CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application Serial No. 62/217,339, filed on September 11 , 2015, the disclosure of which is incorporated herein by reference.

TECHNICAL FIELD

The present disclosure generally relates to systems, devices, and methods for detecting arrhythmia or confirming detection of arrhythmia of a heart of a patient, and more particularly to systems, devices, and methods for detecting arrhythmia or confirming detection of arrhythmia of a heart using multiple devices.

BACKGROUND

Pacing instruments can be used to treat patients suffering from various heart conditions that result in a reduced ability of the heart to deliver sufficient amounts of blood to a patient's body. These heart conditions may lead to rapid, irregular, and/or inefficient heart contractions. To help alleviate some of these conditions, various devices (e.g., pacemakers, defibrillators, etc.) can be implanted in a patient's body. Such devices may monitor and provide electrical stimulation to the heart to help the heart operate in a more normal, efficient and/or safe manner. In some cases, the devices may be part of an implantable medical device system.

SUMMARY

The present disclosure generally relates to systems, devices, and methods for detecting arrhythmia or confirming detection of arrhythmia of a heart of a patient, and more particularly to systems, devices, and methods for detecting arrhythmia or confirming detection of arrhythmia of a heart using multiple devices.

In a first illustrative embodiment, a medical device system may comprise a leadless cardiac pacemaker (LCP) and a medical device remote from the LCP. In some instances, the LCP may comprise a plurality of electrodes, a sensor, and a controller connected to the plurality of electrodes and the sensor. The LCP may be configured to receive an indication from the medical device that a cardiac arrhythmia is detected and, after receiving an indication from the medical device, monitor a signal generated by the sensor and, based at least in part on the monitored signal, confirm whether a cardiac arrhythmia is occurring or not.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, after the LCP confirms whether a cardiac arrhythmia is occurring, the LCP may be configured to deliver one or more electrical stimulation pulses to the plurality of electrodes.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, after the LCP confirms whether a cardiac arrhythmia is occurring, the LCP may be configured to transmit a confirmation message to the medical device, and wherein the medical device may be configured to generate one or more electrical stimulation pulses in accordance with a therapy program in response to receiving the confirmation message.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, the sensor may comprise an accelerometer.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, the sensor may comprise one or more of a flow sensor and a pressure sensor.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, confirming whether a cardiac arrhythmia is occurring or not may comprise determining whether there is synchronicity between a cardiac electrical signal of the patient's heart and the monitored signal.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, determining whether there is synchronicity between the cardiac electrical signal of the patient's heart and the monitored signal may comprise determining an occurrence of one or more peaks in the monitored signal havmg an amplitude above a threshold amplitude within a predefined monitoring window after an occurrence of a cardiac event detected in the cardiac electrical signal.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, confirming whether the cardiac arrhythmia is occurring may comprise determining whether a frequency of the monitored signal is greater than a threshold frequency. Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, determining whether the cardiac arrhythmia is occurring may comprise determining whether a maximum amplitude of the sampled signal is below a threshold amplitude.

Additionally, or alternatively, in any of the above embodiments with respect to the first illustrative embodiment, monitoring the signal generated by the sensor may comprise sampling the signal, and wherein the signal may be sampled at a higher sample rate after receiving an indication from the remote device that a cardiac arrhythmia is detected than before receiving an indication from the remote device that a cardiac arrhythmia is detected.

In a second illustrative embodiment, a leadless cardiac pacemaker (LCP) may comprise a plurality of electrodes, a sensor, and a controller connected to the plurality of electrodes and the sensor. In some embodiments, the controller may be configured to receive an indication from a remote device that a cardiac arrhythmia is detected, monitor a signal generated by the sensor, and, based at least in part on the monitored signal confirm whether a cardiac arrhythmia is occurring or not.

Additionally, or alternatively, in any of the above embodiments with respect to the second illustrative embodiment, after determining that a cardiac arrhythmia is occurring, the controller may be further configured to deliver electrical stimulation pulses to the plurality of electrodes in accordance with a therapy program.

Additionally, or alternatively, in any of the above embodiments with respect to the second illustrative embodiment, the controller may be further configured to, along with confirming whether the arrhythmia is occurring, determine if the arrhythmia is hemodynamically stable or hemodynamically unstable.

Additionally, or alternatively, in any of the above embodiments with respect to the second illustrative embodiment, the controller may be further configured to transmit a confirmation message to the remote device after confirming that a cardiac arrhythmia is occurring.

Additionally, or alternatively, in any of the above embodiments with respect to the second illustrative embodiment, the sensor may be an accelerometer. Additionally, or alternatively, in any of the above embodiments with respect to the second illustrative embodiment, the sensor may comprise one or more of a flow sensor and a pressure sensor

In a third illustrative embodiment, a method for detecting a cardiac arrhythmia of a patient's heart may comprise receiving, by a leadless cardiac pacemaker fixed in the patients' heart, an indication from a remote device that a cardiac arrhythmia is detected, monitoring, by the leadless cardiac pacemaker, a signal generated by a sensor that is located within the patient's heart, and based at least in part on the monitored signal, confirming whether a cardiac arrhythmia is occurring or not. In some embodiments, the method may further comprise, if a cardiac arrhythmia is confirmed, delivering a therapy to treat the cardiac arrhythmia.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, the method may further comprise transmitting the monitored signal from the leadless cardiac pacemaker to the remote device and the remote device using the transmitted monitored signal to confirm whether a cardiac arrhythmia is occurring or not,

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, the leadless cardiac pacemaker may confirm whether a cardiac arrhythmia is occurring or not, and if a cardiac arrhythmia is confirmed, may transmit a confirmation message to the remote device.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, the remote device may deliver the therapy to treat the cardiac arrhythmia.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, the sensor may comprise an accelerometer, and the accelerometer may be part of the leadless cardiac pacemaker.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, the sensor may comprise one or more of a flow sensor and a pressure sensor.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, confirming whether a cardiac arrhythmia is occurring or not may comprise determining whether there is synchronicity between a cardiac electrical signal of the patients' heart and the monitored signal. Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, determining whether there is synchronicity between the cardiac electrical signal of the patients' heart and the monitored signal may comprise determining an occurrence of one or more peaks in the monitored signal having an amplitude above a threshold amplitude within a predefined monitoring window after an occurrence of a cardiac event detected in the cardiac electrical signal.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, confirming whether the cardiac arrhythmia is occurring may comprise determining whether a frequency of the monitored signal is greater than a threshold frequency.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, determining whether the cardiac arrhythmia is occurring may comprise determining whether a maximum amplitude of the sampled signal is below a threshold amplitude.

Additionally, or alternatively, in any of the above embodiments with respect to the third illustrative embodiment, monitoring the signal generated by the sensor may comprise sampling the signal, and wherein the signal may be sampled at a higher sample rate after receiving an indication from the remote device that a cardiac arrhythmia is detected than before receiving an indication from the remote device that a cardiac arrhythmia is detected.

in a fourth illustrative embodiment, a method may comprise sampling, by a leadless cardiac pacemaker, a signal generated by a sensor in accordance with a first set of sampling parameters, receiving, by the leadless cardiac pacemaker, an indication from a remote device that a cardiac arrhythmia is detected, and after receiving the indication of an occurrence of a cardiac arrhythmia, sampling by the leadless cardiac pacemaker, the signal generated by the sensor in accordance with a second set of sampling parameters, wherein the second set of sampling parameters are different from the first set of sampling parameters. In some embodiments, the method may further comprise confirming, based on the signal sampled according to the second set of sampling parameters, whether a cardiac arrhythmia is occurring or not, and, if a cardiac arrhythmia is confirmed, delivering a therapy to treat the cardiac arrhythmia.

Additionally, or alternatively, in any of the above embodiments with respect to the fourth illustrative embodiment, the method may further comprise transmitting the sampled signal from the leadless cardiac pacemaker to the remote device and the remote device using the transmitted sampled signal to confirm whether a cardiac arrhythmia is occurring or not.

Additionally, or alternatively, in any of the above embodiments with respect to the fourth illustrative embodiment, the leadless cardiac pacemaker may confirm whether a cardiac arrhythmia is occurring or not, and if a cardiac arrhythmia is confirmed, may transmit a confirmation message to the remote device.

Additionally, or alternatively, in any of the above embodiments with respect to the fourth illustrative embodiment, the remote device may deliver the therapy to treat the cardiac arrhythmia.

Additionally, or alternatively, in any of the above embodiments with respect to the fourth illustrative embodiment, the sensor may comprise an accelerometer, and the accelerometer may be part of the leadless cardiac pacemaker.

In a fifth illustrative embodiment, a leadless cardiac pacemaker (LCP) may comprise a plurality of electrodes, an accelerometer, and a controller connected to the plurality of electrodes and the accelerometer. In some embodiments, the controller may be configured to receive an indication from another device that an arrhythmia is detected, and in response, confirm whether a cardiac arrhythmia is occurring or not based at least in part on a signal generated by the accelerometer and transmit whether a cardiac arrhythmia is confirmed.

Additionally, or alternatively, in any of the above embodiments with respect to the fifth illustrative embodiment, the controller may be further configured to sense one or more cardiac electrical signals via two or more of the electrodes, and may confirm whether a cardiac arrhythmia is occurring or not based at least in part on the one or more cardiac electrical signals.

Additionally, or alternatively, in any of the above embodiments with respect to the fifth illustrative embodiment, the controller may be configured to confirm whether a cardiac arrhythmia is occurring or not based at least in part on whether there is synchronicity between the one or more cardiac electrical signals and the signal generated by the accelerometer.

