Implantable medical systems enter an exposure mode of operation, either manually via a down linked programming instruction or by automatic detection by the implantable system of exposure to a magnetic disturbance. A controller then determines the appropriate exposure mode by considering various pieces of information including the device type including whether the device has defibrillation capability, pre-exposure mode of therapy including which chambers have been paced, and pre-exposure cardiac activity that is either intrinsic or paced rates. Additional considerations may include determining whether a sensed rate during the exposure mode is physiologic or artificially produced by the magnetic disturbance. When the sensed rate is physiologic, then the controller uses the sensed rate to trigger pacing and otherwise uses asynchronous pacing at a fixed rate.

Implantable medical systems enter an exposure mode of operation, either manually via a down linked programming instruction or by automatic detection by the implantable system of exposure to a magnetic disturbance. A controller then determines the appropriate exposure mode by considering various pieces of information including the device type including whether the device has defibrillation capability, pre-exposure mode of therapy including which chambers have been paced, and pre-exposure cardiac activity that is either intrinsic or paced rates. Additional considerations may include determining whether a sensed rate during the exposure mode is physiologic or artificially produced by the magnetic disturbance. When the sensed rate is physiologic, then the controller uses the sensed rate to trigger pacing and otherwise uses asynchronous pacing at a fixed rate.

Implantable medical systems enter an exposure mode of operation, either manually via a down linked programming instruction or by automatic detection by the implantable system of exposure to a magnetic disturbance. A controller then determines the appropriate exposure mode by considering various pieces of information including the device type including whether the device has defibrillation capability, pre-exposure mode of therapy including which chambers have been paced, and pre-exposure cardiac activity that is either intrinsic or paced rates. Additional considerations may include determining whether a sensed rate during the exposure mode is physiologic or artificially produced by the magnetic disturbance. When the sensed rate is physiologic, then the controller uses the sensed rate to trigger pacing and otherwise uses asynchronous pacing at a fixed rate.

Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous device (e.g. subcutaneous implantable (SD)) and a leadless pacing device (LPD) are described. In one or more embodiments, a computer-implemented method includes sensing a first electrical signal from a heart of a patient through a SD. The first signal is stored into memory and serves as a baseline rhythm for a patient. Subsequently, a second signal is sensed from the heart through the SD. A cardiac condition can be detected within the sensed second electrical signal through the SD. A determination is made as to whether cardiac resynchronization therapy (CRT) is appropriate to treat the detected cardiac condition. A determination can then be made as to the timing of pacing pulse delivery to cardiac tissue through a leadless pacing device (LPD). The LPD receives communication from the SD requesting the LPD to deliver CRT to the heart. The SD senses and extracts data from a third electrical signal from the heart of the patient to determine whether the pacing by LPD provided efficacious resynchronization or whether the delivery and timing of the LPD pulse should be modified.

Methods, devices and program products are provided for under control of one or more processors within an implantable medical device (IMD). Sensing near field (NF) and far field (FF) signals are between first and second combinations of electrodes coupled to the IMD. The method applies an arrhythmia detection algorithm to the NF signals for identifying events within the NF signal and designates events marker based thereon and monitors the event markers to detect a candidate arrhythmia condition in the NF signals. The candidate under-detected condition comprises at least one of an under-detected arrhythmia or over-sensing. In response to detection of the candidate arrhythmia condition, the method analyzes the FF signals for a presence of an under-detected arrhythmia indicator. The method delivers an arrhythmia therapy based on the presence of the under-detected arrhythmia indicator in the FF signals and the candidate under-detected arrhythmia condition in the NF signals.

An intracardiac pacemaker device, comprising a housing that is configured to be implanted entirely within a ventricle (V) of a heart (H), an electronic module for generating pacing pulses, a battery for supplying energy to the electronic module, an elongated lead extension protruding from the housing, at least a first electrode arranged on the elongated lead extension, and a pacing electrode and a return electrode for applying the pacing pulses to cardiac tissue, wherein the pacing electrode is arranged on the housing. The electronic module is electrically coupled to the pacing electrode via the housing, and wherein the electronic module is configured to carry out measurements of electrical activity via the at least one first electrode of the elongated lead extension.

A leadless pacemaker device for providing an intra-cardiac pacing includes processing circuitry configured to generate ventricular pacing signals for stimulating ventricular activity at a ventricular pacing rate, a first sensor configuration receiving a first sense signal, and a second sensor configuration receiving a second sense signal. The processing circuitry derives, in a first sensing state, atrial events from the first sense signal for controlling the ventricular pacing rate based on the atrial events. The processing circuitry switches, based on at least one switching criterion, from the first sensing state to a second sensing state in which the processing circuitry derives atrial events from the second sense signal. The second sense signal is received by the second sensor configuration for detection of atrial events and the second sensor configuration is a motion sensor or a sound sensor. A method for operating the pacemaker device is also provided.

The present disclosure relates generally to pacing of the cardiac conduction system of a patient, and more particularly, to providing adaptive cardiac conducting system pacing therapy and to determining selective or non-selective capture of the cardiac conduction system by cardiac conduction system pacing therapy. The adaptive cardiac conduction system pacing therapy may adjust AV delay and VV delay based on various signals and metrics and may switch between cardiac conduction system pacing therapy exclusively and cardiac conduction system pacing therapy in combination with traditional left ventricular pacing therapy.

A method for heart failure management includes monitoring one or more sensor-based parameters for a patient to determine a pacing therapy. If the one or more parameters indicate atrial tachycardia or atrial fibrillation, a first pacing therapy is delivered. If the one or more parameters do not indicate atrial tachycardia or atrial fibrillation, it is determined whether the patient is asleep. If the patient is asleep, a second pacing therapy is delivered. If the one or more parameters do not indicate atrial tachycardia, atrial fibrillation, or that the patient is asleep, the patient's P-wave duration is evaluated with respect to a P-wave duration threshold value. When the patient's P-wave duration is determined to exceed the P-wave duration threshold value, a third pacing therapy is delivered, and when the patient's P-wave duration is determined to not exceed the P-wave duration threshold value, a fourth pacing therapy is delivered.

In some examples, a leadless pacing device (LPD) is configured to switch from a sensing without pacing mode to ventricular pacing mode in response to determining that no intrinsic ventricular activity was detected within a ventricular event detection window for at least one cardiac cycle, which may be referred to as loss of conduction. The ventricular pacing mode may be selected based on whether atrial oversensing is detected in combination with the loss of conduction. In some examples, an atrio-ventricular synchronous pacing mode is selected in response to detecting loss of conduction and in response to determining that atrial oversensing is not detected. In addition, in some examples, an asynchronous ventricular pacing mode is selected in response to detecting both atrial oversensing and loss of conduction.