According to some embodiments, a device operates by comparative morphological analysis of depolarization signals collected in spontaneous rhythm on separate respective channels, with two temporal components combined into a single 2D parametric VGM vectogram characteristic. Similarity quantification methods evaluate a variation over time of a descriptor parameter of a current VGM compared to a stored previous reference VGM. This variation is compared with predetermined thresholds to diagnose an occurrence of remodeling or reverse remodeling in a patient, and/or to detect a lead failure or an occurrence of ischemia. The descriptor parameter is a function of a velocity vector of the VGM, a comparison relating to a correlation coefficient between respective magnitudes of a current VGM velocity vector and of a reference VGM velocity vector, and an average angle between these respective velocity vectors.

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.

A system is provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device (IMD). The system also includes one or more processors configured to determine an atrial-ventricular (AV) conduction interval (AR.sub.RV) between the A site and a first RV sensed event at the RV site, determine an inter-ventricular (VV) conduction interval (R.sub.LV-R.sub.RV) between a paced event at the LV site and a second RV sensed event at the RV site, and set a ventricular refractory period (VRP) based on at least one of the AV conduction interval or the VV conduction interval and a predetermined offset. The one or more processors are also configured to blank signals over the RV sensing channel during the VRP.

A pacemaker system includes a drive-sense circuit (DSC) operably coupled to a pacemaker lead. The DSC generates a pace signal including electrical impulses based on a reference signal. The DSC provides the pace signal via the pacemaker lead to an electrically responsive portion of a cardiac conductive system of a subject to facilitate cardiac operation of a cardiovascular system of the subject. The DSC senses, via the pacemaker lead, cardiac electrical activity of the cardiovascular system of the subject that is generated in response to the pace signal and electrically coupled into the pacemaker lead and generates a digital signal that is representative of the cardiac electrical activity of the cardiovascular system of the subject that is sensed via the pacemaker lead. The DSC provides digital information to one or more processing modules that includes and/or is coupled to memory and that provide the reference signal to the DSC.

An implantable medical device system includes an extracardiac sensing device and an intracardiac pacemaker. The sensing device senses a P-wave attendant to an atrial depolarization of the heart via housing-based electrodes carried by the sensing device when the sensing device is implanted outside the cardiovascular system and sends a trigger signal to the intracardiac pacemaker in response to sensing the P-wave. The intracardiac pacemaker detects the trigger signal and schedules a ventricular pacing pulse in response to the detected trigger signal.

Computer implemented methods, devices and systems for monitoring a trend in heart failure (HF) progression are provided. The method comprises sensing left ventricular (LV) activation events at multiple LV sensing sites along a multi-electrode LV lead. The activation events are generated in response to an intrinsic or paced ventricular event. The method implements program instructions on one or more processors for automatically determining a conduction pattern (CP) across the LV sensing sites based on the LV activation events, identifying morphologies (MP) for cardiac signals associated with the LV activation events and repeating the sensing, determining and identifying operations, at select intervals, to build a CP collection and an MP collection. The method calculates an HF trend based on the CP collection and MP collection and classifies a patient condition based on the HF trend to form an HF assessment.

In some examples, a computing apparatus may determine information corresponding to a data structure and indicating delays associated with an atrium lead, a left ventricle (LV) lead, and a right ventricle (RV) lead based on one or more input variables. The computing apparatus may determine a plurality of individualized characteristics based on the information corresponding to the data structure. The computing apparatus may receive, from the plurality of measurement electrodes, a plurality of second sets of electrical measurements indicating second electrical signals applied to the patient's heart based on the plurality of individualized characteristics. The computing apparatus may determine cardiac resynchronization index (CRI) values using a first set of electrical measurements (e.g., native measurements) and the plurality of second sets of electrical measurements. The computing apparatus may generate a graphical representation based on a populated data structure and cause display of the graphical representation.

A device and a method thereof for determining a hemodynamic state of an individual from a magnitude of a perfusion signal or a signal which is a measure of a volume of blood in the thoracic cavity of the individual, wherein the control device is configured to receive a first signal and a heart rate signal, divide the first signal into frames, wherein a frame length is determined from an oscillation period of the heart rate signal, and determine a magnitude of the first signal from at least two frames, so as to obtain a more reliable magnitude of the first signal.

A method and implantable medical device system for delivering a left ventricular (LV) cardiac pacing therapy via a single-pass coronary sinus lead and sensing far-field cardiac signals via one or more far-field sensing vectors formed between the plurality of electrodes. Beat morphologies corresponding to the far-field cardiac signals are determined, and a beat morphology match between each of the far-field beat morphologies and an intrinsic beat morphology template is determined so that one of loss of LV capture, pseudo fusion and loss of synchrony is determined in response to the determined beat morphology match. One of a loss of capture adjustment, a pseudo fusion adjustment, and a resynchronization adjustment is performed in response to the determined one of loss of LV capture, pseudo fusion and loss of synchrony in response to the determined beat morphology match to generate an adjusted LV cardiac pacing therapy.

The disclosure describes an enhancement to lead monitoring techniques, which uses a sensing integrity counter (SIC). The techniques of this disclosure may enhance lead monitoring techniques by detecting possible sensing issues based on a significant increase in periodic, e.g., daily, SIC counts relative to previous periods. Some issues with sensing cardiac signals via implantable cardiac leads can result in an implantable medical device (IMD) measuring very short intervals between what appears to be sensed heart beats. Examples of issues include insulation breach, conductor fracture, or poor electrical connection, which may cause noise that appears to be an R-wave. The IMD may detect the noise, along with actual R-waves, and determine that there are relatively short (e.g., less than a threshold) intervals between the “R-waves.” A significant increase in the number or frequency of very short intervals between R-waves may indicate the date/time of a significant sensing issue.