Patent application number | Description | Published |
20090157136 | MOTION-BASED OPTIMIZATION FOR PLACEMENT OF CARDIAC STIMULATION ELECTRODES - An exemplary method includes use of a multielectrode device that can help position a cardiac stimulation lead to an optimal site in the heart based at least in part on cardiac motion information acquired via the multielectrode device and one or more pairs of current delivery electrodes that establish potential fields (e.g., for use as a coordinate system). An exemplary multielectrode device may be a multielectrode catheter or a multifilar, electrode-bearing guidewire. Various other exemplary methods, devices, systems, etc., are also disclosed. | 06-18-2009 |
20090254140 | CARDIAC RESYNCHRONIZATION THERAPY OPTIMIZATION USING PARAMETER ESTIMATION FROM REALTIME ELECTRODE MOTION TRACKING - An exemplary method includes providing at least two-dimensional position information, for at least two points in time, for an electrode located in a cardiac space; determining a local estimator based on the position information; and, based at least in part on the determined local estimator, selecting a configuration for delivering a cardiac pacing therapy or diagnosing a cardiac condition. Exemplary methods for regional estimators and exemplary methods for global estimators are also disclosed along with devices and systems configured to perform various methods. | 10-08-2009 |
20090306732 | CARDIAC RESYNCHRONIZATION THERAPY OPTIMIZATION USING ELECTROMECHANICAL DELAY FROM REALTIME ELECTRODE MOTION TRACKING - An exemplary method includes providing a mechanical activation time (MA time) for a myocardial location, the location defined at least in part by an electrode and the mechanical activation time determined at least in part by movement of the electrode; providing an electrical activation time (EA time) for the myocardial location; and determining an electromechanical delay (EMD) for the myocardial location based on the difference between the mechanical activation time (MA time) and the electrical activation time (EA time). | 12-10-2009 |
20090318995 | CARDIAC RESYNCHRONIZATION THERAPY OPTIMIZATION USING MECHANICAL DYSSYNCHRONY AND SHORTENING PARAMETERS FROM REALTIME ELECTRODE MOTION TRACKING - Therapy optimization includes tracking electrode motion using an electroanatomic mapping system and generating, based on tracked electrode motion, one or more mechanical dyssynchrony metrics to thereby guide a clinician in therapy optimization (e.g., via optimal electrode sites, optimal therapy parameters, etc.). Such a method may include a vector analysis of electrode motion with respect to factors such as times in cardiac cycle, phases of a cardiac cycle, and therapy conditions, e.g., pacing sites, pacing parameters and pacing or no pacing. Differences in position-with-respect-to-time data for electrodes may also be used to provide measurements of mechanical dyssynchrony. | 12-24-2009 |
20100042174 | SELECTING PACING SITE OR SITES BASED ON CARDIO-PULMONARY INFORMATION - An exemplary method for multi-tier pacing includes delivering single site, left ventricular pacing, sensing patient activity; comparing the sensed patient activity to a patient activity threshold and, if the sensed patient activity exceeds the patient activity threshold, then delivering multi-site, left ventricular pacing for a predetermined period of time and, after the predetermined period of time, delivering single, site left ventricular pacing. In such a method, the period of time may be determined based on cardio-pulmonary demand. Other exemplary technologies are also disclosed. | 02-18-2010 |
20100082087 | IMPLANTABLE LEAD/ELECTRODE DELIVERY MEASUREMENT AND FEEDBACK SYSTEM - A lead implantation system with an introducer, a lead configured to engage with the introducer such that the introducer can convey the lead to a desired internal target location, and at least one sensor. The sensor is adapted to generate an indicator of desired engagement of the system with the desired target tissue location prior to engagement of the lead with the target tissue. Also a method of implanting an implantable patient lead including advancing a lead implantation assembly towards a desired target location along an introduction axis and monitoring at least one indicator of lead implantation assembly position along the lead introduction axis. At least one indicator can be generated by the lead implantation assembly. Advancing of the lead introduction assembly can be halted when the monitoring indicates contact with the desired target tissue. The patient lead can then be advanced towards the target tissue and fixed to the target tissue. | 04-01-2010 |
20100152801 | Cardiac Resynchronization Therapy Optimization Using Vector Measurements Obtained from Realtime Electrode Position Tracking - An exemplary method includes selecting multiple electrodes located in a patient; acquiring position information during one or more cardiac cycles for the multiple electrodes where the acquiring includes using each of the electrodes for measuring one or more electrical potentials in an electrical localization field established in the patient; calculating one or more vector metrics based on the acquired position information for one or more vectors, each vector defined by two of the multiple electrodes; and analyzing the one or more vector metrics to assess cardiac performance during the one or more cardiac cycles. Various other methods, devices, systems, etc., are also disclosed. | 06-17-2010 |
20100268059 | THERAPY OPTIMIZATION VIA MULTI-DIMENSIONAL MAPPING - An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient where the cardiac information comprises position information, electrical information and mechanical information; mapping local electrical activation times to anatomic positions to generate an electrical activation time map; mapping local mechanical activation times to anatomic positions to generate a mechanical activation time map; generating an electromechanical delay map by subtracting local electrical activation times from corresponding local mechanical activation times; and rendering at least the electromechanical delay map to a display. Various other methods, devices, systems, etc., are also disclosed. | 10-21-2010 |
