Abstract: Systems and methods permit remotely-monitored rehabilitation of a patient. A system can comprise a patient monitor configured to monitor a patient's physiological data. The patient monitor can monitor using a first monitoring mode. A patient communication device can be configured to present, to the patient, an option to perform an exercise regimen, and to receive a response indicating whether the patient will perform the exercise regimen. A configuration module coupled to the patient communication device can be configured to activate a second monitoring mode when the response indicates that the patient will perform the exercise regimen. When the exercise regimen is complete, the first monitoring mode can be re-established. When the response indicates that the patient will not perform the exercise regimen, the response can be recorded as a negative response, and the option to perform the exercise regimen can be presented again.

Abstract: Various aspects of the present subject matter provide devices and methods to treat AV-conducted ventricular tachyarrhythmia (AVCVT). According to various embodiments of the method, an AVCVT is sensed, an IVC-LA fat pad is stimulated when the AVCVT is sensed to block AV conduction, and bradycardia support pacing is provided while the IVC-LA fat pad is stimulated. Other aspects and embodiments are provided herein.

Abstract: A chronically implanted medical device, connected to a medical electrical lead that includes a sensor, is used to detect diastolic dysfunction. A LV accelerometer signal is sensed through the sensor. Based on the LV accelerometer signal, a determination is made as to whether diastolic dysfunction data exists.

Abstract: Various embodiments of the present invention are directed to systems, methods and devices for cardiac applications including those relating to pacing devices. One such device is directed to a cardiac rhythm therapy (CRT) device designed for dual chamber pacing using two pacing signals each having a positive and negative component that has been modified for single chamber pacing. The device comprises a first output that connects to a pacing lead; a second output that connects to the pacing lead; a third output that connects to a reference point; and electrical circuitry connecting the second electrical connection to the first output, the third electrical connection to the second output, and the first and fourth electrical connections to the third output.

Abstract: A system for synchronizing application of treatment signals with a cardiac rhythm is provided. The system includes a memory that receives and stores a synchronization signal indicating that a predetermined phase such as R-wave of a cardiac rhythm of a patient has started. A synchronization module analyzes whether the stored synchronization signal is erroneous and if so, prevents a medical treatment device from applying a treatment energy signal such as an IRE pulse to a patient to take into account an irregular heart beat and noise in the synchronization signal in order to maximize safety of the patient.

Abstract: A magnetic delivery system for delivering a magnetizable particle to a location in a body, the device includes a magnetizable object implanted in the body, wherein the magnetizable object includes a plurality of segments distributed throughout the magnetizable object and wherein the segments are configured to provide a magnetic gradient for attracting the magnetizable particle and an external source of a magnetic field capable of (i) magnetizing the magnetizable particle and (ii) increasing a degree of magnetization of the magnetizable object and thereby creating the magnetic gradient. A drug delivery system including the magnetic delivery system and a magnetizable particle associated with a therapeutic agent and/or a cell. A cell delivery system based on the magnetic delivery system and a magnetizable particle associated with a cell. A method of using the magnetic delivery system for delivery of a therapeutic agent and/or a cell to a targeted location in a body.

Abstract: A device for detecting cardiac ischemia is disclosed. The device includes a processor that is configured to distinguish between two different heart beats types such as ventricularly paced beats and supraventricular beats. The processor collects separate reference data for a first one of the beat types indicative of the normal values of a cardiac feature. The processor performs an ischemia test to beats of the first type by first checking whether valid reference data exists for that beat type. If so, the ischemia test is based on this reference data. If no valid reference data exists for the first beat type, the processor applies an ischemia test that is not based on reference data for the first beat type.

Abstract: An implantable electrical medical system comprises a low voltage cathode electrode assembly, including a cathode surface adapted for, intimate contact with electrically active tissue, and a low voltage anode electrode assembly, including an anode surface and a porous layer extending over the anode surface. The cathode surface and the anode surface function as a bipolar pair for pacing and the porous layer extending over the anode surface allows conduction therethrough and prevents the anode surface from contacting the electrically active tissue in order to prevent anodal stimulation.

