface may be used with trial stimulators well suited for use interoperatively and during patient trial. Stimulators of embodiments are adapted for use in providing stimulation to a plurality of tissues and/or areas of the body, such as spinal cord stimulation, deep brain stimulation, etcetera.

Abstract: A test assembly for an implantable medical device, which includes a patient simulator capable of providing signals to the implantable medical device that are representative of the patient's organ function to thereby test whether the implantable medical device is capable of detecting circumstances requiring the deliver of therapy. The patient simulator further includes a plurality of loads that can be selected to correspond to the loads actually seen by the implantable medical device when delivering therapy to the patient.

Abstract: Methods and devices for testing lead impedance in an implantable cardiac stimulus device. A resistor is placed in series with the lead impedance, and a predetermined or known voltage is applied to the resistor and lead impedance. The voltage across the resistor is measured, and it is then determined whether the lead impedance falls within an acceptable range.

Abstract: An active implantable medical device, such as a double chamber pacemaker or defibrillator or cardiovertor, having an improved adjustment of atrial sensitivity and of atrial stimulation energy. This device includes control algorithms for suspecting a loss of atrial detection and/or atrial capture that operates by analysis of a sequence of detected stimulations and ventricular and atrial detections.

Abstract: An implantable cardiac device is configured to classify cardiac arrhythmias using a plurality of arrhythmia discrimination algorithms. Data is provided that is associated with a plurality of cardiac arrhythmic episodes for which a cardiac electrical therapy was delivered or withheld by the implantable medical device based on the plurality of arrhythmia discrimination algorithms. A metric for each of the arrhythmic episodes is computed. The metric defines a measure by which the implantable cardiac device properly classified the arrhythmia. Potentially misclassified arrhythmic episodes of the plurality of cardiac arrhythmic episodes for which cardiac electrical therapy was inappropriately delivered or withheld are algorithmically identified using the metric.

Abstract: A cardiac pacemaker in which an electrogram is recorded from an evoked response sensing channel in order to detect changes indicative of cardiac ischemia. If such changes are detected, the maximum allowable pacing rate can be decreased for those pacing modes that allow the pacing rate to change with metabolic demand.

Abstract: In one implementation, a method is provided for detecting heart failure which includes retrieving a three-dimensional posture template corresponding to a normal evoked response. The method further includes capturing an intracardiac electrogram of an evoked response and detecting a three-dimensional posture corresponding with the intracardiac electrogram. The detected three-dimensional posture and the three-dimensional posture template are compared. The captured intracardiac electrogram is used for heart failure trend analysis if the comparison of the detected three-dimensional posture and the three-dimensional posture template indicates a same posture.

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

Abstract: This document discusses, among other things, an external device capable of independently distinguishing between pace pulses delivered by an implantable cardiac rhythm management device to different locations of a subject's heart. In one example, polarity of the pace pulses is detected along two different electrocardiograph (ECG) vectors defined by three external skin electrodes. In a further example, the detection of a ventricular depolarization is also used to assign location information to pace pulses. In another example, characterizing information (e.g., polarity, amplitude, pulsewidth, time difference between a pace pulse and a corresponding heart depolarization) is used to classify pace pulses into distinct classes to which location information can be assigned. An ECG display/recorder of the external device is capable of annotating pace pulses or markers using the location information.

Abstract: A switch for use with a medical device. The switch includes an accelerometer for detecting motion, a controller cooperating with said accelerometer to determine whether said detected motion is substantially identical to a predefined motion of a user. The controller alters the functioning state of the medical device, if the detected motion is substantially identical to the predefined motion of the user.

Abstract: A method and apparatus for determining oversensing in a medical device that includes sensing cardiac signals and detecting cardiac events via a first electrode configuration, determining the presence of an episode event in response to the detected cardiac events, and sensing the cardiac signals via a second electrode configuration. Amplitudes associated with a predetermined number of cardiac signals sensed via the second electrode configuration corresponding to the event episode are determined, and delivery of therapy is controlled in response to the determined amplitudes.

Abstract: An exemplary method includes detecting a change in position, measuring cardiac output after the detecting a change in position and, based at least in part on the measuring cardiac output, deciding whether to increase a cardiac pacing rate. An exemplary method may rely on activity in lieu of or in addition to position to decide whether to increase a cardiac pacing rate. Various exemplary methods aim to compensate for orthostatic effects such as those associated with dysautonomia. Various other exemplary methods are disclosed along with various exemplary devices, systems, etc.