Additionally, or alternatively, in any of the above embodiments with respect to the fifth illustrative embodiment, the indication from the another device that an arrhythmia is detected may be recei ved via two or more of the plurality of electrodes.

The above summary is not intended to describe each embodiment or every implementation of the present disclosure. Advantages and attainments, together with a more complete understanding of the disclosure, will become apparent and appreciated by referring to the following description and claims taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure may be more completely understood in consideration of the following description of various illustrative embodiments in connection with the accompanying drawings, in which:

FIG. 1 is a schematic block diagram of an illustrative ieadiess cardiac pacemaker (LCP) according to one embodiment of the present disclosure;

FIG. 2 is a schematic block diagram of another illustrative medical device that may be used in conjunction with the LCP of FIG. 1;

FIG. 3 is a schematic diagram of an exemplary medical system that includes multiple LCPs and/or other devices in communication with one another;

FIG. 4 is a schematic diagram of a system including an LCP and another medical device, in accordance with another embodiment of the present disclosure;

FIG. 5 is a graph showing an illustrative cardiac electrical signal and illustrative accelerometer signals, as well as sensing windows, according to one aspect of the present disclosure;

FIG. 6 is another graph showing an illustrative cardiac electrical signal and illustrative accelerometer signals, as well as sensing windows, according to another aspect of the present disclosure;

FIG. 7 shows an example sensing window that includes a portion of an accelerometer signal of FIG. 6;

FIG. 8 shows another example sensing window that includes a portion of an accelerometer signal of FIG. 6; and

FIG. 9 shows another example sensing window that includes a portion of an accelerometer signal generated during fibrillation of a heart.

While the disclosure is amenable to various modifications and alternative forms, specifics thereof have been shown by way of embodiment in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit aspects of the disclosure to the particular illustrative embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure. DESCRIPTION

The following description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The description and the drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the disclosure.

FIG. 1 is a conceptual schematic block diagram of an exemplary leadless cardiac pacemaker (LCP) that may be implanted on the heart or within a chamber of the heart and may operate to sense physiological signals and parameters and deliver one or more types of electrical stimulation therapy to the heart of the patient. Example electrical stimulation therapy may include bradycardia pacing, rate responsive pacing therapy, cardiac resynchronization therapy (CRT), anti-tachycardia pacing (ATP) therapy and/or the like. As can be seen in FIG. 1, LCP 100 may be a compact device with all components housed within LCP 100 or directly on housing 120. In some instances, LCP 100 may include communication module 102, pulse generator module 104, electrical sensing module 106, mechanical sensing module 108, processing module 110, energy storage module 112, and electrodes 1 14.

As depicted in FIG. 1, LCP 100 may include electrodes 1 14, which can be secured relative to housing 120 and electrically exposed to tissue and/or blood surrounding LCP 100. Electrodes 1 14 may generally conduct electrical signals to and from LCP 100 and the surrounding tissue and/or blood. Such electrical signals can include communication signals, electrical stimulation pulses, and intrinsic cardiac electrical signals, to name a few. Intrinsic cardiac electrical signals may include electrical signals generated by the heart and may be represented by an electrocardiogram (ECG).

Electrodes 114 may include one or more biocompatible conductive materials such as various metals or alloys that are known to be safe for implantation within a human body. In some instances, electrodes 114 may be generally disposed on either end of LCP 100 and may be in electrical communication with one or more of modules 102, 104, 106, 108, and 110. In embodiments where electrodes 114 are secured directly to housing 120, an insulative material may electrically isolate the electrodes 1 14 from adjacent electrodes, housing 120, and/or other parts of LCP 100. In some instances, some or all of electrodes 1 14 may be spaced from housing 120 and connected to housing 120 and/or other components of LCP 100 through connecting wires. In such instances, the electrodes 114 may be placed on a tail (not shown) that extends out away from the housing 120. As shown in FIG. 1, in some embodiments, LCP 100 may include electrodes 114'. Electrodes 114' may be in addition to electrodes 114, or may replace one or more of electrodes 114. Electrodes 114' may be similar to electrodes 114 except that eiectrodes 114' are disposed on the sides of LCP 100. In some cases, eiectrodes 114' may increase the number of eiectrodes by which LCP 100 may deliver communication signals and/or electrical stimulation pulses, and/or may sense intrinsic cardiac electrical signals, communication signals, and/or electrical stimulation pulses.

Electrodes 114 and/or 114' may assume any of a variety of sizes and/or shapes, and may ^¬ be spaced at any of a variety of spacings. For example, electrodes 114 may have an outer diameter of two to twenty millimeters (mm). In other embodiments, electrodes 114 and/or 114' may have a diameter of two, three, five, seven millimeters (mm), or any other suitable diameter, dimension and/or shape. Example lengths for electrodes 114 and/ or 1 14' may include, for example, one, three, five, ten millimeters (mm), or any other suitable length. As used herein, the length is a dimension of electrodes 114 and/or 1 14' that extends away from the outer surface of the housing 120. In some instances, at least some of electrodes 114 and/or 114' may be spaced from one another by a distance of twenty, thirty, forty, fifty millimeters (mm), or any other suitable spacing. The electrodes 1 14 and/or 1 14' of a single device may have different sizes with respect to each other, and the spacing and/or lengths of the electrodes on the device may or may not be uniform.

In the embodiment shown, communication module 102 may be electrically coupled to electrodes 114 and/or 1 14' and may be configured to deliver communication pulses to tissues of the patient for communicating with other devices such as sensors, programmers, other medical devices, and/or the like. Communication signals, as used herein, may be any modulated signal that conveys information to another device, either by itself or in conjunction with one or more other modulated signals. In some embodiments, communication signals may be limited to subthreshold signals that do not result in capture of the heart yet still convey information. The communication signals may be delivered to another device that is located either external or internal to the patient's body. In some instances, the communication may take the form of distinct communication pulses separated by various amounts of time. In some of these cases, the timing between successive pulses may convey information. Communication module 102 may additionally be configured to sense for communication signals delivered by other devices, which may be located external or internal to the patient's body.

Communication module 102 may communicate to help accomplish one or more desired functions. Some example functions include delivering sensed data, using communicated data for determining occurrences of events such as arrhythmias, coordinating delivery of electrical stimulation therapy, and/or other functions. In some cases, LCP 100 may use communication signals to communicate raw information, processed information, messages and/or commands, and/or other data. Raw information may include information such as sensed electrical signals (e.g. a sensed ECG), signals gathered from coupled sensors, and the like. In some embodiments, the processed information may include signals that have been filtered using one or more signal processing techniques. Processed information may also include parameters and/or events that are determined by the LCP 100 and/or another device, such as a determined heart rate, timing of determined heartbeats, timing of other determined events, determinations of threshold crossings, expirations of monitored time periods, accelerometer signals, activity level parameters, blood- oxygen parameters, blood pressure parameters, heart sound parameters, and the like. Messages and/or commands may include instructions or the like directing another device to take action, notifications of imminent actions of the sending device, requests for reading from the receiving device, requests for writing data to the receiving device, information messages, and/or other messages commands.

In at least some embodiments, communication module 102 (or LCP 100) may further include switching circuitry to selectively connect one or more of electrodes 114 and/or 114' to communication module 102 in order to select which electrodes 1 14 and/or 114' that communication module 102 delivers communication pulses. It is contemplated that communication module 102 may be communicating with other devices via conducted signals, radio frequency (RF) signals, optical signals, acoustic signals, inductive coupling, and/or any other suitable communication methodology. Where communication module 102 generates electrical communication signals, communication module 102 may include one or more capacitor elements and/or other charge storage devices to aid in generating and delivering communication signals. In the embodiment shown, communication module 102 may use energy stored in energy storage module 112 to generate the communication signals. In at least some examples, communication module 102 may include a switching circuit that is connected to energy storage module 112 and, with the switching circuitry, may connect energy storage module 112 to one or more of electrodes 114/114' to generate the communication signals.

As shown in FIG. 1 , a pulse generator module 104 may be electrically connected to one or more of electrodes 114 and/or 114'. Pulse generator module 104 may be configured to generate electrical stimulation pulses and deliver the electrical stimulation pulses to tissues of a patient via one or more of the electrodes 114 and/or 14' in order to effectuate one or more electrical stimulation therapies. Electrical stimulation pulses as used herein are meant to encompass any electrical signals that may be delivered to tissue of a patient for purposes of treatment of any type of disease or abnormality. For example, when used to treat heart disease, the pulse generator module 104 may generate electrical stimulation pacing pulses for capturing the heart of the patient, i.e. causing the heart to contract in response to the delivered electrical stimulation pulse. In some of these cases, LCP 100 may vary the rate at which pulse generator 104 generates the electrical stimulation pulses, for example in rate adaptive pacing. In other embodiments, the electrical stimulation pulses may include defibrillation/cardioversion pulses for shocking the heart out of fibrillation or into a normal heart rhythm. In yet other embodiments, the electrical stimulation pulses may include anti-tachycardia pacing (ATP) pulses. It should be understood that these are just some examples. When used to treat other ailments, the pulse generator module 104 may generate electrical stimulation pulses suitable for neurostimulation therapy or the like. Pulse generator module 104 may include one or more capacitor elements and/or other charge storage devices to aid in generating and delivering appropriate electrical stimulation pulses. In at least some embodiments, pulse generator module 104 may use energy stored in energy storage module 112 to generate the electrical stimulation pulses. In some particular embodiments, pulse generator module 104 may include a switching circuit that is connected to energy storage module 112 and may connect energy storage module 112 to one or more of electrodes 114/114' to generate electrical stimulation pulses.

