Computer implemented methods and systems are provided for automatically determining capture thresholds for an implantable medical device equipped for cardiac stimulus pacing using a multi-pole left ventricular (LV) lead. The methods and systems measures a base capture threshold for a base pacing vector utilizing stimulation pulses varied over at least a portion of an outer test range. The base pacing vector is defined by a first LV electrode provided on the LV lead and a second electrode located remote from an LV chamber. The methods and systems designate a secondary pacing vector that includes the first LV electrode and a neighbor LV electrode provided on the LV lead. The methods and systems further define an inner test range having secondary limits based on the base capture threshold, wherein at least one of the limits for the inner test range differs from a corresponding limit for the outer test range. The methods and systems measure a secondary capture threshold associated with the secondary pacing vector utilizing stimulation pulses varied over at least a portion of the inner test range.

An electrical stimulation system includes a sheath that includes conductive points that are operative to facilitate electrical stimulation to a bodily portion of a user. Drive-sense circuits (DSCs) generate electrical stimulation signals based on reference signals and provide those electrical stimulation signals via electrodes to the conductive points of the sheath. The electrical stimulation signal is coupled into respective locations of the bodily portion of the user that are in proximity to or in contact with the conductive points of the sheath. In addition, the DSCs sense, via the conductive points of the sheath and via the electrodes, changes of the electrical stimulation signals based on coupling of them into the respective locations of the bodily portion of the user. The DSCs provide digital signals that are representative of the changes of the electrical stimulation signals to one or more processing modules that includes and/or is coupled to memory.

A biostimulator, such as a leadless pacemaker, has electrode(s) coated with low-polarization coating(s). A low-polarization coating including titanium nitride can be disposed on an anode, and a low-polarization coating including a first layer of titanium nitride and a second layer of platinum black can be disposed on a cathode. The anode can be an attachment feature used to transmit torque to the biostimulator. The cathode can be a fixation element used to affix the biostimulator to a target tissue. The low-polarization coating(s) impart low-polarization to the electrode(s) to enable an atrial evoked response to be detected and used to effect automatic output regulation of the biostimulator. Other embodiments are also described and claimed.

An implantable medical device comprises therapy delivery circuitry and processing circuitry. The therapy delivery circuitry is configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient. The ATP therapy includes one or more pulse trains and each of the one or more pulse trains includes a plurality of pacing pulses. The processing circuitry is configured to, for at least one of the plurality of pacing pulses of at least one of the one or more pulse trains, determine at least one latency metric of an evoked response of the heart to the pacing pulse. The processing circuitry is further configured to modify the ATP therapy based on the at least one latency metric.

In some examples, an implantable medical device determines that another medical device delivered an anti-tachyarrhythmia shock, and delivers post-shock pacing in response to the determination. The implantable medical device may be configured to both detect the delivery of the shock in a sensed electrical signal and, if delivery of the shock is not detected, determine that the shock was delivered based on detection of asystole of the heart. The asystole may be detected based on the sensed electrical signal. In some examples, an implantable medical device is configured to revert from a post-shock pacing mode to a baseline pacing mode by iteratively testing a plurality of decreasing values of pacing pulse magnitude until loss of capture is detected. The implantable medical device may update a baseline value of the pacing pulse magnitude for the baseline mode based on the detection of loss of capture.

An implantable system for stimulating a human heart or an animal heart, comprising a first stimulation unit and a first detection unit, wherein the first stimulation unit is used to stimulate at least one cardiac region of a human or an animal heart, and wherein the first detection unit is used to detect an electrical signal of at least one cardiac region of the same human or animal heart. The system comprises a first timer, which is used to provide a defined delivery of stimulation pulses, in terms of time, by the first stimulation unit. The system comprises a second timer, which is provided and configured to match a delivery point in time of at least one pulse to be delivered by the second stimulation unit to a delivery point in time of at least one pulse to be delivered by the first stimulation unit.

Methods and systems of evaluating cardiac pacing in candidate patients for cardiac resynchronization therapy and cardiac resynchronization therapy patients are disclosed. The methods and systems disclosed allow treatments to be personalized to patients by measuring the extent of tissue capture from cardiac pacing under various therapy parameter conditions. Systems and methods of optimizing right ventricle only cardiac pacing are also disclosed.

A cardiac stimulation system and associated capture management method are provided in which capture and device longevity are improved. The device determines a series of capture thresholds. Capture threshold is the minimum pulse level (pulse energy or pulse amplitude or pulse width) that captures the heart. Each determination requires delivery of pacing pulses at several (at least two) known levels (pulse energy, pulse amplitude and/or pulse width) over time. The individual determined capture thresholds are combined into a set and the variability of the set is used to set the safety margin. The greater the variability in the capture thresholds, the bigger the safety margin.

An example system and method associated with identifying and treating a source of a heart rhythm disorder are disclosed. In accordance therewith, a spatial element associated with a region of the heart is selected. Progressive rotational activations or progressive focal activations are determined in relation to the selected spatial element over a period of time. The selecting and determining are repeated over multiple periods of time. A source parameter of rotation activations or focal activations is determined, wherein the source parameter indicates consistency of successive rotational activations or focal activations in relation to a portion of the region of the heart. The determining of a source parameter is repeated for multiple regions of the heart. Thereafter, representation of the source parameter is displayed for each of the multiple regions of the heart to identify a shape representing the source of the heart rhythm disorder.

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.