US Pat. No. 9,108,062

VENTRICULAR PACING TO AUGMENT ATRIAL NATRIURETIC HORMONE PRODUCTION

Cardiac Pacemakers,Inc., ...

16. An apparatus comprising:
a cardiac rhythm management device comprising:
a ventricular pacing circuit, configured to deliver a ventricular pace;
a processor circuit, coupled to the ventricular pacing circuit, the processor configured to comprise a first operating mode,
the processor configured to time delivery of the ventricular pace, when in the first operating mode, so that: delivery of
the ventricular pace is synchronized to occur during an atrial diastole time period, and delivery of the ventricular pace
results in a substantial overlap of ventricular systole and atrial systole; and

a physiologic sensor, coupled to the processor, the physiologic sensor configured to measure physiologic parameters of a subject
including a physical activity, a cardiac output, and a fluid status;

wherein the processor is configured to adjust the first operating mode based on the physiologic parameters, including using
information about the fluid status and limiting use of the first mode of operation to when the physical activity is above
a first threshold and to when cardiac output is below a second threshold.

US Pat. No. 9,521,744

FILTERED FEEDTHROUGH ASSEMBLY FOR IMPLANTABLE MEDICAL ELECTRONIC DEVICES

Cardiac Pacemakers, Inc.,...

1. A filtered feedthrough assembly for an implantable medical device, comprising:
a ferrule configured to be attached to a metal case of the implantable medical device;
an electrical insulator coupled to the ferrule by a connection element;
a feedthrough conductor extending through the electrical insulator;
a printed circuit board (PCB) coupled to at least one of the ferrule and the electrical insulator, the PCB including a ground
layer and a plurality of vias, the connection element being electrically coupled to the ground layer through the vias; and

a capacitor having a ground terminal electrically coupled to the ground layer through at least one of the vias, and a conductor
terminal electrically coupled to the feedthrough conductor.

US Pat. No. 9,352,160

METHOD AND APPARATUS FOR PHRENIC STIMULATION DETECTION

Cardiac Pacemakers, Inc.,...

1. A method, comprising;
delivering a pulse with a predetermined pulse energy;
determining if the delivered pulse produced phrenic stimulation;
if it is determined that the delivered pulse did not produce phrenic stimulation, performing a capture threshold test without
performing a phrenic stimulation threshold test; and

if it is determined that the delivered pulse did produce phrenic stimulation, performing a capture threshold test and a phrenic
stimulation threshold test.

US Pat. No. 9,216,289

METHOD AND APPARATUS FOR CONTROLLING AUTONOMIC BALANCE USING NEURAL STIMULATION

Cardiac Pacemakers, Inc.,...

1. A method for delivering a therapy from a medical device to a patient, comprising:
applying sympathetic inhibition to sympathetic afferent nerve fibers extending from chemoreceptors to the central nervous
system of the patient to decrease sympathetic tone, wherein applying the sympathetic inhibition includes inhibiting sympathetic
nerve traffic in the sympathetic afferent nerve fibers to provide a therapeutic effect.

US Pat. No. 9,308,380

TOROIDAL COMPRESSIBLE ELEMENT INCLUDING A SWITCHBACK PATTERN

Cardiac Pacemakers, Inc.,...

1. An apparatus for use within a header of an implantable medical device, the apparatus comprising:
a substantially annular spring, sized and shaped to be disposed in the header, the spring defining a loop extending about
a central axis and defining a horizontal plane perpendicular to the central axis, the spring including a plurality of elastically
deformable inner and outer switchback portions that both zigzag and curve transversely about the loop to define a surface
that at least partially encompasses the loop, wherein the spring includes a gap running in the horizontal plane, and defined
by a width between an end of the inner switchback portion and an end of the outer switchback portion, the gap dimensioned
such that there is no overlap between the end of the inner switchback portion and the end of the outer switchback portion.

US Pat. No. 9,084,883

THIN PROFILE CONDUCTOR ASSEMBLY FOR MEDICAL DEVICE LEADS

Cardiac Pacemakers, Inc.,...

1. A method for making a conductive assembly for a medical electrical lead, the method comprising:
masking a non-conductive tubular core member by winding a mask helically around the non-conductive tubular core member to
form gaps between adjacent turns of the mask, wherein the tubular core member defines a lumen;

depositing a first conductive layer on the masked tubular core member, the first conductive layer deposited on the non-conductive
tubular core member in the gaps between adjacent turns of the mask;

depositing a second conductive layer on the first conductive layer, wherein the second conductive layer has a conductivity
greater than the first conductive layer;

removing the mask from the tubular core member such that portions of the first conductive layer and the second conductive
layer deposited on the mask are removed with the mask and a helical conductive pattern remains on the tubular core member,
the helical conductive pattern comprising the first conductive layer and the second conductive layer; and

covering the tubular core member and the helical conductive pattern with a first insulative layer.

US Pat. No. 9,138,585

USER INTERFACE SYSTEM FOR USE WITH MULTIPOLAR PACING LEADS

Cardiac Pacemakers, Inc.,...

1. A method for configuring a medical device for use with a multipolar electrode system, the method comprising:
providing to a user an interactive representation of a first set of cardiac electrostimulation vectors, the interactive representation
including display portions corresponding to at least first and second electrostimulation vectors that are available for user-selection
for use in an electrostimulation parameter test, wherein each of the at least first and second electrostimulation vectors
represents a different electric field between at least two electrodes in the multipolar electrode system;

receiving a first selection of the first electrostimulation vector from among the first set of cardiac elecuostimulation vectors,
wherein the first electrostimulation vector represents a first electric field between at least first and second electrodes;

providing a visual indication of the first selection of the first electrostimulation vector using the display portion of the
interactive representation corresponding to the selected first electrostimulation vector; and

interactively using the first selection of the first electrostimulation vector, wherein interactively using the first selection
comprises displaying, using the interactive representation, an electrostimulation configuration score for the first electrostimulation
vector, the electrostimulation configuration score based on multiple device-measured electrostimulation parameter test results
associated with the first electrostimulation vector, and the electrostimulation configuration score indicative of a relative
electrostimulation vector preference, the interactively using the first selection further including displaying the electrostimulation
configuration score in the same display portion of the interactive representation corresponding to the first elecuostimulation
vector and in visual correspondence with the displayed first electrostimulation vector.

US Pat. No. 9,083,129

MULTIPOLAR LEAD EVALUATION DEVICE

Cardiac Pacemakers, Inc.,...

1. A lead evaluation device configured for connection to a proximal portion of an implantable lead having a terminal boot,
a plurality of terminal contacts and a terminal pin, the lead evaluation device comprising:
a main body including an opening configured to frictionally engage the terminal boot, the main body including a first side
and an opposing second side;

a channel extending through the main body from the opening, the channel configured to accommodate the proximal portion of
the implantable lead including the plurality of terminal contacts; and

a plurality of terminal contact clips coupled to the main body such that each of the plurality of terminal contact clips,
having one or more external ridges extending horizontally along the terminal contact clip and configured to provide a contact
for an alligator clip and one or more internal ridges arranged extending vertically along the terminal contact clip, wherein
each of the plurality of terminal contact clips are biased into a relaxed configuration and positioned to releasably make
electrical contact with a corresponding one of the plurality of terminal contacts via the one or more internal ridges when
the implantable lead is disposed within the channel and in response to a force applied by placing the alligator clip.

US Pat. No. 9,333,342

SYSTEM AND METHODS FOR CHRONIC FIXATION OF MEDICAL DEVICES

CARDIAC PACEMAKERS, INC.,...

1. An implantable apparatus comprising:
an electrostimulation electrode assembly including:
a primary fixation member that is sized, shaped, or configured to be actively engaged or affixed to a target tissue of a patient;
a secondary fixation member that is sized, shaped, or configured to passively bias against the target tissue when the primary
fixation member is engaged or affixed to the target tissue; and

an electrostimulation electrode body having a proximal end and a distal end, the electrode body including at least one electrode,
wherein the electrode body is sized, shaped, or configured to be attached to the primary fixation member and the secondary
fixation member, and to deliver electrostimulation to a stimulation site of the patient via the at least one electrode;

wherein the primary fixation member and the secondary fixation member extend distally from the distal end of the electrode
body;

wherein the secondary fixation member includes an expanded configuration and a collapsed configuration;
wherein the secondary fixation member extends distally a first distance when in the expanded configuration;
wherein the secondary fixation member extends distally a second distance when in the collapsed configuration; and
wherein the first distance is greater than the second distance.