LCP 100 may further include an electrical sensing module 106 and mechanical sensing module 108. Electrical sensing module 106 may be configured to sense intrinsic cardiac electrical signals conducted from electrodes 114 and/or 114' to electrical sensing module 106. For example, electrical sensing module 106 may be electrically connected to one or more electrodes 114 and/or 114' and electrical sensing module 106 may be configured to receive cardiac electrical signals conducted through electrodes 114 and/or 114' via a sensor amplifier or the like. In some embodiments, the cardiac electrical signals may represent local information from the chamber in which LCP 100 is implanted. For instance, if LCP 100 is implanted within a ventricle of the heart, cardiac electrical signals sensed by LCP 100 through electrodes 114 and/or 1 14' may represent ventricular cardiac electrical signals. Mechanical sensing module 108 may include, or be electrically connected to, various sensors, such as accelerometers, including multi-axis accelerometers such as two- or three-axis accelerometers, gyroscopes, including multi-axis gyroscopes such as two- or three-axis gyroscopes, blood pressure sensors, heart sound sensors, piezoelectric sensors, blood-oxygen sensors, and/or other sensors which measure one or more physiological parameters of the heart and/or patient. Mechanical sensing module 108, when present, may gather signals from the sensors indicative of the various physiological parameters. Both electrical sensing module 106 and mechanical sensing module 108 may be connected to processing module 110 and may provide signals representative of the sensed cardiac electrical signals and/or physiological signals to processing module 1 10. Although described with respect to FIG. 1 as separate sensing modules, in some embodiments, electrical sensing module 106 and mechanical sensing module 108 may be combined into a single module, in at least some examples, LCP 100 may only include one of electrical sensing module 106 and mechanical sensing module 108. In some cases, any combination of the processing module 110, electrical sensing module 106, mechanical sensing module 108, communication module 102, pulse generator module 104 and/or energy storage module may be considered a controller of the LCP 100.

Processing module 1 10 may be configured to direct the operation of LCP 1 00 and may, in some embodiments, be termed a controller. For example, processing module 1 10 may be configured to receive cardiac electrical signals from electrical sensing module 106 and/or physiological signals from mechanical sensing module 108. Based on the received signals, processing module 110 may determine, for example, occurrences and types of arrhythmias and other determinations such as whether LCP 100 has become dislodged. Processing module 1 10 may further receive information from communication module 102. In some embodiments, processing module 1 10 may additionally use such received information to determine occurrences and types of arrhythmias and/or and other determinations such as whether LCP 100 has become dislodged. In still some additional embodiments, LCP 100 may use the received information instead of the signals received from electrical sensing module 106 and/or mechanical sensing module 108 - for instance if the received information is deemed to be more accurate than the signals received from electrical sensing module 106 and/or mechanical sensing module 108 or if electrical sensing module 106 and/or mechanical sensing module 108 have been disabled or omitted from LCP 100.

After determining an occurrence of an arrhythmia, processing module 1 10 may control pulse generator module 104 to generate electrical stimulation pulses in accordance with one or more electrical stimulation therapies to treat the determined arrhythmia. For example, processing module 1 10 may control pulse generator module 104 to generate pacing pulses with varying parameters and in different sequences to effectuate one or more electrical stimulation therapies. As one example, in controlling pulse generator module 104 to deliver bradycardia pacing therapy, processing module 110 may control pulse generator module 104 to deliver pacing pulses designed to capture the heart of the patient at a regular interval to help prevent the heart of a patient from falling below a predetermined threshold. In some cases, the rate of pacing may be increased with an increased activity level of the patient (e.g. rate adaptive pacing). For instance, processing module 110 may monitor one or more physiological parameters of the patient which may indicate a need for an increased heart rate (e.g. due to increased metabolic demand). Processing module 1 10 may then increase the rate at which pulse generator 104 generates electrical stimulation pulses.

For ATP therapy, processing module 1 10 may control pulse generator module 104 to deliver pacing pulses at a rate faster than an intrinsic heart rate of a patient in attempt to force the heart to beat in response to the delivered pacing pulses rather than in response to intrinsic cardiac electrical signals. Once the heart is following the pacing pulses, processing module 1 10 may- control pulse generator module 104 to reduce the rate of delivered pacing pulses down to a safer level. In CRT, processing module 1 10 may control pulse generator module 104 to deliver pacing pulses in coordination with another device to cause the heart to contract more efficiently. In cases where pulse generator module 104 is capable of generating defibrillation and/or cardioversion pulses for defibrillation/cardioversion therapy, processing module 1 10 may control pulse generator module 104 to generate such defibrillation and/ or cardioversion pulses. In some cases, processing module 110 may control pulse generator module 104 to generate electrical stimulation pulses to provide electrical stimulation therapies different than those examples described above. Aside from controlling pulse generator module 104 to generate different types of electrical stimulation pulses and in different sequences, in some embodiments, processing module 110 may also control pulse generator module 104 to generate the various electrical stimulation pulses with varying pulse parameters. For example, each electrical stimulation pulse may have a pulse width and a pulse amplitude. Processing module 110 may control pulse generator module 104 to generate the various electrical stimulation pulses with specific pulse widths and pulse amplitudes. For example, processing module 1 10 may cause pulse generator module 04 to adjust the pulse width and/or the pulse amplitude of electrical stimulation pulses if the electrical stimulation pulses are not effectively capturing the heart. Such control of the specific parameters of the various electrical stimulation pulses may help LCP 100 provide more effective delivery of electrical stimulation therapy.

In some embodiments, processing module 110 may further control communication module 102 to send information to other devices. For example, processing module 110 may control communication module 102 to generate one or more communication signals for communicating with other devices of a system of devices. For instance, processing module 1 1 0 may control communication module 102 to generate communication signals in particular pulse sequences, where the specific sequences convey different information. Communication module 102 may also receive communication signals for potential action by processing module 1 10.

In further embodiments, processing module 1 1 0 may control switching circuitry by which communication module 102 and pulse generator module 104 deliver communication signals and/or electrical stimulation pulses to tissue of the patient. As described above, both communication module 102 and pulse generator module 104 may include circuitry for connecting one or more electrodes 114 and/1 14' to communication module 102 and/or pulse generator module 104 so those modules may deliver the communication signals and electrical stimulation pulses to tissue of the patient. The specific combination of one or more electrodes by which communication module 102 and/or pulse generator module 104 deliver communication signals and electrical stimulation pulses may influence the reception of communication signals and/or the effectiveness of electrical stimulation pulses. Although it was described that each of communication module 102 and pulse generator module 104 may include switching circuitry, in some embodiments, LCP 100 may have a single switching module connected to the communication module 102, the pulse generator module 104, and electrodes 1 14 and/or 114'. In such embodiments, processing module 110 may control the switching module to connect modules 102/104 and electrodes 114/114' as appropriate.

In some embodiments, processing module 1 10 may include a pre-programmed chip, such as a very-large-scale integration (VLSI) chip or an application specific integrated circuit (ASIC). In such embodiments, the chip may be pre-programmed with control logic in order to control the operation of LCP 100. By using a pre-programmed chip, processing module 1 10 may use less power than other programmable circuits while able to maintain basic functionality, thereby potentially increasing the battery life of LCP 100. In other instances, processing module 1 10 may include a programmable microprocessor or the like. Such a programmable microprocessor may allow a user to adjust the control logic of LCP 100 after manufacture, thereby allowing for greater flexibility of LCP 100 than when using a pre-programmed chip. In still other embodiments, processing module 110 may not be a single component. For example, processing module 110 may include multiple components positioned at disparate locations within LCP 00 in order to perform the various described functions. For example, certain functions may be performed in one component of processing module 1 10, while other functions are performed in a separate component of processing module 110.

Processing module 110, in additional embodiments, may include a memory circuit and processing module 110 may store information on and read information from the memory circuit. In other embodiments, LCP 100 may include a separate memory circuit (not shown) that is in communication with processing module 110, such that processing module 110 may read and write information to and from the separate memory circuit. The memory circuit, whether part of processing module 110 or separate from processing module 1 10, may be volatile memory, nonvolatile memory, or a combination of volatile memory and non-volatile memory.

Energy storage module 1 12 may provide a power source to LCP 100 for its operations. In some embodiments, energy storage module 112 may be a non-rechargeable lithium-based battery. In other embodiments, the non-rechargeable battery may be made from other suitable materials. In some embodiments, energy storage module 1 12 may include a rechargeable battery. In still other embodiments, energy storage module 112 may include other types of energy storage devices such as capacitors or super capacitors.

To implant LCP 100 inside a patient's body, an operator (e.g., a physician, clinician, etc.), may fix LCP 100 to the cardiac tissue of the patient's heart. To facilitate fixation, LCP 100 may include one or more anchors 116. The one or more anchors 116 are shown schematically in FIG. 1. The one or more anchors 116 may include any number of fixation or anchoring mechanisms. For example, one or more anchors 116 may include one or more pins, staples, threads, screws, helix, tines, and/or the like. In some embodiments, although not shown, one or more anchors 116 may include threads on its external surface that may run along at least a partial length of an anchor member. The threads may provide friction between the cardiac tissue and the anchor to help fix the anchor member within the cardiac tissue. In some cases, the one or more anchors 1 16 may include an anchor member that has a cork-screw shape that can be screwed into the cardiac tissue. In other embodiments, anchor 116 may include other structures such as barbs, spikes, or the like to facilitate engagement with the surrounding cardiac tissue.

