Methods and devices herein are provided for managing atrial (A) pacing in connection with premature atrial contracts (PAC). The methods and devices obtain an atrial pace-on-PAC (APAC) interval and cardiac activity (CA) signals. The methods and devices are configured to: i) during a first cardiac beat; following a ventricular paced (VP) or ventricular sensed (VS) event, activate a timer for a post ventricular-atrial refractory period (PVARP) interval; and determine whether a first atrial refractory (AR) event occurs during the PVARP interval; ii) during a second cardiac beat; in response to the detecting that the first AR event occurred, initiate an APAC interval; during the APAC interval for the second cardiac beat, determine whether a second AR event occurs; and update a count of APAC events when the second AR event occurs; and iii) repeat i) and ii) for multiple cardiac beats, to track the count of APAC events.

An implantable medical device has a therapy module configured to generate a composite pacing pulse including a series of at least two individual pulses. The therapy module is configured to generate the composite pacing pulse by generating a first pulse of the at least two individual pulses by selectively coupling a first portion of a plurality of capacitors to an output signal line and generate a second pulse of the at least two individual pulses by selectively coupling a second portion of the plurality of capacitors to the output signal line.

Systems and methods for managing cardiac arrhythmias are discussed. A data management system receives a first detection algorithm including a detection criterion for detecting a cardiac arrhythmia. An arrhythmia detector detects arrhythmia episodes from a physiologic signal using a second detection algorithm that is different from and has a higher sensitivity for detecting the cardiac arrhythmia than the first detection algorithm. The arrhythmia detector assigns a detection indicator to each of the detected arrhythmia episodes. The detection indicator indicates a likelihood that the detected arrhythmia episode satisfies the detection criterion of the first detection algorithm. The system prioritizes the detected arrhythmia episodes according to the assigned detection indicators, and outputs the arrhythmia episodes to a user or a process according to the episode prioritization.

A method and device apparatus to deliver a pacing therapy capable of remodeling a patient's heart over a period of time that includes monitoring one or more parameters in response to a delivered cardiac remodeling pacing, determining whether the cardiac remodeling pacing has an effect on cardiac normalization in response to the monitoring, and adjusting the cardiac remodeling pacing in response to the determined effect on cardiac normalization. The method and device may also perform short-term monitoring of one or more parameters in response to the delivered cardiac remodeling pacing, monitor one or more long-term parameter indicative of a long-term effect of the delivered cardiac remodeling pacing, determine the long-term effect of the delivered cardiac remodeling pacing on cardiac normalization in response to the monitoring, and adjust the cardiac remodeling pacing in response to one or both of the short-term monitoring and the determined long-term effect on cardiac normalization.

A system for predicting heart failure hospitalization, comprises a processing device configured to process data derived from signals sensed by an implantable medical device, said signals being indicative of cardiac activity, to obtain a heart failure prediction index. The processing device is configured to process a multiplicity of variables relating to different cardiac characteristics to obtain a multiplicity of processed variables, and to combine said processed variables using a mathematical model to compute said heart failure prediction index.

A medical device senses cardiac electrical signals including T-waves attendant to ventricular myocardial repolarizations and detects a T-wave template condition associated with non-pathological changes in T-wave morphology. The device generates a T-wave template from T-waves sensed by the sensing circuit during the T-wave template condition. After generating the T-wave template, the device acquires a T-wave signal from the cardiac electrical signal and compares the acquired T-wave signal to the T-wave template. The device detects a pathological event in response to the acquired T-wave signal not matching the T-wave template.

Systems, methods and devices for delivering stimulating energy with a lead are disclosed. One method includes inserting a lead for cardiac therapy into an intercostal space of a patient and proximate to a lateral margin of the patient's sternum (the lead having a distal end configured to transmit therapeutic electrical pulses from a pulse generator to the heart), advancing the distal end of the lead through the intercostal space, and coupling a proximal end of the lead to the pulse generator for delivery of therapeutic electrical pulses for pacing or defibrillation of the heart.

A medical electrical lead and methods of implanting medical electrical leads in lumens. Leads in accordance with the invention employ preformed biases to stabilize the lead within a lumen or lumen and to provide feedback to lead implanters.

An implantable medical device is configured to control a therapy module to couple a capacitor array comprising a plurality of capacitors to a plurality of extra-cardiovascular electrodes and control the therapy module to deliver a composite pacing pulse to a patient's heart via the plurality of extra-cardiovascular electrodes by sequentially discharging at least a portion of the plurality capacitors to produce a series of at least two individual pulses that define the composite pacing pulse.

An implantable system for stimulating a heart contains a processor, a memory, a stimulator, and a first detection unit for detecting a cardiac rhythm disturbance of a cardiac region. The memory includes a computer-readable program, which prompts the processor to carry out the following steps: a) detecting via the first detection unit whether a cardiac rhythm disturbance is present in a cardiac region of a heart of a patient; b) when a cardiac rhythm disturbance is present, selecting a stimulation strategy based on a selection criterion; c) stimulating the cardiac region in which the cardiac rhythm disturbance was detected by way of the stimulator, using the selected stimulation strategy; d) detecting a success and/or an efficiency of the conducted stimulation; e) comparing the success and/or the efficiency to a predefinable success and/or efficiency criterion; and f) if the predefinable success and/or efficiency criterion was not achieved, optimizing the stimulation strategy.