Abstract: A differential or relative measurement between an orthogonal measurement vector and another measurement vector can be used to determine the location where fluid accumulation is occurring or the local change in such fluid accumulation. This can help diagnose or treat infection or hematoma or seroma at a pocket of an implanted cardiac rhythm management device, other implanted medical device, or prosthesis. It can also help diagnose or treat pulmonary edema, pneumonia, pulmonary congestion, pericardial effusion, pericarditis, pleural effusion, hemodilution, or another physiological condition.

Abstract: A method of treating a patient in cardiac arrest (e.g., in fibrillation, electrochemical dissociation, or asystole), the method comprising delivering an agent for enhancement of cardiac function to the coronary arteries of the patient; and microperfusing the patient's cardiac tissue by electromagnetically stimulating the cardiac issue at an energy level below a threshold sufficient to defibrillate the heart.

Abstract: A method of treating a patient in cardiac arrest (e.g., in fibrillation, electrochemical dissociation, or asystole), the method comprising delivering an agent for enhancement of cardiac function to the coronary arteries of the patient; and microperfusing the patient's cardiac tissue by electromagnetically stimulating the cardiac issue at an energy level below a threshold sufficient to defibrillate the heart.

Abstract: Aspects of the invention are directed to advanced monitoring and control of medium voltage therapy (MVT) in implantable and external devices. Apparatus and methods are disclosed that facilitate dynamic adjustment of MVT parameter values in response to new and changing circumstances such as the patient's condition before, during, and after administration of MVT. Administration of MVT is automatically and dynamically adjusted to achieve specific treatment or life-support objectives, such as prolongation of the body's ability to endure and respond to MVT, specifically addressing the type of arrhythmia or other pathologic state of the patient with targeted treatment, a tiered-intensity MVT treatment strategy, and supporting patients in non life-critical conditions where the heart may nevertheless benefit from a certain level of assistance.

Abstract: A device and method for delivering electrical stimulation to the heart in order to improve cardiac function in heart failure patients. The stimulation is delivered as high-output pacing in which the stimulation is excitatory and also of sufficient energy to augment myocardial contractility. The device may be configured to deliver high-output pacing upon detection of cardiac decompensation.

Abstract: Cardiac resynchronization therapy (CRT) delivered to a heart of a patient may be adjusted based on detection of a surrogate indication of the intrinsic atrioventricular conduction of the heart. In some examples, the surrogate indication is determined to be a sense event of the first depolarizing ventricle of the heart within a predetermined period of time following the delivery of a fusion pacing stimulus to the later depolarizing ventricle. In some examples, the CRT is switched from a fusion pacing configuration to a biventricular pacing configuration if the surrogate indication is not detected, and the CRT is maintained in a fusion pacing configuration if the surrogate indication is detected.

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

Abstract: Approaches to rank potential left ventricular (LV) pacing vectors are described. Early elimination tests are performed to determine the viability of LV cathode electrodes. Some LV cathodes are eliminated from further testing based on the early elimination tests. LV cathodes identified as viable cathodes are tested further. Viable LV cathode electrodes are tested for hemodynamic efficacy. Cardiac capture and phrenic nerve activation thresholds are then measured for potential LV pacing vectors comprising a viable LV cathode electrode and an anode electrode. The potential LV pacing vectors are ranked based on one or more of the hemodynamic efficacy of the LV cathodes, the cardiac capture thresholds, and the phrenic nerve activation thresholds.

Abstract: The present disclosure is directed to the classification of cardiac episodes using an algorithm. In various examples, an episode classification algorithm evaluates electrogram signal data to determine whether T-wave oversensing has occurred. The T-wave oversensing analysis may include, for example, identifying beat runs within the cardiac episode whether the beats within the run have at least one characteristic that alternates beat to be or clustering beats within the cardiac episode based on beat to beat interval length. The T-wave oversensing determination may be based on probabilistic analysis in some examples.

