A cardiac pacing system having a pulse generator for generating therapeutic electric pulses, a lead electrically coupled with the pulse generator having an electrode, a first sensor configured to monitor a physiological characteristic of a patient, a second sensor configured to monitor a second physiological characteristic of a patient and a controller. The controller can determine a pacing vector based on variables including a signal received from the second sensor, and cause the pulse generator to deliver the therapeutic electrical pulses according to the determined pacing vector. The controller can also modify pacing characteristics based on variables including a signal received from the second sensor.

A system for application of neurostimulation includes an outer sheath, an elongate inner member in the outer sheath and movable relative to the outer sheath. The inner lumen has a distal end. An expandable member is coupled to the distal end of the inner member and is in the outer sheath. The expandable member is self-expanding upon from a compressed state in the outer sheath to an expanded state out of the outer sheath. The expandable member includes a distal portion including a plurality of wires woven together and a proximal portion including the plurality of wires extending parallel to a longitudinal axis. The system includes a plurality of electrode assemblies outward of the expandable member and circumferentially spaced around the expandable member. Each electrode assembly is coupled to two of the wires extending parallel to the longitudinal axis. Each electrode assembly includes a plurality of longitudinally-spaced electrodes.

The presence of a return of spontaneous circulation (ROSC) in a patient is determined by evaluating physiological signals in the patient. In one embodiment, methods and devices device evaluate optical characteristics of light transmitted into a patient to ascertain physiological signals, such as pulsatile changes in general blood volume proximate a light detector module. Using these features, the methods and devices determine whether pulsatile blood flow is present in the patient and also whether the patient has ROSC based on whether the pulsatile blood flow is present. Some examples of the methods and devices indicate that the patient has ROSC if the patient's pulsatile blood flow is detected after defibrillation therapy has been delivered to the patient. Other example methods and devices either prompt a user to deliver additional defibrillation therapy to a patient or automatically deliver additional defibrillation therapy to a patient if the patient does not have ROSC.

Systems, methods, and devices for delivering stimulating energy with a lead having a directional defibrillation electrode are disclosed. The lead includes a directional defibrillation electrode configured for implantation on or near the inner surface of a rib or the inner surface of the innermost intercostal muscle and having an electrically active portion configured to emanate stimulating energy from an exposed portion of the directional defibrillation electrode toward the pericardium and the heart. 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.

A system to monitor a biological subject includes an implantable device to be inserted inside the subject, the device including an implanted transceiver, an accelerometer, one or more sensors, a battery to power the transceiver, accelerometer and one or more sensors, and a wireless charger to charge the battery; and a wireless charging system outside of the subject to charge the battery in the implantable device. Drug(s) may be carried in reservoir(s) and dispensed based on sensor output.

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.

Provided is an accurate, fast and long-term stable fused CRAP. The electrode includes a positioning anchor, a silicone catheter, a sensor compartment and a connecting wire. The method monitors physiological information such as blood PPG, blood oxygen saturation, temperature and impedance of blood in the right ventricular cavity, and monitors blood temperature information, which is also a slowly changing metabolic rate, to provide cross-comparison with blood oxygen saturation information, improving monitoring accuracy of blood oxygen saturation. The rapidly changing right ventricular apical impedance information is monitored to improve rapid response ability of CRAP. The LEDs driving current is dynamically adjusted by monitoring the internal temperature of the PPG sensor and the impedance change of the attached biological tissue, which indirectly reflects thickness change of the attached biological tissue, thereby delaying the failure time of the PPG sensor.

A system for application of neurostimulation includes an outer sheath, an elongate inner member in the outer sheath and movable relative to the outer sheath. The inner lumen has a distal end. An expandable member is coupled to the distal end of the inner member and is in the outer sheath. The expandable member is self-expanding upon from a compressed state in the outer sheath to an expanded state out of the outer sheath. The expandable member includes a distal portion including a plurality of wires woven together and a proximal portion including the plurality of wires extending parallel to a longitudinal axis. The system includes a plurality of electrode assemblies outward of the expandable member and circumferentially spaced around the expandable member. Each electrode assembly is coupled to two of the wires extending parallel to the longitudinal axis. Each electrode assembly includes a plurality of longitudinally-spaced electrodes.

Systems and methods for adaptively controlling an electrical stimulation device, such as a closed-loop stimulation device, based in part on a Bayesian optimization of the operational parameters of the device are described. An adaptive dual control of the stimulation device can be provided. In a first control loop parameters are extracted from signals recorded from the subject by the stimulation device, and in a second control loop a Bayesian optimization is implemented with a hardware processor and memory to compute updated operational parameters for the stimulation device. As noted, the stimulation device is an electrical stimulation device, and may be a closed-loop stimulation device. Such devices can be used for deep brain stimulation (DBS), cardiac resynchronization therapy (CRT), and other electrophysiological stimulation applications.

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.