An implantable medical device system is configured to detect a tachyarrhythmia from a cardiac electrical signal and start an ATP therapy delay period. The implantable medical device determines whether the cardiac electrical signal received during the ATP therapy delay period satisfies ATP delivery criteria. A therapy delivery module is controlled to cancel the delayed ATP therapy if the ATP delivery criteria are not met and deliver the delayed ATP therapy if the ATP delivery criteria are met.

Brugada syndrome and related forms of ion channelopathies, including ventricular asynchrony of contraction, originate in the region near the His bundle or para-Hisian regions of the heart. Manifestations of Brugada syndrome can be corrected by delivering endocardial electrical stimulation coincident to the activation wave front propagated from the atrioventricular (AV) node early enough to compensate for the conduction problems that start in those regions. The stimulation can include waveforms of the same polarity delivered to a site within the region near the His bundle or para-Hisian regions of the heart associated with a low cardiac electrical asynchrony level or can include at least two single-phased superimposed waveforms of opposite polarity delivered through a pair of pacing electrodes relative to a reference electrode, which can be delivered to any site within the region near the His bundle or para-Hisian regions. Defibrillation can also be used to terminate an arrhythmia.

Devices and methods are disclosed for the treatment or repair of regurgitant cardiac valves, such as a mitral valve. An illustrative annuloplasty device can be placed in the coronary sinus to reshape the mitral valve and reduce mitral valve regurgitation. The disclosure also provides improved techniques for cardiac pacing.

An implantable medical device comprises a communication module that comprises at least one of a receiver module and a transmitter module. The receiver module is configured to both receive from an antenna and demodulate an RF telemetry signal, and receive from a plurality of electrodes and demodulate a tissue conduction communication (TCC) signal. The transmitter module is configured to modulate and transmit both an RF telemetry signal via the antenna and a TCC signal via the plurality of electrodes. The RF telemetry signal and the TCC signal are both within a predetermined band for RF telemetry communication. In some examples, the IMD comprises a switching module configured to selectively couple one of the plurality of electrodes and the antenna to the receiver module or transmitter module.

An implantable 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.

An implantable system for stimulating a human heart or an animal heart, comprising a first stimulation unit and a first detection unit, wherein the first stimulation unit is used to stimulate at least one cardiac region of a human or an animal heart, and wherein the first detection unit is used to detect an electrical signal of at least one cardiac region of the same human or animal heart. The system comprises a first timer, which is used to provide a defined delivery of stimulation pulses, in terms of time, by the first stimulation unit. The system comprises a second timer, which is provided and configured to match a delivery point in time of at least one pulse to be delivered by the second stimulation unit to a delivery point in time of at least one pulse to be delivered by the first stimulation unit.

Apparatus, systems and methods are provided for prevention and/or remediation of cardiac arrhythmias, e.g. optimizing anti-tachycardia pacing (ATP) algorithms. More particularly, implantable devices are provided that measure and treat cardiac arrhythmias. By monitoring the ATP attempt from additional electrodes, far-field morphology analyses, and/or measuring the return interval from a failed ATP attempt; the devices may estimate when entrainment has occurred, the amount of delay within the reentrant tachycardia, and/or tachycardia termination/acceleration. These variables and occurrences can be used to optimize the first and/or subsequent ATP attempts. Furthermore, other exemplary embodiments describe methods to integrate electrical restitution properties into the design of ATP pacing algorithms to facilitate tachycardia termination.

An implantable lead assembly is provided that comprises a lead body having a proximal end portion and a distal end portion, and having a length extending there between. A plurality of electrodes are disposed along the lead body. A plurality of cable conductors are contained within the lead body, the conductors extending from the electrodes to the proximal end portion. A lead connector is provided at the proximal end portion. The lead connector includes a connector pin configured to mate with a corresponding header contact; a first termination pin coupled to one of the plurality of cable conductors; a collar coupler securely and electrically coupling the connector pin and first termination pin in an axially offset alignment with one another; and a body segment that is elongated along a longitudinal axis and extends between a header mating face and a lead mating end. The body segment is over-molded about the connector pin, the first termination pin and the collar coupler, the connector pin extending from the header mating face, the first termination pin extending from the lead mating end.

An example of a system for pacing through multiple electrodes in a ventricle includes a sensing circuit to sense cardiac signal(s), a pacing output circuit to deliver pacing pulses, a heart sound sensor to sense a heart sound signal, and a control circuit to control the delivery of the pacing pulses. The control circuit includes a heart sound detector to detect heart sounds using the heart sound signal, an electrical event detector to detect cardiac electrical events using the cardiac signal(s), a measurement module to measure an optimization parameter using the detected heart sounds, an optimization module to perform an optimization procedure using the optimization parameter in response to an optimization command, and an optimization initiator to generate the optimization command. The optimization procedure includes selection of a single electrode or a plurality of electrodes from the multiple electrodes in the ventricle for pacing that ventricle.

An apparatus comprises a cardiac signal sensing circuit configured for coupling electrically to a plurality of electrodes and to sense intrinsic cardiac activation at three or more locations within a subject's body using the electrodes; a stimulus circuit configured for coupling to the plurality of electrodes; a signal processing circuit electrically coupled to the cardiac signal sensing circuit and configured to determine a baseline intrinsic activation vector according to the sensed intrinsic cardiac activation; and a control circuit electrically coupled to the cardiac signal sensing circuit and stimulus circuit and configured to: initiate delivery of electrical pacing therapy using initial pacing parameters determined according to the baseline intrinsic activation vector; initiate sensing of a paced activation vector; and adjust one or more pacing therapy parameters according to the paced activation vector.