A system and method of implanting pacing lead in a patient's heart. The system may include a catheter configured to by inserted through the coronary sinus ostium such that the distal end region of the catheter is positioned past the anterolateral vein and proximate at least one septal perforating vein. The catheter is configured to inject contrast proximate the septal perforating vein to identify an implant region for a pacing lead. Further, a controller is configured to deliver pacing therapy to the implant region.

Apparatus and methods for placement of electrodes into selected tissue, such as the septal wall separating the left and right ventricles, with, in some cases, access to the septal wall from the right ventricle. Torque sleeves may be used to provide for rotation as needed.

Systems, methods, and interfaces are described herein for assisting a user in noninvasive evaluation of patients for cardiac therapy and noninvasive evaluation of cardiac therapy being delivered. The systems, methods, and interfaces may provide graphical representations of cardiac electrical activation times about one or more portions of human anatomy and one or more cardiac health metrics.

System and methods for monitoring and/or controlling nerve activity in a subject are provided. In one embodiment, a system includes electrodes configured to be placed proximate to a subject's skin, and a signal detector configured to detect electrical signals using the electrodes. The system also includes a signal processor configured to receive the electrical signals from the signal detector, and apply a filter to the received electrical signals to generate filtered signals, the filter configured to attenuate at least signals having frequencies corresponding to heart muscle activity during a heartbeat. The signal processor is also configured to identify a skin nerve activity using the filtered signals, estimate a sympathetic nerve activity using the identified skin nerve activity, and further to generate a report indicative of the estimated sympathetic nerve activity. In some aspects, the system further includes a signal generator to deliver the electrical stimulation to the subject's skin.

Systems and methods for monitoring and treating patients with heart failure are discussed. The system may receive patient atrioventricular (AV) conduction characteristic under different heart rates or patient conditions. Stimulation parameters including stimulation timing parameters may be stored in a memory. The system may include a stimulation control circuit configured to determine a parameter update schedule indicating a timing at which to update stimulation parameter using patient AV conduction characteristic, and dynamically update at least a portion of the stored set of stimulation parameters at the determined parameter update schedule. For a specified heart rate or heart rate range, a stimulation parameter may be selected from the set of the stimulation parameters for use during cardiac stimulation.

An exemplary method includes receiving a signal from an intrathoracic vibration sensor, analyzing the signal for vibration associated with deceleration of blood flow into the left ventricle, based at least in part on the analyzing, deciding whether to call for adjustment to one or more parameters of a bi-ventricular pacing therapy. Other exemplary methods, devices, systems, etc., are also disclosed.

A method for identifying reversible cardiac dyssynchrony (RCD) of a patient and treating the RCD measures an event relating to a rapid increase in the rate of pressure increase within the left ventricle. The method calculates a first time delay between the event and a first reference time. If the first time delay is longer than a set fraction of electrical activation of the heart, then the presence of cardiac dyssynchrony in the patient is identified. Pacing is applied to the heart, and a second time delay between the event following pacing and a second reference time following pacing is calculated. If the second time delay is shorter than the first time delay, the method identifies a shortening of a delay to onset of myocardial synergy, OoS, thereby identifying the presence of RCD in the patient. Treatment of the RCD is performed.

An intra cardiac device is disclosed. The device comprises means for transforming kinetic energy from heart tissue movement into electrical energy in use, from which electrical energy information in respect of heart function is obtainable. Furthermore, a system is disclosed, comprising one such intra cardiac device and at least one receiver, wherein the intra cardiac device comprises means of communication, through which said at least one device communicates with the receiver(s) wirelessly. In this way energy from heart movement provides self contained intra cardiac devices for conveniently monitoring or stimulating a patient's heart.

In some examples, an electromechanical disassociation state (EMD) of a heart of a patient can be treated by delivering electrical stimulation to a tissue site to at least one of modulate afferent nerve activity or inhibit efferent nerve activity upon determining that the heart is in an electromechanical dissociation state, where the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site. The delivery of electrical stimulation may effectively treat the EMD state of the heart, e.g., by enabling effective mechanical contraction of the heart. In another example, an electromechanical disassociation state of a heart of a patient can be treated by determining autonomic nervous system activity associated with a detected EMD state of the heart of a patient, and delivering electrical stimulation therapy to the patient based on the determined autonomic nervous system activity of the patient associated with the EMD state.

Systems and methods are provided for delivering vagus nerve stimulation and cardioversion/defibrillation therapies to patients for treating chronic heart failure. The vagus nerve stimulation and cardioversion/defibrillation therapies may be provided using a single implantable pulse generator, which can coordinate delivery of the therapies to provide an acute vagus nerve stimulation therapy in advance of delivering cardioversion-defibrillation energy.