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: Different types of cardiac arrhythmia are classified based on the morphology of the arrhythmic beats. Cardiac beats associated with an arrhythmic episode are compared to a plurality of representative beat morphologies, each representative beat morphology characterizing a type of arrhythmia of the heart. An arrhythmic episode may be classified as a particular type of arrhythmia if the morphology of the arrhythmic cardiac beats matches a representative beat morphology characterizing the particular type of arrhythmia. An appropriate therapy for the particular type of arrhythmia may be selected based on the arrhythmia classification. A particular type of arrhythmia may be associated with one or more therapies used to treat the arrhythmia. The therapy used to treat the arrhythmia may comprise a therapy identified as a previously successful therapy.

Abstract: The present application describes an intravascular implantable pacing and/or defibrillation system. The described system includes a pulse generator that is implantable within a blood vessel and proportioned to blood flow through the blood vessel, and at least one lead attachable to the pulse generator. During implantation, the pulse generator is introduced into a patient's vasculature, advanced to a desired vessel and anchored in place within the vessel. The lead or leads are placed within the heart or surrounding vessels as needed to deliver electrical pulses to the appropriate location.

Abstract: A capacitor is presented that includes a housing, an electrode stack, a liner, and a fill port. The liner is located between the housing and the electrode stack. The liner includes a recessed portion. A fill port extends through the housing across from the recessed portion in the liner. A gap is formed between the recessed portion and the fill port.

Abstract: Cardiac treatment methods and devices providing templates representative of past tachyarrhythmia events, each template associated with a therapy. A cardiac waveform is detected, and if it corresponds to a particular template associated with a previous therapy that was satisfactory in terminating a past event, the previous therapy is delivered again. If unsatisfactory, the previous therapy is eliminated as an option. If, for example, the previous therapy was an antitachycardia pacing therapy unsatisfactory in terminating the past tachyarrhythmia event, delivery of the antitachycardia pacing therapy is eliminated as an option. Instead of ATP therapy, one or more of a cardioversion, defibrillation, or alternate anti-tachycardia pacing therapy may be associated with the particular template.

Abstract: A catheter, in particular for insertion of heart-pacemaker- or ICD-electrodes into a patient's body, comprises a catheter wall and a reinforcement therein for stabilization of the catheter. The reinforcement is a profile element which is adjusted to the desired mechanical properties of the catheter in the axial and peripheral direction thereof.

Abstract: A power supply for an implantable cardioverter-defibrillator for subcutaneous positioning between the third rib and the twelfth rib and for providing cardioversion/defibrillation energy to the heart, the power supply comprising a capacitor subsystem for storing the cardioversion/defibrillation energy for delivery to the patient's heart; and a battery subsystem electrically coupled to the capacitor subsystem for providing electrical energy to the capacitor subsystem.

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

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: An implantable medical device may deliver pacing, cardioversion, and/or defibrillation stimulation to a heart of a patient via extravascular electrodes and delivers electrical stimulation to a nonmyocardial tissue site to modulate the autonomic nervous system of the patient. The implantable medical device may include a cardiac therapy module that generates and delivers at least one of pacing, cardioversion, or defibrillation therapy to a patient via an extravascular electrode, and a neurostimulation therapy module that generates and delivers a neurostimulation signal to the patient via a neurostimulation electrode. The cardiac therapy module and neurostimulation therapy module may be disposed in a common housing of the medical device. In some examples, at least one common lead may electrically couple the neurostimulation electrode and the extravascular electrode to the neurostimulation and cardiac therapy modules, respectively.

