Abstract: A medical device includes a first substrate, a second substrate, a control module, and an energy storage device. The first substrate includes at least one of a first semiconductor material and a first insulating material. The second substrate includes at least one of a second semiconductor material and a second insulating material. The second substrate is bonded to the first substrate such that the first and second substrates define an enclosed cavity between the first and second substrates. The control module is disposed within the enclosed cavity. The control module is configured to at least one of determine a physiological parameter of a patient and deliver electrical stimulation to the patient. The energy storage device is disposed within the cavity and is configured to supply power to the control module.

Abstract: A method of forming an implantable medical device includes providing an implantable microstimulator. The microstimulator includes a body with a first end and an opposing second end. The microstimulator further includes internal circuitry that is disposed in the body and that provides stimulation energy. The microstimulator additionally includes a first microstimulator electrode that is electrically coupled to the internal circuitry and that is disposed along the first end portion of the body. The method further includes providing a first lead assembly that includes an insulated conductor with at least one first remote electrode disposed at a distal end of the insulated conductor, and a first connector disposed at a proximal end of the insulated conductor. The first connector is disposed over the first microstimulator electrode to completely cover the first microstimulator electrode. The first connector also electrically couples the insulated conductor to the first microstimulator electrode.

Abstract: A method for stimulating a portion of a vagus nerve of a patient to treat a pulmonary disorder is provided. At least one electrode is coupled to at least one portion of a left vagus nerve and/or a right vagus nerve of the patient. An electrical signal is applied to the portion of the vagus nerve using the electrode to treat the pulmonary disorder. The electrical signal may perform a blocking of an intrinsic neural activity on said at least one portion of the left vagus nerve and said right vagus nerve.

Abstract: A system and method to deliver a therapeutic quantity of energy to a patient. The system includes a capacitor having a rated energy storage capacity substantially equal to the therapeutic quantity of energy, a boost converter coupled with the capacitor and constructed to release energy from the capacitor at a substantially constant current for a time interval, and an H-bridge circuit coupled with the boost converter and constructed to apply the substantially constant current in a biphasic voltage waveform to the patient. The method includes storing a quantity of energy substantially equal to the therapeutic quantity of energy in a capacitor, releasing the quantity of energy at a relatively constant current during a time interval using a boost converter coupled with the capacitor, and delivering a portion of the quantity energy in a direction to the patient using an H-bridge circuit coupled with the boost converter.

Abstract: An implantable electrical lead that, upon implantation in an animal, is biocompatible and compatible with a magnetic resonance imaging scanner. The upon implantation in an animal has a body of dielectric material with a plurality of lumens and a plurality of insulated conductive helical coils embedded in one or more layers of dielectric material and placed within the plurality of lumens. Each helical coil is formed by one or more conductive wires having a predefined and controlled pitch and diameter. A layer of dielectric material separates the plurality of lumens, wherein the separation distance and properties of the dielectric material create a high impedance at the Larmor frequency of the magnetic resonance imaging scanner. A mechanically flexible, biocompatible layer forms an external layer of the electrical lead and is adapted to contact bodily tissue and bodily fluids of the animal.

Abstract: An implantable medical device (IMD) may include multiple power supply circuits and an electrostimulation therapy output circuit configured to, in response to a control signal specifying an electrostimulation therapy, controllably connect any one or more of the first or second power supply circuits to any one or more of a first electrostimulation output node or a second electrostimulation output node to deliver an electrostimulation. In an embodiment, the IMD may include an electrostimulation therapy return circuit configured to establish a return path for the electrostimulation delivered via one or more of the first electrostimulation output node or the second electrostimulation output node.

Abstract: Methods and systems involve adjusting cardiac pacing based on information acquired via a respiratory therapy device. A medical system includes a respiratory therapy device having one or more sensors and a therapy delivery unit. The one or more sensors are configured to sense respiration cycles. The therapy delivery unit is configured to deliver an external respiratory therapy to the patient. The medical system also includes a pulse generator configured to deliver cardiac pacing pulses to the patient. A controller is coupled to the one or more sensors and the pulse generator. The control unit configured to adjust a cardiac pacing rate based on the patient's respiration cycles.

Abstract: A method of modifying the force of contraction of at least a portion of a heart chamber, including providing a subject having a heart, comprising at least a portion having an activation, and applying a non-excitatory electric field having a given duration, at a delay after the activation, to the portion, which causes the force of contraction to be increased by a least 5%.