Abstract: An atrial event and a ventricular event can be received, and an atrioventricular (AV) delay can be provided using information about the atrial and ventricular events. The AV delay can be increased after a first condition is satisfied to allow a heart to regain intrinsic control of ventricular activation, and changed after a second condition is satisfied to allow the heart to remain in intrinsic control of ventricular activation.

Abstract: Systems and methods are provided for treating chronic pain occurring secondarily to subacromial impingement syndrome in a human body. A system is provided to deliver percutaneous electrical stimulation through at least one electrode to neurological motor points of the posterior and middle deltoid muscles to mediate such pain. One-time, continued and/or periodic dosing of treatment methods according to the present invention may result in a change to central nervous system maladaptive neuroplasticity.

Abstract: Various systems, methods and arrangements are implemented in connection with ventricular pacing. One such method relates to a method for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle. Ventricular function of the heart is sensed. The sensed ventricular function is used to determine whether a conduction abnormality exists. The ventricular pacing is provided in response to determining a conduction abnormality exists and the ventricular pacing is inhibited in response to determining a conduction abnormality does not exist.

Abstract: Some embodiments provide a system, comprising a peripheral nerve field modulation (PNFM) therapy delivery system, PNFM electrodes configured to be implanted subcutaneously, and a controller. The PNFM electrodes are electrically connected to the PNFM therapy system. The PNFM therapy delivery system and the PNFM electrodes are configured to deliver current and/or control the field potentials at one or more peripheral nerve fields. The controller is configured to control the PNFM therapy delivery system to deliver a PNFM therapy to the one or more peripheral nerve fields. The controller includes a scheduler configured to control timing of the PNFM therapy.

Abstract: Methods, systems, and devices for signal analysis in an implanted cardiac monitoring and treatment device such as an implantable cardioverter defibrillator. In some examples, captured data including detected events is analyzed to identify likely overdetection of cardiac events. In some illustrative examples, when overdetection is identified, data may be modified to correct for overdetection, to reduce the impact of overdetection, or to ignore overdetected data. Several examples emphasize the use of morphology analysis using correlation to static templates and/or inter-event correlation analysis.

Abstract: One embodiment of the present subject matter includes an implantable medical device which includes a first power source comprising a first plurality of substantially planar electrodes, the first power source including at least a first power source face, an electronics module including a first substantially planar electronics face, and a second electronics face opposed to the first substantially planar electronics face, with the first substantially planar electronics face adjacent to, and substantially coextensive with, the first power source face and a second power source comprising a second plurality of substantially planar electrodes, the second power source positioned adjacent to and adapted to interface with the second electronics face.

Abstract: One embodiment of the present subject matter includes a capacitor, comprising a first metallic cupped shell having a first opening, and a second metallic cupped shell having a second opening, wherein the first opening and the second opening are adapted to sealably mate to form a closed shell defining a volume therein. In the embodiment, the closed shell is adapted for retaining electrolyte. A plurality of capacitor layers in a substantially flat arrangement are disposed within the volume, along with electrolyte, in the present embodiment. The present closed shell includes one or more ports for electrical connections.

Abstract: A medical device for characterizing the cardiac status of a patient equipped with a bi-ventricular pacing active implant device. The implant collects an endocardiac acceleration signal and searches for an optimal pacing configuration. This latter tests a plurality of different pacing configurations and delivers for each tested configuration parameters derived from the endocardiac acceleration peak (PEA). The device derives a patient clinical status from those parameters, the indication being representative of the patient's response to the cardiac resynchronization therapy. Those parameters include: the possibility to automatically get or not a valid optimal AV Delay among all the biventricular pacing configurations; a factor indicating the character sigmoid of the PEA/AVD characteristic; the average value of the PEA for the various configurations; and the PEA signal/noise ratio.

Abstract: An implantable cardiac function management device including a programmable controller can be used to include a user-specifiable therapy control parameter set. The therapy control parameter set may then be configured to include at least one therapy control parameter that is user-configurable to automatically switch from a first parameter value to a second parameter value at a time that occurs between separate user programming sessions of the device. Various attributes of physiological measures may allow for refinement of the parameter sets to adapt to changed conditions of the subject. Methods of use are also presented.

