Genetic modification of targeted regions of the cardiac conduction system

Disclosed are methods and systems for preventing or treating cardiac dysfunction, particularly cardiac pacing dysfunction by genetic modification of the conduction system of the heart. In one embodiment, the invention provides a method of genetically modifying the cells by delivering to the cells one or more coding sequence in a genetic construct capable of modifying the expression of ion channels of the cells.

RATE CONTROL DURING AF USING CELLULAR INTERVENTION TO MODULATE AV NODE

A biologic intervention method and apparatus generates a persistent modification to an AV node that is physiologically stable after the agent has matured but is alterable with subsequent application of an agent. Specifically, the generic agent is used to modulate a node in a cardiac conduction system including rate control using one and a combination of a family of K channel or equivalent. Specifically, the channel is implemented to slow conduction by generating an outward current during optimization of action potential and repolarization phase thus decreasing the current that is available to excite downstream cells. A Kv 1.3 channel, for example, may be used as the biologic channel. The invention enables reversal of the modulation or adjustment for various heart rates (BPM) based on medical and patient-specific needs. 19-. (canceled)10. A method for manipulating cardiac conduction , the method comprising delivering a biological intervention agent in a cardiac conduction node; wherein the biological intervention agent imposes a greater voltage load in the conduction node to suppress charge transfer to an adjacent cell.11. (canceled)12. The method of further comprising performing effective refractory interval study to determine ERP and measuring Wenckebach rate prior to delivering the biological intervention agent in the cardiac conduction node.13. The method of further comprising titrating the dose of the biological intervention agent based on the patient's nodal modulation needs including heart rate (BPM) considerations to undertake various physical activities.14. The method of wherein the dosage of the biologic intervention agent is determined by the ERP and/or the lowest pacing rate that produces Wenckebach phenomenon.1520-. (canceled)21. The method of claim 10 , wherein the cardiac conduction node is selected from the group consisting of atrio-ventricular (AV) node claim 10 , His bundle and Purkinje fibers.22. The method of claim 10 , wherein the biological ...

MULTI-ARRAY MONOPHASIC ACTION POTENTIAL MEDICAL DEVICE

A medical device including a catheter having a shaft with a distal portion; a first plurality of substantially hemispherical electrodes coupled to the distal portion; a second plurality of substantially hemispherical electrodes coupled to the shaft proximal of the first plurality, where the second plurality of electrodes are oriented substantially orthogonal to the first plurality of electrodes; and an additional electrode coupled to the shaft. A console may have a processor in electrical communication with the first and second plurality of electrodes and the reference electrode, the processor programmed to obtaining a monophasic action potential recording from at least one of the first and second plurality of electrodes. 1. A medical device , comprising:a shaft having a distal portion;a first electrode array coupled to the distal portion;a second electrode array coupled to a lateral surface of the shaft proximal to the first array; andan additional electrode coupled to the shaft.2. The medical device according to claim 1 , wherein the second electrode array is oriented substantially orthogonal to the first electrode array.3. The medical device according to claim 1 , wherein the second electrode array includes a plurality of electrodes positioned along a length of the shaft claim 1 , the electrodes arranged in two rows approximately 180 degrees apart from one another.4. The medical device according to claim 3 , wherein the shaft is controllably deflectable within a defined plane claim 3 , and the two rows of electrodes are aligned in the plane.5. The medical device according to claim 1 , wherein at least one of the first electrode array and the second electrode array includes a plurality of substantially hemispherical shaped electrodes.6. The medical device according to claim 1 , wherein the first electrode array includes a plurality of electrodes made of substantially non-polarizable material.7. The medical device according to claim 1 , wherein the first electrode ...

ACOUSTIC BASED COUGH DETECTION

The present disclosure is directed to the detection of coughs and coughing episodes using acoustic signals. In various examples, an implantable medical device processes an acoustic signal obtained from an acoustic sensor to determine whether a patient has coughed. In some examples, the implantable medical device also performs a cough severity assessment. In some examples, the cough severity assessment may include a determination of the depth of the cough, the duration of the coughing episode, or whether the cough was wet or dry. 1. A method comprising:receiving an acoustic signal from an acoustic sensor implanted in a patient;receiving a patient activity signal from an activity sensor implanted in the patient;analyzing the acoustic signal in combination with the patient activity signal; anddetermining whether a cough has occurred based on the analysis of the acoustic signal in combination with the patient activity signal.2. The method of claim 1 , further comprising determining a severity of the cough based on the analysis of the acoustic signal and the patient activity signal.3. The method of claim 2 , further comprising incrementing a cough index by an amount that is determined as a function of the severity of the cough.4. The method of claim 2 , wherein determining a severity of the cough comprises determining a duration and frequency of a cough episode.5. The method of claim 2 , wherein determining a severity of the cough comprises determining an amplitude of the cough.6. The method of claim 1 , further comprising determining a depth of the cough based on one or more of the acoustic signal and the patient activity signal.7. The method of claim 1 , further comprising determining if the cough is a wet cough based on the acoustic signal:8. The method of claim 1 , further comprising updating a cough index based on the determination of whether a cough has occurred.9. The method of claim 8 , further comprising sending a notification when the cough index passes a ...

IMPLANTABLE MEDICAL DEVICE HAVING OPTICAL FIBER FOR SENSING ELECTRICAL ACTIVITY

An implantable medical device for optically sensing action potential signals in excitable body tissue. The device includes an elongated tubular lead body carrying an optical fiber extending from a proximal lead end to a distal lead end to position the optical fiber at a target site. The lead body additionally carries a conduit for dispensing a voltage-sensitive fluorescent dye into tissue surrounding the target site. The optical fiber transmits excitation light to the fluorescent dye to cause the dye to fluoresce with varying intensity as the transmembrane potentials of local tissue cells vary due to passing depolarization wavefronts. The optical fiber transmits the fluorescence signal to the device to generate an action potential signal or fiducial points of an action potential signal for use in accurately measuring and characterizing electrical activity of excitable tissue. 111-. (canceled)12. An implantable medical device for monitoring gene expression in a target tissue site co-transfected with a therapeutic gene and a marker gene that expresses a fluorescent protein , the implantable medical device comprising:an elongated lead body extending from a proximal end to a distal end adapted to be positioned at the target tissue site;a first optical fiber and a second optical fiber, each having a proximal lead end and a distal lead end extending through the elongated lead body;the first optical fiber transmitting an excitation light to the distal lead end of the first optical fiber positioned at the target tissue site;the excitation light providing the excitation energy needed for the fluorescent protein expressed by the marker gene to emit a fluorescence signal; andthe second optical fiber transmitting the emitted fluorescence signal from the distal lead end of the first optical fiber positioned at the target tissue site to the proximal end of the second optical fiber;thereby monitoring gene expression in the target tissue site co-transfected with the therapeutic ...

Queued cooperative wireless networks configuration using rateless codes

A system using cooperative communication with rateless codes is presented that uses communication transmission aspects of cooperative communication with rateless codes over Rayleigh fading channels and queuing aspects for buffering messages at intermediate relays. The system transmits a subsequent message while a current message is en route to the destination by receiving and buffering the current message in queues at intermediate relays. A relay with a best instantaneous communication link to the source may receive a message first and forward the received message to the destination. Alternatively, if inter-relay communication links are strong, all relays may cooperate simultaneously.

MEDICAL SYSTEM FOR THERAPY ADJUSTMENT

Methods and systems for seamless adjustment of treatment are disclosed. A determination can be made as to whether to intervene with a patient's treatment based on data obtained from implantable electrodes and/or non-implantable electrodes. The data from non-implantable electrodes have a correction factor applied to adjust for less accuracy compared to data acquired from implantable electrodes. 1. A system for managing patient therapy , the system comprising:(a) an implantable medical device comprising one or more electrodes configured to be implanted within a patient's body, to acquire first signals corresponding to signals sensed from within the patient's body and to generate first data transmissions in response to the acquired first signals;(b) a wearable device comprising one or more electrodes configured to be positioned in contact with an external surface of the patient's body, to acquire second signals corresponding to signals sensed from the external surface of the patient's body, and to generate second data transmissions in response to the acquired second signals;(c) an input/output device to receive the first data transmissions and the second data transmissions; and (1) receive the first data transmissions and the second data transmissions,', '(2) compare the received first data transmissions and the received second data transmissions to one or more thresholds,', '(3) determine whether data of the received first data transmissions and the received second data transmissions is indicative of a heart failure (HF) worsening episode based on the comparing, and', "(4) adjust a patient's therapy in response to the HF worsening episode being indicated."], '(d) one or more processors configured to2. A system for managing patient therapy , the system comprising:(a) an implantable medical device comprising one or more electrodes configured to be implanted within a patient's body, to acquire first signals corresponding to signals sensed from within the patient's body ...

CORONARY SINUS CONDUCTION SYSTEM PACING AND DELIVERY

An implantable medical system includes an implantable catheter advanceable into a coronary sinus of a patient's heart. A guide element and an implantable lead receivable in the side lumen is advanceable through an angled opening of the catheter to be deflected laterally away from the catheter at the deflection angle to position the at least one testing electrode or at least one pacing electrode, respectively, in a myocardium of the patient's heart when the distal portion of the catheter is positioned in the coronary sinus. 1. An implantable medical system comprising:an implantable catheter advanceable into a coronary sinus of a patient's heart, the catheter comprising a sheath body extending between a proximal portion and a distal portion, the catheter comprising a side lumen and an angled opening proximal to the distal portion in fluid communication with the side lumen, wherein the side lumen and the angled opening define a deflection angle;a guide element receivable in the side lumen, the guide element extending from a proximal portion to a distal portion, wherein the distal portion includes at least one testing electrode, wherein the guide element is advanceable through the angled opening to be deflected laterally away from the catheter at the deflection angle to position the at least one testing electrode in a myocardium of the patient's heart when the distal portion of the catheter is positioned in the coronary sinus; andan implantable lead receivable in the side lumen, the lead comprising a lead body extending from a proximal portion to a distal portion, wherein the implantable lead comprises an anchoring element disposed along the lead body and at least one pacing electrode disposed along the distal portion, wherein the lead is advanceable through the angled opening to be deflected laterally away from the catheter at the deflection angle to implant the at least one pacing electrode in the myocardium to pace a conduction system of the patient's heart.2. The ...

Absolute intrathoracic impedance based scheme to stratify patients for risk of a heart failure event

A health care system acquires data determines whether a patient is at risk of hypervolemia or hypovolemia. The method comprises (a) acquiring from a device memory a patient's absolute intrathoracic impedance data over a pre-specified time period, (b) determining a running average of the intrathoracic impedance data over the pre-specified time period, and (c) determining by the system whether the running average of the intrathoracic impedance data over the pre-specified time period exceeds one of a first and second range, the first range being a higher value boundary of intrathoracic electrical impedance and the second range being a lower value boundary of intrathoracic electrical impedance.

DETERMINING PROSPECTIVE RISK OF HEART FAILURE HOSPITALIZATION

A method of operation of a medical device system for determining prospective heart failure hospitalization risk. The method includes measuring one or more data observations via one or more electrodes of an implanted medical device disposed in a patient's body. The data observations are stored into memory of the implantable medical device of a patient. The data observations are transmitted to an external device. The processor of the external device parses the data observations into one or more evaluation periods. Using the number of observations in one or more evaluation periods, a look up table, stored into memory of the external device, is accessed. The look up table associates prospective heart failure hospitalization risk with the data observations noted in the evaluation period. One or more embodiments involve a weighted prospective heart failure hospitalization risk for the set of evaluation periods. The prospective heart failure hospitalization is then displayed on the graphical user interface. 1. A method of operation of a medical system for determining prospective heart failure hospitalization risk , the method comprising:(a) acquiring from a device memory a heart failure patient's current and preceding evaluation periods;(b) counting detected data observations in the current evaluation period for a current evaluation total amount and counting detected data observations in the preceding evaluation period for a preceding evaluation period total amount;(c) associating the current evaluation and preceding evaluation total amounts with a lookup table to acquire prospective risk of heart failure hospitalization (HFH) for the preceding evaluation period and the current evaluation period;(d) employing weighted sums of the prospective risk of HFH for the preceding evaluation period and the current evaluation period to calculate a weighted prospective risk of HFH for a patient; and(e) displaying on a graphical user interface the weighted prospective risk of HFH for ...

