This document describes methods and materials for reducing incision sizes for improving the treatment of pathological conditions, including arrhythmias and trauma, using temperature modulation via implantable devices. For example, this document describes methods and devices for treating atrial and/or ventricular fibrillation by cooling the epicardium.

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 a biosensor and other sensors. 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 one of the sensors. In response to the first preliminary determination being that the IMD has changed status, the processing circuitry may make a second preliminary determination that the IMD based on a second signal from the biosensor or some other sensor. 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 has changed status.

A medical device is configured to sense a cardiac signal that includes far field ventricular event signals and determine a ventricular activity metric from the sensed cardiac signal. The ventricular activity metric may be representative of a ventricular rate or an atrioventricular time interval. The medical device is configured to determine an atrioventricular synchrony metric based on the ventricular activity metric and generate an output based on the atrioventricular synchrony metric. The device may include a memory configured to store data corresponding to the atrioventricular synchrony metric.

An implantable medical device for stimulating a human or animal heart. In operation, the device performs the following steps: a) sensing an atrial electric signal a the first detection unit; b) sensing an electric signal at the His bundle with a second detection unit upon termination of a first time period starting upon sensing the atrial electric signal with the first detection unit and/or starting upon applying a stimulation pulse, wherein the first time period lies in a range of from 10 ms to 100 ms; c) classifying the electric signal sensed with the second detection unit as His bundle activity signal or as ventricular activity signal.

An implantable medical device for stimulating a human or animal heart, comprising a first processor, a first memory unit, a stimulation unit configured to stimulate a first cardiac region of a human or animal heart, and a detection unit configured to detect an electric signal at the first cardiac region of the same heart, wherein the detection unit comprises i) an electrode lead having an electrode pole and ii) a first channel for measuring electric signals provided by the electrode lead. A maximum sensitivity of the first channel of the detection unit is adjustable in dependence on a stimulation site of the electrode pole, wherein the maximum sensitivity of the first channel lies in a range of from 0.1 mV to 0.4 mV if the electrode pole is intended to detect electric signals at the His bundle of the heart.

A programming device for programming an implantable medical device for stimulating a human or animal heart, wherein the following steps are performed: a) allowing to select one of at least two electrode lead configurations for stimulating a human or animal heart, wherein the at least two electrode lead configurations comprise a second electrode lead configuration in which at least one electrode lead is connected to an electrode lead port, the electrode lead port being configured to receive an electrode lead for stimulating a second cardiac region or detecting an electric signal at the second cardiac region, wherein the second cardiac region is a part of a ventricular conduction system of the heart, wherein the at least one electrode lead is intended to be implanted or is implanted in the second cardiac region; b) generating and releasing a notification signal if the second electrode lead configuration is selected.

An implantable medical device for stimulating a human or animal heart. In operation, the device performs the following steps: a) sensing an atrial electric signal a the first detection unit; b) sensing an electric signal at the His bundle with a second detection unit upon termination of a first time period starting upon sensing the atrial electric signal with the first detection unit and/or starting upon applying a stimulation pulse, wherein the first time period lies in a range of from 10 ms to 100 ms; c) classifying the electric signal sensed with the second detection unit as His bundle activity signal or as ventricular activity signal.

An implantable medical device for stimulating a human/animal heart, comprising a first electrode lead port for receiving an electrode lead. The first electrode lead port comprises a first marking element and a second marking element, wherein the first marking element indicates a first kind of electrode lead that can be received by the first electrode lead port and for an operation of which the first electrode lead port is designed to be configured, wherein the first kind of electrode lead is a His bundle electrode lead , wherein the second marking element indicates a second kind of electrode lead that can be received by the first electrode lead port and for an operation of which the first electrode lead port is designed to be configured. The second kind of electrode lead includes one of an atrial electrode lead, a right ventricular electrode lead, and a left ventricular electrode lead.

A programming device for programming an implantable medical device for stimulating a human or animal heart, wherein the programming device carries out the steps: a) allowing to select one of at least two electrode lead configurations for stimulating a heart, wherein the at least two electrode lead configurations comprise: i) a first electrode lead in which an atrial electrode lead and a right ventricular electrode lead are connected to electrode lead ports, and ii) a second electrode lead in which an atrial electrode lead and a His bundle electrode lead are connected to electrode lead ports; b) allowing to select a first timing parameter value if the first electrode lead is selected and to select a second timing parameter value if the second electrode lead is selected, wherein the first timing parameter value is an atrioventricular interval and the second timing parameter value is an atrial-His interval.

An implantable medical device for stimulating a human/animal heart having a stimulation unit which stimulates the His bundle and a detection unit which detects an electrical signal at the His bundle. The device performs: a) determining a first value of a parameter of a first measuring pulse measured between a first electrode pole and a housing; b) determining a second value of the same parameter of a second measuring pulse measured between the first electrode pole and a second electrode pole; c) comparing the first and second values; d) determining, based on the comparing step, whether the first or second measuring pulses enables a higher available level control range of the analog-to-digital converter; e) measuring an impedance in a unipolar manner between the first electrode pole and the housing or in a bipolar manner between the first electrode pole and the second electrode pole depending on the determining step.