Medtronic, Inc.

Thomas J Mullen

Paul A Belk

John Charles Stroebel

David Arthur Casavant

Aleksandre T Sambelashvili

Xiaohong Zhou

Todd Jon Sheldon

Gary William King

Michael R S Hill

John E Burnes

Jeffrey M Gillberg

Xusheng Zhang

Robert A Betzold

Edward Chinchoy

Rajan Prakash

Steven R Hornberger

Daniel Robert Kaiser

Douglas A Peterson

Avram Scheiner

Yong Kyun Cho

Rodolphe Katra

Can Cinbis

Jonathan L Kuhn

David A Anderson

Paul J Degroot

Richard J O'Brien

Nathan A Grenz

Karen J Kleckner

Douglas A Hettrick

Rahul Mehra

Walter H Olson

Berthold Stegemann

Kathryn Hilpisch

John C Rueter

Roy L Testerman

Michael O Sweeney

Trent M Fischer

Vasant Padmanabhan

Nirav Vijay Sheth

Sameh Sowelam

Lee A Duran

Nicholas David Skadsberg

Marcus J Mianulli

Steve R Laporte

Aleksandra T Sambelashvili

Aleksandrew T Sambelashvili

Karin J Kleckner

Nicholas D Skadsberg

Daniel R Kaiser

Robert A Betzhold

In some examples, controlling delivery of cardiac resynchronization therapy (CRT) includes storing, in a memory of an implantable medical device system and in association with each of a plurality of heart rates, at least one respective value for an interval between an atrial event and a ventricular event. Processing circuitry of the implantable medical device system may determine a heart rate of a patient and select one of the stored values for the interval between the atrial event and the ventricular event associated with the determined heart rate. The processing circuitry may further determine whether to control therapy delivery circuitry of the implantable medical device system to deliver fusion pacing or biventricular pacing, based on the selected one of the stored values for the interval between the atrial event and the ventricular event.

Heart rate based control of cardiac resynchronization therapy

A medical device system and associated method predict a patient response to a cardiac therapy. The system includes for delivering cardiac pacing pulses to a patient's heart coupled to a cardiac sensing module and a cardiac pacing module for generating cardiac pacing pulses and controlling delivery of the pacing pulses at multiple pace parameter settings. An acoustical sensor obtains heart sound signals. A processor is enabled to receive the heart sound signals, derive a plurality of heart sound signal parameters from the heart sound signals, and determine a trend of each of the plurality of heart sound signal parameters with respect to the plurality of pace parameter settings. An external display is configured to present the trend of at least one heart sound parameter with respect to the plurality of pace parameter settings.

System and method for pacing parameter optimization using heart sounds

Cardiac resynchronization therapy (CRT) delivered to a heart of a patient may be adjusted based on detection of a surrogate indication of the intrinsic atrioventricular conduction of the heart. In some examples, the surrogate indication is determined to be a sense event of the first depolarizing ventricle of the heart within a predetermined period of time following the delivery of a fusion pacing stimulus to the later depolarizing ventricle. In some examples, the CRT is switched from a fusion pacing configuration to a biventricular pacing configuration if the surrogate indication is not detected, and the CRT is maintained in a fusion pacing configuration if the surrogate indication is detected.

Adaptive cardiac resynchronization therapy

A method and apparatus are used to provide therapy to a patient experiencing ventricular dysfunction or heart failure. At least one electrode is located in a region associated with nervous tissue, such as nerve bundles T1-T4, in a patient's body. Electrical stimulation is applied to the at least one electrode to improve the cardiac efficiency of the patient's heart. One or more predetermined physiologic parameters of the patient are monitored, and the electrical stimulation is adjusted based on the one or more predetermined physiologic parameters.

Method and apparatus for electrically stimulating the nervous system to improve ventricular dysfunction, heart failure, and other cardiac conditions

Provided herewith are methods and apparatus for optimizing an atrioventricular (AV) pacing delay interval. One manner described involves dynamically programming an AV interval in cardiac resynchronization therapy (CRT) device having a rate-adaptive AV (RAAV) feature in such a way that not less than a minimum AV interval is maintained. That is, the AV interval is not allowed to be reduced so much that the P-wave is truncated by the QRS complex. In this form of the invention, the AV interval is reduced by one millisecond per one bpm increase in heart rate (and vice versa for reducing heart rate) but maintained at a value calculated from the end of the P-wave (PWend) and the beginning of the QRS complex (QRSbeg) or delivery of a ventricular pacing stimulus or to the end of the end of the QRS complex (QRSend).

Apparatus and methods of adjusting atrioventricular pacing delay intervals in a rate adaptive pacemaker

Methods for optimizing an atrioventricular (AV) pacing delay interval based upon ECG-based optimization such that an AV pacing delay interval value can be dynamically adjusted in an ambulatory subject. Ends of P-waves are determined. An operating atrioventricular interval is modified to maintain intervals between the determined ends of P-waves and beginnings of corresponding following QRS complexes above a predetermined certain value. The value may be between 30 and 60 milliseconds.

Apparatus and methods of optimizing atrioventricular pacing delay intervals

A preferred atrial-based pacing method and apparatus is provided using an intelligent cardiac pacing system to having the ability to continue atrial-based pacing as long as relatively reliable AV conduction is present. In the event that such relatively reliable AV conduction is not present, mode switching to a DDD/R or a DDI/R pacing mode while continually biased to mode switch back to atrial-based pacing. The standard or relatively reliable AV conduction may be changed either automatically or manually. This increases pacing that utilizes natural AV conduction however possible so as to gain all the benefits of cardiac contractile properties resulting therefrom, while tolerating the occasional missed ventricular depolarization (i.e., non-conducted P-wave). In the event where relatively reliable AV conduction is not present, the pacing mode is switched to a DDD/R mode while detecting a return of the relatively reliable AV conduction (and resulting mode switch to preferred atrial based pacing).

Preferred ADI/R: a permanent pacing mode to eliminate ventricular pacing while maintaining backup support

A medical device and associated method for controlling a cardiac pacing therapy sense a first cardiac signal including events corresponding to cardiac electrical events and a second cardiac signal including events corresponding to cardiac hemodynamic events. A processor is enabled to measure a cardiac conduction time interval using the first cardiac signal and control a signal generator to deliver a pacing therapy. A pacing control parameter is adjusted to a plurality of settings during the pacing therapy delivery. A hemodynamic parameter value is measured from the second cardiac signal during application of each of the control parameter settings. The processor identifies an optimal setting from the plurality of settings and solves for a patient-specific equation defining the pacing control parameter as a function of the cardiac conduction time interval.

Heart-sounds based adaptive cardiac resynchronization therapy timing parameter optimization system

An implantable medical device and associated method provide atrial pacing and measure an atrial ventricular (AV) delay. An autonomic function index is computed using the AV delay. The autonomic function index may be compiled in a medical report. In some embodiments, the autonomic function index is used to adjust atrial pacing control parameters.

Algorithm to modulate atrial-ventricular delay and rate response based on autonomic function

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Andover, MN, United States of America

Thomas J Mullen