Cardiac pacing with anodal stimulation detection

Methods and device for determining a pacing vector for delivering an electrostimulation therapy are described. An implantable medical device may be configured to determine an anode capture threshold and a cathode capture threshold for a first anode and cathode pair of electrodes, switch a polarity of the first anode and cathode pair of electrodes, and determine an anode capture threshold and a cathode capture threshold for the first anode and cathode pair of electrodes having the switched polarity. The implantable medical device may be further configured to compare a cathodal capture threshold for the anode and cathode pair having the switched polarity to the anodal capture threshold of the first anode and cathode pair of electrodes and select either an anode or a cathode for delivering an electrostimulation therapy based at least in part on the comparison. Other methods and systems are also contemplated and described.

MULTI-VECTOR SENSING IN CARDIAC DEVICES USING A HYBRID APPROACH

Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. A preferred sensing configuration may be selected at a given point in time, for example under clinical conditions. Signal quality for the preferred sensing configuration is then monitored, and if the signal quality degrades under selected conditions, re-analysis may be performed to select a different sensing vector configuration for at least temporary use. If signal quality increases for the preferred sensing configuration, temporary use of the different sensing vector configuration may cease and reversion to the preferred sensing configuration takes place if certain conditions are met. The conditions for reversion may depend in part of a history of sensing signal quality for the preferred sensing configuration. 1. A cardiac rhythm management device having operational circuitry for analyzing cardiac signals including a least first and second cardiac sensing vectors and first and second sensing channels , wherein the operational circuitry is configured to use the at least first and second sensing vectors as follows:comparing one or more sensing quality metrics of the at least first and second cardiac sensing vectors;selecting one of the at least first and second cardiac sensing vectors as a preferred sensing configuration;implementing the preferred sensing configuration to analyze cardiac signals; re-analyzing sensing quality metrics of the at least first and second cardiac sensing vectors;', 'identifying a better sensing configuration than the preferred sensing configuration, at least as assessed at the time of the low sensing quality of the preferred sensing configuration;', 'if one or more first preconditions are met, implementing the better sensing configuration to analyze cardiac signals; and', 'monitoring signal quality of the preferred sensing configuration until the low sensing quality for the preferred sensing configuration ...

LEAD INTEGRITY MONITORING

A system for lead integrity monitoring includes an implantable medical device (IMD) having a housing enclosing a control circuit; and a lead, having a first sensor. The lead is coupled to the housing and electrically coupled to the control circuit. The system also includes at least one processing device configured to identify a first lead failure alert based on a first set of information; obtain a second set of information generated by a second sensor; perform an evaluation of the first set of information in the context of the second set of information; and confirm or cancel the first lead failure alert based on the evaluation. 1. A system for monitoring lead integrity , comprising: a housing enclosing a control circuit; and', 'a lead, having a first sensor, wherein the lead is coupled to the housing and electrically coupled to the control circuit; and, "an implantable medical device (IMD) configured to be implanted within a patient's body, the IMD comprising:"} identify a first lead failure alert, the first lead failure alert comprising an indication of a potential lead failure based on a first set of information satisfying an alert criterion;', 'obtain a second set of information generated by a second sensor;', 'perform an evaluation of the first set of information in the context of the second set of information; and', 'confirm or cancel the first lead failure alert based on the evaluation., 'at least one processing device configured to2. The system of claim 1 , the first set of information comprising at least one of a first set of impedance data associated with the lead claim 1 , a set of user input associated with the lead claim 1 , a set of sensed noise information claim 1 , a set of pace capture information claim 1 , a set of sensed intrinsic information claim 1 , a set of non-sustained tachycardia episode information claim 1 , and a set of phrenic nerve stimulation information.3. The system of claim 2 , the first set of information comprising at least one of ...

CONFIDENCE OF ARRHYTHMIA DETECTION

Systems and methods for detecting an arrhythmic event and storing physiological information associated with the detected arrhythmic event are described. A system may include a first detector to detect an arrhythmic event from a physiological signal sensed from a subject, and generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event. If the confidence indicator indicates a relatively high confidence of arrhythmia detection, the system may provide the detected arrhythmic event to a first process for storing the detected arrhythmic event or generating an alert. If the confidence indicator indicates a relatively low confidence of arrhythmia detection, the system may provide the detected arrhythmic event to at least a second process including confirming or rejecting the detected arrhythmic event. 1. A system , comprising:a physiological sensor circuit including a sense amplifier to sense a physiological signal from a subject;a first arrhythmia detector circuit configured to detect an arrhythmic event from the sensed physiological signal;a confidence indicator generator circuit configured to generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event; and provide the detected arrhythmic event to a first process in response to the confidence indicator indicating a first confidence level; and', 'provide the detected arrhythmic event to at least a second process different from the first process in response to the confidence indicator indicating a different second confidence level., 'a controller circuit coupled to the arrhythmia detector circuit, the controller circuit configured to2. The system of claim 1 , wherein the first arrhythmia detector circuit is configured to detect the arrhythmic event including an atrial or ventricular arrhythmia.3. The system of claim 1 , wherein the controller circuit is configured to claim 1 , in response to the confidence indicator exceeding a confidence ...

PHYSIOLOGIC EVENT DETECTION AND DATA STORAGE

Systems and methods for detecting a target physiologic event and storing physiologic information associated with the detected physiologic event are disclosed. A system can receive a physiologic signal obtained from a subject, and detect the target physiologic event using a first portion of the received physiologic signal. The system can confirm the target physiologic event using a second portion of the received physiologic signal. If the target physiologic event is confirmed, the system can store physiologic information associated with the confirmed target physiologic event in a memory. 1. A system , comprising:a signal receiver circuit, configured to receive a physiologic signal obtained from a subject;a physiologic event detector circuit, configured to detect a target physiologic event using a first portion of the received physiologic signal; confirm the target physiologic event using a second portion of the received physiologic signal, the second portion including at least part of the first portion of the received physiologic signal; and', 'generate a data storage trigger signal using the detection and the confirmation of the target physiologic event; and, 'a data storage decision circuit, coupled to the signal receiver circuit and the physiologic event detector circuit, configured toa controller circuit, coupled to the data storage decision circuit, configured to store in a memory in response to the data storage trigger signal, physiologic information associated with the confirmed target physiologic event.2. The system of claim 1 , wherein the first portion includes a first data window of the received physiologic signal claim 1 , and the second portion includes a second data window temporally located at a specified location within the first data window.3. The system of claim 2 , wherein the second data window is temporally located within a latter half of the first data window.4. The system of claim 1 , wherein the first portion includes a first data window of ...

REDUCING FALSE POSITIVES IN DETECTION OF POTENTIAL CARDIAC PAUSES

Embodiments of the disclosure include systems and methods for reducing false positives in detection of pauses. For example, embodiments include a sensing component configured to obtain values of a first physiological parameter and determine a cardiac pause based on the values of the first physiological parameter. Furthermore, embodiments include performing a validation check of the determined cardiac pause using at least one of: the values of the first physiological parameter or values of a second physiological parameter. 1. A system comprising:a sensing component configured to be operatively coupled to a patient and to obtain values of a first physiological parameter; and determine a potential cardiac pause of the patient using the values of the first physiological parameter; and', 'perform a validation check of the potential cardiac pause using at least one of: the values of the first physiological parameter or values of a second physiological parameter., 'at least one processor configured to2. The system of claim 1 , wherein the values of the first physiological parameter are values of an electrogram.3. The system of claim 2 , wherein the potential cardiac pause is determined when at least one of the following occurs: (1) a first R-R interval of the electrogram is greater than a time threshold claim 2 , wherein the first R-R interval is identified using a first electric potential claim 2 , or (2) a subsequent R wave does not occur within a specified period of time after an R wave is identified claim 2 , wherein the R wave is identified using the first electric potential threshold.4. The system of claim 3 , wherein the at least one processor performs the validation check by calculating a second R-R interval and wherein an R wave of the second R-R interval is identified using a second electric potential threshold claim 3 , the second electric potential threshold being less than the first electric potential threshold.5. The system of claim 1 , wherein the values of ...

MULTI-VECTOR SENSING IN CARDIAC DEVICES WITH DETECTION COMBINATIONS

Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. Signals from multiple vectors may be combined using weighting factors and/or by conversion to different coordinate systems than the original inputs, which may or may not be normalized to patient anatomy. Signals from multiple sensing vectors may be combined prior to or after several analytical steps or processes including before or after filtering, and before or after cardiac cycle detection. Cardiac cycle detection information may be combined across multiple sensing vectors before or after analysis of individual vectors for noise or overdetection. Cardiac cycle detection information may also be combined across multiple sensing vectors to identify noise and/or overdetection. 1. A cardiac rhythm management device comprising at least first , second and third input electrical nodes to define at least first and second sensing vectors , and operational circuitry for analyzing cardiac signals on at least three data streams as follows:a first data stream for a signal on the first sensing vector;a second data stream for a signal on the second sensing vector; anda third data stream for a signal calculated as a combined signal generated by combining signals from at least the first and second sensing vectors;wherein the operational circuitry is configured to perform the following:identify a potential new cardiac cycle by analysis of at least the third data stream;determine whether there is noise on any of the first, second and third data streams and, if so, do one of the following:if noise is present on all three data streams, discard data associated with the potential new cardiac cycle; orif noise is present on less than all three data streams, change the manner in which the first and second data streams are combined together.2. The cardiac rhythm management device of wherein:the operational circuitry is configured to combine the signals from ...

ATRIAL FIBRILLATION DETECTION

An apparatus includes a sensing circuit configured to generate a sensed physiological signal representative of cardiac activity of a subject, and an arrhythmia detection circuit. The arrhythmia detection circuit is configured to monitor information corresponding to ventricular depolarization (V-V) intervals using the sensed physiological signal; determine a V-V interval distribution; determine a heart rate density index (HRDI) as a portion of samples of the V-V interval distribution corresponding to a V-V interval occurring most often in the distribution; and generate an indication of atrial fibrillation (AF) using the HRDI. 1. An apparatus comprising:a sensing circuit configured to generate a sensed physiological signal representative of cardiac activity of a subject; andan arrhythmia detection circuit configured to:sample ventricular depolarization (V-V) intervals using the sensed physiological signal;determine a V-V interval distribution of V-V interval samples;determine a heart rate density index (HRDI) as a portion of samples of the V-V interval distribution corresponding to a V-V interval occurring most often in the distribution; andgenerate an indication of atrial fibrillation (AF) using the HRDI.2. The apparatus of claim 1 , wherein the arrhythmia detection circuit is configured to:determine a heart rate mode as a heart rate corresponding to a V-V interval value having most samples in the V-V interval distribution;determine the HRDI as the portion of the V-V intervals having the heart rate mode; andgenerate an indication of AF using the heart rate mode and the HRDI.3. The apparatus of claim 2 , wherein the arrhythmia detection circuit is configured to compare the heart rate mode to a specified heart rate mode threshold value; compare the HRDI to a specified HRDI threshold value; and generate the indication of AF when the determined heart rate mode satisfies the specified heart rate mode threshold value or the determined HRDI satisfies the HRDI threshold ...

AUTOMATED SCREENING METHODS AND APPARATUSES FOR IMPLANTABLE MEDICAL DEVICES

Automated pre-implant screening for candidate recipients of implantable medical devices. A set of cutaneous electrodes placed on a patient transcutaneously capture a cardiac signal using a screening device coupled to the electrodes. A first beat rate may be determined by identifying individual R-waves, QRS complexes or cardiac cycles from the captured cardiac signal using the cutaneous electrodes. A second beat rate may be calculated using one of several different methods, for example, by optical measurement, by monitoring heart sounds, by a second electric cardiac signal analysis, or by using an implanted device. The rates are compared to one another and, if a match is identified, the patient is deemed well suited to receive a particular device. 1. A method of determining whether an implantable device is appropriate for a patient comprising:sensing cardiac signals by applying a plurality of cutaneous electrodes to a patient and receiving electrical signals therefrom;analyzing a first cardiac signal using a first method for generating a heart rate to yield a first rate;using a second method for generating a heart rate to yield a second heart rate, wherein the first and second methods are distinct from one another;determining whether the first rate and second rate match using predefined parameters for finding a match; and, if so, determining that the implantable device is appropriate for the patient.2. The method of further comprising claim 1 , if the first rate and second rate do not match claim 1 , performing manual screening of the patient.3. The method of wherein the first cardiac signal is sensed between first and second cutaneous electrodes that define a first sensing vector claim 1 , wherein if the first rate and the second rate do not match using the predefined parameters claim 1 , the method further comprises:sensing a second cardiac signal using a second sensing vector different from the first sensing vector;analyzing the second cardiac signal using the ...

Implanted lead analysis system and method

Implanted medical device data is received, where the data was sensed by a first lead portion and a sensor over a time period. The number of detected noise events sensed by the first lead portion is counted based on applying first noise detection criteria to the data sensed by the first lead portion. The number of detected noise events over the sensor is counted based on applying second noise detection criteria to the data sensed by the sensor. The mean number of detected noise events is calculated for the first lead portion and sensor based on the number of noise events sensed by the first lead portion and the number of noise events sensed by the sensor. Potential lead failure in the first lead is recorded if the number of detected noise events over the first lead is greater than the mean number of noise events by at least 5%.

SIGNAL QUALITY MONITORING FOR MULTIPLE SENSE VECTORS IN CARDIAC DEVICES

New and alternative approaches to the monitoring of cardiac signal quality for external and/or implantable cardiac devices. In one example, signal quality is monitored continuously or in response to a triggering event or condition and, upon identification of a reduction in signal quality, a device may reconfigure its sensing state. In another example, one or more trends of signal quality are monitored by a device, either continuously or in response to a triggering event or condition, and sensing reconfiguration may be performed in response to identified trends and events. In yet another example, a device may use a looping data capture mode to track sensing data in multiple vectors while primarily relying on less than all sensing vectors to make decisions and, in response to a triggering event or condition, the looped data can be analyzed automatically, without waiting for additional data capture to reconfigure sensing upon identification of the triggering event or condition. In another example a device calculates a composite cardiac cycle by overlaying signal morphology for a number of cardiac cycles and analyzes the composite cardiac cycle to calculate signal quality metrics.