Abstract: The invention concerns the therapy with a cardiac resynchronization device (CRT) and/or therapy with an automated internal cardiac defibrillator (ICD) for treating patients with any cancer or patients with cachexia due to acute or chronic illness other than cardiac illness, including malignant tumor disease, COPD, chronic renal failure, liver cirrhosis, chronic infections, and/or AIDS. Areas of application are the life sciences, in particular medicine and medical technology.

Abstract: An improved architecture for an implantable medical device such as an implantable pulse generator (IPG) is disclosed. In one embodiment, the various functional blocks for the IPG are incorporated into a signal integrated circuit (IC). Each of the functional blocks communicate with each other, and with other off-chip devices if necessary, via a centralized bus governed by a communication protocol. To communicate with the bus and to adhere to the protocol, each circuit block includes bus interface circuitry adherent with that protocol. Because each block complies with the protocol, any given block can easily be modified or upgraded without affecting the design of the other blocks, facilitating debugging and upgrading of the IPG circuitry. Moreover, because the centralized bus can be taken off the integrated circuit, extra circuitry can easily be added off chip to modify or add functionality to the IPG without the need for a major redesign of the main IPG IC.

Abstract: Apparatus and methods are provided for use with a heart of a subject, including a set of one or more electrodes. A control unit paces the heart by driving a first electric current via the electrode set into tissue of the subject, in accordance with a first set of parameters. The control unit stimulates nitric oxide production by a portion of the heart by driving a second electric current via the electrode set into the portion of the heart, in accordance with a second set of parameters. Other embodiments are also described.

Abstract: A medical device for intracorporeal use formed at least in part from aerographite.

Abstract: A leadless cardiac pacemaker is provided which can include any number of features. In one embodiment, the pacemaker can include a tip electrode, pacing electronics disposed on a p-type substrate in an electronics housing, the pacing electronics being electrically connected to the tip electrode, an energy source disposed in a cell housing, the energy source comprising a negative terminal electrically connected to the cell housing and a positive terminal electrically connected to the pacing electronics, wherein the pacing electronics are configured to drive the tip electrode negative with respect to the cell housing during a stimulation pulse. The pacemaker advantageously allows p-type pacing electronics to drive a tip electrode negative with respect to the can electrode when the can electrode is directly connected to a negative terminal of the cell. Methods of use are also provided.

Abstract: The disclosure relates to a device and a method for detecting electromagnetic fields, in particular fields occurring in imaging magnetic resonance tomography.

Abstract: A subcutaneous cardiac device includes a subcutaneous electrode and a housing coupled to the subcutaneous electrode by a lead with a lead wire. The subcutaneous electrode is adapted to be implanted in a frontal region of the patient so as to overlap a portion of the patient's heart. The subcutaneous electrode is configured for therapy delivery in combination with one or both of the housing or a second subcutaneous electrode.

Abstract: An embodiment of the invention provides an apparatus for the detection and treatment of atrial arrhythmia comprising an electrical lead having proximal and distal portions. The distal portion is positionable in an atrial chamber and the end of the proximal portion is configured to be coupled to a pacemaker. The lead comprises a plurality of conductive wires clad with an insulative coating and has sufficient flexibility to be positioned in the atria from a percutaneous introductory site. The conductive wires are coupled to a plurality of pairs of bipolar electrodes positioned on a membrane attachable to an endocardial wall. The electrode pairs are distributed in a pattern defining an area for detecting a location of a foci of aberrant electrical activity located within or adjacent the area and sending a pacing signal to that location to prevent or stop an occurrence of atrial fibrillation caused by that foci.

Abstract: Devices, systems, and methods for treating a heart of a patient may make use of structures which limit a size of a chamber of the heart, such as by deploying a tensile member to bring a wall of the heart toward (optionally into contact with) a septum of the heart. The implant may include an electrode or other structure for applying pacing signals to one or both ventricles of the heart, for defibrillating the heart, for sensing beating of the heart or the like. A wireless telemetry and control system may allowing the implant to treat congestive heart failure, monitor the results of the treatment, and apply appropriate electrical stimulation.

