A cardiac pacing system comprising one or more leadless cardiac pacemakers configured for implantation in electrical contact with a cardiac chamber and configured to perform cardiac pacing functions in combination with a co-implanted implantable cardioverter-defibrillator (ICD). The leadless cardiac pacemaker comprises at least two leadless electrodes configured for delivering cardiac pacing pulses, sensing evoked and/or natural cardiac electrical signals, and bidirectionally communicating with the co-implanted ICD.

This disclosure relates to an active implantable medical device of the cardiac resynchronizer type. The device includes a pulse generator to produce pacing pulses, at least one detection electrode for detecting atrial and ventricular events, at least one stimulation electrode, a memory storing executable instructions, and a processor configured to execute the instructions. The processor is configured to execute the instructions to apply an atrioventricular delay (AVD) between a sensed or stimulated atrial event and the delivery of a ventricular pacing pulse, quantify a degree of fusion between the delivery of a pacing pulse to a cavity and a spontaneous contraction of another cavity, calculate a fusion rate, and modify the value of the AVD applied to the delivery of said ventricular pacing pulse, as a function of a comparison.

Systems and methods for selecting one or more sites at or within at least one heart chamber for cardiac stimulation are disclosed. The system can include a physiologic sensor circuit to sense physiologic signals at two or more candidate stimulation sites. The system can generate respective activation timing indicators corresponding to the two or more candidate stimulation sites, and detect MI indicators indicating the presence of, or spatial proximity of each of the two or more candidate stimulation sites to a MI tissue. The system can use the activation timing indicators and the MI indicators to select at least one target stimulation site or to determine an electrostimulation vector. The system can display the selected target stimulation site to a user, or deliver electrostimulation to the patient at the target stimulation site or according to the determined electrostimulation vector.

The present disclosure provides systems and methods for optimizing pacing parameters of a cardiac pacing device implanted in a patient. The systems and methods measure a plurality of hemodynamic responses of the patient. Each hemodynamic response is associated with the cardiac pacing device configured with one candidate pacing parameter set of a plurality of candidate pacing parameter sets. Each candidate pacing parameter set is classified as electrically equivalent to a reference pacing parameter set according to a classification criterion. The systems and methods further identify an optimal hemodynamic response from the plurality of hemodynamic responses, and select a final candidate pacing parameter set corresponding to the optimal hemodynamic response.

Methods and devices are is provided for controlling a pacing therapy utilizing left ventricular multi-point pacing (MPP). The method and device provide electrodes configured to be located proximate to an atrial (A) site, a right ventricular (RV) site and multiple left ventricular (LV) sites of the heart. The method and device utilizes one or more processors. The processors determine atrial-ventricular conduction delays (AVCD) between the A site and multiple corresponding LV sites and determines pacing latencies at the LV sites. The processors adjusts the AVCDs, based on the pacing latency at the corresponding LV sites, to form atrial-ventricular latency adjusted (ARPL) conduction delays for the corresponding LV sites, calculates interventricular pacing (VV) delays for combinations of the LV sites based on the corresponding ARPL conduction delays and manages pacing therapy, that utilizes left ventricular MPP, based on the VV delays for the corresponding LV sites.

An implantable device and associated method for delivering multi-site pacing therapy is disclosed. The device comprises a set of electrodes including a first ventricular electrode and a second ventricular electrode, spatially separated from one another and all coupled to an implantable pulse generator. The device comprises a processor configured for selecting a first cathode and a first anode from the set of electrodes to form a first pacing vector at a first pacing site along a heart chamber and selecting a second cathode and a second anode from the set of electrodes to form a second pacing vector at a second pacing site along the same heart chamber. The pulse generator is configured to deliver first pacing pulses to the first pacing vector and delivering second pacing pulses to the second pacing vector. The pulse generator generates a recharging current for recharging a first coupling capacitor over a first recharge time period in response to the first pacing pulses. The pulse generator for generating a recharging current for recharging a second coupling capacitor over a second recharge time period in response to the second pacing pulses. An order of recharging the first and second coupling capacitors is dependent upon one of ventricular pacing mode, left ventricle to right ventricle delay (V-V) pace delay, multiple point LV delay and latest delivered pacing pulses to one of the first and second pacing vectors.

The present disclosure pertains to cardiac pacing methods and systems, and, more particularly, to cardiac resynchronization therapy (CRT). In particular, the present disclosure pertains to determining whether a patient is experiencing atrial fibrillation (AF). If the patient is experiencing AF, the efficacy of CRT is determined. A signal is sensed in response to a ventricular pacing stimulus. Through signal processing, a number of features are parsed from the signal and a determination is made as to whether the ventricular pacing stimulus evoked a response from the ventricle.

Methods, devices and program products are provided for controlling a left univentricular (LUV) pacing therapy using an implantable medical device. Electrodes are configured to be located proximate to an atrial (A) site, left ventricular (LV) site and right ventricular (RV) site of the heart. A conduction different is determined based on i) an atrial-ventricular conduction delay (AR.sub.RV) between the A site and the RV site, and ii) an atrial-ventricular conduction delay (AR.sub.LV) between the A site and the LV site. A correction term is based on intrinsic inter-ventricular conduction delay (IVCD) between the LV and RV. An LV atrial-ventricular pacing (AV.sub.LV) delay is set based on the conduction difference , a pacing latency PL and the correction term and manages the LUV pacing therapy based on the AV.sub.LV delay, wherein the LUV pacing therapy lacks pacing in the RV.

Systems and methods for determining multiple sites for multi-site cardiac stimulation are disclosed. The system can comprise an electrostimulation circuit that can deliver electrostimulation to one or more candidate sites in at least one chamber of the heart, such as a left ventricle of the heart, within the same cardiac cycle. The system can sense a physiologic signal during the electrostimulation of the heart, determine activation timings from first and second sets of physiologic signals respectively sensed at the plurality of candidate sites when the heart undergoes specified intrinsic activities or stimulation, and determine at least first and second selected sites, among a plurality of candidate sites, using the respective activation timings. The system can deliver multi-site stimulation such as to the first and second selected sites during a same cardiac cycle, simultaneously or separated by a specified temporal offset.

The present disclosure pertains to cardiac pacing methods and systems, and, more particularly, to cardiac resynchronization therapy (CRT). In particular, the present disclosure pertains to determining whether a patient is experiencing atrial fibrillation (AF). If the patient is experiencing AF, the efficacy of CRT is determined. A signal is sensed in response to a ventricular pacing stimulus. Through signal processing, a number of features are parsed from the signal and a determination is made as to whether the ventricular pacing stimulus evoked a response from the ventricle.