METHOD TO TRIGGER AN ATRIAL FIBRILLATION ELECTROGRAM IN AN IMPLANTABLE DEVICE THAT DETECTS R-WAVES

An apparatus includes a sensing circuit configured to generate a sensed physiological signal representative of cardiac activity of a subject, an arrhythmia detection circuit, a control circuit, and a memory. The arrhythmia detection circuit detects an episode of atrial fibrillation (AF) in the sensed cardiac signal using a first AF detection criterion, and detects the episode of AF using a second AF detection criterion. The first AF detection criterion has greater sensitivity to AF detection than the second AF detection criterion, and the second AF detection criterion has greater specificity to AF detection than the first AF detection criterion. The control circuit initiates storing of sampled values of a segment of the cardiac signal that includes the episode of AF when the episode of AF is detected by both the first AF detection criterion and the second AF detection criterion. 1. An apparatus comprising:a sensing circuit configured to generate a sensed cardiac signal representative of cardiac activity of a subject; and detect an episode of atrial fibrillation (AF) in the sensed cardiac signal using a first AF detection criterion; and', 'detect the episode of AF using a second AF detection criterion, wherein the first AF detection criterion has greater sensitivity to AF detection than the second AF detection criterion, and the second AF detection criterion has greater specificity to AF detection than the first AF detection criterion; and, 'an arrhythmia detection circuit electrically coupled to the sensing circuit and configured toa control circuit configured to trigger storage of sampled values of a segment of the cardiac signal that includes the episode of AF when the episode of AF is detected by both the first AF detection criterion and the second AF detection criterion.2. The apparatus of claim 1 , wherein the arrhythmia detection circuit is configured to:monitor information corresponding to ventricular depolarization (V-V) intervals;determine a V-V interval ...

Adaptive event storage in a medical device

Monitoring physiological parameter using an implantable physiological monitor in order to detect a condition predictive of a possible future pathological episode and collecting additional physiological data associated with the condition predictive of a possible future pathological episode. Monitoring another physiological parameter in order to detect a condition indicative of the beginning of a present pathological episode and collecting additional pathological data in response to the condition. Determining that the condition predictive of a future episode and the condition indicative of a present episode are associated and, in response thereto, storing all the collected physiological data.

MULTI-VECTOR SENSING IN CARDIAC DEVICES WITH SIGNAL COMBINATIONS

Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. Signals from multiple vectors may be combined using weighting factors and/or by conversion to different coordinate systems than the original inputs, which may or may not be normalized to patient anatomy. Signals from multiple sensing vectors may be combined prior to or after several analytical steps or processes including before or after filtering, and before or after cardiac cycle detection. Cardiac cycle detection information may be combined across multiple sensing vectors before or after analysis of individual vectors for noise or overdetection. Cardiac cycle detection information may also be combined across multiple sensing vectors to identify noise and/or overdetection. 1. A cardiac rhythm management device having operational circuitry for analyzing cardiac signals using a least first and second cardiac sensing vectors and first and second sensing channels , wherein the operational circuitry is configured to combine the first and second cardiac signals as follows:calculating at least first and second weighting factors for the at least first and second sensing vectors;applying the first weighting factor to modify signals sensed with the first sensing vector;applying the second weighting factor to modify signals sensed with the second sensing vector;combining the signals from the first and second sensing vectors, as modified by the weighting factors, together for analysis to detect cardiac cycles; andon a triggered or continuous basis, recalculating the weighting factors.2. The device of wherein the operational circuitry is configured to calculate a phase factor to apply to delay one of the first or second cardiac signal vectors for the combining step.3. The device of wherein the operational circuitry is configured to apply filtering to the first and second sensing vectors prior to applying the weighting factors.4. The device of ...

System and method for selection of pacing vectors

Various techniques are disclosed for quickly and efficiently determining cardiac pacing vectors that minimize phrenic nerve stimulation.

Implanted lead analysis system and method

The technology disclosed herein relates to a method for lead analysis for an implanted medical device. A summary data record is retrieved associated with one or more episodes from an implanted medical device through a communication module. Episode selection criteria are applied to the summary data record by a processing module. One or more episode data records are retrieved from the implanted medical device for one or more episodes for which the episode selection criteria was satisfied. Noise detection criteria are applied to the episode data record. A notification module is configured to generate an alert if the noise detection criteria are satisfied.

METHOD AND APPARATUS FOR ENHANCING VENTRICULAR BASED ATRIAL FIBRILLATION DETECTION USING ATRIAL ACTIVITY

An example of a system may include a sensing circuit to sense a cardiac signal indicative of atrial and ventricular depolarizations and an atrial fibrillation (AF) detection circuit to detect AF. The AF detection circuit may include a detector and a detection enhancer. The detector may be configured to detect the ventricular depolarizations using the cardiac signal, measure ventricular intervals, and detect AF using the ventricular intervals. The detection enhancer may be configured to generate atrial detection windows each being a time interval prior to each of the detected ventricular depolarizations, compute an atrial activity score using a rolling average of portions of the cardiac signal within the atrial detection windows, and verify the detection of the AF using the atrial activity score and an atrial activity threshold. The atrial activity score is a measure of consistency between a relationship between the atrial depolarizations and the ventricular depolarizations. 1. A system , comprising:a sensing circuit configured to sense a cardiac signal indicative of atrial and ventricular depolarizations; and a detector configured to detect the ventricular depolarizations using the cardiac signal, to measure ventricular intervals each between two successively detected ventricular depolarizations, and to detect AF using the ventricular intervals; and', 'a detection enhancer configured to generate atrial detection windows each being a time interval prior to each of the detected ventricular depolarizations, to compute an atrial activity score using a rolling average of portions of the cardiac signal within the atrial detection windows, and to verify the detection of the AF using the atrial activity score and an atrial activity threshold, the atrial activity score being a measure of consistency between a relationship between the atrial depolarizations and the ventricular depolarizations., 'an atrial fibrillation (AF) detection circuit configured to detect AF using the ...

ADAPTIVE EVENT STORAGE IN IMPLANTABLE DEVICE

Monitoring physiological parameter using an implantable physiological monitor in order to detect a condition predictive of a possible future pathological episode and collecting additional physiological data associated with the condition predictive of a possible future pathological episode. Monitoring another physiological parameter in order to detect a condition indicative of the beginning of a present pathological episode and collecting additional pathological data in response to the condition. Determining that the condition predictive of a future episode and the condition indicative of a present episode are associated and, in response thereto, storing all the collected physiological data. 120.-. (canceled)21. A system , comprising:a physiological data monitor, configured to monitor one or more physiological data parameters; detect an episode predictor condition using a first physiological data parameter monitored by the physiological data monitor, wherein the episode predictor condition is predictive of a possible future pathological episode;', 'detect an episode beginning condition using a second physiological data parameter monitored by the physiological data monitor, wherein the episode beginning condition is indicative of beginning of a present pathological episode; and', 'determine that the episode predictor condition is associated with the present pathological episode., 'a processor, coupled to the physiological data monitor, the processor configured to,'}22. The system of claim 21 , wherein detecting the episode predictor condition includes detecting that the first physiological data parameter exceeds an episode predictor condition threshold but stays below an episode beginning condition threshold.23. The system of claim 22 , where detecting the episode beginning condition includes detecting that the second physiological data parameter exceeds the episode beginning condition threshold.24. The system of claim 21 , further including:a static memory buffer ...

AF MONITOR AND OFFLINE PROCESSING

A system for monitoring a subject for an arrhythmia includes an external monitoring device (EMD) configured to be disposed outside of a subject's body. The EMD includes a first communication component configured to receive, from a medical device, a first physiological parameter signal and an indication of a detected trigger event associated with a first portion of the first physiological parameter signal. The trigger event is indicative of a potential arrhythmia. The EMD also includes an analysis component configured to (1) identify a second portion of the first physiological parameter signal, where the second portion satisfies a discard criterion, (2) discard the second portion, and (3) perform an arrhythmia confirmation evaluation using a third portion of the first physiological parameter signal. 1. A system , comprising: a sensing component configured to obtain a first physiological parameter signal;', 'a trigger component configured to detect, based on a first portion of the first physiological parameter signal, a trigger event indicative of a potential arrhythmia;', 'a first communication component configured to transmit the first physiological parameter signal; and, "a medical device operatively coupled to a subject's body, the medical device comprising:"} a second communication component configured to receive, from the first communication component, the first physiological parameter signal; and', 'an analysis component configured to (1) identify a second portion of the first physiological parameter signal, wherein the second portion satisfies a discard criterion, (2) discard the second portion, and (3) perform an arrhythmia confirmation evaluation using a third portion of the first physiological parameter signal., "an external monitoring device (EMD) configured to be disposed outside of the subject's body, the EMD comprising:"}2. The system of claim 1 , wherein the trigger event comprises a potential atrial fibrillation episode.3. The system of claim 2 , ...

Intracardiac electrogram time frequency noise detection

Systems, methods, and apparatus for identifying and classifying noise of an intracardiac electrogram of a cardiac rhythm management device to prevent inaccurate detection of a cardiac episode are disclosed. In an example, three channels are analyzed to identify and determine whether an episode or noise has been detected.

METHOD TO TRIGGER STORAGE OF ONSET OF PHYSIOLOGIC CONDITION IN AN IMPLANTABLE DEVICE

An apparatus includes a sensing circuit configured to generate a sensed physiological signal that includes physiological information of a subject, a detection circuit, and a control circuit. The detection circuit detects a physiological condition of a subject using the physiological signal. The control circuit stores sampled values of a segment of the physiological signal in temporary memory storage; and stores the sampled values in non-temporary storage in response to receiving an indication of continued detection of the physiological condition. 1. An apparatus comprising:a sensing circuit configured to generate a sensed physiological signal, wherein the physiological signal includes physiological information of a subject;a detection circuit electrically coupled to the sensing circuit and configured to detect a physiological condition of a subject using the physiological signal; anda control circuit configured to store sampled values of a segment of the physiological signal in temporary memory storage; and to store the sampled values in non-temporary storage in response to receiving an indication of continued detection of the physiological condition.2. The apparatus of claim 1 , wherein the control circuit is configured to trigger storage of the sampled values of the segment of the physiological signal in temporary memory storage in response to detection of onset of the physiological condition; and to store the sampled values in non-temporary storage in response to receiving an indication of confirmation of the physiological condition as the indication of continued detection of the physiological condition.3. The apparatus of claim 2 , wherein the detection circuit is configured to detect syncope of the subject claim 2 , and wherein the control circuit is configured to trigger storage of the sampled values in temporary memory storage in response to detection of syncope of the subject; and to store the sampled values in non-temporary storage in response to receiving ...

Physiologic event detection and data storage

Systems and methods for detecting a target physiologic event and storing physiologic information associated with the detected physiologic event are disclosed. A system can receive a physiologic signal obtained from a subject, and detect the target physiologic event using a first portion of the received physiologic signal. The system can confirm the target physiologic event using a second portion of the received physiologic signal. If the target physiologic event is confirmed, the system can store physiologic information associated with the confirmed target physiologic event in a memory.

METHOD AND APPARATUS FOR AUTOMATIC ARRHYTHMIA CLASSIFICATION WITH CONFIDENCE ESTIMATION

An arrhythmia classification system receives cardiac data from an implantable medical device, performs automatic adjudication of each cardiac arrhythmia episode indicated by the cardiac data, and generates episode data representative of information associated with the episode. The episode data include at least an episode classification resulting from the automatic adjudication of the episode and a confidence level in the episode classification. In one embodiment, the episode data further include key features rationalizing the automatic adjudication of the episode. 1. A medical system comprising:a medical device configured to sense one or more cardiac signals indicative of one or more arrhythmia episodes and produce cardiac data representative of the one or more cardiac signals; receive cardiac data transmitted from the medical device,', 'determine a voting classification for each episode by executing an adjudication algorithm of a plurality of adjudication algorithms,', 'perform automatic episode classification of each episode of one or more arrhythmia episodes using the determined voting classification for each episode, and generate episode data representative of information associated with each episode including the episode classification of each episode resulting from the automatic adjudication of each episode;, 'an arrhythmia analysis circuit communicatively coupled to the medical device, the arrhythmia analysis circuit configured toa memory circuit communicatively coupled to the arrhythmia analysis circuit, the memory circuit configured to store data including the cardiac data, the episode data and the episode classifications; anda user interface communicatively coupled to the arrhythmia analysis circuit and the memory circuit, the user interface including a presentation device configured to present the information associated with each episode.2. The system of claim 1 , wherein the arrhythmia analysis circuit is configured to determine a confidence level in ...

RHYTHM DISCRIMINATION ENHANCEMENT - CHAMBER OF TACHY ORIGINATION

An apparatus comprises an implantable cardiac signal sensing circuit and a controller circuit. The implantable cardiac signal sensing circuit provides a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium. The controller circuit includes an onset detection circuit and a classification circuit. The onset detection circuit detects an onset episode that includes fast cardiac depolarizations and identifies a depolarization that initiates the onset episode. The classification circuit classifies the onset episode as supra-ventricular tachycardia (SVT) when the initiating onset episode is identified in the atrium and the number of atrial depolarizations is greater than or equal to the number of ventricular depolarizations during the onset episode, and as ventricular tachycardia (VT) when the initiating onset depolarization is identified in the ventricle and the number of ventricular depolarizations is greater than the number of atrial depolarizations during the onset episode. 1. An apparatus comprising:an implantable cardiac signal sensing circuit, configured to provide a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium; anda controller circuit communicatively coupled to the implantable cardiac signal sensing circuit, wherein the controller circuit includes: determine ventricular depolarization intervals (V-V intervals) and atrial depolarization intervals (A-A intervals);', 'detect an onset episode that includes fast cardiac depolarizations; and', 'identify an initiating onset depolarization in the onset episode; and, 'an onset detection circuit configured to [ supra-ventricular tachycardia (SVT) when the initiating onset depolarization is identified in the atrium and the number of atrial depolarizations is greater than or equal to the number of ventricular depolarizations during the onset episode; and', 'ventricular tachycardia (VT) when the initiating onset depolarization is ...

RHYTHM DISCRIMINATION ENHANCEMENT - AV DRIVE

An apparatus comprises an implantable cardiac signal sensing circuit and a controller circuit. The implantable cardiac signal sensing circuit provides a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium. The controller circuit includes a one-to-one detector circuit and a tachyarrhythmia discrimination circuit. The one-to-one detector circuit measures cardiac depolarization intervals of the atrium and the ventricle and determines whether a relationship of atrial depolarizations to ventricular depolarizations is substantially one-to-one. The tachyarrhythmia discrimination circuit increments a counter when detecting a shortening or prolonging of a V-V interval that immediately precedes the same shortening or prolonging of an A-A interval, classifies the episode as VT according to the counter, and provides the classification of the tachyarrhythmia episode to a user or process. 1. An apparatus comprising:an implantable cardiac signal sensing circuit, configured to provide a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium; and [ measure cardiac depolarization intervals of the atrium and the ventricle; and', 'determine whether a relationship of atrial (A-A) depolarizations to ventricular (V-V) depolarizations is substantially one-to-one;, 'a one-to-one detector circuit configured to, 'a first counter circuit and a second counter circuit; and', detect an episode of tachyarrhythmia while the relationship atrial depolarizations to ventricular depolarizations is substantially one-to-one;', 'increment the first counter when detecting one of a shortening or prolonging of a V-V interval that is immediately preceded by the same one of a detected shortening or prolonging of an A-A interval during the episode;', 'increment the second counter when detecting one of a shortening or prolonging of an A-A interval during the episode that is immediately preceded by the same one of a shortening or ...

