An implantable medical device (IMD) for managing therapy is provided that can include a lead with an electrode, a memory configured to store program instructions and one or more processors. The one or more processors can be configured to execute the program instructions to determine a sensed right atrium (RAs) event or a paced right atrial (RAp) event (RAs,p event), determine a sensed right ventricle (RVs) event by detecting a cardiac activity (CA) signal reaches a threshold amplitude and determining a maximum amplitude in a determined period of time after the CA signal reaches the threshold amplitude, and determine an RAs,p-RVs interval between the RAs,p event and RVs event. The one or more processors can also be configured to calculate an atrioventricular delay (AV) delay based on the RAs,p-RVs interval, and manage therapy, provided by the IMD, based on the AV delay that is calculated.

A system and method are provided for managing atrial-ventricular (AV) delay adjustments. An AV interval is measured that corresponds to an interval between an atrial paced (Ap) event or an atrial sensed (As) event and a sensed ventricular (Vs) event. A candidate AV delay is set based on the AV interval and a bundle branch adjustment (BBA) value. A QRS characteristic of interest (COI) is measured while utilizing the candidate AV delay in connection with delivering a pacing therapy. The BBA value is adjusted and the candidate AV delay is reset based on the BBA value as adjusted. A collection of QRS COIs and corresponding candidate AV delays are obtained and one of the candidate AV delays is selected as a BBA AV delay. The pacing therapy is managed, based on the BBA AV delay.

A ventricular pacemaker is configured to determine a ventricular rate interval by determining at least one ventricular event interval between two consecutive ventricular events and determine a rate smoothing ventricular pacing interval based on the ventricular rate interval. The pacemaker is further configured to detect an atrial event from a sensor signal and deliver a ventricular pacing pulse in response to detecting the atrial event from the sensor signal. The pacemaker may start the rate smoothing ventricular pacing interval to schedule a next pacing pulse to be delivered upon expiration of the rate smoothing ventricular pacing interval.

Systems, interfaces, and methods are described herein for evaluation and adjustment cardiac therapy. The systems, interfaces, and methods may utilize, or include, a graphical user interface to display various information with respect to a plurality of external electrodes and electrical activity monitored using such external electrodes and to allow a user to adjust what information to display.

In some examples, a computing apparatus may determine information corresponding to a data structure and indicating delays associated with an atrium lead, a left ventricle (LV) lead, and a right ventricle (RV) lead based on one or more input variables. The computing apparatus may determine a plurality of individualized characteristics based on the information corresponding to the data structure. The computing apparatus may receive, from the plurality of measurement electrodes, a plurality of second sets of electrical measurements indicating second electrical signals applied to the patient's heart based on the plurality of individualized characteristics. The computing apparatus may determine cardiac resynchronization index (CRI) values using a first set of electrical measurements (e.g., native measurements) and the plurality of second sets of electrical measurements. The computing apparatus may generate a graphical representation based on a populated data structure and cause display of the graphical representation.

A method of delivering a pacing lead may include locating a potential implantation site adjacent to or within the triangle of Koch region of a patient's heart. The method may include advancing a pacing lead to the potential implantation site. The pacing lead has an elongate body and a fixation element coupled to a distal portion and attachable to the right-atrial endocardium adjacent to or within the triangle of Koch region. The method may include implanting the pacing lead at the potential implantation site to or sense electrical activity of the left ventricle in the basal and/or septal region of the left ventricular myocardium of the patient's heart. The pacing lead may include a lumen configured to receive a guide wire. A sheath of a delivery system used to deliver the pacing lead may include two or more curves to facilitate implanting the pacing lead at the implantation site.

Implantable medical device configured to provide for an intra-cardiac pacing includes an electrode arrangement configured to sense a cardiac sense signal and processing circuitry operatively connected to the electrode arrangement. The processing circuitry is configured to start a first timer based on a ventricular sense event; to open an atrial detection window based on a first timer count; to start a second timer based on an atrial sense event; to identify a first timeout based on a comparison of a second timer count and a first pacing delay; to identify a second timeout based on a comparison of the first timer count and a second pacing delay; to identify a third timeout based on a comparison of the first timer count and a basic rate interval; and to trigger a ventricular pace signal based on an identification of at least one of the first, second and third timeouts.

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.

A cardiac pacemaker which stays synchronized with the heart's natural cycle but also provides a safe patient support in cases where an atrial rhythm is detected by the implant promoting suspicion that an SVT occurred. The pacemaker includes a processing unit, a detector and a pacing signal generator, wherein the detector and the pacing signal generator are electrically connected to the processing unit, wherein the processing unit is configured to determine a ventricular pacing time value and/or a ventricular pacing rate value and to transmit a corresponding pacing information to the pacing signal generator for providing a pacing signal for a patient's heart based on this information.

An operation method of such a pacemaker, a respective computer program product and computer readable data carrier are also disclosed.

Certain embodiments of the present technology described herein relate to detecting atrial oversensing, characterizing atrial oversensing, determining when atrial oversensing is likely to occur, and or reducing the chance of atrial oversensing occurring. Some such embodiments characterize and/or avoid atrial oversensing.