20110015690 | Neurostimulation and Neurosensing Techniques to Optimize Atrial Anti-Tachycardia Pacing for Prevention of Atrial Tachyarrhythmias - Implantable systems and method for use therewith are provided that take advantage of various neuromodulation and neurosensing techniques for either preventing atrial fibrillation (AF) or terminating AF. Specific embodiments are for use with an implantable device that includes one or more atrial electrode for sensing atrial fibrillation (AF) and/or delivering AATP and one or more electrode for monitoring and/or stimulating atrial vagal fat pads. | 01-20-2011 |
20110054559 | PACING, SENSING AND OTHER PARAMETER MAPS BASED ON LOCALIZATION SYSTEM DATA - An exemplary method generates a map of a pacing parameter, a sensing parameter or one or more other parameters based in part on location information acquired using a localization system configured to locate electrodes in vivo (i.e., within a patient's body). Various examples map capture thresholds, qualification criteria for algorithms, undesirable conditions and sensing capabilities. Various other methods, devices, systems, etc., are also disclosed. | 03-03-2011 |
20110054560 | PACING, SENSING AND OTHER PARAMETER MAPS BASED ON LOCALIZATION SYSTEM DATA - An exemplary method generates a map of a pacing parameter, a sensing parameter or one or more other parameters based in part on location information acquired using a localization system configured to locate electrodes in vivo (i.e., within a patient's body). Various examples map capture thresholds, qualification criteria for algorithms, undesirable conditions and sensing capabilities. Various other methods, devices, systems, etc., are also disclosed. | 03-03-2011 |
20110066201 | ELECTRODE AND LEAD STABILITY INDEXES AND STABILITY MAPS BASED ON LOCALIZATION SYSTEM DATA - A method includes selecting an electrode located in a patient; acquiring position information with respect to time for the electrode where the acquiring uses the electrode for repeatedly measuring electrical potentials in an electrical localization field established in the patient; calculating a stability metric for the electrode based on the acquired position information with respect to time; and deciding if the selected electrode, as located in the patient, has a stable location for sensing biological electrical activity, for delivering electrical energy or for sensing biological electrical activity and delivering electrical energy. Position information may be acquired during one or both of intrinsic or paced activation of a heart and respective stability indexes calculated for each activation type. | 03-17-2011 |
20110066202 | ELECTRODE AND LEAD STABILITY INDEXES AND STABILITY MAPS BASED ON LOCALIZATION SYSTEM DATA - A method includes selecting an electrode located in a patient wherein the electrode comprises a lead-based electrode; acquiring position information with respect to time for the electrode, during both loaded and unloaded conditions of the lead, where the acquiring uses the electrode for repeatedly measuring electrical potentials in an electrical localization field established in the patient; calculating a both loaded and unloaded stability metrics for the electrode based on the acquired position information with respect to time; and comparing the unloaded and loaded stability metrics to decide whether the electrode, as located in the patient, comprises a stable location for delivery of therapy. | 03-17-2011 |
20110066203 | ELECTRODE AND LEAD STABILITY INDEXES AND STABILITY MAPS BASED ON LOCALIZATION SYSTEM DATA - A method includes selecting an electrode located in a patient; acquiring position information with respect to time for the electrode, during both acute and chronic states of the electrode, where the acquiring uses the electrode for repeatedly measuring electrical potentials in an electrical localization field established in the patient; calculating an acute state stability metric and a chronic state stability metric for the electrode based on the acquired position information with respect to time; and comparing the acute state stability metric to the chronic state stability metric to decide whether the electrode, as located in the patient in the chronic state, comprises a stable location for delivery of a therapy. The chronic state stability metric of an electrode may be monitored over time to decide whether stability of the electrode has changed. | 03-17-2011 |
20110092809 | CARDIAC COORDINATE SYSTEM FOR MOTION ANALYSIS - An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient wherein the cardiac information comprises position information with respect to time for one or more electrodes of the catheter; performing a principal component analysis on at least some of the position information; and selecting at least one component of the principal component analysis to represent an axis of a cardiac coordinate system. Various other methods, devices, systems, etc., are also disclosed. | 04-21-2011 |
20110098546 | ASSESSING MEDICAL CONDITIONS BASED ON VENOUS OXYGEN SATURATION AND HEMATOCRIT INFORMATION - Methods for assessing, diagnosing and treating medical conditions using SvO | 04-28-2011 |
20110098770 | SYSTEMS AND METHODS FOR OPTIMIZING MULTI-SITE LEFT VENTRICULAR PACING BASED ON INTERELECTRODE CONDUCTION DELAYS - Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, MSLV interelectrode conduction delays are determined among the electrodes of the multi-pole LV lead. MSLV interelectrode pacing delays are then set based on the MSLV interelectrode conduction delays for use in delivering MSLV pacing. To this end, various criteria are exploited for determining optimal values for the pacing delays based on the interelectrode conduction delays. MSLV pacing is then controlled using the specified MSLV interelectrode pacing delays. In some examples, the optimization procedure is performed by the implantable device itself. In other examples, the procedure is performed by an external programmer device. In such an embodiment, the external device determines optimal MSLV interelectrode pacing delays and then transmits programming commands to the implantable device to program the device to use the pacing delays. | 04-28-2011 |