APPARATUS AND METHOD FOR COMBINED CARDIAC FUNCTION MANAGEMENT AND RENAL THERAPIES

A system can coordinate operation of a cardiac function management (CFM) device and a renal device, such as during a vulnerable period in which a patient has an increased risk of tachyarrhythmia. 1. An apparatus , comprising: a data input configured to receive information about or from an external renal monitoring or therapy device;', 'a control circuit, comprising first and second operating modes, the first operating mode controlling operation of the implantable cardiac function management device in the absence of triggering information about or from the renal monitoring or therapy device, and the second operating mode controlling operation of the implantable cardiac function management device in response to receiving triggering information about or from the renal monitoring or therapy device; and', 'wherein the second operating mode includes an exit condition, returning control of operation of the implantable cardiac function management device to the first operating mode, when a vulnerable period, including a time period corresponding to an increased risk of tachyarrhythmia or intradialytic hypotension, has elapsed., 'an ambulatory cardiac function management device comprising2. The apparatus of claim 1 , wherein the control circuit is configured to adjust or direct therapy claim 1 , provided by the cardiac function management device claim 1 , in response to the triggering information received from the renal monitoring or therapy device.3. The apparatus of claim 2 , wherein the control circuit is configured to adjust or direct an anti-tachyarrhythmia therapy claim 2 , provided by the cardiac function management device claim 2 , in response to the triggering information received from the renal monitoring or therapy device.4. The apparatus of claim 1 , wherein the control circuit is configured to adjust or direct a physiological sensor of the cardiac function management device in response to the triggering information received from the renal monitoring or therapy ...

OFF-LINE SENSING METHOD AND ITS APPLICATIONS IN DETECTING UNDERSENSING, OVERSENSING, AND NOISE

A system and method for performing independent, off-line evaluation of event sensing for collected electrograms, comprising: sensing an electrogram using an implantable medical device (IMD); determining locations of heart beats on at least one channel of the electrogram using a multi-pass process, resulting in a group of multi-pass beat locations; storing the electrogram and device-identified beat locations in a memory location; and retrieving the electrogram and device-identified beat locations from the memory location. The multi-pass process determines locations of heart beats on at least a first channel of the electrogram. The device-identified group of beat locations are then compared to the multi-pass group of beat locations identified using the multi-pass method. Based on the comparing step, oversensing of beats, undersensing of beats, or noise from the device can be detected. 1. A method for performing and evaluating independent , off-line event sensing for collected electrograms , comprising:sensing an electrogram using an implantable medical device (IMD);the IMD determining locations of heart beats within the electrogram, resulting in a group of device-identified beat locations for the electrogram;storing the electrogram and device-identified beat locations in a memory location;retrieving the electrogram and device-identified beat locations from the memory location; identifying a preliminary group of beat location candidates within the electrogram;', 'eliminating a portion of the preliminary group of beat location candidates using a first algorithm resulting in a refined group of beat location candidates; and', 'eliminating a portion of the refined group of beat location candidates using a second algorithm resulting in the group of multi-pass beat locations; and, 'after retrieving the electrogram from the memory location, determining locations of heart beats on at least a first channel of the electrogram using a multi-pass process, resulting in a group of ...

SYSTEM AND METHOD FOR OFF-LINE ANALYSIS OF CARDIAC DATA

A system and method for performing off-line analysis of cardiac electrogram data, comprising: retrieving an electrogram from a memory location; identifying a first-channel group of candidate beats from at least a first channel of the electrogram; and identifying a second-channel group of candidate beats from at least a second channel of an electrogram. For each first-channel beat candidate near a second-channel beat candidate, the amplitude of the first-channel beat candidate is compared with the amplitude of a previous beat and the amplitude of a next beat on the first electrogram channel, and first-channel beat candidates that are outside of a first pre-determined range from either the previous or next beat are removed. Then first-channel beat candidates that are outside of a second pre-determined range from either the previous or next beat candidate are removed. 1. An off-line method for analyzing cardiac electrogram data , comprising:retrieving an electrogram from a memory location;identifying a first-channel group of candidate beats from at least a first channel of the electrogram;identifying a second-channel group of candidate beats from at least a second channel of an electrogram;for each first-channel beat candidate near a second-channel beat candidate, comparing the amplitude of the first-channel beat candidate with an amplitude of a previous beat and an amplitude of a next beat on the first electrogram channel and removing first-channel beat candidates that are outside of a first pre-determined range from either the previous or next beat; andfor each first-channel beat candidate near a second-channel beat candidate, comparing the amplitude of the first-channel beat candidate with an amplitude of a previous beat candidate and an amplitude of a next beat candidate on the first electrogram channel and removing first-channel beat candidates that are outside of a second pre-determined range from either the previous or next beat candidate;wherein a first-channel ...

AUTOTHRESHOLD WITH SENSING FROM PACING CATHODE

Cardiac electrostimulation energy is delivered to a heart chamber of a subject according to a normal pacing mode using a set of implantable pacing electrodes. When a threshold test for the heart chamber is initiated and a sensing electrode independent from the set of pacing electrodes is unavailable for the heart chamber, cardiac electrostimulation energy is delivered to the subject according to a threshold test mode. The threshold test mode includes sensing a cardiac activity signal from a subject using a set of sensing electrodes that includes an electrode common to the set of pacing electrodes, and changing the electrostimulation energy and sensing a resulting cardiac activity signal using the set of sensing electrodes to determine the optimum electrostimulation energy for capture of the heart chamber. 1. An apparatus comprising:a therapy circuit configured to provide cardiac electrostimulation energy to a heart chamber of a subject using a set of implantable pacing electrodes;a cardiac signal sensing circuit configured to sense a cardiac activity signal; and initiate delivery of electrostimulation energy to the heart chamber according to a normal pacing mode; and', 'initiate a first threshold test mode when receiving an indication to start a threshold test for the heart chamber and a sensing electrode independent from the set of pacing electrodes is unavailable for the heart chamber,', 'wherein, when in the first threshold test mode, the control circuit is configured to recurrently change the electrostimulation energy delivered to the heart chamber, receive a cardiac activity signal sensed using a set of sensing electrodes that includes an electrode common to the set of pacing electrodes, and determine an optimum electrostimulation energy for capture of the heart chamber using the sensed cardiac activity signal., 'a control circuit communicatively coupled to the cardiac signal sensing circuit and the therapy circuit, wherein the control circuit is configured to2 ...

HYBRID AUTOTHRESHOLD

An apparatus comprises a control circuit that initiates a normal pacing mode for delivery of electrostimulation energy to the heart chamber. In response to an indication to initiate a threshold test, the control circuit determines an electrode configuration used to deliver the electrostimulation energy in the normal pacing mode, selects a first threshold test mode when a sensing electrode independent from the set of pacing electrodes is unavailable for the heart chamber, wherein a cardiac activity signal is sensed using a set of sensing electrodes that includes an electrode common to the set of pacing electrodes, and selects a second threshold test mode when a sensing electrode independent from the set of pacing electrodes is available for the heart chamber, wherein the cardiac activity signal is sensed using a set of sensing electrodes that excludes an electrode common to the set of pacing electrodes. 1. An apparatus comprising:a therapy circuit configured to provide cardiac electrostimulation energy to a heart chamber of a subject using a set of implantable pacing electrodes;a cardiac signal sensing circuit configured to sense a cardiac activity signal; anda control circuit communicatively coupled to the cardiac signal sensing circuit and the therapy circuit, wherein the control circuit is configured to:initiate a normal pacing mode for delivery of electrostimulation energy to the heart chamber; andreceive an indication to initiate a threshold test to determine an optimum electrostimulation energy for capture of the heart chamber, and in response to the indication, the control circuit is configured to:determine an electrode configuration used to deliver the electrostimulation energy in the normal pacing mode;select a first threshold test mode when a sensing electrode independent from the set of pacing electrodes is unavailable for the heart chamber, wherein the cardiac activity signal is sensed using a set of sensing electrodes that includes an electrode common to ...

RHYTHM DISCRIMINATION ENHANCEMENT - AV DRIVE

An apparatus comprises an implantable cardiac signal sensing circuit and a controller circuit. The implantable cardiac signal sensing circuit provides a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium. The controller circuit includes a one-to-one detector circuit and a tachyarrhythmia discrimination circuit. The one-to-one detector circuit measures cardiac depolarization intervals of the atrium and the ventricle and determines whether a relationship of atrial depolarizations to ventricular depolarizations is substantially one-to-one. The tachyarrhythmia discrimination circuit classifies the episode as VT when detecting a shortening or prolonging of a V-V interval that immediately precedes the same shortening or prolonging of an A-A interval. 1. A system comprising:an implantable device including:an implantable cardiac signal sensing circuit, configured to provide a sensed depolarization signal from a ventricle and a sensed depolarization signal from an atrium; and [ measure cardiac depolarization intervals of the atrium and the ventricle; and', 'determine whether a relationship of atrial (A-A) depolarizations to ventricular (V-V) depolarizations is substantially one-to-one;, 'a one-to-one detector circuit configured to, detect an episode of tachyarrhythmia when the relationship atrial depolarizations to ventricular depolarizations is substantially one-to-one;', 'generate an indication of VT when detecting one of a shortening or prolonging of an A-A interval during the episode that is immediately preceded by the same one of a shortening or prolonging of a V-V interval during the episode;', 'generate an indication of a supra-ventricular tachycardia (SVT) event when detecting one of a shortening or prolonging of an A-A interval that immediately precedes the same one of a shortening or prolonging of the V-V interval during the episode; and', 'classify the tachyarrhythmia episode as one of VT or SVT according to the ...

METHOD AND APPARATUS FOR AUTOMATIC ARRHYTHMIA CLASSIFICATION WITH CONFIDENCE ESTIMATION

An arrhythmia classification system receives cardiac data from an implantable medical device, performs automatic adjudication of each cardiac arrhythmia episode indicated by the cardiac data, and generates episode data representative of information associated with the episode. The episode data include at least an episode classification resulting from the automatic adjudication of the episode and a confidence level in the episode classification. In one embodiment, the episode data further include key features rationalizing the automatic adjudication of the episode. 1. A system configured to be communicatively coupled to an implantable medical device sensing one or more cardiac signals indicative of one or more arrhythmia episodes and produce cardiac data representative of the one or more cardiac signals , the system comprising:an arrhythmia analysis circuit configured to receive cardiac data transmitted from the implantable medical device, perform automatic adjudication of each episode of one or more arrhythmia episodes using the cardiac data, and generate episode data representative of information associated with the each episode including an episode classification resulting from the automatic adjudication of the each episode and a confidence level in the episode classification;a memory circuit configured to store data including the cardiac data and the episode data; anda user interface including a presentation device configured to present the information associated with the each episode.2. The system of claim 1 , wherein the arrhythmia analysis circuit is configured to determine the episode classification for the each episode and the confidence level in the episode classification using the cardiac data by executing a plurality of adjudication algorithms.3. The system of claim 2 , wherein the arrhythmia analysis circuit comprises an automatic arrhythmia adjudicator configured to execute the adjudication algorithms each being a machine learning algorithm implementing ...

SYSTEM AND METHOD FOR SELECTION OF PACING VECTORS

Various techniques are disclosed for quickly and efficiently determining cardiac pacing vectors that minimize phrenic nerve stimulation. 1. A system comprising:an implantable medical device configured to deliver pacing stimuli to a heart; andat least one processor configured to: deliver at least one first pacing stimulus at a first specified pacing energy;', 'determine whether, in response to the delivered at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one first pacing stimulus;', 'adjust the pacing stimulus to determine a first pacing threshold value; and', 'categorize acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;, 'for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode deliver at least one second pacing stimulus at at least one second pacing energy;', 'determine whether, in response to the delivered at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one second pacing stimulus; and', 'categorize the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;, 'pair one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, and for a particular pairingevaluate the categorized pairings using information about a margin between the ...

SYSTEMS AND METHODS FOR MANAGING PATIENT-TRIGGERED EPISODES

Systems and methods for managing machine-generated medical events detected from one or more patients are described herein. A medical event management system includes an event analyzer circuit to detect a medical event using physiological data from a patient-triggered episode acquired from a medical device. The event analyzer circuit determines a confidence score of the medical event detection, and generates an alignment indicator indicating a degree of concordance between the detected medical event and the information about the patient-triggered episode. The system assigns priority information to the patient-triggered episode using the generated alignment indicator and the confidence score of the detection. An output circuit can output the received physiological information to a user or a process according to the assigned priority information. 1. A system for prioritizing medical events detected by an ambulatory medical device (AMD) , the system comprising:a receiver circuit configured to receive physiological information from the AMD corresponding to a patient-triggered episode;an event analyzer circuit configured to analyze the received physiological information corresponding to the patient-triggered episode, and to determine a confidence score for the patient-triggered episode; andan event prioritizer circuit configured to assign priority information to the received patient-triggered episode using the confidence score.2. The system of claim 1 , wherein the event analyzer circuit is configured to perform offline analysis of the received physiological information corresponding to the patient-triggered episode.3. The system of claim 1 , wherein the patient-triggered episode includes information about patient-reported sign or symptom claim 1 , and the event analyzer circuit is configured to detect a medical event and generate an alignment indicator indicating a concordance between the information about patient-reported sign or symptom and the detected medical event.4 ...

ADJUSTABLE SENSING IN A HIS-BUNDLE PACEMAKER

Systems and methods for pacing cardiac conductive tissue are described. An embodiment of a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to stimulate a His bundle, and a cardiac event detector to detect a His-bundle activity within a time window following an atrial activity. The cardiac event detector may use a cross-chamber blanking, or an adjustable His-bundle sensing threshold, to avoid or reduce over-sensing of far-field atrial activity and inappropriate inhibition of HBP therapy. The electrostimulation circuit may deliver HBP in the presence of the His-bundle activity. The system may further recognize the detected His-bundle activity as either a FFPW or a valid inhibitory event, and deliver or withhold HBP therapy based on the recognition of the His-bundle activity. 1. A system for pacing a heart , comprising:an electrostimulation circuit configured to generate His-bundle pacing (HBP) pulses to stimulate a His bundle of the heart;a cardiac event detector configured to sense a physiologic signal from a His-bundle region, and to detect a His-bundle activity from the sensed physiologic signal during a time period following an atrial activity; anda control circuit configured to control the electrostimulation circuit to deliver the HBP pulses if no His-bundle activity is detected within the time period following the atrial activity, and to withhold the HBP pulses if the His-bundle activity is detected within the time period following the atrial activity.2. The system of claim 1 , wherein the cardiac event detector is configured to switch from a first sensing mode to a second sensing mode to detect the His-bundle activity in response to an indication of HBP claim 1 , the second sensing mode having a lower sensitivity than the first sensing mode.3. The system of claim 2 , wherein the first sensing mode includes a first sensing threshold and the second sensing mode includes a second sensing threshold higher than the ...