Abstract: Various aspects of the present subject matter provide an implantable medical device. In various embodiments, the device comprises a pulse generator, a lead, a sensor, and a controller. The pulse generator generates a baroreflex stimulation signal as part of a baroreflex therapy. The lead is adapted to be electrically connected to the pulse generator and to be intravascularly fed into a heart. The lead includes an electrode to be positioned in or proximate to the heart to deliver the baroreflex signal to a baroreceptor region in or proximate to the heart. The sensor senses a physiological parameter regarding an efficacy of the baroreflex therapy and provides a signal indicative of the efficacy. The controller is connected to the pulse generator to control the baroreflex stimulation signal and to the sensor to receive the signal indicative of the efficacy of the baroreflex therapy. Other aspects are provided herein.

Abstract: Methods of nerve signal differentiation, methods of delivering therapy using such nerve signal differentiation, and to systems and devices for performing such methods. Nerve signal differentiation may include locating two electrodes proximate nerve tissue and differentiating between efferent and afferent components of nerve signals monitored using the two electrodes.

Abstract: An implantable medical device operates to promote intrinsic ventricular depolarization according to a pacing protocol. When a cardiac rate exceeds a predetermined threshold, the implantable medical device modifies the pacing protocol parameters to promote AV synchrony.

Abstract: Methods and/or devices are disclosed herein for monitoring cardiac impedance signal and delivering therapy to a patient's heart based upon the monitored cardiac impedance.

Abstract: A method for operating an implantable medical device includes delivering a plurality of pacing pulses to an atria of a patient's heart and monitoring intrinsic atrial activity to detect intrinsic atrial contractions between one or more of the plurality of pacing pulses. The method further includes detecting atrial undersensing as a function of the detection of intrinsic atrial contractions.

Abstract: In the present disclosure, conservation of an implantable medical device power supply of is facilitated by controlling the power consumption of the device's processing component. The power supplied to the processing component is controlled to enable processing of received events as a function of predetermined criteria rather than the actual occurrence of the events which is frequent, but irregular. Accordingly, the need for the processing component to start and stop (and thereby be fully powered on each start) with receipt of each event is obviated thereby maintaining the power consumption of the processing component and increasing longevity of the device. Event data associated with received events is stored in an event queue and subsequently retrieved and transmitted for processing based on predetermined criteria. The power supplied during an idle state of the processing component may be reduced in relation to the power supplied during a wake up state.

Abstract: A leadless intra-cardiac medical device includes a housing that is configured to be implanted entirely within a single local chamber of the heart. A first electrode is provided on the housing at a first position such that when the housing is implanted in the local chamber, the first electrode engages the local wall tissue at a local activation site within the conduction network of the local chamber. An intra-cardiac extension is coupled to the housing and configured to extend from the local chamber into an adjacent chamber of the heart. A stabilization arm of the intra-cardiac extension engages the adjacent chamber. A second electrode on the intra-cardiac extension engages distal wall tissue at a distal activation site within the conduction network of the adjacent chamber.

Abstract: A left-ventricular pacing interval and a right-ventricular pacing interval for timing the delivery of pacing pulses to a left ventricle and a right ventricle of a heart, respectively, may be based an intrinsic conduction time interval between at least one of an atrial sensing event or an atrial pacing event of an atrial chamber of a heart and a ventricular sensing event of a ventricular chamber of the heart. In some examples, the left-ventricular pacing interval is based on the time interval, where the left-ventricular pacing interval is less than the time interval. In some examples, the right-ventricular pacing interval is based on the time interval, where the right-ventricular pacing interval is greater than the left-ventricular pacing interval and less than the time interval.

Abstract: An apparatus for reversing ventricular remodeling with electro-stimulatory therapy. A ventricle is paced by delivering one or more stimulatory pulses in a manner such that a stressed region of the myocardium is pre-excited relative to other regions in order to subject the stressed region to a lessened preload and afterload during systole. The unloading of the stressed myocardium over time effects reversal of undesirable ventricular remodeling.

Abstract: A noise-suppressing electrocardiograph (ECG) adapter having a first end, a second end, and a noise-suppression element is presented, together with an ECG noise-suppressing system and related methods. In an embodiment, the noise-suppressing ECG adapter includes a housing having at least one first connector disposed at a first end of the housing adapted to electrically couple with an ECG lead set, and at least one second connector adapted for coupling to an input of an ECG device. The adapter includes a noise suppression element. The noise suppression element includes a ferromagnetic element having an opening defined therein. In an embodiment the noise suppression element is internal to the adapter. In another embodiment, the noise suppression element is tethered externally to the adapter and configured to clamp around at least a portion of an ECG leadwire.

