A multi-electrode implantable device for sensing cardiac signals and various methods for using the sensed cardiac signals are described herein. The multi-electrode device comprises a tetrahedral electrode cluster at a tip at a distal end of the lead/device; four electrodes embedded in the tetrahedral configuration; and four individual wires extending from the electrodes within the lead for receiving voltages sensed by the four electrodes. The methods can be used for deriving various physiological features that can be used in various ways including: diagnosing a physiological condition, efficient sensing of physiological signals, applying more efficient pacing by a pacemaker and indirect cardiac mapping. One or more of the physiological features may be used for applying appropriate treatment methods by a pacemaker/ICD or for applying cardiac ablation or cryofreezing.

Methods and devices are provided for, under control of one or more processors within an implantable medical device (IMD), delivering cardiac resynchronization therapy (CRT) at one or more pacing sites. The processors obtain cardiac signals, associated with a candidate beat, from multi-site left ventricular (MSLV) electrodes distributed along a left ventricle and analyze the cardiac signals to collect at least one of a MSLV conduction pattern or a MSLV morphology. The processors compare at least one of the MSLV conduction pattern or MSLV morphology to one or more associated templates. The processors then label the candidate beat as a pseudo-fusion beat based on the comparing and adjust the CRT based on the labeling.

The invention relates to a stimulation device for electrotherapy, in particular a defibrillator device and/or external pacemaker device, comprising: at least two contact electrodes (11, 12), which can be applied to the body of a patient at suitable stimulation positions and by means of which current pulses can be applied to the body of the patient (10), the first of the at least two contact electrodes (11, 12) acting as a supply electrode (12) having positive polarity, and the second of the at least two contact electrodes (11, 12) acting as a removal electrode (11) having negative polarity with respect to an emitted current pulse; and a current pulse generator (14), which is or can be connected to the contact electrodes (11, 12) by means of line connections (21, 17). In order to simplify the correct positioning of the contact electrodes on the body of the patient, a signal evaluation unit (15), which is or can be connected to the contact electrodes (11, 12), is provided for determining the application positions of the contact electrodes (11, 12) on the body of the patient (10), by means of which signal evaluation unit the polarity of the electrodes can also be automatically reversed in a preferred embodiment.

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.

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.

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.

When generating a stimulation signal comprising stimulation pulses delivered to a target area of a human or animal body, an electrophysiological signal measured from the body for closed-loop control of the stimulation signal, is sampled, at a sampling frequency in an analogue-to-digital converter for deriving a feedback signal for closed-loop control of the stimulation signal. The generation of the stimulation signal and the sampling of the electrophysiological signal are synchronised and have a relative phase selected to cause the sampling to occur outside the stimulation pulses, which prevents the effect of the stimulation pulses from interfering with the digital electrophysiological signal, whiles allowing maintenance of Nyquist-Shannon rules and the integrity of the discrete Laplace transform (z-transform) required in discrete control theory.

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.

Systems and methods are described herein related to the evaluation and adjustment of left bundle branch (LBB) pacing therapy. Evaluation of the LBB pacing therapy may utilize electrical activity monitored from a plurality of external electrodes. The electrical activity may be used to provided one or more metrics of dispersion of surrogate cardiac electrical activation times, which may then be used to evaluate, and potentially adjust the LBB pacing therapy.

An implantable device and associated method for delivering multi-site pacing therapy is disclosed. The device comprises a set of electrodes including a first and second left ventricular electrodes spatially separated from one another and a right ventricular electrode, all coupled to an implantable pulse generator. The processing circuit coupled to the implantable pulse generator, the processing circuit configured to determine whether a prospective heart failure condition has occurred and if so to trigger the pulse generator to switch from a first pacing mode to a second pacing mode, the first pacing mode comprising delivering only a first pacing pulse to a left ventricle (LV) and thereafter delivering an RV pacing pulse to the right ventricular electrode within a single cardiac cycle and the second pacing mode comprising delivering first and a second pacing pulses to the LV and thereafter delivering an RV pacing pulse to the right ventricular electrode within a single cardiac cycle.