Priority-based medical data management system

Systems and methods for managing medical information storage and transmission are discussed. A data management system may include a receiver circuit to receive information about a physiological event sensed from a patient, and an event prioritizer circuit to assign a priority to the received information. A control circuit may perform data reduction of the received information according to the assigned priority. Data reduction at a higher reduction rate is performed on the received information if a lower priority is assigned than if a higher priority is assigned. The system may include an output circuit to output the received information to a user or a process, or to transmit the received information to an external device, according to the assigned priority.

SUPERVISED CARDIAC EVENT DETECTION

Systems and methods for detecting physiologic events in a patient are described herein. An embodiment of a medical system includes a memory circuit to store physiologic event episodes detected and recorded by a medical device. The system includes a control circuit to analyze the stored physiologic event episodes, and determine a presence of a target cardiac event under a plurality of detection settings. Using the determined presence of the target cardiac event from the stored physiologic event episodes, and user adjudication of the stored event episodes, the control circuit may select, from the plurality of detection settings, a detection setting to detect a subsequent target cardiac event. The control circuit may also prioritize the physiologic event episodes for storage in the memory circuit. 1. A system for detecting cardiac events from a patient , the system comprising:a memory circuit configured to store physiologic event episodes recorded by a medical device from a patient; and determine a presence of a target cardiac event in one or more of the stored physiologic event episodes under a first detection setting;', 'provide the determined presence of the target cardiac event under the first detection setting to a user;', 'receive from the user an adjudication of the stored physiologic event episodes under the first detection setting from the user;', 're-determine a presence of the target cardiac event in the one or more of the stored physiologic event episodes under a second detection setting different than the first detection setting;', 'provide the re-determined presence of the target cardiac event in the one or more stored physiologic event episodes under the second detecting setting to the user; and', 'receive, in response to the provided re-determined presence of the target cardiac event, a selected detection setting for a subsequent determination of the presence of the target cardiac event in the patient., 'a control circuit, including a detection control ...

IMPLANTED LEAD ANALYSIS SYSTEM AND METHOD

Implanted medical device data is received, where the data was sensed by a first lead portion and a sensor over a time period. The number of detected noise events sensed by the first lead portion is counted based on applying first noise detection criteria to the data sensed by the first lead portion. The number of detected noise events over the sensor is counted based on applying second noise detection criteria to the data sensed by the sensor. The mean number of detected noise events is calculated for the first lead portion and sensor based on the number of noise events sensed by the first lead portion and the number of noise events sensed by the sensor. Potential lead failure in the first lead is recorded if the number of detected noise events over the first lead is greater than the mean number of noise events by at least 5%. 1. A method comprising:receiving implanted medical device data, wherein the medical device data was sensed by a first lead portion and a sensor over a period of time of at least one day;applying first noise detection criteria to the medical device data sensed by the first lead portion;counting the number of detected noise events sensed by the first lead portion over the time period based on the first noise detection criteria;applying second noise detection criteria to the medical device data sensed by the sensor;counting the number of detected noise events over the sensor over the time period based on the second noise detection criteria;calculating the mean number of detected noise events over the time period, wherein at least the number of detected noise events sensed by the first lead portion and the number of detected noise events sensed by the sensor are included in the mean calculation; andrecording a determination of potential lead failure in the first lead if the number of detected noise events over the first lead over the time period is greater than the mean number of noise events by at least 5%.2. The method of claim 16 , further ...

Reducing false alarms in cardiac monitoring devices

An apparatus comprises an arrhythmia detection circuit configured to: receive a cardiac signal representative of cardiac activity of a subject; apply a first arrhythmia detection criteria to the received cardiac signal; apply, in response to the applied first arrhythmia detection criteria producing a positive indication of arrhythmia, a second arrhythmia detection criteria to the received cardiac signal, wherein the second arrhythmia detection criteria is more specific to detection of arrhythmia than the first detection criteria; detect, in response to the applied first and second arrhythmia detection criteria, a sensing event indicating one or both of the first and second arrhythmia detection criteria are susceptible to false indications of arrhythmia; and adjust, in response to a detected sensing event, sensitivity or specificity of one or both of the first and second arrhythmia detection criteria.

SYSTEMS AND METHODS FOR PRESENTING PHYSIOLOGIC DATA

Systems and methods for presenting physiologic data to a user are discussed. An exemplary system includes a presentation control circuit configured to generate signal metrics from data subsets of a physiologic signal corresponding to a device-detected presence of a physiologic event. The signal metrics represent characteristics of the physiologic event. The presentation control circuit may determine, from the plurality of data subsets, a target subset of clinical significance, which has the corresponding signal metric satisfying a specific condition. The presentation control circuit may present the recognized target subset over other subsets of the physiologic data. A user may adjudicate the device detection of the physiologic event or adjust device parameters. 1. A system for presenting physiologic data to a user , comprising: generate a signal metric respectively for data subsets of a physiologic signal corresponding to a device-detected presence of a physiologic event, the signal metric representing a characteristic of the physiologic event;', 'determine, from the data subsets of the physiologic signal, a target subset with the corresponding generated signal metric satisfying a specific condition; and', 'present the determined target subset of the physiologic signal to the user., 'a presentation control circuit configured to2. The system of claim 1 , comprising a user interface configured to:display the target subset prior to other data subsets of the physiologic signal; andreceive a user adjudication of the device-detected presence of the physiologic event.3. The system of claim 1 , wherein the physiologic signal is recorded in response to a device-detected presence of a cardiac arrhythmia episode claim 1 , and the signal metric represents a cardiac timing or a signal morphology of the recorded physiologic signal.4. The system of claim 1 , wherein the physiologic signal is recorded in response to a device-detected presence of an atrial tachyarrhythmia episode ...

ATRIAL FIBRILLATION DETECTION USING VENTRICULAR RATE VARIABILITY

Atrial fibrillation information can be determined from ventricular information or a ventricular location, such as using ventricular rate variability. An ambulatory medical device can receive indications of pairs of first and second ventricular rate changes of three temporally adjacent ventricular heart beats. A first count of instances of the pairs meeting a combined rate change magnitude characteristic and a second count of instances of the pairs in which both of the first and second ventricular rate changes are negative can be used to provide atrial fibrillation information. 1. An apparatus to detect atrial fibrillation , the apparatus comprising: an input to receive indications of pairs of first and second ventricular rate changes of three temporally adjacent ventricular heart beats;', 'a first counter circuit, to determine a first count of instances of the pairs in which a combined rate change magnitude characteristic is less than at least one first criterion;', 'a second counter circuit, to determine a second count of instances of the pairs in which both of the first and second ventricular rate changes are negative; and', 'an output to provide atrial fibrillation information using the first and second counts., 'a processor circuit, comprising2. The apparatus of claim 1 , wherein the second counter circuit is configured to exclude instances of the pairs counted by the first counter circuit.3. The apparatus of claim 2 , wherein the second counter circuit is configured to exclude instances of pairs of the first and second ventricular rate changes wherein (1) a magnitude of the first ventricular rate change is less than a specified first threshold rate change amount and (2) a magnitude of the second ventricular rate change is less than a specified second threshold rate change amount.4. The apparatus of claim 1 , wherein the input to receive indications of the pairs is configured to receive the indications of the pairs over multiple windows claim 1 , individual ...

SYSTEMS AND METHODS FOR MONITORING IMMUNOTHERAPY TOXICITY

Systems, devices, and methods for monitoring and assessing immunotherapy toxicity are discussed. An exemplary system receives physiologic information from a patient using an ambulatory medical device. In response to an immunotherapy such as CAR T-cell therapy, the system determines a toxicity indication using the received physiologic information. A therapy can be initiated or adjusted using the toxicity indication. 1. A system comprising:an ambulatory medical device configured to receive physiologic information from a patient receiving immunotherapy; andan assessment circuit configured to determine a toxicity indication associated with the immunotherapy using the received physiologic information.2. The system of claim 1 , comprising a drug delivery system configured to control delivery of the immunotherapy to the patient according to a delivery parameter claim 1 ,wherein the immunotherapy includes a chimeric antigen receptor (CAR) T-cell therapy, and the assessment circuit is configured to determine an optimized delivery parameter for delivering the immunotherapy using the determined toxicity indication.3. The system of claim 2 , wherein the delivery parameter includes at least one of a dosage claim 2 , a timing claim 2 , or a drug.4. The system of claim 1 , wherein the assessment circuit is configured to provide an alert to a user using the determined toxicity indication.5. The system of claim 1 , comprising a therapy circuit configured to control a therapy to the patient according to a therapy parameter claim 1 ,wherein the assessment circuit is configured to adjust the therapy parameter using the determined toxicity indication.6. The system of claim 5 , wherein the assessment circuit is configured to:determine an acute toxicity index for the patient using the received physiologic information;compare the determined acute toxicity index to a threshold; andin response to the determined acute toxicity index exceeding the threshold, adjust the therapy parameter using ...

IDENTIFYING P WAVE OVERSENSING

Systems and methods to determine P wave oversensing (PWOS) are disclosed, including identifying cardiac signal features in received cardiac electrical information, determining a first indication of PWOS using a pattern of identified cardiac signal features, and in response to the determined first indication of PWOS, determining a second indication of PWOS using a morphology of the received cardiac electrical information. 1. A system; comprising:a signal receiver circuit configured to receive cardiac electrical information of a patient; identify cardiac signal features in a first portion of the received cardiac electrical information;', 'determine a first indication of P wave oversensing (MOS) in the first portion of the received cardiac electrical information using a pattern of identified cardiac signal features; and', 'in response to the determined first indication of PWOS in the first portion of the received cardiac electrical information, determine a second indication of PWOS in the first portion of the received cardiac electrical information using a morphology of the first portion of the cardiac electrical information., 'an assessment circuit configured to2. The system of claim 1 , wherein the first portion of the received cardiac electrical information includes a first cardiac cycle of the patient claim 1 , andwherein the cardiac signal features include at least one of a P wave or an R wave of the first cardiac cycle.3. The system of claim 1 , wherein the first portion of the received cardiac electrical information includes multiple cardiac cycles of the patient claim 1 , andwherein the cardiac signal features include at least one of a P wave of the multiple cardiac cycles or an R wave of the multiple cardiac cycles.4. The system of claim 1 , wherein the pattern of identified cardiac signal features includes a pattern of amplitudes of the identified cardiac signal features or timings of or between the identified cardiac signal features.5. The system of claim 4 ...

Adaptive event storage in implantable device

Monitoring physiological parameter using an implantable physiological monitor in order to detect a condition predictive of a possible future pathological episode and collecting additional physiological data associated with the condition predictive of a possible future pathological episode. Monitoring another physiological parameter in order to detect a condition indicative of the beginning of a present pathological episode and collecting additional pathological data in response to the condition. Determining that the condition predictive of a future episode and the condition indicative of a present episode are associated and, in response thereto, storing all the collected physiological data.

SYSTEMS AND METHODS FOR DETECTING ATRIAL TACHYARRHYTHMIA

Systems and methods for detecting cardiac arrhythmia are discussed. A medical-device system includes an arrhythmia detector circuit and an event prioritizer circuit. The arrhythmia detector circuit can detect an atrial activation event from a cardiac electrical signal sensed from the patient, and determine an atrial fibrillation (AF) confidence indicator based on a signal characteristic of the atrial activation event. The event prioritizer circuit can generate an event priority for the AF event based on the AF confidence indicator. Multiple AF events may be prioritized in a specific order and presented to a user or a process. 1. A medical-device system for detecting cardiac arrhythmia in a patient , the system comprising:{'claim-text': ['receive a cardiac electrical signal sensed from the patient;', 'detect an atrial fibrillation (AF) event using the cardiac electrical signal;', 'detect an atrial activation event from a cardiac electrical signal; and', 'based at least on a signal characteristic of the detected atrial activation event, determine an AF confidence indicator indicating a confidence level of the detected AF event; and'], '#text': 'an arrhythmia detector circuit configured to:'}an event prioritizer circuit configured to generate an event priority for the AF event based on the AF confidence indicator.2. The system of claim 1 , wherein the arrhythmia detector circuit is configured to:detect the atrial activation event from an ensemble average of segments of the cardiac electrical signal corresponding to a plurality of cardiac cycles; andgenerate the signal characteristic including a peak intensity or a signal power of the detected atrial activation event.3. The system of claim 1 , wherein the arrhythmia detector circuit is configured to:detect a plurality of atrial activation events respectively from segments of the cardiac electrical signal corresponding to a plurality of cardiac cycles;generate signal characteristics respectively from the plurality of ...

IMPLANTED LEAD ANALYSIS SYSTEM AND METHOD

The technology disclosed herein relates to a method for lead analysis for an implanted medical device. A summary data record is retrieved associated with one or more episodes from an implanted medical device through a communication module. Episode selection criteria are applied to the summary data record by a processing module. One or more episode data records are retrieved from the implanted medical device for one or more episodes for which the episode selection criteria was satisfied. Noise detection criteria are applied to the episode data record. A notification module is configured to generate an alert if the noise detection criteria are satisfied 1. An external device for determining a lead-related condition associated with an implantable medical device (IMD) capable of being implanted in a patient:(a) a communication module configured to retrieve patient data from an IMD, wherein the patient data comprises at least episode data records each associated with an episode and a summary data record corresponding to one or more episodes; (i) initiate periodic retrieval of a summary data record by the communication module from the IMD;', '(ii) apply an episode selection criteria to the summary data record to identify one or more episodes of interest,', '(iii) initiate retrieval from the IMD by the communication module of one or more episode data records associated with each episode of interest, and', '(iv) apply noise detection criteria to the one or more episode data records; and, '(b) a processing module configured to execute rapid sensing analysis comprising(c) a notification module configured to generate an alert if the noise detection criteria are satisfied.2. The device of wherein each summary data record of the one or more summary data records comprises a shock indicator indicating whether a shock was delivered by the IMD for a particular episode and the episode selection criteria excludes episodes during which a shock was delivered by the IMD.3. The device of ...

