Medtronic, Inc.

Vitatron Medical B. V.

Geeske Van Oort

Malcolm J Begemann

Gustaaf A Stoop

Johannes S Van Der Veen

Gustaaf A P Stoop

Bernardus F Vonk

Willem Boute

Peter M Van Dam

Peter W Wohlgemuth

Christianus J J E Van Groeningen

Willem A Wesselink

Dave J Munneke

John F Norris

Jos W J Van Hove

Jonathan Pitts-Crick

Bernhard A P De Vries

Astrid M Tholen

Jonathan Pitts Crick

An implantable medical device uses a method for dynamically managing physiological signal monitoring. A physiological signal is sensed for detecting physiological events in response a first threshold. A determination is made whether a second threshold has been met in response to detecting physiological events. If the second threshold has been met, detailed monitoring of the physiological events is enabled.

Implantable medical device and method for physiological event monitoring

There is provided an implantable cardiac pacing system or other cardiac monitoring system having an enhanced capability to classify intracardiac signals through a combination of DSP techniques and software algorithms. The implantable device has one or more DSP channels corresponding to different signals which are being monitored. Each DSP channel most preferably amplifies the incoming signal, converts the signal from analog to digital form, digitally filters the converted signals to provide a filtered signal, operates on the filtered signal to provide a slope signal, determines from the filtered and slope signals when an intracardiac event has been detected, signal processes the filtered and slope signals for a predetermined analysis interval after threshold crossing, and generates a plurality of wave parameters corresponding to the signal. The generated wave parameters are further operated on by a programmable algorithm to classify the detected event based upon DSP-generated parameters, and then monitor or detect the onset, development or presence of an undesired heart condition in a patient. The system may further provide for the delivery of treatment, storage of intracardiac data, or provision of a warning to a patient or physician in response to the detection of such a heart condition.

Cardiac pacing system with improved physiological event classification and heart monitoring based on DSP

A system and method for characterizing the atrial wall of the heart is provided. The characterization of the atrial wall can be used for a variety of diagnostic and therapeutic purposes. For example, it can be used to detect precursors to various types of hear disease, such as atrial fibrillation. In one embodiment, the system and method is used to determine a likelihood of fibrosis in the atrial wall. Furthermore, the system and method can detect changes in atrial wall fibrosis that can indicate a continuing degradation in the atrial wall health and an increasing likelihood of atrial fibrillation. In another embodiment, the system and method is used to determine if electrical instability exists in the atrial wall.

System and method for characterization of atrial wall using digital signal processing

A method of pacing opposing chambers of a heart with a pacing system is provided. The pacing system comprises a first bipolar medical electrical lead having at least one first electrode configured for positioning in a first opposing chamber of the heart, a second bipolar medical electrical lead having at least one second electrode configured for positioning in a second opposing chamber of the heart, an implantable pulse generator operably connected to the first and second bipolar medical electrical leads. The implantable pulse generator further comprises a hermetically sealed housing capable of serving as a can electrode. The method designates a primary electrode configuration by selecting a cathode and an anode from either the first electrode, second electrode, or the can. Selection of the cathode is based on a comparison of thresholds measured in each chamber. Systems, programs and devices using the method are also provided.

Dual-chamber pacemaker system for simultaneous bi-chamber pacing and sensing

A system and method for use in an implanted cardiac pacing device, whereby an optimal AV delay is determined at or near lower rate (pacing) limit (LRL) by determining measuring the variance, or instability, of the QT interval for a set of intervals. In one embodiment, asynchronous 'LRL pacing' with a first programmed AV delay determines a measure of QT variance. The difference between the maximum QT and the minimum QT is expressed as QT difference (QTD). For each programmed AV delay the QT variance is again measured and the optimal AV delay produces minimum QTD. In another embodiment, AV delay is modulated around base values for a time. The difference between QT for the modulated AV and for the base AV (dQT) is measured at each base value, and the optimal AV delay corresponds to the smallest dQT.

Synchronous pacemaker with AV interval optimization

A method of pacing opposing chambers of a heart with a pacing system is provided. The pacing system comprises a first unipolar medical electrical lead having at least one first electrode configured for positioning in a first opposing chamber of the heart, a second unipolar medical electrical lead having at least one second electrode configured for positioning in a second opposing chamber of the heart, an implantable pulse generator operably connected to the first and second unipolar medical electrical leads. The implantable pulse generator further comprises an hermetically sealed housing capable of serving as a can electrode, and means for switching electrode configurations between the first electrode and the can electrode, between the second electrode and the can electrode, between the first electrode and the second electrode and between the second electrode and the first electrode. A primary electrode configuration is determined. A cathode is selected from the first electrode, the second electrode and the can electrode based on the primary electrode configuration. An anode is selected from the first electrode, the second electrode and the can electrode based on the primary electrode configuration. A first pulse is delivered between the cathode and the anode. Systems, programs and devices using the method are also provided.

