Systems and methods for controlling blood pressure by controlling atrial pressure and atrial stretch are disclosed. In some embodiments, a stimulation circuit may be configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of a patient, and at least one controller may be configured to execute delivery of one or more stimulation patterns of stimulation pulses to the at least one cardiac chamber, wherein at least one of the stimulation pulses stimulates the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced.

Systems and methods for managing heart failure are described. The system receives physiological information including a first HS signal corresponding to paced ventricular contractions and a second HS signal corresponding to intrinsic ventricular contractions. The system detects worsening heart failure (WHF) using the received physiological information. A signal analyzer circuit can generate a paced HS metric from the first HS signal and a sensed HS metric from the second HS signal, and determine a concordance indicator between the paced and the sensed HS metrics. In response to the detected WHF, the system can use the concordance indicator to generate a therapy adjustment indicator for adjusting electrostimulation therapy, or a worsening cardiac contractility indicator indicating the detected WHF is attributed to degrading myocardial contractility.

An implantable medical device (IMD) and process are provided comprising one or more electrodes configured to be implanted to define a pacing vector through at least a portion of a ventricle. Sensing circuitry is configured to sense intrinsic atrial activity (As) and intrinsic ventricular activity (Vs). A pulse generator (PG) if provided, and memory configured to store program instructions and an atrioventricular delay search parameter (AVD.sub.SEARCH). The AVD.sub.SEARCH is an interval of time. One or more processors, that when executing the program instructions, is configured to direct the PG to deliver ventricular pacing pulses based on an atrioventricular delay (AVD) and periodically initiate an AVD search operation utilizing the AVD.sub.SEARCH. A heart rate is determined and compared to a threshold. Responsive to determining that the heart rate exceeds the threshold, the AVD.sub.SEARCH is reduced, and cardiac activity is detected during the AVD search operation utilizing the reduced AVD.sub.SEARCH.

This disclosure relates to an active implantable medical device of the cardiac resynchronizer type. The device includes a pulse generator to produce pacing pulses, at least one detection electrode for detecting atrial and ventricular events, at least one stimulation electrode, a memory storing executable instructions, and a processor configured to execute the instructions. The processor is configured to execute the instructions to apply an atrioventricular delay (AVD) between a sensed or stimulated atrial event and the delivery of a ventricular pacing pulse, quantify a degree of fusion between the delivery of a pacing pulse to a cavity and a spontaneous contraction of another cavity, calculate a fusion rate, and modify the value of the AVD applied to the delivery of said ventricular pacing pulse, as a function of a comparison.

Methods and devices are is provided for controlling a pacing therapy utilizing left ventricular multi-point pacing (MPP). The method and device provide electrodes configured to be located proximate to an atrial (A) site, a right ventricular (RV) site and multiple left ventricular (LV) sites of the heart. The method and device utilizes one or more processors. The processors determine atrial-ventricular conduction delays (AVCD) between the A site and multiple corresponding LV sites and determines pacing latencies at the LV sites. The processors adjusts the AVCDs, based on the pacing latency at the corresponding LV sites, to form atrial-ventricular latency adjusted (ARPL) conduction delays for the corresponding LV sites, calculates interventricular pacing (VV) delays for combinations of the LV sites based on the corresponding ARPL conduction delays and manages pacing therapy, that utilizes left ventricular MPP, based on the VV delays for the corresponding LV sites.

An implantable medical device (IMD) is configured with a pressure sensor. The IMD includes a housing and a diaphragm that is exposed to the environment outside of the housing. The diaphragm is configured to transmit a pressure from the environment outside of the housing to a piezoelectric membrane. In response, the piezoelectric membrane generates a voltage and/or a current, which is representative of a pressure change applied to the housing diaphragm. In some cases, only changes in pressure over time are used, not absolute or gauge pressures.

Methods, devices and program products are provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device. Electrodes are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. A conduction different is determined based on i) an atrial-ventricular conduction delay (AR.sub.RV) between the A site and the RV site, and ii) an atrial-ventricular conduction delay (AR.sub.LV) between the A site and the LV site. A correction term is based on intrinsic inter-ventricular conduction delay (IVCD) between the LV and RV. An LV atrial-ventricular pacing (AV.sub.LV) delay is set based on the conduction difference , a pacing latency PL and the correction term and manages the LUV pacing therapy based on the AV.sub.LV delay, wherein the LUV pacing therapy lacks pacing in the RV.

Systems and methods are described herein for selection of a cardiac cycle, or heartbeat, from a plurality of cardiac cycles monitored over time. The cardiac cycle may be selected using various metrics including a single-cycle metric and a cycle-series metric. Further, the selected cardiac cycle may be used for further cardiac analysis (for example, to generate electrical activation times).

Systems and methods are described for subject rehospitalization management. In an example, multiple physiologic signals can be obtained from a subject using multiple sensors. In response to a hospitalization event, pre-hospitalization characteristics of the multiple physiologic signals can be identified. Post-hospitalization characteristics of the multiple physiologic signals can be identified, including characteristics that differ from their corresponding pre-hospitalization characteristics. Later subsequent physiologic signals can be further monitored after the hospitalization event, such as using the same multiple sensors, and subsequent physiologic signal characteristics can be identified. In an example, a heart failure diagnostic indication can be determined using information about the pre-hospitalization characteristics, the post-hospitalization characteristics, and the subsequent characteristics. Information about relative changes in signal characteristics from multiple sensors can be used to identify particular subject physiologic signals to monitor during subsequent periods.

The present disclosure provides systems and methods for providing temporary induced dyssynchrony (TID) therapy to patients with atrial tachycardia. An implantable cardiac device includes a pulse generator coupled to a plurality of electrodes, and a controller communicatively coupled to the pulse generator and configured to cause the pulse generator to apply TID therapy to a patient's heart via the plurality of electrodes, determine that the patient's heart is experiencing atrial tachycardia, and adjust at least one parameter of the TID therapy based on the determination.