Cardiac Pacemakers, Inc.

Boston Scientific Scimed, Inc.

Boston Scientifique Scimed, Inc.

Jason J Hamann

Stephen B Ruble

David J Ternes

Juan Gabriel Hincapie Ordonez

Shantha Arcot-Krishnamurthy

Weiying Zhao

Allan Charles Shuros

Quan Ni

Manfred Franke

Krzysztof Z Siejko

Andrew P Kramer

Stephen John Hahn

Jeffrey E Stahmann

Rafael Carbunaru

Scott R Vanderlinde

Keith R Maile

Aiden Flanagan

Bryan Allen Clark

Viktoria A Averina

Shibaji Shome

Eric A Mokelke

Abhi Chavan

Kenneth L Baker

Arjun D Sharma

Pramodsingh Hirasingh Thakur

Kerry A Bradley

Barun Maskara

Brian D Soltis

Kevin John Stalsberg

Gary Thomas Seim

Craig Michael Stolen

Mary M Byron

Jacob I Laughner

Paul Hultz

Les Norman Peterson

Robert Shipley

Jack Gordon

Matthew S Sulkin

Kevin J Mohsenian

An example of a method embodiment may include receiving a user programmable neural stimulation (NS) dose for an intermittent neural stimulation (INS) therapy, and delivering the INS therapy with the user programmable NS dose to an autonomic neural target of a patient. Delivering the INS therapy may include delivering NS bursts, and delivering the NS bursts may include delivering a number of NS pulses per cardiac cycle during a portion of the cardiac cycles and not delivering NS pulses during a remaining portion of the cardiac cycles. The method may further include sensing cardiac events within the cardiac cycles, and controlling delivery of the user programmable NS dose of INS therapy using the sensed cardiac events to time delivery of the number of NS pulses per cardiac cycle to provide the user programmable NS dose. The user programmable NS dose may determine the number of NS pulses per cardiac cycle.

Dosed delivery of autonomic modulation therapy

A neurostimulation system provides for capture verification and stimulation intensity adjustment to ensure effectiveness of vagus nerve stimulation in modulating one or more target functions in a patient. In various embodiments, stimulation is applied to the vagus nerve, and evoked responses are detected to verify that the stimulation captures the vagus nerve and to adjust one or more stimulation parameters that control the stimulation intensity.

Methods and apparatus for adjusting neurostimulation intensity using evoked responses

According to various method embodiments, a person is indicated for a therapy to treat a cardiovascular disease, and the therapy is delivered to the person to treat the cardiovascular disease. Delivering the therapy includes delivering a vagal stimulation therapy (VST) to a vagus nerve of the person at a therapeutically-effective intensity for the cardiovascular disease that is below an upper boundary at which upper boundary the VST would lower an intrinsic heart rate during the VST.

Systems and methods for delivering vagal nerve stimulation

A medical device including an elongate member having a proximal end configured to be electrically coupled to an energy source, and a distal member disposed at a distal end of the elongate member. The distal member may include a plurality of contact elements configured to deliver stimulating energy to innervated tissue, detect a response from the innervated tissue to the stimulating energy, and deliver therapeutic energy to the innervated tissue based on the response from the innervated tissue.

Systems and methods for assessing and treating tissue

In various method embodiments for operating an implantable neural stimulator to deliver a neural stimulation therapy to an autonomic neural target, the method comprises using the implantable neural stimulator to deliver the neural stimulation therapy to the autonomic neural target, and evaluating an evoked response to the neural stimulation bursts. The neural stimulation therapy includes a plurality of neural stimulation bursts where each neural stimulation burst includes a plurality of neural stimulation pulses and successive neural stimulation bursts are separated by a time without neural stimulation pulses. Evaluating the evoked response includes sensing the evoked response to the neural stimulation bursts where sensing the evoked response includes sensing at least one physiological parameter affected by the neural stimulation bursts, comparing the sensed evoked response against a baseline, and determining if the evoked response substantially returns to the baseline between neural stimulation bursts.