Abstract: A method and system for programming an implantable therapeutic stimulation device sensing from and delivering therapeutic stimulations to multiple sites within a patient under a plurality of programmable parameters. The method includes automatically determining which parameters need to be programmed, graphically indicating specific parameters that need to be programmed in a spatial correspondence to the affected sites in the patient and/or displaying a waveform corresponding to expected physiological activity with the programming, and providing control inputs to program the specific parameters. The method can also include automatically evaluating the programmed parameters, and if errors exist in the programming, indicating the errors and awaiting corrective input, else programming the implantable device. The method can also include automatically determining a number of sensing and stimulation electrodes connected to the device.

Abstract: An implantable cardiac stimulation device and method measure atrioventricular conduction times and automatically adjust an atrioventricular delay time based on the measured conduction time values.

Abstract: Methods and devices for classifying a cardiac response to pacing involve establishing a plurality of classification windows relative to and following a pacing pulse. One or more characteristics of a cardiac signal sensed following the pacing pulse are detected within one or more particular classification windows. The characteristics may be compared to one or more references. Classification of the cardiac response may be performed based on the comparison of the one or more characteristics to the one or more references and the particular classification windows in which the one or more characteristics are detected.

Abstract: A neural stimulation system automatically corrects or adjusts the stimulus magnitude (stimulation energy) in order to maintain a comfortable and effective stimulation therapy. Because the changes in impedance associated with the electrode-tissue interface can indicate obstruction of current flow and positional lead displacement, lead impedance can indicate the quantity of electrical stimulation energy that should be delivered to the target neural tissue to provide corrective adjustment. Hence, a change in impedance or morphology of an impedance curve may be used in a feedback loop to indicate that the stimulation energy needs to be adjusted and the system can effectively auto correct the magnitude of stimulation energy to maintain a desired therapeutic effect.

Abstract: In general, the invention is directed to techniques for capture testing of a capture threshold in cooperation with measurement of other cardiac parameters. Physiological or non-physiological parameters may indicate a possible change in the capture threshold, and a significant change in a cardiac parameter may trigger more frequent monitoring of the capture threshold. In addition, measurement of cardiac parameters in relation to measurement of the capture threshold may be useful in diagnosing problems and forecasting possible loss of capture.

Abstract: A monitoring system and method for monitoring signals from an implantable medical device are disclosed. The monitoring system and method include a monitor configured to detect a radio frequency artifact from the signals of the implantable medical device and circuitry for processing the radio frequency artifact from the signals of the implantable medical device.

Abstract: A medical device, programmer, or other computing device may determine values of one or more activity and, in some embodiments, posture metrics for each therapy parameter set used by the medical device to deliver therapy. The metric values for a parameter set are determined based on signals generated by the sensors when that therapy parameter set was in use. Activity metric values may be associated with a postural category in addition to a therapy parameter set, and may indicate the duration and intensity of activity within one or more postural categories resulting from delivery of therapy according to a therapy parameter set. A posture metric for a therapy parameter set may indicate the fraction of time spent by the patient in various postures when the medical device used a therapy parameter set. The metric values may be used to evaluate the efficacy of the therapy parameter sets.

Abstract: This document discusses, among other things, systems and methods for automatic electrode integrity management. Interelectrode impedance is measured for various electrode combinations of an implantable cardiac function management device. The impedance data is processed, such as at an external remote server, to determine whether an electrode is failing or has failed, to select an alternate electrode configuration, to alert a physician or patient, to predict a time-to-failure such as by using population data, or to reprogram electrode configuration or other device parameters of the implantable cardiac function management device.

Abstract: A biventricular pacing system is provided which includes an automatic capture verification system for verifying capture of left ventricular pacing pulses on a beat by beat basis. A loss of capture recovery system delivers a backup safety pulse in the event of loss of capture detected in either the right or left ventricle. An automatic stimulation threshold search system is provided for measuring the capture threshold of both left and right ventricles based on various triggers. An automatic output regulation system for both the left and right ventricular channels is provided to set the pacing amplitude to levels sufficient to ensure capture plus a safety margin. A left ventricular automatic stimulation threshold search is triggered upon detection of any loss of capture in the left ventricle and periodically based on a number of different triggers.