CARDIAC PACING WITH ANODAL STIMULATION DETECTION

Methods and device for determining a pacing vector for delivering an electrostimulation therapy are described. An implantable medical device may be configured to determine an anode capture threshold and a cathode capture threshold for a first anode and cathode pair of electrodes, switch a polarity of the first anode and cathode pair of electrodes, and determine an anode capture threshold and a cathode capture threshold for the first anode and cathode pair of electrodes having the switched polarity. The implantable medical device may be further configured to compare a cathodal capture threshold for the anode and cathode pair having the switched polarity to the anodal capture threshold of the first anode and cathode pair of electrodes and select either an anode or a cathode for delivering an electrostimulation therapy based at least in part on the comparison. Other methods and systems are also contemplated and described. 1. An implantable medical device comprising:an electrostimulation energy delivery circuit configured to deliver a number of pacing pulses to a subject's heart via an electrode configuration comprising a first electrode and a second electrode;an evoked response (ER) sensing circuit configured to sense an ER signal of a subject in response to each of the delivered pacing pulses; and cause the electrostimulation energy delivery circuit to deliver a number of pacing pulses using a first polarity of the first electrode and the second electrode;', 'cause the electrostimulation energy delivery circuit to adjust a pacing energy of the delivered pacing pulses over time, and monitor the ER signal via the evoked response (ER) sensing circuit until a change is detected that indicates a change in capture at the first electrode and/or at the second electrode; and', 'once a change is detected that indicates a change in capture at the first electrode and/or the second electrode, identify from the evoked response if capture is occurring at the second electrode but not ...

SYSTEM AND METHOD FOR SELECTION OF PACING VECTORS

Various techniques are disclosed for quickly and efficiently determining cardiac pacing vectors that minimize phrenic nerve stimulation. 1. (canceled)2. A system comprising:an implantable medical device configured to deliver pacing stimuli to a heart; andat least one processor configured to: deliver a first pacing stimulus at a first specified pacing energy;', 'determine whether, in response to the delivered first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred; and', 'categorize acceptability of the first electrodes of the at least two pacing vectors using information about whether the first cardiac depolarization occurred and whether the first phrenic nerve stimulation occurred., 'for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode3. The system of claim 2 , wherein the determination of whether a first phrenic nerve stimulation occurred includes using physiological information received in response to the delivered first pacing stimulus.4. The system of claim 2 , wherein the at least one processor is configured to adjust the pacing stimulus to determine a first pacing threshold value.5. The system of claim 2 , pair one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, and for a particular pairing:', 'deliver a second pacing stimulus at a second pacing energy;', 'determine whether, in response to the delivered at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred; and', 'categorize the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred; and, 'wherein, for the set of at least two pacing vectors, wherein each vector is at least partially defined by a ...

SYSTEMS AND METHODS FOR DETECTING AND REPORTING ARRHYTHMIAS

Systems and methods for managing cardiac arrhythmias are discussed. A data management system receives a first detection algorithm including a detection criterion for detecting a cardiac arrhythmia. An arrhythmia detector detects arrhythmia episodes from a physiologic signal using a second detection algorithm that is different from and has a higher sensitivity for detecting the cardiac arrhythmia than the first detection algorithm. The arrhythmia detector assigns a detection indicator to each of the detected arrhythmia episodes. The detection indicator indicates a likelihood that the detected arrhythmia episode satisfies the detection criterion of the first detection algorithm. The system prioritizes the detected arrhythmia episodes according to the assigned detection indicators, and outputs the arrhythmia episodes to a user or a process according to the episode prioritization. 1. A system for monitoring cardiac arrhythmia in a patient , comprising: receive arrhythmia detection criteria including a first detection criterion and a second detection criterion having a higher sensitivity to a cardiac arrhythmia than the first detection criterion;', 'detect an arrhythmia episode from a physiologic signal using the second detection criterion; and', 'for the detected arrhythmia episode, determine a detection indicator indicating a likelihood of the detected arrhythmia episode satisfying the first detection criterion; and, 'an arrhythmia detector circuit, configured to initiate an automatic transmission of the detected arrhythmia episode if the detection indicator indicates that the detected arrhythmia episode satisfies the first detection criterion; and', 'initiate a commanded transmission of the detected arrhythmia episode in response to a user command if the detection indicator indicates that the detected arrhythmia episode does not satisfy the first detection criterion., 'a controller circuit configured to initiate data transmission between two devices according to the ...

HIS-BUNDLE OR BUNDLE BRANCH PACING CAPTURE VERIFICATION

Systems and methods for pacing cardiac conductive tissue are described. In an embodiment, a medical system includes an electrostimulation circuit to generate pacing pulses to stimulate a His bundle or a bunch branch. A sensing circuit senses a far-field ventricular activation, determines a cardiac synchrony indicator using the far-field ventricular activation in response to His bundle or bundle branch pacing, and verifies His-bundle capture status using the determined cardiac synchrony indicator. The system can determine a pacing threshold using the capture status under different stimulation strength values. The electrostimulation circuit can deliver stimulation pulses in accordance with the determined pacing threshold. 1. A system for pacing a heart , comprising:an electrostimulation circuit configured to generate electrostimulation pulses to stimulate a His bundle or a bundle branch of the heart;a sensing circuit configured to sense a far-field ventricular activation; and determine a cardiac synchrony indicator using the sensed far-field ventricular activation in response to the electrostimulation of the His bundle or the bundle branch; and', 'verify a capture status using the determined cardiac synchrony indicator., 'a control circuit, including a capture verification circuit configured to2. The system of claim 1 , wherein:the sensing circuit is configured to sense the far-field ventricular activation including a far-field electrogram in response to the stimulation of the His bundle or the bundle branch, and to measure a QRS width using the sensed far-field electrogram; andthe capture verification circuit is configured to verify the capture status using the measured QRS width.3. The system of claim 2 , wherein the capture verification circuit is configured to verify the capture status as one of:a His-bundle capture if the measured QRS width falls below a threshold; ora para-Hisian capture or a loss of capture if the measured QRS width exceeds the threshold.4. The ...

MULTI-SENSOR STROKE DETECTION

This document discusses, among other things, systems, devices, and methods for detecting stroke in a patient. A system may comprise a sensor circuit for sensing in a patient at first physiological signal and a second physiological signal or a functional signal. A stroke risk circuit may establish a physiological trend from at least the first physiological signal over time, and generate a stroke risk indicator using the physiological trend and the second physiological or functional signal. Indications of behavioral or cognitive impairment may also be used in stroke risk indicator generation. The system includes an output unit that outputs the stroke risk indicator to a user or a process. 1. A system for monitoring a patient at risk of a stroke , the system comprising:a sensor circuit, coupled to a first sensor to sense from the patient a first physiological signal and a second sensor to sense from the patient a different second physiological signal or a functional signal; establish a physiological trend from at least the first physiological signal over time; and', 'generate a stroke risk indicator using the physiological trend and the second physiological or functional signal; and, 'a stroke risk circuit communicatively coupled to the sensor circuit, the stroke risk circuit configured toan output unit configured to output the stroke risk indicator to a user or a process.2. The system of claim 1 , wherein the stroke risk circuit is configured to generate the stroke risk indicator using the physiological trend established over a first time window and a second functional signal sensed within a second time window claim 1 , the first time window starting at a time preceding the second time window.3. The system of claim 1 , wherein the stroke risk circuit is configured to generate the stroke risk indicator using the physiological trend and the second physiological or functional signal respectively weighted by weight factors indicating respective physiological or functional ...

INTERACTIVE WEARABLE AND E-TATTOO COMBINATIONS

A system for monitoring one or more respiratory conditions is disclosed. The system comprises a medical device and an e-tattoo configured to attach to the subject's skin. The medical device is configured to monitor at least one respiratory parameter of a subject and transmit a signal in response to monitoring a trigger event in the at least one respiratory parameter. The e-tattoo is configured to: receive the signal from the medical device; sense at least one environmental parameter in response to receiving the signal; and transmit the at least one environmental parameter. 1. A system for monitoring one or more respiratory conditions , the system comprising: monitor at least one respiratory parameter of a subject; and', 'transmit a signal in response to monitoring a trigger event in the at least one respiratory parameter; and, 'a medical device configured to receive the signal from the medical device;', 'sense at least one environmental parameter in response to receiving the signal; and', 'transmit the at least one environmental parameter., "an e-tattoo configured to attach to the subject's skin, the e-tattoo configured to:"}2. The system of claim 1 , wherein the medical device is configured to receive the at least one transmitted environmental parameter.3. The system of claim 2 , wherein the medical device is configured to modify a therapy in response to receiving the at least one transmitted environmental parameter.4. The system of claim 2 , wherein the medical device is further configured to:determine the at least one environmental parameter is an adverse environmental parameter; andprovide, to a subject, an indication the at least one environmental parameter is an adverse environmental parameter.5. The system of claim 1 , wherein the at least one environmental parameter is at least one of: a particulate and a volatile organic compound.6. The system of claim 1 , wherein the trigger event is at least one of: a change in a respiratory sound and a change in ...

System and Methods for Heart Rate and Electrocardiogram Extraction from a Spinal Cord Stimulation System

A system and method for extracting a cardiac signal from a spinal signal include measuring a spinal signal at one or more electrodes that are connected to a neurostimulator and implanted within a patient's spinal canal and processing the spinal signal to extract the cardiac signal, which includes features that are representative of the patient's cardiac activity. Processing the spinal signal to extract the cardiac signal can include filtering the spinal signal, or use of model reduction schemes such as independent component analysis. The extracted cardiac signal can include a number of features that correspond to an electrocardiogram and can be used to determine the patient's heart rate and/or to detect a cardiac anomaly. Cardiac features that are determined from the cardiac signal can additionally be used to adjust parameters of the stimulation that is provided by the neurostimulator. 1. A system , comprising: ["cause the medical device to provide stimulation to the patient's spinal cord at a first one or more of the electrodes;", 'receive information indicative of a spinal signal measured at a second one or more of the electrodes, wherein the spinal signal comprises a neural response to the stimulation; and', "process the information to extract a cardiac signal indicative of the patient's cardiac activity."], "electrodes implantable within a patient's spinal canal, the external device comprising first control circuitry configured to:"}, 'an external device configured to communicate with a medical device comprising'}2. The system of claim 1 , wherein the first control circuitry is configured to process the information using one or more of a low-pass filter claim 1 , a moving average filter claim 1 , or a model reduction scheme to extract the cardiac signal.3. The system of claim 1 , wherein the spinal signal further comprises a stimulation artifact resulting from an electric field created in the spinal column in response to the stimulation.4. The system of claim 1 ...

SYSTEMS AND METHODS FOR DETECTING SLOW AND PERSISTENT CARDIAC RHYTHMS

Systems and methods for detecting slow and persistent rhythms, such as indicative of ventricular response to atrial tachyarrhythmia (AT), are described herein. An arrhythmia detection system monitors patient ventricular heart rate, and identifies slow heart beats with corresponding heart rates falling below a rate threshold during a detection period. The system identifies one or more sustained slow beat (SSB) sequences each including two or more slow heart beats. The system determines a first prevalence indicator of the identified slow heart beats, and a second prevalence indicator of the identified SSB sequences during the detection period. An arrhythmia detector circuit detects a slow and persistent rhythm using the first and second prevalence indicators. 1. A system for detecting cardiac arrhythmias , comprising: monitor a ventricular heart rate corresponding to a plurality of heart beats;', 'identify, from the plurality of heart beats during a detection period, slow heart beats with corresponding heart rates falling below a rate threshold; and', 'identify, during the detection period, one or more sustained slow beat (SSB) sequences each including two or more of the slow heart beats; and, 'a heart rate analyzer circuit configured toan arrhythmia detector circuit configured to detect a slow and persistent rhythm based on the identified slow heart beats and the identified one or more SSB sequences.2. The system of claim 1 , wherein the heart rate analyzer circuit is configured to determine a first prevalence indicator of the identified slow heart beats claim 1 , and a second prevalence indicator of the one or more SSB sequences claim 1 , and the arrhythmia detector circuit is configured to detect the slow and persistent rhythm when (1) the first determined prevalence indicator exceeds a first prevalence threshold claim 1 , and (2) the second determined prevalence indicator exceeds a second prevalence threshold.3. The system of claim 2 , wherein the heart rate ...

AMBULATORY DEHYDRATION MONITORING DURING CANCER THERAPY

Systems and methods to determine an indication of patient dehydration are disclosed, including receiving first and second physiologic information of a patient, the first physiologic information including heart sound information of the patient and the second physiologic information different than the first physiologic information, and determining the indication of patient dehydration using the received first and second physiologic information. 1. A system for determining patient dehydration during cancer therapy , comprising:a signal receiver circuit configured to receive first and second physiologic information of a patient, the first physiologic information comprising heart sound information of the patient, and the second physiologic information different than the first physiologic information; and 'determine an indication of patient dehydration using the received first and second physiologic information.', 'an assessment circuit configured to2. The system of claim 1 , wherein the assessment circuit is configured to determine the indication of patient hydration using the first physiologic information in response to the second physiologic information meeting a predetermined criterion.3. The system of claim 2 , wherein the heart sound information of the patient comprises third heart sound (S3) information of the patient claim 2 ,wherein the second physiologic information comprises impedance information of the patient, andwherein the assessment circuit is configured to determine the indication of patient hydration using the impedance information when a change in S3 information is below a threshold.4. The system of claim 2 , wherein the heart sound information of the patient comprises second heart sound (S2) information of the patient claim 2 ,wherein the second physiologic information comprises at least one of posture or activity information of the patient, andwherein the assessment circuit is configured to determine the indication of patient hydration using the S2 ...

METHOD AND SYSTEM TO IMPROVE CLINICAL WORKFLOW

Described herein are systems and methods for classifying clinical episodes in order to more accurately generate alerts for those episodes that warrant them. In some embodiments, alerts are only generated for those episodes that are new or different from previous episodes, where the previous episodes have been found to be not significant enough to warrant an alert. 1. A computing device , comprising:processing circuitry and memory;wherein the processing circuitry is configured to:accept input data relating to past clinical episodes collected from a patient over time;group the past clinical episodes into one or more classification clusters accordance with a similarity metric;receive additional input data relating to a new clinical episode collected from the patient;assign the new clinical episode to a classification cluster if the new clinical episode is similar to one or more of the past clinical episode contained within the classification cluster as determined the similarity metric; and,issue an alert or display the new clinical episode on a display if the new clinical episode is not assigned to a classification cluster.2. The device of wherein past and new clinical episodes are represented by an episode vector in a p-dimensional vector space made up of p numerically valued features reflective of the patient's clinical condition claim 1 , p being an integer and wherein the processing circuitry is further configured to:apply a clustering procedure to the past episode vectors to compute clusters that groups the past episode vectors into a plurality of clusters based upon a distance metric in the p-dimensional vector space; and,define the one or more classification clusters as represented by the centroids of clusters of past episode vectors generated by the clustering procedure; and,assign a new episode vector representing a recent clinical episode to the classification cluster that corresponds to the centroid closest to the new episode vector if the distance from the ...