20110118803 | Cardiac Resynchronization Therapy Optimization Using Vector Measurements Obtained From Realtime Electrode Position Tracking - An exemplary method includes selecting a first pair of electrodes to define a first vector and selecting a second pair of electrodes to define a second vector; acquiring position information during one or more cardiac cycles for the first and second pairs of electrodes wherein the acquiring comprises using each of the electrodes for measuring one or more electrical potentials in an electrical localization field established in the patient; and determining a dyssynchrony index by applying a cross-covariance technique to the position information for the first and the second vectors. Another method includes determining a phase shift based on the acquired position information for the first and the second vectors; and determining an interventricular delay based at least in part on the phase shift. | 05-19-2011 |
20110137364 | MULTI-SITE PACING FOR ATRIAL TACHYARRHYTHMIAS - Tachyarrhythmia is treated by applying anti-tachycardia pacing through at least one multi-site electrode set located on, in or around the heart. The electrode set is arranged and located such that an electrical activation pattern having a wave-front between substantially flat and concave is generated through a reentrant circuit associated with the tachyarrhythmia. The electrode set may be one of a plurality of predefined, multi-site electrode sets located on, in or around the atria. Alternatively, the electrode set may be formed using at least two selectable electrodes located on, in or around the atria | 06-09-2011 |
20110137369 | OPTIMAL PACING CONFIGURATION VIA VENTRICULAR CONDUCTION DELAYS - An exemplary method for optimizing pacing configuration includes providing distances between electrodes of a series of three or more ventricular electrodes associated with a ventricle; selecting a ventricular electrode from the series; delivering energy to the ventricle via the selected ventricular electrode, the energy sufficient to cause an evoked response; acquiring signals of cardiac electrical activity associated with the evoked response via non-selected ventricular electrodes of the series; based on signals of cardiac electrical activity acquired via the non-selected ventricular electrodes and the distances, determining conduction velocities; based on the conduction velocities, deciding if the selected ventricular electrode is an optimal electrode for delivery of a cardiac pacing therapy; and, if the selected ventricular electrode comprises an optimal electrode for delivery of the cardiac pacing therapy, calling for delivery of the cardiac pacing therapy using the selected ventricular electrode. Various other methods, devices, systems, etc., are also disclosed. | 06-09-2011 |
20110144510 | METHODS TO IDENTIFY DAMAGED OR SCARRED TISSUE BASED ON POSITION INFORMATION AND PHYSIOLOGICAL INFORMATION - An exemplary system includes one or more processors; memory; and control logic, of one or more modules operable in conjunction with the one or more processors and the memory, to acquire myocardial potential data associated with position information, acquire myocardial electrical activation data associated with position information, acquire myocardial position data with respect to time, generate isopotential contours based on the potential data, generate isochronal contours based on the electrical activation data, generate isomotion contours based on the position data with respect to time, and overlay the generated isopotential contours, isochronal contours and isomotion contours on a display to indicate a region of myocardial damage or myocardial scarring with respect to a map that comprises anatomical markers. Various other methods, devices, systems, etc., are also disclosed. | 06-16-2011 |
20110184274 | ELECTRODE CONFIGURATIONS FOR LEADS OR CATHETERS TO ENHANCE LOCALIZATION USING A LOCALIZATION SYSTEM - An exemplary method includes positioning a lead in a patient where the lead has a longitudinal axis that extends from a proximal end to a distal end and where the lead includes an electrode with an electrical center offset from the longitudinal axis of the lead body; measuring electrical potential in a three-dimensional potential field using the electrode; and based on the measuring and the offset of the electrical center, determining lead roll about the longitudinal axis of the lead body where lead roll may be used for correction of field heterogeneity, placement or navigation of the lead or physiological monitoring (e.g., cardiac function, respiration, etc.). Various other methods, devices, systems, etc., are also disclosed. | 07-28-2011 |
20110196441 | SYSTEMS AND METHODS FOR OPTIMIZING MULTI-SITE CARDIAC PACING AND SENSING CONFIGURATIONS FOR USE WITH AN IMPLANTABLE MEDICAL DEVICE - Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, referred to herein as QuickStim, cardiac pacing configurations are optimized based on an assessment of hemodynamic benefit and device longevity. In another example, referred to herein as QuickSense, cardiac sensing configurations are optimized based on sensing profiles input by a clinician. Various virtual sensing channels are also described that provide for the multiplexing or gating of sensed signals. Anisotropic oversampling is also described. | 08-11-2011 |
20110196442 | SYSTEMS AND METHODS FOR OPTIMIZING MULTI-SITE CARDIAC PACING AND SENSING CONFIGURATIONS FOR USE WITH AN IMPLANTABLE MEDICAL DEVICE - Techniques are provided for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead. In one example, referred to herein as QuickStim, cardiac pacing configurations are optimized based on an assessment of hemodynamic benefit and device longevity. In another example, referred to herein as QuickSense, cardiac sensing configurations are optimized based on sensing profiles input by a clinician. Various virtual sensing channels are also described that provide for the multiplexing or gating of sensed signals. Anisotropic oversampling is also described. | 08-11-2011 |
20110213260 | CRT LEAD PLACEMENT BASED ON OPTIMAL BRANCH SELECTION AND OPTIMAL SITE SELECTION - An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a coronary sinus of a patient where the cardiac information includes electrical information and mechanical information; calculating scores based on the cardiac information where each of the scores corresponds to the coronary sinus or a tributary of the coronary sinus; and based on the scores, selecting a tributary of the coronary sinus as an optimal candidate for placement of a left ventricular lead. Accordingly, the selected tributary may be relied on during an implant procedure for the left ventricular lead. Various other methods, devices, systems, etc., are also disclosed. | 09-01-2011 |
