Abstract: Systems and methods for monitoring and performing tissue modulation are disclosed. An example system may include an elongate shaft having a distal end region and a proximal end and having at least one modulation element and one sensing electrode disposed adjacent to the distal end region. The sensing electrode may be used to determine and monitor changes in tissue adjacent to the modulation element.

Abstract: Techniques for automatically identifying medical devices, e.g., implantable medical device, using wireless communications in order to communicate with the medical devices are described. For instance, a programming system securely discovers a set of medical devices which have the capacity to communicate using wireless communication links. The programming system may then apply one or more search heuristics to identify a set of discovered medical devices that are likely to be a medical device with which a user desires to interact. When the user selects the desired one of the identified medical devices, the programming system launches a device interaction application associated with the desired medical device. The user may use the device interaction application to interact with the desired medical device.

Abstract: Systems, methods, and interfaces are described herein for assisting a user in noninvasive evaluation of patients for cardiac therapy and noninvasive evaluation of cardiac therapy being delivered. The systems, methods, and interfaces may provide graphical representations of cardiac electrical activation times about one or more portions of human anatomy and one or more cardiac health metrics.

Abstract: Systems, methods, and interfaces are described herein for assisting a user in noninvasive evaluation of patients for cardiac therapy and noninvasive evaluation of cardiac therapy being delivered. The systems, methods, and interfaces may provide graphical representations of cardiac electrical activation times about one or more portions of human anatomy and one or more cardiac health metrics.

Abstract: A method utilizing computer processing for detecting, within a cardiac cycle, the earliest onset of global, Q-onset, ventricular depolarization in the presence of an operating pacemaker. The method, in general terms, features (a) gathering a plurality of ECG-obtained QRS heart-cycles waveforms, (b) identifying and categorizing of evidences and specific timings therein of intrinsic Q-onset and pacemaker spike events, (c) looking in a single, selected QRS waveform, between specific, defined first and second time marks, for the most significant slope change appearing in that waveform, and (d) designating to be the correct Q-onset that event which immediately precedes that slope change.

Abstract: An implementation provides a system that includes: a control module including a first antenna, the control module configured to generate a first radio frequency (RF) signal and transmit the first RF signal using the first antenna; an implantable lead module including a second antenna and at least one electrode configured to stimulate excitable tissue of a subject; and a relay module configured to receive the first RF signal; generate a second RF signal based on the first RF signal, the second RF signal encoding a stimulus waveform to be applied by the at least one electrodes of the implantable lead module to stimulate the excitable tissue of the subject; and transmit the second RF signal to the implantable lead module.

Abstract: Electrode structures for transvascular nerve stimulation combine electrodes with an electrically-insulating backing layer. The backing layer increases the electrical impedance of electrical paths through blood in a lumen of a blood vessel and consequently increases the flow of electrical current through surrounding tissues. The electrode structures may be applied to stimulate nerves such as the phrenic, vagus, trigeminal, obturator or other nerves.

Abstract: A method for analysis of cardiac rhythms, based on calculations of entropy and moments of interbeat intervals. An optimal determination of segments of data is provided that demonstrate statistical homogeneity, specifically with regard to moments and entropy. The invention also involves calculating moments and entropy on each segment with the goal of diagnosis of cardiac rhythm. More specifically, an absolute entropy measurement is calculated and provided as a continuous variable, providing dynamical information of fundamental importance in diagnosis and analysis. Through the present invention, standard histograms, thresholds, and categories can be avoided.

Abstract: An implantable medical device (IMD) configures one or more operating parameters of the IMD based on a type of source of a disruptive energy field to which the IMD is exposed. The disruptive energy field may, in one example, include magnetic and/or radio frequency (RF) fields generated by an MRI scanner. In one aspect, the IMD may distinguish between different types of MRI scanners and select an exposure operating mode tailored to reduce the effects of the particular type of MRI scanner. In another aspect, the IMD may adjust one or more operating parameters that will be used when the IMD returns to a normal operating mode after exposure to the MRI scanner based on the type of MRI scanner to which the IMD is exposed.

