An example of a system for pacing through multiple electrodes in a ventricle includes a sensing circuit to sense cardiac signal(s), a pacing output circuit to deliver pacing pulses, a heart sound sensor to sense a heart sound signal, and a control circuit to control the delivery of the pacing pulses. The control circuit includes a heart sound detector to detect heart sounds using the heart sound signal, an electrical event detector to detect cardiac electrical events using the cardiac signal(s), a measurement module to measure an optimization parameter using the detected heart sounds, an optimization module to perform an optimization procedure using the optimization parameter in response to an optimization command, and an optimization initiator to generate the optimization command. The optimization procedure includes selection of a single electrode or a plurality of electrodes from the multiple electrodes in the ventricle for pacing that ventricle.

An example of a system for pacing through multiple electrodes in a ventricle includes a sensing circuit to sense cardiac signal(s), a pacing output circuit to deliver pacing pulses, a heart sound sensor to sense a heart sound signal, and a control circuit to control the delivery of the pacing pulses. The control circuit includes a heart sound detector to detect heart sounds using the heart sound signal, an electrical event detector to detect cardiac electrical events using the cardiac signal(s), a measurement module to measure an optimization parameter using the detected heart sounds, and an optimization module to approximately optimize one or more pacing parameters using the measured optimization parameter. The one or more pacing parameters include an electrode configuration parameter specifying one or more electrodes selected from the multiple electrodes in the ventricle for delivering ventricular pacing pulses to that ventricle.

An apparatus comprises a cardiac signal sensing circuit configured for coupling electrically to a plurality of electrodes and to sense intrinsic cardiac activation at three or more locations within a subject's body using the electrodes; a stimulus circuit configured for coupling to the plurality of electrodes; a signal processing circuit electrically coupled to the cardiac signal sensing circuit and configured to determine a baseline intrinsic activation vector according to the sensed intrinsic cardiac activation; and a control circuit electrically coupled to the cardiac signal sensing circuit and stimulus circuit and configured to: initiate delivery of electrical pacing therapy using initial pacing parameters determined according to the baseline intrinsic activation vector; initiate sensing of a paced activation vector; and adjust one or more pacing therapy parameters according to the paced activation vector.

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.

A system and method for managing atrial-ventricular (AV) delay adjustments are provided and includes electrodes configured to be located proximate to an atrial (A) site and at least one of a left bundle branch (LBB) site or a HIS site. An IMD has a header that includes a right atrial (RA) header port, a right ventricular (RV) header port and a left ventricular (LV) header port. The system includes memory configured to store program instructions and one or more processors that, when configured to execute the program instructions measure an AV interval corresponding to an interval between an atrial paced (Ap) event or an atrial sensed (As) event and a sensed ventricular (Vs) event. The system sets a candidate AV delay based on the AV interval and a bundle branch adjustment (BBA) value, measures a QRS characteristic of interest (COI) while utilizing the candidate AV delay in connection with delivering a pacing therapy by the IMD and adjusts the BBA value and reset the candidate AV delay based on the BBA value as adjusted. The system repeats the adjust, reset and measure to obtain a collection of QRS COIs and corresponding candidate AV delays, selects one of the candidate AV delays, that corresponds to a select one of the QRS COIs, as a BBA AV delay and manages the pacing therapy, utilized by the IMD, based on the BBA AV delay.

A wireless cardiac stimulation device is disclosed comprising a controller-transmitter, a receiver, and a stimulating electrode, wherein the stimulating electrode and the receiver are separately implantable at cardiac tissue locations of the heart and are connected by a local lead. Having separately implantable receiver and stimulating electrodes improves the efficiency of ultrasound mediated wireless stimulation by allowing the receiver to be placed optimally for reception efficiency, thereby resulting in longer battery life, and by allowing the stimulating electrode to be placed optimally for stimulus delivery. Another advantage is a reduced risk of embolization, since the receiver and stimulating electrode ensemble is attached at two locations of the heart wall, with the connecting local leads serving as a safety tether should either the receiver or the stimulating electrode become dislodged.

Methods and devices for reducing ventricle filling volume are disclosed. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to reduce ventricle filling volume or even blood pressure. When the heart is stimulated in a consistent way to reduce blood pressure, the cardiovascular system may over time adapt to the stimulation and revert back to the higher blood pressure. In some embodiments, the stimulation pattern may be configured to be inconsistent such that the adaptation response of the heart is reduced or even prevented. In some embodiments, an electrical stimulator may be used to stimulate a patient's heart to cause at least a portion of an atrial contraction to occur while the atrioventricular valve is closed. Such an atrial contraction may deposit less blood into the corresponding ventricle than when the atrioventricular valve is opened throughout an atrial contraction.

Methods and systems are provided for a rate adaptive bi-ventricular fusion pacing. The methods and systems deliver a first pulse at a left ventricular (LV) lead and a second pulse at a right ventricular (RV) lead based on a paced atrio-ventricular (AV) delay. The first pulse timed to be delivered concurrently with an intrinsic ventricular conduction. The methods and systems further repeat the delivery of the first pulse and the second pulse for a predetermined number of cycles. Additionally, the methods and systems measure an intrinsic AV conduction interval, and adjust the paced AV delay based on the intrinsic AV conduction interval and a negative hysteresis delta.

Systems and methods for monitoring and treating patients with heart failure are discussed. The system may receive patient atrioventricular (AV) conduction characteristic under different heart rates or patient conditions. Stimulation parameters including stimulation timing parameters may be stored in a memory. The system may include a stimulation control circuit configured to determine a parameter update schedule indicating a timing at which to update stimulation parameter using patient AV conduction characteristic, and dynamically update at least a portion of the stored set of stimulation parameters at the determined parameter update schedule. For a specified heart rate or heart rate range, a stimulation parameter may be selected from the set of the stimulation parameters for use during cardiac stimulation.

One embodiment provides a system for determination and utilization of cardiac electrical asynchrony data. The system includes an analysis circuitry including a processor and a memory, the analysis circuitry configured to: obtain a plurality of sets of cardiac signals collected in at least two locations of a heart of a patient, the signals comprising at least one of surface electrocardiography signals and pseudo-surface ECG signals; detect one or more QRS complexes for each of the sets based on the cardiac signals for that set; obtain one or more cross-correlation signals, each of the cross-correlation signals being between at least two of the signal sets and being obtained using the detected QRS complexes from the signal sets; and calculate one or more asynchrony indices using one or more of the cross-correlation signals, each of the asynchrony indices being indicative of a level of asynchrony between the at least two locations.