Abstract: Certain embodiments of the present disclosure provide an externally-secured medical device (ESMD) configured to be securely affixed to skin of a patient. The ESMD may include at least one pad configured to be directly secured to the skin of the patient. The pad(s) may include at least one electrode configured to direct therapeutic energy into the skin of the patient toward an internal organ. An adhesion component is provided on a patient-engaging surface of the at least one pad configured to securely affix the at least one pad in a persistent and enduring manner to the skin of the patient. The at least one pad is directly secured to the skin of the patient through the adhesion component.

Abstract: Techniques relate to operating a medical device in response to a detected posture state of a patient. A trigger event such as a request to modify how therapy is being delivered to the patient may cause a determination to be made as to whether the patient's posture state is stable. If the posture state is stable, an association is created between the posture state and one or more therapy parameter values. Over time, a library of such associations is created that may reflect any posture state in three dimensional space, wherein a posture state comprises at least one of a posture and an activity component. The library of associations may be used to automatically control therapy delivery. Similar ones of the associations may automatically be grouped into posture state regions to facilitate more efficient classification of the patient's posture state to control therapy delivery.

Abstract: In one embodiment, a wearable defibrillation system may sense whether its wearer meets an unconscious bradyarrhythmia condition that can be associated with becoming unconscious. Even though such a condition might not be helped with a defibrillation pulse, the wearable defibrillation system may still administer pacing pulses to prevent the bradycardia from becoming worse, such as a sudden cardiac arrest. In some embodiments, the pacing pulses are administered at a frequency too slow for the patient to regain consciousness. An advantage is that, because the patient remains unconscious, he does not experience the sometimes severe discomfort due to the pacing pulses.

Abstract: Methods and devices providing multiple criteria for use in arrhythmia identification. Based on inputs including defined rules or parameters, one of a more conservative or more aggressive set of arrhythmia identification parameters can be selected. One or the other of the selectable sets of arrhythmia identification parameters may also be adaptive or modifiable during the use of the system, for example, in response to identified nonsustained episodes, the more conservative set of arrhythmia identification parameters can be modified to become still more conservative. Such modification of arrhythmia identification criteria allows reduced time to therapy when indicated, while allowing more deliberate decisions in other circumstances.

Abstract: A method for accurately determining timing points for T-wave shocks is particularly useful in a system for determining a cardiac shock strength in an implantable cardioverter defibrillator (ICD. The method involves acquiring at least one first signal, acquiring at least a second signal, comparing the signals, and selecting a timing point with the T-wave of the signal. The first and second signals may be two different aspects of a single electrogram, first and second electrograms, or a combination thereof. Comparison preferably involves signal alignment and qualitative analysis.

Abstract: An automated external defibrillator (AED) (10) having a treatment decision processor (28) is described which follows a “shock first” or a “CPR first” rescue protocol after identification of a treatable arrhythmia, depending upon an estimate of the probability of successful resuscitation made from an analysis of a patient parameter measured at the beginning of the rescue. The invention may also follow different CPR protocols depending on the estimate. The invention also may use the trend of the measured patient parameter to adjust the CPR protocol either during a CPR pause or after the initial CPR pause. The AED (10) thus enables an improved rescue protocol.

Abstract: A Wireless Monitoring Apparatus is used in conjunction with an automated external defibrillator (AED) system for patient rescue in mass-casualty incidents. The rescuer applies the device on each patient. The wireless monitoring apparatus automatically analyzes the patient's heart rhythm and communicates with the AED system. The AED system is therefore is able to display information with regard to each patient, notifies the rescuer on actions to take and can deliver defibrillation therapy if needed.

Abstract: A transthoracic defibrillator for external defibrillation comprises at least three electrodes configured to be attached to the thorax of a patient to establish at least two electrical paths across the thoracic cavity and through the heart of the patient. In addition, a defibrillator circuit contained in a defibrillator housing has the capability to deliver a different defibrillation waveform across each of the at least two electrical paths.