Abstract: Methods and/or devices may be configured to track effectiveness of pacing therapy by monitoring activation times over time, e.g., between pacing stimulus and electrical activity resulting from the pacing stimulus. Generally, the methods and/or devices may determine whether the delivered pacing therapy was effective based on the measured activation times.

Abstract: The present application discloses systems and methods for distributed processing of electrophysiological signals. The system may include a processor, a remote device, and an implant comprising an array of electrodes. The method may comprise the processor receiving an electrophysiological signal request from the remote device that specifies at least one electrode at the implant from which to receive an electrophysiological signal, transmitting to the implant instructions to apply a plurality of stimuli via the specified at least one electrode and, for individual stimuli in the plurality of stimuli, recording an electrophysiological signal component resulting from the stimulus. The method may also comprise the processor combining the recorded individual electrophysiological signal components to produce the electrophysiological signal and transmitting the electrophysiological signal to the remote device for further processing.

Abstract: Methods and/or devices may be configured to monitor ventricular activation times and modify an atrioventricular delay (AV delay) based on the monitored ventricular activation times. Further, the methods and/or devices may determine whether the AV delay should be modified based on the measured activation times before modifying the AV delay.

Abstract: A medical device for stimulating the heart using biventricular stimulation. The device includes a sensor for detecting an endocardial acceleration parameter and a processing circuit configured to receive the endocardial acceleration parameter. The device further includes stimulation electronics coupled to the processing circuit. The processing circuit is configured to use the EA parameter to evaluate the biventricular stimulation. The evaluation includes comparing the value of the EA parameter in biventricular mode to the value of the EA parameter in left only mode or right only mode, and using the comparison and an assessment of the variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising: (a) normal operation, (b) a loss of RV or LV capture, (c) possible anodal stimulation. The processing circuit is further configured to conduct at least one update to operational parameters of the device based on the determined case.

Abstract: An implantable rate responsive pacemaker includes a sensor module configured to produce an activity signal correlated to a metabolic demand of a patient and a posture signal correlated to patient posture. The pacemaker further includes a pulse generator configured to generate and deliver pacing pulses to a patient's heart via a pair of electrodes coupled to the pacemaker. A control module is coupled to the pulse generator and the sensor module and is configured to determine a sensor indicated pacing rate from the activity signal, compare the posture signal to verification criteria for confirming an exercising posture of the patient, and withhold an adjustment of a pacing rate to the sensor indicated pacing rate responsive to the verification criteria not being met.

Abstract: An implantable medical device (IMD) determines an effect of the disruptive energy field and adjusts one or more operating parameters of the IMD based on at least the determined effect. In some instances, the IMD may determine an actual effect of the disruptive energy field, such as a temperature change, impedance change, pacing or sensing threshold change, MRI-induced interference one pacing or sensing, or other actual effect. In other instances, the IMD may determine a predicted effect of the disruptive energy field based on one or more characteristics of the exposure. In any case, the IMD adjusts one or more parameters based on at least the determined effect.

Abstract: A medical electrical lead having an elongated lead body and a fixation helix extending along a generally helical axis, mounted around the outer circumference of the lead body. The fixation helix has a free end spaced from and extending from the lead body for less than the circumference of the lead body. The lead body includes an additional component which provides a rotation stop extending from the outer circumference of the lead body and provides stop surface generally perpendicular to the axis of the helix.

Abstract: The invention provides a method of monitoring a subject's neurological condition. In some embodiments, the method includes the steps of analyzing a physiological signal (such as an EEG) from a subject to determine if the subject is in a contra-ictal condition; and if the subject is in a contra-ictal condition, providing an indication (e.g., to the subject and/or to a caregiver) that the subject is in the contra-ictal condition, such as by activating a green light or other visible output. In some embodiments, if the subject is in a pro-ictal condition, the method includes the step of providing an indication (such as a red light) that the subject is in the pro-ictal condition. The invention also provides neurological system monitors.

