One aspect of the present disclosure relates to a system for monitoring a diaphragmatic twitch response. The diaphragmatic twitch response can be used to determine a depth of neuromuscular blockade. The system includes a neural stimulation device to stimulate a phrenic nerve of a subject, which has the effect of stimulating the subject's diaphragm. The system also includes a monitor to detect the diaphragm's response to the stimulation. For example, the monitor can include a nasogastric tube with two distally positioned inflatable balloons. Each of the inflatable balloons is coupled to a sensor to measure a corresponding pressure (e.g., an esophageal pressure and a gastric pressure). The pressure differential between the esophagus above the diaphragm and the stomach below the diaphragm (also referred to as the transdiaphragmatic pressure) can be used as a measure of the diaphragmatic twitch response.

Methods, agents, and devices to treat medical conditions through local chemical neuromodulation of the autonomic nervous system are described. Drug formulations may be injected at or near ganglia, nerve plexi, ganglionated plexi, and nerves to treat different diseases. Target sites for the treatment of cardiac and other disease conditions may include extrinsic stellate (cervicothoracic) and cervical ganglia of the sympathetic chain, and intrinsic cardiac nerves and ganglionated plexi innervating the myocardium.

Various aspects of the present subject matter provide an implantable medical device. In various embodiments, the device comprises a pulse generator, a first monitor and a controller. The pulse generator is adapted to generate a neural stimulation signal for a neural stimulation therapy. The neural stimulation signal has at least one adjustable parameter. The first monitor is adapted to detect an undesired effect. In some embodiments, the undesired effect is myocardial infarction. The controller is adapted to respond to the first monitor and automatically adjust the at least one adjustable parameter of the neural stimulation signal to avoid the undesired effect of the neural stimulation therapy. Other aspects are provided herein.

Systems and methods are provided for using stored physiologic information about a subject to detect a previous treatment event. Physiologic information can be sensed from a subject using one or more sensors. Using a detection circuit, a change in the sensed physiologic information, such as a change from reference physiologic information, can be used to identify a candidate previous treatment event. An alert or other information about the candidate treatment event can be provided to a patient or clinician. In an example, a candidate treatment event can include a heart failure or diuresis treatment that is identified using information about a change in one or more of a subject's circadian pattern, a subject's thoracic impedance, or a subject's respiration status.

A device for the active fixation of an implantable medical lead includes a housing, a tine assembly, an electrode, and a rotatable shaft. The housing includes a proximal end for connecting to the lead and a distal end opposite the proximal end. The housing defines a housing lumen extending between the proximal end and a recess adjacent to the distal end. The tine assembly is disposed within the housing lumen and includes at least one tine configured to self-bias from a linear configuration within the housing to a curved configuration outside of the housing. The electrode assembly is disposed at the distal end of the housing and includes a plurality of electrodes. The rotatable shaft extends through the housing lumen and is configured to engage the tine assembly such that rotation of the shaft transitions the at least one tine between the linear configuration and the curved configuration.

Methods of preventing, treating, and/or controlling a hemorrhage in an organ of a patient include providing electrical stimulation to the arteries, veins, nerves innervating the arteries or veins, or walls of the organ. The apparatus has at least one electrode operably connected to a stimulus generator and placed in electrical communication with an artery, vein, nerve, or organ wall. An electrical stimulus generator causes an electrical stimulus to be administered to the artery, vein, nerve, or wall through the at least one electrode, where the electrical stimulus is effective for preventing, treating, and/or controlling a hemorrhage.

A wearable device combines its existing functions (e.g., a headphone) with non-invasive autonomic modulation using tragus or other external auditory meatus stimulation. The wearable device can output audio to a user, such as music, podcast, etc., and further provide modulation of the vagus nerve via tragus stimulation or other external auditory meatus stimulation to treat various diseases.

A catheter system configured for delivering a neuromodulation therapy, includes a first therapeutic element positionable in a first target vessel selected from the group of blood vessels consisting of the superior vena cava, left brachiocephalic vein, right brachiocephalic vein, azygos vein or azygos arch, and a second therapeutic element in a second target vessel selected from the group of blood vessels consisting of the superior vena cava, left brachiocephalic vein, right brachiocephalic vein, internal jugular vein, azygos vein or azygos arch. The system and associated method deliver therapeutic energy to at least one parasympathetic nerve fiber external to the first target vessel using the first therapeutic element, and deliver therapeutic energy to at least one sympathetic nerve fiber external to the second target vessel using the second therapeutic element.

A method, system, and apparatus for providing a stimulation signal comprising a variable ramping portion using an implantable medical device (IMD). The first electrical comprises a first ramping portion. The first ramping portion comprises a first parameter and having a first value. The first electrical signal is applied to a target location of the patient's body. A second electrical signal comprising a second ramping portion is generated. The second ramping portion comprises the first parameter having a second value that is different from the first value. The second electrical signal is applied to a target location of the patient's body.

An implantable pulse generator system includes a nerve stimulation unit providing vagal nerve stimulation (VNS) pulses; an autonomic tone sensor which determines the patient's autonomic status; and a control unit connected to the nerve stimulation unit and the autonomic tone sensor. The control unit controls the nerve stimulation unit to generate VNS with varying intensity, depending on the autonomic status (which is evaluated in a moving window). The control unit gradually increases VNS intensity when the autonomic status indicates a shift toward more sympathetic dominance, and it gradually decreases VNS intensity when the autonomic status indicates a shift toward more parasympathetic dominance, wherein the gradual increase and the gradual decrease of the VNS intensity follow two different paths.