Systems and methods for monitoring and treating patients with heart failure (HF) are discussed. The system may sense cardiac signals, and receives information about patient physiological or functional conditions. A stimulation parameter table that includes recommended values of atrioventricular delay (AVD) or other timing parameters maybe created at a multitude of patient physiological or functional conditions. The system may periodically reassess patient physiological or functional conditions. A therapy programmer circuit may dynamically switch between left ventricular-only pacing and biventricular pacing, or switch between single site pacing and multisite pacing based on the patient condition. The therapy programmer circuit may adjust AVD and other timing parameters using the cardiac signal input and the stored stimulation parameter table. A HF therapy may be delivered according to the determined stimulation site, stimulation mode, and the stimulation timing.

An intracardiac ventricular pacemaker having a motion sensor, a pulse generator and a control circuit coupled to the pulse generator and the motion sensor is configured to identify a ventricular systolic event, detect a ventricular passive filling event signal from the motion signal, and determine a time interval from the ventricular systolic event to the ventricular passive filling event. The pacemaker establishes a minimum pacing interval based on the time interval.

Systems, methods and devices for delivering stimulating energy with a lead having a directional electrode are disclosed. The lead includes a directional electrode having an electrically active portion configured to emanate stimulating energy from an exposed portion of the directional electrode. The lead also has an electrically insulating portion around at least part of the circumference of the lead. The electrically insulating portion is configured to insulate surrounding muscle and/or tissue from the stimulating energy when the lead is implanted in the patient.

Cardiac pacing is performed using leadless pacemakers (LPs). An AV delay is determined based on a P-wave duration. When pacing occurs during cardiac cycles starting with intrinsic atrial events, the AV delay is set to the P-wave duration plus a first offset if the P-wave duration is greater than a first threshold duration, and the AV delay is set to the P-wave duration plus a second offset that is greater than the first offset, if the P-wave duration is less than the first threshold duration. When pacing occurs during cardiac cycles starting with paced atrial events, the AV delay is set to the P-wave duration plus a third offset, if the P-wave duration is greater than a second threshold duration, or is set to the P-wave duration plus a fourth offset that is greater than the third offset, if the P-wave duration is less than the second threshold duration.

A computer implemented method for determining heart arrhythmias based on cardiac activity that includes under control of one or more processors of an implantable medical device (IMD) configured with specific executable instructions to obtain far field cardiac activity (CA) signals at electrodes located remote from the heart, and obtain acceleration signatures, at an accelerometer of the IMD, indicative of heart sounds generated during the cardiac beats. The IMD is also configured with specific executable instructions to declare a candidate arrhythmia based on a characteristic of at least one R-R interval from the cardiac beats, and evaluate the acceleration signatures for ventricular events (VEs) to re-assess a presence or absence of at least one R-wave from the cardiac beats and based thereon confirming or denying the candidate arrhythmia.

In at least one example, a medical device is provided. The medical device includes at least one therapy electrode, at least one acoustic sensor, and at least one processor coupled with the at least one therapy electrode and the at least one acoustic sensor. The at least one processor is configured to deliver at least one pacing pulse via the at least one therapy electrode and to analyze processed acoustic data to determine whether the at least one pacing pulse resulted in capture.

A method and apparatus for treatment of hypertension and heart failure by increasing secretion of endogenous atrial hormones by pacing of the heart. Pacing is done during the ventricular refractory period resulting in premature atrial contraction that does not result in ventricular contraction. Pacing results in the atrial wall stress, peripheral vasodilation, ANP secretion. Concomitant reduction of the heart rate is monitored and controlled as needed with backup pacing.

A method and apparatus for treatment of hypertension and heart failure by increasing secretion of endogenous atrial hormones by pacing of the heart. Pacing is done during the ventricular refractory period resulting in premature atrial contraction that does not result in ventricular contraction. Pacing results in the atrial wall stress, peripheral vasodilation, ANP secretion. Concomitant reduction of the heart rate is monitored and controlled as needed with backup pacing.

In at least one example, a medical device is provided. The medical device includes at least one therapy electrode, at least one electrocardiogram (ECG) electrode, at least one acoustic sensor, and at least one processor coupled with the at least one acoustic sensor, the at least one ECG electrode, and the at least one therapy electrode. The at least one processor can receive at least one acoustic signal from the at least one acoustic sensor, receive at least one electrode signal from the ECG electrode, detect at least one unverified cardiopulmonary anomaly using the at least one electrode signal, and verify the at least one unverified cardiopulmonary anomaly with reference to data descriptive of the at least one acoustic signal.

An implantable pacemaker is configured to provide electrical pacing pulses to the heart of a patient. The pacemaker has a pulse generator configured to generate the electrical pacing pulses, at least one pacing electrode to apply the electrical pacing pulses to the heart, a sensing unit configured to sense events of electrical activity of a ventricle of the heart, a sensor configured to measure a signal relating to the patient, and a memory configured to store values of a parameter. The pacemaker is configured to be operated in a first mode to generate a reference curve and to select a target range of values of the parameter corresponding to a desired range of atrioventricular delays. The pacemaker is further configured to be operated in a second mode for approaching the target range.