In some examples, LCP 100 may be configured to be implanted on a patient's heart or within a chamber of the patient's heart. For instance, LCP 100 may be implanted within any of a left atrium, right atrium, left ventricle, or right ventricle of a patient's heart. By being implanted within a specific chamber, LCP 100 may be able to sense cardiac electrical signals originating or emanating from the specific chamber that other devices may not be able to sense with such resolution. Where LCP 100 is configured to be implanted on a patient's heart, LCP 100 may be configured to be implanted on or adjacent to one of the chambers of the heart, or on or adjacent to a path along which intrinsically generated cardiac electrical signals generally follow. In these examples, LCP 100 may also have an enhanced ability to sense localized intrinsic cardiac electrical signals and deliver localized electrical stimulation therapy.

FIG. 2 depicts an embodiment of another device, medical device (MD) 200, which may operate to sense physiological signals and parameters and deliver one or more types of electrical stimulation therapy to tissues of the patient. In the embodiment shown, MD 200 may include a communication module 202, a pulse generator module 204, an electrical sensing module 206, a mechanical sensing module 208, a processing module 210, and an energy storage module 218. Each of modules 202, 204, 206, 208, and 210 may be similar to modules 102, 104, 106, 108, and 110 of LCP 100. Additionally, energy storage module 218 may be similar to energy storage module 1 12 of LCP 100. However, in some embodiments, MD 200 may have a larger volume within housing 220. In such embodiments, MD 200 may include a larger energy storage module 218 and/or a larger processing module 210 capable of handling more complex operations than processing module 110 of LCP 100. While MD 200 may be another leadless device such as shown in FIG. 1, in some instances MD 200 may include leads, such as leads 212. Leads 212 may include electrical wires that conduct electrical signals between electrodes 214 and one or more modules located within housing 220. In some cases, leads 212 may be connected to and extend away from housing 220 of MD 200. In some embodiments, leads 212 are implanted on, withm, or adjacent to a heart of a patient. Leads 212 may contain one or more electrodes 214 positioned at various locations on leads 212 and various distances from housing 220. Some leads 212 may only include a single electrode 214, while other leads 212 may include multiple electrodes 214. Generally, electrodes 214 are positioned on leads 212 such that when leads 212 are implanted withm the patient, one or more of the electrodes 214 are positioned to perform a desired function. In some cases, the one or more of the electrodes 214 may be in contact with the patient's cardiac tissue. In other cases, the one or more of the electrodes 2 4 may be positioned subcutaneously but adjacent the patient's heart. The electrodes 214 may conduct intrinsically generated electrical cardiac signals to leads 212. Leads 212 may, in turn, conduct the received electrical cardiac signals to one or more of the modules 202, 204, 206, and 208 of MD 200. In some cases, MD 200 may generate electrical stimulation signals, and leads 212 may conduct the generated electrical stimulation signals to electrodes 214. Electrodes 214 may then conduct the electrical stimulation signals to the cardiac tissue of the patient (either directly or indirectly). MD 200 may also include one or more electrodes 214 not disposed on a lead 212. For example, one or more electrodes 214 may be connected directly to housing 220.

Leads 212, in some embodiments, may additionally contain one or more sensors, such as accelerometers, blood pressure sensors, heart sound sensors, blood-oxygen sensors, and/or other sensors which are configured to measure one or more physiological parameters of the heart and/or patient. In such embodiments, mechanical sensing module 208 may be in electrical communication with leads 212 and may receive signals generated from such sensors.

While not required, in some embodiments MD 200 may be an implantable medical device. In such embodiments, housing 220 of MD 200 may be implanted in, for example, a transthoracic region of the patient. Housing 220 may generally include any of a number of known materials that are safe for implantation in a human body and may, when implanted, hermetically seal the various components of MD 200 from fluids and tissues of the patient's body. In such embodiments, leads 212 may be implanted at one or more various locations within the patient, such as within the heart of the patient, adjacent to the heart of the patient, adjacent to the spine of the patient, or any other desired location.

In some embodiments, MD 200 may be an implantable cardiac pacemaker (ICP). In these embodiments, MD 200 may have one or more leads, for example leads 212, which are implanted on or withm the patient's heart. The one or more leads 212 may include one or more electrodes 214 that are in contact with cardiac tissue and/or blood of the patient's heart. MD 200 may be configured to sense intrinsically generated cardiac electrical signals and determine, for example, one or more cardiac arrhythmias based on analysis of the sensed signals. MD 200 may be configured to deliver CRT, ATP therapy, bradycardia therapy, and/or other therapy types via leads 2 2 implanted within the heart. In some embodiments, MD 200 may additionally be configured to provide defibrillation/cardioversion therapy.

In some instances, MD 200 may be an implantable cardioverter-defibrillator (ICD). In such embodiments, MD 200 may include one or more leads implanted within a patient's heart. MD 200 may also be configured to sense electrical cardiac signals, determine occurrences of tachyarrhythmias based on the sensed electrical cardiac signals, and deliver defibrillation and/or cardioversion therapy in response to determining an occurrence of a tachyarrhythmia (for example by delivering defibrillation and/or cardioversion pulses to the heart of the patient). In other embodiments, MD 200 may be a subcutaneous implantable cardioverter-defibrillator (SICD). In embodiments where MD 200 is an SICD, one of leads 212 may be a subcutaneous!}' implanted lead. In at least some embodiments where MD 200 is an SICD, MD 200 may include only a single lead which is implanted subcutaneous!}' but outside of the chest cavity, however this is not required.

In some embodiments, MD 200 may not be an implantable medical device. Rather, MD 200 may be a device external to the patient's body, and electrodes 214 may be skin-electrodes that are placed on a patient's body. In such embodiments, MD 200 may be able to sense surface electrical signals (e.g. electrical cardiac signals that are generated by the heart or electrical signals generated by a device implanted within a patient's body and conducted through the body to the skin). MD 200 may further be configured to deliver various types of electrical stimulation therapy, including, for example, defibrillation therapy via skin-electrodes 214.

FIG. 3 illustrates an embodiment of a medical device system and a communication pathway through which multiple medical devices 302, 304, 306, and/or 310 of the medical device system may communicate. In the embodiment shown, medical device system 300 may include LCPs 302 and 304, external medical device 306, and other sensors/devices 310. External device 306 may be a device disposed external to a patient's body, as described previously with respect to MD 200. In at least some examples, external device 306 may represent an external support device such as a device programmer, as will be described in more detail below. Other sensors/devices 3 0 may be any of the devices described previously with respect to MD 200, such as ICPs, ICDs, and SICDs. Other sensors/devices 310 may also include various diagnostic sensors that gather information about the patient, such as aecelerometers, blood pressure sensors, or the like. In some cases, other sensors/devices 310 may include an external programmer device that may be used to program one or more devices of system 300.

Various devices of system 300 may communicate via communication pathway 308. For example, LCPs 302 and/or 304 may sense intrinsic cardiac electrical signals and may communicate such signals to one or more other devices 302/304, 306, and 310 of system 300 via communication pathway 308. in one embodiment, one or more of devices 302/304 may receive such signals and, based on the received signals, determine an occurrence of an arrhythmia. In some cases, device or devices 302/304 may commumcate such determinations to one or more other devices 306 and 310 of system 300. In some cases, one or more of devices 302/304, 306, and 310 of system 300 may take action based on the communicated determination of an arrhythmia, such as by delivering a suitable electrical stimulation to the heart of the patient. One or more of devices 302/304, 306, and 310 of system 300 may additionally communicate command or response messages via communication pathway 308. The command messages may cause a receiving device to take a particular action whereas response messages may include requested information or a confirmation that a receiving device did, in fact, receive a communicated message or data.

It is contemplated that the various devices of system 300 may communicate via pathway 308 using RF signals, inductive coupling, optical signals, acoustic signals, or any other signals suitable for communication. Additionally, in at least some embodiments, the various devices of system 300 may communicate via pathway 308 using multiple signal types. For instance, other sensors/device 310 may communicate with external device 306 using a first signal type (e.g. RF communication) but communicate with LCPs 302/304 using a second signal type (e.g. conducted communication). Further, in some embodiments, communication between devices may be limited. For instance, as described above, in some embodiments, LCPs 302/304 may communicate with external device 306 only through other sensors/devices 310, where LCPs 302/304 send signals to other sensors/devices 310, and other sensors/devices 310 relay the received signals to external device 306.

In some cases, the various devices of system 300 may communicate via pathway 308 using conducted communication signals. Accordingly, devices of system 300 may have components that allow for such conducted communication. For instance, the devices of system 300 may be configured to transmit conducted communication signals (e.g. a voltage and/or current waveform punctuated with current and/or voltage pulses, referred herein as electrical communication pulses) into the patient's body via one or more electrodes of a transmitting device, and may receive the conducted communication signals via one or more electrodes of a receiving device. The patient's body may "conduct" the conducted communication signals from the one or more electrodes of the transmitting device to the electrodes of the receiving device in the system 300. In such embodiments, the delivered conducted communication signals may differ from pacing pulses, defibrillation and/or cardioversion pulses, or other electrical stimulation therapy signals. For example, the devices of system 300 may deliver electrical communication pulses at an amplitude/pulse width that is sub-threshold. That is, the communication pulses have an amplitude/pulse width designed to not capture the heart. In some cases, the amplitude/pulse width of the delivered electrical communication pulses may be above the capture threshold of the heart, but may be delivered during a refractory period of the heart and/or may be incorporated in or modulated onto a pacing pulse, if desired.

