Abstract: Systems and methods for pacing cardiac conductive tissue are described. In an embodiment, a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses. A sensing circuit senses an atrial activation. A control circuit detects a retrograde atrial conduction timing, such as a His-to-atrial interval between the HBP pulse and the sensed atrial activation in response to the HBP pulse, and verifies capture status using the determined retrograded atrial conduction timing. Based on the capture status, the control circuit determines a HBP threshold, and the electrostimulation circuit delivers HBP pulses in accordance with the determined HBP threshold.

Abstract: A computer implemented method and device for providing dual chamber sensing with a single chamber leadless implantable medical device (LIMD) are provided. The method is under control of one or more processors in the LIMD configured with specific executable instructions. The method obtains a far field (FF) cardiac activity (CA) signals for activity in a remote chamber of a heart and compares the far field CA signals to a P-wave template to identify an event of interest associated with the remote chamber. The method sets an atrial-ventricular (AV) delay based on the P-wave identified and delivers pacing pulses at a pacing site of interest to a local chamber based on the AV delay.

Abstract: An implantable medical device delivery system includes a delivery catheter including an elongated body with a first portion defining a first lumen and a second portion defining a second lumen. An angle is defined between a first axis and a second axis defined by the first and second portions, respectively. The second axis points toward the left ventricular (LV) apex of the patient's heart when the first axis points into the CS. The first portion or an elongated element may extend into the CS to anchor the delivery catheter to the orientation of the CS.

Abstract: Methods, apparatus, and systems are provided to control contraction of the heart. At least one sensing element receives signals indicating electrical activity of sinus rhythm of the heart. Based on the received signals, the progress of contraction of the heart is determined. Based on the progress of contraction, the chamber of the heart may then be stimulated at a plurality of locations. In another embodiment, a plurality of electrodes are implanted in the left ventricle to stimulate at multiple locations in the left ventricle for the purpose of improving hemodynamic performance and increasing cardiac output in a patient who is suffering from congestive heart failure.

Abstract: The invention relates to a determination system (1) for determining a heart failure risk for a subject (4). The determination system is adapted to provide a cardiogram selected from a group consisting of a ballistocardiogram, a seismocardiogram and an impedance cardiogram of the subject, to detect at least one of a presence of a postextrasystolic potentiation (PESP) and a disturbed force-frequency relation (FFR) based on the provided cardiogram and to determine the heart failure risk based on this detection. By using the detection of the presence of the PESP and/or of a disturbed FFR, the heart failure risk can be reliably determined. In particular, it can be determined that the heart failure risk is relatively large, if a PESP is not present and/or if the FFR is disturbed.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT.

Abstract: Systems and methods for dynamically controlling HBP delivery based on patient AV conduction status are disclosed. An exemplary medical system includes an electrostimulation circuit to generate HBP pulses to stimulate a His bundle or a bundle branch of the heart. An AV conduction monitor circuit continuously or periodically assesses AV conduction status, and detects an indication of presence or absence of AV conduction abnormality. If an AV conduction abnormality is indicated, a control circuit may control the electrostimulation circuit to deliver the HBP pulses. Ventricular backup pacing may be delivered if HBP fails to capture and elicit ventricular activation. When the AV conduction become normal, the control circuit may withhold HBP delivery and promote patient intrinsic ventricular activation.

Abstract: A method for positioning an electrode array of a neuromodulation catheter at a target circumferential position along a posterior wall of a blood vessel. The method includes advancing the catheter to a target longitudinal position within the blood vessel and positioning the array within the blood vessel so as to minimize interference by CRM leads or coils in the blood vessel during therapeutic delivery of energy using the array.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, and alternate the first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay. Physiologic information can be received from the patient, and one of the first or second pacing period for delivery to the patient can be determined using the received physiologic information.

Abstract: An exemplary tissue detection and location identification apparatus can include, for example, a first electrically conductive layer at least partially (e.g., circumferentially) surrounding a lumen, an insulating layer at least partially (e.g., circumferentially) surrounding the first electrically conductive layer, and a second electrically conductive layer circumferentially surrounding the insulating layer, where the insulating layer can electrically isolate the first electrically conductive layer from the second electrically conductive layer. A further insulating layer can be included which can at least partially surrounding the second electrically conductive layer.

