Systems and methods for cardiac pacing are provided, where a pacing lead is placed at or near the bundle of His. A method for pacing a heart of a patient comprises: introducing a sheath to vasculature of the patient; steering the sheath within a coronary sinus in the heart to lodge a distal end of the sheath to a target location proximal to the bundle of His above a septum separating a left ventricle and a right ventricle of the heart; advancing a pacing lead through a lumen of the sheath to the target location; coupling the pacing lead to cardiac tissue at the target location; removing the sheath; and electrically pacing the bundle of His using the pacing lead.

An implantable medical device (IMD) and method are provided. The IMD includes a sensing channel configured to obtain biological signals indicative of biological behavior of an anatomy of interest over a period of time. The biological behavior has a feature of interest that repeats over time. The biological signals have clinically relevant (CR) segments that include information related to the feature of interest. The biological signals have non-clinically relevant (NCR) segments that do not include information related to the feature of interest. At least one of circuitry or a processor are configured to compare the biological signals to an amplitude window to distinguish the CR segments from the NCR segments, save to memory the CR segments and delete the NCR segments, save to memory time information indicative of a duration of the NCR segments that were deleted and to form a lossy compressed data set for the biological signals.

A medical device is configured to sense an electrical signal and determine that signal to noise criteria are met based on electrical signal segments stored in response to sensed electrophysiological events. The medical device is configured to determine an increased gain signal segment from one of the stored electrical signal segments in response to determining that the signal to noise criteria are met. The medical device determines a noise metric from the increased gain signal segment. The stored electrical signal segment associated with the increased gain signal segment may be classified as a noise segment in response to the noise metric meeting noise detection criteria.

The present disclosure provides embodiments of devices that are useful in the structural remodeling of various parts of the cardiovascular system, most notably the heart. Certain of the disclosed devices relate to RAMIN procedures (“remodeling and ablation using myocardial interstitial navigation”). RAMIN procedures, as described herein, represent a new family of non-surgical catheter-based procedures in order to accomplish ablation, drug delivery, re-shaping, pacing, and related structural heart interventional procedures, as desired.

The embodiments described herein relate to a self-positioning, quick-deployment low profile transvenous electrode system for sequentially pacing both the atrium and ventricle of the heart in the “dual chamber” mode, and methods for deploying the same.

A composite electrode intracardiac defibrillation catheter includes a first electrode group including at least two first electrodes for detecting an electrophysiological electrical signal of a site or a cell group in a heart chamber, and a second electrode group including at least one second electrode located between an adjacent pair of the at least two first electrodes for causing an electric current by a high-voltage defibrillation electric shock for defibrillation to flow in a contact site in the heart chamber or a contact site in a vein, and a conductive length of a surface of the at least one second electrode in a longitudinal direction of the composite electrode intracardiac defibrillation catheter is longer than a conductive length of each of the at least two first electrodes.

In an example, an apparatus is described that includes an implantable housing, a heart signal sensing circuit configured to sense intrinsic electrical heart signals, a ventricular tachyarrhythmia (VT) detector circuit, operatively coupled to the heart signal sensing circuit, the detector circuit operable to detect a VT based on the sensed heart signals, a processor configured to control delivery of an anti-tachyarrhythmia pacing (ATP) therapy based on the detected VT, and an energy delivery circuit configured to deliver the ATP therapy in response to the detected VT, wherein the apparatus does not include a shock circuit capable of delivering a therapeutically-effective cardioverting or defibrillating shock.

A fixation mechanism of an implantable lead includes a plurality of depressions of an outermost surface of the lead and a relatively flexible sleeve mounted around the outermost surface. The depressions are spaced apart from one another along a length, and each extends circumferentially, wherein a longitudinal center-to-center spacing between each adjacent depression is uniform along the length, and each depression is of substantially the same size. The sleeve has an internal surface in sliding engagement with the outermost surface of the lead, and an external surface, in which suture grooves are formed. A longitudinal center-to-center spacing between adjacent suture grooves may be substantially the same as, or a multiple of, the longitudinal center-to-center spacing between adjacent depressions of the outermost surface of the lead. The sleeve may also include a ridge protruding from the internal surface, aligned with, or offset (by center-to-center spacing of depressions) from, the grooves.

Disclosed are various configurations of electrodes with accompanying extensions and wires configured to be attached at or near the left atrium of a heart to allow the device to be held snug against the endocardium and out of the blood flow for low energy defibrillation of the atria in response to atrial fibrillation or other atrial arrhythmias. The portion of the lead internal to the atrium (e.g., the left atrium) is restrained against the endocardium of the left atrium by way of a restraint mechanism. In one example, the electrode is configured to attach to the atrial septum, with wires containing memory-shaped metal to keep the wires against the heart wall. In yet another example, the electrode is configured to be part of a mitral valve device.

An implantable medical device includes an electrode and an insulative material secured to the electrode via an adhesive. The electrode includes a metal substrate and a metal coating. The metal substrate includes a connection segment and an active segment along a length of the metal substrate. The metal coating is disposed on an outer surface of the metal substrate along the connection segment and the active segment. The insulative material surrounds the connection segment of the metal substrate without surrounding the active segment, and the adhesive adheres to the metal coating on the connection segment.