Systems and methods for controlling blood pressure by controlling atrial pressure and atrial stretch are disclosed. In some embodiments, a stimulation circuit may be configured to deliver a stimulation pulse to at least one cardiac chamber of a heart of a patient, and at least one controller may be configured to execute delivery of one or more stimulation patterns of stimulation pulses to the at least one cardiac chamber, wherein at least one of the stimulation pulses stimulates the heart such that an atrial pressure resulting from atrial contraction of an atrium overlaps in time a passive pressure build-up of the atrium, such that an atrial pressure of the atrium resulting from the stimulation is a combination of the atrial pressure resulting from atrial contraction and the passive pressure build-up and is higher than an atrial pressure of the atrium would be without the stimulation, and such that the blood pressure of the patient is reduced.

Apparatus, systems, and methods are provided for optimizing intracardiac filling pressures and cardiac output in patients with heart failure, conduction disease, and atrial fibrillation. The system is able to adjust and optimize intracardiac filling pressures and cardiac output by adjusting heart rate and the effective amount of total body blood volume. The device includes an adjustable member that may create a mean pressure differential in order to manifest an effective mechanical diuresis by sequestering extraneous blood volume to the high-capacitance of the venous vasculature. The system is therefore designed to reduce intracardiac filling pressures while maintaining or even increasing cardiac output.

A blood pressure decreasing system that decreases blood pressure of a patient by noninvasively blocking the sympathetic innervation of the kidney, blocking all three pathways of the sympathetic nerves to adrenal gland medulla and expanding the renal artery of the patient. The blood pressure decreasing system has at least one sensor for measuring the blood pressure of the patient and generates systolic blood pressure value and/or diastolic blood pressure value; at least two electrodes that are placed to skin dermatomal of the patient; at least one stimulator that sends electrical signals to electrodes in order to block the sympathetic nerve innervation to arterial smooth muscle and kidney, all three pathways of the sympathetic nerves to adrenal medulla and expand renal artery of the patient; and at least one control unit, which receives the blood pressure values from said sensor, compares received values with predetermined threshold values and controls the stimulator.

A lead delivery system having a base for securing a lead delivery device to one or more anatomical structures of a patient and a lead advancer configured to incrementally advance a lead into a patient by a predefined amount.

A ventricularly implantable medical device that includes a sensing module that is configured to identify a search window of time within a cardiac cycle to search for an atrial artifact. Control circuitry in the ventricular implantable medical device is configured to deliver a ventricular pacing therapy to a patient's heart, wherein the ventricular pacing therapy is time dependent, at least in part, on an atrial event identified in the search window of time.

A leadless pacemaker device configured to provide for an intra-cardiac pacing includes a processing circuitry configured to generate ventricular pacing signals for stimulating ventricular activity at a ventricular pacing rate and a sensor configuration configured to receive a sense signal over a multiplicity of heart cycles. The processing circuitry is configured to derive, from signal portions of the sense signal relating to the multiplicity of heart cycles, a combined signal portion and to analyze the combined signal portion for obtaining information relating to an atrial event. The processing circuitry is configured to sum a predefined number of signal portions relating to different heart cycles to obtain the combined signal portion. The leadless pacemaker device allows, in particular, for a reliable detection of signals relating to an atrial activity and the use of such signals for controlling a ventricular pacing rate for a ventricular pacing.

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.

Guidewires and methods for transmitting electrical stimuli to a heart and for guiding and supporting the delivery of elongate treatment devices within the heart are disclosed. A guidewire can comprise an elongate body, including first and second elongate conductors, and at least first and second electrodes. A distal end portion of the elongate body can include a preformed bias shape, such as a pigtail-shaped region, on which the first and second electrodes can be located. The preformed bias shape can optionally be non-coplanar relative to an intermediate portion of the elongate body. The first and second elongate conductors can be formed of a single structure or two or more electrically connected structures. The conductors can extend from proximal end portions to distal end portions that electrically connect to the first and second electrodes. A corewire can extend the length of the elongate body, can at least partially form the first conductor, and can be at least partially surrounded by the second conductor.

In some examples, determining a heart failure status of a patient using a medical device comprising a plurality of electrodes includes determining an estimated arterial pressure waveform of the patient based on an arterial impedance signal received from at least two of the plurality of electrodes. The estimated arterial pressure waveform may comprise a plurality of arterial pressure cycles. Each of the plurality of arterial pressure cycles may correspond to a different cardiac cycle of a plurality of cardiac cycles of the patient. At least one value of an intrinsic frequency of the corresponding arterial pressure cycle may be determined for at least some of the plurality of cardiac cycles and the heart failure status of the patient may be determined based on the at least one value of the intrinsic frequency.

A ventricular implantable medical device that is configured to detect an atrial timing fiducial from the ventricle. The ventricular implantable medical is configured to deliver a ventricular pacing therapy to the ventricle based on the detected atrial timing fiducial. If the ventricular implantable medical device temporarily fails to detect atrial activity because of noise, posture, patient activity or for any other reason, an atrial implantable medical device may be configured to communicate atrial events to the ventricular implantable medical device and the ventricular implantable medical device may synchronize the ventricular pacing therapy with the atrium activity based on those communications.