Abstract: A device and method for delivering electrical stimulation to the heart in a manner which provides a protective effect against subsequent ischemia is disclosed. The protective effect is produced by configuring a cardiac pacing device to intermittently switch from a normal operating mode to a stress augmentation mode in which the spatial pattern of depolarization is varied to thereby subject a particular region or regions of the ventricular myocardium to increased mechanical stress.

Abstract: An implantable medical device (IMD) with internal processor is configured for diagnostic emulation using an external processor coupled to the internal processor through a high speed serial link. The native external processor parallel data and address bus content can be converted to a serial communications stream, sent into the device, converted back to parallel address and data bus formats, and used to drive the device in place of the internal processor. The serial communication allows use of a small number of contact pads, conductors, or feed-throughs, depending on the device. Some devices allow serialized communication through the feed-through typically used for electrical stimulation. The devices can be used to enhance diagnostic testing with capabilities such as faster testing and more realistic testing. The IMD can be a wide variety of implantable devices such as neuro stimulators, pace makers, defibrillators, drug delivery pumps, diagnostic recorders, cochlear implants, and the like.

Abstract: A wireless communication system is provided that includes an antenna structure adapted for coupling to a medical device antenna when the medical device is not implanted in a patient's body. The antenna structure effectively extends the medical device antenna length, thereby improving the efficiency and reliability of a communication link between the medical device and a programmer or monitor outside the implanted environment. The antenna structure is fabricated from any conductive material, which may be in the form of conductive wire, tape, ink, foil, film, adhesive or the like, and is attached to a portion of a medical device packaging assembly or another accessory device or substrate such as a pouch or overlay. The antenna structure may be a monopole, dipole, slot antenna, microstrip patch, or loop antenna, and may be fixed or movable relative to the substrate on which it is implemented.

Abstract: A method and apparatus for detecting a lead-related condition that includes determining whether a first oversensing criteria is satisfied, determining whether a second oversensing criteria is satisfied, determining whether an impedance criteria has been satisfied, and generating an alert in response to more than one of the first oversensing criteria, the second over sensing criteria and the impedance criteria being satisfied.

Abstract: Exemplary methods and devices for analyzing intracardiac electrocardiograms (IEGMs) using ensemble averaging and/or an ensemble average. Various methods and/or devices are suitable for use with atrial and/or ventricular autocapture. Other methods, devices and/or systems are also disclosed.

Abstract: A method for diagnosing and mapping atrial fibrillation correlates recordings of electrical activity from intracardiac multielectrode catheters with the locations of electrodes within the heart to obtain a global mapping of cardiac electrical activity. Time delay and/or amplitude information in the recorded electrical activities is fused with electrode location information to generate a display on a 3-D anatomical template of the heart. Time delay and/or amplitude information is displayed using color code and/or lines of equal value, to aid diagnosis and localization of electrical activity irregularities. Mapping of atrial fibrillation enables physicians to treat arrhythmia by ablation, pacing, shock therapy and/or drugs at initiation or during an episode based on therapy delivery at critical mapped locations for arrhythmia onset or maintenance. Locations for placement of pacing leads and pacemaker timing parameters may also be obtained from the display.

Abstract: A medical device programmer automatically adjusts parameters to be programmed to a medical device in response to a user modifying related parameters. Slide controllers on the programmer display screen can adjust parameters. In response to slide controller movement, the programmer automatically adjusts related parameters by moving their slide controllers. This graphically illustrates to the user the automatic adjustments being made to the related parameters. and the relationship between parameters being adjusted by the user and automatically. In response to on screen parameter changes, the system graphically illustrates the parameter values that are changed and those that are programmed to the medical device and those that would cause unsafe condition in the medical device if programmed. The method also prevents the programming to the medical device the parameters that would cause an unsafe condition.

Abstract: An implantable medical device with internal processor is configured for diagnostic emulation with an external processor to enhance diagnostic testing with capabilities such as faster testing and more realistic testing. The implantable medical device can be a wide variety of implantable devices such as neuro stimulators, pacemakers, defibrillators, drug delivery pumps, diagnostic recorders, cochlear implants, and the like. The external processor is coupleable to the medical device to execute software involving medical device components with a bus switch coupled to the address bus, the data bus, and the internal processor. The bus switch has a bus switch external connector that when activated is configured to couple an external processor through the address bus external connection to the address bus and the external processor through the data bus external connector to the data bus.