20110282226 | CARDIAC ANALYSIS SYSTEM FOR COMPARING CLINICAL AND INDUCED VENTRICULAR TACHYCARDIA EVENTS - A cardiac analysis system is provided that includes an implantable medical device (IMD), at least one sensor, and an external device. The IMD has electrodes positioned proximate to a heart that sense first cardiac signals of the heart and associated with a clinical ventricular tachycardia (VT) event and second cardiac signals associated with an induced VT event. The sensor measures first and second cardiac parameters of the heart associated with the clinical and induced VT events, respectively. The external device is configured to receive the first and second cardiac signals associated with the clinical and the induced VT events and the first and second cardiac parameters associated with the clinical and the induced VT events. The external device compares the first and second cardiac signals and compares the first and second cardiac parameters to determine if the clinical and induced VT events are a common type of VT event. | 11-17-2011 |
20110295137 | CARDIAC RESYNCHRONIZATION THERAPY OPTIMIZATION USING ELECTROMECHANICAL DELAY FROM REALTIME ELECTRODE MOTION TRACKING - An exemplary method includes providing a mechanical activation time (MA time) for a myocardial location, the location defined at least in part by an electrode and the mechanical activation time determined at least in part by movement of the electrode; providing an electrical activation time (EA time) for the myocardial location; and determining an electromechanical delay (EMD) for the myocardial location based on the difference between the mechanical activation time (MA time) and the electrical activation time (EA time). | 12-01-2011 |
20110319954 | METRICS AND TECHNIQUES FOR OPTIMIZATION OF CARDIAC THERAPIES - An exemplary method includes, based on metrics available as input to a chronic phase optimization algorithm for selecting an optimal electrode configuration for delivery of a cardiac pacing therapy, executing the chronic phase optimization algorithm during an acute phase to select an optimal electrode configuration for delivery of a cardiac pacing therapy; during the acute phase, acquiring position information with respect to time for electrodes implanted in a body; determining one or more acute phase metrics based on the acquired position information; and validating the chronic phase optimization algorithm based at least in part on the one or more acute phase metrics. | 12-29-2011 |
20120016253 | Methods and Systems for Filtering Respiration Noise from Localization Data - A method of filtering respiration noise from a localization signal includes acquiring a localization signal from at least one position measurement sensor within a localization field and acquiring an acceleration signal for at least one localization field generator (e.g., a patch electrode). A displacement signal for the field generator is calculated, for example by integrating the acceleration signal twice, and transformed into the frequency domain in order to calculate a fractional power indicative of patient respiration. The fractional power can then be compared to a threshold value, and the localization signal can be filtered if the fractional power exceeds the threshold value. Alternatively, the acquired acceleration signal can be used to gate collection of data points from the localization signal. | 01-19-2012 |
20120089038 | Method and system for identifying cardiac arrhythmia driver sites - A method of identifying potential driver sites for cardiac arrhythmias includes acquiring a plurality of electrograms from a plurality of locations on at least a portion of a patient's heart. Using the acquired electrograms, at least one electrical activity map is generated. Desirable electrical activity maps include complex fractionated electrogram standard deviation and mean maps, dominant frequency maps, peak-to-peak voltage maps, and activation sequence maps. Using one or more of these maps (e.g., by analyzing one or more electrogram morphological characteristics represented by these maps), at least one potential driver site can be detected. | 04-12-2012 |
20120143278 | DETECTING IMPLANTED MEDICAL ELECTRICAL LEAD DISLODGEMENT USING CARDIAC SIGNALS - Evaluation of an implanted electrical lead condition includes comparing electrogram template features with test electrogram features. The evaluating also includes determining the implanted electrical lead condition based solely on the electrogram comparison. The compared test electrogram features and template electrogram features may be atrial amplitudes and ventricular amplitudes. The sensing may be with a quad polar lead. The compared test electrogram features and electrogram template features may account for different patient postures and/or may account for respiration modulation. | 06-07-2012 |
20120158079 | SYSTEMS AND METHODS FOR ASSESSING THE SPHERICITY AND DIMENSIONAL EXTENT OF HEART CHAMBERS FOR USE WITH AN IMPLANTABLE MEDICAL DEVICE - Techniques are provided for use with an implantable medical device for assessing left ventricular (LV) sphericity and atrial dimensional extent based on impedance measurements for the purposes of detecting and tracking heart failure and related conditions such as volume overload or mitral regurgitation. In some examples described herein, various short-axis and long-axis impedance vectors are exploited that pass through portions of the LV for the purposes of assessing LV sphericity. In other examples, impedance measurements taken along a vector between a right atrial (RA) ring electrode and an LV electrode implanted near the atrioventricular (AV) groove are exploited to assess LA extent, biatrial extent or mitral annular diameter. The assessment techniques can be employed alone or in conjunction with other heart failure detection techniques, such as those based on left atrial pressure (LAP.) | 06-21-2012 |