Abstract: A device for electrical stimulation of one or more components of the periodontal complex and surrounding tissue of a tooth, for uses such as reducing orthodontic pain and encouraging tooth movement, has electrodes of a rigid, electrically conductive material in a fixed spatial relationship configured for application to oral mucosa and attached gingiva adjacent to, and along a periodontal ligament of, a root structure of a single tooth. An electrical circuit is configured for electrical connection to the at least two electrodes. The electrical circuit has an output providing a subsensory electrical stimulus comprising a waveform in accordance with predetermined stimulation parameters. After the electrodes are applied to the oral mucosa and attached gingiva adjacent to, and along the periodontal ligament of, a root structure of the tooth, a switch, when activated, activates the electrical circuit to output the electrical stimulus through the at least two electrodes.

Abstract: Systems and methods for monitoring and treating patients with heart failure (HF) are discussed. The system may sense cardiac signals, and receives information about patient physiological or functional conditions. A stimulation parameter table that includes recommended values of atrioventricular delay (AVD) or other timing parameters maybe created at a multitude of patient physiological or functional conditions. The system may periodically reassess patient physiological or functional conditions. A therapy programmer circuit may dynamically switch between left ventricular-only pacing and biventricular pacing, or switch between single site pacing and multisite pacing based on the patient condition. The therapy programmer circuit may adjust AVD and other timing parameters using the cardiac signal input and the stored stimulation parameter table. A HF therapy may be delivered according to the determined stimulation site, stimulation mode, and the stimulation timing.

Abstract: A communication device that includes an antenna including a first electrode and a second electrode, at least one of the first electrode or the second electrode including a plurality of segmented electrodes. The communication device further includes a communication circuit, coupled to the antenna, that performs a transmission operation and a reception operation of transmission data between a device and the communication circuit based on a communication protocol that includes a plurality of communication stages. The communication device further includes a switch that switches whether or not each of the plurality of segmented electrodes is to be coupled to the communication circuit and a controller that changes an effective electrode area of at least one of the first electrode or the second electrode by the switch, based on at least one of the operations of the communication circuit, a type of the transmission data, or the communication stages.

Abstract: A medical device including an electric measurement circuit, in which are connected at least two sensors the impedance of which varies as a function of a sensed physical parameter, a source of electrical power for powering the electric measurement circuit, an antenna for emitting an electromagnetic field as a function of the impedance of the electric measurement circuit, each of the sensors being associated with a switch for short circuiting the sensor in the measurement circuit, the medical device further including a system for controlling the switches in order successively to command the opening or closing of the switches in determined configurations. The medical device may notably be able to be applied to the human body or implanted in the human body.

Abstract: Techniques are described in this disclosure for delivering electrical stimulation therapy to a patient over multiple channels, with independent rate control for each channel, using a single stimulation generator. In one example, the disclosure describes a method for delivering electrical stimulation therapy to a patient that includes delivering first electrical stimulation pulses at a first programmed rate on a first channel using a stimulation generator, and delivering second electrical stimulation pulses at a second programmed rate on a second channel using the stimulation generator, the second programmed rate being different than the first programmed rate, and the second programmed rate being independent of the first programmed rate.

Abstract: This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, to alternate first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, and to determine an increased pacing rate for the first pacing waveform during the first pacing period using the first AV delay, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay.

Abstract: The present disclosure provides systems and methods for protection circuitry for an implantable pulse generator (IPG) of a neurostimulation system. The protection circuitry is coupled to an IPG ground, a plurality of electrodes, and an IPG case, and operable to protect IPG stimulation and sensing circuitry from damage during electrostatic discharge and cardiac defibrillation, and to mitigate unintended stimulation during electromagnetic interference. The protection circuitry includes an IPG ground connection, a plurality of protection Zener diodes, wherein one of the protection Zener diodes is electrically coupled between the IPG case and a float Zener diode, and wherein the remaining protection Zener diodes are electrically coupled between the plurality of electrodes and the float Zener diode, and the float Zener diode electrically coupled between the plurality of protection Zener diodes and the IPG ground.

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: In some examples, a system can be used for delivering cardiac resynchronization therapy (CRT). The system may include a pacing device configured to be implanted within a patient. The pacing device can include a plurality of electrodes, signal generation circuitry configured to deliver ventricular pacing via the plurality of electrodes, and a sensor configured to produce a signal that indicates mechanical activity of the heart. Processing circuitry can be configured to identify one or more features of a cardiac contraction within the signal, and determine whether the contraction was a fusion beat based on the one or more features.