Abstract: Automated treatment of arrhythmia utilizing an electrotherapy device. Time-coordinated applications of medium-voltage therapy (MVT) followed by high-voltage therapy (HVT) include a first MVT waveform to a first target region and a second MVT waveform to a second target region, such that the HVT is synchronized relative to a first compression cycle corresponding to activation of the first target region, and to a second compression cycle corresponding to activation of the second target region resulting from the administration of the MVT.

Abstract: Nano-constructs comprising nanoshells and methods of using the nano-constructs for treating or ameliorating a vascular condition are provided.

Abstract: Methods and implantable devices for cardiac signal analysis. The methods and devices make use of waveform appraisal techniques to distinguish event detections into categories for suspect events and waveform appraisal passing events. When adjustments are made to the data entering analysis for waveform appraisal, the waveform appraisal thresholds applied are modified as well. For example, when the data analysis window for waveform appraisal changes in length, a waveform appraisal threshold is modified. Other changes, including changes in sensing characteristics with which waveform appraisal operates may also result in changes to the waveform appraisal threshold including changes in gain, sensing vector, activation of other devices, implantee posture and other examples which are explained.

Abstract: In a subcutaneous implantable cardioverter/defibrillator, cardiac arrhythmias are detected to determine necessary therapeutic action. Cardiac signal information is sensed from far field electrodes implanted in a patient. The sensed cardiac signal information is then amplified and filtered. Parameters such as rate, QRS pulse width, cardiac QRS slew rate, amplitude and stability measures of these parameters from the filtered cardiac signal information are measured, processed and integrated to determine if the cardioverter/defibrillator needs to initiate therapeutic action.

Abstract: CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.

Abstract: An apparatus comprises an electrostimulation energy storage capacitor, a circuit path communicatively coupled to the electrostimulation energy storage capacitor and configured to provide quasi-constant current neural stimulation through a load from the electrostimulation energy storage capacitor, a current measuring circuit communicatively coupled to the circuit path and configured to obtain a measure of quasi-constant current delivered to the load, and a control circuit communicatively coupled to the current measuring circuit, wherein the control circuit is configured to initiate adjustment of the voltage level of the storage capacitor for a subsequent delivery of quasi-constant current according to a comparison of the measured load current to a specified load current value.

Abstract: Apparatus and methods are described, including a method for treating a clinical episode. The method comprises sensing at least one parameter of a subject without contacting or viewing the subject or clothes the subject is wearing, analyzing the parameter, detecting the clinical episode at least in part responsively to the analysis, and responsively to detecting the clinical episode, treating the clinical episode using a device implanted in the subject. Other applications are also described.

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

Abstract: Various system embodiments comprise circuitry to determine when an arrhythmia has terminated, and a neural stimulator adapted to temporarily deliver neural stimulation therapy to assist with recovering from the arrhythmia in response to termination of the arrhythmia.

Abstract: A wearable therapeutic device to facilitate care of a subject is provided. The wearable therapeutic device can include a garment having a sensing electrode. The garment includes at least one of an inductive element and a capacitive element, and a controller identifies an inductance of the inductive element or a capacitance of the capacitive element, and determines a confidence level of information received from the sensing electrode based on the inductance or the capacitance. The wearable therapeutic device also includes an alarm module coupled with the controller and configured to provide a notification to a subject based on the confidence level.

Abstract: The present invention is directed to an apparatus that includes a microcurrent delivery device portion and at least one independent sensory cue delivery means. The independent sensory cue delivery means can provide an independent sensory cue selected from the group consisting of vibration, heat, cool, skin irritation, tingling, fragrance or auditory.

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

Abstract: A system and method for painlessly calculating an estimated defibrillation threshold, such as by using an implantable medical device and a controller. The estimated defibrillation threshold can be calculated using a delivered first energy to a first thoracic location, an electric field detected at a second thoracic location, and an electric field detected between a third thoracic location and a fourth thoracic location. The estimated defibrillation threshold represents an energy that, when delivered at the first thoracic location, can create an electric field strength in a target region of the heart that meets or exceeds a target electric field strength.