Abstract: Systems and methods for monitoring and performing tissue modulation are disclosed. An example system may include an elongate shaft having a distal end region and a proximal end and having at least one modulation element and one sensing electrode disposed adjacent to the distal end region. The sensing electrode may be used to determine and monitor changes in tissue adjacent to the modulation element.

Abstract: An electronic device and a method for determining a shield state in an electronic device are provided. The method includes at a detecting pad, detecting an electrical signal corresponding to a contact state of a shielding that contacts a ground or the detecting pad, and determining a shield state by the shielding based on the detected electrical signal.

Abstract: Systems and methods can be used to provide an indication of heart function, such as an indication of mechanical function or hemodynamics of the heart, based on electrical data. For example, a method for assessing a function of the heart can include determining a time-based electrical characteristic for a plurality of points distributed across a spatial region of the heart. The plurality of points can be grouped into at least two subsets of points based on at least one of a spatial location for the plurality of points or the time-based electrical characteristics for the plurality of points. An indication of synchrony for the heart can be quantified based on relative analysis of the determined time-based electrical characteristic for each of the at least two subsets of points.

Abstract: Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. The implanted stimulation device includes a physiological sensor for monitoring the patient's response to the neurostimulation therapy on an ambulatory basis over extended periods of time and a control system for adjusting stimulation parameters to maintain stimulation in the neural fulcrum zone based on detected changes in the physiological response to stimulation.

Abstract: An implantable medical device (IMD) may be configured into a sensing only mode in which the IMD does not delivery therapy. For example, the IMD may be configured to operate in a sensing only mode to reduce the undesirable effects that may be caused by external fields, such as those generated by an MRI device. However, there may be instances, such as a change in the patient's condition, in which it may be desirable to transition from the sensing only mode to a pacing mode to provide therapy. In accordance with the techniques described herein, the IMD monitors signals on one or more leads coupled to the medical device while operating in the sensing only mode and transitions to a pacing mode in response to not detecting a minimum number of signals on the one or more leads.

Abstract: An implantable pacemaker is configured to sense a cardiac electrical signal received by a pair of electrodes coupled to the pacemaker, start a pacing escape interval to control a time that a pacing pulse is delivered in a heart chamber, and detecting if the sensed cardiac electrical signal is a crosstalk event that is an electrical pulse delivered to the patient by a different device than the implantable pacemaker. The implantable pacemaker withholds restarting the pacing escape interval in response to sensing the cardiac electrical signal based on detecting the sensed cardiac electrical signal as the crosstalk event.

Abstract: Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous device (e.g. subcutaneous implantable (SD)) and a leadless pacing device (LPD) are described. In one or more embodiments, a computer-implemented method includes sensing a first electrical signal from a heart of a patient through a SD. The first signal is stored into memory and serves as a baseline rhythm for a patient. Subsequently, a second signal is sensed from the heart through the SD. A cardiac condition can be detected within the sensed second electrical signal through the SD. A determination is made as to whether cardiac resynchronization therapy (CRT) is appropriate to treat the detected cardiac condition. A determination can then be made as to the timing of pacing pulse delivery to cardiac tissue through a leadless pacing device (LPD). The LPD receives communication from the SD requesting the LPD to deliver CRT to the heart.

Abstract: Apparatus for facilitating ablation of nerve tissue of a subject is provided, comprising (1) an ablation unit, configured to be percutaneously advanced to a site adjacent to a first portion of the nerve tissue; (2) at least one electrode unit, coupled to the ablation unit, and configured to be percutaneously advanced to a site adjacent to a second portion of the nerve tissue, and to initiate unidirectional action potentials in the nerve tissue, such that the unidirectional action potentials propagate toward the first portion of the nerve tissue; and (3) a control unit, configured: (a) to drive the ablation unit to ablate, at least in part, the first portion of the nerve tissue of the subject, and (b) to drive the at least one electrode unit to initiate the unidirectional action potentials by applying an excitatory current to the second portion of the nerve tissue.

