Medtronic, Inc.

Carleen J Juran

Karen J Kleckner

Charles G Yerich

H Toby Markowitz

Michael F Hess

James W Busacker

Michael B Shelton

John D Wahlstrand

Robert A Betzold

John Charles Stroebel

Leroy L Perz

Kevin L Bright

Richard E Hester

Pierce Vatterott

Thomas P Edery

Charles R Brynelsen

Harry A Strandquist

Kristin Yakimow

Carlos C Acosta

Thomas C Wendell

Apparatus and method assure the electrical characteristics of a stimulation waveform to an electrode of an Implantable Neuro Stimulator. The embodiment comprises a regulator, a measurement module, a generator, and a processor. The generator provides an input signal to the regulator. The regulator consequently regulates the input signal in order to form a pulse that is applied to the electrode. The processor instructs the measurement module to perform an electrical measurement that is indicative of an amplitude of the pulse. If the electrical measurement is sufficiently different from a desired value, the processor instructs the generator to be reconfigured in order that the amplitude of the pulse is within an acceptable value. A redundant capacitor pair may be inserted in a capacitor arrangement in order to compensate for a reduced battery voltage, or a detected faulty component such as a capacitor or a regulator may be replaced with a redundant component.

Automatic waveform output adjustment for an implantable medical device

Multi-site cardiac pacing systems for providing pacing to multiple sites in a patient's heart, e.g., in a single heart chamber or in right and left heart chambers, while avoiding inappropriate responses to double sensing of an evoked depolarization conducted between the sites. A conditional refractory period and further post-event time periods, e.g. a conventional refractory period, are started upon a sense event or pacing pulse sensed at or delivered to a first pace/sense site. A sense event detected at another sense site that occurs during the conditional refractory period is characterized as a conditional refractory event, and it restarts shortened post-event time periods and terminates the conditional refractory period. The restarted post-event time periods are reduced in length by the elapsed time between the starting and termination of the conditional refractory period. The undue prolongation of the post-event period due to a sense event resulting from sensing of delayed propagation of a depolarization between the spaced apart pace/sense sites is avoided. However, the full length post-event time periods are restarted if a sense event is then detected during the previously restarted post-event time periods. Multi-site single heart chamber pacemaker and right and left heart chamber pacemaker embodiments of the invention are disclosed. In an atrial synchronous, bi-ventricular pacemaker embodiment, the undue prolongation of the post-event period due to a ventricular event sense event resulting from sensing of delayed propagation of a single ventricular depolarization between the left and right ventricles is avoided, and legitimate atrial sense event signals occurring thereafter are not characterized as refractory and are able to restart the AV delay.

Multi-site cardiac pacing system having conditional refractory period

A pacing system for selectively sensing spontaneous ventricular cardiac depolarizations at first and second spaced apart ventricular sites during the time-out of an AV delay and delivering pace pulses to the spaced apart ventricular sites in a triggered pacing mode. The first and second ventricular sites are preferably right ventricular (RV) and left ventricular (LV) pace/sense electrode sites, and RV event and LV event signals are sensed at the RV and LV pace/sense electrodes. A V-A pacing escape interval and a ventricular refractory period, a trigger pace window, an upper rate interval and further post-event time periods are started upon a RV or LV sense event or a first ventricular pace pulse delivered upon time-out of the AV delay. A triggered ventricular pace pulse or pulses is delivered to one or both of the RV and LV pace/sense electrode sites upon detecting an RV sense event or LV sense event during the AV delay. In one triggered pacing mode, a RV or LV pace pulse is delivered upon a RV or LV sense event during the AV delay to one of the RV or LV pace/sense electrode sites. In another triggered pacing mode, a triggered pace pulse is delivered to the other one of the RV or LV pace/sense electrode sites after a triggered pacing delay timed from a non-refractory RV or LV sense event occurring during the AV delay. In still another triggered pacing mode, a first pace pulse is delivered upon a RV or LV sense event, the triggered pacing delay is timed out, and a second pace pulse is delivered to the other one of the RV or LV pace/sense electrode sites after time-out of the triggered pacing delay. Triggered ventricular pacing is disabled during the V-A escape interval. Such a system could be employed in pacemakers that are part of a cardio defibrillator system if desired.

AV synchronous cardiac pacing system delivering multi-site ventricular pacing triggered by a ventricular sense event during the AV delay

Multi-site cardiac pacing systems for providing pacing to multiple spaced apart sites of a patient's heart, including especially but not limited to sites in right heart chamber (RHC) and left heart chamber (LHC), in triggered pacing modes while avoiding inappropriate delivery of triggered pacing to the RHC and/or LHC on a non-refractory sense event that occurs early in the cardiac cycle.

Multi-site cardiac pacing system having trigger pace window

A system for pacing in a right and its corresponding left heart chamber provides a predetermined or programmable triggered delay in a predetermined or programmable, right-to-left or left-to right sequence without first determining from which of the two chambers a triggering event originated. Devices that provide cardio defibrillation today often have pacemakers for delivering adjunct therapies, and such devices can also use the invention.

Cardiac pacing system delivering multi-site pacing in a predetermined sequence triggered by a sense event

An automatic, body-implantable medical device having at least two modes of operation is disclosed. The device is provided with circuitry for automatically detecting when the device has been implanted in a patient, so that the device can automatically switch from a first mode to a second mode of operation upon implantation. In one embodiment, the first mode is a power conserving mode in which one or more non-essential sub-systems of the device are disabled. Prior to detection of implant, at least two conditions of the device known to reflect whether the device has been implanted are monitored. After implant has been detected, situations in which power to the device is disrupted and then restored will cause the device to enter a predefined 'power-on-reset' mode of operation. Prior to detection of implant, however, such conditions do not result in the device entering the power-on-reset mode, or this mode is reset. An Elective Replacement Indicator mode is also used which is based on measured impedance against a target battery impedance. When the measured battery impedance reaches the target level, the voltage of the battery that precipitates an ERI condition is modified.

Resetting ERI/POR/PIR/indicators in implantable medical devices

A method and apparatus for the simultaneous administration of multiple pacing therapies in which two or more pacing features which operate to cause the dynamic adjustment of a common operational parameter of a pacing system are activatable at the same time. In one embodiment, a prioritization among multiple pacing features is established, such that when two (or more) features which operate to cause adjustment of a common operational parameter, a lower-priority feature will not override an adjustment made by any higher-priority feature.

Method and apparatus for cardiac pacing in accordance with multiple

Pacemaker implant recognition

A pacemaker control method and apparatus for determining the presence of atrial tachyarrhythmias uses a true interval value and compares it to a predetermined tachy value. The true interval value is updated based on the presence of far field R waves in PVARP that meet certain sequencing criteria. The criteria selected allows the control method and apparatus to reduce or eliminate event sequences that will generate false positive tachy detection and subsequent mode switching, while still allowing for the detection of tachy events in PVARP.

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Shoreview, MN, United States of America

Carleen J Juran