20120165643 | MOTION-BASED OPTIMIZATION FOR PLACEMENT OF CARDIAC STIMULATION ELECTRODES - An exemplary method includes use of a multielectrode device that can help position a cardiac stimulation lead to an optimal site in the heart based at least in part on cardiac motion information acquired via the multielectrode device and one or more pairs of current delivery electrodes that establish potential fields (e.g., for use as a coordinate system). An exemplary mutlielectrode device may be a multielectrode catheter or a multifilar, electrode-bearing guidewire. Various other exemplary methods, devices, systems, etc., are also disclosed. | 06-28-2012 |
20120165892 | SYSTEMS AND METHODS FOR OPTIMIZING AV/VV PACING DELAYS USING COMBINED IEGM/IMPEDANCE-BASED TECHNIQUES FOR USE WITH IMPLANTABLE MEDICAL DEVICES - Systems and methods are provided wherein intracardiac electrogram (IEGM) signals are used to determine a set of preliminary optimized atrioventricular (AV/PV) and interventricular (VV) pacing delays. In one example, the preliminary optimized AV/VV pacing delays are used as a starting point for further optimization based on impedance signals such as impedance signals detected between a superior vena cava (SVC) coil electrode and a device housing electrode, which are influenced by changes in stroke volume within the patient. Ventricular pacing is thereafter delivered using the AV/VV pacing delays optimized via impedance. In another example, parameters derived from IEGM signals are used to limit the scope of an impedance-based optimization search to reduce the number of pacing tests needed during impedance-based optimization. Biventricular and multi-site left ventricular (MSLV) examples are described. | 06-28-2012 |
20120172867 | SYSTEM AND METHOD FOR TREATING ARRHYTHMIAS IN THE HEART USING INFORMATION OBTAINED FROM HEART WALL MOTION - A system and method for treating an arrhythmia in a heart are provided. The system includes an electronic control unit configured to monitor movement of one or more position sensor over a period of time. The position sensors may, for example, comprise electrodes or coils configured to generate induced voltages and currents in the presence of electromagnetic fields. The positions sensors are in contact with portions of heart tissue and changes in position are representative of motion of that tissue. The electronic control unit is further configured to generate an indicator, responsive to the movements of the sensors over the period of time, of a characteristic of the heart affected by delivery of ablation energy to heart tissue. In this manner, the effectiveness and safety of cardiac tissue ablation for treatment of the arrhythmia can be assessed and a post-ablation therapy regimen determined. | 07-05-2012 |
20120185012 | SYSTEMS AND METHODS FOR SELECTIVELY LIMITING MULTI-SITE VENTRICULAR PACING DELAYS DURING OPTIMIZATION OF CARDIAC RESYNCHRONIZATION THERAPY PARAMETERS - Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays. | 07-19-2012 |
20120191154 | System and Method for ATP Treatment Utilizing Multi-Electrode Left Ventricular Lead - An implantable medical device includes a lead configured to be located proximate to the left ventricle (LV) of the heart, the lead including multiple LV electrodes to sense cardiac activity at multiple LV sensing sites. The a detection module to detect an arrhythmia that represents at least one of a tachycardia and fibrillation based at least in part on the cardiac activity sensed at the multiple LV sensing sites. The ATP therapy module to identify at least one of an ATP configuration or an ATP therapy site based on the cardiac sensed activity at the LV sensing sites, the ATP therapy module to control delivery of antitachycardia pacing (ATP) therapy at the ATP therapy site. The ATP therapy module delivers a stimulus to electrodes at one or more of an LV site, right ventricular (RV) site and right atrial (RA) site, the detection module to sense evoked responses at the LV sensing sites, the ATP therapy module to designate the ATP therapy site to include at least the LV sensing site with a shortest activation time relative to the one or more LV site, RV site and RA site where the stimulus is delivered. | 07-26-2012 |
20120253419 | SYSTEMS AND METHODS FOR OPTIMIZING VENTRICULAR PACING BASED ON LEFT ATRIAL ELECTROMECHANICAL ACTIVATION DETECTED BY AN AV GROOVE ELECTRODE - Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead having a proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient. A left atrial (LA) cardioelectrical event is sensed using the proximal electrode of the LV lead and a corresponding LA cardiomechanical event is also detected, either using an implantable sensor or an external detection system. The electromechanical activation delay between the LA cardioelectrical event and the corresponding LA cardiomechanical event is determined and then pacing delays are set based on the electromechanical activation delay for use in controlling pacing. The pacing delays can include, e.g., AV delays for use with biventricular cardiac resynchronization therapy (CRT) pacing. Other techniques described herein are directed to exploiting right atrial (RA) cardioelectrical events detected via an RA lead for the purposes of setting pacing delays. | 10-04-2012 |
20120271371 | CAPTURE VERIFICATION AND PACING ADJUSTMENTS FOR USE WITH MULTISITE LEFT VENTRICULAR PACING - Various embodiments of the present invention are directed to, or are for use with, an implantable system including a lead having multiple electrodes implantable in a patient's left ventricular (LV) chamber. In accordance with an embodiment, the patients LV chamber is paced at first and second sites within the LV chamber using a programmed LV1-LV2 delay, wherein the LV1-LV2 delay is a programmed delay between when first and second pacing pulses are to be delivered respectively at the first and second sites within the LV chamber. Evoked responses to the first and second pacing pulses are monitored for, and one or more LV pacing parameter is/are adjusted and/or one or more backup pulse is/are delivered based on results of the monitoring. | 10-25-2012 |
20120310296 | DETERMINATION OF CARDIAC RESYNCHRONIZATION THERAPY SETTINGS - CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber. | 12-06-2012 |