US Pat. No. 9,275,801

SYSTEMS AND METHODS FOR ENHANCED DIELECTRIC PROPERTIES FOR ELECTROLYTIC CAPACITORS

Cardiac Pacemakers, Inc.,...

1. A capacitor adapted to be disposed in an implantable medical device, comprising:
an anode;
a cathode; and
a dielectric separating the anode and the cathode, the dielectric comprising aluminum oxide doped with an oxide having a dielectric
constant greater than aluminum oxide, wherein the oxide is integrated into the aluminum oxide and wherein the doped aluminum
oxide is distributed evenly through the entirety of the dielectric in contact with the anode and the cathode and is configured
to provide an increased energy storage capacity per volume for the capacitor.

US Pat. No. 9,381,358

REMOTE DETECTION OF PHYSIOLOGICAL PARAMETER USING AN IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. A method for operating an implanted neural stimulation device where the implanted neural stimulator includes both a neural
stimulator lead and sensing electrodes that are implanted and where the sensing electrodes of the implanted neural stimulation
device are used for sensing cardiac activity when the sensing electrodes are in a position remote from a heart, the method
comprising:
implementing a neural stimulation therapy stored in the implanted neural stimulation device including delivering the neural
stimulation therapy through the neural stimulator lead, wherein the neural stimulation therapy includes a programmed intermittent
neural stimulation with a programmed duty cycle for cycling between programmed stimulation ON time periods and programmed
stimulation OFF time periods, each of the programmed stimulation ON time periods including a programmed train of pulses followed
by the stimulation OFF time period; and

monitoring cardiac activity, including remotely detecting cardiac activity using the sensing electrodes when the sensing electrodes
are in the position remote from the heart to detect heart rate during implementation of the neural stimulation therapy.

US Pat. No. 9,219,293

CONTROLLING LITHIUM DEPOSITION DURING MANUFACTURE OF A BATTERY

Cardiac Pacemakers, Inc.,...

1. A method of manufacturing a lithium battery for an implantable device, the method comprising:
decreasing the formation of lithium deposits, wherein decreasing the formation of lithium deposits includes conditioning the
battery during manufacture using a controlled rate of discharge and load current, wherein conditioning the battery includes
controlling the rate of discharge of the battery to be the rate of discharge the battery takes to discharge in one hour.

US Pat. No. 9,242,097

SYSTEM AND METHOD FOR MAPPING BARORECEPTORS

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
placing a set of stimulation electrodes on tissue containing a baroreceptor region;
automatically mapping the baroreceptor region using a controller and at least one physiologic response sensor, including:
testing bipolar configurations of the electrodes, each of the bipolar configurations of the electrodes including at least
one of the electrodes configured to function as an anode and at least one other of the electrodes configured to function as
a cathode, wherein testing the bipolar configurations includes stimulating the tissue using each of the bipolar configurations;

for each of the tested bipolar configurations monitoring at least one physiological parameter for a baroreflex response to
stimulation of the tissue; and

recording the baroreflex response for each of the tested bipolar configurations.

US Pat. No. 9,345,888

MRI COMPATIBLE IMPLANTABLE MEDICAL DEVICES AND METHODS

Cardiac Pacemakers, Inc.,...

1. An implantable medical device comprising:
a housing comprising an electrically conductive material;
pulse generation circuitry disposed within the housing for generating electrical voltage pulses;
a protection diode disposed in series with and between the housing and the pulse generation circuitry;
a first switch configured to selectively change between a bipolar mode and a unipolar mode; and
a second switch disposed in series with the protection diode, the second switch configured to interrupt a current path through
the protection diode to selectively isolate the housing from the pulse generation circuitry during magnetic resonance imaging.

US Pat. No. 9,138,151

METHOD AND APPARATUS FOR MANAGEMENT OF HEART FAILURE HOSPITALIZATION

Cardiac Pacemakers, Inc.,...

1. A system for managing a heart failure patient, the system comprising:
a sensor processing circuit configured to receive one or more physiological signals and produce sensor data representative
of the one or more physiological signals; and

a heart failure analyzer circuit coupled to the sensor processing circuit, the heart failure analyzer configured to operate
in a post-hospitalization mode including to:

receive diagnostic data including information about the sensor data, the diagnostic data indicative of one or more conditions
associated with heart failure decompensation, wherein the diagnostic data includes post-hospitalization respiration data associated
with the patient; and

produce a risk class parameter classifying a level of risk for rehospitalization within a specified period using the diagnostic
data.

US Pat. No. 9,403,018

ACTIVITY SENSOR PROCESSING FOR PHRENIC NERVE ACTIVATION DETECTION

Cardiac Pacemakers, Inc.,...

1. An implantable medical device, comprising:
a pulse generator configured to deliver cardiac pacing to a heart;
an accelerometer configured to generate an acceleration signal at an accelerometer output terminal;
a first filter channel configured to attenuate first frequencies of the acceleration signal to produce a first physiological
signal, wherein the first physiological signal provides a measure of a patient's respiration;

a second filter channel, separate from the first filter channel, the second filter channel configured to attenuate second
frequencies of the acceleration signal to produce a second physiological signal indicative of phrenic nerve activation; and

circuitry configured to: determine one or more characteristics of a patient's state based at least in part on the first physiological
signal, identify a phase of respiration of the patient using the first physiological signal, to detect phrenic nerve activation
in a time relation to the phase of respiration caused by cardiac pacing during the phase of respiration based at least in
part on the second physiological signal, and to adjust a value of at least parameter of the cardiac pacing based on detected
phrenic nerve activation.

US Pat. No. 9,491,796

METHODS AND SYSTEMS FOR PROVIDING MULTIPLE ACCESS WITHIN A NETWORK

Cardiac Pacemakers, Inc.,...

1. A method of communicating between a first master node and a first slave node, wherein contention for a carrier of a network
medium occurs between a plurality of master nodes, comprising:
determining at the first master node, whether to send or receive data;at the first master node, gaining use of the carrier; and
sending, from the first master node, a request to send message when the first master node determines to send data to the first
slave node, and a request for request to send message when the first master node determines to receive data from the first
slave node,

wherein the request for request to send message requests another node to send data, and
wherein a sent message includes an access code;
at the first slave node, receiving the request for request to send message having an access code, and determining whether
the access code of the request for request to send message corresponds to the first slave node;

after determining that the access code of the request for request to send message does correspond to the first slave node,
sending a request to send message from the first slave node;

at the first master node, upon receiving the request to send message, sending a clear to send message from the first master
node;

at the first slave node, upon receiving the clear to send message, sending a data send message from the first slave node,
wherein the data send message contains data for use by the first master node;

at the first master node, after receiving the data send message, sending an acknowledge message; and
at the first slave node, receiving the acknowledge message;
wherein the first slave node is an implantable device.

US Pat. No. 9,289,619

TIMING CYCLES FOR SYNCHRONIZED MULTISITE CARDIAC PACING

Cardiac Pacemakers, Inc.,...

1. A method for operating a cardiac rhythm management device to deliver pacing pulses to a heart, comprising:
sensing for an electrical depolarization of a right ventricle during a cardiac cycle through a right ventricular sensing channel;
sensing for an electrical depolarization of a left ventricle during the cardiac cycle through a left ventricular sensing channel;
initiating the VA pacing escape interval for the cardiac cycle relative to a determined first in time sensed ventricular depolarization
for the cardiac cycle when sensing both a left ventricular depolarization and a separate right ventricular depolarization
for the cardiac cycle, wherein the determined first in time sensed ventricular depolarization comprises either the sensed
right ventricular depolarization or the sensed left ventricular depolarization; and

delivering pacing for the cardiac cycle using the VA pacing escape interval.

US Pat. No. 9,227,068

CONCURRENT THERAPY DETECTION IN IMPLANTABLE MEDICAL DEVICES

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
detecting a therapy using an implantable device to implement a process, including:
detecting at least one electrical pulse;
extracting at least one characteristic from the at least one electrical pulse, wherein the therapy includes therapy pulses
with at least one characteristic;

comparing the at least one characteristic of the detected pulse to the at least one characteristic of the therapy pulses;
and

detecting that the therapy is being applied when the at least one characteristic of the detected pulse favorably compares
to the at least one characteristic of the therapy pulses.

US Pat. No. 9,186,498

PACING LEADS WITH A STRUCTURED COATING

Cardiac Pacemakers, Inc.,...

