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.

An implantable system for treating a heart contains a processor, a memory unit, a treatment unit including a treatment electrode, and a detection unit for detecting a cardiac event requiring treatment. The memory unit includes a computer-readable program, which prompts the processor to perform the following steps: a) detecting by way of the detection unit whether a cardiac event to be treated has occurred in the heart; b) if a cardiac event to be treated has occurred, determining a position of the treatment electrode or determining a variable correlating with this position; and c) comparing the position of the treatment electrode or the variable correlating with the position to a reference variable, and carrying out, or not carrying out a cardiac treatment by way of the treatment unit and the treatment electrode as a function of the position of the treatment electrode or the variable correlating with the position.

A leadless pacemaker device configured to provide for an intra-cardiac pacing, including: processing circuitry configured to generate ventricular pacing signals for stimulating ventricular tissue, 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.

An implantable medical device which performs the following steps during operation: a) performing a detection of whether the implantable medical device is in an implanted state; b) if it is detected that the implantable medical device is in an implanted state, activating a first diagnostic or therapeutic function of the implantable medical device, and subsequently activating a second diagnostic or therapeutic function of the implantable medical device, wherein the second diagnostic or therapeutic function is activated only after the fulfillment of at least one activation criterion selected from the group consisting of an elapse of a first time period from the activation of the first diagnostic or therapeutic function, an elapse of a second time period from the detection that the implantable medical device is in an implanted state, and a passing of a function test.

Techniques for switching an implantable medical device (IMD) from a first mode to a second mode in relation to signals obtained from internal sensors are described. The internal sensors may include a temperature sensor and a biosensor. In some examples, processing circuitry of the IMD may make a first preliminary determination that the IMD is implanted based on a first signal from the temperature sensor. In response to the first preliminary determination being that the IMD is implanted, the processing circuitry may make a second preliminary determination that the IMD is implanted based on a second signal from the biosensor. The processing circuitry may switch the IMD from a first mode to a second mode based on both the first preliminary determination and the second preliminary determination being that the IMD is implanted.

A leadless pacemaker, and method for storing event data therein, comprising a central processing unit, a first logic circuit configured to generate event data based on a first event occurring during operation of the leadless pacemaker, a first hardware event counter configured to be incremented if specific event data are generated by said first logic circuit, a first memory unit comprising a first bit configured to be set if said first hardware event counter is incremented to a first maximum number of counts, a second memory unit communicating with said first memory unit, wherein said central processing unit is configured to transfer said first bit to said second memory unit, a first RAM event counter in a random access memory of said leadless pacemaker, wherein said central processing unit is configured to increment said first RAM event counter if said first bit is transferred to the second memory unit.

Systems and methods are described herein for evaluation and configuration cardiac therapy. The systems and methods may monitor electrical activity using a plurality of external electrodes and may utilize multiple-electrode cardiac metrics such as electrical heterogeneity information, single-electrode cardiac metrics, and vectorcardiographic metrics to determine and select one or more paced settings from a plurality of different paced settings.

An extra-cardiovascular implantable cardioverter defibrillator (ICD) having a low voltage therapy module and a high voltage therapy module is configured to select, by a control module of the ICD, a pacing output configuration from at least a low-voltage pacing output configuration of the low voltage therapy module and a high-voltage pacing output configuration of the high voltage therapy module. The high voltage therapy module includes a high voltage capacitor having a first capacitance and the low voltage therapy module includes a plurality of low voltage capacitors each having up to a second capacitance that is less than the first capacitance. The ICD control module controls a respective one of the low voltage therapy module or the high voltage therapy module to deliver extra-cardiovascular pacing pulses in the selected pacing output configuration via extra-cardiovascular electrodes coupled to the ICD.

An implantable medical device is configured determine a numerical value of a variable that is monitored by the implantable medical device and convert the numerical value to a data sequence of modulated electrical stimulation rate intervals. The implantable medical device delivers electrical stimulation pulses according to the data sequence of modulated stimulation rate intervals to cause a modulated rate of activation of excitable tissue of a patient corresponding to the modulated stimulation rate intervals. The modulated rate of activation is detectable by a rate monitor for demodulation to the numerical value of the monitored variable data value. In some examples, the implantable medical device is a pacemaker delivering cardiac pacing pulses according to modulated pacing rate intervals to cause a modulated heart rate of the patient detectable by a heart rate monitor for demodulation to the numerical value of the monitored variable.

The control module of a first pacemaker included in an implantable medical device system including the first pacemaker and a second pacemaker is configured to set a pacing escape interval in response to a far field pacing pulse sensed by the first pacemaker. The far field pacing pulse is a pacing pulse delivered by the second pacemaker. The pacing escape interval is allowed to continue without restarting the in response to a far field intrinsic event sensed by the first pacemaker during the pacing escape interval. The first pacemaker delivers a cardiac pacing pulse to the heart upon expiration of the pacing escape interval.