20130006317 | DEVICES, SYSTEMS AND METHODS TO ANALYZE EVOKED RESPONSES TO PRE-PACING PULSES TO PREDICT IMMINENT VT/VF, ESTIMATE ISCHEMIC BURDEN AND/OR CHARACTERIZE ELECTRICAL SUBSTRATES - Described herein are implantable systems, and methods for use therewith, to predict whether ventricular tachycardia (VT) or ventricular fibrillation (VF) is imminent, estimate ischemic burden and/or characterize an electrical substrate of the LV chamber. For each of a plurality of cardiac cycles, a pacing vector comprising a first set of electrodes is used to deliver a pre-pacing pulse at a site within the LV chamber (wherein the pre-pacing pulse is delivered prior to an intrinsic activation of the LV chamber), and a sensing vector comprising a second set of electrodes is used to detect an evoked response to the pre-pacing pulse. The detected evoked responses to the pre-pacing pulses are analyzed, and results of the analysis are used predict whether VT or VF is imminent, estimate ischemic burden and/or characterize an electrical substrate of the LV chamber. | 01-03-2013 |
20130030312 | DEVICES, SYSTEMS AND METHODS TO PERFORM ARRHYTHMIA DISCRIMINATION BASED ON R-R INTERVAL STABILITY CORRESPONDING TO A PLURALITY OF VENTRICULAR REGIONS - Described herein are implantable systems and devices, and methods for use therewith, that can be used to perform arrhythmia discrimination. A plurality of different sensing vectors are used to obtain a plurality of different IEGMs, each of which is indicative of cardiac electrical activity at a different ventricular region. The plurality of different IEGMs can include, e.g., an IEGM indicative of cardiac electrical activity at a first region of the patient's left ventricular (LV) chamber and an IEGM indicative of cardiac electrical activity at a second region of the patient's LV chamber. Additionally, the plurality of different IEGMs can further include an IEGM indicative of cardiac electrical activity at a region of a patient's right ventricular (RV) chamber. For each of the IEGMs, there is a determination of a corresponding localized R-R interval stability metric indicative of the R-R interval stability at the corresponding ventricular region. This can include, e.g., determining, for each of the IEGMs, a plurality of R-R intervals corresponding to a plurality of consecutive cardiac cycles of the IEGM. For each IEGM, a measure of variation (e.g., standard deviation, range or variance, but not limited thereto) can then be determined for the plurality of R-R intervals to thereby determine the localized R-R interval stability metric for the IEGM. Arrhythmia discrimination is then performed using the plurality of determined localized R-R interval stability metrics. | 01-31-2013 |
20130030314 | DEVICES, SYSTEMS AND METHODS TO PERFORM ARRHYTHMIA DISCRIMINATION BASED ON THE ATRIAL AND VENTRICULAR ACTIVATION TIMES - Described herein are implantable systems and devices, and methods for use therewith, that can be used to perform arrhythmia discrimination based on activation times. A plurality of different sensing vectors are used to obtain a plurality of IEGMs that collectively enable electrical activations to be detected in the left atrial (LA) chamber, the right atrial (RA) chamber, and at least one ventricular chamber of a patient's heart. For each of a plurality of cardiac cycles, there is a determination, based on the plurality of obtained IEGMs, of an LA activation time, an RA activation time, and a ventricular activation time. Arrhythmia discrimination is then performed based on the determined activation times. | 01-31-2013 |
20130030315 | DEVICES, SYSTEMS AND METHODS TO MONITOR AND TREAT HEART FAILURE (HF) - Described herein are implantable systems and devices, and methods for use therewith, that can be used to monitor and treat heart failure (HF). Such implantable systems preferably includes a lead having at least two electrodes implantable in a patient's left ventricular (LV) chamber. A plurality of different sensing vectors are used to obtain a plurality of IEGMs each of which is indicative of an evoked response at a corresponding different region of the LV chamber. For each of the IEGMs, there is a determination of one or more evoked response metrics indicative of a localized cardiac function at the corresponding region of the LV chamber. The evoke response metrics can be, e.g., paced depolarization integral (PDI) and/or maximum upward slope of an R-wave, but are not limited thereto. The patient's HF condition is monitored based on the localized cardiac function at the plurality of different regions of the LV chamber as determined based on the one or more evoked response metrics determined for each of the IEGMs. | 01-31-2013 |
20130030487 | DEVICES, SYSTEMS AND METHODS TO INCREASE COMPLIANCE WITH A PREDETERMINED VENTRICULAR ELECTRICAL ACTIVATION PATTERN - Described herein are implantable systems and devices, and methods for use therewith, that can be used to increase compliance with a predetermined preferred ventricular electrical activation pattern. Such implantable systems preferably includes a first lead having at least one electrode implantable in a right ventricular (RV) chamber, and a second lead having at least two electrodes implantable in a left ventricular (LV) chamber. A plurality of different sensing vectors are used to obtain a plurality of IEGMs that collectively enable electrical activations to be detected in at least the RV chamber and at at least two separate regions of the LV chamber. The IEGMs can be obtained while the patient's LV chamber is not being paced, or during bi-ventricular (BiV) pacing that includes pacing at only a single site within the LV chamber. An actual ventricular electrical activation pattern is determined based on the plurality of IEGMs. Additionally, there is a determination of whether the actual ventricular electrical activation pattern matches the predetermined preferred ventricular electrical activation pattern. If the actual ventricular electrical activation pattern does not match the predetermined preferred ventricular electrical activation pattern, then multisite LV (MSLV) pacing is delivered to achieve the predetermined preferred ventricular electrical activation pattern. | 01-31-2013 |