Abstract: An electrical parameter value indicative of an impedance of an electrical path between a first medical device implanted within a patient and a second medical device implanted within the patient may be determined by generating and delivering an electrical signal between electrodes connected to the first medical device and sensing the electrical signal with two or more sense electrodes connected to the second medical device. In some examples, the electrical parameter value indicative of the impedance may be used to detect a system integrity issue, such as relative movement between the first and second medical devices, such as between leads connected to the medical devices, or a lead-related condition. In other examples, the determined impedance may indicate a transthoracic impedance of the patient.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: Techniques for minimizing interference between first and second medical devices of a therapy system may include providing an outer housing for at least one of the medical devices that comprises an electrically insulative layer formed over at least the electrically conductive portions (e.g., an electrically conductive layer) of the housing, or providing an electrically insulative pouch around an electrically conductive housing of at least the first medical device. The electrically insulative layer or electrically insulative pouch may reduce or even eliminate shunt-current that flows into the medical device via the housing. The shunt-current may be generated by the delivery of electrical stimulation by the second medical device. In some examples, the techniques may also include shunt-current mitigation circuitry that helps minimize or even eliminate shunt-current that feeds into the first medical device via one or more electrodes electrically connected to the first medical device.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: This document discusses, among other things, a lead assembly including a porous polyethylene cover. In an example, the cover includes sections that have differing pore sizes. In an example, a section of the cover near a distal end portion of a lead assembly includes pores that are large enough to allow tissue ingrowth. In another example, a lead assembly includes two or more polyethylene covers having different porosities.

Abstract: A system and method provide precise detection of the time of occurrence of a cardiac event of a heart. The method comprises the steps of sensing electrical activity of the heart to generate an electrogram of the heart and applying the electrogram to an event detector having a plurality of spaced apart thresholds. The thresholds are selected such that the electrogram has an amplitude for crossing at least one of the thresholds. The method further comprises determining a characteristic identifying feature of the electrogram at each threshold crossing of the electrogram, comparing the determined characteristic identifying features to an electrogram template, and identifying the time of occurrence of the cardiac event based upon the comparison.

Abstract: Electrical crosstalk between two implantable medical devices or two different therapy modules of a common implantable medical device may be evaluated, and, in some examples, mitigated. In some examples, one of the implantable medical devices or therapy modules delivers electrical stimulation to a nonmyocardial tissue site or a nonvascular cardiac tissue site, and the other implantable medical device or therapy module delivers cardiac rhythm management therapy to a heart of the patient.

Abstract: A device and method of detecting the severity of myocardial ischemia and heart attack risk is provided. The method includes obtaining an electrogram signal, determining T-wave measurements based on the electrogram signal, and determining ST segment measurements based on the electrogram signal. The method also includes identifying T-wave alternans based on the T-wave measurements and identifying ST segment changes based on the ST segment measurements. The method further includes correlating the T-wave alternans with the ST segment changes in order to detect a severity of ischemia.

Abstract: A method and apparatus to determine possible atrial fibrillation or absence of atrial fibrillation that includes detecting pulse rhythms from a succession of time intervals each corresponding to a respective interval of time between successive pulse beats; analyzing the detected pulse rhythms to make a determination of possible atrial fibrillation; indicating the possible atrial fibrillation from the determination; or making a determination of the absence of atrial fibrillation.

Abstract: The present disclosure provides methods and systems for tachyarrhythmia therapy involving pacing the heart to prior to the application of a cardioversion/defibrillation shock. One or more pace pulses are delivered to the arrhythmic chamber or chambers. The pace pulses may be delivered to the heart at an adaptable rate selected to organize the electrical activity of the heart. If the pace pulses produce capture, cardioversion/defibrillation stimulation is delivered.

Abstract: A non-electrode-lead ultra-thin flexible micro multifunctional heart rate adjusting device comprises an integrative ultra-thin flexible micro non-electrode-lead pacemaker formed by assembling a micro battery, an ultra-low-power source circuit, a wireless receiving/transmitting circuit and an application circuit unit together, the needle electrodes are positioned on one side of the pacemaker and all of them form a small electrode body which can directly implanted into heart or external surface of heart; a multifunctional microcomputer heart rate adjusting remote controller connects with various non-electrode-lead pacemakers via wireless communication; the non-electrode-lead pacemakers and/or the heart rate adjusting remote controller connect with a control base station via wireless network, and the control base station connects with a computer.

Abstract: A pacing device and method for operating same is disclosed in which the point of origin of an arrhythmia is estimated in order to more provide more effective treatment. The origin of an arrhythmia may be estimated by analyzing the timing of electrical events as detected at different electrode sites and/or using different sensing vectors. Anti-tachycardia pacing (ATP) may then be delivered to the most appropriate location.