Abstract: One embodiment of the present subject matter includes a method for pulse generation in an implantable device, comprising measuring an impedance between a first electrode and a second electrode and delivering a pulse based on a pulse energy level and a pulse duration limit, comprising generating a pulse duration as a function of the pulse energy level and the impedance and selecting a capacitance value from a plurality of capacitances in a partitioned capacitor bank to deliver a pulse at the pulse energy level and wherein the pulse duration is less than the pulse duration limit.

Abstract: Methods, apparatus, and systems are provided to stimulate multiple sites in a heart. A controller senses electrical activity associated with sinus rhythm of the heart. A signal generator is configured to generate an electrical signal for stimulating the heart. Based on the electrical signal, a distributor circuit then distributes the stimulating signals, such as pacing pulses, to a heart. The distributor circuit may vary the delay time between stimulating signals, inhibit a stimulating signal, trigger application of a stimulating signal, or vary the characteristics, such as the pulse width and amplitude, of a stimulating signal.

Abstract: Methods and devices detect context related to a patient when monitoring a physiological condition of the patient and/or when applying one or more modes of therapy. The context may be a patient context such as posture or an environmental context such as ambient conditions. The context may be used in various ways in relation to the physiological measurement, such as to control when the physiological measurements are made, to appropriately flag physiological measurements, to be recorded in association with the physiological measurements, and/or to correct the physiological measurements based on a reference context. A device such as a beacon transmitter issued in detecting the context and a measurement device such as an implantable cardiovascular device is used to capture the physiological measurements.

Abstract: Methods of cardiac rhythm analysis in an implantable cardiac stimulus device, and devices configured for such methods. In an illustrative embodiment, certain data relating to cardiac event rate or amplitude is modified following delivery of a cardiac stimulus. In another embodiment, cardiac rhythm analysis is performed using one of plural states, with the plural states using different criteria, such as a detection threshold, to detect cardiac events in a sensed signal. Following delivery of a cardiac stimulus, data is manipulated to force the analysis into one of the states, where stimulus is delivered, in the illustrative embodiment, only after a different state is invoked. Implantable devices incorporating operational circuitry for performing such methods are also included in other illustrative embodiments.

Abstract: Automated treatment of arrhythmia utilizing an electrotherapy device. Time-coordinated applications of medium-voltage therapy (MVT) followed by high-voltage therapy (HVT) include a first MVT waveform to a first target region and a second MVT waveform to a second target region, such that the HVT is synchronized relative to a first compression cycle corresponding to activation of the first target region, and to a second compression cycle corresponding to activation of the second target region resulting from the administration of the MVT.

Abstract: Automated treatment of arrhythmia utilizing an electrotherapy device. Time-coordinated applications of medium-voltage therapy (MVT) followed by high-voltage therapy (HVT) include a first MVT waveform to a first target region and a second MVT waveform to a second target region, such that the HVT is synchronized relative to a first compression cycle corresponding to activation of the first target region, and to a second compression cycle corresponding to activation of the second target region resulting from the administration of the MVT.

Abstract: Various aspects of the present disclosure are directed toward an implantable electrostimulation device, a plurality of sensing and pacing elements, and a fine wire lead extending in a sealed relationship from the electrostimulation device and to the plurality of sensing and pacing elements. The fine wire lead includes multiple discrete conductors and a drawn silica or glass fiber core, a polymer cladding on the drawn silica or glass fiber core, and a conductive metal cladding over the polymer cladding. Additionally, the fine wire lead simultaneously delivers different electrical signals or optical signals between the sensing and pacing elements and the electrostimulation device.