Abstract: Bootstrap circuit includes: a first transistor of first conductivity type having a first main electrode, a second main electrode and a control electrode connected to a first power supply terminal, a first node, and a second node, respectively; a second transistor of the first conductivity type having a first main electrode, a second main electrode, and a control electrode connected to the first power supply terminal, the second node and the first node, respectively; a first capacitor having a first end connected to the first node and a second end where a first boost pulse is applied; a second capacitor having a first end connected to the second node and a second end where a second boost pulse having opposite polarity to the first boost pulse is applied; and a boost output terminal which outputs boost voltage higher than first power supply voltage supplied to the first power supply terminal.

Abstract: Methods and/or devices may be configured to monitor ventricular activation times and modify an atrioventricular delay (AV delay) based on the monitored ventricular activation times. Further, the methods and/or devices may determine whether the AV delay should be modified based on the measured activation times before modifying the AV delay.

Abstract: Apparatus and methods are described, including apparatus for pacing a heart of a subject. The apparatus includes an implantable pulse generator (IPG) and a coiled lead connected to the IPG. The coiled lead includes a smaller-diameter coiled portion, a lumen of which having a first coil-lumen-diameter, and a larger-diameter coiled portion electrically in series with the smaller-diameter coiled portion, a lumen of the larger-diameter coiled portion having a second coil-lumen-diameter that is larger than the first coil-lumen-diameter. A perpendicular distance from a central longitudinal axis of the smaller-diameter coiled portion to the lumen of the larger-diameter coiled portion is greater than an outer radius of the smaller-diameter coiled portion, when the central longitudinal axis of the smaller-diameter coiled portion is parallel to a central longitudinal axis of the larger-diameter coiled portion. Other applications are also described.

Abstract: A system and method for identifying whether local tissue latency is present. The system and method comprises an implanted lead having a first electrode for cardiac pacing and sensing. A sensing module for sensing heart activity with the first electrode to produce an electrogram (EGM) waveform. A processor is configured to receive the EGM waveform and extract two or more features from the EGM waveform representative of heart activity in response to monoventricular or biventricular pacing stimulus at the electrode and identify local tissue latency at a site of the first electrode based upon at least two of the extracted features indicating local tissue latency.

Abstract: Designs and methods of construction for an implantable medical device employ an internal support structure. The single-piece support structure holds various electronic components such as a communication coil and a circuit board, and further is affixed to a battery, thus providing a subassembly that is mechanically robust. The support structure further provides electrical isolation between these and other components. A method of construction allows for the subassembly to be adhered to a case of the implantable medical device at the battery, and possibly also at the support structure. The battery includes an insulating cover having holes. An adhesive is used consistent with the location of the holes to affix the battery to the case without electrically shorting the battery to the case.

Abstract: A wireless cardiac stimulation device is disclosed comprising a controller-transmitter, a receiver, and a stimulating electrode, wherein the stimulating electrode and the receiver are separately implantable at cardiac tissue locations of the heart and are connected by a local lead. Having separately implantable receiver and stimulating electrodes improves the efficiency of ultrasound mediated wireless stimulation by allowing the receiver to be placed optimally for reception efficiency, thereby resulting in longer battery life, and by allowing the stimulating electrode to be placed optimally for stimulus delivery. Another advantage is a reduced risk of embolization, since the receiver and stimulating electrode ensemble is attached at two locations of the heart wall, with the connecting local leads serving as a safety tether should either the receiver or the stimulating electrode become dislodged.

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: Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. This neural fulcrum zone may be identified by monitoring a patient's response to incrementally increased intensity settings at a first frequency. If the incremental intensity increases do not result in the identification of the neural fulcrum zone, the frequency may be changed to provide finer resolution identification of the neural fulcrum zone.

Abstract: Embodiments include an implantable electronic device with at least one electromagnetic field detection unit and at least one antenna, wherein the at least one electromagnetic field detection unit is connected to the at least one antenna. The at least one electromagnetic field detection unit responds to electromagnetic fields that occur or are present in an environment surrounding a patient outside an environment of an MRI device and electromagnetic fields that are shielded in the environment of the MRI device. The at least one electromagnetic field detection unit indicates an absence of the electromagnetic fields that typically occur in the environment surrounding a patient outside an MRI device and that are shielded in the environment of an MRI device.