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: In a method and a system for initiating communication with an implantable medical device to conduct a wireless communication session between the implantable medical device and an external programmer device. A directional antenna is employed for initiating communication between a programmer device and an implantable medical device (IMD). The IMD is targeted by the programmer device by having an operator of the programmer device orient the directional antenna toward the IMD and transmitting a communication-initiating signal from the programmer to the IMD via the directional antenna. The directional antenna has a directional characteristic and communication range. the IMD responds to the communication-initiating signal by sending identification information to the programmer. the programmer may then use this identification to establish a communication session with the IMD targeted by the directional antenna.

Abstract: According to various method embodiments, a person is indicated for a therapy to treat a cardiovascular disease, and the therapy is delivered to the person to treat the cardiovascular disease. Delivering the therapy includes delivering a vagal stimulation therapy (VST) to a vagus nerve of the person at a therapeutically-effective intensity for the cardiovascular disease that is below an upper boundary at which upper boundary the VST would lower an intrinsic heart rate during the VST.

Abstract: A computer-implemented system and method for selecting therapy profiles of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction is provided. An external programmer includes a plurality of therapy profiles stored in memory. The therapy profiles include different sets of stimulation parameters that cooperatively define alternating cycles of stimuli application and stimuli inhibition for a neurostimulator that are tuned to both efferently activate the heart's intrinsic nervous system and afferently activate the patient's central reflexes. A programming wand is configured to provide the set of stimulation parameters chosen by the user to the neurostimulator through wireless telemetry. Finally, an implantable neurostimulator device includes a stimulation therapy lead terminated by helical electrodes and electrically coupled to the neurostimulator.

Abstract: A system embodiment comprises at least one respiration sensor, a neural stimulation therapy delivery module, and a controller. The respiration sensor is adapted for use in monitoring respiration of the patient. The neural stimulation therapy delivery module is adapted to generate a neural stimulation signal for use in stimulating the autonomic neural target of the patient for the chronic neural stimulation therapy. The controller is adapted to receive a respiration signal from the at least one respiration sensor indicative of the patient's respiration, and adapted to control the neural stimulation therapy delivery module using a respiratory variability measurement derived using the respiration signal.

Abstract: Various embodiments intermittently deliver a sympathetic stimulus, including deliver a sequence of stress-inducing pacing pulses adapted to increase sympathetic tone during the stress-inducing pacing. The stress-inducing pacing results in a parasympathetic reflex after the sequence of stress-inducing pacing. The embodiment further delivers neural stimulation to elicit a parasympathetic response or a sympathetic response in a coordinated manner with respect to the sequence of stress-inducing pacing pulses.

Abstract: A pacing system computes optimal cardiac resynchronization pacing parameters using intrinsic conduction intervals. In various embodiments, values for atrio-ventricular delay intervals are each computed as a function of an intrinsic atrio-ventricular interval and a parameter reflective of an interventricular conduction delay. Examples of the parameter reflective of the interventricular conduction delay include QRS width and interval between right and left ventricular senses.

Abstract: Various system embodiments comprise a stimulator adapted to deliver a stimulation signal for a heart failure therapy, a number of sensors adapted to provide at least a first measurement of a heart failure status and a second measurement of the heart failure status, and a controller. The controller is connected to the stimulator and to the number of sensors. The controller is adapted to use the first and second measurements to create a heart failure status index, and control the stimulator to modulate the signal using the index. Other aspects and embodiments are provided herein.

Abstract: An implantable medical device applies an electric signal over two electrodes and measures the resulting electric signal over a candidate pair of neighboring electrodes on a lead for a first heart ventricle or over a candidate electrode of the lead and a case electrode. An impedance signal is determined for each candidate pair or electrode based on the applied signal and the measured resulting signal. A time difference between start of contraction in a second ventricle and the timing of local myocardial contraction as identified from the impedance signal at the site of the candidate pair or electrode is determined for each candidate pair or electrode. An optimal pacing electrode is selected to correspond to one of the electrodes of the candidate pair having the largest time difference or the candidate electrode having largest time difference.

Abstract: Generally, the disclosure is directed one or more methods or systems of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes. Pacing using the right ventricular electrode and a first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Pacing using the right ventricular electrode and a second one of the ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses.

