A cardiac pacing system having a pulse generator for generating therapeutic electric pulses, a lead electrically coupled with the pulse generator having an electrode, a first sensor configured to monitor a physiological characteristic of a patient, a second sensor configured to monitor a second physiological characteristic of a patient and a controller. The controller can determine a pacing vector based on variables including a signal received from the second sensor, and cause the pulse generator to deliver the therapeutic electrical pulses according to the determined pacing vector. The controller can also modify pacing characteristics based on variables including a signal received from the second sensor.

Disclosed is a delivery system for a component, for example, a splitting lead. A splitting lead can have a proximal portion to engage a controller and a distal portion to split apart into sub-portions that travel in multiple directions during implantation into a patient. The delivery system can include a handle and a component advancer to advance and removably engage a portion of the component. The component advancer can be coupled to the handle and advance the component into the patient by applying a force to the portion in response to actuation of the handle by the operator. Also, the delivery system can include an insertion tip with first and second ramps to facilitate advancement of first and second sub-portions into the patient in first and second directions. The leads may have various electrode configurations including, for example, wrapped or embedded electrodes, helical or elliptical coils, thin metallic plates, etc.

An implantable device comprises a plurality of electrode pairs, a sensing unit, and a pacing unit. The electrode pairs comprise a first electrode pair. The first electrode pair is configured to implant at or near a first location of a heart. The sensing unit is configured to sense electrical activity in the heart, determine that the electrical activity indicates an abnormal rhythm, determine a feature of the electrical activity, and select the first electrode pair from the electrode pairs based on the feature. The pacing unit is configured to cause, in response to the abnormal rhythm and the feature, the first electrode pair to provide a first electrical pulse at a first time.

A system and method for extra cardiac defibrillation is disclosed. In a particular embodiment, an extra cardiac implantable cardioverter defibrillator system includes an implantable defibrillator having a metal case and a defibrillation lead. The defibrillation lead has a connector at its proximal end for coupling to the implantable defibrillator and a first defibrillation coil electrode at a distal portion of the lead. The first defibrillation electrode configured to be disposed in an inferior vena cava.

A device for extending a lead according to some embodiments includes a body, a tubular member coupled to the body, the tubular member comprising an outer surface, wherein the outer surface is sized to insert into an inner lumen of a lead, the tubular member is movable between a first configuration in which the tubular member slides into the lead, and a second configuration in which at least a portion of the tubular member expands to engage an inner surface of the lead; and, an actuation mechanism operatively coupled to the tubular member, the actuation mechanism configured to move the tubular member between the first configuration and second configuration.

Delivery devices, systems, and methods for delivering implantable leadless pacing devices are disclosed. An example delivery device may include a proximal section including a deflection mechanism for deflecting the proximal section, and a distal holding section extending distally of a distal end of the proximal section and defining a cavity therein for receiving an implantable leadless pacing device. The distal holding section may be structured to have portions that flex and bend while allowing the implantable device to be recaptured within the distal holding section.

Representative embodiments of the present invention provide for novel, minimally invasive implantable devices and methods for targeted tissue drug delivery of cardiovascular drugs.

Implantable cardiac pacing systems and methods for providing substernal pacing are described. In one example, a cardiac pacing system includes a pacemaker implanted in a patient and an implantable medical electrical lead. The implantable medical electrical lead includes an elongated lead body having a proximal end and a distal portion, a connector configured to couple to the pacemaker at the proximal end of the elongated lead body, and one or more electrodes along the distal portion of the elongated lead body, wherein the distal portion of the elongated lead body of the lead is implanted substantially within an anterior mediastinum of the patient and the pacemaker is configured to deliver pacing pulses to a heart of the patient.

Various embodiments of a sealed package and a method of forming such package are disclosed. The package includes a housing, a substrate hermetically sealed to the housing, and a light source disposed on a first major surface of the substrate. The package further includes a detector disposed on the first major surface of the substrate and having a detecting surface. The package also includes a masking layer disposed on at least one of the first major surface and a second major surface of the substrate, where the masking layer includes a first aperture aligned with an emission axis of the light source in a direction orthogonal to the first major surface of the substrate. The masking layer further includes a second aperture aligned with a detection axis of the detector in a direction orthogonal to the first major surface of the substrate.

A system for guiding implantation of an energy delivery component of a cardiac pacing device at a fixation location within a heart of a patient is provided. During a procedure to implant an energy pulse delivery component, the system receives a patient cardiogram collected during pacing of the energy pulse delivery component while the energy pulse delivery component is positioned at a current location within the heart. The system then determines based on the patient cardiogram the current location of the energy pulse delivery component. The system then outputs an indication of the current location to guide affixing of the energy pulse delivery component at the intended fixation location. This process is repeated until the energy pulse delivery component is at the fixation location. The system also evaluates the effectiveness of pacing at intermediate location to optimize the final location based upon simulated electro-mechanics of the system in near-real time.