Medtronic, Inc.

Medtronics, Inc.

Tom Dean Bennett

D Curtis Deno

Lawrence J Mulligan

James David Webb

Paul M Stein

David L Thompson

Yong Kyun Cho

Eduardo N Warman

Vinod Sharma

Terrell M Williams

Michael R S Hill

Todd M Zielinski

Brian Bruce Lee

Glenn M Roline

Lucy M Nichols

David A Igel

Richard J Shaw

H Toby Markowitz

Douglas A Hettrick

James Kevin Carney

Rahul Mehra

Can Cinbis

Jonathan L Kuhn

William J Combs

Jonathan P Roberts

David A Anderson

Mark K Erickson

Richard J O'Brien

George J Klein

Robert T Taepke

Paul A Sobotka

Robert C Beck

Charles P Sperling

Russell L Lundstrom, Jr

Kallok, Michael J

Systems and methods include differential diagnosis for acute heart failure to provide treatment to a patient including determining whether the patient has cardiac volume overload, determining whether the patient has decreased abdominal venous system volume, and providing the appropriate treatment in response to the determinations. A multi-sensor system may be used to determine cardiac volume and abdominal venous system volume. Fluid redistribution treatment may be provided when cardiac volume overload is accompanied by a decrease in abdominal venous system volume. Fluid accumulation treatment may be provided when cardiac volume overload is not accompanied by a decrease in abdominal venous system volume.

Acute heart failure monitoring and treatment

The exemplary systems and methods may monitor one or more signals to be used to assess the hemodynamic status of a patient. The one or more signals may be used to calculate, or determine, a plurality of pulse transit times. The plurality of pulse transit times may be used to determine hemodynamic status values that may be indicative of a patient's aggregate hemodynamic status.

Systems and methods for monitoring hemodynamic status

Continuous remote monitoring of patients based on data obtained from an implantable hemodynamic monitor provides an interactive patient management system. Using network systems, patients are remotely monitored to continuously diagnose and treat heart-failure conditions. A screen displayable summary provides continuous feedback and information to physicians, patients and authorized third parties. The quick look summary includes various sites and presentation tailored to match the patients' and physicians' needs. The quick look summary further includes intelligent features that understand and retain the user's interests, preferences and use patterns. Patients, physicians and other caregivers are seamlessly connected to monitor and serve the chronic needs of heart-failure patients in a reliable and economic manner.

Heart failure monitor quicklook summary for patient management systems

A system and method for determining mean pulmonary arterial pressure (MPAP) using a pressure sensor located within a ventricle of a heart, and a signal indicative of cardiac electrical activity such as an electrocardiogram (EGM) signal. The pressure may be sensed within the right and/or left ventricle using an implanted pressure sensor. The sensed pressure may be used to determine the Ventricular Systolic Pressure (VSP) and an estimated Pulmonary Arterial Diastolic pressure (ePAD). The VSP, ePAD, and time intervals associated with systole and diastole may then be used to obtain an MPAP that closely approximates mean pulmonary arterial pressure measured using a sensor located in the pulmonary artery.

Method and apparatus for measurement of mean pulmonary artery pressure from a ventricle in an ambulatory monitor

An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP&equals;systolic P&minus;diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (E ), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. The physician can determine whether a particular therapy is appropriate, prescribe the therapy for a period of time while again accumulating the stored patient data for a later review and assessment to determine whether the applied therapy is beneficial or not, thereby enabling periodic changes in therapy, if appropriate. Drug therapies and electrical stimulation therapies, including PESP stimulation, and pacing therapies including single chamber, dual chamber and multi-chamber (bi-atrial and/or bi-ventricular) pacing can be delivered. In patient's prone to malignant tachyarrhythmias, the assessment of heart failure state can be taken into account in setting parameters of detection or classification of tachyarrhythmias and the therapies that are delivered.

Implantable medical device for treating cardiac mechanical dysfunction by electrical stimulation

Medical device data is transferred using a universal adaptor between an implanted medical device and hospital monitoring systems. The universal adaptor is an interface compatible with various built-in hospital monitoring network comprised of equipment from a variety of manufacturers. The universal adaptor includes a telemetry circuitry, a calibration system for atmospheric pressure and an analog interface. The calibration system relates to barometric correction and includes an external pressure reference system.

Universal interface for implantable medical device data management

An implantable stimulator and monitor measures a group of heart failure parameters indicative of the state of heart failure employing EGM signals, measures of blood pressure including absolute pressure P, developed pressure (DP&equals;systolic P&minus;diastolic P), and/or dP/dt, and measures of heart chamber volume (V) over one or more cardiac cycles. These parameters include: (1) relaxation or contraction time constant tau (&tgr;); (2) mechanical restitution (MR), i.e., the mechanical response of a heart chamber to premature stimuli applied to the heart chamber; (3) recirculation fraction (RF), i.e., the rate of decay of PESP effects over a series of heart cycles; and (4) end systolic elastance (E ), i.e., the ratios of end systolic blood pressure P to volume V. These heart failure parameters are determined periodically regardless of patient posture and activity level. However, certain of the parameters are only measured or certain of the data are only stored when the patient heart rate is regular and within a normal sinus range between programmed lower and upper heart rates. The parameter data is associated with a date and time stamp and with other patient data, e.g., patient activity level, and the associated parameter data is stored in IMD memory for retrieval at a later date employing conventional telemetry systems. Incremental changes in the parameter data over time, taking any associated time of day and patient data into account, provide a measure of the degree of change in the heart failure state of the heart.