1. An implantable medical device comprising:
a lead body having a distal end and a proximal end;
a lumen extending through the lead body from the distal end to the proximal end;
at least one lead wire extending through the lumen from the distal end to the proximal end, the lead wire having an outer
surface; and

a polymeric coating on at least a portion of the outer surface of the lead wire, wherein the coating comprises a bulk material
and a plurality of flexible microstructures disposed on the bulk material, wherein the microstructures extend outwardly from
a surface of the polymeric coating.

US Pat. No. 9,379,508

IMPLANTABLE LEADS WITH A CONDUCTOR COIL HAVING TWO OR MORE SECTIONS

Cardiac Pacemakers, Inc.,...

1. A method of constructing a coil conductor of an implantable medical lead, the coil conductor having at least a proximal
segment and a distal segment, the method comprising:
winding at least one filars into a coiled configuration over a first section of a mandrel to form the proximal segment, wherein
the proximal segment comprises a first outer diameter and a first pitch, the proximal segment ending at a transition point,
the at least one filars having a coating thereon during the winding of the proximal segment;

removing the coating from a section of the at least one filars; and
winding the section of the at least one filars from the transition point into a coiled configuration over a second section
of the mandrel to form the distal segment, the distal segment comprising a second outer diameter and a second pitch, the distal
segment wound from the section such that the at least one filars are uncoated along the distal segment and are coated along
the proximal segment

wherein an outside diameter of the first section of the mandrel is different from an outside diameter of the second section
of the mandrel.

US Pat. No. 9,314,635

AUTOMATIC BAROREFLEX MODULATION RESPONSIVE TO ADVERSE EVENT

Cardiac Pacemakers, Inc.,...

1. A system for providing baroreflex stimulation, comprising:
an adverse event detector to sense a predetermined adverse event and provide a signal indicative of the adverse event; and
a baroreflex stimulator, including:
a pulse generator to provide a baroreflex stimulation signal for baroreflex therapy; and
a modulator to receive the signal indicative of the adverse event and to modulate the baroreflex stimulation signal based
on the signal indicative of the adverse event, wherein the pulse generator and modulator are configured to cooperate to adjust
blood pressure for the adverse event by providing a first baroreflex therapy when the adverse event is not detected and providing
and a second baroreflex therapy when the adverse event is detected, wherein the baroreflex stimulation signal for the first
baroreflex therapy is different than the baroreflex therapy for the second baroreflex therapy.

US Pat. No. 9,254,390

SYSTEM AND METHODS FOR IMPROVING DEVICE THERAPY USING MULTIPLE SENSOR METRICS

Cardiac Pacemakers, Inc.,...

1. An ambulatory medical device, comprising:
a stimulation generation circuit configured to generate stimulations for stimulating a target site;
a signal analyzer circuit configured to receive one or more physiologic signals and generate two or more signal metrics from
the one or more physiologic signals;

a device parameter adjustment circuit configured to determine a desired device parameter value for a device parameter, the
device parameter adjustment circuit including one or more of:

a sensitivity calculator circuit configured to determine for at least two of the two or more signal metrics a respective sensitivity
to a perturbation to the device parameter in response to the stimulations, the sensitivity determined using a comparison of
values of the same signal metric during stimulations having different values of the device parameter;

a variability calculator circuit configured to determine for at least two of the two or more signal metrics a respective variability
in response to the stimulations;

a covariability calculator circuit configured to determine a covariability between at least two of the two or more signal
metrics in response to the stimulations; and

an information fusion circuit configured to determine the desired device parameter value using at least one of the sensitivity
for the at least two signal metrics, the variability for the at least two signal metrics, or the covariability between the
at least two signal metrics during stimulations having different values of the device parameter; and

a controller circuit configured to be included with or coupled to the signal analyzer circuit, the device parameter adjustment
circuit, and the stimulation generation circuit, the controller circuit configured to program or schedule delivery of the
stimulations using the desired device parameter value.

US Pat. No. 9,174,063

HOUSINGS FOR IMPLANTABLE MEDICAL DEVICES AND METHODS FOR FORMING HOUSINGS

Cardiac Pacemakers, Inc.,...

1. An implantable medical device, comprising:
(a) a metal housing comprising:
(i) a first portion having a base and one or more sidewalls wherein the base and sidewalls each have an interior surface and
an exterior surface and wherein the interior surfaces of the base and sidewalls define a cavity;

(ii) a second portion configured to enclose the cavity defined by the first portion when the housing is assembled;
(iii) one or more structural elements extending from and integrally molded with the interior surface of the first or second
portions of the housing, wherein the one or more structural elements are disposed within the cavity; and

(b) an electronic package configured to be disposed within the housing;
wherein the one or more structural elements are configured to reinforce the structural integrity of the housing.

US Pat. No. 9,132,269

METHOD FOR COATING DEVICES USING ELECTROSPINNING

Cardiac Pacemakers, Inc.,...

1. A medical electrical lead comprising:
an insulative lead body extending from a distal region to a proximal region;
a conductor disposed within the insulative lead body and extending from the proximal region to the distal region;
an electrode disposed on the insulative lead body and in electrical contact with the conductor; and
a non-conductive fibrous matrix comprising polytetrafluoroethylene disposed at least partially over the electrode, the fibrous
matrix having an average fiber diameter between 40 nanometers and 800 nanometers, an average thickness between about 2.54
microns and about 254 microns, and an average fiber-to-fiber spacing between about 10 microns to about 50 microns.

US Pat. No. 9,061,136

SYSTEMS AND METHODS FOR DELIVERING VAGAL NERVE STIMULATION

Cardiac Pacemakers, Inc.,...

1. An implantable medical system for delivering vagal stimulation therapy (VST) using implantable electrodes to a vagus nerve
of a person indicated for a treatment of a cardiovascular disease, comprising:
an implantable device housing;
electrodes on the implantable device housing;
a pulse generator within the implantable device housing, the pulse generator to deliver vagal stimulation (VS) through the
implantable electrodes to the vagus nerve; and

a heart rate detector configured to use the electrodes on the implantable device housing to detect heart rate,
wherein the VST has programmed parameters to deliver a therapeutically-effective dose of VST for the cardiovascular disease
at a programmed intensity below an upper bound below which upper bound the VST does not produce an undesired physiological
response.

US Pat. No. 9,186,512

METHOD AND APPARATUS FOR ORGAN SPECIFIC INFLAMMATION MONITORING

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an implantable sensor configured to be positioned at a lymph node of a subject, wherein the implantable sensor provides a
physiologic sensor signal;

a therapy circuit configured to provide one or more of cardiac pacing therapy, cardiac resynchronization therapy, cardioversion
therapy, and cardiac defibrillation therapy; and

a detection circuit configured to:
detect a change in a physiologic parameter of the lymph node that exceeds a threshold change wherein the change in the physiologic
parameter includes at least one of a change in the electrical impedance of the lymph node that exceeds a threshold impedance
change and a change in at least one of a change in size of the lymph node that exceeds a threshold size change;

generate an indication that the change in the physiologic parameter corresponds to a change in physiological status associated
with the lymph node; and

adjust a parameter of the one or more of cardiac pacing therapy, cardiac resynchronization therapy, cardioversion therapy;
and cardiac defibrillation therapy in response to the generated indication.

US Pat. No. 9,126,045

METHOD AND APPARATUS FOR ADAPTIVE CONTROL OF NEUROSTIMULATION USING CARDIAC RESTITUTION

Cardiac Pacemakers, Inc.,...

1. A neurostimulation system for stimulating a nerve of a patient's autonomic nervous system using an electrode placed on
the nerve, comprising:
a stimulation output circuit configured to deliver neurostimulation through the electrode;
a sensing input configured to receive one or more cardiac signals; and
a control circuit coupled to the stimulation output circuit and the sensing circuit, the control circuit including:
a measurement circuit configured to measure a cardiac interval and a restitution parameter using the one or more cardiac signals;
a restitution analyzer configured to analyze restitution of the restitution parameter, the restitution analyzer including
a slope computer configured to compute a restitution slope using values of the restitution parameter measured at a plurality
of cardiac intervals, the restitution slope being a rate of change of the restitution parameter with respect to change in
the cardiac interval; and

a stimulation controller configured to control an autonomic modulation therapy including the delivery of the neurostimulation
using the restitution slope, the stimulation controller including:

a comparator configured to compare the restitution slope to a specified target range; and
a stimulation adjuster configured to adjust the delivery of the neurostimulation using an outcome of the comparison, the stimulation
adjuster configured to stop the delivery of the neurostimulation in response to the computed restitution slope being within
the specified target range.