Abstract: Systems and methods for pacing cardiac conductive tissue are described. A medical system includes an electrostimulation circuit that may generate His-bundle pacing (HBP) pulses for delivery at or near the His bundle. In response to the delivery of the HBP pulse, the system senses a near-field cardiac activity representative of excitation of a para-Hisian myocardial tissue, and a far-field cardiac activity representative of excitation of the His bundle and a ventricle. The system classifies a tissue response to HBP into one of a plurality of capture types based on the sensed near-field and far-field cardiac activities. The system includes a control circuit to adjust one or more stimulation parameters based on the classified capture type. The electrostimulation circuit generates and delivers the HBP pulses according to the adjusted stimulation parameters to excite the His bundle.

Abstract: The present invention aims to provide a method which has not been established yet and which is useful for achieving long-term and fundamental cure of a necrotic cardiac tissue region to allow recovery of functionality of the heart. The present invention provides an injectable composition for treatment of a cardiac disease, the composition comprising fibroblasts, wherein the fibroblasts contain CD106-positive fibroblasts, preferably contain CD90-positive fibroblasts, and the fibroblasts do not form colonies.

Abstract: A method and apparatus for treatment of hypertension and heart failure by increasing secretion of endogenous atrial hormones by pacing of the heart. Pacing is done during the ventricular refractory period resulting in premature atrial contraction that does not result in ventricular contraction. Pacing results in the atrial wall stress, peripheral vasodilation, ANP secretion. Concomitant reduction of the heart rate is monitored and controlled as needed with backup pacing.

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 defibrillation therapy. In another example, a modular antitachyarrhythmia therapy system includes a sensing module, an analysis module, and a therapy module.

Abstract: A system can include a wearable device that obtains real-time physiological data and activity data from a user and transmits that data to another device. A computing device can receive HRV and activity data and determine whether the user's autonomic nervous system is in a predominantly sympathetic or parasympathetic state. For example, the determination can include comparing an average variance in a portion of the HRV data with a threshold value. In response to determining that the user's autonomic nervous system is in a sympathetic state, the device can perform an action.

Abstract: In some examples, controlling delivery of cardiac resynchronization therapy (CRT) includes storing, in a memory of an implantable medical device system and in association with each of a plurality of heart rates, at least one respective value for an interval between an atrial event and a ventricular event. Processing circuitry of the implantable medical device system may determine a heart rate of a patient and select one of the stored values for the interval between the atrial event and the ventricular event associated with the determined heart rate. The processing circuitry may further determine whether to control therapy delivery circuitry of the implantable medical device system to deliver fusion pacing or biventricular pacing, based on the selected one of the stored values for the interval between the atrial event and the ventricular event.

Abstract: A ventricularly implantable medical device that includes a sensing module that is configured to gather information during a cardiac cycle and to identify a cardiac interval based at least on part on the gathered information. Control circuitry in the implantable medical device is configured to deliver a ventricular pacing therapy to a patient's heart, wherein the ventricular pacing therapy is time dependent, at least in part, on the identified cardiac interval.

Abstract: An optoelectronic electrode element includes an electrode module (40) having at least a first and second electrodes (41, 42) each having an electrode surface (41s, 42s). An an optoelectronic module (20) is provided and having a photovoltaic cell (21a) suitable for transforming optical energy into electrical energy. A feeding fibre optic (31a) is also provided. A coupling module (10) is provided and having a circuit receiving portion (12) for inserting, positioning, and rigidly fixing the optoelectronic module (20) to the coupling module (10); and a feeding fibre cavity (11a) for inserting and coupling the feeding fibre optic to bring it in optimal optical communication with the photovoltaic cell. The coupling module (10) is coupled directly to a fixing area of the electrode module (40), such that the photovoltaic cell be in electrical contact with the first and second electrodes (41, 42).

