Implantable cardiac systems and methods for providing substernal pacing in an ICD system are described. In one example, an implantable cardiac system comprises an ICD system and an implantable leadless pacing device (LPD) communicatively coupled to the ICD system. The ICD system includes an ICD and an implantable defibrillation lead having a proximal portion coupled to the ICD and a distal portion having a defibrillation electrode configured to deliver a defibrillation shock to a heart of the patient. The LPD includes a housing, a first electrode on the housing, a second electrode on the housing, and a pulse generator within the housing and electrically coupled to the first electrode and the second electrode. The housing of the LPD is implanted substantially within an anterior mediastinum of the patient and the pulse generator is configured to deliver pacing pulses to a heart via the first and second electrodes.

An intra cardiac device is disclosed. The device comprises means for transforming kinetic energy from heart tissue movement into electrical energy in use, from which electrical energy information in respect of heart function is obtainable. Furthermore, a system is disclosed, comprising one such intra cardiac device and at least one receiver, wherein the intra cardiac device comprises means of communication, through which said at least one device communicates with the receiver(s) wirelessly. In this way energy from heart movement provides self contained intra cardiac devices for conveniently monitoring or stimulating a patient's heart.

In some examples, an electromechanical disassociation state (EMD) of a heart of a patient can be treated by delivering electrical stimulation to a tissue site to at least one of modulate afferent nerve activity or inhibit efferent nerve activity upon determining that the heart is in an electromechanical dissociation state, where the tissue site comprises at least one of a nonmyocardial tissue site or a nonvascular cardiac tissue site. The delivery of electrical stimulation may effectively treat the EMD state of the heart, e.g., by enabling effective mechanical contraction of the heart. In another example, an electromechanical disassociation state of a heart of a patient can be treated by determining autonomic nervous system activity associated with a detected EMD state of the heart of a patient, and delivering electrical stimulation therapy to the patient based on the determined autonomic nervous system activity of the patient associated with the EMD state.

Systems and methods are provided for delivering vagus nerve stimulation and cardioversion/defibrillation therapies to patients for treating chronic heart failure. The vagus nerve stimulation and cardioversion/defibrillation therapies may be provided using a single implantable pulse generator, which can coordinate delivery of the therapies to provide an acute vagus nerve stimulation therapy in advance of delivering cardioversion-defibrillation energy.

Injectable subcutaneous heart device (ISHD) for regulating arrhythmias in a heart of a patient, including a plurality of linked structures, each one of the linked structures being hollow, an interconnecting bus, a biocompatible coating, at least two electrodes and a plurality of sensors, the interconnecting bus for electrically coupling the linked structures and the biocompatible coating for hermetically sealing and electrically insulating the linked structures, one of the linked structures encapsulating a power source, another one of the linked structures encapsulating at least one capacitor and a third one of the linked structures encapsulating electronics, the electrodes and the sensors being respectively placed on an outer surface of the linked structures located at opposite ends of the ISH D, for detecting arrhythmias and providing electrical shocks to the heart, the electrodes and the sensors being electrically coupled with the interconnecting bus and the ISHD being positioned subcutaneously around the heart.

The device includes a cardiac therapy circuit with a first terminal, and a peripheral therapy circuit with a second terminal. These terminals can either receive a cardiac detection/stimulation lead or a peripheral detection/stimulation lead of an organ. The device is configured to recognize the leads and automatically configure the connection terminals according to the type of lead received by the terminal. This includes discrimination methods for identifying the terminal on which a cardiac signal is detected, and selectively activating the cardiac therapy circuit and the peripheral therapy circuit based on the detection of the cardiac signal on a lead.

Systems and methods involve an intrathoracic cardiac stimulation device operable to provide autonomous cardiac sensing and energy delivery. The cardiac stimulation device includes a housing configured for intrathoracic placement relative to a patient's heart. A fixation arrangement of the housing is configured to affix the housing at an implant location within cardiac tissue or cardiac vasculature. An electrode arrangement supported by the housing is configured to sense cardiac activity and deliver stimulation energy to the cardiac tissue or cardiac vasculature. Energy delivery circuitry in the housing is coupled to the electrode arrangement. Detection circuitry is provided in the housing and coupled to the electrode arrangement. Communications circuitry may optionally be supported by the housing. A controller in the housing coordinates delivery of energy to the cardiac tissue or cardiac vasculature in accordance with an energy delivery protocol appropriate for the implant location.

According to some embodiments, a device operates by comparative morphological analysis of depolarization signals collected in spontaneous rhythm on separate respective channels, with two temporal components combined into a single 2D parametric VGM vectogram characteristic. Similarity quantification methods evaluate a variation over time of a descriptor parameter of a current VGM compared to a stored previous reference VGM. This variation is compared with predetermined thresholds to diagnose an occurrence of remodeling or reverse remodeling in a patient, and/or to detect a lead failure or an occurrence of ischemia. The descriptor parameter is a function of a velocity vector of the VGM, a comparison relating to a correlation coefficient between respective magnitudes of a current VGM velocity vector and of a reference VGM velocity vector, and an average angle between these respective velocity vectors.

An ICD multimode system comprises a microcontroller or FPGA having a memory, a differentially driven phased array amplifier, one or more sensors, and a wireless transmitter/receiver. Based upon sensor data and demand criteria programmed into the memory, the system provides late systolic impulse (LSI) therapy to treat congestive heart failure (CHF), ventricle level-shifting (VLS) therapy to block unwanted PVCs to prevent VT or VF, and cardiac resynchronization therapy (CRT) that adjusts LV and RV contraction synchronization based upon timing. An integrated echocardiogram and ultrasound system automatically adjusts the therapies administered based upon sensor and demand data in real time to allow a patient's heart to function at a level of improved performance and efficiency.

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 region. The stimulation can include waveforms of the same or different 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 of the heart.