US Pat. No. 9,089,710

SYSTEMS AND METHODS TO OPTIMIZE PACING FUSION WITH NATIVE ACTIVATION

Cardiac Pacemakers, Inc.,...

1. A system comprising:
a therapy control circuit configured to:
receive information indicative of an offset duration defining a duration difference between an intrinsic first atrioventricular
(AV) delay of a subject at rest and a second AV delay specified to enhance a cardiac output of a subject heart when the subject
is at rest, the intrinsic first AV delay defining a duration between a paced or sensed event in an atrium of the subject heart
and a sensed event in a ventricle of the subject heart, and the second AV delay defining a duration between a paced or sensed
event in an atrium of the subject heart and a paced event in a ventricle of the subject heart;

receive information about a heart rate of the subject; and
adjust a pacing therapy using information about the received ea rate of the subject, a heart-rate-dependent third. AV delay,
and the offset duration.

US Pat. No. 9,050,472

AUTOMATIC SELECTION OF LEAD CONFIGURATION FOR A NEURAL STIMULATION LEAD

Cardiac Pacemakers, Inc.,...

1. A neurostimulation system comprising:
a neural stimulation lead having a plurality of electrodes, the plurality of electrodes configured for positioning proximate
a portion of the autonomic nervous system;

a neural stimulation circuit, coupled to the plurality of electrodes, to deliver neural stimulation pulses to the plurality
of electrodes;

a user interface, the user interfacing including a display; and
a processor and controller configured to:
control the neural stimulation circuit to deliver first neural stimulation pulses to each of a plurality of electrode configurations,
each electrode configuration comprising one or more of the plurality of electrodes,

receive information related to motor fiber activity that is induced in response to delivery of the first neural stimulation
pulses to each of the plurality of electrode configurations,

prioritize the plurality of electrode configurations based on a first capture threshold of the motor fiber activity,
control the neural stimulation circuit to deliver second neural stimulation pulses to induce additional physiological activity
to a subset of the plurality of electrode configurations identified with a lowest capture threshold for motor fiber activity,
the second neural stimulation pulses having an amplitude greater than the first neural stimulation pulses,

receive information related to one or more physiological responses induced in response to delivery of the second neural stimulation
pulses to the subset of electrode configurations, the one or more physiological responses including intended physiological
activity and undesirable physiological activity,

prioritize the subset of electrode configurations that avoid the undesirable physiological activity and induce intended physiological
activity based on the amplitude being above a second capture threshold for the intended physiological activity, and

represent the prioritization of the subset of electrode configurations as a recommendation on the display.

US Pat. No. 9,431,814

FERRULE FOR IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. An apparatus for providing electrical communication through a housing that is metallic and hermetically sealed, the apparatus
comprising:
a one-piece ferrule that is biocompatible, the ferrule configured to be located at least partially within a passage into an
implantable medical device housing, the ferrule including:

an exterior flange configured to abut an exterior surface of the metallic housing, the exterior flange defining an exit opening;
a tunnel extending from the exterior flange, the tunnel defining a tunnel interior extending away from the exit opening and
terminating at inlet opening of the ferrule;

at least one interior tab extending away from an interior of the tunnel in a direction generally aligned with the exterior
flange such that a first surface of the at least one interior tab faces the exterior flange and a second, opposite surface
of the at least one interior tab faces away from the exterior flange, the at least one interior tab configured to exert a
spring bias with the first surface directly against an interior surface of the metallic housing and toward the exterior flange
while the exterior flange abuts the exterior surface of the metallic housing to draw the exterior flange toward the exterior
surface of the metallic housing;

an electrically insulative insert disposed at least partially inside the tunnel; and
a hermetic seal disposed between the electrically insulative insert and the tunnel.

US Pat. No. 9,314,627

SYSTEMS AND METHODS TO ACCOUNT FOR NECK MOVEMENT DURING NERVE STIMULATION

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
performing a neural stimulation test routine for stimulating a neural target in a cervical region of a patient, wherein a
patient's head is moved into a plurality of positions including a plurality of selected head positions for threshold testing,
and for each of a plurality of selected head positions, performing the neural stimulation test routine includes using a neural
stimulator and electrodes to deliver neural stimulation to test a plurality of electrode configurations to provide threshold
data, and collecting the threshold data;

recording the threshold data for each of the tested electrode configurations for the plurality of selected head positions;
and

recommending an electrode configuration based on the recorded threshold data using an algorithm executed by a processor.
US Pat. No. 9,079,033

RESPIRATION AS A TRIGGER FOR THERAPY OPTIMIZATION

CARDIAC PACEMAKERS, INC.,...

1. A method of operating a medical system, the method comprising:
displaying a preprogrammed menu on a display, the menu displaying an alert criteria used to assess a change in patient status
and further displaying one or more corresponding alert criteria setting for the displayed alert criteria;

the displayed alert criteria settings including at least a baseline respiration rate displayed in a first pull-down menu and
an allowed increase over the baseline respiration rate displayed in a second pull-down menu;

receiving an input from a user to change one or more of the alert criteria settings via the corresponding pull-down menu,
and displaying the changed alert criteria settings via the menu;

configuring alert criteria for assessing the change in patient status based at least in part on the alert criteria settings;
sensing respiration and storing respiration data;
determining a respiration parameter from the respiration data;
assessing the change in patient status including comparing a measure related to the respiration parameter to the configured
alert criteria; and

generating a signal indicating the change in patient status responsive to the comparison.
US Pat. No. 9,066,659

TRANSIENT SENSOR RESPONSE TO POSTURE AS A MEASURE OF PATIENT STATUS

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a processor circuit, including:
a first data input configured to receive information indicative of a change in posture status;
a second data input configured to receive, at multiple instances temporally near or at the change in posture status, a transient
response signal of a physiological parameter in response to the change in posture status, the transient response signal representing
temporal variation of the physiological parameter occurring during the change in posture status; and

a processor-readable medium, including instructions that, when performed by the processor circuit, configure the apparatus
to:

extract a waveform morphology feature from the transient response signal, the waveform morphology feature occurring during
the change in posture status;

provide an indication of a cardiac status using the extracted waveform morphology feature; and
display the indication in an output device; and
a therapy delivery circuit configured to deliver a therapy based at least on the indication of the cardiac status.

US Pat. No. 9,381,371

IMPLANTABLE MEDICAL DEVICE WITH AUTOMATIC TACHYCARDIA DETECTION AND CONTROL IN MRI ENVIRONMENTS

Cardiac Pacemakers, Inc.,...

1. An implantable medical device (IMD) comprising:
one or more leads configured to sense cardiac signals and deliver therapy signals;
a sensor configured to detect the presence of static and time-varying scan fields in a magnetic resonance imaging (MRI) environment;
and

a controller configured to process detect cardiac event based on the cardiac signals, compare the sensed static and time-varying
scan fields to static and time-varying scan field thresholds, and control delivery of a first type of stimulation therapy
and a second type of stimulation therapy as a function of the detection of the cardiac events, the comparison of the sensed
static scan field to the static scan field threshold, and the comparison of the time-varying scan fields to the time-varying
scan field thresholds such that:

when the static and time-varying scan field thresholds are exceeded, the controller disqualifies the cardiac events to inhibit
delivery of the first type of stimulation therapy and the second type of stimulation therapy, and

when the static scan field threshold is exceeded and the time-varying scan field threshold is not exceeded, the controller
processes sensed cardiac events, causes the IMD to deliver the first type of stimulation therapy upon detection of the cardiac
events, and inhibits delivery of the second type of stimulation therapy.

US Pat. No. 9,364,154

DIFFERENTIATING DECOMPENSATION DETECTION BASED ON CO-MORBIDITIES IN HEART FAILURE

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
a port configured to receive co-morbidity information of a subject;
a sensor signal selection circuit configured to select, according to the co-morbidity information, one or more physiological
sensor signals selectable from among a plurality of physiologic sensor signals for monitoring using an implantable medical
device;

a threshold adjustment circuit configured to adjust detection thresholds of the one or more selected physiologic sensor signals
according to the co-morbidity information, wherein the threshold adjustment circuit includes a weighting circuit configured
to change a weighting that a selected physiologic sensor signal is accorded in a heart failure (HF) event determination based
on the co-morbidity information; and

a communication circuit configured to communicate information with the implantable medical device, including an indication
of the one or more selected physiologic sensor signals to monitor and an indication of the adjusted detection thresholds to
the implantable medical device.

