An extra-cardiovascular implantable cardioverter defibrillator (ICD) system receives a cardiac electrical signal by an electrical sensing circuit via an extra-cardiovascular sensing electrode vector and senses cardiac events from the cardiac electrical signal. The ICD system detects tachycardia from the cardiac electrical signal and determines a tachycardia cycle length from the cardiac electrical signal. The ICD system determines an ATP interval based on the tachycardia cycle length and sets an extended ATP interval that is longer than the ATP interval. The ICD delivers ATP pulses to a patient's heart via an extra-cardiovascular pacing electrode vector different than the sensing electrode vector. The ATP pulses include a leading ATP pulse delivered at the extended ATP interval after a cardiac event is sensed from the cardiac electrical signal and a second ATP pulse delivered at the ATP interval following the leading ATP pulse.

In some examples, a medical device system includes an electrode. The medical device system may include impedance measurement circuitry coupled to the electrode, the impedance measurement circuitry may be configured to generate an impedance signal indicating impedance proximate to the electrode. The medical device system may include processing circuitry that may be configured to identify a first component of the impedance signal. The first component of the impedance signal may be correlated to a cardiac event. The processing circuitry may be configured to determine that the cardiac event occurred based on the identification of the first component of the impedance signal.

An active implantable medical device includes a detection electrode and a pulse generator. The pulse generator is configured to collect via the detection electrode at least two EGM signals, combine the EGM signals into two time components, and combine the components into a single 2D parametric characteristic representing the cardiac cycle. During a tachyarrhythmia episode, the device measures stores values of a cycle-to-cycle variation in an amplitude of the at least one of the EGM signals, distributes the amplitude variation values into a plurality of classes, each class corresponding to an amplitude interval, and analyzes a size of each of the plurality of classes to deliver at least one of an indicator of suspicion of an artifact of extracardiac origin or an indicator of a type of tachyarrhythmia selectively as a function of at least one predetermined criterion applied to the distribution of the amplitude variation values.

A non-invasive bodily-attached ambulatory medical monitoring and treatment device with pacing is provided. The noninvasive ambulatory pacing device includes a battery, at least one therapy electrode coupled to the battery, a memory storing information indicative of a patient's cardiac activity, and at least one processor coupled to the memory and the at least one therapy electrode. The at least one processor is configured to identify a cardiac arrhythmia within the information and execute at least one pacing routine to treat the identified cardiac arrhythmia.

A device comprising a three-dimensional polymeric element and an electronic element integrated with the polymeric element is disclosed. The electronic element is made up of one or more electrode(s) each individually connectable to a measuring device and/or a controller, and each independently having a thin electrically-isolating layer deposited thereon such that the electrode is exposed to an environment surrounding the electrode at one or more pre-determined locations over the electrode. The device can include cells and/or tissue and/or a therapeutically active agent incorporated within the polymeric material. Processes of fabricating the device, systems for operating the device and methods utilizing same are also disclosed.

Systems, methods, and devices for delivering stimulating energy with a lead having a directional defibrillation electrode are disclosed. The lead includes a directional defibrillation electrode configured for implantation on or near the inner surface of a rib or the inner surface of the innermost intercostal muscle and having an electrically active portion configured to emanate stimulating energy from an exposed portion of the directional defibrillation electrode toward the pericardium and the heart. The lead also has an electrically insulating portion around at least part of the circumference of the lead. The electrically insulating portion is configured to insulate surrounding muscle and/or tissue from the stimulating energy when the lead is implanted in the patient.

A medical device comprises therapy delivery circuitry and processing circuitry. The therapy delivery circuitry is configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient. The ATP therapy includes one or more pulse trains and each of the one or more pulse trains includes a plurality of pacing pulses. The processing circuitry is configured to, for at least one of the plurality of pacing pulses of at least one of the one or more pulse trains, determine at least one latency metric of an evoked response of the heart to the pacing pulse. The processing circuitry is further configured to modify the ATP therapy based on the at least one latency metric.

Implantation of a cardiac stimulus system using the intercostal veins. Superior, intercostal, and inferior access methods are discussed and disclosed. Superior access may be performed by entering the brachiocephalic vein from a jugular, subclavian, or other vein, and then accessing the internal thoracic vein, traversing a portion of the internal thoracic vein and then accessing an intercostal vein therefrom. Inferior access may be accomplished inferior to the lower rib margin via the superior epigastric vein, advancing superiorly into the internal thoracic vein and then accessing an intercostal vein therefrom. Intercostal access may include creating an opening in an intercostal space between two ribs and advancing a needle using ultrasound guidance to enter the intercostal vein directly.

A method of pacing a His bundle of a patient heart using a stimulation system including a memory, a pulse generator, a stimulating electrode and at least one sensing electrode includes applying a plurality of impulses through the stimulating electrode to induce a plurality of responses from the patient heart. Each impulse of the plurality of impulses is delivered at a different impulse energy corresponding to a respective output setting of the stimulation system. The response characteristics for each of the plurality of responses are measured and each impulse is assigned a classification based on whether the respective response characteristics indicate capture of one or both of the His bundle and a ventricle of the patient heart. The output setting and classification for each impulse is then stored in the memory.

A method for assessment, optimization and logging of the effects of a therapy for a medical condition, including (a) receiving into a signal processor input signals indicative of the subject's brain activity; (b) characterizing the spatio-temporal behavior of the brain activity using the signals; (c) delivering a therapy to a target tissue of the subject; (d) characterizing the spatio-temporal effect of the therapy on the brain activity; (e) in response to the characterizing, optimizing at least one parameter of the therapy if the brain activity has not been satisfactorily modified and/or has been adversely modified by the therapy; (f) characterizing the spatio-temporal effect of the at least one optimized parameter; and (g) logging to memory the at least one optimized parameter. A computer readable program storage unit encoded with instructions that, when executed by a computer, performs the method.