Abstract: A novel wearable electronic skin patch sensor device configured for the real time acquisition, processing and communicating of cardiac activity and other types of biological information within a wired or wireless network is disclosed. A system level scheme for networking the sensor device with client devices that include intelligent personal health management appliances, cellular telephones, PDAs, portable computers, personal computers, RFID Tags and servers is disclosed. The sensor device and the system enable distributed processing, archival and correlation of the biological information with biometrics, gastronomic information, user profiles and health factors that include height, weight, blood pressure and physical activity facilitating real time personal health management at any time and any place.

Abstract: A patient parameter monitoring pod in embodiments of the teachings may include one or more of the following features: (a) portable housing containing a power supply, (b) a patient parameter module connectable to a patient via lead cables to collect patient data, the patient data including at least one vital sign, (c) a transceiver adapted to wirelessly transmit the patient data to a defibrillator, (d) a data port adapted to supply the patient data via a direct electrical connection to the defibrillator, and (e) a carrying handle extending from the housing proximate a patient lead cable port that permits connection of the lead cables to the pod, the carrying handle positioned to protect the patient lead cable port and the patient lead cables attached to the port from direct impact.

Abstract: This document discusses, among other things, a modular antitachyarrhythmia therapy system. In an example, a modular antitachyarrhythmia system includes at least two separate modules that coordinate delivery an antitachyarrhythmia therapy, such as a defibrillation therapy. In another example, a modular antitachyarrhythmia therapy system includes a sensing module, an analysis module, and a therapy module.

Abstract: An external defibrillator system is disclosed that generates and applies a diagnostic signal to the patient in conjunction with defibrillation therapy. The diagnostic signal is designed to elicit a physiologic response from the patient's heart, namely, mechanical cardiac response and electrical cardiac response, electrical cardiac response only, or no cardiac response. Depending upon the type of cardiac response detected, the system selects an appropriate resuscitation protocol that considers the likely responsiveness of the patient to defibrillation therapy. In one practical embodiment, a stimulus signal is applied to patients that show mechanical and electrical capture in response to the diagnostic signal. The stimulus signal maintains the mechanical capture (and, therefore, perfusion) for a period of time prior to the delivery of a defibrillation pulse.

Abstract: Systems and methods for arrhythmia therapy in MRI environments are disclosed. Various systems disclosed utilize ATP therapy rather than ventricular shocks when patients are subjected to electromagnetic fields in an MRI scanner bore and shock therapy is not available. As the patient is moved out from within the scanner bore and away from the MRI scanner, the magnetic fields diminish in strength eventually allowing a high voltage capacitor within the IMD to charge if necessary. The system may detect when the electromagnetic fields no longer interfere with the shock therapy and will transition the IMD back to a normal operational mode where shock therapy can be delivered. Then, if the arrhythmia still exists, the system will carry out all of the system's prescribed operations, including the delivery of electric shocks to treat the arrhythmia.

Abstract: Systems and methods related to the field of cardiac resuscitation, and in particular to devices for assisting rescuers in performing cardio-pulmonary resuscitation (CPR) are described herein. In some aspects, a system and method can include obtaining values for depths of a plurality of the chest compressions and information about a physiological parameter of the person and providing periodic feedback to a user about chest compressions performed by the user based at least in part on the values for the depths of the plurality of the chest compressions and a target compression depth.

Abstract: To provide a fibrillation detector and a defibrillator that are capable of correctly detecting within a short time a ventricular fibrillation (VF) that shows an irregular amplitude or shape, an R-wave detection unit R_DETECT_MEAN converts power of a frequency component making up an R wave of an electrocardio signal ECG into an approximately DC component, and outputs the converted power as R-wave power V_R. A T-wave detection unit T_DETECT_MEAN converts power of a frequency component making up a T wave of the electrocardio signal ECG into an approximately DC component, and outputs the converted power as T-wave power V_T. The R-wave power V_R and the T-wave power V_T are input to a comparison unit CMP, and the comparison unit CMP outputs a magnitude comparison result between the R-wave power V_R and the T-wave power V_T as a comparison signal sig_comp.