US Pat. No. 9,345,894

CONNECTOR BLOCKS FOR A HEADER OF AN IMPLANTABLE DEVICE

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an implantable housing;
a header mounted to the implantable housing and including a connector block cavity; and
a connector block located within the connector block cavity, the connector block including a plastic housing portion, a coil
spring configured to receive a terminal pin, and a metallic termination member connected to the coil spring and exposed outside
the plastic housing portion and configured to electrically couple to a feedthrough that extends from the housing to the header,
wherein the plastic housing portion includes an outer surface with the metallic termination member lying flush against the
outer surface.

US Pat. No. 9,265,960

USE CASE-BASED SERVICES

Cardiac Pacemakers, Inc.,...

1. A method comprising:
receiving a wireless communication signal using an external device, wherein the external device is configured to communicate
with an implantable device and receive the wireless communication signal from at least a third device;

determining, by the external device, a location of the external device according to the wireless communication signal received
in the external device from at least the third device;

receiving user identity information into the external device; and
configuring, by the external device, user access to an implantable device feature according to the determined location and
received user identity information;

presenting, by an external device, a user option to disable delivery of defibrillation therapy by an implantable device;
receiving an indication into the external device to disable delivery of the defibrillation therapy and disabling the defibrillation
therapy in response thereto; and

generating an alert when a triggering event occurs and defibrillation therapy by the implantable device remains disabled.

US Pat. No. 9,295,405

SV/CO TRENDING VIA INTRACARDIAC IMPEDANCE

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a processor circuit, including:
a first data input configured to receive reference impedance information and test impedance information from a thoracic impedance
vector;

a second data input configured to receive a reference indication of a cardiac stroke volume from at least one physiological
sensor; and

a processor-readable medium, including instructions that, when performed by the processor, configure the apparatus to:
extract a test waveform feature from the test impedance information;
extract a reference waveform feature from the reference impedance information;
determine a model for cardiac stroke volume using the reference waveform feature and the reference indication of the cardiac
stroke volume;

determine a test indication of a cardiac stroke volume using the test waveform feature and the model for cardiac stroke volume;
and

provide an indication of a cardiac status using the test indication of a cardiac stroke volume.

US Pat. No. 9,269,251

MEDICAL DATA TRANSPORT OVER WIRELESS LIFE CRITICAL NETWORK

Cardiac Pacemakers, Inc.,...

1. A communicator configured to facilitate communications with a remote server, the communicator comprising:
a processor;
memory coupled to the processor, wherein the memory stores firmware and data transfer instructions, the data transfer instructions
executable by the processor for transferring data to the remote server in accordance with a priority level;

a communications module configured to effect communications with the remote server using each of a plurality of communications
protocols, in accordance with program instructions of the firmware executable by the processor; and

the processor configured to execute program instructions for selecting a communications protocol from the plurality of communications
protocols based at least in part on the priority level and transmitting the data to the remote server using the selected transport
mechanism via the communications protocol.

US Pat. No. 9,403,007

SYSTEMS AND METHODS TO REDUCE SYNCOPE RISK DURING NEURAL STIMULATION THERAPY

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
a posture change detector configured to detect posture transitions including a posture change determined to be indicative
of an increased risk of syncope; and

a neural stimulator configured to deliver a scheduled neural stimulation therapy, the neural stimulator including a syncope
avoidance module configured to temporarily override the scheduled neural stimulation therapy to ameliorate the risk of increased
syncope only in response to detecting the posture change that is determined to be indicative of the increased risk of syncope,
and then return to the scheduled neural stimulation therapy after the risk of syncope from the detected posture change has
subsided.

US Pat. No. 9,387,335

IMPLANTABLE DEVICE HEADER AND METHOD

Cardiac Pacemakers, Inc.,...

1. An implantable medical device comprising:
a device container including an electronic module within the device container, wherein a first wire and a second wire extend
from the device container;

a modular header core including:
a first core module including a first bore hole portion of a first bore hole configured to receive a first electrical component,
the first core module including a first electronic connection feature configured to electrically couple the first electrical
component with the electronic module, wherein the first wire extends from the device container, along a first external surface
of the first core module, and is directly coupled to the first electronic connection feature; and

a second core module including a second bore hole portion of a second bore hole different than the first bore hole, the second
bore hole portion configured to receive a second electrical component, the second core module including a second electronic
connection feature configured to electrically couple the second electrical component with the electronic module, wherein the
second wire extends from the device container, along the first external surface, along a second external surface of the second
core module, and is directly coupled to the second electronic connection feature, and wherein the first core module is detachably
engaged with the second core module prior to overmolding; and

a header shell disposed around the modular header core and attached to the device container.

US Pat. No. 9,345,410

DIAGNOSTIC AND OPTIMIZATION USING EXERCISE RECOVERY DATA

Cardiac Pacemakers, Inc.,...

1. A system comprising:
a sensor interface circuit configured to obtain information indicative of both (1) a physical activity of a subject and (2)
a heart sound of the subject from a mechanical sensor, and to provide a resulting sensor signal;

a signal processor circuit, coupled to the sensor interface circuit to receive the sensor signal, the signal processing circuit
configured to, using information about the sensor signal:

detect a first physical activity level transition from a first elevated activity level to a less elevated activity level;
detect a second physical activity level transition from a different second elevated activity level to the same or different
less elevated activity level;

identify heart sounds corresponding to multiple cardiac cycles following the detected first and second physical activity level
transitions;

determine respective heart sound characteristics for the identified heart sounds; and
determine a physiologic indicator using a trend of the determined heart sound characteristics.

US Pat. No. 9,272,152

REMOTE PROGRAMMING OF MRI SETTINGS OF AN IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. A system comprising:
an implantable medical device (IMD) configured to be programmed with magnetic resonance imaging (MRI) settings for use during
an MRI scan, wherein the IMD stores identity data that uniquely identifies the IMD or a patient having the IMD;

an external storage media configured to receive MRI settings associated with the IMD from a device clinic programmer and configured
to store the MRI settings associated with the IMD; and

a retrieval programmer configured to perform the following steps:
retrieve identity data from the IMD,
initiate contact with the external storage media, retrieve the MRI settings associated with the IMD from the external storage
media, wherein the MRI settings were received by the external storage media before the programmer retrieved the identity data
from the IMD, and

program the IMD using the MRI settings,
wherein the MRI settings comprise a validity timeframe over which the MRI settings will be valid and after which the MRI settings
cannot be retrieved from the external storage media.

US Pat. No. 9,339,231

HEART FAILURE MANAGEMENT TO AVOID REHOSPITALIZATION

Cardiac Pacemakers, Inc.,...

20. A system comprising:
multiple physiologic sensors coupled to an implantable medical device and configured to sense respective physiologic signals;
and

a heart failure analysis module, coupled to the multiple physiologic sensors, the heart failure analysis module including
one or more processor circuits configured to:

receive pre-episode physiologic signal characteristics corresponding to the multiple physiologic signals obtained using one
or more of the physiologic sensors;

receive one or more post-treatment physiologic signal characteristics that are of the same type and different than their corresponding
one or more pre-episode physiologic signal characteristics, the one or more post-treatment physiologic signal characteristics
obtained using the same one or more physiologic sensors as the pre-episode physiologic signal characteristics;

receive a subsequent physiologic signal, after a hospitalization period that includes a subject treatment, the subsequent
physiologic signal corresponding to one of the one or more post-treatment physiologic signal characteristics, the subsequent
physiologic signal obtained using the same one or more physiologic sensors as the pre-episode physiologic signal characteristics
and the post-treatment physiologic signal characteristics;

identify a subsequent physiologic signal characteristic using the subsequent physiologic signal; and
update a therapy provided by the implantable medical device using information about the subsequent physiologic signal characteristic
relative to its corresponding pre-episode physiologic signal characteristic.

US Pat. No. 9,095,265

CARDIAC WAVEFORM TEMPLATE CREATION, MAINTENANCE AND USE

Cardiac Pacemakers, Inc.,...

1. A device for generating a cardiac waveform template, comprising: electrodes; and
a processor configured to execute programmed commands to:
provide target regions, each target region comprising a two dimensional time and amplitude region at a location and further
defined by one or more characteristics comprising a size characteristic, a shape characteristic, and a waveform inflection
characteristic;

establish a template using the target regions;
detect one or more cardiac waveforms with the electrodes; and
adjust at least one dimension or location of at least one of the two dimensional target regions of the template using features
of the one or more detected cardiac waveforms having characteristics similar to those of the target regions.