Abstract: The invention relates to methods and devices to define and control the design of a configurable chip module, instrument or systems, for example, for measurement, control and communication systems or any portion thereof. The module may include one or more chip elements. This can be achieved using, for example, a Graphical User Interface (GUI), that transforms selections made by the user to a hardware and/or software configuration for the system in a process transparent to the user. This enables implementation of a plurality of devices and larger subsystems on a chip or a chip module without specific semiconductor design knowledge from the user. This transformation process is thus accomplished transparently to the user, who operates the GUI to define the measurement or action which needs to be performed, thereby resulting in an automatic combination of hardware and/or software elements available to create a specific configuration.

Abstract: Systems and methods for monitoring and treating patients with heart failure (HF) are discussed. The system may sense cardiac signals, and receives information about patient physiological or functional conditions. A stimulation parameter table that includes recommended values of atrioventricular delay (AVD) or other timing parameters maybe created at a multitude of patient physiological or functional conditions. The system may periodically reassess patient physiological or functional conditions. A therapy programmer circuit may dynamically switch between left ventricular-only pacing and biventricular pacing, or switch between single site pacing and multisite pacing based on the patient condition. The therapy programmer circuit may adjust AVD and other timing parameters using the cardiac signal input and the stored stimulation parameter table. A HF therapy may be delivered according to the determined stimulation site, stimulation mode, and the stimulation timing.

Abstract: This disclosure relates to an active implantable medical device of the cardiac resynchronizer type. The device includes a pulse generator to produce pacing pulses, at least one detection electrode for detecting atrial and ventricular events, at least one stimulation electrode, a memory storing executable instructions, and a processor configured to execute the instructions. The processor is configured to execute the instructions to apply an atrioventricular delay (AVD) between a sensed or stimulated atrial event and the delivery of a ventricular pacing pulse, quantify a degree of fusion between the delivery of a pacing pulse to a cavity and a spontaneous contraction of another cavity, calculate a fusion rate, and modify the value of the AVD applied to the delivery of said ventricular pacing pulse, as a function of a comparison.

Abstract: Systems and methods for His bundle pacing using a stimulation device include applying an impulse to a His bundle of a patient heart using the stimulation device. The stimulation device then measures a response of the patient heart to application of the impulse that includes a response of a ventricle of the patient heart. The stimulation device calculates a ventricular delay as a time from application of the impulse to onset of the response of the ventricle and delivers, using a lead of the stimulation device, a backup impulse to the ventricle when at least the ventricular delay exceeds a delay value stored in a memory of the stimulation device. The stored delay may, for example, correspond to a previously determined value indicative of selective or other His bundle capture.

Abstract: Techniques for evaluating cardiac electrical dyssynchrony are described. In some examples, an activation time is determined for each of a plurality of torso-surface potential signals. The dispersion or sequence of these activation times may be analyzed or presented to provide variety of indications of the electrical dyssynchrony of the heart of the patient. In some examples, the locations of the electrodes of the set of electrodes, and thus the locations at which the torso-surface potential signals were sensed, may be projected on the surface of a model torso that includes a model heart. The inverse problem of electrocardiography may be solved to determine electrical activation times for regions of the model heart based on the torso-surface potential signals sensed from the patient.

Abstract: A medical device and medical device system for controlling delivery of therapeutic stimulation pulses that includes a sensing device to sense a cardiac signal and emit a trigger signal in response to the sensed cardiac signal, a therapy delivery device to receive the trigger signal and deliver therapy to the patient in response to the emitted trigger signal, and a processor positioned within the sensing device, the processor configured to determine whether the sensed cardiac signal exceeds a possible P-wave threshold, compare a portion of the sensed cardiac signal to a P-wave template having a sensing window having a length less than a width of the P-wave, confirm an occurrence of a P-wave signal in response to the comparing, emit the trigger signal in response to the occurrence of a P-wave signal being confirmed, and inhibit delivery of the emitting signal in response to the occurrence of a P-wave signal not being confirmed.

Abstract: Medical device systems, methods, and algorithms are disclosed for providing complex stimulation waveforms. The waveforms may selectively modulate or activate specific neural targets or selected ratios of specific neural targets. Some of the waveforms include pre-pulse phases defined by parameters, the value of which changes during the pre-pulse phase. Also disclosed herein are graphical user interfaces (GUIs) that allow the selection of waveforms configured to selectively modulate or activate specific neural targets or selected ratios of the neural targets. Adjustable parameters of the waveforms are adjusted automatically based on selection of user-defined parameters.