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 medical electrical system includes a device including a connector port and an external electrically active surface and an auxiliary lead including a supplemental electrode and a connector end. The external electrically active surface of the device is adapted to receive the auxiliary lead connector end, thereby electrically coupling the supplemental electrode to the device via contact between the connector end and the external surface.

Abstract: A medical device includes a rechargeable lithium-ion battery for providing power to the medical device. The lithium-ion battery includes a positive electrode comprising a current collector and an active material comprising a material selected from the group consisting of LiCoO2, LiMn2O4, LiNixCoyNi(1?x?y)O2, LiAlxCoyNi(1?x?y)O2, LiTixCoyNi(1?x?y)O2, and combinations thereof. The lithium-ion battery also includes a negative electrode having a current collector and an active material including a lithium titanate material. The current collector of the negative electrode includes a material selected from the group consisting of aluminum, titanium, and silver. The battery is configured for cycling to near-zero-voltage conditions without a substantial loss of battery capacity.

Abstract: An implantable cardiac rhythm/function management system integrates cardiac contractility modulation (CCM) and one or more other therapies, such as to preserve device safety, improve efficacy, enhance sensing and detection, or enhance therapy effectiveness and delivery. Examples of the one or more other therapies can include pacing, defibrillation/cardioversion, cardiac resynchronization therapy (CRT), or neurostimulation.

Abstract: A system detects events related to cardiac activity. The system comprises a primary cardiac signal sensing circuit, at least one secondary cardiac signal sensing circuit having a higher sensitivity than the primary sensing circuit, and a controller circuit coupled to the primary and secondary cardiac signal sensing circuits. The controller circuit determines a rate of depolarization using the primary sensing circuit and detects tachyarrhythmia using the rate. The controller circuit also detects tachyarrhythmia using the secondary sensing circuit and also deems the tachyarrhythmia valid if the controller circuit detects the tachyarrhythmia using both the primary and secondary sensing circuit.

Abstract: A method and apparatus to determine possible atrial fibrillation or absence of atrial fibrillation that includes detecting pulse rhythms from a succession of time intervals each corresponding to a respective interval of time between successive pulse beats; analyzing the detected pulse rhythms to make a determination of possible atrial fibrillation; indicating the possible atrial fibrillation from the determination; or making a determination of the absence of atrial fibrillation.

Abstract: Embodiments of the invention provide an energy harvesting mechanism comprising a central conductive element and a plurality of transductive elements. Each transductive element is positioned to be in contact with a corresponding peripheral length segment of the central conductive element. Also each transductive element is deformable in a characteristic radial direction to convert its deformation into a corresponding electrical signal. The plurality of transductive elements are arranged so that any one of the plurality of transductive elements is capable of being deformed in the characteristic radial direction to trigger the corresponding electrical signal. Embodiments of the mechanism can be used for harvesting energy from a variety of bio-kinetic events such as a heartbeat, respiration, muscle contraction or other movement. Such embodiments can be used for powering a variety of implanted medical devices such as pacemakers, defibrillators and various monitoring devices.

Abstract: A device (1) that serves for the defibrillation of the heart (2), and can be implanted as a whole. The device includes an implantable combined pacemaker and defibrillator (3), at least one defibrillation electrode (6), and a counter electrode (4, 41, 42), and a stimulation and sensor electrode (5) that can also be implanted, wherein the defibrillation electrode (6) can be retracted subcutaneously near the heart exterior in the region of the cardiac apex (2a), such as by a tension element (13) and a needle (12), and can be implanted, and is configured as at least one flexible helix made of metal or biocompatible steel, thus having high flexibility and low space requirement.

Abstract: An apparatus comprises an implantable ventricular depolarization sensing circuit configured to provide a sensed ventricular depolarization signal, a timer circuit configured to provide a ventricular time interval between ventricular depolarizations, and a controller circuit communicatively coupled to the ventricular depolarization sensing circuit and the timer circuit. The controller circuit includes a ventricular tachycardia (VT) detection circuit configured to declare an episode of VT when a number of accelerated beats are detected, calculate a hysteresis VT detection threshold interval, and deem whether the episode of VT persists using the hysteresis VT detection threshold interval.