VENTRICULAR TACHYCARDIA DETECTION ALGORITHM USING ONLY CARDIAC EVENT INTERVALS

An implantable medical device system includes a pacemaker and an extravascular implantable cardioverter defibrillator (ICD). The pacemaker is configured to acquire a cardiac electrical signal, determine RR intervals from the cardiac electrical signal, apply ventricular tachycardia detection criteria solely to the RR intervals, detect ventricular tachycardia (VT) when the detection criteria are met; and deliver anti-tachycardia pacing in response to detecting the VT before the extravascular ICD delivers a shock therapy. 1. An intracardiac pacemaker comprising:a housing sized to fit within a heart;at least two electrodes disposed on the housing;a sensing module enclosed within the housing and electrically coupled to the at least two electrodes, the sensing module configured to sense R-waves from a first cardiac electrical signal received from the at least two electrodes coupled to the sensing module;a pulse generator enclosed within the housing and electrically coupled to the at least two electrodes, the pulse generator configured to generate cardiac pacing pulses for delivery to the heart via the at least two electrodes; and determine RR intervals between consecutive ones of the sensed R-waves;', 'apply RR interval-based ventricular tachycardia (VT) detection criteria solely to the determined RR intervals;', 'detect a monomorphic VT when the VT detection criteria are met; and', 'control the pulse generator to deliver anti-tachycardia pacing in response to detecting the monomorphic VT,', 'wherein applying the detection criteria solely to the determined RR intervals comprises applying at least a non-sinus rhythm criterion, a supraventricular tachycardia rejection criterion, and a threshold number of tachycardia detection intervals to the RR intervals., 'a control module enclosed within the housing and electrically coupled to the sensing module and the pulse generator, the control module configured to2. The intracardiac pacemaker of claim 1 , wherein the control module ...

CONTEXT-BASED DIGITAL SIGNAL PROCESSING

Various systems and methods for implementing context-based digital signal processing are described herein. An object detection system includes a processor to: access sensor data from a first sensor and a second sensor integrated in a vehicle; access an operating context of the vehicle; assign a first weight to a first object detection result from sensor data of the first sensor, the first weight adjusted based on the operating context; assign a second weight to a second object detection result from sensor data of the second sensor, the second weight adjusted based on the operating context; and perform a combined object detection technique by combining the first object detection result weighted by the first weight and the second object detection result weighted by the second weight. 1. An object detection system , the system comprising: access sensor data from a first sensor and a second sensor integrated in a vehicle;', 'access an operating context of the vehicle;', 'assign a first weight to a first object detection result from sensor data of the first sensor, the first weight adjusted based on the operating context;', 'assign a second weight to a second object detection result from sensor data of the second sensor, the second weight adjusted based on the operating context; and', 'perform a combined object detection technique by combining the first object detection result weighted by the first weight and the second object detection result weighted by the second weight., 'a processor to2. The system of claim 1 , further comprising:a sensor array interface to obtain, when in operation, the sensor data from the first sensor and the second sensor.3. The system of claim 1 , wherein the first sensor is a visible light camera.4. The system of claim 1 , wherein the first sensor is an acoustic sensor.5. The system of claim 1 , wherein the first sensor is a laser scanner.6. The system of claim 1 , wherein the first sensor is a radar.7. The system of claim 1 , further ...

NEURAL NETWORK TRAINING

Systems and techniques for neural network training are described herein. A training set may be received for a neural network. Here, the neural network may comprise a set of nodes arranged in layers and a set of inter-node weights between nodes in the set of nodes. The neural network may then be iteratively trained to create a trained neural network. An iteration of the training may include generating a random unit vector, creating an update vector by calculating a magnitude for the random unit vector based on a degree that the random unit vector matches a gradient—where the gradient represented by a dual number, and updating a parameter vector for an inter-node weight by subtracting the update vector from a previous parameter vector of the inter-node weight. The trained neural network may then be used to classify data. 1. A device for neural network training , the device comprising:an interface to receive a training set for a neural network, the neural network comprising a set of nodes arranged in layers and a set of inter-node weights between nodes in the set of nodes; generation of a random unit vector;', 'creation of an update vector by calculating a magnitude for the random unit vector based on a degree that the random unit vector coincides with an estimated gradient between a member of the training set and an objective function for the neural network, the gradient represented by a dual number; and', 'update of a parameter vector for an inter-node weight by subtracting the update vector from a previous parameter vector of the inter-node weight., 'a set of processing nodes to train the neural network to create a trained neural network via iterations, an iteration in the iterations including2. The device of claim 1 , wherein the generation of the random unit vector includes calculation of {right arrow over (u)}=˜(0 claim 1 , hI) claim 1 , where {right arrow over (u)} is the random unit vector and (0 claim 1 , hI) is an n-dimensional random Gaussian vector with ...

Adaptive processing of spatial imaging data

Machine vision processing includes capturing 3D spatial data representing a field of view and including ranging measurements to various points within the field of view, applying a segmentation algorithm to the 3D spatial data to produce a segmentation assessment indicating a presence of individual objects within the field of view, wherein the segmentation algorithm is based on at least one adjustable parameter, and adjusting a value of the at least one adjustable parameter based on the ranging measurements. The segmentation assessment is based on application of the segmentation algorithm to the 3D spatial data, with different values of the at least one adjustable parameter value corresponding to different values of the ranging measurements of the various points within the field of view.

SYSTEMS AND METHODS FOR MONITORING HEMODYNAMIC STATUS

The exemplary systems and methods may monitor one or more signals to be used to assess the hemodynamic status of a patient. The one or more signals may be used to calculate, or determine, a plurality of pulse transit times. The plurality of pulse transit times may be used to determine hemodynamic status values that may be indicative of a patient's aggregate hemodynamic status. 1. A system for use in assessment of a patient's hemodynamic status comprising: a first sensor to measure a first signal from tissue of a patient, and', "a second sensor to measure a second signal from tissue of the patient from a different location along a circulatory path from the patient's heart than the first sensor, wherein the one or more devices are configured to periodically measure the first and second signals over a monitoring time period; and"], 'one or more devices comprising receive data representative of the first and second signals from the one or more devices;', 'determine a pulse transit time based on the data representative of the first and second signals for each measurement of the first and second signals resulting in a plurality of pulse transit times for the monitoring time period; and', "determine a surrogate hemodynamic status value based on the plurality of pulse transit times representative of the patient's aggregate hemodynamic status for the monitoring time period."], 'an external monitoring device wirelessly operatively coupled to the one or more devices and configured to2. The system of claim 1 , wherein the monitoring time period is greater than or equal to 1 hour.3. The system of claim 1 , wherein the external monitoring device is further configured to:monitor the hemodynamic status values for a plurality of monitoring time periods; anddetermine whether the hemodynamic status of the patient has changed based on the hemodynamic status values over the plurality of monitoring time periods.4. The system of claim 3 , wherein the external monitoring device is further ...

DIFFERENTIATION OF HEART FAILURE RISK SCORES FOR HEART FAILURE MONITORING

A method for differentiating heart failure risk scores that includes receiving a current data transmission and acquiring patient metrics from a remote device, determining a daily heart failure risk score for each day occurring during a time period from a previous received data transmission to the current received data transmission based on the acquired patient metrics, determining a maximum daily heart failure risk score of the determined daily heart failure risk scores during a lookback window prior to the current received data transmission, determining a heart failure risk status alert for the received data transmission based on the temporal proximity of the determined maximum heart failure risk score and receipt of the current data transmission, selecting a type of notification based on the heart failure risk status differentiation, and indicating the transmission heart failure risk status and the heart failure risk status differentiation via the selected type of notification. 1. A method of differentiating heart failure risk statuses in a device , comprising:receiving, at the device, a current data transmission from a remote device;acquiring patient metrics from the current received data transmission;determining a daily heart failure risk status for each day occurring during a time period from a previous received data transmission to the current received data transmission based on the acquired patient metrics, wherein determining each heart failure risk status comprises selecting one of a plurality of heart failure statuses;determining a maximum daily heart failure risk status of the determined daily heart failure risk statuses during a lookback window prior to receipt of the current received data transmission;determining a transmission heart failure risk status for the current received data transmission based on the determined maximum daily heart failure risk status; anddetermining a heart failure risk status differentiation for the current received data ...

MULTI- ARRAY MONOPHASIC POTENTIAL MEDICAL DEVICE

A medical device including a catheter having a shaft with a distal portion; a first plurality of substantially hemispherical electrodes coupled to the distal portion; a second plurality of substantially hemispherical electrodes coupled to the shaft proximal of the first plurality, where the second plurality of electrodes are oriented substantially orthogonal to the first plurality of electrodes; and an additional electrode coupled to the shaft. A console may have a processor in electrical communication with the first and second plurality of electrodes and the reference electrode, the processor programmed to obtaining a monophasic action potential recording from at least one of the first and second plurality of electrodes. 1. A medical device , comprising:a shaft having a distal portion;a first electrode array coupled to the distal portion;a second electrode array coupled to a lateral surface of the shaft proximal to the first array, the second electrode array being oriented substantially orthogonal to the first electrode array; andan additional electrode coupled to the shaft.2. The medical device according to claim 1 , wherein the second electrode array includes a plurality of electrodes positioned along a length of the shaft claim 1 , the electrodes arranged in two rows approximately 180 degrees apart from one another.3. The medical device according to claim 2 , wherein the shaft is controllably deflectable within a defined plane claim 2 , and the two rows of electrodes are aligned in the plane.4. The medical device according to claim 1 , wherein at least one of the first electrode array and the second electrode array includes a plurality of substantially hemispherical shaped electrodes.5. The medical device according to claim 1 , wherein the first electrode array includes a plurality of electrodes made of substantially non-polarizable material.6. The medical device according to claim 1 , wherein the first electrode array includes four electrodes equally spaced ...

AUTOMATIC DETECTION OF BODY PLANES OF ROTATION

Techniques are disclosed for automatically calibrating a reference orientation of an implantable medical device (IMD) within a patient. In one example, sensors of an IMD sense a plurality of orientation vectors of the IMD with respect to a gravitational field. Processing circuitry of the IMD processes the plurality of orientation vectors to identify an upright vector that corresponds to an upright posture of the patient. The processing circuitry classifies the plurality of orientation vectors with respect to the upright vector to define a sagittal plane of the patient and a transverse plane of the patient. The processing circuitry determines, based on the upright vector, the sagittal plane, and the transverse plane, a reference orientation of the IMD within the patient. As the orientation of the IMD within the patient changes over time, the processing circuitry may recalibrate its reference orientation and accurately detect a posture of the patient. 1. A method comprising:sensing, by one or more sensors of an implantable medical device (IMD), a plurality of orientation vectors of the IMD with respect to a gravitational field;processing, by processing circuitry of the IMD, the plurality of orientation vectors to identify an upright vector of the plurality of orientation vectors, the upright vector corresponding to an upright posture of a patient;classifying, by the processing circuitry, the plurality of orientation vectors with respect to the upright vector to define a transverse plane of the patient;classifying, by the processing circuitry, the plurality of orientation vectors with respect to the upright vector to define a sagittal plane of the patient; anddetermining, by the processing circuitry and based on the upright vector, the transverse plane, and the sagittal plane, a reference orientation of the IMD.2. The method of claim 1 , wherein processing the plurality of orientation vectors to identify the upright vector of the plurality of orientation vectors ...