SYSTEMS AND METHODS FOR DETECTING ARRHYTHMIAS

Systems and methods for detecting cardiac arrhythmia are discussed. An exemplary arrhythmia detection system can receive physiologic information of the patient, measure a first signal metric using a first portion of the received physiologic information, and determine an arrhythmia detection duration using a comparison between the measured first signal metric and a reference signal metric value. The system includes an arrhythmia detector to detect an AT episode using a second portion of the physiologic information corresponding to the determined arrhythmia detection duration. 1. A system for detecting cardiac arrhythmia in a patient , comprising: receive physiologic information of the patient;', 'measure a first signal metric using a first portion of the received physiologic information; and', 'compare the first signal metric to one or more thresholds, and determine an atrial tachyarrhythmia (AT) detection criterion based on the comparison; and, 'a detection criterion circuit configured toan arrhythmia detector circuit configured to detect an AT episode using a second portion of the physiologic information and the determined AT detection criterion.2. The system of claim 1 , wherein the detection criterion circuit is configured to determine the AT detection criterion including an arrhythmia detection duration using a comparison between the measured first signal metric and a reference detection threshold claim 1 , and wherein the arrhythmia detector circuit is configured to:identify the AT episode as a sustained AT if the second portion of the physiologic information satisfies a detection criterion through the determined arrhythmia detection duration;determine that no AT episode is present if the second portion of the physiologic information fails to satisfy the detection criterion through the determined arrhythmia detection duration; andidentify the AT episode as a non-sustained AT if the second portion of the physiologic information inconsistently satisfies the ...

SYSTEMS AND METHODS FOR DETECTING ARRHYTHMIAS

Systems and methods for detecting cardiac arrhythmias such as atrial tachyarrhythmia (AT) are discussed. An exemplary system includes a ventricular beat analyzer circuit to detect ventricular beats and assess ventricular activity, such as to evaluate a ventricular rate stability. The system includes an arrhythmia detector circuit to detect respective AT indications in distinct time periods using portions of received physiologic information during the distinct time periods. A control circuit can monitor the ventricular beats on a beat-by-beat basis, in response to the detected ventricular beats satisfying an instability condition, trigger AT detections during the distinct time periods and withhold AT detection in a subsequent time period if no AT is detected in the present time period. An AT characteristic may be generated using the detected AT indications. A therapy may be delivered in accordance with the AT characteristic. 1. A system for detecting atrial tachyarrhythmia (AT) , comprising:a ventricular beat analyzer circuit configured to receive physiologic information of a patient and to detect ventricular beats using the received physiologic information;an arrhythmia detector circuit configured to detect respective AT indications in distinct time periods using portions of the received physiologic information during the distinct time periods; and monitor the ventricular beats on a beat-by-beat basis, and in response to the ventricular beats satisfying an instability criterion indicative of unstable ventricular rate, trigger the arrhythmia detector circuit to detect the respective AT indications in distinct time periods using stability of ventricular beats in the distinct time periods; and', 'determine an AT characteristic using the detected respective AT indications., 'a control circuit configured to2. The system of claim 1 , wherein:the ventricular beat analyzer circuit is configured to evaluate a ventricular rate stability (VRS) using the detected ventricular ...

HIS-BUNDLE PACING FOR RATE REGULARIZATION

Systems and methods for pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT. 1. A medical-device system , comprising:an arrhythmia detector configured to detect an atrial tachyarrhythmia (AT) indication with intermittent ventricular conduction in a patient; and receive information of ventricular activation;', 'in response to a detected AT indication, determine a His-bundle pacing (HBP) configuration using the received information of ventricular activation; and', 'control an electrostimulation circuit configured to generate HBP pulses, and provide a control signal to deliver the generated HBP pulses to stimulate a physiologic conduction pathway of a heart of the patient in accordance with the determined HBP configuration to regularize ventricular activation rate., 'a control circuit configured to2. The system of claim 1 , including the electrostimulation circuit claim 1 , wherein:the control circuit is configured to detect ventricular beats from the received information of ventricular activation, and in response to the detected AT indication, update the HBP configuration on a beat-by-beat basis using the detected ventricular beats; andthe electrostimulation circuit is configured to stimulate the physiologic conduction pathway in accordance with the updated HBP ...

ATRIOVENTRICULAR CONDUCTION GUIDED HIS-BUNDLE PACING

Systems and methods for dynamically controlling HBP delivery based on patient AV conduction status are disclosed. An exemplary medical system includes an electrostimulation circuit to generate HBP pulses to stimulate a His bundle or a bundle branch of the heart. An AV conduction monitor circuit continuously or periodically assesses AV conduction status, and detects an indication of presence or absence of AV conduction abnormality. If an AV conduction abnormality is indicated, a control circuit may control the electrostimulation circuit to deliver the HBP pulses. Ventricular backup pacing may be delivered if HBP fails to capture and elicit ventricular activation. When the AV conduction become normal, the control circuit may withhold HBP delivery and promote patient intrinsic ventricular activation. 1. A medical-device system , comprising:an atrioventricular (AV) conduction monitor circuit configured to detect an indication of a presence or absence of AV conduction abnormality of a heart of a subject; and in response to a detected indication of presence of AV conduction abnormality of the heart, deliver HBP pulses to stimulate a physiologic conduction pathway of the heart; and', 'in response to a detected indication of absence of AV conduction abnormality of the heart, withhold delivery of HBP pulses., 'a control circuit configured to control an electrostimulation circuit configured to generate His-bundle pacing (HBP) pulses, and to provide a control signal to2. The system of claim 1 , including the electrostimulation circuit claim 1 , wherein claim 1 , in response to the detected indication of absence of AV conduction abnormality:the control circuit is configured to sense an intrinsic ventricular activation during a first atrioventricular delay (AVD) that begins at the atrial sensed event or the atrial paced event; andthe electrostimulation circuit is configured to deliver ventricular demand pacing (VDP) at expiration of the first AVD if no intrinsic ventricular ...

ATRIAL FIBRILLATION DISCRIMINATION USING HEART RATE CLUSTERING

This document discusses, among other things, apparatus, systems, and methods to determine a first atrial fibrillation (AF) indication using received information about a heart over a first period, to cluster depolarization information about the heart over the first period, and to discriminate between an atrial fibrillation (AF) event and a non-AF event in the first period using the determined first AF indication the clustered depolarization information. 1. A system , comprising: a first AF detection circuit configured to determine a first AF indication in the first period using the received information about the heart; and', 'a second AF detection circuit configured to receive depolarization information about the heart over the first period, and to cluster the received depolarization information,, 'an atrial fibrillation (AF) detection circuit configured to receive information about a heart over a first period including a number of cardiac intervals, and to discriminate between an AF event and a non-AF event, the AF detection circuit includingwherein the AF detection circuit is configured to discriminate between an AF event and a non-AF event in the first period using the determined first AF indication and the clustered depolarization information.2. The system of claim 1 , wherein claim 1 , if the first AF indication is indicative of an AF event in the first period claim 1 , the second AF detection circuit is configured to cluster the received depolarization information to verify the first AF indication claim 1 , andwherein the AF detection circuit is configured to provide an indication of an AF event in the first period if the first AF indication is indicative of an AF event in the first period and the clustered depolarization information is indicative of an AF event in the first period.3. The system of claim 1 , wherein claim 1 , if the first AF indication is indicative of a non-AF event over the first period claim 1 , the second AF detection circuit does not ...

IDENTIFICATION OF IMPLANTED ELECTRODE LOCATION

A medical device system has a medical device interface configured to download data from an implanted medical device. Memory stores electrode location identification rules and display definitions. Each of the display definitions correspond to possible electrode placement locations of the implanted medical device. Processing circuitry is configured to compare the downloaded data from the implanted medical device to the electrode location identification rules to identify one or more actual electrode placement locations of the possible electrode placement locations of the implanted medical device. A user output interface is in communication with the processing circuitry. The processing circuitry is configured to cause the output to display the one or more actual electrode placement locations. 1. A medical device system comprising:a medical device interface configured to download data from an implanted medical device;memory storing electrode location identification rules and display definitions, wherein each of the display definitions correspond to possible electrode placement locations of the implanted medical device;processing circuitry configured to compare the downloaded data from the implanted medical device to the electrode location identification rules to identify one or more actual electrode placement locations of the possible electrode placement locations of the implanted medical device; anda user output interface in communication with the processing circuitry, wherein the processing circuitry is configured to cause the user output interface to display the one or more actual electrode placement locations.2. A medical device system of claim 1 , wherein the downloaded data comprises patient physiological data claim 1 , and the user output interface is configured to display a graphical representation of the downloaded data.3. A medical device system of claim 2 , wherein the downloaded data further comprises electrode location data and the processing circuitry is ...

His-bundle pacing system with left-ventricular pacing

Systems and methods for cardiac pacing are described in this document. A medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to capture a His bundle, and LV pacing (LVP) pulses to capture a left ventricle. A sensing circuit may sense a cardiac activity, such as an atrial or an LV cardiac electrical activity. The system includes a control circuit controlling the delivery of HBP and LVP pulses. The HBP and LVP may be delivered concurrently or sequentially. In an example, the LVP pulses may be delivered based on a His-bundle capture status in response to the HBP pulse. The system may adjust one or more His-bundle stimulation parameters based on the His-bundle capture status.

SIGNAL QUALITY MONITORING FOR MULTIPLE SENSE VECTORS IN CARDIAC DEVICES

New and alternative approaches to the monitoring of cardiac signal quality for external and/or implantable cardiac devices. In one example, signal quality is monitored continuously or in response to a triggering event or condition and, upon identification of a reduction in signal quality, a device may reconfigure its sensing state. In another example, one or more trends of signal quality are monitored by a device, either continuously or in response to a triggering event or condition, and sensing reconfiguration may be performed in response to identified trends and events. In yet another example, a device may use a looping data capture mode to track sensing data in multiple vectors while primarily relying on less than all sensing vectors to make decisions and, in response to a triggering event or condition, the looped data can be analyzed automatically, without waiting for additional data capture to reconfigure sensing upon identification of the triggering event or condition. In another example a device calculates a composite cardiac cycle by overlaying signal morphology for a number of cardiac cycles and analyzes the composite cardiac cycle to calculate signal quality metrics. 1. A cardiac rhythm management device having a plurality of sensing electrodes defining at least first and second sensing vectors coupled to operational circuitry configured to select a default sensing vector from among the at least first and second sensing vectors , wherein the operational circuitry is configured to perform the following:analyzing a cardiac signal captured using the default sensing vector to determine whether an arrhythmia appears to be present, while a set of disabled sensing vectors that does not include the default sensing vector is disabled;determining that an arrhythmia is likely occurring using analysis of the cardiac signal captured using the default sensing vector;enabling one or more disabled sensing vectors from the set of the disabled sensing vectors to capture ...

METHOD AND APPARATUS FOR ENHANCING ATRIAL FIBRILLATION DETECTION

An example of a system may include a sensing circuit and an atrial fibrillation (AF) detection circuit. The sensing circuit may be configured to sense a cardiac signal indicative of atrial and ventricular depolarizations. The AF detection circuit may be configured to detect AF using the cardiac signal and may include a detector and a detection enhancer. The detector may be configured to detect the ventricular depolarizations using the cardiac signal, to measure ventricular intervals each between two successively detected ventricular depolarizations, and to detect the AF using the ventricular intervals. The detection enhancer may include a respiratory sinus arrhythmia (RSA) detector configured to detect RSA using the cardiac signal and may be configured to verify each detection of the AF based on whether the RSA is detected. 1. A system , comprising:a sensing circuit configured to sense a cardiac signal indicative of atrial and ventricular depolarizations; and a detector configured to detect the ventricular depolarizations using the cardiac signal, to measure ventricular intervals each between two successively detected ventricular depolarizations, and to detect the AF using the ventricular intervals; and', 'a detection enhancer including a respiratory sinus arrhythmia (RSA) detector configured to detect RSA using the cardiac signal, the detection enhancer configured to verify each detection of the AF based on whether the RSA is detected., 'an atrial fibrillation (AF) detection circuit configured to detect AF using the cardiac signal, the AF detection circuit including2. The system of claim 1 , wherein the detector is configured to compute a measure of ventricular rate variability using the ventricular intervals and to indicate a suggested detection of the AF in response the measure of ventricular rate variability satisfying one or more criteria for the AF claim 1 , and the detection enhancer is configured to indicate a detection of the AF in response to the suggested ...

SYSTEMS AND METHODS FOR DETECTING AND REPORTING ARRHYTHMIAS

Systems and methods for managing cardiac arrhythmias are discussed. A data management system receives a first detection algorithm including a detection criterion for detecting a cardiac arrhythmia. An arrhythmia detector detects arrhythmia episodes from a physiologic signal using a second detection algorithm that is different from and has a higher sensitivity for detecting the cardiac arrhythmia than the first detection algorithm. The arrhythmia detector assigns a detection indicator to each of the detected arrhythmia episodes. The detection indicator indicates a likelihood that the detected arrhythmia episode satisfies the detection criterion of the first detection algorithm. The system prioritizes the detected arrhythmia episodes according to the assigned detection indicators, and outputs the arrhythmia episodes to a user or a process according to the episode prioritization. 1. A system for monitoring cardiac arrhythmia , comprising: receive a physiologic signal and a first detection algorithm having a first sensitivity, the first detection algorithm including a detection criterion for detecting a cardiac arrhythmia;', 'detect an arrhythmia episode from the physiologic signal using a second detection algorithm having a second sensitivity higher than the first sensitivity of the first detection algorithm for detecting the cardiac arrhythmia; and', 'assign a detection indicator to the detected arrhythmia episode, the detection indicator indicating a likelihood that the detected arrhythmia episode satisfies the detection criterion of the first detection algorithm; and, 'an arrhythmia detector circuit configured toan event prioritizer circuit configured to prioritize the detected arrhythmia episode according to the assigned detection indicators.2. The system of claim 1 , wherein the arrhythmia detector circuit is configured to generate the second detection algorithm by adjusting one or more detection parameters of the first detection algorithm.3. The system of claim 2 ...