20130035737 | SYSTEMS AND METHODS FOR DETERMINING PACING RELATED PARAMETERS - Pacing related timing is determined for an implantable medical device (IMD) by pacing at an RV pacing site, a first LV pacing site and a second LV pacing site in accordance with a first site, a second site and a third site pacing order, and further in accordance with a first inter-electrode pacing delay between pacing at the first site and pacing at the second site and a second inter-electrode pacing delay between pacing at the second site and pacing at the third site. At least one of a sensed event or a paced event is detected for at each of the second site and the third site. The first inter-electrode pacing delay and the second inter-electrode pacing delay are adjusted to avoid sensed events in favor of paced events at each of the second site and the third site. An atrio-ventricular delay may also be adjusted to avoid sensed events or lack of capture due to possible fusion at the first site, in favor of paced events at the first site. | 02-07-2013 |
20130035738 | METHODS AND SYSTEMS FOR DETERMINING PACING PARAMETERS BASED ON REPOLARIZATION INDEX - Methods and systems are provided for determining pacing parameters for an implantable medical device (IMD). The methods and systems provide electrodes in the right atrium (RA), right ventricle (RV) and left ventricle (LV). The methods and systems sense RV cardiac signals and LV cardiac signals at an RV electrode and an LV electrode, respectively, over multiple cardiac cycles, to collect global activation information. The methods and systems identify a T-wave in the LV cardiac signal. The methods and systems calculate a repolarization index based at least in part on a timing of the T-wave identified in the LV cardiac signal. The methods and systems set at least one pacing parameter based on the repolarization index, wherein the at least one pacing parameter that is set represents at least one of an AV delay, an inter-ventricular interval and an intra-ventricular interval. Optionally, the methods and systems may deliver an RV pacing stimulus at the RV electrode such that the LV cardiac signal sensed thereafter includes the RV pacing stimulus followed by a T-wave. The methods and systems determine a waveform metric such as at least one of a QT interval, T-wave duration, and T-wave amplitude, and utilize the waveform metric to determine as the repolarization index. | 02-07-2013 |
20130066221 | METHOD AND SYSTEM FOR IDENTIFYING CARDIAC ARRHYTHMIA DRIVER SITES - A method of identifying potential driver sites for cardiac arrhythmias includes acquiring a plurality of electrograms from a plurality of locations on at least a portion of a patient's heart. Using the acquired electrograms, at least one electrical activity map is generated. Desirable electrical activity maps include complex fractionated electrogram standard deviation and mean maps, dominant frequency maps, peak-to-peak voltage maps, and activation sequence maps. Using one or more of these maps (e.g., by analyzing one or more electrogram morphological characteristics represented by these maps), at least one potential driver site can be detected. | 03-14-2013 |
20130066222 | SYSTEMS AND METHODS FOR DETECTING FAR-FIELD OVERSENSING BASED ON SIGNALS SENSED BY THE PROXIMAL ELECTRODE OF A MULTIPOLAR LV LEAD - A device senses cardioelectrical signals using a right atrial (RA) lead, which might include far-field R-waves as well as near-field P-waves. The device concurrently senses events using a proximal electrode of an LV lead, which can sense both P-waves and R-waves as substantially near-field events. Suitable templates are then applied to the signals sensed via the proximal LV electrode to identify the origin of the signals (e.g. atrial vs. ventricular) so as to properly classify the corresponding events sensed in the RA as near-field or far-field events. In this manner, far-field oversensing is conveniently detected. | 03-14-2013 |
20130158619 | MULTI-VENTRICULAR SITE TIMING OPTIMIZATION USING CARDIOGENIC IMPEDANCE - A method of calculating a timing delay for an implantable medical device based on cardiogenic impedance estimates cardiogenic impedance from a signal between a first electrode and a second electrode positioned in at least one chamber of a heart. The method also determines the timing delay based on the estimated cardiogenic impedance. | 06-20-2013 |
20130184777 | SYSTEMS AND METHODS FOR ASSESSING AND EXPLOITING CONCURRENT CATHODAL AND ANODAL CAPTURE USING AN IMPLANTABLE MEDICAL DEVICE - Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth. | 07-18-2013 |
20130204312 | SYSTEMS AND METHODS FOR CONTROLLING PACING INDUCED DYSSYNCHRONY TO REDUCE ISCHEMIC INJURY USING AN IMPLANTABLE MEDICAL DEVICE - Techniques are provided for use by an implantable medical device for optimizing the amount of ventricular dyssynchrony induced within a patient during protective pacing. In one example, the device analyzes intracardiac electrogram signals to detect an ischemic event within the heart. The device then delivers pacing stimulus in accordance with adjustable pacing parameters to induce ventricular dyssynchrony within the heart and adjusts the pacing parameters within a range of permissible values to achieve a preferred degree of ventricular dyssynchrony within the patient, so long as there is no significant reduction in left ventricular pumping functionality. Preferably, the pacing parameters are adjusted to maximize or otherwise optimize the degree of dyssynchrony induced within the patient. If a significant reduction in LV pumping functionality is detected, the dyssynchrony-inducing pacing is preferably suspended to avoid any deterioration in the condition of the heart. Techniques for detecting early onset of ischemia are also disclosed. | 08-08-2013 |
20130296962 | CAPTURE VERIFICATION AND PACING ADJUSTMENTS FOR USE WITH MULTISITE LEFT VENTRICULAR PACING - Various embodiments of the present invention are directed to, or are for use with, an implantable system including a lead having multiple electrodes implantable in a patient's left ventricular (LV) chamber. In accordance with an embodiment, the patient's LV chamber is paced at first and second sites within the LV chamber using a programmed LV1-LV2 delay, wherein the LV1-LV2 delay is a programmed delay between when first and second pacing pulses are to be delivered respectively at the first and second sites within the LV chamber. Evoked responses to the first and second pacing pulses are monitored for, and one or more LV pacing parameter is/are adjusted and/or one or more backup pulse is/are delivered based on results of the monitoring. | 11-07-2013 |