DETERMINING PROSPECTIVE RISK OF HEART FAILURE HOSPITALIZATION

A method of operation of a medical device system for determining prospective heart failure hospitalization risk. The method includes measuring one or more data observations via one or more electrodes of an implanted medical device disposed in a patient's body. The data observations are stored into memory of the implantable medical device of a patient. The data observations are transmitted to an external device. The processor of the external device parses the data observations into one or more evaluation periods. Using the number of observations in one or more evaluation periods, a look up table, stored into memory of the external device, is accessed. The look up table associates prospective heart failure hospitalization risk with the data observations noted in the evaluation period. One or more embodiments involve a weighted prospective heart failure hospitalization risk for the set of evaluation periods. The prospective heart failure hospitalization is then displayed on the graphical user interface. 1. A method of operation of a medical system for determining prospective heart failure hospitalization (HFH) risk , the method comprising:(a) determining a number of an individual heart failure patient's detected data observations during an individual evaluation period;(b) employing a lookup table to determine prospective heart failure hospitalization risk based upon the said individual evaluation period; and wherein the lookup table comprises a set of data observations categories and for each said category a stored ratio.', 'wherein each said data observations category defines a total number of group data evaluation periods each having a defined same number of data observations from a population of patients therein; and, '(c) displaying on a graphical user interface the prospective risk of HFH,'}wherein the stored ratio for each said data observations category comprises a ratio of heart failure hospitalizations associated with the said data observations category to the ...

IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) TACHYARRHYTHMIA DETECTION MODIFICATIONS RESPONSIVE TO DETECTED PACING

An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train. 1. A method comprising:detecting, with an extravascular implantable medical device (IMD), initiation of a pacing train delivered by a second implantable medical device;determining a type of the detected pacing train; andmodifying a tachyarrhythmia detection algorithm based on the type of the detected pacing train.2. The method of claim 1 , wherein determining a type of the detected pacing train comprises:estimating a cycle length of the pacing train;comparing the estimated cycle length of the pacing train to at least one cycle length threshold; anddetermining a type of the detected pacing train based on the comparison.3. The method of claim 1 , wherein determining a type of the detected pacing train comprises analyzing one or more of an onset of the heart rate immediately prior to the detected pacing train claim 1 , a regularity of the pacing pulse intervals claim 1 , a consistency of the pacing artifact amplitude claim 1 , a consistency of the pacing pulse slew rate claim 1 , and/or a consistency of the pacing pulse polarity.4. The method of claim 1 , further comprising:obtaining an electrical signal sensed on an implantable electrical lead coupled to the IMD; andanalyzing at least one of an amplitude and a slew rate of the electrical signal to detect pacing pulses in the electrical signal, wherein detecting initiation of the pacing train comprises detecting initiation of the pacing train using the detected pacing ...

ELECTRIC STIMULATION SYSTEM

An example method of cycling electric stimulation includes delivering, via an implantable device, electric stimulation to a patient in accordance with a first therapy program; monitoring, via the implantable device and while the electric stimulation is being delivered in accordance with the first therapy program, a biomarker; and responsive to determining the biomarker satisfies a threshold, delivering, via the implantable device, electric stimulation to the patient in accordance with a second therapy program that is different than the first therapy program. 1. A method of cycling electric stimulation , the method comprising:delivering, via an implantable device, electric stimulation to a patient in accordance with a first therapy program;monitoring, via the implantable device and while the electric stimulation is being delivered in accordance with the first therapy program, a biomarker; andresponsive to determining the biomarker satisfies a threshold, delivering, via the implantable device, electric stimulation to the patient in accordance with a second therapy program that is different than the first therapy program.2. The method of claim 1 , wherein the biomarker comprises a first biomarker claim 1 , the method further comprising:monitoring, via the implantable device and while the electric stimulation is being delivered in accordance with the second therapy program, a second biomarker.3. The method of claim 2 , wherein the first biomarker and the second biomarker are different biomarkers.4. The method of claim 2 , wherein the first biomarker and the second biomarker are the same biomarker.5. The method of claim 4 , further comprising:responsive to determining the second biomarker satisfies the threshold, delivering, via the implantable device, electric stimulation to the patient in accordance with a first therapy program.6. The method of claim 4 , wherein the threshold comprises a first threshold claim 4 , the method further comprising:responsive to determining ...

TENSOR-BASED COMPUTING SYSTEM FOR QUATERNION OPERATIONS

A machine-learning system includes a quaternion (QT) computation engine. Input data to the QT computation engine includes quaternion values, each comprising a real component and three imaginary components, represented as a set of real-valued tensors. A single quaternion value is represented as a 1-dimensional real-valued tensor having four real-valued components, wherein a first real-valued component represents the real component of the single quaternion value, and wherein a second, a third, and a fourth real-valued component each respectively represents one of the imaginary components. A quaternion-valued vector having a size N is represented as a 2-dimensional real-valued tensor comprising N 1-dimensional real-valued tensors. A quaternion-valued matrix having N×M dimensions is represented as a 3-dimensional real-valued tensor comprising M 2-dimensional real-valued tensors comprising N 1-dimensional real-valued tensors. 126.-. (canceled)27. A machine-learning system , comprising:processing hardware, including computation circuitry and data storage circuitry, the processing hardware configured to form a quaternion (QT) computation engine; a single quaternion value is represented as a 1-dimensional real-valued tensor having four real-valued components, wherein a first real-valued component represents the real component of the single quaternion value, and wherein a second, a third, and a fourth real-valued component each respectively represents one of the imaginary components;', 'a quaternion-valued vector having a size N is represented as a 2-dimensional real-valued tensor comprising N 1-dimensional real-valued tensors; and', 'a quaternion-valued matrix having N×M dimensions is represented as a 3-dimensional real-valued tensor comprising M 2-dimensional real-valued tensors comprising N 1-dimensional real-valued tensors., 'wherein input data to the QT computation engine includes quaternion values, each comprising a real component and three imaginary components, ...

EFFICIENT UTILIZATION OF PROCESSING ELEMENT ARRAY

A computer-implemented method includes receiving a neural network model for implementation using a processing element array, where the neural network model includes a convolution operation on a set of input feature maps and a set of filters. The method also includes determining, based on the neural network model, that the convolution operation utilizes less than a threshold number of rows in the processing element array for applying a set of filter elements to the set of input feature maps, where the set of filter elements includes one filter element in each filter of the set of filters. The method further includes generating, for the convolution operation and based on the neural network model, a first instruction and a second instruction for execution by respective rows in the processing element array, where the first instruction and the second instruction use different filter elements of a filter in the set of filters. 1. A computer-implemented method comprising:receiving a neural network model for implementing using a neural network accelerator that includes a first number of rows of processing elements, the neural network model including a network layer that includes a convolution operation for generating an output feature map using a second number of input feature maps and a set of filters;determining that the second number is equal to or less than a half of the first number; padding the second number of input feature maps with padding data to generate padded input feature maps;', 'dividing each of the padded input feature maps into partitions; and', 'dividing the convolution operation into sub-operations based on the partitions;, 'adding operations to the neural network model, the operations includinggenerating, based on the neural network model, instructions for execution by the neural network accelerator to implement the convolution operation;detecting, from the instructions, a first instruction and a second instruction that both use a first partition in the ...

Differentiation of heart failure risk scores for heart failure monitoring

A method and device for differentiating heart failure risk scores that includes determining receipt of a current data transmission and acquiring patient metrics from a remote monitoring device, determining a daily heart failure risk score for each day occurring during a time period from a previous received data transmission to the current received data transmission based on the acquired patient metrics, and determining a maximum daily heart failure risk score of the determined daily heart failure risk scores during a lookback window prior to the current received data transmission. A heart failure risk score is determined for the received data transmission based on the determined maximum daily heart failure risk score, and a heart failure risk score alert is determined for the received data transmission based on the proximity of the determined maximum heart failure risk score and the current received data transmission. A display of at least one of the determined heart failure risk score and the determined heart failure risk score alert is generated, and the determined daily heart failure risk score for each day occurring during the time period and the generated display are stored.

METHOD AND APPARATUS FOR ACCURATELY DETERMINING HEART RATE VARIABILITY AND SYMPATHETIC RESERVE

An implantable monitoring device is disclosed for monitoring a patient's heart rate variability over time. The device includes a cardiac electrogram amplifier, a sensing electrode coupled to an input of the amplifier, timing circuitry, processing circuitry and a memory. The timing circuitry defines successive shorter time periods during each monitoring period. The processing circuitry relies upon electrogram activity that occurs during rest periods that extend as long as T1, all of which is stored into memory. Active periods are not considered as part of the heart rate variability calculation. The processing circuitry calculates median intervals between depolarizations of the patient's heart sensed by the amplifier during the shorter time periods and calculates a standard deviation of the median intervals during T2, a longer monitoring period. 1. A device for monitoring a patient's heart rate variability comprising:a sensing electrode to detect a cardiac depolarization;a sense amplifier coupled to the sensing electrode to produce a signal indicative of a detected cardiac depolarization;an activity sensor to generate a signal indicative of activity;processing means for measuring intervals between successive cardiac depolarizations;a timing means for defining successive shorter time periods during a longer monitoring period;processing means for using the signal for determining whether a patient is active;processing means for using data from the signal for determining rest periods that extend as long as the shorter time period;processing means for determining cardiac intervals occurring during each rest period;storing means for storing the measured cardiac intervals;processing means for calculating a central tendency metric of the measured cardiac intervals during each rest period; andin response to calculating the central tendency metric, processing means for determining a coefficient of variation of the cardiac intervals during the rest periods within the longer ...

Intervention for heart failure management

A method for heart failure management may include volume overload intervention in response to sensor-based parameters indicating volume overload. The method may include administering non-volume overload intervention in response to the sensor-based parameters not indicating volume overload. Volume overload may be determined based on monitoring sensor-based parameters. Sensor-based parameters may be monitored in response to receiving an alert indicative of a worsening heart failure score or status for a patient.

DIFFERENTIATION OF HEART FAILURE RISK SCORES FOR HEART FAILURE MONITORING

A method for differentiating heart failure risk scores that includes receiving a current data transmission and acquiring patient metrics from a remote device, determining a daily heart failure risk score for each day occurring during a time period from a previous received data transmission to the current received data transmission based on the acquired patient metrics, determining a maximum daily heart failure risk score of the determined daily heart failure risk scores during a lookback window prior to the current received data transmission, determining a heart failure risk status alert for the received data transmission based on the temporal proximity of the determined maximum heart failure risk score and receipt of the current data transmission, selecting a type of notification based on the heart failure risk status differentiation, and indicating the transmission heart failure risk status and the heart failure risk status differentiation via the selected type of notification. 1. A method of differentiating heart failure risk statuses comprising , by processing circuitry:receiving a current data transmission from a remote device;acquiring patient metrics from the current data transmission;determining a heart failure risk status for each data transmission occurring during a time period from a previous data transmission to the current data transmission based on the acquired patient metrics for that data transmission, wherein determining each heart failure risk status comprises selecting one of a predetermined set of heart failure statuses;determining a maximum heart failure risk status of the determined heart failure risk statuses during a lookback window prior to receipt of the current data transmission;determining a transmission heart failure risk status for the current data transmission based on the determined maximum heart failure risk status; anddetermining a heart failure risk status differentiation for the current data transmission based on a temporal ...

Pace pulse detector for a medical device

In situations in which an implantable medical device (e.g., a subcutaneous ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the subcutaneous ICD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the ICD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the ICD includes a first pace pulse detector configured to obtain a sensed electrical signal and analyze the sensed electrical signal to detect a first type of pulses having a first set of characteristics and a second pace pulse detector configured to obtain the sensed electrical signal and analyze the sensed electrical signal to detect a second type of pulses having a second set of characteristics.

