Medtronic, Inc.

Medtronics, Inc.

Luc Roland Mongeon

Yong Kyun Cho

Rahul Mehra

John E Burnes

John C Rueter

Michael R Hill

Xiaoyi Min

David A Igel

Jodi Zilinski

H Toby Markowitz

Eduardo N Warman

Mark K Erickson

Harry Stone

Todd Jon Sheldon

Catherine R Condie

Michael R S Hill

Amisha Somabhai Patel

Kenneth M Anderson

Paul J DeGroot

Donald N Jensen

Scott W Davie

Steven L Ning

Gerald A Portzline

John S Brandstetter

David K L Peterson

Karen J Kleckner

Li Ping Wang

Walter H Olson

John D Wahlstrand

David K Peterson

Lucy M Nichols

Kenneth M Riff

James E Willenbring

Susan Heilman Kilbane

Chris J Gennaro

Thomas W Sinner

Christopher John Gennaro

Stephanie Michele Fitts

Harold E Stone

Steve R Hornberger

Susan E Heilman

David E Igel

Jody Zlinski

A system and associated method receives, by a database coupled to a communication network, patient medical data from multiple data sources including data retrieved from implantable medical devices implanted in patients. A processor accesses the database to generate a dataset from the medical data having at least one data characteristic matching a corresponding data characteristic of a patient group of at least one patient. At least one subset of the dataset is identified that had a therapy intervention subsequent to a time point that the subset had the matching data characteristic(s). An outcome of the subset is determined and a predictive outcome for the patient group is produced based on the outcome of at least one subset.

System for using patient data combined with database data to predict and report outcomes

The present invention provides a technique for verifying pacing capture of a ventricular chamber, particularly to ensure desired delivery of a ventricular pacing regime (e.g., 'CRT'). The invention also provides ventricular capture management by delivering a single ventricular pacing stimulus and checking inter-ventricular conduction during a temporal window to determine if the stimulus captured. If a loss-of-capture LOC) signal results from the capture management testing, then the applied pacing pulses are modified and the conduction test repeated. If LOC, an alert message can issue. Other aspects include: use of a trend of A-RV/LV and LV-RV timing intervals to monitor changes in the patient's heart conduction properties; bi-ventricular verification test and search&#x2014;while still pacing BiV by detecting latent sense; single-V pacing threshold search, use of timing of sense in other V chamber to establish capture and LOC windows; (iv) use of a premature V pace rather than short AV interval if VV cannot be discriminated from AV; (v) option to run a threshold search only if the Bi-ventricular verification test fails.

Bi-ventricular ventricular capture management in cardiac resynchroniziation therapy delivery devices

Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV) delay intervals in order to optimize cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change.

Algorithm for the automatic determination of optimal AV and VV intervals

Embodiments of the present invention provide a system in which a medical device selects less than all of its stored information and provides the selected subset of information to a data mart for storage, processing, and/or communication to one or more interested parties. In many embodiments, customers, patients, or even components of the medical device or of the remote patient management system can access selected medical device information (e.g., customers can access medical device information tailored to the care they are providing to one or more patients). In many embodiments, customers can receive such medical device information according to a schedule that best suits their care (or whenever they desire such information, irrespective of a schedule). In many embodiments, providing less than full transmissions to the data mart reduces the strain on medical device batteries.

Patient management system

Impedance, e.g. sub-threshold impedance, is measured across the heart at selected cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right ventricle to left ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at end systole. Another embodiment varies the VV interval to maximize impedance change. Other methods vary the AA interval to maximize impedance change over the entire cardiac cycle or during the atrial cycle.

Algorithm for the automatic determination of optimal pacing intervals

An implantable device is described that collects and aggregates data from non-implanted medical devices external from a body of a patient. The device may also collect and aggregate data from medical devices implanted within the body. The implantable device includes a wireless transceiver to acquire physiological data from the external medical devices, and a storage medium to store the physiological data. A processor retrieves the physiological data and communicates the physiological data to a remote patient management system. The device may collect the physiologic data from the various external data sources, possibly over an extended period of time, and stores the data for subsequent upload to a common patient management system. In addition, the implantable device may collect physiological data from other medical devices implanted within the patient. In this manner, the device provides a central point for collection and aggregation of physiological data relating to the patient.