Additionally, unlike normal electrical stimulation therapy pulses, the electrical communication pulses may be delivered in specific sequences which convey information to receiving devices. For instance, delivered electrical communication pulses may be modulated in any suitable manner to encode communicated information. In some cases, the communication pulses may be pulse width modulated and/or amplitude modulated. Alternatively, or in addition, the time between pulses may be modulated to encode desired information. In some cases, a predefined sequence of communication pulses may represent a corresponding symbol (e.g. a logic "1" symbol, a logic "0" symbol, an ATP therapy trigger symbol, etc.). In some cases, conducted communication pulses may be voltage pulses, current pulses, biphasic voltage pulses, biphasic current pulses, or any other suitable electrical pulse as desired. FIG. 4 depicts an illustrative medical device system 400 that may be configured to operate together. For example, system 400 may include multiple devices that are implanted within a patient and are configured to sense physiological signals, determine occurrences of cardiac arrhythmias, and deliver electrical stimulation to treat detected cardiac arrhythmias. In some embodiments, the devices of system 400 may be configured to determine occurrences of dislodgment of one or more devices of system 400. In FIG. 4, an LCP 402 is shown fixed to the interior of the right ventricle of the heart 410, and a pulse generator 406 is shown coupled to a lead 412 having one or more electrodes 408a-408c. In some cases, pulse generator 406 may be part of a subcutaneous implantable cardioverter-defibrillator (SICD), and the one or more electrodes 408a-408c may be positioned subcutaneously adjacent the heart. LCP 402 may communicate with the SICD, such as via communication pathway 308. The locations of LCP 402, pulse generator 406, lead 412, and electrodes 408a-c depicted in FIG. 4 are just exemplary. In other embodiments of system 400, LCP 402 may be positioned in the left ventricle, right atrium, or left atrium of the heart, as desired. In still other embodiments, LCP 402 may be implanted externally adjacent to heart 410 or even remote from heart 410.

Medical device system 400 may also include external support device 420. External support device 420 can be used to perform functions such as device identification, device programming and/or transfer of real-time and/or stored data, between devices using one or more of the communication techniques described herein, or other functions involving communication with one or more devices of system 400. As one example, communication between external support device 420 and pulse generator 406 can be performed via a wireless mode, and communication between pulse generator 406 and LCP 402 can be performed via a conducted communication mode. In some embodiments, communication between LCP 402 and external support device 420 is accomplished by sending communication information through pulse generator 406. However, in other embodiments, communication between the LCP 402 and external support device 420 may be via a communication module.

Figures 4 only illustrates one example embodiment of a medical device system that may be configured to operate according to techniques disclosed herein. Other example medical device systems may include additional or different medical devices and/or configurations. For instance, other medical device systems that are suitable to operate according to techniques disclosed herein may include additional LCPs implanted within the heart. Another example medical device system may include a plurality of LCPs with or without other devices such as pulse generator 406, with at least one LCP capable of delivering defibrillation therapy. Still another example may include one or more LCPs implanted along with a transvenous pacemaker and with or without an implanted SICD. In yet other embodiments, the configuration or placement of the medical devices, leads, and/or electrodes may be different from those depicted in FIG. 4. Accordingly, it should be recognized that numerous other medical device systems, different from system 400 depicted in FIG. 4, may be operated in accordance with techniques disclosed herein. As such, the embodiment shown in FIG. 4 should not be viewed as limiting in any way.

In some embodiments, LCP 100 may be configured to operate in one or more modes. Within each mode, LCP 100 may operate in a somewhat different manner. For instance, in a first mode, LCP 100 may be configured to sense certain signals and/or determine certain parameters. In a second mode, LCP 100 may be configured to sense the signals differently, sense at least some different signals, and/or determine at least some different parameters than in the first mode. In at least one mode, LCP 100 may be configured to confirm whether an arrhythmia of a patient's heart is occurring. For ease of description, a mode that includes LCP 100 being configured to confirm whether an arrhythmia of a patient's heart is occurring may be called an arrhythmia confirmation mode. Other modes may include one or more programming and/or therapy modes, and it may be possible for LCP 100 to be engaged in multiple modes concurrently.

FIG. 5 is a graph 500 showing illustrative signal tracings that represent signals sensed or generated by LCP 100 during a time period when LCP 100 is attached to a wall of a patient's heart and not operating in an arrhythmia confirmation mode. In the example shown in FIG. 5, signal 502 represents a cardiac electrical signal sensed by LCP 100. Signals 504, 506, and 508 all represent signals from different axes generated by a three-axis accelerometer of LCP 100. Signal 510 represents an accelerometer magnitude signal, which may be determined by summing signals 504, 506, and 508 or summing the absolute values of signals 504, 506, and 508. In other embodiments, signal 510 may represent a different signal generated by another combinations of signals 504, 506, and 508, such as a root-mean-square or root-sum-square of signals 504, 506, and 508, or any other derivation of signals 504, 506, and 508 as desired. While various accelerometer signals 504, 506, 508 and 510 are shown, it is contemplated that less or more accelerometer signals may be used.

When not in an arrhythmia confirmation mode, LCP 100 may be configured to sense one or more of signals 504, 506, 508 and/or 510, or generate one or more of signals 504, 506, 508 and/or 510 via the accelerometer, during predetermined time periods. For instance, to sense signals 504, 506, 508 and/or 510, LCP 00 may be configured to receive signals 504, 506, 508 and/or 510 at processing module 110. In some embodiments, LCP 100 may connect an output of the accelerometer to processing module 110 during the time periods where LCP 100 is sensing signals 504, 506, 508 and/or 510. In other embodiments, the accelerometer may be configured to actively output signals 504, 506, 508 and/or 510 during the time periods where LCP 00 is sensing signals 504, 506, 508 and/or 510, for example using a communication link connecting processing module 110. Where processing module 110 is a digital device, sensing signals 504, 506, 508 and/or 510 may include sampling signals 504, 506, 508 and/or 510, which may be done by processing module 110, or the accelerometer may communicate signal samples to processing module 110. In other embodiments, LCP 100 may control the generation of signals 504, 506, 508 and/or 510 by the accelerometer. For instance, LCP 100 may control when power is delivered to the accelerometer, and the accelerometer may only generate signals 504, 506, 508 and/or 510 when power is delivered to the accelerometer, or the accelerometer may only provide a substantial or valid signal at an output during times where power is delivered to the accelerometer. In some cases, LCP 100 may switch the accelerometer from a lower-power state to a higher-power state during time periods where LCP 100 senses the accelerometer signal. Durmg the lower-power state, the accelerometer may not provide an appreciable signal at an output for LCP 100 to sense.

When LCP 100 is not in an arrhythmia confirmation mode, LCP 100 may be configured to sense one or more signals according to a first set of sensing or sampling parameters. For instance, LCP 100 may be configured to sense one or more signals during predetermined time periods and/or at a first sampling rate. Such predetermined time periods may be represented by, for example, sensing periods 512a-512d in FIG. 5. The first set of sensing or sampling parameters may further include the lengths of sensing periods 512a-512d and when sensing periods 512a-512d occur within a cardiac cycle. In some embodiments, sensing periods 512a- 512d may range in length from between about 1 ms to about 5 ms, but this is just an example. In alternative embodiments, sensing periods 512a-512d may only represent one sample. For instance, LCP 100 may only sense a single sample of signals 504, 506, 508 and/or 510 during sensing periods 512a-512d.

Sensing periods 512a-512d may occur at regular intervals, such as eve ? five seconds, every second, every eight hundred milliseconds, every seven hundred milliseconds, or any other suitable interval. Alternatively, LCP 00 may initiate sensing periods 512a-512d after every heartbeat, once every other heartbeat, once every five heartbeats, or at any other suitable frequency or time. In at least some cases, LCP 100 may adjust the timing of the intervals according to a heart rate of the patient such that sensing periods 512a-512d occur during the same portion of each successive cardiac cycle.

In some cases, LCP 00 may implement sensing periods 512a~512d based on one or more detected features of cardiac electrical signal 502. For instance, LCP 100 may detect one or more features of cardiac electrical signal 502, such as cardiac electrical events 511. Cardiac electrical events 511 may, in some cases, represent R-vvaves or other morphological features that may be detected by LCP 100. Upon detection of a cardiac electrical event 51 1 , LCP 100 may initiate a time delay, such as time delay 514. Upon expiration of time delay 514, LCP 100 may initiate sensing periods 512a-512d, during which LCP 100 may sense one or more of signals 504, 506, 508 and 510. In some cases, LCP 100 may adjust time delay 514 based on the heart rate of the patient. For instance, when the heart rate is at a relatively higher rate, LCP 100 may shorten time delay 514, and when the heart rate is at a relatively lower rate, LCP 100 may lengthen time delay 514. This may help to ensure that LCP 100 consistently initiates sensing periods 512a-512d during the same or similar portion of each cardiac cycle.