MODIFICATION OF HEART FAILURE MONITORING ALGORITHM TO ADDRESS FALSE DETERMINATIONS

In some examples, a system comprises one or more medical devices configured to, for each of a plurality of periods, determine a respective value for each of a plurality of parameters of a patient and processing circuitry. The processing circuitry can for each of the plurality of periods, execute an algorithm to determine at least one of a heart failure risk score or status for the patient based on the determined values for the period, determine a number of the determined heart failure risk scores or statuses that were false determinations, determine that the number of false determinations for the patient satisfies a false determination threshold, and modify the algorithm for the patient in response to the determination that the number of false determinations for the patient satisfies the false determination threshold. 1: A system comprising:one or more medical devices configured to, for each of a plurality of periods, determine a respective value for each of a plurality of parameters of a patient; and for each of the plurality of periods, determine at least one of a heart failure risk score or status for the patient based on the determined values for the period using one or more thresholds;', 'determine a number of the determined heart failure risk scores or statuses that were false determinations;', 'determine that the number of false determinations for the patient satisfies a false determination criterion; and', 'modify at least one of the one or more thresholds for the patient in response to the determination that the number of false determinations for the patient satisfies the false determination criterion., 'processing circuitry configured to2: The system of claim 1 , wherein claim 1 , in order to determine the at least one of the heart failure risk score or status claim 1 , the processing circuitry is configured to:determine an evidence level for each of the parameters based on the respective value for the parameter;determine a risk level based on the ...

USING BIOMARKER INFORMATION FOR HEART FAILURE RISK COMPUTATION

Provided is a method, system and/or apparatus for determining prospective heart failure event risk. Acquired from a device memory are a heart failure patient's current and preceding risk assessment periods. Counting detected data observations in the current risk assessment period for a current risk assessment total amount and counting detected data observations in the preceding risk assessment period for a preceding risk assessment period total amount. Associating the current risk assessment and preceding risk assessment total amounts with a lookup table to acquire prospective risk of heart failure (HF) event for the preceding risk assessment period and the current risk assessment period. Employing weighted sums of the prospective risk of the HF event for the preceding risk assessment period and the current risk assessment period to calculate a weighted prospective risk of the HF event for a patient. Displaying on a graphical user interface the weighted prospective risk of the HF event for the patient. 1. A method of operation of a medical system for determining prospective heart failure hospitalization risk , the method comprising:(a) acquiring from a device memory a heart failure patient's data observations collected during an evaluation period;(b) counting collected data observations to provide a total amount;(c) associating the total amount with a lookup table to acquire prospective risk of heart failure hospitalization (HFH) for the evaluation period;(d) employing the prospective risk to modify therapy delivered by an implantable device; and(e) delivering the modified therapy to the patient using the implantable device.2. The method of wherein the lookup table comprises a set of data observations categories and for each said category a stored ratio claim 1 , wherein each said data observations category defines a total number of group data evaluation periods each having a defined same number or falling within a same range of numbers of data observations from a ...

USING BIOMARKER INFORMATION FOR HEART FAILURE RISK COMPUTATION

Provided is a method, system and/or apparatus for determining prospective heart failure event risk. Acquired from a device memory are a heart failure patient's current and preceding risk assessment periods. Counting detected data observations in the current risk assessment period for a current risk assessment total amount and counting detected data observations in the preceding risk assessment period for a preceding risk assessment period total amount. Associating the current risk assessment and preceding risk assessment total amounts with a lookup table to acquire prospective risk of heart failure (HF) event for the preceding risk assessment period and the current risk assessment period. Employing weighted sums of the prospective risk of the HF event for the preceding risk assessment period and the current risk assessment period to calculate a weighted prospective risk of the HF event for a patient. Displaying on a graphical user interface the weighted prospective risk of the HF event for the patient. 1. A method of operation of a medical system for determining prospective heart failure event risk , the method comprising:(a) acquiring from a device memory a heart failure patient's current and preceding risk assessment periods;(b) counting detected data observations in the current risk assessment period for a current risk assessment total amount and counting detected data observations in the preceding risk assessment period for a preceding risk assessment period total amount;(c) associating the current risk assessment and preceding risk assessment total amounts with a lookup table to acquire prospective risk of heart failure (HF) event for the preceding risk assessment period and the current risk assessment period;(d) employing weighted sums of the prospective risk of the HF event for the preceding risk assessment period and the current risk assessment period to calculate a weighted prospective risk of the HF event for a patient; and(e) displaying on a graphical ...

GRADIENT-BASED TRAINING ENGINE FOR QUATERNION-BASED MACHINE-LEARNING SYSTEMS

A deep neural network (DNN) includes hidden layers arranged along a forward propagation path between an input layer and an output layer. The input layer accepts training data comprising quaternion values, outputs a quaternion-valued signal along the forward path to at least one of the hidden layers. At least some of the hidden layers include quaternion layers to execute consistent quaternion (QT) forward operations based on one or more variable parameters. A loss function engine produces a loss function representing an error between the DNN result and an expected result. QT backpropagation-based training operations include computing layer-wise QT partial derivatives, consistent with an orthogonal basis of quaternion space, of the loss function with respect to a QT conjugate of the one or more variable parameters and of respective inputs to the quaternion layers. 120.-. (canceled)21. A machine-learning system comprising: an input layer, an output layer, and a plurality of hidden layers arranged along a forward propagation path between the input layer and the output layer;', 'wherein the input layer is to accept training data comprising quaternion values, and to output a quaternion-valued signal along the forward propagation path to at least one of the plurality of hidden layers;', 'wherein at least some of the hidden layers include, quaternion layers to execute consistent quaternion (QT) forward operations based on one or more variable parameters, to produce a corresponding at least one feature map output along the forward propagation path; and', 'wherein the output layer produces a DNN result that is based on the QT forward operations;, 'processing hardware, including computation circuitry and data storage circuitry, the processing hardware configured to form a deep neural network (DNN) includingthe DNN further including a loss function engine to produce a loss function representing an error between the DNN result and an expected result; computation of layer-wise QT ...

ACUTE HEART FAILURE MONITORING AND TREATMENT

Systems and methods include differential diagnosis for acute heart failure to provide treatment to a patient including determining whether the patient has cardiac volume overload, determining whether the patient has decreased abdominal venous system volume, and providing the appropriate treatment in response to the determinations. A multi-sensor system may be used to determine cardiac volume and abdominal venous system volume. Fluid redistribution treatment may be provided when cardiac volume overload is accompanied by a decrease in abdominal venous system volume. Fluid accumulation treatment may be provided when cardiac volume overload is not accompanied by a decrease in abdominal venous system volume. 1. A method comprising:determining whether a patient has cardiac volume overload;determining whether the patient has decreased abdominal venous system volume; anddetermining an appropriate treatment based on determining whether the patient has cardiac volume overload and determining whether the patient has decreased abdominal venous system volume.2. A method as in claim 1 , further comprising providing fluid redistribution treatment in response to determining that the patient has a cardiac volume overload and a decreased abdominal venous system volume.3. A method as in or claim 1 , further comprising providing fluid accumulation treatment in response to determining that the patient has a cardiac volume overload and that the abdominal venous system volume of the patient has not decreased.4. A method as in claim any preceding claim claim 1 , wherein one or both of cardiac volume overload and decreased abdominal venous system volume of the patient is determined based on a fixed value threshold or a cumulative value threshold.5. A method as in any preceding claim claim 1 , wherein providing fluid redistribution treatment comprises one or more of: using or increasing adrenergic blockade claim 1 , providing instructions for bed rest claim 1 , and providing instructions for ...

COMPUTATIONALLY-EFFICIENT QUATERNION-BASED MACHINE-LEARNING SYSTEM

A quaternion deep neural network (QTDNN) includes a plurality of modular hidden layers, each comprising a set of QT computation sublayers, including a quaternion (QT) general matrix multiplication sublayer, a QT non-linear activations sublayer, and a QT sampling sublayer arranged along a forward signal propagation path. Each QT computation sublayer of the set has a plurality of QT computation engines. In each modular hidden layer, a steering sublayer precedes each of the QT computation sublayers along the forward signal propagation path. The steering sublayer directs a forward-propagating quaternion-valued signal to a selected at least one QT computation engine of a next QT computation subsequent sublayer. 124.-. (canceled)25. A machine-learning system , comprising: wherein the input layer is to accept training data comprising quaternion values, and to output a quaternion-valued signal along the forward propagation path to at least one of the plurality of hidden layers; and', 'wherein at least some of the hidden layers include, quaternion layers to execute consistent quaternion (QT) forward operations based on one or more variable parameters, to produce a corresponding at least one feature map output along the forward propagation path; wherein the output layer produces a DNN result that is based on the QT forward operations;, 'processing hardware, including computation circuitry and data storage circuitry, the processing hardware configured to form a deep neural network (DNN) including: an input layer, an output layer, and a plurality of hidden layers arranged along a forward propagation path between the input layer and the output layer;'} 'wherein the quaternion layers are to execute QT backpropagation-based training operations that include:', 'the DNN further including a loss function engine to produce a loss function representing an error between the DNN result and an expected result; and'}computation of layer-wise QT partial derivatives, consistent with an ...

MEDICAL SYSTEM FOR SEAMLESS THERAPY ADJUSTMENT

Methods and systems for seamless adjustment of treatment are disclosed. A determination is made as to whether to intervene with a patient's treatment. Implanted device memory data is acquired over a pre-specified time period. Risk status is determined from the device memory data. Another external device memory data is acquired over a pre-specified time period. A determination is made as to whether to adjust treatment of the patient in response to the risk status, the data acquired from the implanted device memory and the external device memory data. 1. A system for determining whether to intervene with a patient's treatment , the system comprising:an implantable device having a memory;an implantable sensor;an implantable processor;an external device;sensing means for sensing data through the implanted sensor;the implanted processor configured to compare the data against a threshold stored in the memory of the implanted device to determine whether the data is considered to be indicative of a heart failure (HF) worsening episode occurrence based on a result of the comparison;storing means for storing a determined occurrence in the memory of the implanted device;transmitting means for transmitting the occurrence to the external device;processing means for determining a risk status from the occurrence and any other applicable data using the external device;means for acquiring additional data, the additional data being one of weight, symptoms, and blood pressure; andthe external device configured to automatically determine whether to adjust the patient's treatment plan comprising a set of pharmaceutical physician prescriptions based on the risk status, the data acquired from the implanted device memory and the one or more other external devicesthe external device further configured to signal a medication dispenser to dispense a correct medication in response to determining to adjust the patient's treatment plan.2. The system of wherein the additional data is acquired ...

LIQUID PHASE ADDITIVE FOR USE IN THERMAL CRACKING PROCESS TO IMPROVE PRODUCT YIELDS

The present invention relates to a liquid phase additive comprising an alkyl nitrate; a petroleum sulphonates; an aliphatic, aromatic, cyclohexylamines or hetroalkylated lower amines; a hindered phenol based compounds; a phosphate esters and an aliphatic alcohols for use in delayed coking process with decreased coke yield and increased yield of liquid and/or gaseous product and a process for preparing the liquid phase additive. The present invention also relates to a process for thermal cracking of petroleum residue producing petroleum coke and lighter hydrocarbon products by using liquid phase additive. 1. A liquid phase additive comprising:(i) an alkyl nitrate;(ii) a petroleum sulphonates;(iii) an aliphatic, aromatic, cyclohexylamines or hetroalkylated lower amines;(iv) a hindered phenol based compounds;(v) a phosphate esters; and(vi) an aliphatic alcohols.2. The additive as claimed in claim 1 , wherein the alkyl nitrate is selected from 2-ethylhexyl nitrate and isopropyl nitrate.3. The additive as claimed in claim 1 , wherein the petroleum sulphonates is selected from calcium petroleum sulphonates of less than 100 TBN.4. The additive as claimed in claim 1 , wherein the aliphatic claim 1 , aromatic claim 1 , cyclohexylamines or hetroalkylated lower amines are selected from dimethyl-cyclohexylamine claim 1 , dibutylamine claim 1 , mono & di-ethanol amine claim 1 , and benzylamine.5. The additive as claimed in claim 1 , wherein the hindered phenol based compounds is selected from 2 claim 1 ,6 ditertiary-butyl-4-methyl-phenol claim 1 , 2 claim 1 ,4 dimethyl-6-tertiary-butyl-phenol claim 1 , and 2 claim 1 ,6 ditertiary-butyl-phenol.6. The additive as claimed in claim 1 , wherein the phosphate esters is selected from trialkyl claim 1 , and triaryl phosphates.7. The additive as claimed in claim 1 , wherein the aliphatic alcohols is selected from butanol claim 1 , hexanol claim 1 , 2-ethylhexanol and mixtures thereof.8. The additive as claimed in claim 1 , wherein an ...