Implantable medical device for monitoring congestive heart failure

A physiologic rate responsive pacer which alters the pacer's escape interval in response to the patient's respiratory minute ventilation derived from the electromyogram of selected respiratory muscle groups. The directly detected electromyogram (EMG) signal is amplified and band passed filtered, processed to remove any electrocardiogram (ECG) or pacing impulse signal, full-wave rectified, processed to develop a moving time average signal from which the peak, the maximal slope, and the average slope of the EMG moving time average may be calculated and processed in conjunction with the inspiratory and expiratory times between successive slope detections of the moving time average EMG to develop a rate control signal representative of minute ventilation. The EMG may be selectively picked up from electrodes implanted in or near the parasternal intercostal muscles, the external intercostal muscles, the internal intercostal muscles, the diaphragm, or any other respiratory muscle such as the scalenes, or the sternocleidomastoid, and coupled to conventionally designed or special configuration pacemaker pulse generators and cardiac pace/sense lead systems.

Respiratory muscle electromyographic rate responsive pacemaker

Method for implanting electromyographic sensing electrodes

A dual chamber pacemaker system and method are provided for HOCM and like pacing therapy, with the feature of searching or scanning values of AV escape interval to define an optimized value at about the longest AV escape interval value consistent with full capture in response to a delivered ventricular pace pulse. In a preferred embodiment of the invention, the system and method sense and process FFRS signals derived from the atrial lead and otherwise, and obtain therefrom a characteristic which is evaluated for a determination of optimized AV escape interval. In one specific embodiment, the time durations between delivered ventricular pacing pulses and resulting FFRS signals are analyzed as a function of AV escape interval, and the optimized AV escape interval is chosen at about the longest AV escape interval corresponding to the longest such time duration, i.e., at about the knee of the FFRS time duration vs. AV escape interval curve. In another embodiment, the FFRS characteristic utilized is duration, and the system determines the longest AV escape interval corresponding to the highest duration value. The system and method can be utilized either with an external programmer or can be adapted to operate automatically in an implanted pacemaker.

Dual chamber pacing system and method with optimized adjustment of the

A pacemaker capable of automatically adjusting the sensitivity of its sense amplifier to electrical cardiac signals is disclosed. In one embodiment, a pacemaker having a pressure sensor disposed on the distal end of its pacing/sensing lead counts the number of pressure events and electrical events which occur during an autosensitivity timing period. If the number of electrical events exceeds the number of pressure events by more than a predetermined margin, the sense amplifier's sensitivity threshold is decreased. If the number of electrical events does not exceed the number of pressure events by more than the predetermined margin, the sense amplifier's sensitivity threshold is increased. In another embodiment, the pacemaker maintains a running average of the peak voltages of sensed electrical events over a predetermined history period. Periodically, the pacemaker computes the ratio of the running average of peak voltages to a preprogrammed sense margin value, and adjusts the sensitivity threshold of the sense amplifier according to this computation. By basing the adjustment of the sense amplifier's sensitivity threshold on a long-term average of peak sense values, the effects of cycle-to-cycle variation in sensed values are minimized. In still another embodiment of the invention, a pressure sensor alone is employed to detect natural cardiac events.

Automatic sensitivity adjust for cardiac pacemakers

A method and apparatus for providing an enhanced capability of detecting and gathering electrical cardiac signals via an array of relatively closely spaced subcutaneous electrodes (located on the body of an implanted device) which may be employed with suitable switching circuits, signal processors, and memory to process the electrical cardiac signals between any selected pair or pairs of the electrode array in order to provide a leadless, orientation insensitive means for receiving the electrical signal from the heart. This far-field EGM may be used to provide storage and analysis of arrhythmic events and to provide control signals for the delivery of various therapies including pacing, cardioversion and defibrillation therapies as well as the delivery of antiarrhythmic drugs, and, in the pacing context, to effect capture detection and automatic stimulation threshold adaption, recording of PMT episodes, measurement of refractory periods in order to set timing windows for antitachy pacing therapies, and as a control signal for use in adjusting pacing rate to physiologic demand.

Subcutaneous multi-electrode sensing system, method and pacer

An implantable physiologic device, e.g., a multi-programmable, microprocessor based cardiac pacemaker, is provided with data storage and transmission capabilities for transmitting out certain current operating parameters and sensed events and for storing counted events for transmission of counts, histograms and real-time clock data out on command. The device preferably comprises a rate responsive cardiac pacemaker for providing an optimized pacing rate of stimulation pulses as a function of at least one selected rate control parameter. Each rate control parameter has a value which varies as a function of changes in a patient's physiologic demand and includes a sensor system for sensing the rate control parameter value and for providing a sensor output representative thereof. The cardiac pacemaker also includes control circuitry which includes a rate response defining means for deriving desired pacing rates as a function of the sensor output signal(s) modified by sensor gain and selective weighting coefficient values. An achievement monitoring means that has a predetermined achievement criterion monitors the relationship between the derived pacing rates and the achievement criterion over an optimization period. Output circuitry providing optimized pacing rates as a function of optimization is accomplished by adjusting the rate response gain for each sensor as a function of the monitored achievement relationship. Another optimization function is provided by adjusting a sensor weighting coefficient value which weights or regulates the relative contribution each sensor's derived desired pacing rates will contribute toward the pacemaker-derived optimized pacing rate.

Diagnostic function data storage and telemetry out for rate responsive

Growing community of inventors

Shoreview, MN, United States of America

Tom Dean Bennett