Abstract: Systems and methods for selection of electrodes and related pacing configuration parameters used to pace a heart chamber are described. A change in the hemodynamic state of a patient is detected. Responsive to the detected change, a distribution of an electrical, mechanical, or electromechanical parameter related to contractile function of a heart chamber with respect to locations of multiple electrodes disposed within the heart chamber is determined. A pacing output configuration, including one or more electrodes of the multiple electrodes, is selected and the heart chamber is paced using the selected pacing output configuration.

Abstract: An implantable medical device and associated method control the delivery of extra systolic stimulation by determining a coupling interval, setting an extra systolic interval in response to the coupling interval; and delivering a supraventricular stimulation pulse upon expiration of the extra systolic interval. The supraventricular stimulation pulse evokes a depolarization that is conducted to the ventricles occurring at a ventricular coupling interval relative to a ventricular event.

Abstract: Various aspects relate to a device which, in various embodiments, comprises a header, a neural stimulator, a detector and a controller. The header includes at least one port to connect to at least one lead, and includes first and second channels for use to provide neural stimulation to first and second neural stimulation sites for a heart. The controller is connected to the detector and the neural stimulator to selectively deliver a therapy based on the feedback signal. A first therapy signal is delivered to the first neural stimulation site to selectively control contractility and a second therapy signal is delivered to the second neural stimulation site to selectively control one of a sinus rate and an AV conduction. Other aspects and embodiments are provided herein.

Abstract: Methods of nerve signal differentiation, methods of delivering therapy using such nerve signal differentiation, and to systems and devices for performing such methods. Nerve signal differentiation may include locating two electrodes proximate nerve tissue and differentiating between efferent and afferent components of nerve signals monitored using the two electrodes.

Abstract: Approaches for selecting an electrode combination of multi-electrode pacing devices are described. Electrode combination parameters that support cardiac function consistent with a prescribed therapy are evaluated for each of a plurality of electrode combinations. Electrode combination parameters that do not support cardiac function are evaluated for each of the plurality of electrode combinations. An order is determined for the electrode combinations based on the parameter evaluations. An electrode combination is selected based on the order, and therapy is delivered using the selected electrode combination.

Abstract: A cardiac pacing system controls the progression of a cardiac disorder such as heart failure by delivering cardiac pacing to create or augment regional stress in the heart. The cardiac pacing is delivered intermittently, such as on a periodic basis, according to a cardiac stress augmentation pacing sequence that includes alternating pacing and non-pacing periods. One or more physiological signals are monitored for closed-loop control of the cardiac pacing using baseline characteristics of the cardiac disorder, acute cardiac stress created by the cardiac pacing, and/or risk associated with the cardiac pacing.

Abstract: Disclosed are methods of treatment or prophylaxis of a disease state or a condition ameliorated or prevented by electromagnetic field application. A person having or susceptible to such disease state or condition is subjected to electromagnetic fields having a frequency between zero and about 200 Hertz. The diseased state or condition may include diseased heart valves, an enlarged heart, circulatory blockage, coronary insufficiencies, and ischemia. The treatment may be administered non-invasively or invasively. An implantable device for invasively administering the treatment may include at least one component emitting electromagnetic fields having a frequency between zero and about 200 Hertz. The component may include at least one inductor.

Abstract: Generally, the disclosure is directed one or more methods or systems of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes. Pacing using the right ventricular electrode and a first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Pacing using the right ventricular electrode and a second one of the ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses.

Abstract: Disclosed herein are methods of and systems for predicting recurrence of atrial fibrillation comprising protease and protease inhibitor profiling.

Abstract: A refractory period for a pacemaker sensing channel refers to a period of time during which the sensing channel is either blind to incoming electrical signals, termed a blanking interval, and/or during which the device is configured to ignore such signals for purposes of sense event detection. Methods and devices for implementing refractory periods in the context of multi-site left ventricular pacing are described.

Abstract: In a pacing mode where the left ventricle is paced upon expiration of an escape interval that is reset by a right ventricular sense, there is the risk that the left ventricular pace may be delivered in the so-called vulnerable period that occurs after a depolarization and trigger an arrhythmia. To reduce this risk, a left ventricular protective period (LVPP) may be provided. Methods and devices for implementing an LVPP in the context of multi-site left ventricular pacing are described.

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 system is disclosed that is configured to detect a laryngeal activation response of a patient to an electrical stimulation signal. Detection of the laryngeal activation can be used to control vagal stimulation therapy to a patient.