Abstract: Systems and methods for determining the coronary sinus vein branch location of a left ventricle electrode are disclosed. The systems and methods involve detecting the occurrence of electrical events within the patient's heart including sensing one or more of the electrical events with the electrode and then analyzing the electrical events to determine the electrode's position. The determination of electrode position may be used to automatically adjust operating parameters of a VRT device. Furthermore, the determination of electrode position may be made in real-time during installation of the electrode and a visual indication of the electrode position may be provided on a display screen.

Abstract: A system and method for measuring the capture threshold of a bipolar lead in order to determine an appropriate value for the stimulus pulse energy to be used with the lead by a cardiac rhythm management device. An appropriate bipolar stimulating configuration can also be determined. The method is particularly useful in testing bipolar leads used to excite the left ventricle such as when delivering cardiac resynchronization therapy.

Abstract: Pacing parameters are provided to address cross talk and intrinsic ventricular events occurring within a predefined blanking period following an atrial event. The parameters are used in conjunction with protocol for minimizing or reducing ventricular pacing, wherein ignoring intrinsic ventricular events during the blanking period might otherwise affect the performance of the protocol.

Abstract: A cardiac rhythm management system selects an atrioventricular (A-V) delay based on a time-interval between an atrial depolarization and mitral valve closure (MVC). For several different A-V delays, the system measures time intervals between atrial depolarizations (i.e., sensed or paced P-waves) and accelerometer-detected MVCs. Based on this information, the system selects a particular A-V delay for improving cardiac output during subsequent delivery of cardiac rhythm management therapy.

Abstract: An implantable medical device and associated method for automatically generating morphology templates during fast cardiac rhythms, confirming a provisional template as a confirmed template, and using the confirmed template to classify subsequent detected arrhythmias. A provisional SVT template may be created during a fast ventricular rate and activated as a confirmed SVT template upon verification that the fast rate was due to an SVT. The confirmed SVT template may be used to discriminate SVT from VT/VF.

Abstract: A system for controlling an implantable medical device (e.g., a drug delivery device) susceptible to malfunctioning during exposure to a magnetic field and/or Radio Frequency field (e.g., during a magnetic resonance imaging procedure) and a method for operating the same. Exposure of the implantable device to the magnetic field and/or the Radio Frequency field is detected using the sensing device. When the detected magnetic field and/or Radio Frequency field exceeds a corresponding predetermined threshold level, an input signal is generated at the microcontroller.

Abstract: A cardiac rhythm management system selects one of multiple electrodes associated with a particular heart chamber based on a relative timing between detection of a depolarization fiducial point at the multiple electrodes, or based on a delay between detection of a depolarization fiducial point at the multiple electrodes and detection of a reference depolarization fiducial point at another electrode associated with the same or a different heart chamber. Subsequent contraction-evoking stimulation therapy is delivered from the selected electrode.

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. In one embodiment, the graphical display graphically represents, illustrates or displays the lead(s), the electrode(s), a pulse polarity, and a vector. According to another aspect, the method generally comprises receiving information for a medical device having at least one lead with at least one electrode in a configuration, and presenting a graphical representation of the configuration on a display.

Abstract: An implantable cardioverter defibrillator (ICD) automatically determines whether to use electrogram (EGM) signals sensed by a true bipolar electrode pair or those sensed by an integrated bipolar electrode pair. EGM signals from both the true bipolar pair and the integrated bipolar pair are simultaneously sensed and compared to determine which pair produced more accurate sensing of cardiac events. The more accurate source of EGM signals is selected and used in determining the therapy to be delivered.

Abstract: A method and device for sensing cardiac activity that includes a first plurality of electrodes forming a first electrode configuration to sense cardiac activity, a second plurality of electrodes forming a second electrode configuration to sense cardiac activity, and a third plurality of electrodes to deliver a stimulation pulse in response to the sensed cardiac activity. A microprocessor determines whether an escape interval associated with the delivered stimulation pulse is less than a rate limit interval, and a control circuit switches from the first plurality of electrodes to the second plurality of electrodes in response to the escape interval being less than the rate limit interval.

Abstract: An electrical therapy device has a blocking triggering unit and a re-use blocking unit. The re-use blocking unit prevents the functions of the electrical therapy device during implantation in dependence on the condition of the blocking triggering unit. The blocking triggering unit is triggered either upon implantation or explantation of the electrical therapy device. In some aspects, an electrical therapy device has a blocking triggering unit and a re-use blocking unit, wherein the re-use blocking unit prevents the functions of the electrical therapy device in dependence on the condition of the blocking triggering unit. The blocking triggering unit is triggered upon explantation of the electrical therapy device.