IMPLANTABLE MEDICAL DEVICE (IMD) SENSING MODIFICATIONS RESPONSIVE TO DETECTED PACING PULSES

In situations in which an implantable medical device (IMD) (e.g., an extravascular ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the IMD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the IMD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the IMD includes a pace pulse detector that detects, based on the processing of sensed electrical signals, delivery of a pacing pulse from a second implantable medical device and blank, based on the detection of the pacing pulse, the sensed electrical signal to remove the pacing pulse from the sensed electrical signal. 1. An implantable medical device comprising:a sensing channel that includes a plurality of components that process electrical signals sensed on an implantable electrical lead coupled to the implantable medical device;a pace pulse detector that detects pacing pulses delivered by a second implantable medical device based on the processing of the electrical signals sensed on the implantable electrical lead;a blanking module; anda blanking control module configured to, in response to pace pulse detector detecting the pacing pulse, cause the blanking module to blank the electrical signal of the sense channel to remove the pacing pulse from the sensed electrical signal.2. The device of claim 1 , wherein the pace pulse detector detects pacing pulses having amplitudes greater than or equal to four (4) millivolts and a pulse width of at least one (1) millisecond.3. The device of claim 1 , the blanking module holds the sensed electrical signal at a value of the sensed electrical signal prior to the pacing pulse to remove the pacing pulse from the sensed electrical signal.4. The device of claim 3 , wherein the blanking module ...

IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) TACHYARRHYTHMIA DETECTION MODIFICATIONS RESPONSIVE TO DETECTED PACING

An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train. 1. A method comprising:detecting, with an extravascular implantable medical device (IMD), initiation of a pacing train delivered by a second implantable medical device;determining a type of the detected pacing train; andmodifying a tachyarrhythmia detection algorithm based on the type of the detected pacing train.2. The method of claim 1 , wherein determining a type of the detected pacing train comprises:estimating a cycle length of the pacing train;comparing the estimated cycle length of the pacing train to at least one cycle length threshold; anddetermining a type of the detected pacing train based on the comparison.3. The method of claim 1 , wherein determining a type of the detected pacing train comprises analyzing one or more of an onset of the heart rate immediately prior to the detected pacing train claim 1 , a regularity of the pacing pulse intervals claim 1 , a consistency of the pacing artifact amplitude claim 1 , a consistency of the pacing pulse slew rate claim 1 , and/or a consistency of the pacing pulse polarity.4. The method of claim 1 , further comprising:obtaining an electrical signal sensed on an implantable electrical lead coupled to the IMD; andanalyzing at least one of an amplitude and a slew rate of the electrical signal to detect pacing pulses in the electrical signal, wherein detecting initiation of the pacing train comprises detecting initiation of the pacing train using the detected pacing ...

PACE PULSE DETECTOR FOR AN IMPLANTABLE MEDICAL DEVICE

In situations in which an implantable medical device (e.g., a subcutaneous ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the subcutaneous ICD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the ICD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the ICD includes a first pace pulse detector configured to obtain a sensed electrical signal and analyze the sensed electrical signal to detect a first type of pulses having a first set of characteristics and a second pace pulse detector configured to obtain the sensed electrical signal and analyze the sensed electrical signal to detect a second type of pulses having a second set of characteristics. 1. An implantable medical device comprising:a first pace pulse detector configured to obtain a sensed electrical signal and analyze the sensed electrical signal to detect a first type of pulses having a first set of characteristics; anda second pace pulse detector configured to obtain the sensed electrical signal and analyze the sensed electrical signal to detect a second type of pulses having a second set of characteristics.2. The device of claim 1 , wherein the first set of characteristics is a first amplitude and the first pace pulse detector includes a first threshold detector that detects the first type of pulses when an amplitude of the sensed electrical signal is greater than or equal to the first amplitude claim 1 , andwherein the second set of characteristics is a second amplitude, the second amplitude being less than the first amplitude, and the second pace pulse detector includes a second threshold detector that detects the second type of pulses when the amplitude of the sensed electrical signal is greater than or equal to ...

MEDICAL SYSTEM FOR THERAPY ADJUSTMENT

Methods and systems for seamless adjustment of treatment are disclosed. A determination can be made as to whether to intervene with a patient's treatment based on data obtained from implantable electrodes and/or non-implantable electrodes. The data from non-implantable electrodes have a correction factor applied to adjust for less accuracy compared to data acquired from implantable electrodes.

SENSING FOR HEART FAILURE MANAGEMENT

In some examples, determining a heart failure status includes using an implantable medical device configured for subcutaneous implantation and comprising a plurality of electrodes and an optical sensor. Processing circuitry of a system comprising the device may determine, for a patient, a current tissue oxygen saturation value based on a signal received from the at least one optical sensor, a current tissue impedance value based on a subcutaneous tissue impedance signal received from the electrodes, and a current pulse transit time value based on a cardiac electrogram signal received from the electrodes and at least one of the signal received from the optical sensor and the subcutaneous tissue impedance signal. The processing circuitry may further compare the current tissue oxygen saturation value, current tissue impedance value, and current pulse transit time value to corresponding baseline values, and determine the heart failure status of the patient based on the comparison. 1. A method for determining a heart failure status of a patient using an implantable medical device configured for subcutaneous implantation outside of a thorax of the patient , the implantable medical device comprising a plurality of electrodes and at least one optical sensor , the method comprising , by processing circuitry of a medical device system comprising the implantable medical device:determining a current tissue oxygen saturation value of the patient based on a signal received from the at least one optical sensor;determining a current tissue impedance value of the patient based on a subcutaneous tissue impedance signal received from a first at least two of the plurality of electrodes;determining a current pulse transit time value of the patient based on a cardiac electrogram signal received from a second at least two of the plurality of electrodes and at least one of the signal received from the at least one optical sensor and the subcutaneous tissue impedance signal;comparing the ...

METHOD OF EFFICIENT BACKUP OF DISTRIBUTED FILE SYSTEM FILES WITH TRANSPARENT DATA ACCESS

Examples include techniques for backing up a file to long term “cold” storage by using circuitry, and logic for execution by the circuitry, to receive a request to back up the file in a distributed file system to cold storage, to copy the file from at least one data node of the distributed file system to cold storage, to set a location of the file in cold storage in a name node of the distributed file system, and to set a length of the file to zero in the name node. 1. An apparatus comprising:circuitry; andlogic for execution by the circuitry to:receive a request to back up a file in a distributed file system to cold storage;copy the file from at least one data node of the distributed file system to cold storage;set a location of the file in cold storage in a name node of the distributed file system; andset a length of the file to zero in the name node.2. The apparatus of claim 1 , the logic for execution by the circuitry to cause deletion of the file in the at least one data node when the file length is set to zero.3. The apparatus of claim 1 , wherein the name node to store the location of the file in metadata in a file index table in the name node.4. The apparatus of claim 3 , wherein the metadata comprises one or more extended attributes of the file.5. The apparatus of claim 1 , wherein the data node to store the file in one or more of a hot storage and a warm storage in the data node.6. The apparatus of claim 5 , wherein the hot storage comprises one or more of a random-access memory (RAM) and a solid-state drive (SSD) claim 5 , the warm storage comprises a hard disk drive (HDD) claim 5 , and the cold storage comprises one or more of an optical disk drive and a tape drive.7. The apparatus of claim 1 , wherein the distributed file system comprises one of Apache Hadoop claim 1 , Ceph claim 1 , and OpenStack Swift.8. A method comprising:receiving a request to back up a file in a distributed file system to cold storage;copying the file from at least one data node ...

ABSOLUTE INTRATHORACIC IMPEDANCE BASED SCHEME TO STRATIFY PATIENTS FOR RISK OF A HEART FAILURE EVENT

A health care system acquires data determines whether a patient is at risk of hypervolemia or hypovolemia. The method comprises (a) acquiring from a device memory a patient's absolute intrathoracic impedance data over a pre-specified time period, (b) determining a running average of the intrathoracic impedance data over the pre-specified time period, and (c) determining by the system whether the running average of the intrathoracic impedance data over the pre-specified time period exceeds one of a first and second range, the first range being a higher value boundary of intrathoracic electrical impedance and the second range being a lower value boundary of intrathoracic electrical impedance. 1. A medical system for determining whether a patient is at risk of exhibiting excessive fluid or dehydration and for delivering treatment in response thereto , the system comprising: a processor configured to:', 'a) determine an average of the intrathoracic impedance data over the time period;', '(b) define a target impedance range having a lower bound defined by a first range and an upper bound defined by a second range, the first range comprising lower value intrathoracic electrical impedances and the second range comprising higher value intrathoracic electrical impedances;', '(c) determine whether the average of the intrathoracic impedance data is outside of the target impedance range; and', '(d) in response to the intrathoracic impedance data being outside the target impedance range c, determine a level of heart failure (HF) event risk; and', 'means for adjusting therapy delivered to the patient by a cardiac pacemaker in response to step (d), wherein the therapy is adjusted by switching to one of fusion pacing, biventricular pacing, and multisite pacing delivered by the cardiac pacemaker., "an implantable medical having a device memory storing a patient's absolute intrathoracic impedance data over a time period;"}2. The system of wherein the processor determines that the ...

ADAPTIVE TREATMENT MANAGEMENT SYSTEM

An adaptive treatment management system includes a sensor system, a treatment optimization system, and a treatment delivery system. The treatment optimization system may update a treatment regimen multiple times between physician visits to facilitate optimization of treatment. The treatment optimization system may determine a treatment regimen based on at least one of patient data, treatment compliance data, and related treatment data. Patient data may be provided by the sensor system. Treatment compliance data may be provided by the treatment delivery system. Related treatment data may be provided by a remote system. 1. A heart failure treatment management system comprising:a sensor system to provide patient data about a patient or an environment related to the patient using a non-implantable sensor and an implantable sensor;a heart failure treatment delivery system to administer treatment based on a treatment regimen and to provide treatment compliance data; anda heart failure treatment optimization system operably coupled to the sensor system and the heart failure treatment delivery system to update a heart failure treatment regimen based on the patient data from the sensor system and the treatment compliance data from the heart failure treatment delivery system and to provide the updated heart failure treatment regimen to the heart failure treatment delivery system.2. The system according to claim 1 , wherein the heart failure treatment optimization system is configured to update the treatment regimen at least daily.3. The system according to claim 1 , wherein the heart failure treatment optimization system is configured to update the treatment regimen automatically between physician inputs to maintain the patient in a stable region.4. The system according to claim 1 , wherein the heart failure treatment optimization system is operably coupled to a remote system to receive related treatment data to train a risk score generator claim 1 , a treatment regimen ...

Rate Responsive Pacing

Some aspects relate to systems, devices, and methods of delivering rate responsive pacing therapy. The method includes monitoring activity information related to an activity level of a patient and delivering rate responsive pacing (RRP) to the patient at a pacing rate corresponding to a RRP profile. The RRP profile may be used to generate the pacing rate based on the activity information and may be adjusted based on the monitored activity information. 1. An implantable medical device comprising;a sensing apparatus comprising a sensor to sense activity information of a patient;a control apparatus comprising processing circuitry to select a rate responsive pacing (RRP) profile based on the sensed activity information received from the sensing apparatus; andan electrode apparatus comprising a plurality of pacing electrodes, the electrode apparatus operably coupled to the control apparatus, the electrode apparatus to deliver rate responsive pacing to the patient at a pacing rate corresponding to the RRP profile,wherein control apparatus is to adjust the RRP profile based on the sensed activity information.2. The device of claim 1 , wherein the pacing electrodes are to deliver rate responsive pacing at the pacing rate corresponding to the RRP profile during activity events based on the sensed activity information.3. The device of claim 1 , wherein the control apparatus is to adjust the RRP profile based on the sensed activity information indicating an increase in the patient's activity and a maximum aggressiveness is not exceeded.4. The device of claim 1 , wherein the electrode apparatus is to deliver rate responsive pacing corresponding to a plurality of RRP profiles claim 1 , wherein the RRP profile is adjusted from a first RRP profile of a plurality of RRP profiles to a second RRP profile of the plurality of RRP profiles based on the sensed activity information indicating an increase in an activity level of the patient.5. A therapy system comprising:a sensing ...