Abstract: Systems and methods of providing life support are provided. A life support system includes a first life support device that has a control unit and is configured to apply a life support protocol to a subject. The first life support device also includes a memory unit that can store life support protocol information, and the control unit can provide the life support protocol information to a second life support device. The control unit can also receive operating instructions from the second life support device based on the life support protocol information, and can implement the operating instructions.

Abstract: An automated defibrillator attachment for an electronic device such as a smart phone includes an electronics module, at least two electrodes, and a connector. The at least two electrodes extend from the electronics module for connecting to a patient. The connector extends from the electronics module for coupling to at least one receptacle of the electronics device. The at least two electrodes provide at least one electrical shock to the patient that is supplied from an energy source of the electronic device. Other embodiments include an energy storage element to supply the at least one electrical shock.

Abstract: A method of controlling a defibrillator with a function of analyzing an electrocardiogram, includes: dividing an electrocardiogram of a patient into a plurality of analysis zones; executing analysis of the electrocardiogram in each of the divided analysis zones; based on a result of the analysis of the electrocardiogram in each of the analysis zones, executing determination whether electric shock on the patient is necessary or not, and calculating reliability of the determination; and based on a combination of the determination and the reliability, instructing a first procedure to be performed on the patient.

Abstract: A method and device for detecting arrhythmias in a patient that includes electrodes positioned subcutaneously within the patient, a microprocessor, coupled to the electrodes, determining one of a sequence of the sensing of cardiac signals by the electrodes and a duration between the sensing of cardiac signals by the electrodes, and control circuitry delivering a therapy in response to one of the determined sequence and the determined duration.

Abstract: An external defibrillator, such as a wearable defibrillator can have a heart rhythm detector to detect the heart rhythm of a patient. The defibrillator can also have a synchronous shock operating mode and an asynchronous shock operating mode. A controller can set the defibrillator in the synchronous shock operating mode or the asynchronous shock operating mode. The defibrillator can also include a shock module to cause the defibrillator to deliver shock therapy to the patient according to the operating mode of the defibrillator and a sync module configured to identify a first portion of the heart rhythm detected from a first ECG lead with which to time the delivery of the shock therapy to the patient when the operating mode of the defibrillator is in synchronous shock operating mode. A comparator module can compare timing of a QRS complex detected from the first ECG lead with the timing of the QRS complex detected by the second EGG lead.

Abstract: The defibrillator may include a heart rhythm detector to detect the heart rhythm of a patient, a manual mode controller structured to set the defibrillator in a synchronous shock operating mode or an asynchronous shock operating mode depending on an input from a human operator, a shock module to cause the defibrillator to deliver a shock to the patient according to the operating mode, and an automatic mode controller structured to, after the shock module has delivered the shock to the patient, set the external defibrillator to the synchronous shock operating mode or the asynchronous shock operating mode depending on the detected heart rhythm of the patient and without input from the human operator.

Abstract: Methods, systems, and devices for signal analysis in an implanted cardiac monitoring and treatment device such as an implantable cardioverter defibrillator. In illustrative examples, captured data including detected events is analyzed to identify likely overdetection of cardiac events. In some illustrative examples, when overdetection is identified, data may be modified to correct for overdetection, to reduce the impact of overdetection, or to ignore overdetected data. New methods for organizing the use of morphology and rate analysis in an overall architecture for rhythm classification and cardiac signal analysis are also discussed.

Abstract: The disclosure relates to an apparatus and method for inducing ventricular fibrillation in a patient to facilitate defibrillation threshold testing. The apparatus includes a plurality of output capacitors that are dynamically configurable in a selected stacking arrangement that facilitates delivery of energy for inducing the ventricular fibrillation.

Abstract: In one embodiment, a wearable defibrillation system may sense whether its wearer meets an unconscious bradyarrhythmia condition that can be associated with becoming unconscious. Even though such a condition might not be helped with a defibrillation pulse, the wearable-defibrillation system may still administer pacing pulses to prevent the bradycardia from becoming worse, such as a sudden cardiac arrest. In some embodiments, the pacing pulses are administered at a frequency too slow for the patient to regain consciousness. An advantage is that, because the patient remains unconscious, he does not experience the sometimes severe discomfort due to the pacing pulses.