Abstract: A medical device and associated method establish an occurrence of a premature atrial contraction. The device senses a ventricular signal. A control unit is configured to determine a metric of the ventricular signal during an interval following the premature atrial contraction and detect a change in cardiac stress tolerance in response to the determined metric.

Abstract: An implantable cardiac electrostimulator includes an atrial sensing channel generating an atrial sense event signal upon detection of atrial activity, a ventricular sensing channel generating a ventricular sense event signal upon detection of ventricular activity, a VES detector detecting ventricular extrasystoles, atrial and ventricular stimulation pulse generators, and a stimulation control unit. The stimulation control unit determines scheduled delivery times of atrial stimulation pulses (T(A)) and/or ventricular stimulation pulses (T(V)), and triggers delivery if no atrial sense event signal arises before the end of an atrial escape interval (VAI) timing out at T(A), or if no ventricular sense event signal arises before the end of a ventricular escape interval (VEI) timing out at T(V). T(A) and T(V) depend upon detection of a ventricular extrasystole, and proper atrioventricular synchrony is maintained by setting a physiologically adequate A-V-delay between T(A) and T(V).

Abstract: An implantable medical device includes a sensor configured to generate an endocardial acceleration (EA) signal representative of activity of a patient's heart. The device further includes one or more circuits configured to identify within the EA signal at least one EA signal component corresponding to at least one peak of endocardial acceleration, and extract from the at least one EA signal component at least two characteristic parameters. The one or more circuits are further configured to generate a composite index based on a combination of the at least two characteristic parameters, determine a plurality of values of the composite index for a plurality of pacing configurations, and select a current pacing configuration from among the plurality of pacing configurations based on the plurality of values of the composite index.

Abstract: A pacing system delivers cardiac protection pacing to protect the heart from injuries associated with ischemic events. The pacing system detects an ischemic event and, in response, initiates one or more cardiac protection pacing sequences each including alternative pacing and non-pacing periods. In one embodiment, the pacing system initiates cardiac protection pacing sequences including at least one postconditioning sequence to protect the heart from a detected ischemic event and a plurality prophylactic preconditioning sequences to protect the heart from probable future ischemic events.

Abstract: A delivery system for implanting a biostimulation device comprising a stylet extending along an axis from knob end to a threaded end configured to engage an internally threaded nut of the biostimulation device and a catheter tube configured to axially contain the stylet. The catheter tube comprises a feature that engages a corresponding feature on the biostimulation device whereby the stylet can be rotated relative to the catheter tube for disengagement of the stylet threaded end from the biostimulation device threaded end.

Abstract: A cardiac rhythm management (CRM) system includes an implantable medical device that delivers anti-tachyarrhythmia therapies including ATP. When a tachyarrhythmia episode is detected, the implantable medical device analyzes the morphology of a cardiac signal to determine whether and/or when to deliver an ATP therapy. In various embodiments, the implantable medical device produces morphological parameters indicative of the likeliness of success of the ATP therapy and selects an anti-tachyarrhythmia therapy mode based on the morphological parameters. In various embodiments, the implantable medical device also controls the timing of the ATP therapy delivery using morphological features of the cardiac signal to maximize the probability that the ATP therapy is delivered into an ATP window during which a tachyarrhythmia episode can be effectively terminated by pacing.

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: An implantable device (100) having an electronic component (110) and a biologic materials component (130). The biologic materials component has target cells in a matrix that interfaces the electronic component with the surrounding environment.

Abstract: A method and system for post-processing of sensing data associated with identification of a cardiac event by a medical device that includes transmitting a plurality of stored sensing data generated by the medical device to an access device, the stored sensing data including sensed atrial events and sensed ventricular events. The access device determines, in response to the transmitted data, instances where the medical device identified a cardiac event being detected in response to the sensing data, and generates a template in response to correlated morphologies of adjacent intervals prior to a detection interval corresponding to the cardiac being identified as the cardiac event and a morphology of the detection interval.