MEDICAL DEVICE FOR FALL DETECTION

A medical device is configured to produce an accelerometer signal and detect a patient fall from the accelerometer signal. The device generates a body posture signal and a body acceleration signal from the accelerometer signal and detects a patient fall in response to determining that the body posture signal and the body acceleration signal meet fall detection criteria. The medical device is configured to receive a truth signal from another device that is not the medical device. The truth signal may indicate that the detected patient fall is a falsely detected patient fall and, responsive to receiving the truth signal, the medical device adjusts at least one fall detection control parameter. 1. A medical device comprising:an accelerometer circuit configured to produce an accelerometer signal and generate a body posture signal and a body acceleration signal from the accelerometer signal; determine that the body posture signal and the body acceleration signal meet fall detection criteria; and', 'detect a patient fall in response to the body posture signal and the body acceleration signal meeting the fall detection criteria; and, 'a control circuit configured to receive the body posture signal and the body acceleration signal anda telemetry circuit configured to receive a first truth signal transmitted from another device, the truth signal indicating that the detected patient fall is a falsely detected patient fall,responsive to the telemetry circuit receiving the first truth signal, the control circuit being further configured to adjust at least one fall detection control parameter used to control at least one of: generating the body posture signal from the accelerometer signal; generating the body acceleration signal from the accelerometer signal; and determining that the fall detection criteria are met.2. The medical device of claim 1 , wherein the control circuit is configured to determine that the body posture signal and the body acceleration signal meet the fall ...

IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) TACHYARRHYTHMIA DETECTION MODIFICATIONS RESPONSIVE TO DETECTED PACING

An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train. 1. A method comprising:detecting, with an extravascular implantable medical device (IMD), initiation of a pacing train delivered by a second implantable medical device;determining a type of the detected pacing train; andmodifying a tachyarrhythmia detection algorithm based on the type of the detected pacing train.2. The method of claim 1 , wherein determining a type of the detected pacing train comprises:estimating a cycle length of the pacing train;comparing the estimated cycle length of the pacing train to at least one cycle length threshold; anddetermining a type of the detected pacing train based on the comparison.3. The method of claim 1 , wherein determining a type of the detected pacing train comprises analyzing one or more of an onset of the heart rate immediately prior to the detected pacing train claim 1 , a regularity of the pacing pulse intervals claim 1 , a consistency of the pacing artifact amplitude claim 1 , a consistency of the pacing pulse slew rate claim 1 , and/or a consistency of the pacing pulse polarity.4. The method of claim 1 , further comprising:obtaining an electrical signal sensed on an implantable electrical lead coupled to the IMD; andanalyzing at least one of an amplitude and a slew rate of the electrical signal to detect pacing pulses in the electrical signal, wherein detecting initiation of the pacing train comprises detecting initiation of the pacing train using the detected pacing ...

MEDICAL SYSTEM FOR SEAMLESS THERAPY ADJUSTMENT

Methods and systems for seamless adjustment of treatment are disclosed. A determination is made as to whether to intervene with a patient's treatment. Implanted device memory data is acquired over a pre-specified time period. Risk status is determined from the device memory data. Another external device memory data is acquired over a pre-specified time period. A determination is made as to whether to adjust treatment of the patient in response to the risk status, the data acquired from the implanted device memory and the external device memory data. 1. A method of delivering diuretic medication therapy to a patient using a computer system , comprising:defining first and second rounds of diuretic medication therapy;using the computer system to determine that the patient is suffering from a worsening heart failure (HF) condition;in response to the determination that the patient is suffering from the worsening heart failure (HF) condition, initiating the first round of diuretic medication therapy without first contacting a physician;thereafter determining whether the patient has undergone a weight change in excess of a defined amount;in response to a determination that the patient has undergone a weight change in excess of the defined amount, determining whether the patient is also experiencing a specific HF symptom;in response to the determination that the patient is also experiencing the specific HF symptom, stopping delivery of the first round of diuretic medication therapy; andthereafter using the computer system to monitor the patient for the worsening HF condition.2. The method of wherein the step of initiating the first round of diuretic medication therapy comprises using the computer system to provide the patient with a pre-authorized prescription for the first round of diuretic medication therapy.3. The method of wherein the patient has the first round of diuretic medication therapy on-hand and wherein the step of initiating the first round of diuretic ...

DELIVERY OF CARDIAC PACING THERAPY FOR CARDIAC REMODELING

A method and device apparatus to deliver a pacing therapy capable of remodeling a patient's heart over a period of time that includes monitoring one or more parameters in response to a delivered cardiac remodeling pacing, determining whether the cardiac remodeling pacing has an effect on cardiac normalization in response to the monitoring, and adjusting the cardiac remodeling pacing in response to the determined effect on cardiac normalization. The method and device may also perform short-term monitoring of one or more parameters in response to the delivered cardiac remodeling pacing, monitor one or more long-term parameter indicative of a long-term effect of the delivered cardiac remodeling pacing, determine the long-term effect of the delivered cardiac remodeling pacing on cardiac normalization in response to the monitoring, and adjust the cardiac remodeling pacing in response to one or both of the short-term monitoring and the determined long-term effect on cardiac normalization. 1. A method , comprising:delivering cardiac remodeling pacing to stimulate normalization of a condition of the patient's heart;monitoring one or more parameters in response to the delivered remodeling pacing;determining whether the cardiac remodeling pacing has an effect on cardiac normalization in response to the monitoring; andadjusting the cardiac remodeling pacing in response to the determined effect on cardiac normalization.2. The method of claim 1 , further comprising:determining tissue perfusion during delivery of the remodeling pacing therapy;comparing the determined tissue perfusion with a non-paced baseline tissue perfusion level determined prior to the cardiac remodeling pacing being delivered to the patient; anddetermining whether the cardiac remodeling pacing has had an effect on cardiac normalization in response to the comparing.3. The method of claim 2 , wherein comparing the determined tissue perfusion with a non-paced baseline tissue perfusion level determined prior to ...

DELIVERY OF CARDIAC PACING THERAPY FOR CARDIAC REMODELING

A method and device apparatus to deliver a pacing therapy capable of remodeling a patient's heart over a period of time that includes delivering remodeling pacing during a first interval, the first interval comprising a first rate and a first duration, determining whether to adjust one or both of the first rate and the first duration during delivery of remodeling pacing during a next interval subsequent to the first interval, and delivering remodeling pacing during the next interval in response to the determining, wherein the next interval comprises one of the first rate and the first duration of the first interval and the adjusted one or both of the first rate and the first duration. 1. A method for delivering a cardiac remodeling pacing therapy to a patient , comprising:delivering cardiac remodeling pacing during a first interval at a first rate for a first duration;determining whether to adjust one or both of the first rate and the first duration during delivery of cardiac remodeling pacing during a next interval subsequent to the first interval;adjusting one or both of the first rate and the first duration during delivery of cardiac remodeling pacing during a next interval subsequent to the first interval in response to the determining to adjust one or both of the first rate and the first duration; anddelivering cardiac remodeling pacing during the next interval at the first rate for the first duration.2. The method of claim 1 , further comprising delivering cardiac remodeling pacing at a second rate for a second duration claim 1 , wherein the second rate is greater than the first rate and the second duration is less than the first duration.3. The method of claim 2 , further comprising delivering cardiac remodeling pacing at the first rate for the first duration subsequent to delivery of the cardiac remodeling pacing at the second rate for the second duration.4. The method of claim 2 , further comprising delivering cardiac remodeling pacing at a third rate for ...

Detection of infection based on temperature and impedance

A system comprises an implantable medical device configured to generate temperature data and impedance data associated with temperature and impedance of a patient proximate to the implantable medical device. The system further comprises processing circuitry configured to determine whether a first one or more infection criteria are satisfied by temperature data and impedance data generated by the implantable medical device during a first time interval, wherein the first one or more infection criteria include at least one criterion indicative of decreased impedance, determine whether a second one or more infection criteria are satisfied by the temperature data and impedance data generated by the implantable medical device during a second time interval subsequent to the first time interval, wherein the second one or more infection criteria include at least one criterion indicative of increased impedance, and output, based on satisfaction of the first and second infection criteria, an indication of infection.

METHOD FOR PREDICTING RECYCLING VENTRICULAR ARRHYTHMIES

Implantable medical device (IMD) sensing modifications responsive to detected pacing pulses

In situations in which an implantable medical device (IMD) (e.g., an extravascular ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the IMD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the IMD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the IMD includes a pace pulse detector that detects, based on the processing of sensed electrical signals, delivery of a pacing pulse from a second implantable medical device and blank, based on the detection of the pacing pulse, the sensed electrical signal to remove the pacing pulse from the sensed electrical signal.

Implantable cardioverter-defibrillator (ICD) tachyarrhythmia detection modifications responsive to detected pacing

An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train.

Pace pulse detector for an implantable medical device

In situations in which an implantable medical device (e.g., a subcutaneous ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the subcutaneous ICD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the ICD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the ICD includes a first pace pulse detector configured to obtain a sensed electrical signal and analyze the sensed electrical signal to detect a first type of pulses having a first set of characteristics and a second pace pulse detector configured to obtain the sensed electrical signal and analyze the sensed electrical signal to detect a second type of pulses having a second set of characteristics.

Pace pulse detector for a medical device

In situations in which an implantable medical device (e.g., a subcutaneous ICD) is co-implanted with a leadless pacing device (LPD), it may be important that the subcutaneous ICD knows when the LPD is delivering pacing, such as anti-tachycardia pacing (ATP). Techniques are described herein for detecting, with the ICD and based on the sensed electrical signal, pacing pulses and adjusting operation to account for the detected pulses, e.g., blanking the sensed electrical signal or modifying a tachyarrhythmia detection algorithm. In one example, the ICD includes a first pace pulse detector configured to obtain a sensed electrical signal and analyze the sensed electrical signal to detect a first type of pulses having a first set of characteristics and a second pace pulse detector configured to obtain the sensed electrical signal and analyze the sensed electrical signal to detect a second type of pulses having a second set of characteristics.

Implantable cardioverter-defibrillator (ICD) tachyarrhythmia detection modifications responsive to detected pacing

An implantable medical device comprises a sensing module configured to obtain electrical signals from one or more electrodes and a control module configured to process the electrical signals from the sensing module in accordance with a tachyarrhythmia detection algorithm to monitor for a tachyarrhythmia. The control module detects initiation of a pacing train delivered by a second implantable medical device, determines a type of the detected pacing train, and modifies the tachyarrhythmia detection algorithm based on the type of the detected pacing train.

Crossbar switch for multi-processor system

A self-routing crossbar switch interconnects a plurality of processors with a plurality of memory modules. In a self-routing crossbar switch connecting N processors and N memory modules, a processor is connected to each input port and a memory module is connected to each output port; each of the N processors can transmit a memory request simultaneously provided that there is no port contention and no bank contention. Port contention occurs if two or more processors attempt to access the same output port of the self-routing crossbar switch at the same time. The memory module consists of several memory banks that are connected in an interleaved manner. If the memory bank is accessed before it is ready to accept a new request, bank contention is said to have occurred. In the self-routing crossbar switch the requests directed to a port are first passed through an aligner and a conflict resolution logic. There is one aligner associated with each output port. The aligner inputs the requests directed at an output port and aligns them so that, at the output of the aligner, all the active requests appear in a consecutive fashion. The conflict resolution logic resolves the port and bank contention.

