An electric stimulator for heart (as in heart pacemakers), brain (as in DBS), organs and general cells, with electrodes in the space surrounding the main stimulating electrodes. These surrounding electrodes are more effective at creating the best electric field to guide the stimulating electric charges necessary for the purpose of the device. The surrounding electrodes are supported on a second supporting device, while the main electrodes are in a first supporting device we call picafina.

Methods and systems are provided for managing residual charge for multi-point pacing therapy. The method and system provide an electrode configuration that includes an atrial (A) electrode, a right ventricular (RV) electrode and multiple left ventricular (LV) electrodes. The method and system deliver pacing pulses for an MPP therapy, during a first cardiac cycle, from a pulse generator to the electrode configurations. The pacing pulses are separated by pacing pulse (PP) intervals. The method and system dynamically adjust at least one of a timing or a duration of discharge pulses for the residual charge to form a discharge sequence. The method and system activate the discharge pulses based on the discharge sequence, during the first cardiac cycle, to the multiple LV electrodes to distribute the residual charge across the PP intervals.

An apparatus comprises a stimulus circuit, a cardiac signal sensing circuit, and a control circuit. The cardiac signal sensing circuit senses a cardiac activity signal using a sensing channel. The stimulus circuit provides electrical pulse energy to a first pacing channel that includes a first left ventricular (LV) electrode and a second pacing channel that includes a second LV electrode. The control circuit initiates delivery of electrical pulse energy using the first and second pacing channels according to a first multi-site LV pacing mode; determines a cardiac event associated with a change in cardiac conduction path using a sensed cardiac activity signal; and changes to a second LV pacing mode in response to determining the cardiac event. The second LV pacing mode is different from the first multi-site LV pacing mode in one or more of a pacing site location and inter-electrode stimulus timing.

Systems and methods are provided for detecting arrhythmias in cardiac activity is provided. The systems and methods include measuring conduction delays between an atria (A) and multiple left ventricular (LV) electrodes to obtain multiple intrinsic A/LV intervals, measuring conduction delays between a right ventricular (RV) and the multiple LV electrodes to obtain multiple intrinsic VV intervals. The systems and methods include calculating a first atrial ventricular (AV) delay based on at least one of the intrinsic A/LV intervals, and calculating a second AV delay based on at least one of the intrinsic VV intervals. The systems and methods include selecting a biventricular (BiV) pacing mode or an LV only pacing mode based on a relation between the first and second AV delays, and delivering a pacing therapy based on the selecting operation.

An electric stimulator for heart (as in heart pacemakers), brain (as in DBS), organs and general cells, with a supporting structure where there exists a plurality of electrically isolated electrodes called passive electrodes or field-shaping electrodes that are located under the surface of the supporting structure. The passive electrodes are controlled by an appropriate electronics control unit and powered by some electric energy storage, as a battery. Passive or field-shaping electrodes are electrically insulated, being unable to inject current in the surrounding medium, but they are capable of shaping the electric field in the space surrounding the electrodes, which has consequence on the path of the stimulating currents injected by other devices or by the organism itself. The invention also discloses locating the passive electrodes at different depths from the surface of the supporting structure.

An electric stimulator for heart (as in heart pacemakers), brain (as in DBS), organs and general cells, with a supporting structure where there exists a plurality of electrically isolated electrodes called passive electrodes or field-shaping electrodes that are located under the surface of the supporting structure. The passive electrodes are controlled by an appropriate electronics control unit and powered by some electric energy storage, as a battery. Passive or field-shaping electrodes are electrically insulated, being unable to inject current in the surrounding medium, but they are capable of shaping the electric field in the space surrounding the electrodes, which has consequence on the path of the stimulating currents injected by other devices or by the organism itself. The invention also discloses locating the passive electrodes on surfaces that surround the desired target volume.

An apparatus comprises a stimulus circuit, a recharge circuit, a switch circuit, and a control circuit. The stimulus circuit provides electrical cardiac pacing stimulation to multiple combinations of a plurality of electrodes, and the electrical stimulation is selectively applied at the first electrode of the electrode combinations. The recharge circuit includes a recharge capacitor electrically coupled to the second electrode of the electrode combinations, and the switch circuit selectively enables electrode combinations for electrical coupling to the stimulus circuit and the recharge circuit. The control circuit includes a pacing activation sub-circuit that selectively initiates delivery of the electrical stimulation using multiple electrode combinations, and enables simultaneous delivery of pacing recharge energy from the recharge capacitor to the second electrode of multiple electrode combinations.

A device and method for providing cardiac pacing of triangle of Koch and bundle of His zones by multiple electrodes inserted using in a single conduit are provided. The method includes providing a single conduit with multiple electrodes, positioning electrodes in the target zone of a heart, selecting acceptable electrodes as active based on a predetermined criteria and providing cardiac stimulation for multiple chambers of the heart from a single location.

Methods, systems, and devices that are used for improving cardiac resynchronization therapy (CRT) are described herein. Such a method can include, for each set of pacing parameters, of a plurality of sets of pacing parameters, performing CRT using a set of pacing parameters and simultaneously therewith sensing a plurality of intracardiac electrograms (IEGMs) using different combinations of implanted electrodes. Additionally, for each set of pacing parameters, of the plurality of sets of pacing parameters, the method includes producing a respective reconstructed multi-lead surface electrocardiogram (ECG) based on the plurality of IEGMs that were sensed while CRT was performed using the set of pacing parameters. The method also includes analyzing the reconstructed multi-lead surface ECGs that were produced for the plurality of sets of pacing parameters, and based on results thereof, identifying a set of pacing parameters to be use for further CRT.

A medical device system and associated method predict a patient response to a cardiac therapy. The system includes for delivering cardiac pacing pulses to a patient's heart coupled to a cardiac sensing module and a cardiac pacing module for generating cardiac pacing pulses and controlling delivery of the pacing pulses at multiple pace parameter settings. An acoustical sensor obtains heart sound signals. A processor is enabled to receive the heart sound signals, derive a plurality of heart sound signal parameters from the heart sound signals, and determine a trend of each of the plurality of heart sound signal parameters with respect to the plurality of pace parameter settings. An external display is configured to present the trend of at least one heart sound parameter with respect to the plurality of pace parameter settings.