Abstract: A system and method can sense a tachyarrhythmia, compare the sensed tachyarrhythmia with a ventricular tachyarrhythmia criterion, provide a ventricular tachyarrhythmia therapy when the sensed tachyarrhythmia satisfies the ventricular tachyarrhythmia criterion, provide a neural stimulation when the sensed tachyarrhythmia does not satisfy the ventricular tachyarrhythmia criterion, determine whether the tachyarrhythmia continues during or after the neural stimulation when the tachyarrhythmia is sustained, compare the tachyarrhythmia sensed during or after the neural stimulation with a supraventricular tachyarrhythmia (SVT) criterion, and provide a ventricular tachyarrhythmia therapy when the sensed tachyarrhythmia does not satisfy the SVT criterion.

Abstract: An exemplary method includes detecting ventricular fibrillation, delivering a low voltage cardiac stimulus, determining whether the low voltage cardiac stimulus terminated the ventricular fibrillation, and delivering a higher voltage cardiac stimulus if the low voltage cardiac stimulus did not terminate the ventricular fibrillation. In one example, the delivering the low voltage cardiac stimulus occurs within approximately 10 event intervals from the detected onset of ventricular fibrillation; otherwise, delivery of an appropriate higher voltage cardiac stimulus occurs. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: Multiple sensing configurations may be qualified based on one induced tachyarrhythmia, e.g., ventricular fibrillation, or other qualification event during an implantation procedure. Each sensing configuration comprises a different combination of two or more electrodes used for sensing electrical signals of the heart of the patient. In some examples, an implantable medical device or other device generates qualification information for each sensing configuration, which may indicate whether the sensing configuration is qualified for subsequent cardiac event detection based on an accuracy of the cardiac event detection for the sensing configuration during the qualification event. One of the qualified configurations may initially be selected as a primary sensing configuration for subsequent cardiac event detection. Switching to an alternate sensing configuration, e.g.

Abstract: A cardiac arrhythmia may be induced by delivering a sequence of pulses to a patient via one or more extravascular electrodes. In one example, one or more pacing pulses may be delivered to a patient via an extravascular electrode and a shock pulse may be delivered to the patient the extravascular electrode. In some examples, the pacing pulses and the shock pulse may be generated with energy from a common energy storage module and without interim charging of the module. For example, the pacing and shock pulses may be generated as the energy storage module dissipates. In another example, a cardiac arrhythmia may be induced in a patient by delivering a burst of pulses to a patient via an extravascular electrode. In some cases, the burst of pulses may be generated with energy from a common energy storage module and without interim charging of the energy storage module.

Abstract: A method and apparatus sense a cardiac electrical signal and determine a signal quality parameter of the cardiac electrical signal. A number of shock pulses to be delivered to a patient's heart is determined in response to the signal quality parameter. Each of the shock pulses are scheduled to be delivered at a unique offset from a T-wave shock interval in one embodiment of the invention.

Abstract: Methods for determination of timing for electrical shocks to the heart to determine shock strength necessary to defibrillate a fibrillating heart. The timing corresponds the window of most vulnerability in the heart, which occurs during the T-wave of a heartbeat. Using a derivatized T-wave representation, the timing of most vulnerability is determined by a center of the area method, peak amplitude method, width method, or other similar methods. Devices are similarly disclosed embodying the methods of the present disclosure.

Abstract: In one embodiment, an ICD is provided which includes a case having a connector block and a conductor post integrally formed with the connector block and extending through a dielectric feedthrough extending through the case. A capacitor is located within the dielectric. In some embodiments, the conductor post is a straight conductor post extending from a side of the connector block facing the feedthrough directly toward the feedthrough. The conductor post and the connector block may be formed of the same material, such as titanium. In some embodiments, a plurality of straight conductor posts and connector blocks are integrally formed. In some embodiments, the dielectric may be a single matrix dielectric, such that each of the straight conductor posts extends through the single matrix dielectric. In other embodiments, each of the straight conductor posts extends through a separate dielectric portion.