Abstract: An implantable device, such as a pacer, defibrillator, or other cardiac rhythm management device, can include one or more MRI Safe components. In an example, the implantable device includes a battery including a first electrode and a second electrode separate from the first electrode. The second electrode includes a first surface and a second surface. The second electrode includes a slot through the second electrode from the first surface toward the second surface. The slot extends from a perimeter of the second electrode to an interior of the second electrode. The slot is configured to at least partially segment a surface area of the second electrode to reduce a radial current loop size in the second electrode.

Abstract: A method and apparatus are disclosed for treating a condition of a patient's heart includes placing a first electrode and/or a second electrode in a right ventricle of the heart. In one example, a reference electrode is placed within the patient and internal or external to the heart. A pacing signal is generated including a first signal component, a second signal component and a reference component with the first and second signal components having opposite polarity and with both of the first and second components having a potential relative to the reference component. The pacing signal and the placement of the electrodes are selected to alter a contraction of a left ventricle of the heart.

Abstract: A method and device for delivering ventricular resynchronization pacing therapy in conjunction with electrical stimulation of nerves which alter the activity of the autonomic nervous system is disclosed. Such therapies may be delivered by an implantable device and are useful in preventing the deleterious ventricular remodeling which occurs as a result of a heart attack or heart failure. The device may perform an assessment of cardiac function in order to individually modulate the delivery of the two types of therapy.

Abstract: A device and method for cardiac pacing is disclosed in which anodal pacing of the left ventricle is provided. Anodal pacing occurs when an anodal surface area is sufficiently small to create an area of hyper-polarization of the myocardial cell membrane. This creates a virtual cathode at a location remote from the anode. The virtual cathode results in depolarization of the heart in a manner similar to the virtual cathode at the true fixed cathode. In addition a device and method for summation anodal pacing is provided in which one anode is common between two or more cathodes. This results in hyperpolarization of a larger segment of the myocardium as compared to non-summation anodal pacing and thereby forms a larger virtual electrode to enable capture of localized, discrete cardiac structures such as the bundle of His or the very proximal portions of the right and left bundles.

Abstract: A vagus nerve is efficiently stimulated while preventing wasteful energy consumption. Provided is a nerve stimulating device (1) including a stimulation-signal outputting portion (3) that outputs a stimulation signal to a vagus nerve (B); a heart-event detecting portion (2) that detects a heart event; and a control portion (4) that makes a judgment regarding the responsiveness of a heart (A) based on the heart event detected by the heart-event detecting portion (2) in response to the stimulation signal output from the stimulation-signal outputting portion (3), and that controls the stimulation-signal outputting portion (3) so that an intensity of the stimulation signal is decreased when the responsiveness of the heart (A) is decreased.

Abstract: A method and system of post-processing of sensing data generated by a medical device that includes transmitting a plurality of stored sensing data generated by the medical device to an access device, the stored sensing data including sensed atrial events and sensed ventricular events. The access device determines, in response to the transmitted data, instances where the medical device identified a cardiac event being detected in response to the sensing data, and determines a ratio of sensed atrial events to sensed ventricular events in response to the transmitted data.

Abstract: An indication of an actual or potential heart failure condition is computed. One example includes monitoring a first heart rate preceding a first onset of a first sinus tachyarrhythmia episode. Upon detecting the first sinus tachyarrhythmia episode, the indication is automatically provided using information about the first heart rate and how quickly the first onset occurs.

Abstract: A cardiac medical device and associated method control delivery of dual chamber burst pacing pulses in response to detecting tachycardia. A number of cardiac cycles occurring in a first cardiac chamber are identified subsequent to the dual chamber pacing pulses. The number of sensed intrinsic events occurring in a second cardiac chamber during the first chamber cardiac cycles is determined as a number of second chamber events. The tachycardia episode is classified in response to the number of second chamber events.