Aggregation of data from external data sources within an implantable medical device

An implantable medical device system and method are provided for synchronizing atrial cardioversion shocks to the ventricular rhythm using an adjustable atrial cardioversion/defibrillation ventricular refractory period. Upon determining a need for an atrial shock therapy, the method determines if the ventricular rate meets synchronization criteria based on an upper ventricular refractory period limit. If synchronization criteria are not met, the refractory period is automatically adjusted in stepwise decrements until the synchronization criteria are met, or until a lower refractory period limit is exceeded. If synchronization criteria are met, an atrial shock is synchronized to the next ventricular depolarization occurring outside the current refractory period. If the lower refractory period limit is exceeded, the atrial therapy is aborted.

Automatic adjusting R-wave synchronization algorithm for atrial cardioversion and defibrillation

A system and method for monitoring respiration including sensing a signal that varies with respiration, deriving a respiration parameter, applying criteria for detecting a respiration disturbance and determining one or more respiratory disturbance metrics. The system preferably includes an implantable sensor with an associated implantable medical device such that chronic respiration monitoring is possible. The implantable medical device may execute methods for detecting and measuring respiratory disturbances or may store data to be transferred to an external device for detecting and measuring respiratory disturbances. Respiratory disturbance detection may trigger a responsive action such as physiological data storage, a change in therapy delivery, or a clinician warning. Assessment of cardiac function may be made based on metrics of respiratory disturbances or a measure of circulatory delay time following detection of a respiratory disturbance.

Method and apparatus for detecting respiratory disturbances

Techniques for increasing the accuracy of detection of atrial capture may involve determining a ventricular sensing window for ventricular senses associated with atrial test pulses based on observed ventricular senses. For example, an implanted medical device may deliver atrial test pulses to a patient at a time prior to respective atrial pacing pulses to evaluate atrial capture. The implanted medical device observes ventricular senses in response to the atrial test pulses. The implanted medical device may determine a point such as, for example, a midpoint of the ventricular sensing window for the ventricular senses and shift a midpoint of the default ventricular window to the determined midpoint. Further, the implanted medical device may measure patient parameters, such as heart rate and activity level, and determine a ventricular sensing window for ventricular senses associated with atrial test pulses based on the observed ventricular senses and measured patient parameters.

Atrial capture detection via atrial-ventricular conduction

An implantable medical device (IMD) provides an alert to a patient that has the IMD implanted in their body. The alert is used to remind the patient to schedule and/or proceed to a follow-up physician visit. The reminder is also used to remind the patient to initiate a remote communication so that stored data or other information may be transmitted to a remote computer network or other communication node.

System and method for supplying a patient reminder alert from an implantable medical device

Algorithm for the automatic determination of optimal AV an VV intervals

A method and apparatus for providing a therapy to the patient that includes a therapy component configured to provide the therapy to the patient, sensing circuitry sensing a parameter of the patient, and a microprocessor coupled to the therapy component and the sensing circuitry to determine onset of a first state of the patient in response to the sensed physiologic parameter, and to determine whether the onset of the first state is detected for a predetermined time period.

Method and apparatus for modifying delivery of a therapy in response to onset of sleep

A method and an apparatus for performing implementing external data into an implantable medical device. A first stress test is performed using an external sensor. External data resulting from the initial stress test is acquired. An external data injection process is performed. The external data injection process includes providing the external data to the implantable medical device. A second stress test is performed, the second stress test being substantially similar to the first stress test. Internal data resulting from the second stress test is acquired. Internal data resulting from the second stress test along with the external data resulting from the first stress test, are processed.

Method and apparatus for injection of external data within an implantable medical device

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Minneapolis, MN, United States of America

Luc Roland Mongeon