Cardiac Pacemakers, Inc.

Guidant Corporation

Acumedical, Inc.

Caridac Pacemakers, Inc.

Jiang Ding

Yinghong Yu

Julio Cesar Spinelli

Andrew P Kramer

Qingsheng Zhu

Joseph M Pastore

Jeffrey E Stahmann

Barun Maskara

Bruce H KenKnight

Scott A Meyer

Allan Charles Shuros

Rodney W Salo

Shantha Arcot-Krishnamurthy

Jonathan T Kwok

Gerrard Merrill Carlson

Shibaji Shome

Milton M Morris

Yi Zhang

Aaron R McCabe

Yanting Dong

Michael J Stucky

Jeng Mah

Krzysztof Z Siejko

Jesse W Hartley

Kent Lee

Lawrence S Baumann

Abhilash Patangay

Douglas R Daum

Steven D Girouard

Veerichetty A Kadhiresan

Scott R Vanderlinde

Quan Ni

Carlos Alberto Ricci

M Jason Brooke

Richard Fogoros

Angelo Auricchio

Nancy Yu

Imad Libbus

Pramodsingh Hirasingh Thakur

James O Gilkerson

Donald Lee Hopper

Xuan K Wei

Keith L Herrmann

Jeffrey A Hall

William C Lincoln

Christopher A Hartemink

Lei Chen

Chris Hartemink

Jie Xia

Angelo Aurichio

Approaches to rank potential left ventricular (LV) pacing vectors are described. Early elimination tests are performed to determine the viability of LV cathode electrodes. Some LV cathodes are eliminated from further testing based on the early elimination tests. LV cathodes identified as viable cathodes are tested further. Viable LV cathode electrodes are tested for hemodynamic efficacy. Cardiac capture and phrenic nerve activation thresholds are then measured for potential LV pacing vectors comprising a viable LV cathode electrode and an anode electrode. The potential LV pacing vectors are ranked based on one or more of the hemodynamic efficacy of the LV cathodes, the cardiac capture thresholds, and the phrenic nerve activation thresholds.

Systems and methods for ranking and selection of pacing vectors

A sensing and monitoring system can use acupuncture needle-based electrodes for sensing signals from a person and/or delivering stimulation to the person. In various embodiments, the electrodes can include partially insulated acupuncture needles. In various embodiments, the electrodes can include partially insulated or non-insulated acupuncture needles and one or more electrodes incorporated into a needle stopper configured as a guiding tube for an acupuncture needle or integrated into an acupuncture needle.

Acupuncture needles with accessories for sensing and stimulation

A cardiac rhythm management system selects one of multiple electrodes associated with a particular heart chamber based on a relative timing between detection of a depolarization fiducial point at the multiple electrodes, or based on a delay between detection of a depolarization fiducial point at the multiple electrodes and detection of a reference depolarization fiducial point at another electrode associated with the same or a different heart chamber. Subsequent contraction-evoking stimulation therapy is delivered from the selected electrode.

Cardiac rhythm management system selecting between multiple same-chamber electrodes for delivering cardiac therapy

Method and systems related to monitoring right ventricular function during pacing by a cardiac rhythm management device are described. One or more pacing parameters are selected to provide cardiac resynchronization therapy. For example, the one or more pacing parameters may be selected to provide an optimal or improved therapy. The heart is paced using the selected pacing parameters. While pacing with the selected parameters, pressure is sensed via a pressure sensor disposed the pulmonary artery. The sensed pressure is analyzed to determine right ventricular function achieved during the pacing using the selected pacing parameters. A signal, such as an alert signal or control signal, is generated based on the right ventricular function achieved during the pacing.

Monitoring right ventricular hemodynamic function during pacing optimization

A cardiac rhythm management system provides for cardiac pacing that is delivered to a target portion of conductive tissue in a heart, such as the His bundle. In various embodiments, the system is configured to verify capture of the target portion and provide for selective pacing of the target portion. In various embodiments, the system is configured to detect responses of the target portion and adjacent myocardial tissue to delivery of pacing pulses and use an outcome of the detection to verify selective capture of the target portion (i.e., without directly exciting the adjacent myocardial tissue.