Abstract: A Medical Device Application (MDA) is disclosed for an external device (e.g., a cell phone) that can communicate with an Implantable Medical Device (IMD). The MDA receives data logged in the IMD, processes that data in manners reviewable by an IMD patient, and that can control the IMD based on such processed data. The MDA can use the logged data to adjust IMD therapy based on patient activity or posture, and allows a patient to learn optimal therapy settings for particular activities. The MDA can also use the logged data to allow a patient to review details about IMD battery performance, whether such battery is primary or rechargeable, and to control stimulation parameters based on that performance. The MDA also allows a patient to enter medicine dose information, to review the relationship between medicinal therapy and IMD therapy, and to adjust IMD therapy based on the dosing information.

Abstract: An adaptive cognitive prosthetic that learns to replace neural function that was lost due to a brain injury or disease is described herein. In some embodiments, an adaptive cognitive prosthetic comprises a processing unit for converting input data from an input assembly into a cognitive variable and selecting a stimulation pattern for conveying the cognitive variable. The processing unit employs an adaptive algorithm to assemble the stimulation pattern by combination of subset stimulation patterns, the combination of subset stimulation patterns learned by the adaptive algorithm through error analysis.

Abstract: A medical device comprises therapy delivery circuitry and processing circuitry. The therapy delivery circuitry is configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient. The ATP therapy includes one or more pulse trains and each of the one or more pulse trains includes a plurality of pacing pulses. The processing circuitry is configured to, for at least one of the plurality of pacing pulses of at least one of the one or more pulse trains, determine at least one latency metric of an evoked response of the heart to the pacing pulse. The processing circuitry is further configured to modify the ATP therapy based on the at least one latency metric.

Abstract: Implantable medical systems enter an exposure mode of operation, either manually via a down linked programming instruction or by automatic detection by the implantable system of exposure to a magnetic disturbance. A controller then determines the appropriate exposure mode by considering various pieces of information including the device type including whether the device has defibrillation capability, pre-exposure mode of therapy including which chambers have been paced, and pre-exposure cardiac activity that is either intrinsic or paced rates. Additional considerations may include determining whether a sensed rate during the exposure mode is physiologic or artificially produced by the magnetic disturbance. When the sensed rate is physiologic, then the controller uses the sensed rate to trigger pacing and otherwise uses asynchronous pacing at a fixed rate.

Abstract: A system is disclosed including: one or more electroencephalography (EEG) sensor nodes in a fully reconfigurable sensor network configured to detect electrical signals indicating activity of a brain of a subject and to transmit signal information relating to the detected electrical signals, each EEG sensor node embodying an analog front end (AFE) circuit, and a centralized command control node (CCN) in the sensor network in communication with the one or more EEG sensor nodes and configured to receive the transmitted signal information from the one or more EEG sensor nodes and to perform a processing technique on the received information resulting in processed signal data, wherein the one or more EEG sensor nodes are configured to detect the electrical signals without a driven right leg (DRL) circuit in the sensor network.

Abstract: Embodiments of the present disclosure include a system for determining an error associated with an electrode disposed on a medical device. The system comprises a processor and a memory storing instructions on a non-transitory computer-readable medium. The instructions are executable by the processor to receive an electrode signal from the electrode disposed on the medical device. The instructions are further executable by the processor to receive a plurality of other electrode signals from a plurality of other electrodes disposed on the medical device. The instructions are further executable by the processor to determine that the electrode signal received from the electrode disposed on the medical device is an outlier in relation to the plurality of other electrode signals from the plurality of other electrodes disposed on the medical device, based on a comparison between the electrode signal and the plurality of other electrode signals.

Abstract: Baseline BiV pacing is delivered and a corresponding baseline BiV efficacy score is determined. Intrinsic AV conduction is allowed and an intrinsic AV conduction interval is determined. BiV fusion pacing is delivered and a corresponding efficacy score is determined, for each of a plurality of different paced AV delays, each determined based on the intrinsic AV conduction interval and a different negative hysteresis delta. The baseline BiV pacing is selected for delivery during a period of time if the baseline BiV efficacy score is better than all of the efficacy scores. BiV fusion pacing is selected for delivery during the period of time, using one of the plurality of different paced AV delays for which a corresponding efficacy score was determined, if the efficacy score corresponding to at least one of the plurality of different paced AV delays is better than the baseline BiV efficacy score.

