Systems and methods are described herein for evaluation and adjustment cardiac therapy. The systems and methods may initially evaluate a first pacing parameter while other pacing parameters are fixed to, for example, nominal values, and determine an effective setting for the first pacing parameter. Then, a second pacing parameter may be evaluated while the first pacing parameter is fixed to the previously-determined effective setting. Each evaluation may not test every possible setting for the pacing parameters, and instead, may utilize various processes to limit the settings to a subset of settings to test.

A system and method for designating between types of activation by a pulse generator configured to deliver a left ventricular (LV) pacing pulse at an LV pacing site as part of a cardiac resynchronization therapy (CRT) are provided. The system includes a sensing channel configured to collect cardiac activity (CA) signals along at least one sensing vector extending through a septal wall between the LV and right ventricle (RV). The CA signals are indicative of one or more beats and include a pre-LV pacing segment indicative of cardiac activity preceding the LV pacing pulse and a post-LV pacing segment indicative of cardiac activity following the LV pacing pulse. The system includes memory to store program instructions. One or more processors are configured to implement the program instructions to analyze the pre-LV pacing segment to identify a first myocardium activation (MA) characteristic of interest (COI). The system analyzes the post-LV pacing segment to a second MA COI, compares the first and second MA COI to first and second MA criteria, respectively, designates the CA signals to be indicative of one of a fusion beat, a capture beat or a pseudofusion beat based on the comparison of the first and second MA COI to first and second MA criteria and store a result of the designation.

Systems and methods are described herein for configuration of cardiac therapy. The systems and methods may select, or determine, a plurality of different configuration parameters based electrical activity monitored or measured using a plurality of external electrodes. For example, the systems and methods may select, or determine, a left ventricular pacing vector, adaptive or non-adaptive pacing therapy, an interventricular pacing delay, and a atrioventricular pacing delay.

A method of communication in a system comprising plurality of implantable medical devices, where a first device comprises a means for detection of a signal representative of atrial activity, a transmitter, and a controller, and a second device independent of the first device, the second device comprising a receiver and a controller. The method comprises synchronizing the first device with the second device, determining the duration of a cardiac cycle, determining a synchronization interval, the duration of the synchronization interval determined as a function of the duration of the cardiac cycle, the synchronization interval being shorter than the duration of the cardiac cycle, and the start of the synchronization interval is determined as a function of the synchronization signal, and activating the receiver of the second device during the synchronization interval, wherein the receiver of the second device is deactivated outside of the synchronization interval.

An implantable leadless pacemaker (iLP) for a human or animal heart, wherein the iLP includes a housing, at least two electrode poles for picking up electrical potentials and/or delivering electrical stimulation, a stimulation control unit in connection with the electrode poles, a sensing unit that is in connection with at least one electrode pole, a signal processing unit in connection with the sensing unit, a signal evaluation unit in connection with the signal processing unit and/or the sensing unit, and an energy source. The sensing unit is configured to sense a first signal associated with an activity of the first heart chamber, and the stimulation control unit is configured to deliver electrical stimulation in the first heart chamber via the at least two electrode poles. wherein the sensing unit is configured to sense a second signal associated with an activity of a second heart chamber.

In some examples, a computing apparatus may determine information corresponding to a data structure and indicating delays associated with an atrium lead, a left ventricle (LV) lead, and a right ventricle (RV) lead based on one or more input variables. The computing apparatus may determine a plurality of individualized characteristics based on the information corresponding to the data structure. The computing apparatus may receive, from the plurality of measurement electrodes, a plurality of second sets of electrical measurements indicating second electrical signals applied to the patient's heart based on the plurality of individualized characteristics. The computing apparatus may determine cardiac resynchronization index (CRI) values using a first set of electrical measurements (e.g., native measurements) and the plurality of second sets of electrical measurements. The computing apparatus may generate a graphical representation based on a populated data structure and cause display of the graphical representation.

In some examples, controlling delivery of CRT includes delivering ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay, and acquiring one or more electrograms from respective vectors. For each of the different values of the at least one of A-V delay or V-V delay, at least one of a QRS amplitude or a QRS area may be determined based on the one or more electrograms, and a target change in QRS amplitude or QRS area between adjacent ones of the values of the at least one of A-V delay or V-V delay of the sequence may be identified. In response to the identification of the target change, the implantable medical device may deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification to provide CRT.

An implantable system stimulates a human or animal heart. The system contains a processor, a memory unit, an atrial stimulation unit, a ventricular stimulation unit, and a detection unit for detecting atrial tachycardia. The memory unit stores a computer-readable program that prompts the processor to: a) detect by the detection unit whether atrial tachycardia to be treated is present in the heart; b) when atrial tachycardia to be treated is present, carrying out a ventricular conditioning stimulation by way of the ventricular stimulation unit; and c) applying atrial antitachycardia pacing in the form of a stimulation pulse sequence of 2 to 20 pulses or a high-frequency burst having a frequency of up to 50 Hz and a duration of up to 60 seconds by way of the atrial stimulation unit as the ventricular conditioning stimulation is being carried out and/or thereafter.

The present invention relates to an implantable device for stimulating a heart and lowering blood pressure, comprising: a stimulation unit configured to stimulate the His bundle or the left-bundle branch of the heart, and a sensing unit for detecting atrial activity of the heart. According to the present invention the stimulation unit is configured to stimulate the His bundle or the left bundle branch immediately before or immediately after detection of an atrial activity.

Brugada syndrome and related forms of ion channelopathies, including ventricular asynchrony of contraction, originate in the region near the His bundle or para-Hisian regions of the heart. Manifestations of Brugada syndrome can be corrected by delivering endocardial electrical stimulation coincident to the activation wave front propagated from the atrioventricular (AV) node early enough to compensate for the conduction problems that start in those regions. The stimulation can include waveforms of the same polarity delivered to a site within the region near the His bundle or para-Hisian regions of the heart associated with a low cardiac electrical asynchrony level or can include at least two single-phased superimposed waveforms of opposite polarity delivered through a pair of pacing electrodes relative to a reference electrode, which can be delivered to any site within the region near the His bundle or para-Hisian regions. Defibrillation can also be used to terminate an arrhythmia.