An implantable medical device includes a sensor and a T-wave analyzer. The sensor is implantable within the body of a patient to sense electrical cardiac activity and provide an indication of T-wave alternans within the heart of the patient. The T-wave analyzer is responsive to the sensor, and evaluates cardiac risk based on comparison of the indication of T-wave alternans to a predetermined criterion. The T-wave analyzer may form part of a microprocessor, a digital signal processor, or combination of both. The device may include a pacing generator that applies increased rate pacing stimuli to the heart to facilitate sensing of the T-wave alternans by the sensor. The device also may incorporate a memory that stores the T-wave alternans indication provided by the sensor, e.g., over a number of heartbeats. In addition, the device may be equipped to provide an alert to the patient or a physician in the event the processor generates the indication of cardiac risk. The results of the T-wave alternans analysis over a period of time can be stored as data in memory for access by a physician, e.g., by telemetry. In response to the alternans data, the physician may prescribe pharmacologic therapy, programmed cardiac electrical stimulation, or modifications to an electrical stimulation program in the existing implanted device. In some cases, the implantable medical device can be programmed to response to the alternans data, e.g., by controlling a pacing generator.

Implantable medical device and method using integrated T-wave alternans analyzer

A method of determining kidney failure in a patient using an implantable medical device is described. In one embodiment, a first magnitude of a first polarization signal is measured. An additional magnitude of an additional polarization signal is measured after a first interval. A deflection differential between the first magnitude and the additional magnitude is determined and kidney failure in the patient is determined when the deflection differential is greater than an established threshold.

Method and system for determining kidney failure

A method of diagnosing pulmonary congestion is provided. At least one decrease in a trans-thoracic impedance value from a baseline trans-thoracic impedance value is sensed. At least one increase in a heart rate value from a baseline heart rate value is also sensed. Pulmonary congestion is diagnosed if the decrease in the trans-thoracic impedance value corresponding to the increase in the heart rate does not increase after a predetermined interval. Systems and programs incorporating the method are also provided.

Method and system for diagnosing and administering therapy of pulmonary congestion

There is provided a pacemaker system which includes intervention for overdriving the patient's natural heart rate in the event of a sensed incipient ventricular arrhythmia condition, and particularly torsades de pointes. The pacemaker continually acquires QT signals and analyzes them for respective properties, updating statistical information relating to the properties. In a preferred embodiment, the pacemaker analyzes QT interval, QT dispersion, time derivative of the QT interval, and/or T-wave amplitude and determines an intervention for pacing therapy based upon changes to these properties. The pacemaker also monitors premature ventricular beats and generates data representative of such occurrences, which data is used alone or in combination with QT data in determining whether intervention is indicated, for adjusting the intervention pacing rate. There is thus provided a systematic approach for monitoring relevant data so as to reliably determine when intervention pacing therapy is needed, and for adjusting the intervention pacing rate.

Pacemaker system for preventing ventricular tachycardia

A system and method of programming an implantable medical device is disclosed. The system includes a causal model coupled to an implantable medical device and capable of identifying at least one cause of an abnormal condition associated with the implantable medical device or the patient. An abductive inference engine is coupled to the causal model and is capable of identifying a suggested updated setting for the implantable medical device to alleviate the abnormal condition. A display is coupled to the causal model and displays the abnormal behavior and the suggested updated settings to the clinician such that the clinician may implement the suggested updated settings.

System and method of programming an implantable medical device

There is provided a system and method for determining, in a DDD or DDD(R) pacing system, when a delivered atrial pace pulse has failed to capture the patient's atrium. Each cycle, following a delivered ventricular pace pulse, or every N cycles a measure of change in QT interval is obtained and compared to stored criteria. When an atrial pulse has achieved capture, the difference in QT from the last beat will be small, normally less than 2 ms. However, if there has not been atrial capture, the delivered ventricular pace pulse is in fact asynchronous with respect to the atrium, and under these circumstances the change in QT is greater than 2 ms, e.g., in the range of 2-10 ms. Accordingly, when the pacemaker sees a change in QT within the 2-10 ms range, this indicates failure of capture, and responsive action is taken by either directly incrementing the energy level of the atrial pace pulses, or performing an atrial threshold search and then resetting the atrial pace energy level.

Pacemaker system with simplified atrial capture detection based on QT interval

There is provided a pacemaker system having the capability of providing therapy for preventing conditions likely to lead to myocardial infarction or ventricular arrhythmia during patient morning time. Specifically, a therapy is initiated before calculated patient awakening time, for raising pacing rate slowly so as to shorten QT interval to an acceptable level relative to rate at the time of patient awakening, and specifically a level that achieves satisfactory diastolic filling time. The pre-awakening therapy pacing routine is designed to overcome normal QT prolongation which occurs during sleep state, and which is delayed after patient awakening. In the event that criteria for an acceptable diastolic filling time are not met at or after patient awakening, the pacemaker takes steps to control rate, such as ceasing synchronous pacing and limiting automatic rate response.

Pacemaker system with therapy for minimizing risk of morning myocardial infarctions or arrhythmias

A device and method useful in the diagnosis and treatment of congestive heart failure. Specifically the present invention senses the trans-thoracic impedance as well as patient posture. By correlating changes in posture with trans-thoracic impedance changes, the present invention is able to diagnose and assess the degree of congestive heart failure. The present invention is described in the context of an implantable pulse generator system, but it may also be practiced in conjunction with various types of implantable devices.

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Velp, Netherlands

Geeske Van Oort