A leadless cardiac pacemaker (LCP) is configured to sense cardiac activity and to pace a patient's heart and is disposable within a ventricle of the patient's heart. The LCP MAY include a housing, a first electrode and a second electrode that are secured relative to the housing and are spaced apart. A controller is disposed within the housing and is operably coupled to the first electrode and the second electrode such that the controller is capable of receiving, via the first electrode and the second electrode, electrical cardiac signals of the heart. The LCP may include a pressure sensor and/or an accelerometer. The controller may determine a pace time within a cardiac cycle based at least in part upon an indication of metabolic demand.

Regulating cardiac activity may include pacing the patient's heart at a starting pacing rate and instigating an intrinsic heart beat search algorithm that includes pacing at a reduced rate for a period of time and capturing electrical signals representative of cardiac electrical activity while pacing at the reduced rate in order to determine a presence or absence of intrinsic heart beats. If intrinsic heart beats are not detected, the heart may be paced at a further reduced rate for a period of time. If intrinsic beats are detected, the heart may be paced again at the starting pacing rate. This may continue until intrinsic heart beats are detected or until a lower search rate limit is reached. Diagnostic data may be collected at each stage and transmitted to a display device for analysis by a physician or the like.

Methods and systems for seamless adjustment of treatment are disclosed. A determination is made as to whether to intervene with a patient's treatment. Implanted device memory data is acquired over a pre-specified time period. Risk status is determined from the device memory data. Another external device memory data is acquired over a pre-specified time period. A determination is made as to whether to adjust treatment of the patient in response to the risk status, the data acquired from the implanted device memory and the external device memory data.

A flow control apparatus for controlling a flow of fluid and/or other matter in a lumen formed by a tissue wall of a patient's organ. The apparatus comprises a control device adapted to control contraction of the tissue wall to influence the flow in the lumen. The apparatus further comprises an implantable constriction device adapted to gently and simultaneously constrict a series of wall portions comprising three or more wall portions of the tissue wall to influence the flow in the lumen, wherein the constriction device gently constricts the series of wall portions by constricting the series of wall portions to a constricted state in which the blood circulation in the constricted series of wall portions is substantially unrestricted and the flow in the lumen is at least restricted, and an implantable energized stimulation device adapted to individually and independently stimulate a selected wall portion of the series of wall portions, comprising three or more wall portions.

A neuromodulation system includes a first therapy element adapted for positioning within a superior vena cava, and a second therapy element adapted for positioning within a pulmonary artery. The first therapy element is carried on a first elongate flexible shaft, and the second therapy element is carried on a second elongate flexible shaft. One of the first and second shafts is slidably received within a lumen of the other of the first and second shaftsso that the second therapy element may be advanced within the body relative to the first therapy element. A stimulator is configured to energize the first therapy element within the first blood vessel to deliver therapy to a first nerve fiber disposed external to the superior vena cava and to energize the second therapy element within the pulmonary artery to deliver sympathetic therapy to a second nerve fiber disposed external to the pulmonary artery. For treatment of heart failure, the first nerve fiber may be a vagus nerve and the second nerve fiber may be a sympathetic nerve fiber.

Devices and methods can be used for artificial cardiac pacing and/or resynchronization. For example, this document provides improved electrodes for stimulating and sensing electrical activity of the heart, and provides pacing and resynchronization systems incorporating such electrodes. While the devices and methods provided herein are described primarily in the context of pacing, it should be understood that resynchronization can additionally or alternatively be performed in an analogous manner, and that the scope of this disclosure includes such subject matter.

Some aspects relate to systems, devices, and methods of delivering rate responsive pacing therapy. The method includes monitoring activity information related to an activity level of a patient and delivering rate responsive pacing (RRP) to the patient at a pacing rate corresponding to a RRP profile. The RRP profile may be used to generate the pacing rate based on the activity information and may be adjusted based on the monitored activity information.

A method for monitoring a cardiovascular pressure in a patient may include storing, in a memory of an implantable medical device system and in association with each one or more different patient postures, a respective offset value for the cardiovascular pressure of the patient. The one or more offset values may be determined based on a distance between an implantable pressure sensing device and an anatomical structure of the patient, a location of the implantable pressure sensing device within the patient, or one or more dimensions an anatomical structure of the patient. The method further includes determining a measured value of the cardiovascular pressure and a posture of the patient when the value of the cardiovascular pressure was measured, selecting a stored offset value associated with the current patient posture, and determining an adjusted cardiovascular pressure value based on the selected offset value and the measured cardiovascular pressure value.

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.

A system for monitoring blood pressure includes an implantable medical device (IMD) and an external device (ED). The IMD senses an electrogram (EGM) signal, identifies a feature thereof indicative of a ventricular depolarization, and transmits a conductive communication signal through patient tissue indicating when the ventricular depolarization occurred. The ED is worn against skin and configured to receive the conductive communication signal. The ED is also configured to sense a plethysmography (PG) signal and identify a feature thereof indicative of when a pulse wave responsive to the ventricular depolarization reaches a region of the patient adjacent the ED, and determine a delay time (TD) indicative of how long it takes the pulse wave to travel from the patient's heart to the region of the patient adjacent to the ED. The TD is a surrogate of the patient's blood pressure and useful for monitoring the patient's blood pressure and/or changes therein.