Method and apparatus for selective his bundle pacing

An apparatus comprises an implantable cardiac signal sensing circuit that provides an electrical cardiac signal representative of cardiac activity of a subject, an implantable therapy circuit that delivers electrical pacing stimulation energy to a heart of a subject, and a controller circuit. The controller circuit includes a chronotropic incompetence detection circuit that initiates pacing of an atrium of the subject at a rate higher than a device-indicated rate or a sensed intrinsic rate, monitor the AV interval, initiates an increase in the pacing rate while continuing the monitoring of the AV interval, calculates a change in AV intervals between a highest paced rate used in the monitoring and a lowest paced rate used in the monitoring, and indicates that the AV intervals are evidence of chronotropic incompetence when the calculated change in the AV intervals exceeds a specified threshold AV interval change value.

Automatic determination of chronotropic incompetence using atrial pacing at rest

A method and apparatus for selection of one or more ventricular chambers to stimulate for ventricular resynchronization therapy. Intrinsic intracardia electrograms that include QRS complexes, are recorded from a left and right ventricle. A timing relationship between the intrinsic intracardia electrograms recorded from the left and right ventricle is then determined. In one embodiment, the timing relationship is determined using a delay between a left ventricular and a right ventricular sensed intrinsic ventricular depolarizations and a duration interval of one or more QRS complexes. In one embodiment, the duration of QRS complexes is determined from either intracardiac electrograms or from surface ECG recordings. One or more ventricular chambers in which to provide pacing pulses are then selected based on the timing relationship between intrinsic intracardia electrograms recorded from the right and left ventricle, and the duration of one or more QRS complexes.

Automatic selection of stimulation chamber for ventricular resynchronization therapy

Systems and methods for selection of electrodes and related pacing configuration parameters used to pace a heart chamber are described. A change in the hemodynamic state of a patient is detected. Responsive to the detected change, a distribution of an electrical, mechanical, or electromechanical parameter related to contractile function of a heart chamber with respect to locations of multiple electrodes disposed within the heart chamber is determined. A pacing output configuration, including one or more electrodes of the multiple electrodes, is selected and the heart chamber is paced using the selected pacing output configuration.

Selection of pacing sites to enhance cardiac performance

A method of operating a cardiac therapy system to deliver cardiac resynchronization therapy (CRT) pacing that includes pacing both ventricles or pacing only the left ventricle is described. Delivery of the CRT pacing to one or both ventricles is scheduled for a cardiac cycle. If an intrinsic depolarization of a ventricle is detected during a pacing delay of the ventricle, then the scheduled CRT pacing to the ventricle is inhibited for the cycle. The intrinsic interval of the ventricle, such as the intrinsic atrioventricular interval concluded by the intrinsic depolarization, is measured. During a subsequent cardiac cycle, the pacing delay of the ventricle is decreased to be less than or equal to the measured intrinsic interval. Capture of the ventricle is verified after pacing is delivered during the subsequent cardiac cycle.

Method and apparatus to ensure consistent left ventricular pacing

An A-H delay can be specified, such as by computing the A-H delay using a measured cardiovascular physiologic parameter. The A-H delay can be used for specifying timing between a paced or sensed atrial contraction and a His-bundle pacing time.

Timing for His-bundle pacing

An apparatus comprises a cardiac signal sensing circuit and a first implantable electrode pair. At least one electrode of the first implantable electrode pair is configured for placement at a location in a right branch of a His bundle of the subject. The apparatus can include a therapy circuit and a control circuit. The control circuit can include an AH delay calculation circuit configured to calculate an optimal paced AH delay interval. The pacing stimulation location is distal to a location of RV conduction block in a right branch of the His bundle. The control circuit initiates delivery of an electrical stimulation pulse to the stimulation location in the His bundle according to the calculated paced AH delay interval and in response to an intrinsic depolarization event sensed in an atrium of the subject.

Method and apparatus for right ventricular resynchronization

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Maplewood, MN, United States of America

Jiang Ding