20140107719 | SYSTEMS AND METHODS FOR POSTEXTRASYSTOLIC POTENTIATION USING ANODIC AND CATHODIC PULSES GENERATED BY AN IMPLANTABLE MEDICAL DEVICE - Techniques are provided for use with implantable medical devices to deliver paired or coupled postextrasystolic potentiation (PESP) pacing using split or bifurcated anodic and cathodic pulses. In a paired pacing example, a single-phase anodic pulse is delivered by the device that has sufficient amplitude to depolarize and contract myocardial tissue. During or just following a subsequent relative refractory period, a single-phase cathodic stimulation pulse is delivered that has sufficient amplitude to depolarize but not contract myocardial tissue, i.e., the cathodic pulse provides for PESP. In a coupled pacing example, the single-phase anodic pulse is delivered during or just following the relative refractory period of a first cardiac cycle; whereas the single-phase cathodic pulse is delivered during or immediately following the relative refractory period of the next consecutive cardiac cycle. | 04-17-2014 |
20140277278 | CLOSED-LOOP SYSTEMS AND METHODS FOR CONTROLLING NEUROSTIMULATION BASED ON FAR-FIELD CARDIAC SIGNALS SENSED BY A SPINAL CORD STIMULATION DEVICE - Techniques are provided for controlling spinal cord stimulation (SCS) or other forms of neurostimulation. Far-field cardiac electrical signals are sensed using a lead of the SCS device and neurostimulation is selectively delivering using a set of adjustable SCS control parameters. Parameters representative of cardiac rhythm are derived from the far-field cardiac electrical signals. The parameters representative of cardiac rhythm are correlated with SCS control parameters to thereby map neurostimulation control settings to cardiac rhythm parameters. The delivery of further neurostimulation is then controlled based on the mapping of neurostimulation control settings to cardiac rhythm parameters to, for example, address any cardiovascular disorders detected based on the far-field cardiac signals. In this manner, a closed loop control system is provided to automatically adjust SCS control parameters to respond to changes in cardiac rhythm such as changes associated with ischemia, arrhythmia or heart failure. | 09-18-2014 |
20140309543 | DEVICES, SYSTEMS AND METHODS TO PERFORM ARRHYTHMIA DISCRIMINATION BASED ON THE ATRIAL AND VENTRICULAR ACTIVATION TIMES - Described herein are implantable systems and devices, and methods for use therewith, that can be used to perform arrhythmia discrimination based on activation times. A plurality of different sensing vectors are used to obtain a plurality of IEGMs that collectively enable electrical activations to be detected in the left atrial (LA) chamber, the right atrial (RA) chamber, and at least one ventricular chamber of a patient's heart. For each of a plurality of cardiac cycles, there is a determination, based on the plurality of obtained IEGMs, of an LA activation time, an RA activation time, and a ventricular activation time. Arrhythmia discrimination is then performed based on the determined activation times. | 10-16-2014 |
20140343649 | METHOD TO ENHANCE ELECTRODE LOCALIZATION OF A LEAD - An exemplary method includes positioning a lead in a patient where the lead has a longitudinal axis that extends from a proximal end to a distal end and where the lead includes an electrode with an electrical center offset from the longitudinal axis of the lead body; measuring electrical potential in a three-dimensional potential field using the electrode; and based on the measuring and the offset of the electrical center, determining lead roll about the longitudinal axis of the lead body where lead roll may be used for correction of field heterogeneity, placement or navigation of the lead or physiological monitoring (e.g., cardiac function, respiration, etc.). Various other methods, devices, systems, etc., are also disclosed. | 11-20-2014 |
20140343650 | METHOD TO ENHANCE ELECTRODE LOCALIZATION OF A LEAD - An exemplary method includes positioning a lead in a patient where the lead has a longitudinal axis that extends from a proximal end to a distal end and where the lead includes an electrode with an electrical center offset from the longitudinal axis of the lead body; measuring electrical potential in a three-dimensional potential field using the electrode; and based on the measuring and the offset of the electrical center, determining lead roll about the longitudinal axis of the lead body where lead roll may be used for correction of field heterogeneity, placement or navigation of the lead or physiological monitoring (e.g., cardiac function, respiration, etc.). Various other methods, devices, systems, etc., are also disclosed. | 11-20-2014 |
20140343651 | METHOD TO ENHANCE ELECTRODE LOCALIZATION OF A LEAD - An exemplary method includes positioning a lead in a patient where the lead has a longitudinal axis that extends from a proximal end to a distal end and where the lead includes an electrode with an electrical center offset from the longitudinal axis of the lead body; measuring electrical potential in a three-dimensional potential field using the electrode; and based on the measuring and the offset of the electrical center, determining lead roll about the longitudinal axis of the lead body where lead roll may be used for correction of field heterogeneity, placement or navigation of the lead or physiological monitoring (e.g., cardiac function, respiration, etc.). Various other methods, devices, systems, etc., are also disclosed. | 11-20-2014 |
20140343652 | METHOD TO ENHANCE ELECTRODE LOCALIZATION OF A LEAD - An exemplary method includes positioning a lead in a patient where the lead has a longitudinal axis that extends from a proximal end to a distal end and where the lead includes an electrode with an electrical center offset from the longitudinal axis of the lead body; measuring electrical potential in a three-dimensional potential field using the electrode; and based on the measuring and the offset of the electrical center, determining lead roll about the longitudinal axis of the lead body where lead roll may be used for correction of field heterogeneity, placement or navigation of the lead or physiological monitoring (e.g., cardiac function, respiration, etc.). Various other methods, devices, systems, etc., are also disclosed. | 11-20-2014 |