Abstract: A notebook, laptop computer or tablet computer having an automated external defibrillator (AED) capability, and methods of utilizing the notebook, laptop computer or tablet computer defibrillator to treat victims of sudden cardiac arrest. Kits and methods for converting, adapting or retrofitting a common notebook, laptop computer and tablet computer to enable each to be used as an AED to treat victims of sudden cardiac arrest. A kit including an adjustable case for receiving, encompassing, adapting and converting a common notebook, laptop computer or tablet computer to enable each to be used as an AED. A kit including a slave automated external defibrillator (AED) that is joined to a common notebook, laptop computer or tablet computer to adapt, convert and enable each to be used as an AED.

Abstract: Systems, methods, and devices for protecting against effects of magnetic fields are provided. One implantable medical device includes a lead including a first conductor and a second conductor. The device further includes a generator including an electronic circuit, a metal housing that has a ground potential, and one or more switching devices. The switching devices, in a safekeeping configuration, are configured to disconnect the second conductor from the electronic circuit and to connect the second conductor to the ground potential of the metal housing. The first conductor is connected to the electronic circuit in the safekeeping configuration. The switching devices, in the safekeeping configuration, are configured to cause the second conductor to shield the first conductor from at least a portion of the effects of the magnetic field while the first conductor remains connected to the electronic circuit for use in performing a sensing operation and/or a stimulation operation.

Abstract: A subcutaneous implantable cardioverter-defibrillator is disclosed which has an electrically active canister which houses a source of electrical energy, a capacitor, and operational circuitry that senses the presence of potentially fatal heart rhythms. At least one subcutaneous electrode that serves as the opposite electrode from the canister is attached to the canister via a lead system. Cardioversion-defibrillation energy is delivered when the operational circuitry senses a potentially fatal heart rhythm. There are no transvenous, intracardiac, or epicardial electrodes. A method of subcutaneously implanting the cardioverter-defibrillator is also disclosed as well as a kit for conducting the method.

Abstract: A medical device such as an external defibrillator delivers electrical therapy using a special ascending, biphasic waveform. The special waveform is characterized by a set of at least two peaks. The amplitude of the second peak is greater than the amplitude of the first peak. The waveform is generated by switching capacitance configuration in the defibrillator from a parallel configuration to a series configuration while the defibrillator is delivering the defibrillation shock to the patient. Because of the switching capacitances and/or the waveform, the external defibrillator can be made physically smaller and weigh less, without sacrificing the therapeutic effect of a larger external defibrillator that would deliver a defibrillation shock of higher energy. As such, the defibrillator is easier to configure for transporting, handling, and even wearing.

Abstract: Methods, systems, and devices for signal analysis in an implanted cardiac monitoring and treatment device such as an implantable cardioverter defibrillator. In some illustrative examples, detected events are analyzed to identify changes in detected event amplitudes. When detected event amplitudes are dissimilar from one another, a first set of detection parameters may be invoked, and, when detected event amplitudes are similar to one another, a second set of detection parameters may be invoked. Additional methods determine whether the calculated heart rate is “high” or “low,” and then may select a third set of detection parameters for use when the calculated heart rate is high.

Abstract: A medical device can include a therapy circuit configured to provide a specified electrostimulation therapy to a tissue site, the specified electrostimulation therapy including a scheduled completion, the therapy circuit including a protection circuit configured to adjust specification of the electrostimulation therapy being provided so as to provide an adjusted electrostimulation therapy before the scheduled completion. The medical device can include a monitoring circuit comprising a comparator. The monitoring circuit can be configured to trigger the protection circuit to inhibit the therapy circuit when the therapy circuit output parameter exceeds the specified threshold as indicated by the comparator.