Abstract: A transcutaneous cardiac stimulation system delivers pacing pulses according to a cardioprotective pacing protocol. The pacing pulses are delivered through body-surface electrodes attached onto a patient. The cardioprotective pacing protocol specifies pacing parameters selected to augment cardiac stress on the patient's myocardium to a level effecting cardioprotection against ischemic and reperfusion injuries.

Abstract: Techniques for applying overdrive pacing to one or both atria following termination of an AF episode, to prevent a recurrent AF episode. An implantable medical device such as a pacemaker applies overdrive pacing according to overdrive pacing parameters, and sets the parameters as a function of the response of the patient to overdrive pacing. The parameters may be adjusted upward or downward, so that overdrive pacing may be applied effectively but not over-applied.

Abstract: A cardiac rhythm management device predicts defibrillation thresholds without any need to apply defibrillation shocks or subjecting the patient to fibrillation. Intravascular defibrillation electrodes are implanted in a heart. By applying a small test energy, an electric field near one of the defibrillation electrodes is determined by measuring a voltage at a sensing electrode offset from the defibrillation electrode by a known distance. A desired minimum value of electric field at the heart periphery is established. A distance between a defibrillation electrodes and the heart periphery is measured, either fluoroscopically or by measuring a voltage at an electrode at or near the heart periphery. Using the measured electric field and the measured distance to the periphery of the heart, the defibrillation energy needed to obtain the desired electric field at the heart periphery is estimated. In an example, the device also includes a defibrillation shock circuit and a stimulation circuit.

Abstract: An implantable cardiac rhythm management device for delivering anti-tachyarrhythmia therapy is provided with a temporary disablement feature so that the delivery of anti-tachyarrhythmia therapy may be conveniently disabled and re-enabled. The feature is particularly useful to patients who are undergoing imaging procedures or surgical procedures where electro-cauterizing instruments may cause inadvertent triggering of cardioversion/defibrillation shocks and/or anti-tachycardia pacing.

Abstract: Methods, systems, and apparatus for the treatment of heart failure (both systolic and diastolic), hypertension, and arrhythmia in patients by stimulating one or more nerves, particularly peripheral nerves, using neurostimulation are described. The therapeutic treatment is accomplished by applying electrical signals to at least one or more nerves using cutaneous, subcutaneous, implantable, or catheter-based neurostimulation assemblies, alone or in combination with one or more additional therapy or stimulation devices associated with the patient's heart, and/or with one or more therapeutic drug infusions or therapies, such as immune modulation therapy (IMT).

Abstract: A cardiac rhythm management system identifies a relationship between one or more hemodynamic parameters sensed from a patient and levels of hemodynamic tolerability of the patient. The identified relationship allows an implantable medical device to control delivery of anti-tachyarrhythmia therapy using the patient's hemodynamic tolerability during a detected tachyarrhythmia episode, in addition to classifying the detected tachyarrhythmia episode by its type and origin.

Abstract: A pacing system includes a pacemaker and a pacing protocol module externally attached to the pacemaker. The pacing protocol module stores the pacing protocol. The pacemaker controls delivery of pacing pulses by automatically executing the pacing protocol. In one embodiment, the pacing protocol is a cardioprotective pacing protocol for preventing and/or reducing cardiac injury associated with myocardial infarction (MI) and revascularization procedure. The pacing pulses are generated from the pacemaker and delivered through one or more pacing electrodes incorporated onto one or more percutaneous transluminal vascular intervention (PTVI) devices during the revascularization procedure.

Abstract: An exemplary method includes detecting arrhythmia, detecting myocardial ischemia, determining whether the myocardial ischemia comprises local ischemia or global ischemia and, in response to the determining, calling for delivery of either a local ischemic anti-arrhythmia therapy or a global ischemic anti-arrhythmia therapy. Various other exemplary methods, devices, systems, etc., are also disclosed.