Various techniques include advancing an implantable medical device comprising a tissue-piercing electrode toward the triangle of Koch region of the right atrium or through the coronary sinus to deliver cardiac therapy to or sense electrical activity of the left ventricle in the basal region, septal region, or basal-septal region of the left ventricular myocardium of a patient's heart. The tissue-piercing electrode may include an imagable material. The implantable medical device may include an imagable member made of an imagable material coupled to a housing or a lead of the implantable medical device. Image information representing the patient's heart and the imagable material may be acquired using two-dimensional imaging. Orientation information representing the implantable medical device may be generated based on the acquired image information.

Brugada syndrome and related forms of ion channelopathies, including ventricular asynchrony of contraction, originate in the region near the His bundle or para-Hisian regions of the heart. Manifestations of Brugada syndrome can be corrected by delivering endocardial electrical stimulation coincident to the activation wave front propagated from the atrioventricular (AV) node early enough to compensate for the conduction problems that start in those regions. The stimulation can be delivered in multiple modes and can include waveforms of the same polarity delivered to a site within the region near the His bundle or para-Hisian regions of the heart associated with a low cardiac electrical asynchrony level or can include at least two single-phased superimposed waveforms of opposite polarity delivered through a pair of pacing electrodes relative to a reference electrode, which can be delivered to any site within the region near the His bundle or para-Hisian regions.

Methods and devices for reducing ventricle filling volume are disclosed. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated in a consistent way to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.

A leadless pacing device may include a power supply for providing a power supply voltage, a housing having a first end and a second end with a side extending between the first end and the second end, and a set of electrodes supported by the housing and in communication with the power supply. When leadless pacing device is disposed within a coronary sinus of a patient's heart, the housing may facilitate blood flow across the housing. The housing may include fixing members extending radially outward from the side of the housing to engage a wall of the coronary sinus and expand the coronary sinus to allow blood to flow past the housing. In some cases, the housing may have a recess along a length thereof that allows blood to flow past the housing. The recess may include a groove, a flat feature, or other feature.

A leadless pacing device may include a power supply providing a power supply voltage, a housing having a first end, a second end, and a side extending between the first end and the second end, and a set of electrodes supported by the housing and in communication with the power supply. The housing may be angled to follow a contour of a patient's heart when the housing is positioned within the coronary sinus of the patient's heart. In some cases, an angled portion of the housing may include a smooth-curve. In some cases, an angled portion of the housing may include a first portion of the housing and a second portion of the housing at an angle of less than one-hundred-eighty degrees with respect to the first portion of the housing. One or more of the electrodes may be exposed on a concave side of the angled housing.

An apparatus for treating a heart of a patient includes a first lead and at least a second lead for pacing the heart adapted to be in electrical communication with the heart. The apparatus includes a microcontroller in communication with the first and second leads which triggers the first lead at either different times or the same time from when the microcontroller triggers the second lead. Alternatively, the apparatus includes a microcontroller in communication with the first and second leads that determines heart volume, including stroke volume, end-systolic volume, and calculated values including ejection fraction, from admittance from signals from the first and second leads and uses the admittance as feedback to control heart volume ejected, as measured by stroke volume, calculated values such as ejection fraction, and control end-systolic volume, with respect to the first and second leads. A method for treating the heart of a patient.

Systems and methods for reducing ventricle filling volume are disclosed. In some embodiments, a stimulation circuit may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated at a consistent rate to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, a stimulation circuit may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.

Methods and devices for reducing ventricle filling volume are disclosed. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated in a consistent way to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.

A cardiac pacemaker is disclosed for pacing cardiac tissue to improve synchrony between the atria and ventricles and/or between the left and right ventricles. A pulse generator is configured to deliver a pacing pulse to a patient's ventricle at an atrioventricular (AV) delay following a preceding atrial event. A sensing circuitry configured to sense a signal from the patient's ventricle following delivery of a said pacing pulse. A processing circuitry coupled to the pulse generator and the sensing circuitry and configured to control the pulse generator, the processing circuitry further configured to: (1) acquire from the sensed signal a set of features; (2) determine whether the ventricular pacing pulse effectively captures the patient's ventricle using the set of features; (3) determine whether one or more tissue latency conditions are present. The one or more pacing pulse parameters are adjusted, in response to determining that tissue latency is present.

One embodiment provides a system for cardiac stimulation optimization utilizing cardiac asynchrony and pulse pressure data. The system includes: an analysis circuitry to receive cardiac signals collected at two locations of a patient's heart during an application to the heart of stimulation in accordance with multiple (VV) delay intervals, calculate an asynchrony index for the VV delay intervals, and determine one of the VV intervals as optimal based on the asynchrony index for that VV interval; an implantable stimulation device to cycle through the VV intervals while applying the stimulation, and further configured to cycle through atrioventricular (AV) delay intervals while applying additional stimulation in accordance with the optimal VV delay interval; and an arterial pulse pressure sensor to measure arterial pulse pressure during the application of the additional stimulation, wherein the analysis circuitry determines one of the AV delay intervals as optimal based on the arterial pulse pressure measured.