Methods and systems for use of the Q-wave to R-wave interval to guide placement of a leadless cardiac pacemaker are disclosed. An implant delivery device is equipped with sensing electrodes to sense R-wave onset in a ventricle of a patient's heart to allow placement at a location of last or latest onset of the R-wave. Guidance tools are provided to assist in determination of the Q-wave to R-wave interval during implantation. For a chronic system, a cooperative approach is disclosed in which an implantable medical device and a leadless cardiac pacemaker exchange data to determine Q-wave to R-wave intervals and enhance cardiac resynchronization therapy delivery by the leadless cardiac pacemaker.

A leadless pacemaker device configured to provide for an intra-cardiac pacing, including: processing circuitry configured to generate ventricular pacing signals for stimulating ventricular activity, and a reception device for receiving a sensing signal indicative of an atrial activity, wherein the processing circuitry is configured to detect an atrial event derived from said sensing signal, wherein the atrial event is a valid atrial sense event, where a series of atrial events lie within a range for a normal atrial rate, and/or when the atrial rate variability is within a certain range indicating a regular atrial rhythm, wherein in case a valid atrial sense event is detected, the processing circuitry is further configured to: determine ventricular pacing events according to atrial events, calculate ventricular-atrial time delays, determine a correction value based a measured time delay and the calculated time delay, and adjust the ventricular pacing timing based on the correction value.

A method of increasing peak VO2 including selecting a patient having impaired peak VO2 and estimated to have a potential for improving peak VO2, and applying cardiac contractility modulation stimulation to the patient's heart. A method of increasing peak VO2 including detecting ventricle contraction using one or more leads in a patient's ventricle, and applying Cardiac Contractility Modulation stimulation to the patient's ventricle, after a delay from a time of the detecting, thereby increasing the patient's peak VO2. Related apparatus and methods are also described.

Systems and methods for selecting, positioning, and controlling cardiac resynchronization therapy (CRT) electrodes are disclosed. According to an aspect, a CRT system includes one or more electrodes configured to be positioned on or in proximity to a subject's heart for receiving electrical signals carrying EGM data. The system also includes a CRT device operatively connected to the electrode(s). The CRT device is configured to receive the electrical signals from the electrode(s) when the one or more electrodes are positioned in a first arrangement with respect to the subject's heart. Further, the CRT device is configured to determine a second arrangement of the electrode(s) with respect to the subject's heart based on the carried EGM data. The CRT device is configured to present the second arrangement of the electrode(s).

Systems and methods for selecting, positioning, and controlling cardiac resynchronization therapy (CRT) electrodes are disclosed. According to an aspect, a CRT system includes one or more electrodes configured to be positioned on or in proximity to a subject's heart for receiving electrical signals carrying EGM data. The system also includes a CRT device operatively connected to the electrode(s). The CRT device is configured to receive the electrical signals from the electrode(s) when the one or more electrodes are positioned in a first arrangement with respect to the subject's heart. Further, the CRT device is configured to determine a second arrangement of the electrode(s) with respect to the subject's heart based on the carried EGM data. The CRT device is configured to present the second arrangement of the electrode(s).

A stimulation system includes an energy source, an electronics unit with a controller, and an actuator that is coupled with the electronics unit and/or the energy source. The actuator emits electromagnetic waves for stimulation of genetically manipulated tissue. The electronics unit is disposed in a housing. The stimulation system is configured for at least temporary implantation in a human or animal body. The controller controls the stimulation of tissue in the body by way of the electromagnetic waves emitted by the actuator. A selector of the stimulation system selects the area of the said tissue for stimulation. The selector includes a masking device for masking certain areas of the tissue, so that an intensity of the stimulation for the masked areas is reduced or equal to zero.

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 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.

Certain embodiments described herein related to methods, devices, and systems that provide improved communications between first and second IMDs remotely located relative to one another and capable of communicating using both conductive communication and RF communication. Such a method can include the first IMD using conductive communication to transmit message(s) intended for the second IMD, without using RF communication, during a first period of time that a first trigger event is not detected. The method can also include the first IMD detecting the first trigger event, and in response thereto, the first IMD using RF communication to transmit message(s) intended for the second IMD during a second period of time. Thereafter, in response to first IMD detecting a second trigger event, the first IMD uses conductive communication to transmit one or more messages intended for the second IMD, without using RF communication, during a third period of time.

Systems and methods for monitoring chronic over-pacing (COP) to the heart are discussed herein. In an embodiment, a system includes a receiver circuit to receive information about pacing rates of a plurality of paced heart beats, and a pacing analyzer circuit to generate a pacing rate distribution using pacing rates of the plurality of the paced heart beats. The pacing rate distribution includes a pacing rate histogram. The pacing analyzer circuit may recognize a morphological pattern from the pacing rate distribution, and detect a COP indication using the extracted feature. A programmer circuit adjusts one or more therapy parameters in response to the detected. COP indication.