Abstract: A method and apparatus for treatment of heart failure by increasing secretion of endogenous naturetic hormones ANP and BNP such as by stimulation of the heart atria. Heart pacing is done at an atrial contraction rate that is increased and can be higher than the ventricular contraction rate. Pacing may include mechanical distension of the right atrial appendage. An implantable device is used to periodically cyclically stretch the walls of the appendage with an implanted balloon.

Abstract: A medical device is configured to deliver a shock to a patient's heart via electrodes coupled to the medical device and set an escape interval timer to start running an escape interval after delivering the electrical shock. A sensing module of the medical device is configured to sense a cardiac event in response to a cardiac electrical signal received by the medical device crossing a sensing threshold. The medical device determines if the cardiac event meets reset criteria and allows the escape interval timer to continue running the escape interval if the cardiac event does not meet the reset criteria.

Abstract: A method for mapping an anatomical structure includes sensing activation signals of intrinsic physiological activity with a plurality of electrodes disposed in or near the anatomical structure, identifying at least one of the electrodes not in direct contact with the anatomical structure, and adjusting the activation signals sensed by each of the plurality of electrodes based on the activation signals sensed by the identified at least one of the electrodes not in direct contact with the anatomical structure.

Abstract: A vector method for monitoring a subject's sleep-disordered breathing utilizing a single, anatomy-attached (anatomically outside or implanted inside), three-orthogonal-axis accelerometer(s), including the steps of (1) collecting from a sleeping subject three-orthogonal-axis data relating to at least one of sound data, subject posture, subject activity, snoring, and respiration, and (2) following such collecting, processing and analyzing collected data to detect associated, disordered breathing including assessing the presence of at least one of (a) sleep-disordered breathing generally, (b) sleep apnea specifically, and (c) differentiation between central and obstructive sleep apnea. Further involved is the acquiring of ECG data, and that the mentioned processing and analyzing include recognition of such acquired ECG data.

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

Abstract: An implantable medical device and medical device system for delivering a bi-ventricular pacing therapy that includes a plurality of electrodes to sense a cardiac signal, an emitting device to emit a trigger signal to control delivery of the bi-ventricular pacing, and a processor configured to compare the sensed cardiac signal associated with the delivered bi-ventricular pacing to at least one of an intrinsic beat template and an RV template associated with a morphology of RV-only pacing therapy, determine whether an offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to the comparing, adjust the offset interval in response to the offset interval not being set to the maximum offset interval level, and generate the trigger signal to be emitted by the emitting device to subsequently deliver the bi-ventricular pacing therapy having the adjusted offset interval.

Abstract: Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval. One manner described involves dynamically programming an AV interval in cardiac resynchronization therapy (CRT) device having a rate-adaptive AV (RAAV) feature in such a way that not less than a minimum AV interval is maintained. That is, the AV interval is not allowed to be reduced so much that the P-wave is truncated by the QRS complex. In this form of the invention, the AV interval is reduced by one millisecond per one bpm increase in heart rate (and vice versa for reducing heart rate) but maintained at a value calculated from the end of the P-wave (PWend) and the beginning of the QRS complex (QRSbeg) or delivery of a ventricular pacing stimulus or to the end of the end of the QRS complex (QRSend).

Abstract: A cardiac pacing system having a pulse generator for generating therapeutic electric pulses, a lead electrically coupled with the pulse generator having an electrode, a first sensor configured to monitor a physiological characteristic of a patient, a second sensor configured to monitor a second physiological characteristic of a patient and a controller. The controller can determine a pacing vector based on variables including a signal received from the second sensor, and cause the pulse generator to deliver the therapeutic electrical pulses according to the determined pacing vector. The controller can also modify pacing characteristics based on variables including a signal received from the second sensor.