SYSTEMS AND METHODS FOR DETECTING CHRONIC CARDIAC OVER-PACING

Systems and methods for monitoring chronic over-pacing (COP) to the heart are discussed herein. In an embodiment, a system includes a receiver circuit to receive information about pacing rates of a plurality of paced heart beats, and a pacing analyzer circuit to generate a pacing rate distribution using pacing rates of the plurality of the paced heart beats. The pacing rate distribution includes a pacing rate histogram. The pacing analyzer circuit may recognize a morphological pattern from the pacing rate distribution, and detect a COP indication using the extracted feature. A programmer circuit adjusts one or more therapy parameters in response to the detected. COP indication. 1. A system for managing cardiac pacing in a patient , the system comprising:a receiver circuit configured to receive pacing rates of paced heart beats; and generate a pacing rate distribution using the received pacing rates;', 'extract a feature from the generated pacing rate distribution; and', 'detect a chronic over-pacing (COP) indication using the extracted feature., 'a pacing analyzer circuit configured to2. The system of claim 1 , wherein the pacing analyzer circuit is configured to generate the pacing rate distribution including a pacing rate histogram representing a relative number of paced heart beats with pacing rates falling into each of a plurality of pacing rate bins.3. The system of claim 1 , wherein the extracted feature includes a peak density of the pacing rate distribution.4. The system of claim 3 , wherein the pacing analyzer circuit is configured to detect the COP indication if the peak density includes at least two peaks in the pacing rate distribution.5. The system of claim 2 , wherein the extracted feature includes a morphological pattern of one or more peaks in the pacing rate distribution.6. The system of claim 5 , wherein the morphological pattern includes a slope of the pacing rate histogram across pacing rate bins claim 5 , and the pacing analyzer circuit is ...

SYSTEMS AND METHODS FOR PRESENTING ARRHYTHMIA EPISODES

Systems and methods for managing machine-generated alert notifications of medical events detected from one or more patients are described herein. An embodiment of a data management system may receive an adjudication of a medical event episode including an episode characterization. A storage unit stores an association between one or more episode characterizations and corresponding detection algorithms for detecting a medical event having respective episode characterizations. An episode management circuit may detect from a subsequent episode, using the stored association, a medical event having an episode characterization of at least one medical event episode presented for adjudication, and schedule presenting at least a portion of the subsequent episode based on the detection. 1. A system for managing medical events generated by a medical device , the system comprising:a user interface configured to receive, from a user, an adjudication including an episode characterization characterizing a presented medical event episode;a memory circuit configured to store an association between one or more episode characterizations and corresponding one or more detection algorithms for detecting a medical event having respective episode characterizations; andan episode management circuit configured to detect a medical event from a subsequent episode using a detection algorithm corresponding to the episode characterization of the medical event episode presented for adjudication according to the stored association in the memory circuit.2. The system of claim 1 , wherein:the user interface is configured to present at least a portion of a first arrhythmia episode generated by the medical device and to receive from the user an adjudication decision and a first episode characterization of the first arrhythmia episode; and identify, from the stored association, a detection algorithm corresponding to the first episode characterization of the first arrhythmia episode;', 'process a second ...

Atrial fibrillation detection

An apparatus includes a sensing circuit configured to generate a sensed physiological signal representative of cardiac activity of a subject, and an arrhythmia detection circuit. The arrhythmia detection circuit is configured to monitor information corresponding to ventricular depolarization (V-V) intervals using the sensed physiological signal; determine a V-V interval distribution; determine a heart rate density index (HRDI) as a portion of samples of the V-V interval distribution corresponding to a V-V interval occurring most often in the distribution; and generate an indication of atrial fibrillation (AF) using the HRDI.

PACEMAKER WITH DIAGNOSTIC INTRINSIC BEAT SEARCH

Regulating cardiac activity may include pacing the patient's heart at a starting pacing rate and instigating an intrinsic heart beat search algorithm that includes pacing at a reduced rate for a period of time and capturing electrical signals representative of cardiac electrical activity while pacing at the reduced rate in order to determine a presence or absence of intrinsic heart beats. If intrinsic heart beats are not detected, the heart may be paced at a further reduced rate for a period of time. If intrinsic beats are detected, the heart may be paced again at the starting pacing rate. This may continue until intrinsic heart beats are detected or until a lower search rate limit is reached. Diagnostic data may be collected at each stage and transmitted to a display device for analysis by a physician or the like. 1. An implantable medical device (IMD) configured to sense electrical cardiac activity of a patient's heart and to pace a ventricle of the patient's heart , the IMD comprising:a housing;a plurality of electrodes;a controller disposed within the housing and operably coupled to the plurality of electrodes such that the controller can receive electrical signals from at least two of the plurality of electrodes representing electrical cardiac activity and can deliver pacing pulses to the ventricle of the patient's heart via at least two of the plurality of electrodes;a communications module operably coupled to the controller and configured to wirelessly communicate with a remotely located device;the controller is configured to pace the ventricle of the patient's heart at a therapy based pacing rate using a plurality of pacing pulses but where one or more of the plurality of pacing pulses may be inhibited by a corresponding sensed intrinsic beat; identify a first reduced pacing rate representing a reduction relative to the therapy based pacing rate;', "pace the ventricle of the patient's heart for a period of time at the first reduced pacing rate using a ...

AUTO-THRESHOLD TEST FOR HIS-BUNDLE PACING

Systems and methods for pacing cardiac conductive tissue are described. A medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses. A sensing circuit senses a physiologic signal, and detect a local His-bundle activation discrete from a pacing artifact of the HBP pulse. A control circuit verifies capture status in response to the HBP pulses. Based on the capture status, the control circuit determines one or more pacing thresholds including a selective HBP threshold representing a threshold strength to capture only the His bundle but not the local myocardium, and a non-selective HBP threshold representing a threshold strength to capture both the His bundle and the local myocardium. The electrostimulation circuit may deliver HBP pulses based on the selective and non-selective HBP thresholds. 1. A system for pacing a heart , comprising:an electrostimulation circuit configured to generate His-bundle pacing (HBP) pulses having a stimulation strength to stimulate a His bundle of the heart;a sensing circuit configured to sense a physiologic signal and to detect, from the sensed physiologic signal, a local His-bundle activation discrete from a pacing artifact of the delivered HBP pulses; and verify a capture status using the detection of the local His-bundle activation; and', 'determine, using the verified capture status, one or more of (1) a selective HBP threshold (S-threshold) representing a threshold strength for the HBP pulses to capture only the His bundle but not local myocardium, or (2) a non-selective HBP threshold (NS-threshold) representing a threshold strength for the HBP pulses to capture both the His bundle and the local myocardium., 'a control circuit configured to2. The system of claim 1 , wherein the sensing circuit is configured to detect an isoelectric interval that separates the local His-bundle activation from the pacing artifact of the HBP pulse claim 1 , and the control circuit is configured to verify the capture ...

System and Methods for Heart Rate and Electrocardiogram Extraction from a Spinal Cord Stimulation System

A system and method for extracting a cardiac signal from a spinal signal include measuring a spinal signal at one or more electrodes that are connected to a neurostimulator and implanted within a patient's spinal canal and processing the spinal signal to extract the cardiac signal, which includes features that are representative of the patient's cardiac activity. Processing the spinal signal to extract the cardiac signal can include filtering the spinal signal using a first low-pass filter and a second moving average filter. Model reduction schemes such as independent component analysis can additionally or alternatively be employed to extract the cardiac signal. The extracted cardiac signal can include a number of features that correspond to an electrocardiogram and can be used to determine the patient's heart rate and/or to detect a cardiac anomaly. Cardiac features that are determined from the cardiac signal can additionally be used to adjust parameters of the stimulation that is provided by the neurostimulator. 1. A system comprising:measurement circuitry configured to measure a spinal signal at one or more electrodes that are connectable to a neurostimulator and implantable within a patient's spinal canal; andprocessing circuitry configured to process the spinal signal to extract a cardiac signal that comprises one or more features that are representative of the patient's cardiac activity.2. The system of claim 1 , wherein the processing circuitry is configured to process the spinal signal using one or more of a low-pass filter claim 1 , a moving average filter claim 1 , or a model reduction scheme to extract a cardiac signal.3. The system of claim 1 , wherein the measurement circuitry is within the neurostimulator.4. The system of claim 3 , wherein the processing circuitry is within the neurostimulator.5. The system of claim 3 , wherein the system further comprises control circuitry configured to control stimulation circuitry to provide electrical stimulation ...

MULTIPOLAR LEAD FOR HIS BUNDLE PACING

A device for the active fixation of an implantable medical lead includes a housing, a tine assembly, an electrode, and a rotatable shaft. The housing includes a proximal end for connecting to the lead and a distal end opposite the proximal end. The housing defines a housing lumen extending between the proximal end and a recess adjacent to the distal end. The tine assembly is disposed within the housing lumen and includes at least one tine configured to self-bias from a linear configuration within the housing to a curved configuration outside of the housing. The electrode assembly is disposed at the distal end of the housing and includes a plurality of electrodes. The rotatable shaft extends through the housing lumen and is configured to engage the tine assembly such that rotation of the shaft transitions the at least one tine between the linear configuration and the curved configuration. 1. A device for the active fixation of an implantable medical lead into tissue , the device comprising:a housing including a proximal end for connecting to the lead and a distal end opposite the proximal end, the housing defining a housing lumen having a longitudinal axis, the housing lumen extending between the proximal end and a recess adjacent to the distal end;a tine assembly disposed within the housing lumen, the tine assembly including at least one tine configured to self-bias from a linear configuration within the housing to a curved configuration outside of the housing; a conical tip electrode; and', 'an anode electrode proximal of the conical tip electrode; and, 'an electrode assembly disposed at the distal end of the housing, the electrode assembly includinga rotatable shaft extending through the housing lumen, the shaft configured to engage the tine assembly such that rotation of the shaft transitions the at least one tine between the linear configuration and the curved configuration.2. The device of claim 1 , wherein rotation of the shaft in a first direction moves the ...

PVC ADJUSTED AF DETECTION

This document discusses, among other things, systems and methods to receive cardiac electrical information and premature ventricular contraction (PVC) information of a subject, detect atrial fibrillation (AF) of the subject using the received cardiac electrical information, and adjust AF detection using the received PVC information. 1. A system , comprising:a signal receiver circuit configured to receive cardiac electrical information and premature ventricular contraction (PVC) information of a subject; and detect atrial fibrillation (AF) of the subject using the received cardiac electrical information; and', 'adjust the AF detection using the received PVC information., 'an assessment circuit configured to2. The system of claim 1 , wherein the assessment circuit is configured to determine a PVC state of the subject using the received PVC information and to adjust AF detection using the determined PVC state.3. The system of claim 2 , wherein the assessment circuit is configured to detect a PVC event using the received PVC information and to count detected PVC events in a first detection window.4. The system of claim 3 , wherein the assessment circuit is configured to determine the PVC state of the subject and to adjust the AF detection using the count of PVC events in the first detection window.5. The system of claim 3 , wherein the received PVC information comprises an indication of a detected PVC event.6. The system of claim 3 , wherein claim 3 , if the PVC event count is below a first threshold claim 3 , the assessment circuit is configured to determine a low-PVC state claim 3 , and the system is configured to detect AF of the subject using a low-PVC burden mode claim 3 , andwherein, if the PVC event count meets or exceeds the first threshold, the medial-device system is configured to determine a high-PVC state, and the system is configured to detect AF of the subject using a high-PVC burden mode.7. The system of claim 6 , wherein the assessment circuit is ...

LONG-DURATION ARRHYTHMIA DETECTION

This document discusses, among other things, systems and methods to detect an initial arrhythmia event indication and, after a threshold amount of detection window intervals detecting the initial arrhythmia event indication, adjust a set of arrhythmia parameters or at least one of a respective set of parameter thresholds to increase sensitivity of an extended arrhythmia event indication detection. 1. A system , comprising:a signal receiver circuit configured to receive cardiac electrical information of a subject; and determine a set of arrhythmia parameters for a detection window interval using the received cardiac electrical information of the subject, the set including at least one arrhythmia parameter; and', 'detect, for the detection window interval, an initial arrhythmia event indication using the determined set of arrhythmia parameters and a respective set of parameter thresholds,, 'an assessment circuit configured to perform event detection, comprising to 'adjust the set of arrhythmia parameters or at least one of the respective set of parameter thresholds to increase sensitivity of an extended arrhythmia event indication detection using the adjusted set of arrhythmia parameters or at least one of the respective set of parameter thresholds.', 'wherein, after a threshold amount of detection window intervals detecting the initial arrhythmia event indication, the assessment circuit is configured to adjust the event detection, comprising to2. The system of claim 1 , wherein the threshold amount of detection window intervals detecting the initial arrhythmia event indication comprises a threshold amount of successive detection window intervals detecting the initial arrhythmia event indication.3. The system of claim 2 , wherein the assessment circuit is configured to detect claim 2 , for a subsequent detection window interval claim 2 , subsequent to the successive detection window intervals claim 2 , an extended arrhythmia event indication using the adjusted set of ...

Systems and methods for detecting arrhythmias

Systems and methods for ambulatory detection of medical events such as cardiac arrhythmia are described herein. An embodiment of an arrhythmia detection system may include a detection criterion circuit that determines a patient-specific detection criterion using a baseline cardiac characteristic when the patient is free of cardiac arrhythmias. The detection criterion circuit generates a patient-specific threshold of a signal metric by adjusting a population-based threshold of the signal metric, where the manner and the amount of adjustment is based on information about patient baseline cardiac characteristic. The arrhythmia detection system detects an arrhythmia episode using a physiologic signal sensed from the patient and the patient-specific arrhythmia detection threshold.

ARRHYTHMIA CLASSIFICATION USING CORRELATION IMAGE

Systems and methods for classifying a cardiac arrhythmia are discussed. An exemplary system includes a correlator circuit to generate autocorrelation sequences using information of cardiac activity of a subject, including signal segments taken from a cardiac signal at respective elapsed time with respect to reference time. The correlator circuit can generate a correlation image using the autocorrelation sequences. The correlation image may be constructed by stacking the autocorrelation sequences according to the elapsed time of signal segments. An arrhythmia classifier circuit can classify the cardiac activity of the subject as one of arrhythmia types using the correlation image. 1. A system , comprising:a correlator circuit configured to receive information of cardiac activity of a subject, to generate autocorrelation sequences using the received cardiac activity information, and to generate a correlation image using a plurality of the generated autocorrelation sequences; andan arrhythmia classifier circuit configured to classify the cardiac activity of the subject as one of multiple arrhythmia types using the generated correlation image.2. The system of claim 1 , wherein the multiple arrhythmia types comprise an atrial tachyarrhythmia type and a ventricular tachyarrhythmia type.3. The system of claim 1 , wherein the information of cardiac activity includes a cardiac signal claim 1 , and the correlator circuit is configured to:generate the autocorrelation sequences using respective signal segments and a plurality of time lags, the signal segments each taken from the cardiac signal and starting at a respective elapsed time after a reference time; andgenerate the correlation image by stacking a plurality of the generated autocorrelation sequences according to the respective elapsed time of the signal segments.4. The system of claim 3 , wherein the correlator circuit is configured to determine a range of heart rates corresponding to the plurality of time lags claim 3 ...