In some embodiments, the length of time delay 514 may be chosen to align with a portion of the cardiac cycle where the heart is relatively mechanically inactive, such as shown in FIG. 5. For instance, time delay 514 may be chosen so that it expires between, for example, about fifty milliseconds to about one-hundred fifty milliseconds before the beginning of a next cardiac electrical event 511. In other embodiments, time delay 514 may be chosen so that it expires between about three hundred milliseconds and about eight hundred milliseconds after a detected cardiac electrical event 511. In more specific examples, time delay 514 may have a value of about three-hundred fifty milliseconds, about four-hundred milliseconds, about five-hundred milliseconds, about six-hundred milliseconds, about seven-hundred milliseconds, about eight- hundred milliseconds, or any other suitable value. These timings may, in some cases, ensure that sensing periods 512a-512d occur after repolarization of the heart during a cardiac cycle, but before a re-polarization event during the subsequent cardiac cycle.

The specific values used for time delay 514 and/or for the lengths of sensing periods 512a-512d may differ depending on whether a sensed cardiac electrical event is an intrinsic cardiac electrical event or a paced cardiac electrical event. For instance, the interval between detection of a cardiac electrical event and detection of motion of the heart (e.g. using an accelerometer) may be different if the detected cardiac electrical event is an intrinsic event or a paced event. In general, for a paced cardiac electrical event, time delay 514 may be longer than for an intrinsic cardiac electrical event. Additionally, in some embodiments, the lengths of sensing periods 512a-512d may be longer for paced cardiac electrical events than for intrinsic cardiac electrical events.

In some cases, LCP 100 may use the signals sensed during sensing periods 512a-512d to determine one or more patient parameters. For instance, during the portion of the cardiac cycle represented by sensing periods 512a-512d in FIG. 5, the heart muscle may be in a relatively relaxed state while filling with blood. Accordingly, during this portion of the cardiac cycle, the orientation of LCP 100, and hence the accelerometer within LCP 100, may be disposed at a relatively consistent position. This may facilitate LCP 100 in determining a posture of the patient and/or an activity level of the patient by minimizing movement of the accelerometer caused by the contraction of the heart.

To determine a posture of the patient, LCP 100 may compare the accelerometer signal captured during such a sensing period with a stored template accelerometer signal. For example, LCP 100 may be initially programmed by orienting a patient in a first posture and sensing the accelerometer signal (relative to gravity) during one or more sensing periods 512a-512d while the patient is in the first posture. LCP 100 may store the sensed accelerometer signal in memory. In some cases, this may be repeated several times. The LCP may generate an accelerometer signal template for that posture. This process may be repeated for different postures. LCP 100 may then compare current sensed accelerometer signals to the stored accelerometer signal templates to help determine the current posture of the patient.

In some additional or alternative embodiments, LCP 100 may track a patient activity level parameter using the accelerometer signal sensed during the sensing periods 512a-512d. To determine a patient activity level parameter, LCP 100 may determine a difference between the sensed or sampled current accelerometer signal and a previously sensed or sampled accelerometer signal. LCP 100 may generate an activity level parameter based at least in part on this determined difference. In some cases, LCP 100 may store the determined difference and may generate new determined differences on a rolling basis as LCP 100 sensed or samples new current accelerometer signals. When so provided, LCP 100 may determine a patient activity level parameter from multiple of these determined differences. For instance, LCP 100 may sum the differences together over a rolling period of time to produce a patient activity level parameter. LCP 100 may compare the patient activity level parameter to one or more thresholds to determine an activity level of the patient.

In some instances, LCP 100 may use either or both of the determined posture and patient activity level parameter to adjust delivery of therapy to the heart. For instance, where LCP 100 is a pacemaker and configured to deliver electrical stimulation pulses to the heart of the patient, LCP 100 may adjust the rate of delivery of electrical stimulation pulses based on the posture and/or patient activity level parameter. For example, LCP 100 may decrease the rate of delivery of electrical stimulation pulses after determining that a patient has transitioned from a standing posture to a sitting posture. In another example, LCP 100 may be configured to increase the rate of delivery of electrical stimulation pulses after determining an increase in the value of the patient activity level parameter, it should be understood that these are only a few examples of how LCP 100 may adj st the delivery of therapy based on the determined posture and/or patient activity level parameter.

When LCP 100 is in an arrhythmia confirmation mode, LCP 100 may be configured to sense the accelerometer signal(s) differently. For instance, LCP 100 may be configured to use a second set of sensing or sampling parameters when in an arrhythmia confirmation mode. FIG. 6 depicts an example cardiac electrical signal 502', accelerometer signals 504', 506', 508' and 510', and sensing periods 512a' -512d' during which LCP 100 may be configured to sense the accelerometer signals when in an arrhythmia confirmation mode. Alternatively, or additionally, LCP 100 may employ a different algorithm to determine accelerometer signal 510'. As one example, when not in the arrhythmia confirmation mode, LCP 100 may determine accelerometer signal 510 as the root sum square of accelerometer signals 504, 506, and 508. However, when in the arrhythmia confirmation mode, LCP 100 may determine accelerometer signal 510' as the mean sum square of accelerometer signals 504', 506', and 508'. However, this is just one example. In other embodiments, LCP 100 may change the algorithm to determine accelerometer signal 510' from signals 504', 506', and 508' to be any derivation.

As can be seen, time delay 514' of FIG. 6 is relatively shorter than time delay 514 of FIG. 5. The length of time delay 514' may be chosen to generally align sensing periods 512a'- 512d' with the contraction of the heart. For instance, time delay 514' may be chosen so that sensing periods 512a' -512d' fall during a polarization event of the heart. In other embodiments, time delay 514' may be chosen so that sensing periods 512a' -512d' fall just after a polarization event of the heart, but still capture the mechanical motion of the heart during contraction. Although not shown in FIG. 6, in some cases when in an arrhythmia confirmation mode, LCP 100 may also sense accelerometer signals 504', 506', 508' and 510' during sensing periods corresponding to sensing periods 512a-512d shown in FIG. 5 in order to still obtain information related to patient posture and/or activity, if desired.

In some instances, time delay 514' may be about zero milliseconds, about five milliseconds, about ten milliseconds, about fifteen milliseconds, about twenty milliseconds, about twenty-five milliseconds, about thirty milliseconds, about forty milliseconds, or about fifty milliseconds, or any other suitable period of time. In general, time delay 514' may have a value that is less than an electromechanical delay of the heart, which is the delay between when LCP 100 detects a cardiac electrical event 511 ' (e.g. R-wave) and an onset of cardiac wall motion or a threshold amount of cardiac wall motion. In some additional or alternative embodiments, time delay 514' may have a length that changes along with the heart rate of the patient. As one example, for relatively higher heart rates, time delay 514' may be shorter than for relatively lower heart rates.

The lengths of sensing periods 512a' -512d' may vary from between about 50 ms to about 200 ms, and in some specific embodiments, may have lengths of 50 ms, 100 ms, 150 ms, or 200 ms, or any other suitable value. In some further cases, the lengths of sensing periods 512a'- 512d' may be substantially longer, for instance, about half of a cardiac cycle of the patient, about three quarters of the cardiac cycle of the patient, or may span an entire cardiac cycle such that LCP 100 is continually sensing signals 504', 506', 508' and/or 510'. In at least some embodiments, the lengths of sensing periods 512a'-512d' may change with the heart rate of the patient. In general, the lengths of sensing periods 512a' -512d' may be greater than the lengths of sensing periods 512a-512d.

In further additional or alternative embodiments, LCP 100 may employ a higher sampling rate during sensing periods 512a'-512d' when in an arrhythmia confirmation mode than during sensing periods 512a- 512d when not in an arrhythmia confirmation mode.

In general, LCP 100 may be able to use accelerometer signals sensed during a portion of the cardiac cycle that corresponds to sensing periods 512a' -512d' to help confirm whether an arrhythmia is occurring. For example, LCP 100 may be configured to sense one or more signals, determine one or more parameters, and based on the determined one or more parameters, confirm whether an arrhythmia is occurring. The following techniques describe various illustrative ways in which LCP 100 may confirm whether or not an arrhythmia is occurring based on one or more of such sensed signals.

At implantation, LCP 100 may be configured to determine one or more baseline parameters for use in confirming whether or not an arrhythmia is occurring. For instance, LCP 100 may be configured to sense one or more of signals 504', 506', 508' and/or 510' during sensing periods such as sensing periods 512a' -512d' when it is known that the heart is not experiencing an arrhythmia. FIG. 7 shows a window 522 depicting example accelerometer signal portion 520, which may represent a portion of a signal such as signal 510', sensed during a sensing period such as sensing period 512d'. Based on signal portion 520, LCP 100 may determine one or more baseline parameters. One example baseline parameter may include the maximum amplitude of signal portion 520, indicated by amplitude 521. In some instances, LCP 100 may determine the baseline maximum amplitude as an average maximum amplitude across between about 5 signal portions (each following a different heartbeat) and about 20 signal portions in order to smooth out any outlier contractions which may set the baseline maximum amplitude erroneously low or high.

LCP 100 may be further, or alternatively, configured to determine a synchronicity parameter. For instance, LCP 100 may determine a time at which the maximum amplitude of signal portion 520 occurs, such as time 523 in FIG. 7. Determined time 523 may be in relation to a beginning of the sensing period during which LCP 100 senses signal portion 520 or in relation to a detected cardiac electrical signal feature (such as an R-wave) just prior to when LCP 100 begins sensing signal portion 520. As one illustrative example, time 523 may measure the time from the most recent detected cardiac electrical event (e.g. R-wave) to the time of the maximum amplitude of signal portion 520. Accordingly, this baseline synchronicity parameter may indicate a time delay between an occurrence of a cardiac electrical signal feature, or a beginning of a sensing period, and the maximum amplitude of a sensed signal portion. In some instances, LCP 100 may determine the baseline synchronicity parameter as an average of synchronicity parameters across between about 5 signal portions (each following a different heartbeat) and about 20 signal portions in order to smooth out any outlier contractions which may set the baseline synchronicity parameter erroneously low or high.