US Pat. No. 9,101,275

DETERMINING SYSTOLIC TIME INTERVALS USING HEART SOUNDS

Cardiac Pacemakers, Inc.,...

1. A system comprising:
an acoustic energy sensor, configured to sense an acoustic signal of a subject;
a heart sound detector circuit, configured to detect a heart sound signal using the acoustic signal;
a physiological signal sensing circuit configured to detect a physiological pulsatile signal associated with the subject's
pulse and including a pulsatile cervical impedance signal;

a timing circuit, coupled to the heart sound detector circuit and the physiological signal sensing circuit, configured to
calculate a time interval between a feature on the heart sound signal and a feature on the pulsatile signal; and

at least one of an ambulatory medical device or an adjunct device including a diagnostic circuit configured to determine a
physiologic diagnostic indication using information provided by the timing circuit about the time interval between the feature
on the heart sound signal and the feature on the pulsatile signal.

US Pat. No. 9,211,412

CLOSED LOOP NEURAL STIMULATION SYNCHRONIZED TO CARDIAC CYCLES

Cardiac Pacemakers, Inc.,...

1. A method for treating a patient, comprising:
detecting an electric pulse generated by a cardiac rhythm management (CRM) device; and
activating a baroreflex therapy in response to the detected electric pulse, or if the baroreflex therapy is currently activated
increasing an intensity of the baroreflex activation therapy upon detection of the electric pulse.

US Pat. No. 9,375,152

HEART SOUND DETECTION SYSTEMS AND METHODS USING UPDATED HEART SOUND EXPECTATION WINDOW FUNCTIONS

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
a sensor configured to sense a heart sound signal of a patient; and
a heart sound processor circuit, configured to:
receive the heart sound signal;
obtain an initial heart sound expectation window function that describes a heart sound timing, of a specified type of heart
sound, as a first function of at least one physiologic variable, the physiologic variable comprising at least one of intrinsic
vs. non-intrinsic beat, respiration rate, index of circadian timing, or posture, and the first function comprising at least
one characteristic parameter that describes a value of the heart sound timing of the specified type of heart sound at a specified
value of the physiologic variable;

detect a patient heart sound, of the specified type, using the initial heart sound expectation window function and the heart
sound signal;

update the at least one characteristic parameter using timing information from the detected patient heart sound of the specified
type; and

provide an updated heart sound expectation window function, using the updated at least one characteristic parameter, for subsequent
use in detecting a patient heart sound of the specified type, the updated heart sound expectation window function describing
the heart sound timing, of the specified type of heart sound, as a second function different from the first function of the
at least one physiologic variable.

US Pat. No. 9,079,032

POWER SUPPLY MANAGEMENT FOR IMPLANTABLE NEUROSTIMULATION DEVICES

Cardiac Pacemakers, Inc.,...

1. An ambulatory medical device comprising:
a therapy circuit configured to provide a specified neural stimulation current value at an output of the therapy circuit;
an impedance measurement circuit configured to measure a value of impedance at the output of the therapy circuit;
a supply voltage generating circuit configured to provide an adjustable supply voltage value to the therapy circuit including
a first supply voltage value when in a first mode;

a control circuit communicatively coupled to the therapy circuit, the impedance measuring circuit, and the supply voltage
generating circuit, wherein the control circuit, upon receiving an indication to exit the first mode, is configured to:

initiate an impedance measurement by the impedance measurement circuit;
determine a second supply voltage value using the impedance measurement and the specified neural stimulation current value,
wherein the second supply voltage value is sufficient to operate the therapy circuit and to provide the specified neural stimulation
current value to the measured impedance; and

initiate a change from the first supply voltage value to the second supply voltage value.

US Pat. No. 9,242,104

SYSTEMS FOR PATIENT CONTROL OF IMPLANTABLE MEDICAL DEVICE THERAPY

Cardiac Pacemakers, Inc.,...

1. A method performed by an implantable medical device to deliver a therapy to a patient, the method comprising:
delivering the therapy to the patient;
detecting a therapy interruption trigger that is controlled by the patient;
automatically interrupting the therapy in response to the detected therapy interruption trigger;
automatically restoring the therapy after a defined restoration period after the detected therapy interruption trigger;
counting a number of detected therapy interruption triggers over a defined therapy interruption trigger count period, the
counted number of detected therapy interruption triggers over the defined interruption trigger count period being greater
than one, and each of the counted number of detected therapy interruption triggers corresponding to an automatic interruption
in the therapy; and

when the counted number of detected therapy interruption triggers over the defined trigger count period reaches a defined
number of detected therapy interruption triggers greater than one trigger, automatically interrupting the therapy in response
to the detected therapy interruption trigger includes automatically interrupting the therapy until an authorized individual
resets the therapy.

US Pat. No. 9,138,596

OPTICAL DEPOLARIZATION OF CARDIAC TISSUE

Cardiac Pacemakers, Inc.,...

1. A cardiac rhythm management system for stimulating a heart having photosensitive tissue, the system comprising:
a light emitting device configured to emit light having frequency characteristics suitable for depolarization of the photosensitive
tissue;

a tachyarrhythmia detection and classification circuit adapted to detect tachyarrhythmia using a ventricular rate and a plurality
of tachyarrhythmia rate zones each including a threshold rate and classify the detected tachyarrhythmia using one or more
of an atrial rate, the ventricular rate, an onset rate of the detected tachyarrhythmia, a stability parameter indicative of
a degree of variability of the ventricular rate, and a correlation coefficient representative of a correlation between a cardiac
signal waveform sensed during the detected tachyarrhythmia and a template waveform; and

a control circuit coupled to the light emitting device and the tachyarrhythmia detection and classification circuit, the control
circuit adapted to control the emission of the light for a period of time to depolarize the photosensitive tissue in response
to the detected tachyarrhythmia being classified as a type to be terminated.

US Pat. No. 9,457,191

SYSTEM AND METHOD FOR ASSESSING AND SELECTING STIMULATION VECTORS IN AN IMPLANTABLE CARDIAC RESYNCHRONIZATION THERAPY DEVICE

Cardiac Pacemakers, Inc.,...

1. A method of providing CRT therapy to a patient with an implanted multi-site pacing medical device, wherein the method comprises:
determining an electrical delay associated with each of two or more left ventricle electrodes, wherein each of the two or
more left ventricle electrodes is included in a different stimulation vector which includes an anode and a cathode, and wherein
the electrical delay is a measure of time delay between delivery of electrical stimulation to one of a cathode or anode of
a stimulation vector and detecting the electrical stimulation at the other of the anode or cathode of the stimulation vector;

comparing the electrical delay associated with each of the two or more left ventricle electrodes to an electrical delay threshold;
if the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold,
selecting a left ventricle electrode for use during subsequent CRT therapy; and

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold,
selecting two or more of the left ventricle electrodes for use during subsequent CRT therapy.

US Pat. No. 9,227,054

ACTIVE FIXATION LEADS AND METHOD OF ASSEMBLY

Cardiac Pacemakers, Inc.,...

1. A method of manufacturing an elongate lead body including an outer sheath and a multiple lumen internal member, the method
comprising steps of:
extruding the multiple lumen internal member, the multiple lumen internal member including a coil lumen having an extruded
coil lumen cross-sectional area, a cable lumen and longitudinally extending crumple zones formed in an outer surface of the
multiple lumen internal member; and

stringing the extruded multiple lumen internal member through the outer sheath to form the elongate lead body, the coil lumen
having a strung coil lumen cross-sectional area;

wherein the strung coil lumen cross-sectional area is less than about 25 percent smaller than the extruded coil lumen cross-sectional
area after the extruded multiple lumen internal member has been strung through the outer sheath.

US Pat. No. 9,216,291

METHOD AND APPARATUS FOR CONTROLLING NEURAL STIMULATION DURING DISORDERED BREATHING

Cardiac Pacemakers, Inc.,...

1. A neural stimulation system, comprising:
an implantable medical device including:
a therapy output device configured to deliver a neural stimulation therapy treating a non-respiratory disorder;
a therapy delivery controller coupled to the therapy output device, the therapy delivery controller configured to control
the delivery of the neural stimulation therapy treating the non-respiratory disorder;

a respiratory signal input configured to receive a respiratory signal;
a respiratory disorder detector coupled to the respiratory signal input, the respiratory disorder detector configured to detect
a respiratory disorder using the respiratory signal and determine whether the respiratory disorder is caused or worsened by
the neural stimulation therapy treating the non-respiratory disorder; and

a therapy adjustment module coupled to the therapy delivery controller and the respiratory disorder detector, the therapy
adjustment module configured to adjust the delivery of the neural stimulation therapy treating the non-respiratory disorder
in response to a detection of the respiratory disorder caused or worsened by the neural stimulation therapy treating the non-respiratory
disorder.

