The present invention provides a combined direct cardiac compression and aortic counterpulsation device comprising: an inflatable direct cardiac compression jacket configured when inflated to directly compress a heart and assist in displacing blood therefrom, an aortic counterpulsation chamber configured when inflated to displace aortic volume for the purposes of causing a counterpulsation effect, and a driver operably connected to said inflatable direct cardiac compression jacket and to said aortic counterpulsation chamber, said driver is configured to inflate said direct cardiac compression jacket and to deflate said aortic counterpulsation chamber during systole of the heart; said driver is further configured to deflate said direct cardiac compression jacket and to inflate said aortic counterpulsation chamber during diastole of the heart.

In some examples, controlling delivery of CRT includes delivering ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay, and acquiring one or more electrograms from respective vectors. For each of the different values of the at least one of A-V delay or V-V delay, at least one of a QRS amplitude or a QRS area may be determined based on the one or more electrograms, and a target change in QRS amplitude or QRS area between adjacent ones of the values of the at least one of A-V delay or V-V delay of the sequence may be identified. In response to the identification of the target change, the implantable medical device may deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification to provide CRT.

Devices and methods are disclosed for the treatment or repair of regurgitant cardiac valves, such as a mitral valve. An illustrative annuloplasty device can be placed in the coronary sinus to reshape the mitral valve and reduce mitral valve regurgitation. The disclosure also provides improved techniques for cardiac pacing.

A system to measure intracardiac impedance includes implantable electrodes and a medical device. The electrodes sense electrical signals of a heart of a subject. The medical device includes a cardiac signal sensing circuit coupled to the implantable electrodes, an impedance measurement circuit coupled to the same or different implantable electrodes, and a controller circuit coupled to the cardiac signal sensing circuit and the impedance measurement circuit. The cardiac signal sensing circuit provides a sensed cardiac signal. The impedance measurement circuit senses intracardiac impedance between the electrodes to obtain an intracardiac impedance signal. The controller circuit determines cardiac cycles of the subject using the sensed cardiac signal, and detects tachyarrhythmia using cardiac-cycle to cardiac-cycle changes in a plurality of intracardiac impedance parameters obtained from the intracardiac impedance signal.

An implantable medical device comprising a signal generator configured to generate and deliver anti-tachyarrhythmia pacing (ATP) to a heart of a patient and processing circuitry. The processing circuitry is configured to detect an enable event, responsive to detecting the enable event, enable the delivery of ATP by the signal generator, detect a disable event indicating that another implantable medical device cannot be relied upon to deliver an anti-tachyarrhythmia shock, and responsive to detecting the disable event, disable delivery of ATP.

An implantable medical device comprises therapy delivery circuitry and processing circuitry. The therapy delivery circuitry is configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient. The ATP therapy includes one or more pulse trains and each of the one or more pulse trains includes a plurality of pacing pulses. The processing circuitry is configured to, for at least one of the plurality of pacing pulses of at least one of the one or more pulse trains, determine at least one latency metric of an evoked response of the heart to the pacing pulse. The processing circuitry is further configured to modify the ATP therapy based on the at least one latency metric.

Techniques are disclosed for determining, by an extracardiovascular implantable cardioverter defibrillator (ICD) implanted in a patient, whether one or more test therapy signals generated by another medical device implanted in the patient is detected. In response to detecting the one or more test therapy signals, the extracardiovascular ICD provides an indication that the extracardiovascular ICD has detected the one or more test therapy signals. In some examples, the indication is an audible tone provided to a clinician. In some examples, the other medical device is an intracardiac cardiac pacing device, and the one or more test therapy signals comprises a plurality of anti-tachycardia pacing (ATP) pulses.

In some examples, an implantable medical device determines that another medical device delivered an anti-tachyarrhythmia shock, and delivers post-shock pacing in response to the determination. The implantable medical device may be configured to both detect the delivery of the shock in a sensed electrical signal and, if delivery of the shock is not detected, determine that the shock was delivered based on detection of asystole of the heart. The asystole may be detected based on the sensed electrical signal. In some examples, an implantable medical device is configured to revert from a post-shock pacing mode to a baseline pacing mode by iteratively testing a plurality of decreasing values of pacing pulse magnitude until loss of capture is detected. The implantable medical device may update a baseline value of the pacing pulse magnitude for the baseline mode based on the detection of loss of capture.

An implantable cardioverter defibrillator (ICD) receives a cardiac electrical signal by a sensing circuit while operating in a sensing without pacing mode and detects asystole based on the cardiac electrical signal. The ICD determines, in response to detecting the asystole, if asystole backup pacing is enabled, and automatically switches to a temporary pacing mode in response to the asystole backup pacing being enabled. Other examples of detecting asystole and providing a response to detecting asystole by the ICD are described herein.

The device includes a cardiac therapy circuit with a first terminal, and a peripheral therapy circuit with a second terminal. These terminals can either receive a cardiac detection/stimulation lead and a peripheral detection/stimulation lead of an anatomical structure. The device is configured to recognize the leads and automatically configure the connection terminals. This includes discrimination methods for identifying the terminal on which a cardiac signal is detected, and switching methods for coupling the cardiac therapy circuit to the terminal and the peripheral therapy circuit to the other terminal.