An adherent device to monitor a patient for an extended period comprises a breathable tape. The breathable tape comprises a porous material with an adhesive coating to adhere the breathable tape to a skin of the patient. At least one electrode is affixed to the breathable tape and capable of electrically coupling to a skin of the patient. A printed circuit board is connected to the breathable tape to support the printed circuit board with the breathable tape when the tape is adhered to the patient. Electronic components electrically are connected to the printed circuit board and coupled to the at least one electrode to measure physiologic signals of the patient. A breathable cover and/or an electronics housing is disposed over the circuit board and electronic components and connected to at least one of the electronics components, the printed circuit board or the breathable tape.

A medical device includes a VNS pulse burst generator for stimulation of the vagus nerve, and a controller for analyzing the cardiac rhythm. It further includes a sequencer that uses an estimator to calculate during a given cycle an estimate of the temporal position of the R wave of the next cycle. The controller is configured to define the moment of application of the VNS pulse burst as an instant corresponding to the estimate minus a predetermined advance delay. VNS therapy is thus delivered in a non-vulnerable period, near the end of the period of natural ventricular escape.

Methods, systems, and devices for signal analysis in an implanted cardiac monitoring and treatment device such as an implantable cardioverter defibrillator. In some examples, captured data including detected events is analyzed to identify likely overdetection of cardiac events. In some illustrative examples, when overdetection is identified, data may be modified to correct for overdetection, to reduce the impact of overdetection, or to ignore overdetected data. Several examples emphasize the use of morphology analysis using correlation to static templates and/or inter-event correlation analysis.

Methods and/or devices may be configured to monitor ventricular activation times and modify an atrioventricular delay (AV delay) based on the monitored ventricular activation times. Further, the methods and/or devices may determine whether the AV delay should be modified based on the measured activation times before modifying the AV delay.

Methods, apparatus, and systems are provided to control contraction of the heart. At least one sensing element receives signals indicating electrical activity of sinus rhythm of the heart. Based on the received signals, the progress of contraction of the heart is determined. Based on the progress of contraction, the chamber of the heart may then be stimulated at a plurality of locations. In another embodiment, a plurality of electrodes are implanted in the left ventricle to stimulate at multiple locations in the left ventricle for the purpose of improving hemodynamic performance and increasing cardiac output in a patient who is suffering from congestive heart failure.

Systems and methods for pacing cardiac conductive tissue are described. An exemplary system includes an electrostimulation circuit that may generate HBP pulses to stimulate patient physiologic conduction pathway, such as a His bundle or a bundle branch. The system includes an arrhythmia detector to detect an atrial tachyarrhythmia (AT) with intermittent ventricular conduction. A control circuit may sense ventricular activation and, in response to the detected AT indication, determine or update a His-bundle pacing (HBP) configuration. The HBP may be recursively updated on a beat-by-beat basis using the sensed ventricular activation. The electrostimulation circuit may deliver HBP according to the determined or adjusted HBP configuration to regularize ventricular rate during AT.

A system and method are provided. The system includes a HIS electrode configured to be located proximate to a HIS bundle. A pulse generator is coupled to the HIS electrode and is configured to deliver HIS bundle pacing (HBP), a right atrial (RA) electrode is located in a right atrium, a sensing circuitry coupled to the RA electrode and defines an RA sensing channel that does not utilize the HIS electrode. The system includes a memory including program instructions. The system includes a processor is configured to collect cardiac activity (CA) signals over the RA sensing channel utilizing the RA electrode. The CA signals include a far field (FF) component associated with a ventricular event (VE). The processor analyzes the FF component to identify first and second FF component (FFC) characteristics of interest (COI) of the ventricular event and utilizes the first FFC COI to apply a first capture class (CC) discriminator to distinguish between first and second capture classes. The first capture class includes first and second capture types. The processor utilizes the second FFC COI to apply a second CC discriminator to distinguish between at least one of i) the first and second capture types within the first capture class, or ii) third and fourth capture classes and manages HIS bundle pacing based on distinctions by the first and second CC discriminators.

This document discusses, among other things, systems and methods for monitoring a patient at risk of epilepsy. A system comprises a sensor circuit that senses from the patient at least first and second physiological or functional signals. A wellness detector circuit can detect an epileptic event using the sensed physiological or functional signals, or additionally classify the epileptic event into one of epileptic seizure types. The system can generate a wellness indicator based on a trend of the physiological or functional signal during the detected epileptic event. The wellness indicator indicates an impact of the detected epileptic event on the health status of the patient. The system includes an output unit configured to output the detection of the epileptic event or the wellness indicator to a user or a process.

A system includes a memory and a processor. The memory is configured to store a definition of a cardiac pacing protocol. The processor is configured to (a) receive the stored definition of the cardiac pacing protocol, (b) in accordance with the pacing protocol, to automatically pace from an intracardiac location and to acquire respective sensed ECG signals, (c) based on one or more prespecified criteria for validity of the sensed ECG data, automatically accept or reject the sensed ECG signals, (d) based on one or more prespecified criteria for identification of an arrhythmia, identify the intracardiac location as an arrhythmogenic focus or pathway, (e) overlay the identified intracardiac location an electrophysiological (EP) map, and (f) subsequently identify or reject a new intracardiac location as an arrhythmogenic focus or pathway and overlay the new location on the EP map when pacing again from the new intracardiac location.

Techniques are described for discriminating SVT and, in particular, rapidly conducting AF. The techniques include detecting an onset of a fast rate of ventricular events sensed from a cardiac electrical signal and detecting a pause in the fast rate of ventricular sensed events. A threshold number of ventricular event intervals required to detect a ventricular tachyarrhythmia is detected with each of the threshold number of ventricular event intervals being less than a tachyarrhythmia detection interval. Detection of the ventricular tachyarrhythmia and an electrical stimulation therapy for treating the ventricular tachyarrhythmia are withheld in response to at least the pause being detected.