Automated screening methods and apparatuses for implantable medical devices

Automated pre-implant screening for candidate recipients of implantable medical devices. A set of cutaneous electrodes placed on a patient transcutaneously capture a cardiac signal using a screening device coupled to the electrodes. A first beat rate may be determined by identifying individual R-waves, QRS complexes or cardiac cycles from the captured cardiac signal using the cutaneous electrodes. A second beat rate may be calculated using one of several different methods, for example, by optical measurement, by monitoring heart sounds, by a second electric cardiac signal analysis, or by using an implanted device. The rates are compared to one another and, if a match is identified, the patient is deemed well suited to receive a particular device.

Multi-vector sensing in cardiac devices with signal combinations

Methods and devices for combining multiple signals from multiple sensing vectors for use in wearable or implantable cardiac devices. Signals from multiple vectors may be combined using weighting factors and/or by conversion to different coordinate systems than the original inputs, which may or may not be normalized to patient anatomy. Signals from multiple sensing vectors may be combined prior to or after several analytical steps or processes including before or after filtering, and before or after cardiac cycle detection. Cardiac cycle detection information may be combined across multiple sensing vectors before or after analysis of individual vectors for noise or overdetection. Cardiac cycle detection information may also be combined across multiple sensing vectors to identify noise and/or overdetection.

Adaptive event storage in an implantable device

Monitoring physiological parameter using an implantable physiological monitor in order to detect a condition predictive of a possible future pathological episode and collecting additional physiological data associated with the condition predictive of a possible future pathological episode. Monitoring, using the physiological monitor, another physiological parameter in order to detect a condition indicative of the beginning of a present pathological episode and collecting additional pathological data in response to the condition. Determining that the condition predictive of a future episode and the condition indicative of a present episode are associated and, in response thereto, storing all the collected physiological data.

Intracardiac electrogram time frequency noise detection

Systems, methods, and apparatus for identifying and classifying noise of an intracardiac electrogram of a cardiac rhythm management device to prevent inaccurate detection of a cardiac episode are disclosed. In an example, three channels are analyzed to identify and determine whether an episode or noise has been detected.

Systems for detecting arrhythmias

Systems and methods for detecting cardiac arrhythmia are discussed. An exemplary arrhythmia detection system can receive physiologic information of the patient, measure a first signal metric using a first portion of the received physiologic information, and determine an arrhythmia detection duration using a comparison between the measured first signal metric and a reference signal metric value. The system includes an arrhythmia detector to detect an AT episode using a second portion of the physiologic information corresponding to the determined arrhythmia detection duration.

Reducing false positives in detection of potential cardiac pauses

Embodiments of the disclosure include systems and methods for reducing false positives in detection of pauses. For example, embodiments include a sensing component configured to obtain values of a first physiological parameter and determine a cardiac pause based on the values of the first physiological parameter. Furthermore, embodiments include performing a validation check of the determined cardiac pause using at least one of: the values of the first physiological parameter or values of a second physiological parameter.

Systems for detecting arrhythmias

Signal quality monitoring for multiple sense vectors in cardiac devices

New and alternative approaches to the monitoring of cardiac signal quality for external and/or implantable cardiac devices. In one example, signal quality is monitored continuously or in response to a triggering event or condition and, upon identification of a reduction in signal quality, a device may reconfigure its sensing state. In another example, one or more trends of signal quality are monitored by a device, either continuously or in response to a triggering event or condition, and sensing reconfiguration may be performed in response to identified trends and events. In yet another example, a device may use a looping data capture mode to track sensing data in multiple vectors while primarily relying on less than all sensing vectors to make decisions and, in response to a triggering event or condition, the looped data can be analyzed automatically, without waiting for additional data capture to reconfigure sensing upon identification of the triggering event or condition. In another example a device calculates a composite cardiac cycle by overlaying signal morphology for a number of cardiac cycles and analyzes the composite cardiac cycle to calculate signal quality metrics.

Enhanced reporting of pathological episodes

An apparatus comprises a sensor circuit configured to produce a time-varying physiologic sensor signal of a subject and a pathology detection circuit communicatively coupled to the sensor. The pathology detection circuit is configured to detect a first pathological episode using the sensed physiologic sensor signal, deem that the first pathological episode has ended, detect at least one second pathological episode using the sensed physiologic sensor signal, and indicate the first and second pathological episodes as one pathological episode if the first and second episode are detected within a specified time interval.

Arrythmia adjudication and therapy training systems and methods

A system and method for presenting arrhythmia episode information to a user are described. An episode database has episode data regarding a plurality of different arrhythmia episodes generated from a plurality of data-generating devices. A user interface is configured to display the episode data for one of the arrhythmia episodes and receive characterization data from the user characterizing the displayed episode data. An adjudication database has adjudication conclusions associated with the arrhythmia episodes in the episode database. The system further includes an adjudication processor, configured to process characterization data relative to the adjudication database.

Confidence of arrhythmia detection

Systems and methods for detecting an arrhythmic event and storing physiological information associated with the detected arrhythmic event are described. A system may include a first detector to detect an arrhythmic event from a physiological signal sensed from a subject, and generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event. If the confidence indicator indicates a relatively high confidence of arrhythmia detection, the system may provide the detected arrhythmic event to a first process for storing the detected arrhythmic event or generating an alert. If the confidence indicator indicates a relatively low confidence of arrhythmia detection, the system may provide the detected arrhythmic event to at least a second process including confirming or rejecting the detected arrhythmic event.

Adjustable sensing in a His-bundle pacemaker

Systems and methods for pacing cardiac conductive tissue are described. An embodiment of a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to stimulate a His bundle, and a cardiac event detector to detect a His-bundle activity within a time window following an atrial activity. The cardiac event detector may use a cross-chamber blanking, or an adjustable His-bundle sensing threshold, to avoid or reduce over-sensing of far-field atrial activity and inappropriate inhibition of HBP therapy. The electrostimulation circuit may deliver HBP in the presence of the His-bundle activity. The system may further recognize the detected His-bundle activity as either a FFPW or a valid inhibitory event, and deliver or withhold HBP therapy based on the recognition of the His-bundle activity.

Confidence of arrhythmia detection

Systems and methods for detecting an arrhythmic event and storing physiological information associated with the detected arrhythmic event are described. A system may include a first detector to detect an arrhythmic event from a physiological signal sensed from a subject, and generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event. If the confidence indicator indicates a relatively high confidence of arrhythmia detection, the system may provide the detected arrhythmic event to a first process for storing the detected arrhythmic event or generating an alert. If the confidence indicator indicates a relatively low confidence of arrhythmia detection, the system may provide the detected arrhythmic event to at least a second process including confirming or rejecting the detected arrhythmic event.

Confidence of arrhythmia detection

Systems and methods for detecting an arrhythmic event and storing physiological information associated with the detected arrhythmic event are described. A system may include a first detector to detect an arrhythmic event from a physiological signal sensed from a subject, and generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event. If the confidence indicator indicates a relatively high confidence of arrhythmia detection, the system may provide the detected arrhythmic event to a first process for storing the detected arrhythmic event or generating an alert. If the confidence indicator indicates a relatively low confidence of arrhythmia detection, the system may provide the detected arrhythmic event to at least a second process including confirming or rejecting the detected arrhythmic event.

His-bundle pacing for rate regularization

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

System and method for off-line analysis of cardiac data

A system and method for performing off-line analysis of cardiac electrogram data, comprising: retrieving an electrogram from a memory location; identifying a first-channel group of candidate beats from at least a first channel of the electrogram; and identifying a second-channel group of candidate beats from at least a second channel of an electrogram. For each first-channel beat candidate near a second-channel beat candidate, the amplitude of the first-channel beat candidate is compared with the amplitude of a previous beat and the amplitude of a next beat on the first electrogram channel, and first-channel beat candidates that are outside of a first pre-determined range from either the previous or next beat are removed. Then first-channel beat candidates that are outside of a second pre-determined range from either the previous or next beat candidate are removed.

Multi-sensor stroke detection

This document discusses, among other things, systems, devices, and methods for detecting stroke in a patient. A system may comprise a sensor circuit for sensing in a patient at first physiological signal and a second physiological signal or a functional signal. A stroke risk circuit may establish a physiological trend from at least the first physiological signal over time, and generate a stroke risk indicator using the physiological trend and the second physiological or functional signal. Indications of behavioral or cognitive impairment may also be used in stroke risk indicator generation. The system includes an output unit that outputs the stroke risk indicator to a user or a process.

Autothreshold with sensing from pacing cathode

Cardiac electrostimulation energy is delivered to a heart chamber of a subject according to a normal pacing mode using a set of implantable pacing electrodes. When a threshold test for the heart chamber is initiated and a sensing electrode independent from the set of pacing electrodes is unavailable for the heart chamber, cardiac electrostimulation energy is delivered to the subject according to a threshold test mode. The threshold test mode includes sensing a cardiac activity signal from a subject using a set of sensing electrodes that includes an electrode common to the set of pacing electrodes, and changing the electrostimulation energy and sensing a resulting cardiac activity signal using the set of sensing electrodes to determine the optimum electrostimulation energy for capture of the heart chamber.

Adjudication of arrhythmia episode data systems and methods

A system and method for automatically adjudicating arrhythmia episode information is described, and includes an episode database having episode data regarding a plurality of different arrhythmia episodes and an adjudication processor configured to output characterization data characterizing the input episode data. The characterization data includes an arrhythmia classification. The system further includes an episode processor configured to process the characterization data and episode data, provide at least one report on the characterization data related to a plurality of the different arrhythmia episodes, and provide at least one programming recommendation or at least one alert.

Systems and methods for presenting arrhythmia episodes

Systems and methods for managing machine-generated alert notifications of medical events detected from one or more patients are described herein. An embodiment of a data management system may receive an adjudication of a medical event episode including an episode characterization. A storage unit stores an association between one or more episode characterizations and corresponding detection algorithms for detecting a medical event having respective episode characterizations. An episode management circuit may detect from a subsequent episode, using the stored association, a medical event having an episode characterization of at least one medical event episode presented for adjudication, and schedule presenting at least a portion of the subsequent episode based on the detection.

Intracardiac electrogram time frequency noise detection

Systems, methods, and apparatus for identifying and classifying noise of an intracardiac electrogram of a cardiac rhythm management device to prevent inaccurate detection of a cardiac episode are disclosed. In an example, three channels are analyzed to identify and determine whether an episode or noise has been detected.

Arrhythmia classification using correlation image

Systems and methods for classifying a cardiac arrhythmia are discussed. An exemplary system includes a correlator circuit to generate autocorrelation sequences using information of cardiac activity of a subject, including signal segments taken from a cardiac signal at respective elapsed time with respect to reference time. The correlator circuit can generate a correlation image using the autocorrelation sequences. The correlation image may be constructed by stacking the autocorrelation sequences according to the elapsed time of signal segments. An arrhythmia classifier circuit can classify the cardiac activity of the subject as one of arrhythmia types using the correlation image.

Adjustable sensing in a his-bundle pacemaker

Systems and methods for pacing cardiac conductive tissue are described. An embodiment of a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to stimulate a His bundle, and a cardiac event detector to detect a His-bundle activity within a time window following an atrial activity. The cardiac event detector may use a cross-chamber blanking, or an adjustable His-bundle sensing threshold, to avoid or reduce over-sensing of far-field atrial activity and inappropriate inhibition of HBP therapy. The electrostimulation circuit may deliver HBP in the presence of the His-bundle activity. The system may further recognize the detected His-bundle activity as either a FFPW or a valid inhibitory event, and deliver or withhold HBP therapy based on the recognition of the His-bundle activity.

Ai-based detection of physiologic events

Systems and methods for detecting a physiological event or estimating a physiological parameter using ambulatory electrograms of a subject are discussed. An exemplary system includes a computing device that can receive ambulatory electrograms collected by an ambulatory medical device (AMD) associated with a subject, and apply the ambulatory electrograms to a trained machine learning model to estimate a physiological parameter or to detect a physiological event in the subject. The same or a different machine learning model can be trained to detect an operating status of the AMD using the ambulatory electrograms. The system comprises an output device to output the estimated physiological parameter, the detected physiological event, or the detected device operating status a user or a process such as to initiate or titrate a therapy.

Supervised cardiac event detection

Systems and methods for detecting physiologic events in a patient are described herein. An embodiment of a medical system includes a memory circuit to store physiologic event episodes detected and recorded by a medical device. The system includes a control circuit to analyze the stored physiologic event episodes, and determine a presence of a target cardiac event under a plurality of detection settings. Using the determined presence of the target cardiac event from the stored physiologic event episodes, and user adjudication of the stored event episodes, the control circuit may select, from the plurality of detection settings, a detection setting to detect a subsequent target cardiac event. The control circuit may also prioritize the physiologic event episodes for storage in the memory circuit.

Identification of implanted electrode location

A medical device system has a medical device interface configured to download data from an implanted medical device. Memory stores electrode location identification rules and display definitions. Each of the display definitions correspond to possible electrode placement locations of the implanted medical device. Processing circuitry is configured to compare the downloaded data from the implanted medical device to the electrode location identification rules to identify one or more actual electrode placement locations of the possible electrode placement locations of the implanted medical device. A user output interface is in communication with the processing circuitry. The processing circuitry is configured to cause the output to display the one or more actual electrode placement locations.

Confidence of arrhythmia detection

Systems and methods for detecting an arrhythmic event and storing physiological information associated with the detected arrhythmic event are described. A system may include a first detector to detect an arrhythmic event from a physiological signal sensed from a subject, and generate a confidence indicator indicating a confidence level of the detection of the arrhythmic event. If the confidence indicator indicates a relatively high confidence of arrhythmia detection, the system may provide the detected arrhythmic event to a first process for storing the detected arrhythmic event or generating an alert. If the confidence indicator indicates a relatively low confidence of arrhythmia detection, the system may provide the detected arrhythmic event to at least a second process including confirming or rejecting the detected arrhythmic event.

Systems and methods for clustering physiological events

Systems and methods for managing physiological events generated by a medical device in a patient are discussed. An exemplary system includes a controller circuit to receive information about a plurality of physiological events detected by a medical device in a patient, generate for each of the physiological events a respective feature set using the received information, and cluster the physiological events into different event groups using values of temporal or morphological features of the generated feature sets. The event groups each include a respective set of physiological events. The controller circuit can identify from at least one event group a representative event representing the physiological events of that event group, and output to a user or a process the representative event and an indication that the representative event has been determined and represents the set of physiological events in the even group.