Method and apparatus of dual stage servo control with dual control paths and decoupling feedback for track following in a hard disk drive

A magnetic head follows a track in a hard disk drive as positioned by micro-actuator and voice coil motor. Embodiments operate two control paths. The micro-actuator control path generates a version of micro-actuator control signal stimulating the micro-actuator. The voice coil motor control path generates a version of voice coil control signal, amplified based upon tuning gain to stimulate voice coil motor. A decoupling feedback filter decouples these control paths, using the micro-actuator control signal version. Either control path may include a notch filter. A track following command, with PES removed, directs the micro-actuator control. The servo-controller may digitally support the invention, which may include the servo-controller program system. An implementation may be optimized within a hard disk drive, possibly as part of the manufacturing process. The hard disk drive is a product of that process.

Method and apparatus to control delivery of high-voltage and anti-tachy pacing therapy in an implantable medical device

A system and method for delivering both anti-tachy pacing (ATP) therapy and high-voltage shock therapy in response to detection of abnormal cardiac rhythms is disclosed. The system controls the time between delivering ATP therapy and the charging of high-voltage capacitors in preparation for shock delivery based on a predetermined set of criteria. In one embodiment, the inventive system operates in an ATP during Capacitor Charging (ATP-DCC) mode wherein all, or substantially all, of the ATP therapy is delivered during charging of the high-voltage capacitors. Based on evaluation of the predetermined set of criteria, the system may switch to an additional ATP before Capacitor Charging (ATP-BCC) mode, wherein substantially all of the ATP therapy is delivered prior to charging of the high-voltage capacitor. According to one aspect of the invention, the predetermined set of criteria is based, at least in part, on the effectiveness of previously-delivered ATP therapy.

Determining prospective risk of heart failure hospitalization

A method of operation of a medical device system for determining prospective heart failure hospitalization risk. The method includes measuring one or more data observations via one or more electrodes of an implanted medical device disposed in a patient's body. The data observations are stored into memory of the implantable medical device of a patient. The data observations are transmitted to an external device. The processor of the external device parses the data observations into one or more evaluation periods. Using the number of observations in one or more evaluation periods, a look up table, stored into memory of the external device, is accessed. The look up table associates prospective heart failure hospitalization risk with the data observations noted in the evaluation period. One or more embodiments involve a weighted prospective heart failure hospitalization risk for the set of evaluation periods. The prospective heart failure hospitalization is then displayed on the graphical user interface.

Biological pacemaker

Disclosed are compositions, methods and systems for preventing or treating cardiac dysfunction, particularly cardiac pacing dysfunction by genetic modification of cells of targeted regions of the cardiac conduction system. In particular, a bio-pacemaker composition is delivered to cardiac cells to increase the intrinsic pacemaking rate of the cells, wherein the bio-pacemaker composition increases expression of a channel or subunit thereof that produces funny current and a T-type Ca2+ channel or subunit thereof, and expresses one or more molecules that suppresses the expression of the wild type potassium channel.

Self-fixating scaffolds

A self-fixating scaffold delivers therapeutic material to tissue for treating various diseases/conditions. A scaffold holds the therapeutic material and is implanted into the tissue. A fixation element anchors the scaffold in the tissue making the scaffold less likely to become dislodged.

Microprocessor with digital power throttle

The present invention provides a digital-based mechanism for adjusting the power consumption in a processor. The processor includes one or more functional units and a digital throttle that monitors activity states of the processor's functional units to estimate the processor's power consumption. One embodiment of the digital throttle includes one or more gate units, a monitor circuit (320), and a throttle circuit (330). Each gate unit controls the delivery of power delivery to a functional unit of the processor and provides a signal that indicates the activity state of its associated functional unit. The monitor circuit determines an estimated power consumption level from the signals and compares the estimated power consumption with a threshold power level. The throttle circuit adjusts the instruction flow in the processor if the estimated power consumption exceeds the threshold power level.

Differentiation of heart failure risk scores for heart failure monitoring

A method for differentiating heart failure risk scores that includes receiving a current data transmission and acquiring patient metrics from a remote device, determining a daily heart failure risk score for each day occurring during a time period from a previous received data transmission to the current received data transmission based on the acquired patient metrics, determining a maximum daily heart failure risk score of the determined daily heart failure risk scores during a lookback window prior to the current received data transmission, determining a heart failure risk status alert for the received data transmission based on the temporal proximity of the determined maximum heart failure risk score and receipt of the current data transmission, selecting a type of notification based on the heart failure risk status differentiation, and indicating the transmission heart failure risk status and the heart failure risk status differentiation via the selected type of notification.

process of preparing a compound

PROCESSO DE PREPARAçãO DE UM COMPOSTO. Esta invenção se refere a um processo aprimorado para a preparação de um composto de Fórmula (I), sais da base livre cis-adamantano-2-espiro-3'-8'-[[[ (2'-amino-2'metil propil)amino]carbonil]metil]-1' ,2' ,4'-trioxaespiro [4.5] decano em que X pode ser um ânion. PREPARATION PROCESS OF A COMPOUND. This invention relates to an improved process for the preparation of a compound of Formula (I), cis-adamantane-2-spiro-3'-8 '- [[[(2'-amino-2'methyl] free base salts propyl) amino] carbonyl] methyl] -1 ', 2', 4'-trioxaspiro [4.5] decane wherein X may be an anion.

Ramp design for reducing read-write head track positioning errors

The invention includes a method of A wipping part of the load ramp is a convex finger crossing the read-write head path of motion with respect to a lifting tab engagably moving across the loading ramp.

Systems and methods for monitoring hemodynamic status

The exemplary systems and methods may monitor one or more signals to be used to assess the hemodynamic status of a patient. The one or more signals may be used to calculate, or determine, a plurality of pulse transit times. The plurality of pulse transit times may be used to determine hemodynamic status values that may be indicative of a patient's aggregate hemodynamic status.

Cellular and genetic intervention to treat ventricular tachycardia

A method for decreasing risk of ventricular tachycardia following myocardial infarction increases cell-to-cell coupling and/or excitability in the border zone of an infarcted region of myocardial tissue. Enhanced conduction to treat the border zone is carried out by genetically modifying myocytes in the border zone to form more gap junctions and/or sodium channels and/or calcium channels. Alternatively, enhanced conduction is carried out by incorporating cells into the border zone that form gap junctions with the myocytes and/or form sodium channels and/or form calcium channels.

Combined anti-tachycardia pacing (atp) and high voltage therapy for treating ventricular arrhythmias

The present invention provides a system and method for treating an arrhythmia of the heart. The system and method involves delivery of anti-tachy pacing (ATP) pulses to the heart, possibly followed by the delivery of a high-voltage shock. ATP delivery is controlled such that the time of delivery of any high-voltage shock is not affected by the prior delivery of the ATP pulses. System control may be accomplished using one or more programmable parameters, which may include a user-specified shock energy.

Method and apparatus for micro-actuator stroke sensitivity calibration in a hard disk drive

A sinusoidal signal is added to the notch filtered micro-actuator control signal stimulating the micro-actuator. The voice coil control signal is notch filtered to remove the frequency component of the sinusoidal signal before it stimulates the voice coil motor. The micro-actuator control signal is notch filtered to remove the frequency component of the sinusoidal signal before it stimulates the micro-actuator. The response of the system is measured as the Position Error Signal (PES), for the magnetic head moved by the micro-actuator. The measured PES is then demodulated at the frequency of the sinusoidal signal to create a measured amplitude. The stroke sensitivity is then calculated from the measured amplitude and amplitude of the sinusoidal stimulus. The frequency of the sinusoidal signal and notch filters is essentially the same, chosen away from significant excitation frequencies and outside the bandwidth of the servo system. The invention includes using multiple frequencies, as well as various formulas for the stroke sensitivity. The invention may be applied to more than one micro-actuator within the hard disk drive to create a stroke sensitivity for each micro-actuator, a combination, or for all micro-actuators. The invention includes the method implemented using a servo-controller, as well as the program system for the servo-controller, at least partly implementing the method.

Rate control during AF using cellular intervention to modulate AV node

A biologic intervention method and apparatus generates a persistent modification to an AV node that is physiologically stable after the agent has matured but is alterable with subsequent application of an agent. Specifically, the generic agent is used to modulate a node in a cardiac conduction system including rate control using one and a combination of a family of K + channel or equivalent. Specifically, the channel is implemented to slow conduction by generating an outward current during optimization of action potential and repolarization phase thus decreasing the current that is available to excite downstream cells. A Kv 1.3 channel, for example, may be used as the biologic channel. The invention enables reversal of the modulation or adjustment for various heart rates (BPM) based on medical and patient-specific needs.

Circuit arrangement, method and data processing device for performing a one-cycle addition or subtraction and a comparison in arithmetic redundant form

Schaltungsanordnung zum schnellen Erzeugen eines gültigen Ergebnisses einer arithmetischen und Vergleichs-Operation, aufweisend: a) eine Arithmetikschaltung (2103; 2113) zur Durchführung einer arithmetischen Operation an mehreren Operanden, von denen wenigstens einer in redundanter Form dargestellt ist, wobei die Arithmetikschaltung ein Ergebnis in redundanter Form erzeugt, und b) eine Komparatorschaltung (2106; 2116), die das Ergebnis in redundanter Form empfängt und mit einem Wert vergleicht und ein Vergleichsergebnis erzeugt, das eine Gleichheit des Ergebnisses und des Werts anzeigt, wobei das Vergleichsergebnis unabhängig von irgendeiner Übertragssignalfortpflanzung von einer am geringsten bewerteten Stelle des Ergebnisses der arithmetischen Operation zu einer am höchsten bewerteten Stelle des Ergebnisses über einen Weiterleitungspfad erzeugt wird. A circuit arrangement for quickly generating a valid result of an arithmetic and comparison operation, comprising: a) an arithmetic circuit (2103, 2113) for performing an arithmetic operation on a plurality of operands, at least one of which is shown in redundant form, wherein the arithmetic circuit generates a result in redundant form, and b) a comparator circuit (2106; 2116) which receives the result in redundant form and compares it to a value and generates a comparison result indicating equality of the result and the value, the comparison result being independent of any carry signal propagation from a least significant digit the result of the arithmetic operation is generated to a highest ranked location of the result via a forwarding path.

Cellular and genetic intervention to treat ventricular tachycardia

Published without an Abstract

Computationally-efficient quaternion-based machine-learning system

A quaternion deep neural network (QTDNN) includes a plurality of modular hidden layers, each comprising a set of QT computation sublayers, including a quaternion (QT) general matrix multiplication sublayer, a QT non-linear activations sublayer, and a QT sampling sublayer arranged along a forward signal propagation path. Each QT computation sublayer of the set has a plurality of QT computation engines. In each modular hidden layer, a steering sublayer precedes each of the QT computation sublayers along the forward signal propagation path. The steering sublayer directs a forward-propagating quaternion-valued signal to a selected at least one QT computation engine of a next QT computation subsequent sublayer.

Method and apparatus to terminate ventricular tachycardia via pacing

An implantable device for terminating ventricular tachycardia is disclosed. The device includes a processor configured to determine a first antitachycardia pulse routine of N pulses. In the routine the first N−1 pulses are separated by a first cycle length and the Nth pulse is separated by a second cycle length that is shorter than the first cycle length. The device also comprises a lead coupled to the processor. The lead comprises an electrode configured to sense a tachycardia and further configured, under control of the processor, to administer the antitachycardia pulse routine.

Method and apparatus to control delivery of high-voltage and anti-tachy pacing therapy in an implantable medical device

A system and method for delivering both anti-tachy pacing (ATP) therapy and high-voltage shock therapy in response to detection of abnormal cardiac rhythms is disclosed. The system controls the time between delivering ATP therapy and the charging of high-voltage capacitors in preparation for shock delivery based on a predetermined set of criteria. In one embodiment, the inventive system operates in an ATP During Capacitor Charging (ATP-DCC) mode wherein all, or substantially all, of the ATP therapy is delivered during charging of the high-voltage capacitors. Based on evaluation of the predetermined set of criteria, the system may switch to an additional ATP Before Capacitor Charging (ATP-BCC) mode, wherein substantially all of the ATP therapy is delivered prior to charging of the high-voltage capacitor. According to one aspect of the invention, the predetermined set of criteria is based, at least in part, on the effectiveness of previously-delivered ATP therapy.

