This document discusses, among other things, systems and methods to generate a first pacing waveform during a first pacing period and a second pacing waveform during a second pacing period, and alternate the first and second pacing periods to provide pacing-based hypertension therapy to a heart of a patient to reduce patient blood pressure, wherein the first pacing waveform has a first atrioventricular (AV) delay and the second pacing waveform has a second AV delay longer than the first AV delay. Physiologic information can be received from the patient, and one of the first or second pacing period for delivery to the patient can be determined using the received physiologic information.

Electrotherapy waveform and pulse generation and delivery systems, methods and devices are described, such as for generation and delivery of defibrillation or pacing electrotherapeutic waveforms to patients, using open or closed loop current control. An example system includes a power supply, a therapeutic current control network and a controller. A therapeutic current control network may include at least one current control switch and a resonant tank. During delivery of an electrotherapeutic waveform to a patient with optional closed loop current control, the controller may compare a signal associated with a determined or estimated current provided to the patient with a signal associated with a reference waveform. Based at least in part on the comparison, the controller may adjust operation of the at least one current control switch of the therapeutic current control network in adjusting delivery of the electrotherapeutic waveform to the patient to correspond with the reference waveform. The system may utilize one or more of soft switching, wide bandgap materials and a bidirectional power supply.

A Wearable Medical System (WMS) includes one or more pacing capabilities. The WMS may detect when the patient's heart rhythm starts to deteriorate, but not necessarily in a way that requires defibrillation. In particular, the WMS may detect bradycardia of one or more types, and then confirm the detection before pacing to treat the detected bradycardia.

Methods and systems for alleviating disorders and complications associated with autonomic nervous system dysfunction. The approach generally includes measuring heart rate signals from a subject to measure heart rate variability and determine a heart rate variability threshold, determining that the subject is experiencing autonomic nervous system dysfunction, and alerting the subject to stimulate the auricular branch of the vagus nerve with an ear device.

A wearable cardioverter defibrillator (WCD) system includes a support structure having an adjustable fastening assembly to fasten portions of the support structure together to fit the support structure on a patient. The adjustable fastening assembly enables the patient wearing the support structure to adjust the fit of the support structure without unfastening the portions from each other. The adjustable fastening assembly may also enable the patient to adjust the fit of the support structure while wearing clothing over the support structure and without having to adjust the clothing to view or access the adjustable fastening assembly.

Systems and methods for treating and/or averting cardiac arrhythmias, such as atrial fibrillation, are provided. A device comprises a housing including an energy source, a contact surface and an electrode. The energy source is configured to transmit an electrical impulse to the electrode through the outer skin surface to a vagus nerve of the patient. The electrical impulse comprises bursts of about 2 pulses to about 20 pulses with each of the bursts having a frequency of about 3 Hz to about 100 Hz. The electrical impulse modulates the vagus nerve to treat a cardiac arrhythmia of the patient. A system includes a sensor for detecting a physiological parameter of a patient's heart, such as heart rate variability, and a controller configured to activate the stimulator based on the physiological parameter to cause the stimulator to generate the electrical impulse.

A medical device that includes a power source, a therapy delivery interface, therapy electrodes, electrocardiogram (ECG) sensing electrodes to sense ECG signal of a heart of a patient, a sensor interface to receive and digitize the ECG signal, and a processor. The processor is configured to analyze the ECG signal to determine a cardiac rhythm and a transform value representing a magnitude of a frequency component of the cardiac rhythm, analyze the cardiac rhythm and the transform value to detect a shockable cardiac arrhythmia by classifying the cardiac rhythm as a noise rhythm or a shockable cardiac arrhythmia rhythm based on the transform value, and causing the processor to detect the cardiac arrhythmia if classifying the cardiac rhythm as a shockable cardiac arrhythmia rhythm, initiate a treatment alarm sequence, adjust the shock delivery parameter for a defibrillation shock, and provide the defibrillation shock via the therapy electrodes.

A multi-electrode ear shell includes an inner surface and an outer surface, the inner surface corresponding to a surface of an ear and being configured to overlap a cymba and a cavum of the ear. The multi-electrode ear shell further includes a first socket to receive a first stimulation electrode and a second socket to receive a second stimulation electrode.

In some examples, a method for forming an energy storage device assembly, e.g., for an implantable medical device, may comprise partially enclosing electrodes of an energy storage device within a foil pack, wherein the foil pack includes an unsealed portion and a sealed portion when partially enclosing the electrodes of the energy storage device. The method may further comprise forming a first heat seal at the unsealed portion of the foil pack, and subsequently forming a second heat seal that is redundant with the first heat seal of the foil pack.

A medical monitoring and treatment device that includes a therapy delivery interface, a plurality of therapy electrodes coupled to the therapy delivery interface, a plurality of electrocardiogram sensing electrodes to sense electrocardiogram signals of a patient, a sensor interface to receive the electrocardiogram signals and digitize the electrocardiogram signals, and at least one processor coupled to the sensor interface and the therapy delivery interface to analyze the digitized electrocardiogram signals, to detect a cardiac arrhythmia based on the digitized electrocardiogram signals, and to control the therapy delivery interface to apply electrical therapy to the patient based upon the detected cardiac arrhythmia. The at least one processor is further configured to analyze a frequency domain transform of the digitized electrocardiogram signals, to determine a metric indicative of a metabolic state of a heart of the patient, and to accelerate or delay application of the electrical therapy based upon the metric.