Cardiac Pacemakers, Inc.

David W Yost

Clayton Scott Foster

Kevin John Stalsberg

Scott A Meyer

Yanting Dong

Derek Daniel Bohn

Eric Keith Enrooth

John M Voegele

Aaron R McCabe

Amy Jean Brisben

Doug M Birkholz

James A Esler

David J Ternes

Deepa Mahajan

Shibaji Shome

Jacob I Laughner

Yinghong Yu

Sunipa Saha

Keith L Herrmann

Holly Elizabeth Rockweiler

Systems and methods for efficiently determining one or more parameters for vectors of a multi-electrode implantable medical device, and for identifying one or more suitable vectors for sensing cardiac electrical data and/or delivering electrical stimulation therapy based on one or more of the determined parameters. Reducing the time required to determine the one or more parameters for each vector can help reduce procedure time for implanting and/or configuring an implantable medical device, which can reduce costs and/or improved patient comfort.

Systems and methods for determining parameters for each of a plurality of vectors

An apparatus comprises a control circuit that initiates a normal pacing mode for delivery of electrostimulation energy to the heart chamber. In response to an indication to initiate a threshold test, the control circuit determines an electrode configuration used to deliver the electrostimulation energy in the normal pacing mode, selects a first threshold test mode when a sensing electrode independent from the set of pacing electrodes is unavailable for the heart chamber, wherein a cardiac activity signal is sensed using a set of sensing electrodes that includes an electrode common to the set of pacing electrodes, and selects a second threshold test mode when a sensing electrode independent from the set of pacing electrodes is available for the heart chamber, wherein the cardiac activity signal is sensed using a set of sensing electrodes that excludes an electrode common to the set of pacing electrodes.

Hybrid autothreshold

Methods and systems for detecting noise in cardiac pacing response classification processes involve determining that a cardiac response classification is possibly erroneous if unexpected signal content is detected. The unexpected signal content may comprise signal peaks that have polarity opposite to the polarity of peaks used to determine the cardiac response to pacing. Fusion/noise management processes include pacing at a relatively high energy level until capture is detected after a fusion, indeterminate, or possibly erroneous pacing response classification is made. The relatively high energy pacing pulses may be delivered until capture is detected or until a predetermined number of paces are delivered.

Methods and systems for managing fusion and noise in cardiac pacing response classification

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

Autothreshold with sensing from pacing cathode

Methods and devices are described that allow estimation of an electrostimulation capture threshold, such as a dedicated bipolar pacing vector threshold. In an example, an equal-energy assumption between first and second pacing vectors can be used to estimate an electrostimulation capture threshold of a second pacing vector from a measured electrostimulation capture threshold of the first pacing vector and impedances of the first and second pacing vectors. In an example, a relationship between first and second pacing vectors can be determined from measured data, and a parameter of the relationship can be used with a measurement of an electrostimulation capture threshold of the first pacing vector to estimate an electrostimulation capture threshold of the second pacing vector.

Estimation of dedicated bipolar pacing vector threshold

A method for implementing a neural stimulation therapy mode in an implantable medical device (IMD) comprising the acts of mapping respective device states, defined by one or more timer states that include at least one neural event timer or one or more indications of one or more sensed physiologic events, to associated device actions in a stored neural table, storing an event represented as a device status word and a time stamp in a queue in response to an action input, and comparing one or more current timer states or one or more indications of one or more sensed physiologic events to a device state contained in the neural table and, if found to match, causing performance of one or more associated device actions, wherein the device actions include one or more of a neural stimulation energy delivery or a change in one or more timer states.

Flexible neural stimulation engine

Approaches for adjusting the pacing energy delivered by a pacemaker are provided. Adjusting the pacing energy involves performing a plurality of capture threshold tests, each capture threshold test measuring a capture threshold of the heart. One or more measured captured thresholds are selected, including at least one capture threshold that is higher relative to other measured capture thresholds acquired by the plurality of capture threshold tests. The pacing energy is adjusted based on the one or more selected capture thresholds.

Pacing output determination based on selected capture threshold values

Cardiac devices and methods that select pacing rates for automatic threshold tests based on a patient's hemodynamic need. A sensor-indicated pacing rate corresponding to a patient's hemodynamic need is determined. A test pacing rate is selected from either the sensor-indicated rate or another rate. Capture threshold testing is performed using the selected pacing rate.

Cardiac rhythm pacing rate selection for automatic capture threshold testing

A device and method for implementing a bradycardia pacing mode are disclosed which is mostly hardware-based but still allows the flexibility for making major changes in brady behavior normally found only in firmware-based implementations. The brady behavior of the device is encapsulated by a table in an area of RAM referred to as brady RAM, and the brady behavior can be changed by re-loading the brady RAM with a different table.

Cardiac pacemaker with table-based pacing mode implementation

An implantable medical device comprising stimulation circuitry adapted to provide neural stimulation energy to a neural stimulation electrode, one or more timers, including at least one neural event timer, a device behavior memory including a neural table, and a comparison circuit. The neural table maps a particular device state defined at least in part by a neural event timer to one or more associated device actions that include at least one of a neural stimulation energy delivery, a change in state of at least one neural event timer, and both a neural stimulation energy delivery and a change in state of one or more timers. The comparison circuit is adapted to compare a current state of one or more timers to a device state in the neural table and, if found to match, causing performance of one or more associated device actions.

Adjusting the pacing energy involves performing a plurality of capture threshold tests, each capture threshold test measuring a capture threshold of the heart. One or more measured captured thresholds are selected, including at least one capture threshold that is higher relative to other measured capture thresholds acquired by the plurality of capture threshold tests. The pacing energy is adjusted based on the one or more selected capture thresholds.

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Brooklyn Park, MN, United States of America

David W Yost