In some additional or alternative embodiments, window 522 may represent a substantially greater amount of time than that depicted by sensing period 512d' in FIG. 6. For instance, as mentioned, in some embodiments, sensing period 512d' may span a relatively large portion of a cardiac cycle, and in still further embodiments, LCP 100 may sense signals 504', 506', 508' and/or 510' substantially continuously when in an arrhythmia confirmation mode. FIG. 8 depicts example acceierometer signal portion 520', which is a signal sensed from an acceierometer over multiple cardiac cycles. In at least some of these embodiments, LCP 100 may determine a Fourier transform of signal portion 520' and the transform signal may represent a baseline transform signal.

Accordingly, LCP 100 may store these determined baseline parameters and/or signals in a memory and may use one or more of these parameters and/or signals to assist in confirming whether or not an arrhythmia is occurring. As one example, the parameters and/or signals may be useful in confirming whether or not fibrillation is occurring.

When part of a system, LCP 100 may enter an arrhythmia confirmation mode based on a signal communicated from another device, for example pulse generator 406. In some cases, pulse generator 406 may first generate an indication of an occurrence of an arrhythmia (for example, fibrillation) based on signals sensed by pulse generator 406. For instance, pulse generator 406 may sense a cardiac electrical signal and may process the cardiac electrical signal in one or more ways to determine whether fibrillation is occurring. For example, pulse generator 406 may determine an occurrence of a heart rate elevated above a predetermined threshold. If pulse generator 406 determines that fibrillation is occurring (or likely occurring), pulse generator 406 may then communicate an indication that fibrillation is occurring to LCP 100. After receiving the indication, LCP 100 may enter the arrhythmia confirmation mode and confirm whether or not fibrillation is occurring using the sensed electrical and/or accelerometer signals of the LCP 100.

However, in other embodiments, LCP 100 may be a stand-alone device. Accordingly, in such embodiments, LCP 100 may enter the arrhythmia confirmation mode after determining an occurrence of fibrillation based on cardiac electrical signals sensed by LCP 100. In these embodiments, LCP 100 may confirm its own determination of an occurrence fibrillation before implementing one or more therapy protocols.

When in the arrhythmia confirmation mode, in order to confirm whether or not fibrillation is occurring, LCP 100 may be configured to switch to sensing one or more of signals 504', 506', 508' and/or 510' according to the second set of sensing or sampling parameters as described with respect to FIG. 6. FIG. 9 depicts example signal portion 530, which may represent a portion of a signal such as signal 510 or 510' sensed during a sensing period such as sensing period 512d', although captured when the heart is experiencing fibrillation.

Based on signal portion 530, LCP 100 may determine one or more confirmation parameters and/or signals. For instance, LCP 100 may determine a maximum amplitude of signal portion 530, as indicated by maximum amplitude 531. Maximum amplitude 531 ma - represent a confirmation maximum amplitude parameter. LCP 100 may then compare this confirmation maximum amplitude parameter to a threshold. If the confirmation maximum amplitude parameter is below the threshold, LCP 100 may confirm that fibrillation is occurring. For instance, during fibrillation, the heart muscles may quiver rather than fully contract. This may be evident in an accelerometer signal when compared to an accelerometer signal generated during normal heart function.

In some embodiments, the threshold may be a predetermined threshold and may be between about 0.5g and about Ig. However, in other embodiments, the threshold may be related to the baseline maximum amplitude parameter discussed above. In some of these examples, the threshold may be equal to the baseline maximum amplitude parameter. In other examples, the threshold may be equal to a proportion of the baseline maximum amplitude parameter, such as about sixty percent, about seventy percent, about seventy-five percent, about eighty percent, about ninety percent, or any other suitable percentage of the baseline maximum amplitude parameter. In some instances, LCP 100 may track the confirmation maximum amplitude parameter on a rolling basis as an average maximum amplitude across between about 5 signal portions and about 20 signal portions in order to smooth out any outlier samples. Accordingly, in these embodiments, only if this averaged confirmation maximum amplitude parameter falls below the threshold (sometimes by a predetermined amount) does LCP 100 confirm that fibrillation is occurring.

In some additional or alternative embodiments, LCP 100 may determine a confirmation synchronicity parameter. For instance, LCP 100 may determine a time of the maximum amplitude of a signal portion 530, as indicated by time 532. As with time 523, time 532 may be in relation to a beginning of the sensing period during which LCP 100 sensed signal portion 530 or in relation to a detected cardiac electrical signal feature (such as an R-wave) just prior to sensing signal portion 530. LCP 100 may compare time 532 to time 523. If time 532 is not within a threshold of time 523, LCP 100 may confirm that fibrillation is occurring. In some illustrative embodiments, the threshold may range from about 5 ms to about 15 ms and in more specific embodiments may have a value of about 5 ms, 8 ms, 10 ms, 13 ms, or 15 ms, or any other suitable value. In still other embodiments, however, the threshold may be a certain percentage of time 523, such as about ten percent, about fifteen percent, about twenty percent, about twenty-five percent, or any other suitable percentage.

In some instances, LCP 100 may track the confirmation synchronicity parameter on a rolling basis as an average synchronicity parameter across between about 5 signal portions and about 20 signal portions in order to smooth out any outlier samples. Accordingly, in these embodiments, only if this averaged confirmation synchronicity parameter falls below the threshold (sometimes by a predetermined amount) does LCP 100 confirm that fibrillation is occurring.

In further additional or alternative embodiments, LCP 100 may determine a Fourier transform of signal portion 530 resulting in a confirmation transform signal. As described with respect to FIG. 8, LCP 100 may do this where LCP 100 continuously or substantially continuously senses an accelerometer signal during an arrhythmia confirmation mode. In these embodiments, signal portion 530 may be a signal representing multiple cardiac cycles. In some instances, LCP 100 may compare the baseline transform signal discussed above to the confirmation transform signal. For instance, LCP 100 may perform one or more cross - correlation analyses on these signals, resulting in a correlation parameter. If the correlation parameter is below a threshold value, for instance between about 0.6 and about 0.8, LCP 100 may confirm that fibrillation is occurring. In some cases, the correlation threshold may be about 0.6, about 0.65, about 0.7, about 0.75, about 0.8, or any other suitable value.

Additionally, or alternatively, LCP 100 may confirm whether or not fibrillation is occurring without using any determined baseline parameters or signals. For example, LCP 100 may simply determine whether a signal, such as signal portion 530, sensed during an arrhythmia confirmation mode and during a sensing period such as sensing period 5 2d' of FIG. 6 has a maximum amplitude above a threshold, such as threshold 533 of FIG. 9. If LCP 100 determines that signal portion 530 does not have a maximum amplitude above threshold 533, LCP 100 may confirm that fibrillation is occurring.

In further or alternative embodiments, LCP 100 may determine a frequency of signal portion 530. As one example, LCP 100 may determine a Fourier transform of signal portion 530 and may determine the frequency or frequencies with the greatest power. Alternatively, LCP 100 may determine timings of peaks of signal portion 530. LCP 100 may then use these determined timings to determine a frequency. LCP 100 may compare the determmed frequency or frequencies to a threshold and confirm fibrillation is occurring if the frequency is above the threshold. Some example values of a suitable threshold include about 3 Hz or above, about 3.5 Hz, about 4 Hz, and about 4.5 Hz, to name a few.

In additional or other embodiments, LCP 100 may determine a Fourier transform of signal portion 530 and may compare the total power of the determined Fourier transform between about 0.5 Hz and about 4 Hz to a total power threshold. In the determined total power is greater than the total power threshold, LCP 00 may confirm that fibrillation is occurring.

In still some further embodiments, LCP 100 may check the posture of the patient in order to help confirm whether fibrillation is occurring. For instance, fibrillation may cause pain and may not cause sufficient perfusion of blood throughout the patient often resulting in the patient falling down or laying down. Accordingly, after receiving an indication that fibrillation is occurring, LCP 100 may check to see if the posture of the patient has changed from a relatively vertical posture, such as an upright posture, to a relatively horizontal posture, such as a laying down, prone, or supine posture. If LCP 100 determines that such a posture change has occurred, sometimes in combination with one or more other indications of fibrillation, LCP 100 may confirm that fibrillation is occurring.

In some embodiments, LCP 100 may use multiple of these techniques to confirm whether fibrillation is occurring. In general, it is contemplated that LCP 100 may employ any combination of the above described example techniques (and/or other suitable techniques) for confirming whether fibrillation is occurring. In some instances, LCP 100 may confirm that fibrillation is occurring if any of the above described techniques that LCP 100 performs indicate that fibrillation is occurring. In some cases, LCP 100 may determine that fibrillation is occurring only if two (or more) of the techniques that LCP 100 performs indicate that fibrillation is occurring. In some instances, LCP 100 may confirm that fibrillation is occurring only if all of the techniques that LCP 100 performs indicate that fibrillation is occurring.