Abstract: For supplying energy to a medical implant (100) in a patient's body a receiver (102) cooperates with an external energizer (104) so that energy is wirelessly transferred. A feedback communication system (109) sends feedback information from the receiver to the energizer, the feedback information being related to the transfer of energy to the receiver. The feedback communication system communicates using the patient's body as an electrical signal line. In particular, the communication path between the receiver and the external energizer can be established using a capacitive coupling, i.e. the feedback information can be capacitively transferred over a capacitor having parts outside and inside the patient's body. An energy balance between the amount of energy received in the receiver and the energy used by the medical implant can be followed over time, and then the feedback information is related to the energy balance.

Abstract: A system and method for detecting and treating symptoms of early decompensation utilizing a cardiac rhythm management. The system applies an electrical stimulus to the patient's heart at a first set of pacing parameters including a lower rate limit (LRL) setting, and acquires a coronary venous pressure (CVP) signal from a pressure sensor implanted in a coronary vein of the patient. An average coronary venous end diastolic pressure (CV-EDP) value is calculated from the CVP signal. The system monitors the average CV-EDP value over a predetermined interval, and dynamically adjusts the LRL setting responsive to the detection of a first or a second predetermined event based on the average CV-EDP value.

Abstract: Tools and methods are particularly suited for certain cardiac conditions involving use of a catheter for pacing of the right and left ventricles from a lead in the right ventricle, e.g., to facilitate mechanically and/or electrically synchronous contractions for resynchronization. Certain aspects involve pacing and/or mapping by delivering pulses to a cardiac site useful for improving heart function as measured, e.g., by QRS width, fractionation, late LV activation timing, mechanical synchronicity of free wall and septal wall, effective throughput/pressure, or a combination thereof. In one embodiment, a catheter arrangement includes a fixation mechanism to attach the catheter arrangement to heart tissue, individually-addressable electrodes for providing pacing signals to the heart tissue, and an elongated structure that supports the fixation mechanism and the electrodes.

Abstract: Disclosed are certain methods, apparatus, and processor-readable mediums that may be used to treat a conduction abnormality of the heart. In one example, the apparatus includes an implantable pacing profile generator configured to generate a specified pacing electrostimulation profile for delivery to a heart via electrodes located near a septal region of the right ventricle of the heart near the His bundle, the pacing profile including a first pulse for delivery via a first electrode; and a second pulse for delivery via a second electrode; and wherein the first and second pulses are at least partially concurrent in time and opposite in polarity to each other.

Abstract: Techniques of inducing a physiological perturbation to monitor a heart failure status of a patient are described. An implantable medical device (IMD) may induce a physiological perturbation in the patient to monitor and determine how the patient responds to the physiological change. This response may be indicative of heart failure improvement or worsening. For example, the IMD may deliver electrical stimulation with parameters configured to perturb the patient (e.g., stimulation that deviates from stimulation therapy). The IMD may then detect at least one physiological parameter to monitor the patient's response to the perturbation. Based on the detected physiological parameter, the IMD may generate a heart failure status. The heart failure status may then be used for adjusting patient therapy, with or without the use of remote monitoring.

Abstract: A medical device includes a sensor for sensing for an MRI gradient magnetic field and a microprocessor configured to operate in a signal processing mode in which electrical signals induced by the gradient magnetic field are not counted as cardiac events.

Abstract: Systems and methods involve an intrathoracic cardiac stimulation device operable to provide autonomous cardiac sensing and energy delivery. The cardiac stimulation device includes a housing configured for intrathoracic placement relative to a patient's heart. A fixation arrangement of the housing is configured to affix the housing at an implant location within cardiac tissue or cardiac vasculature. An electrode arrangement supported by the housing is configured to sense cardiac activity and deliver stimulation energy to the cardiac tissue or cardiac vasculature. Energy delivery circuitry in the housing is coupled to the electrode arrangement. Detection circuitry is provided in the housing and coupled to the electrode arrangement. Communications circuitry may optionally be supported by the housing. A controller in the housing coordinates delivery of energy to the cardiac tissue or cardiac vasculature in accordance with an energy delivery protocol appropriate for the implant location.