Rate control during AF using cellular intervention to modulate AV node

A biologic intervention method and apparatus generates a persistent modification to an AV node that is physiologically stable after the agent has matured but is alterable with subsequent application of an agent. Specifically, the generic agent is used to modulate a node in a cardiac conduction system including rate control using one and a combination of a family of K + channel or equivalent. Specifically, the channel is implemented to slow conduction by generating an outward current during optimization of action potential and repolarization phase thus decreasing the current that is available to excite downstream cells. A Kv 1.3 channel, for example, may be used as the biologic channel. The invention enables reversal of the modulation or adjustment for various heart rates (BPM) based on medical and patient-specific needs.

Sensing for heart failure management

In some examples, determining a heart failure status includes using an implantable medical device configured for subcutaneous implantation and comprising a plurality of electrodes and an optical sensor. Processing circuitry of a system comprising the device may determine, for a patient, a current tissue oxygen saturation value based on a signal received from the at least one optical sensor, a current tissue impedance value based on a subcutaneous tissue impedance signal received from the electrodes, and a current pulse transit time value based on a cardiac electrogram signal received from the electrodes and at least one of the signal received from the optical sensor and the subcutaneous tissue impedance signal. The processing circuitry may further compare the current tissue oxygen saturation value, current tissue impedance value, and current pulse transit time value to corresponding baseline values, and determine the heart failure status of the patient based on the comparison.

Modification of heart failure monitoring algorithm to address false determinations

In some examples, a system comprises one or more medical devices configured to, for each of a plurality of periods, determine a respective value for each of a plurality of parameters of a patient and processing circuitry. The processing circuitry can for each of the plurality of periods, execute an algorithm to determine at least one of a heart failure risk score or status for the patient based on the determined values for the period, determine a number of the determined heart failure risk scores or statuses that were false determinations, determine that the number of false determinations for the patient satisfies a false determination threshold, and modify the algorithm for the patient in response to the determination that the number of false determinations for the patient satisfies the false determination threshold.

Needle design for recording monophasic action potential and delivery of therapy

A system and associated method measure monophasic action potential signals for identifying a targeted tissue location and delivering a therapy to the targeted tissue location. The system includes a hollow needle having a sharpened distal tip, a first electrode at the distal tip and a fluid delivery lumen extending through the needle from a proximal needle end to an opening in the sharpened distal tip.

Fabrication of spectrally selective solar surfaces by the thermal treatment of austenitic stainless steel AISI 321

The spectrally selective solar surfaces have been produced after heating the austenitic stainless steel AISI 321 at a firing temperature of 843° K. and for firing times ranging from 10 to 20 minutes. The heating was carried out in a constant temperature oven under normal atmospheric conditions. The optimum values of solar absorptance α s and near-normal emittance ε s were found to be α s =0.92+0.02, ε s =0.22±0.02 respectively. The corresponding values for the unheated steel were 0.50±0.02 and 0.22±0.22. Severe temperature treatments like quenching in liquid nitrogen at 77° K. produced no adverse visible affect on the quality of the selective surfaces. It shows that the thermal coatings so produced are very tough and durable. The value of solar absorptance and near-normal thermal emittance remained unchanged after quenching in liquod nitrogen. The thermal coatings so produced not only offer a technical advantage but also economic advantage over any of the existing techniques for the manufacture of stainless steel solar panels.

In-situ dynamic pitch and roll adjustment in hard disk drives

Disclosed is a head gimbal assembly for a hard disk drive that includes a head pivotally connected to a flexure. The flexure has a longitudinal axis. The assembly includes first and second micro-actuators that are located between the flexure and the head and spaced from the longitudinal axis. By way of example, the first and second micro-actuators may be thin piezo-electric transducers. Control signals can be provided to the micro-actuators to vary the pitch and/or roll of the head.

Delivery of cardiac pacing therapy for cardiac remodeling

A method and device apparatus to deliver a pacing therapy capable of remodeling a patient's heart over a period of time that includes delivering remodeling pacing during a first interval, the first interval comprising a first rate and a first duration, determining whether to adjust one or both of the first rate and the first duration during delivery of remodeling pacing during a next interval subsequent to the first interval, and delivering remodeling pacing during the next interval in response to the determining, wherein the next interval comprises one of the first rate and the first duration of the first interval and the adjusted one or both of the first rate and the first duration.

Method for predicting recurring ventricular arrhythmias

An implantable medical device and method are provided for assessing autonomic tone and risk factors associated with arrhythmias and, based on this assessment, an early recurrence of ventricular tachycardia or ventricular fibrillation is predicted. Specifically, changes in R-R interval, heart rate variability, patient activity, and myocardial ischemia are measured prior to and after a detected an arrhythmia episode. A recurrence score is calculated as a weighted sum of measured parameters and compared to a prediction criterion. The prediction criterion may be a preset threshold score or an individualized episode template based on previously calculated recurrence scores associated with recurring episodes. Stored parameters and episode-related data may be downloaded for offline analyses for optimizing prediction criteria and monitoring patient status.

Patent IN168730B

Medical system for seamless therapy adjustment

Systems for seamless adjustment of treatment are disclosed. A determination is made as to whether to intervene with a patient's treatment. Implanted device memory data is acquired over a pre-specified time period. Risk status is determined from the device memory data. Another external device memory data is acquired over a pre-specified time period. A determination is made as to whether to adjust treatment of the patient in response to the risk status, the data acquired from the implanted device memory and the external device memory data.

Genetic modification of targeted regions of the cardiac conduction system

Disclosed are methods and systems for preventing or treating cardiac dysfunction, particularly cardiac pacing dysfunction by genetic modification of the conduction system of the heart. In one embodiment, the invention provides a method of genetically modifying the cells by delivering to the cells one or more coding sequence in a genetic construct capable of modifying the expression of ion channels of the cells.

Ventricular tachycardia detection algorithm using only cardiac event intervals

An implantable medical device system includes a pacemaker and an extravascular implantable cardioverter defibrillator (ICD). The pacemaker is configured to acquire a cardiac electrical signal, determine RR intervals from the cardiac electrical signal, apply ventricular tachycardia detection criteria solely to the RR intervals, detect ventricular tachycardia (VT) when the detection criteria are met; and deliver anti-tachycardia pacing in response to detecting the VT before the extravascular ICD delivers a shock therapy.

A process for the preparation of dispiro 1,2,4-trioxolane antimalarials (oz277)

This invention relates to an improved process for the preparation of a compound of Formula (I), salts of the free base cis-adamantane-2-spiro-3'-8'-[[[(2'-amino-2'-methyl propyl) amino] carbonyl] methyl]-1',2',4'-trioxaspiro [4.5] decane wherein X can be an anion.

Delivery of cardiac pacing therapy for cardiac remodeling

A method and device apparatus to deliver a pacing therapy capable of remodeling a patient's heart over a period of time that includes monitoring one or more parameters in response to a delivered cardiac remodeling pacing, determining whether the cardiac remodeling pacing has an effect on cardiac normalization in response to the monitoring, and adjusting the cardiac remodeling pacing in response to the determined effect on cardiac normalization. The method and device may also perform short-term monitoring of one or more parameters in response to the delivered cardiac remodeling pacing, monitor one or more long-term parameter indicative of a long-term effect of the delivered cardiac remodeling pacing, determine the long-term effect of the delivered cardiac remodeling pacing on cardiac normalization in response to the monitoring, and adjust the cardiac remodeling pacing in response to one or both of the short-term monitoring and the determined long-term effect on cardiac normalization.

Compositions to Treat Cardiac Pacing Conditions

The HCN polynucleotide includes a nucleotide sequence encoding an HCN polypeptide having channel activity. The amino acid sequence of the HCN polypeptide and the amino acid sequence of a reference polypeptide have at least 80% identity, where the reference polypeptide begins with an amino acid selected from amino acids 92-214 and ends with an amino acid selected from amino acids 723-1188 of SEQ ID NO:8. An example of a reference polypeptide is amino acids 214-723 of SEQ ID NO:8. The HCN polynucleotide may be DNA or RNA. The HCN polynucleotide may be present in a vector, such as a viral vector (including, for instance, a single strand adeno-associated virus or a self complementary adeno-associated virus), a transposon vector, or a plasmid vector.

Tensor-based computing system for quaternion operations

Queued cooperative wireless networks configuration using rateless codes

A system using cooperative communication with rateless codes is presented that uses communication transmission aspects of cooperative communication with rateless codes over Rayleigh fading channels and queuing aspects for buffering messages at intermediate relays. The system transmits a subsequent message while a current message is en route to the destination by receiving and buffering the current message in queues at intermediate relays. A relay with a best instantaneous communication link to the source may receive a message first and forward the received message to the destination. Alternatively, if inter-relay communication links are strong, all relays may cooperate simultaneously.

Apparatus and method using ATP return cycle length for arrhythmia discrimination

An apparatus for discriminating between cardiac events that includes an input circuit receiving signals indicative of the cardiac events, a first output circuit generating pulses in response to the received signals, and a microprocessor determining whether a signal received by the input circuit subsequent to the generated pacing pulses corresponds to a predetermined cardiac event in response to an elapsed time period between the generated pulses and the subsequently received signal and a predetermined discrimination threshold.

Method and apparatus for independent piezoelectric excitation in the micro-actuator assemblies of a hard disk drive for improved drive reliability

A hard disk drive using a micro-actuator assembly to position a slider over a track on a rotating disk surface. The micro-actuator assembly includes a first piezoelectric device and a second piezoelectric device, both mechanically coupled to the slider. The first piezoelectric device includes a first terminal electrically coupled to a first voltage line and a second terminal electrically coupled to a ground line. The second piezoelectric device includes a third terminal electrically coupled to a ground line and a fourth terminal electrically coupled to a voltage line. A voltage applied to the first voltage line stimulates only the first piezoelectric device to alter a lateral position of the slider over the rotating disk surface, and a second voltage applied to the second voltage line stimulates only the second piezoelectric device to alter the lateral position of the slider over the rotating disk surface.

Method and apparatus using micro-actuator stroke sensitivity estimates in a hard disk drive

Operating micro-actuator using stroke sensitivity estimate including controlling micro-actuator directing read-write head toward track using stroke sensitivity to create micro-actuator stimulus signal. Servo controller may support operating micro-actuator. Method of estimating may be used to create stroke sensitivity during at least initialization/calibration of manufacturing hard disk drive. Embedded circuit may include servo controller. Hard disk drive may include servo controller, possibly embedded circuit, coupled to voice coil motor, to provide micro-actuator stimulus signal driving micro-actuator. Invention includes making servo controller, possibly embedded circuit, and/or hard disk drive. Servo controller, embedded circuit, and hard disk drive are products of these processes.

Apparatus for providing space heating in a dwelling

Method and apparatus for sensing and controlling the flying height of a read-write head in a hard disk drive

A slider, flexure finger, head suspension assembly, head gimbal assembly, main flex circuit, actuator assembly, spindle motor, embedded circuit, and hard disk drive using and/or supporting method of estimating flying height of read-write head near rotating disk surface. Method senses leakage current between slider and spindle motor to create potential difference measurement, and converts potential difference measurement to create estimate of flying height. Method controlling flying height using method for estimating by adjusting vertical actuation signal to micro-actuator assembly. The invention includes methods of manufacturing and their products.

Powered vehicle convoying systems and methods of convoying powered vehicles

A vehicle convoy system for use in connection with a vehicle, wherein the vehicle includes at least one drive mechanism to impart drive to the vehicle, includes at least a first processor that is adapted to be placed in operative or communicative connection with the drive mechanism to effect control of the drive mechanism based upon data of the position of a leading vehicle in front of the vehicle so that the vehicle moves to follow movement of the leading vehicle. The vehicle can, for example, be a self-propelled wheelchair.