US Pat. No. 10,237,997

IMD HAVING A CORE CIRCUITRY SUPPORT STRUCTURE

Cardiac Pacemakers, Inc.,...

1. A medical device comprising:a hybrid circuitry assembly comprising a printed circuit board (PCB) having a first surface and a second, parallel surface; and
a core circuitry support structure, comprising:
a frame defining a cavity configured to receive at least a portion of the hybrid circuitry assembly, the frame comprising at least one alignment feature, the at least one alignment feature configured to facilitate the alignment, in only one orientation, of the hybrid circuitry assembly with the core circuitry support structure,
wherein an outer surface of the frame is shaped to correspond to an inside surface of a core assembly housing configured to enclose the hybrid circuitry assembly and the core circuitry support structure.

US Pat. No. 9,403,017

MANAGING PRELOAD RESERVE BY TRACKING THE VENTRICULAR OPERATING POINT WITH HEART SOUNDS

Cardiac Pacemakers, Inc.,...

1. A system comprising:
a preload altering device;
an implantable device including
a transducer;
a control circuit coupled to the transducer, the control circuit configured to cooperate with the transducer to monitor an
S1 heart sound emitted by a heart of a patient, monitor a proxy variable indicating preload exhibited by the heart, and communicate
a control signal to the preload altering device to deliver a level of a diuretic

wherein the control circuit is configured to measure a first state of the patient based on a first monitored S1 heart sound
and a first monitored proxy variable and to measure a second state of a patient based on a second monitored S1 heart sound
and a second monitored proxy variable; and

wherein the control circuit is configured to determine that the heart has reached a critical preload by a comparison of the
first state to the second state; and

wherein the control circuit is configured to determine that the heart has reached a critical preload by a determination of
a slope between the first state and the second state and comparing the slope to a threshold value, the threshold value being
a value that approximately corresponds with the critical preload level on a Frank Starling curve.

US Pat. No. 9,205,271

STYRENE-ISOBUTYLENE COPOLYMERS AND MEDICAL DEVICES CONTAINING THE SAME

Cardiac Pacemakers, Inc.,...

1. An implantable and insertable medical device for electrical stimulation comprising:
an internal member selected from an elongated conductor and an electronic signal generating component; and
an insulating region that comprises:
a first insulating layer disposed over the internal member, the first insulating layer comprising a polyether thermoplastic
polyurethane, a polycarbonate thermoplastic polyurethane, or a polysiloxane thermoplastic polyurethane; and

a second insulating layer disposed over the first insulating layer, the second layer comprising a copolymer that comprises
styrene and isobutylene, wherein the second insulating layer is an outermost layer of the device;

wherein the first insulating layer is directly thermally fused to the second insulating layer.

US Pat. No. 9,409,012

PACEMAKER INTEGRATED WITH VASCULAR INTERVENTION CATHETER

Cardiac Pacemakers, Inc.,...

1. A cardiac pacing system for use during revascularization of a blood vessel, the system comprising:
a percutaneous transluminal vascular intervention (PTVI) device including:
a proximal end portion;
a distal end portion configured to be placed in the blood vessel;
an elongate shaft coupled between the proximal end portion and the distal end portion; and
a plurality of pacing electrodes; and
a pacemaker including:
a flexible circuit substrate affixed to the PTVI device; and
a flexible pacemaker circuit including an electronic circuit built on the flexible circuit substrate, the flexible pacemaker
circuit configured to deliver cardiac pacing pulses through the plurality of pacing electrodes.

US Pat. No. 9,295,845

POST-MI PACING WITH AUTOCAPTURE FUNCTION

Cardiac Pacemakers, Inc.,...

1. A method for minimizing post-infarct ventricular remodeling, comprising:
identifying an infarct region in a ventricle;
delivering pacing pulses to one or more sites in proximity to the infarct region;
wherein the pacing pulses are delivered in a manner that pre-excites the site or sites in proximity to the infarct region
relative to other areas of the ventricle;

verifying whether or not the pacing pulses delivered to the one or more sites have achieved capture;
adjusting the energy of the pacing pulses if capture is not being achieved; and,
changing the pacing site if capture is not being achieved and if the pacing pulse energy cannot be increased sufficiently
to achieve capture, wherein the pacing site is changed in accordance with an ordered list of available electrodes that lists
the electrodes in an order of preferred use reflecting their proximity to the infarct region.

US Pat. No. 9,457,187

SYSTEMS AND METHODS FOR DELIVERING VAGAL NERVE STIMULATION

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
a patient-operable external controller configured to transmit a signal associated with a titration command; and
an implantable neurostimulator configured to receive the signal, the implantable neurostimulator comprising:
a pulse generator configured to deliver, through at least one electrode configured to be operably positioned proximate to
a cervical vagus nerve, a therapy including continuously-cycling, intermittent and periodic pulses delivered at an intensity
that avoids acute physiological side effects and with an unchanging cycle not triggered by physiological markers in a manner
that non-selectively stimulates both afferent axons and efferent axons in the cervical vagus nerve of a patient; and

a memory configured to store instructions for titrating the intensity of the electrical pulses including instructions for
titrating one or more pulse parameters selected from the group consisting of an amplitude, a pulse width and a pulse frequency
and instructions for preventing titration of the intensity by titration of one or more pulse parameters selected from the
group consisting of an amplitude, a pulse width and a pulse frequency from exceeding an upper bound for the intensity, wherein
the implantable neurostimulator includes processing circuitry configured to operate on the instructions to titrate the intensity
of the electrical pulses in response to the signal associated with the titration command.

US Pat. No. 9,443,660

FLAT CAPACITOR FOR AN IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. A process, comprising:
depositing a curable resin mask onto a foil;
curing the curable resin mask into a cured mask;
etching the foil, the cured mask restricting the etch;
removing the cured mask from the foil;
anodizing the foil;
assembling the foil into a flat capacitor stack; and
inserting the flat capacitor stack into a capacitor case.

US Pat. No. 9,402,996

RF SHIELD FOR AN IMPLANTABLE LEAD

Cardiac Pacemakers, Inc.,...

1. A method of shielding an implantable lead, the method comprising:
implanting a lead in a patient, the lead having a distal region, a proximal region, an intermediate region between the distal
region and the proximal region, at least one electrode disposed on the distal region, and at least one conductor extending
from the proximal region to the at least one electrode;

coiling a portion of the intermediate region to define one or more loops; and
selectively shielding the one or more loops of the lead with an RF shield, the RF shield comprising metallic material and
configured to reduce RF signal coupling to the at least one conductor along the one or more loops.

US Pat. No. 9,381,369

BATTERY FOR USE WITH MEDICAL DEVICES

Cardiac Pacemakers, Inc.,...

1. A battery for use with a medical device, the battery comprising:
a housing comprising an interior conductive carbon coating;
a plurality of cathode pellets disposed within the housing;
an anode extending through at least some of the plurality of cathode pellets; and
a lid attached to the housing.

US Pat. No. 9,320,889

CUFF ELECTRODE WITH INTEGRATED TENDRIL

Cardiac Pacemakers, Inc.,...

1. A neurostimulation lead comprising:
a lead body having a proximal portion and a distal portion;
a first conductor extending through the lead body; and
an electrode cuff secured relative to the distal portion of the lead body, the electrode cuff including:
a cuff body having a first region and a second region;
a first tendril extending from the first region of the cuff body, the first tendril biased to a curved configuration;
a second tendril extending from the second region of the cuff body, the second tendril biased to a curved configuration; and
a first electrode disposed on the cuff body and electrically connected to the first conductor.

US Pat. No. 9,242,105

CONTROLLED TITRATION OF NEUROSTIMULATION THERAPY

Cardiac Pacemakers, Inc.,...

