Systems and methods are provided for detecting arrhythmias in cardiac activity is provided. The systems and methods include measuring conduction delays between an atria (A) and multiple left ventricular (LV) electrodes to obtain multiple intrinsic A/LV intervals, measuring conduction delays between a right ventricular (RV) and the multiple LV electrodes to obtain multiple intrinsic VV intervals. The systems and methods include calculating a first atrial ventricular (AV) delay based on at least one of the intrinsic A/LV intervals, and calculating a second AV delay based on at least one of the intrinsic VV intervals. The systems and methods include selecting a biventricular (BiV) pacing mode or an LV only pacing mode based on a relation between the first and second AV delays, and delivering a pacing therapy based on the selecting operation.

VfA cardiac therapy uses an implantable medical device or system. The implantable medical device includes a tissue-piercing electrode implanted in the left ventricular myocardium of the patient's heart from the right atrium through the right atrial endocardium and central fibrous body. The device may include a right atrial electrode, a right atrial motion detector, or both. The device may be implanted completely within the patient's heart or may use one or more leads to implant electrodes in the patient's heart. A separate medical device may be used to provide some functionality for cardiac therapy. The implantable medical device or separate medical device may be used to measure physiological response information, such as cardiac electrical heterogeneity information. The physiological response information may be used to calibrate and deliver adaptive pacing therapy.

Various embodiments include methods of cardiac resynchronization therapy (CRT). Various embodiments may include: generating, using a processing unit, a cardiac activation map including a three-dimensional (3D) heart model of the heart that shows coronary vessels of a patient and shows the propagation of electrical signals through the 3D heart model; determining the location of a left bundle branch block (LBBB) based on the cardiac activation map; implanting a first pacing device and a second pacing device into the patient; stimulating the His Bundle of the heart using the first pacing device; and stimulating the left ventricle (LV) of the heart at a position downstream of the LBBB with respect to a direction of electrical conduction through the LV using the second pacing device after stimulating the His bundle.

An intracardiac ventricular pacemaker having a motion sensor is configured to produce a motion signal including an atrial systolic event and a ventricular diastolic event indicating a passive ventricular filling phase, set a detection threshold to a first amplitude during an expected time interval of the ventricular diastolic event and to a second amplitude lower than the first amplitude after an expected time interval of the ventricular diastolic event. The pacemaker is configured to detect the atrial systolic event in response to the motion signal crossing the detection threshold and set an atrioventricular pacing interval in response to detecting the atrial systolic event.

A cardiac pacemaker is disclosed for pacing cardiac tissue to improve synchrony between the atria and ventricles and/or between the left and right ventricles. A pulse generator is configured to deliver a pacing pulse to a patient's ventricle at an atrioventricular (AV) delay following a preceding atrial event. A sensing circuitry configured to sense a signal from the patient's ventricle following delivery of a said pacing pulse. A processing circuitry coupled to the pulse generator and the sensing circuitry and configured to control the pulse generator, the processing circuitry further configured to: (1) acquire from the sensed signal a set of features; (2) determine whether the ventricular pacing pulse effectively captures the patient's ventricle using the set of features; (3) determine whether one or more tissue latency conditions are present. The one or more pacing pulse parameters are adjusted, in response to determining that tissue latency is present.

An intracardiac ventricular pacemaker is configured to detect a ventricular diastolic event from a motion signal received by a pacemaker control circuit from a motion sensor. The control circuit starts an atrial refractory period having an expiration time set based on a time of the detection of the ventricular diastolic event. The control circuit detects an atrial systolic event from the motion signal after expiration of the atrial refractory period and controls a pulse generator of the pacemaker to deliver a pacing pulse to a ventricle of a patient's heart at a first atrioventricular pacing time interval after the atrial systolic event detection.

The disclosure relates to a device including a plurality of electrodes for stimulation of both ventricles with application of an atrioventricular delay and of an interventricular delay, a processor configured to multidimensionally measure an interventricular conduction delay, and monitor the evolution of a patient's condition. For the multidimensional measurement of the interventricular conduction delay, the device produces stimulation of one of the ventricles and collects, in the other ventricle, two endocardial electrogram signals on separate respective channels, giving two respective temporal components. Both temporal components are combined in one single parametric 2D characteristic representative of the cardiac cycle, and a comparison is made with reference descriptors for deriving an index representative of the evolution of the patient's condition.

According to some embodiments, a device operates by comparative morphological analysis of depolarization signals collected in spontaneous rhythm on separate respective channels, with two temporal components combined into a single 2D parametric VGM vectogram characteristic. Similarity quantification methods evaluate a variation over time of a descriptor parameter of a current VGM compared to a stored previous reference VGM. This variation is compared with predetermined thresholds to diagnose an occurrence of remodeling or reverse remodeling in a patient, and/or to detect a lead failure or an occurrence of ischemia. The descriptor parameter is a function of a velocity vector of the VGM, a comparison relating to a correlation coefficient between respective magnitudes of a current VGM velocity vector and of a reference VGM velocity vector, and an average angle between these respective velocity vectors.

Systems, devices, and methods involving cardiac pace making are provided. Implantable wireless pace making systems, devices, and methods using electromagnetic waveforms to interact with subcutaneous implanted sensors or stimulators, or both, are described. Systems, devices, and methods can include wireless, miniaturized, battery-free, radiofrequency (RF) microwave activated, sensors or stimulators or integrated sensor/stimulators that are implanted in multiple thoracic cavity locations, and interact with a remote pace making control-module or multiple modules.

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.