Abstract: A method of improving data sets, for example, of patients, each being characterized by relatively low-cost medical data, identifies those patients where the acquisition of higher cost medical data would best inform an estimate of the higher cost medical data for the remaining patients. In this way scarce medical resources can be more efficiently applied in characterizing a potential patient pool, for example, for a clinical trial when resources are not available for extensive medical characterization of each trial participant.

Abstract: Various aspects of the present subject matter provide an implantable medical device. In various embodiments, the device comprises a pulse generator, a first monitor and a controller. The pulse generator is adapted to generate a neural stimulation signal for a neural stimulation therapy. The neural stimulation signal has at least one adjustable parameter. The first monitor is adapted to detect an undesired effect. In some embodiments, the undesired effect is myocardial infarction. The controller is adapted to respond to the first monitor and automatically adjust the at least one adjustable parameter of the neural stimulation signal to avoid the undesired effect of the neural stimulation therapy. Other aspects are provided herein.

Abstract: A Brain-Mobile Interface (BMoI) system is provided. A control circuit is configured to execute a predictive model to generate a defined number of predicted signal features in future time based on a number of signal features extracted from a first type sensory data (e.g., electroencephalogram (EEG) data). A predicted future mental state(s) can thus be generated based on the number of predicted signal features and used to trigger a corresponding action(s) in a BMoI application(s). In a non-limiting example, a second type sensory data (e.g., electrocardiogram (ECG) data) can be used to improve accuracy of the predictive model. By using the predicted signal features to generate the predicted future mental state(s) to control the BMoI application(s), it is possible to duty-cycle the BMoI system to help reduce power consumption and processing latency, thus allowing the BMoI application(s) to operate in real-time with improved accuracy and power consumption.

Abstract: Methods and systems of evaluating cardiac pacing in candidate patients for cardiac resynchronization therapy and cardiac resynchronization therapy patients are disclosed. The methods and systems disclosed allow treatments to be personalized to patients by measuring the extent of tissue capture from cardiac pacing under various therapy parameter conditions. Systems and methods of optimizing right ventricle only cardiac pacing are also disclosed.

Abstract: A subcutaneous implantable medical device and method (SIMD) provided. A pulse generator (PG) is configured to be positioned subcutaneously within a lateral region of a chest of a patient. The PG has a housing that includes a PG electrode. The PG has an electronics module. An elongated lead is electrically coupled to the pulse generator. The elongated lead includes a first electrode that is configured to be positioned along a first parasternal region proximate a sternum of the patient and a second electrode that is configured to be positioned at an anterior region of the patient. The first and second electrodes are coupled to be electrically common with one another. The electronics module is configured to provide electrical shocks for antiarrhythmic therapy along at least one shocking vector between the PG electrode and the first and second electrodes.

Abstract: Methods, devices and program products are provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device. Electrodes are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. A conduction different ? is determined based on i) an atrial-ventricular conduction delay (ARRV) between the A site and the RV site, and ii) an atrial-ventricular conduction delay (ARLV) between the A site and the LV site. A correction term ? is based on intrinsic inter-ventricular conduction delay (IVCD) between the LV and RV. An LV atrial-ventricular pacing (AVLV) delay is set based on the conduction difference ?, a pacing latency PL and the correction term ? and manages the LUV pacing therapy based on the AVLV delay, wherein the LUV pacing therapy lacks pacing in the RV.

Abstract: Implantable medical device systems and methods configured to use a detection profile selected from among a plurality of detection profiles to define a detection threshold for identifying cardiac events, in which a close call definition is used to determine which of the plurality of detection profiles is to be chosen. Upon identifying a close call, in which an overdetection nearly occurred but did not actually take place, a relatively less sensitive detection profile is chosen.

Abstract: A medical system for sensing and regulating cardiac activity of a patient may include a cardioverter that is configured to generate and deliver shocks to cardiac tissue and a leadless cardiac pacemaker (LCP) that is configured to sense cardiac activity and to communicate with the cardioverter. The cardioverter may be configured to detect a possible arrhythmia and, upon detecting the possible arrhythmia, may send a verification request to the LCP to help conform that the possible arrhythmia is occurring. The LCP, upon receiving the verification request from the cardioverter, may be configured to activate one or more of a plurality of sensors to attempt to help confirm that the possible arrhythmia is occurring.

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.