The present invention relates to non-excitatory electrical heart failure therapy as a therapy for Heart failure with preserved ejection fraction.

Delivery devices, systems, and methods for delivering implantable leadless pacing devices are disclosed. An example delivery device may include an intermediate tubular member and an inner tubular member slidably disposed within a lumen of the intermediate tubular member. A distal holding section may extend distally of a distal end of the intermediate tubular member and define a cavity therein for receiving an implantable leadless pacing device. The device may be configured to enable fluid flushing of the delivery device prior to use, to remove any air from within the device as well as providing the option of fluid flow during use of the delivery device.

A biostimulator, such as a leadless cardiac pacemaker, including coaxial fixation elements to engage or electrically stimulate tissue, is described. The coaxial fixation elements include an outer fixation element extending along a longitudinal axis and an inner fixation element radially inward from the outer fixation element. One or more of the fixation elements are helical fixation elements that can be screwed into tissue. The outer fixation element has a distal tip that is distal to a distal tip of the inner fixation element, and an axial stiffness of the outer fixation element is lower than an axial stiffness of the inner fixation element. The relative stiffnesses are based on one or more of material or geometric characteristics of the respective fixation elements. Other embodiments are also described and claimed.

An example device includes an elongated housing, a first and second electrode, and signal generation circuitry. The housing can be implanted within a single first chamber of the heart. The first electrode extends distally from the distal end of the elongated housing. A distal end of the first electrode can penetrate into wall tissue of a second chamber of the heart. The second electrode, extending from the distal end of the elongated housing, is configured to flexibly maintain contact with the wall tissue of the first chamber without penetration of the wall tissue of the first chamber by the second electrode. Signal generation circuitry can be within the elongated housing and coupled to the first and second electrode. The signal generation circuitry can deliver cardiac pacing to the second chamber via the first electrode and the first chamber via the second electrode.

An implantable medical device configured to deliver pacing therapy, the implantable medical device including a device body configured to position within a heart, where the device body comprises a proximal body portion and a distal body portion and defines a longitudinal axis extending through the proximal body portion and the distal body portion, the proximal body portion is configured to rotate around the longitudinal axis relative to distal body portion, and a leadlet mechanically coupled to the device body, where the leadlet mechanically supports an electrode configured to deliver pacing therapy, and where in response to the proximal body portion rotating relative to the distal body portion, the device body is configured to alter an extension length of the leadlet.

A guide wire system configured to guide a medical device (e.g., a medical lead) to a target area within a patient. The guide wire system may be configured to penetrate and pass through a tissue wall in the patient to guide the medical device to the target area. The guide wire system includes a support section configured to expand to substantially maintain a position relative to the tissue wall. The guide wire system includes a pull wire configured to cause the support portion to expand. The expanded support section may provide counter-traction to a distal force on the tissue wall exerted by a medical device during, for example, fixation of the medical device to the target area, or other stages of an implantation. The support section is configured to re-establish an initial configuration for proximal withdrawal from the tissue wall.

An electrode assembly for the positioning of an electrode of an implantable medical lead includes a housing and an electrode subassembly. The housing includes a proximal end for connecting to the lead and a distal end. The housing defines a housing lumen extending between the proximal end and the distal end. The housing lumen includes internal screw threads extending along at least a portion of the housing lumen. The electrode subassembly is disposed at least partially within the housing lumen. The electrode subassembly includes a needle electrode and a coupler. The needle electrode is disposed coaxially with the longitudinal axis of the housing lumen. The coupler is disposed at a proximal end of the needle electrode. The coupler includes external screw threads engaged with the internal screw threads of the housing lumen such that rotation of the coupler moves the needle electrode along the longitudinal axis of the housing lumen.

A lead for an implantable stimulation device for cardiac stimulation of a patient generally extends along a longitudinal axis. The lead comprises a body section, a distal lead section extending from the body section along the longitudinal axis and forming a distal end, a first electrode device arranged on the distal lead section for at least one of transmitting an electrical pacing signal and sensing an electrical sense signal, the first electrode device being configured for placement in or on intra-cardiac tissue, and a second electrode device arranged on the body section for emitting an electrical defibrillation signal. The distal lead section in at least one portion comprises a reduced bending stiffness with respect to at least a portion of said body section.

A method includes, based on respective signals acquired by a plurality of electrodes on an anatomical surface of a heart, computing respective local activation times (LATs) at respective locations of the electrodes. The method further includes, based on the LATs, computing respective directions of electrical propagation at the locations. The method further includes selecting pairs of adjacent ones of the electrodes such that, for each of the pairs, a vector joining the pair is aligned, to within a predefined threshold degree of alignment, with the direction of electrical propagation at the location of one of the electrodes belonging to the pair. The method further includes associating respective bipolar voltages measured by the pairs of electrodes with a digital model of the anatomical surface. Other examples are also described.

An intraseptal multi-electrode cardiac pacemaker has a plurality of first individual electrodes implanted at an interventricular septum at varying depths and/or lateral distances from the distal end of a flexible conduit and configured to provide a cardiac pacing therapy by stimulating left bundle branch conduction fibers. A plurality of second individual electrodes may also be implanted in the septum at suitable depths to stimulate conduction fibers of the right bundle branch. After implantation, first and second individual electrodes are interrogated to select a subset of electrodes suitable to deliver the pacing therapy according to a predetermined criterion such as capturing the left ventricle or capturing the right ventricle via normal conduction system of the heart at the lowest voltage level via corresponding bundle branches. A combination of the pacemaker with a cardioverter/defibrillator is provided by positioning a defibrillator coil near the distal end of the flexible conduit of the pacemaker.