It is contemplated that LCP 100 may employ a cascading scheme for confirming whether fibrillation is occurring. For example, LCP 100 may initially employ a first of the above described techniques for confirming whether fibrillation is occurring. Only after LCP 100 has determined that the initial technique indicates that fibrillation is occurring may LCP 100 use a second one of the above described techniques to further confirm whether fibrillation is occurring. LCP 100 may continue in this cascading manner until a predetermined number of the techniques have all indicated that fibrillation is occurring. Then, LCP 100 may ultimately confirm that fibrillation is occurring and take action based on this confirmation, as described in more detail below.

In still some further additional or alternative embodiments, LCP 100 may check one or more negative indications of fibrillation. For example, after receiving an indication that fibrillation is occurring, LCP 100 may determine the activity level of the patient. If the activity level of the patient is above a threshold, LCP 100 may confirm that fibrillation is not occurring, even if other techniques used by LCP 100 indicate that fibrillation is occurring. In some instances, LCP 100 may check this negative indication first and, if the activity level indicates that fibrillation is not occurring, LCP 100 may not perform any of the above described techniques and may confirm that fibrillation is not occurring. Alternatively, if LCP 100 determines that the activity level is above a threshold, LCP 100 may perform one or more of the above described techniques in order confirm whether fibrillation is occurring (or not). In some cases, LCP 100 may require a greater number of the performed techniques to indicate that fibrillation is occurring before ultimately confirming that fibrillation is occurring than if the patient activity level had been below the threshold.

The above described techniques were described with respect to LCP 100 confirming whether fibrillation is occurring. However, it is contemplated that it could be another device confirming whether or not fibrillation is occurring. For example, LCP 100 may gather data as described above and communicate that data to another device (e.g. SICD). In some of these embodiments, the other device may be pulse generator 406 or external support device 420. In some cases, the other device may be the same device that communicated the indication of fibrillation to LCP 00 to transition LCP 100 into an arrhythmia confirmation mode. After the other device receives the data from LCP 100, that device may process the received data to confirm whether or not fibrillation is occurring.

Once LCP 100 confirms that fibrillation is occurring, LCP 100 may communicate a message to another device, for example pulse generator 406, indicating the confirmation. Of course, in other embodiments where pulse generator 406 is the device that actually confirms that fibrillation is occurring, pulse generator 406 may communicate a confirmation message to LCP 100 indicating that fibrillation is occurring. Either way, LCP 100 and/or pulse generator 406 may then initiate therapy. For instance, LCP 100 may be configured to initiate anti- tachycardia pacing (ATP) therapy by delivering pacing pulses to the heart of the patient in accordance with an ATP therapy program. Additionally, or alternatively, where pulse generator 406 includes cardioversion/defibrillation capabilities, pulse generator 406 may initiate cardioversion/defibrillation therapy by delivering one or more cardioversion/defibrillation pulses in accordance with a therapy program. In at least some of these embodiments, LCP 100 and pulse generator 406 may coordinate their delivery of therapy. For example, the system may be configured such that LCP 100 may initially attempt ATP therapy and pulse generator 406 may only attempt cardioversion/defibrillation if the ATP therapy failed to terminate the fibrillation.

Although the above described techniques were described with respect to LCP 100 sensing accelerometer signals and using those sensed signals to confirm whether or not fibrillation is occurring, in other embodiments, LCP 100 may sense other signals to confirm whether fibrillation is occurring. For instance, LCP 100 may include a pressure sensor and/or a flow sensor. Accordingly, LCP 100 may sense intra-cardiac blood pressure and/or blood flow through the heart. These signals may also provide information about whether fibrillation is occurring. During fibrillation, pressure within the heart and blood flow through the heart may decrease from normal levels. Accordingly, in some embodiments, instead of (or in addition to) sensing acceierometer signals to confirm whether fibrillation is occurring, LCP 100 may sense blood pressure and/or blood flow signals and use those sensed signals to help confirm whether fibrillation is occurring. In at least some of these embodiments, LCP 100 may use one or more of the techniques described above in relation to using the sensed acceierometer signal(s) to confirm whether fibrillation is occurring with the blood pressure and/or blood flow signal in order to confirm whether fibrillation is occurring. Although, in other embodiments, LCP 100 may use any combination of acceierometer signals, blood pressure signals, and/or blood flow signals to confirm whether fibrillation is occurring.

Further, LCP 100 may be configured to confirm whether different types of arrhythmias are occurring than just fibrillation. For instance, LCP 100 may use the same or similar techniques described above to confirm whether tachycardias are occurring, including Ventricular Tachycardias (VT) and Supraventricular Tachycardias (SVT).

in some instances, a Ventricular Tachycardias (VT) may be detected by finding a relatively high heart rate (e.g. 1 35-200 beats per minute) using the cardiac electrical signals in combination with finding a maximum of the amplitude, the integral or the double integral of one or more of the acceierometer signals to be less than a threshold value (e.g. the mechanical amplitude of a heartbeat is less than with no VT). A Supraventricular Tachycardias (SVT) may be detected by sensing for the atrial kick of the heart using the acceierometer signals, and also determining if the detected atrial kick is in synchronization with the ventricle contractions (e.g. in sync with the R-wave). If they are in sync, the arrhythmia is likely an SVT, in which cardioversion/defibrillation therapy (e.g. shock) should not be applied.

LCP 100 may further be configured to differentiate when it is appropriate to deliver tachycardia therapy (e.g. ATP or defibrillation therapy) during VT and/or SVT events. If the patient is hemodynamicaily stable during a VT or SVT event, it may not be necessary, or appropriate, to deliver tachycardia therapy. For example, LCP 100 may determine that the intraventricular blood pressure and/or blood flow do not fall below predetermined thresholds during the VT or SVT event. In these examples, the patient may simply be exercising. However if the patient is hemodynamicaily unstable during these events, for instance the intra-ventricuiar blood pressure and/or blood flow do fall below predetermined thresholds, it may be necessary to delivery tachycardia therapy. In other embodiments, LCP 100 may use sensors such as an accelerometer, temperature, and/or impedance to determine hemodynamic stability, as each of these different sensors provide indications of the patient's metabolic demand and supply.

In at least some embodiments, LCP 100 or another device of a system including LCP 100 may further determine whether a confirmed arrhythmia is a symptomatic arrhythmia or an asymptomatic arrhythmia. As an example, LCP 00 or another device may determine whether there is synchronicity between a sensed cardiac electrical signals, such as signal 502', and at least one sensed accelerometer signal, such as signal 510'. LCP 00 or another device may determine whether the accelerometer signal rises above a threshold level within a sensing period following a detected cardiac electrical event, such as sensing period 512d'. In some embodiments, the threshold level may be between about 0.25g and about 0.75g, and in more specific embodiments may have a value of about 0.3g, about 0.35g, about 0.4g, about 0.45g, about 0.5g, about 0.55g, about 0.6g, about 0.65g, about 0.7g, or any other suitable value. Alternatively, LCP 100 or another device may compare the detected accelerometer signal to a template signal using a correlation analysis. If the analysis correlation analysis produces a correlation parameter above a threshold, such as 0.6, 0.65, 0.7, 0.75, 0.8, or any other value, LCP 100 or another device may determine that the arrhythmia is an asymptomatic arrhythmia.

In embodiments where LCP 100 or another device, such as pulse generator 406, determine the arrhythmia is asymptomatic, LCP 100 and/or pulse generator 406 may not initiate therapy. For instance, where LCP 100 confirms that an asymptomatic arrhythmia is occurring, LCP 100 may communicate an indication that the arrhythmia is asymptomatic in addition to an indication confirming that an arrhythmia is occurring to pulse generator 406.

In embodiments where LCP 100 communicates a message indicating the arrhythmia is asymptomatic, LCP 100 and pulse generator 406 may not initiate therapy. Instead, one or more of LCP 100 and pulse generator 406 may store an indication of an occurrence of an arrhythmia for communication to another device. For instance, when the patient is next seen by a doctor, LCP 100 and/or pulse generator 406 may be communicatively coupled to another device, such as external support device 420. During these visits, information collected by LCP 100 and/or pulse generator 406 may be communicated to external support device 420, including indications of arrhythmias. At this point, the physician may note occurrences of one or more asymptomatic arrhythmias for which LCP 100 and pulse generator 406 did not perform therapy and may adjust one or more settings of LCP 100 and/or pulse generator 406, or recommend other treatment to the patient. In some embodiments, instead of storing indications of occurrences of asymptomatic arrhythmias and waiting to communicate with external support device 420, LCP 100 and/ or pulse generator 406 may store the indications of occurrences of asymptomatic arrhythmias and immediately communicate such indications external to the patient. For instance, LCP 100 and/or pulse generator 406 may be connected to one or more wireless networks and may communicate an indication to a server, a computer, or handheld devices such as a phone or pager.

Those skilled in the art will recognize that the present disclosure may be manifested in a variety of forms other than the specific embodiments described and contemplated herein. For instance, as described herein, various embodiments include one or more modules described as performing various functions. However, other embodiments may include additional modules that split the described functions up over more modules than that described herein. Additionally, other embodiments may consolidate the described functions into fewer modules.

Although various features may have been described with respect to less than all embodiments, this disclosure contemplates that those features may be included on any embodiment. Further, although the embodiments described herein may have omitted some combinations of the various described features, this disclosure contemplates embodiments that include any combination of each described feature. Accordingly, departure in form and detail may be made without departing from the scope and spirit of the present disclosure as described in the appended claims.