Abstract: The present disclosure provides a cardiac pacing system. The cardiac pacing system includes a right atrial ring electrode, a right atrial tip electrode, a right ventricle ring electrode, and a pacing integrated circuit (IC) including a first pace output node electrically coupled to the right atrial ring electrode, a pace return node electrically coupled to the right atrial tip electrode, and a second pace output node electrically coupled to the right ventricle ring electrode, wherein the pacing IC has a fast discharge configuration that facilitates reducing or eliminating a DC rectification current generated from RF interference during a fast discharge phase.

Abstract: A system and associated method is disclosed for determining whether signal is valid. The system comprises an electrode apparatus comprising a plurality of electrodes configured to be located proximate tissue of a patient. A display apparatus comprising a graphical user interface, wherein the graphical user interface is configured to present information to a user. A computing apparatus coupled to the electrode apparatus and display apparatus, wherein the computing apparatus is configured to determine whether a signal acquired from a channel associated with an electrode from the plurality of electrodes is valid and sufficiently strong by i) calculating a first derivative of the signal; ii) determining a minimum and maximum derivative from the first derivative; iii) determining whether signs of the minimum and maximum derivative are different; and in response to determining whether the signs of the minimum and maximum derivative are different, displaying on a display apparatus whether the signal is valid.

Abstract: A method, apparatus, or system to identify optimal parameters for programming a cardiac stimulator by a matrix-based decision algorithm using sensor data representing cardiovascular function. The parameters include pacing intervals optimized concurrently to produce the maximum resulting cardiac function.

Abstract: An implantable device, such as a pacer, defibrillator, or other cardiac rhythm management device, can include an automatic testing and adjusting of cardiac signal sensing after an MRI scanning procedure, such as to accommodate an MRI-induced physiological change in sensed cardiac depolarization amplitude or in lead impedance such as at an electrode/tissue interface.

Abstract: An implantable medical device and associated method to determine an optimal control parameter setting for controlling a cardiac therapy that includes a therapy delivery module to deliver cardiac pacing signals at a plurality of pacing rates, and an admittance measurement module to determine admittance signals associated with each of the plurality of pacing rates. A control unit determines metrics of hemodynamic performance corresponding to each of the plurality of pacing rates in response to the determined admittance signals, identifies pacing rates of the plurality of pacing rates as rejected rates in response to the determined metrics of hemodynamic performance, and determines a pacing rate of the plurality of pacing rates as an optimal rate for delivering the cardiac therapy in response to the identified pacing rates.

Abstract: Systems and methods are described herein for assisting a user in identification and/or optimization of an atrioventricular (A-V) interval for use in cardiac therapy. The systems and methods may monitor electrical activity of a patient using external electrode apparatus to provide electrical heterogeneity information for a plurality of different A-V intervals and may identify an A-V interval based on the electrical heterogeneity information.

Abstract: Systems, methods and non-transient software media for performing sensing vector selection in an implantable cardiac device by assessing biphasic or monophasic characteristics of the cardiac signal in vectors under analysis. A factor associated with the biphasic or monophasic nature of the cardiac signal, as seen from a given sensing vector, can be inserted into the assessment of which of several available sensing vectors is considered “best” for purposes of cardiac signal analysis. Additional factors may be considered beyond the biphasic or monophasic nature including the quantity of turning points or inflections and amplitude variability.

Abstract: Novel methods and apparatus for dynamically monitoring paced and sensed P-wave duration, P-wave end and/or QRS duration and/or S-T segment duration, or length, in a patient having an implantable medical device (IMD) provides diagnostic and clinical benefit allowing for predictions about future arrhythmia, advanced notification, alert and intervention as well as providing acute and chronic information regarding cardiac status, including both possibly declining and/or improving cardiac function. The methods can be performed using a wide variety of IMDs, such as pacemakers, cardiac resynchronization therapy (CRT) device, implantable cardioverter defibrillators (ICDs), and implantable loop recorders (e.g., such as the REVEAL® device manufactured by Medtronic, Inc.).