Semi-autonomous vehicle apparatus which is controlled by a plurality of control sources includes a vehicle which may function autonomously and apparatus for control of the vehicle by either an onboard driver or a driver not situated onboard. The vehicle may also be controlled by an off-vehicle computational device. Hierarchy setting apparatus determines which one or combination of the possible control entities take priority. Persons using the apparatus are identified by either a password or, preferably by providing identification based on a biologic feature. Management of impaired vehicle operators is provided for.

A method for monitoring health of a subject based on a physiological response to physical exertion, by processing circuitry of a medical device system, is described that includes detecting a plurality of exertion events of the subject based on a first sensed signal that varies as a function of movement of the subject. The method further includes determining a response of a physiological parameter of the subject to the exertion event for each of the detected exertion events based on second sensed signal that varies as a function of the physiological parameter. The method further includes determining that a change in the responses over time crosses threshold and generating an alert to a user based on the determination that the change crosses the threshold.

Subcutaneous implantable string shaped defibrillator for providing cardiac resynchronization therapy (CRT), including a flexible elongated body, at least two defibrillation leads, at least one sensor, at least two transition units and at least one epicardial lead, the defibrillation leads for providing at least one cardioversion defibrillation shock, the sensor being positioned on at least one of the defibrillation leads, for determining at least one metric of a heart, the transition units for respectively coupling the defibrillation leads to opposite ends of the elongated body, and the epicardial lead, coupled with the elongated body via at least one of the transition units, for providing at least one CRT pulse, the elongated body including a plurality of linked units, the linked units encapsulating at least one capacitor, at least one power source and a processor, wherein the processor provides at least one signal to the epicardial lead for providing the CRT pulse.

Disclosed is a delivery system for a component, for example, a splitting lead. A splitting lead can have a proximal portion to engage a controller and a distal portion to split apart into sub-portions that travel in multiple directions during implantation into a patient. The delivery system can include a handle and a component advancer to advance and removably engage a portion of the component. The component advancer can be coupled to the handle and advance the component into the patient by applying a force to the portion in response to actuation of the handle by the operator. Also, the delivery system can include an insertion tip with first and second ramps to facilitate advancement of first and second sub-portions into the patient in first and second directions. The leads may have various electrode configurations including, for example, wrapped or embedded electrodes, helical or elliptical coils, thin metallic plates, etc.

An implantable system includes an implantable medical device (IMD) and a non-transvenous lead that is configured to be implanted outside of a heart. The IMD includes an output configured to be connected at least to the lead, a current generator (CG) circuit configured to generate pacing pulses, a switching circuit coupled between the CG circuit and the output, one or more capacitors coupled in parallel with the CG circuit and the switching circuit, and a control circuit coupled to the CG circuit. The control circuit is configured to manage the CG circuit to generate the pacing pulses with a constant current at the output.

An implantable medical device (IMD) includes one or more stimulation engines (SEs) and selectively connectable output switching circuitry for driving a plurality of output nodes associated with a respective plurality of electrodes of the IMD's lead system when implanted in a patient. The output switching circuitry may be configured to facilitate self-test mode (STM) functionality in the IMD (e.g., when it is in a hermetically sealed package) by using a dual mode switch in series with a stimulation engine selection switch with respect to each output node in the output switching circuitry under mode selection control.

Implantable devices and systems include one or more leads adapted to be emplaced in the internal thoracic vein (ITV) of a patient. The lead may include features to adapt the lead for such placement. An associated device for use with the lead may include operational circuitry adapted for use with a lead having an electrode for sensing and/or therapy purposes coupled thereto. Methods for implantation and use of such devices and systems are disclosed as well.

A subcutaneous cardiac defibrillation system implantable comprising a housing and a subcutaneous implantable lead comprising a proximal end connected to the housing and a distal free end. The subcutaneous implantable lead comprises at least one defibrillation electrode and at least three detection electrodes. The first detection electrode and the second detection electrode form a first dipole, and the third detection electrode and the first detection electrode, or the third detection electrode and the second detection electrode, or the housing and one of said detection electrodes, form a second dipole. The defibrillation electrode is positioned between the second detection electrode and the third detection electrode, the first dipole is positioned between the housing and the defibrillation electrode, the third electrode is positioned between the free distal end of the lead and the defibrillation electrode, and the length of the first dipole is shorter than the length of the second dipole.

An extra-cardiovascular implantable cardioverter defibrillator (ICD) having a low voltage therapy module and a high voltage therapy module is configured to select, by a control module of the ICD, a pacing output configuration from at least a low-voltage pacing output configuration of the low voltage therapy module and a high-voltage pacing output configuration of the high voltage therapy module. The high voltage therapy module includes a high voltage capacitor having a first capacitance and the low voltage therapy module includes a plurality of low voltage capacitors each having up to a second capacitance that is less than the first capacitance. The ICD control module controls a respective one of the low voltage therapy module or the high voltage therapy module to deliver extra-cardiovascular pacing pulses in the selected pacing output configuration via extra-cardiovascular electrodes coupled to the ICD.

An extra-cardiovascular implantable cardioverter defibrillator (ICD) having a high voltage therapy module is configured to control a high voltage charging circuit to charge a capacitor to a pacing voltage amplitude to deliver charge balanced pacing pulses. The capacitor is chargeable to a shock voltage amplitude that is greater than the pacing voltage amplitude. The ICD is configured to enable switching circuitry of the high voltage therapy module to discharge the capacitor to deliver a first pulse having a first polarity and a leading voltage amplitude corresponding to the pacing voltage amplitude for pacing the patient's heart via a pacing electrode vector selected from extra-cardiovascular electrodes. The high voltage therapy module delivers a second pulse after the first pulse. The second pulse has a second polarity opposite the first polarity and balances the electrical charge delivered during the first pulse.