Neural stimulation with transient response between doses

A catheter system includes a catheter comprising a tip assembly, the tip assembly having a plurality of electrodes and the plurality of electrodes are configured to measure electrical signals. The system also includes a processing unit configured to: receive a first electrical signal sensed by a first electrode of the plurality of electrodes and a second electrical signal sensed by a second electrode of the plurality of electrodes. A first vector is determined based on the first electrical signal that corresponds to the first electrode. A second vector is determined based on the second electrical signal that corresponds to the second electrode. A resultant vector is determined by summing at least the first vector and the second vector, wherein the resultant vector is indicative of the orientation of the tip assembly.

Tissue contact sensing vector

A neural stimulation system delivers neural stimulation to a target nerve with control of direction of propagation of evoked neural signals in one or more fiber types of the target nerve using electrode configuration, thereby providing effective therapy while minimizing unintended effects. In various embodiments, mechanical parameters of a multi-polar electrode are determined to provide directed propagation of the neural stimulation by effecting neural conduction block in or near the stimulation site. In various embodiments, the electrode includes a cathode for evoking action potentials and a plurality of anodes for blocking the propagation of the evoked action potentials in specified direction(s) and fiber type(s) while minimizing the formation of virtual cathodes.

Method and apparatus for directed propagation of neural stimulation

An example of a system may include a stimulator and at least one controller. The stimulator may be configured to deliver nerve stimulation to capture a first set of axons in a nerve and to deliver depletion block stimulation to capture a second set of axons in the nerve, where the second set is a subset of the first. The depletion block stimulation may include a series of pulses at a depletion pulse frequency within a range between about 100 Hz to about 1 kHz, and the nerve stimulation may include a series of pulses at a stimulation pulse frequency within a range of about 0.25 Hz to about 50 Hz. At least a portion of the nerve stimulation and at least a portion of the depletion block stimulation may be delivered to be effective in providing a nerve block while delivering nerve stimulation.

Selective nerve stimulation using presynaptic terminal depletion block

A neurostimulation system delivers neurostimulation to a patient using one or more primary parameters and one or more secondary parameters. The one or more primary parameters are controlled for maintaining efficacy of the neurostimulation. The one or more secondary parameters are adjusted for preventing the patient from developing neural accommodation. In various embodiments, values for the one or more secondary parameters are varied during the delivery of the neurostimulation for prevention of neural accommodation that may result from a constant or periodic pattern of stimulation pulses.

Method and apparatus for neurostimulation with prevention of neural accommodation

An example of a system may include a depletion block neural stimulator and a depletion block controller. The depletion block neural stimulator may be configured to deliver a depletion block stimulation to a nerve. The depletion block stimulation may include a series of pulses at a pulse frequency within a range between about 100 Hz to about 1000 Hz. The depletion block controller may be configured to communicate with the depletion block neural stimulator and control the depletion block stimulation. The depletion block controller may be configured to receive a start depletion block signal and respond to the received start depletion block signal by initiating the delivery of the depletion block stimulation to the nerve, and the depletion block controller may be configured to receive a stop depletion block signal and respond to the received stop depletion block signal by terminating the delivery of the depletion block stimulation to the nerve.

Depletion block to block nerve communication

An example of a method performed by an implantable medical device (IMD) to deliver a therapy to a patient may include delivering the therapy to the patient, detecting a trigger that is controlled by the patient or a caregiver to the patient, and determining if at least one feature of the IMD for responding to a trigger is enabled. The IMD may be configured to allow the patient or the caregiver to the patient to enable the at least one feature. The method may further include, when the at least one feature is enabled, automatically implementing the at least one enabled feature in response to the detected trigger, including automatically suspending the therapy in response to the detected trigger and automatically restoring the therapy after a defined period after the detected trigger.

Patient control of therapy suspension

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Blaine, MN, United States of America

Jason J Hamann