1. An implantable device for delivering neurostimulation to a patient, comprising:
a pulse generator for outputting neurostimulation pulses and for connecting to one or more stimulation electrodes to deliver
electrical stimulation to one or more selected neural sites the produce parasympathetic stimulation and/or sympathetic inhibition;

a controller connected to the pulse generator for controlling the output of neurostimulation pulses in accordance with a defined
schedule that specifies the times of day the neurostimulation pulses are to be delivered and in accordance with one or more
stimulation parameters;

a sensor interfaced to the controller for sensing a physiological variable reflective of a patient's autonomic balance;
a telemetry unit interfaced to the controller, wherein the controller is programmed to receive medication dosage information
via telemetry that includes the time or times of day that a medication affecting the patient's autonomic balance is to be
taken; and,

wherein the controller is programmed to adjust the schedule for delivering neurostimulation in accordance with received medication
dosage information after confirming that the medication has had its expected effect on the patient's autonomic balance as
reflected by the sensed physiological variable.

US Pat. No. 9,295,808

MEDICAL DEVICE WITH TEXTURED SURFACE

Cardiac Pacemakers, Inc.,...

1. A method of forming a guide catheter for guiding a medical device into or through a body lumen, the method comprising:
forming a guide catheter shaft including an inner lumen sized to receive the medical device therein, the inner lumen including
a textured inner surface along at least a portion of a longitudinal length of the catheter shaft, wherein forming the guide
catheter shaft includes:

forming a liner having a surface texture on an inner surface thereof, wherein forming the liner includes extruding a tubular
polymeric member over an extrusion core having a surface configured to form the surface texture on the inner surface of the
liner; and

disposing an outer jacket over the liner, wherein the inner surface of the liner defines the textured inner surface of the
inner lumen of the catheter shaft;

wherein the textured inner surface is configured to minimize friction between the textured inner surface and the medical device
when the medical device is disposed within the catheter lumen.

US Pat. No. 9,295,834

COIL ELECTRODE FITTING

Cardiac Pacemakers, Inc.,...

1. An implantable lead comprising:
a lead body having a proximal end and a distal end;
a conductor extending within the lead body;
a coil electrode having a proximal end, a distal end, and one or more filars, the coil electrode extending along a portion
of the distal end of the lead body and configured to deliver defibrillation therapy to tissue, the one or more filars wound
in a helical pattern to have a pitch;

a tubular fitting having a lumen, the tubular fitting formed from an electrically conductive metal, at least a portion of
the lumen having threading that corresponds to the pitch of the one or more filars, the tubular fitting electrically connecting
the conductor to the coil electrode, wherein the tubular fitting comprises:

an inner fitting axially aligned with the coil electrode, at least a portion of the inner fitting comprising external threading;
and

an outer tubular fitting, the outer tubular fitting defining the lumen, the inner fitting at least partially received within
the lumen, both of the external threading and the one or more filars threadedly engaged with the threading of the lumen; and

a polymer sleeve having a wall, the polymer sleeve extending over the coil electrode, the wall of the polymer sleeve configured
to allow the delivery of the defibrillation therapy through the wall,

wherein one of the proximal end or the distal end of the coil electrode is within the lumen of the tubular fitting and the
coil electrode is mechanically connected to the tubular fitting by interaction between the threading of the lumen and the
one or more filars, and wherein the polymer sleeve extends into the lumen of the tubular fitting, and the wall of the polymer
sleeve is pinched between the threading of the lumen and the one or more filars to mechanically couple the polymer sleeve
to the tubular fitting.

US Pat. No. 9,126,051

REVERSE PACING-MODE SWITCH

Cardiac Pacemakers, Inc.,...

1. A device comprising:
at least one cardiac contraction sensing circuit configured for providing a sensed contraction signal from at least one atrium
of a heart of a subject and a sensed contraction signal from at least one ventricle of the heart;

a timer circuit configured for providing a time duration of an atrial-atrial (A-A) interval between successive atrial contractions,
a ventricular-ventricular (V-V) interval between successive ventricular contractions, and an atrial-ventricular (A-V) interval
between an atrial contraction and a same cardiac cycle ventricular contraction;

an electrical stimulation circuit configured to provide bradycardia pacing electrical stimulation therapy to at least one
atrium and at least one ventricle; and

a controller communicatively coupled to the cardiac contraction sensing circuit, the timer circuit, and the electrical stimulation
circuit, wherein the controller includes:

an event detection module configured for determining whether atrial-ventricular (A-V) block events are sustained over multiple
cardiac cycles; and

a pacing module configured to:
provide bradycardia pacing therapy according to a primary pacing mode, wherein the primary pacing mode includes:
pacing at least one atrium when an A-A interval exceeds an atrial lower rate limit (LRL) interval, wherein the atrial pacing
is non-tracking in regard to events occurring in either ventricle; and

concurrently providing backup pacing to at least one ventricle when a V-V interval exceeds a ventricular LRL interval, wherein
the ventricular backup pacing is non-tracking in regard to events occurring in either atrium; and

switch the pacing therapy from the primary pacing mode to a secondary pacing mode when A-V block events are sustained over
multiple cardiac cycles, wherein the secondary pacing mode includes pacing the at least one ventricle to track events occurring
in the at least one atrium.

US Pat. No. 9,295,843

AUTOMATIC PACING CONFIGURATION SWITCHER

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an implantable electronics unit, the implantable electronics unit including:
an electrostimulation circuit, configured to provide a first electrostimulation to a target tissue using a first electrostimulation
energy and a first electrode configuration selected from multiple electrode configurations;

a communication circuit, configured to communicate with an external device to receive an input indicating a degree of patient
discomfort produced by unintended stimulation of a non-target tissue different from the target tissue by the first electrostimulation
delivered using the first electrostimulation energy and the first electrode configuration; and

a controller circuit, coupled to the electrostimulation circuit and the communication circuit, the controller circuit comprising
a stimulation detector circuit configured to detect the unintended stimulation of the non-target tissue, wherein the controller
circuit is configured to use information about the degree of patient discomfort to provide a second electrostimulation using
at least one of a second electrostimulation energy that is different from the first electrostimulation energy or a second
electrostimulation configuration that is different from the first electrostimulation configuration.

US Pat. No. 9,314,637

METHOD AND APPARATUS FOR ELECTRONICALLY SWITCHING ELECTRODE CONFIGURATION

Cardiac Pacemakers, Inc.,...

1. An implantable medical device, comprising:
a neural stimulator adapted to provide neural stimulation therapy using either a first electrode configuration to deliver
neural stimulation or a second electrode configuration to deliver neural stimulation;

a controller operably connected to the neural stimulator and configured to select the first electrode configuration to control
delivery of the neural stimulation therapy through the first electrode configuration;

an electrode configuration tester for testing for a fault in the first electrode configuration during delivery of the neural
stimulation therapy to a patient, the fault occurring when the efficacy of the neural stimulation therapy using the first
electrode configuration is lower than a threshold; and

the controller operably connected to the electrode configuration tester to repeatedly test the first electrode configuration
during delivery of the neural stimulation therapy to ensure uninterrupted neural stimulation to the patient, and to respond
to a detected failure in the first electrode configuration by selecting the second electrode configuration and controlling
delivery of the neural stimulation therapy through the second electrode configuration.

US Pat. No. 9,393,427

LEADLESS CARDIAC PACEMAKER WITH DELIVERY AND/OR RETRIEVAL FEATURES

CARDIAC PACEMAKERS, INC.,...

1. A system for implanting an implantable leadless cardiac pacing device, comprising:
an implantable cardiac pacing device having a housing, an electrode positioned proximate a distal end of the housing, and
a docking member extending from a proximal end of the housing opposite the distal end, the docking member including a head
portion and a reduced diameter neck portion extending between the housing and the head portion; and

a delivery device including an elongate shaft and a driver mechanism at a distal end of the elongate shaft, the driver mechanism
configured for engagement with the head portion of the docking member;

wherein the driver mechanism includes a first lug and a second lug configured to engage a recess extending into the head portion
from a proximal surface of the head portion;

wherein the head portion includes a member extending between a first portion of the recess and a second portion of the recess;
wherein the first lug is positionable in the first portion of the recess on a first side of the member and the second lug
is positionable in the second portion of the recess on a second side of the member,

wherein the head portion includes an aperture below the member, the aperture connecting the first and second portions of the
recess.

US Pat. No. 9,345,887

LOCAL AND NON-LOCAL SENSING FOR CARDIAC PACING

Cardiac Pacemakers Inc., ...

1. An implantable cardiac rhythm management device, comprising:
a plurality of body-implantable electrodes configured to electrically couple to a heart, the plurality of implantable electrodes
including at least a first pair of electrodes and a second pair of electrodes, at least one of the first pair of electrodes
to be in direct contact with myocardial tissue for use to sense at least one local cardiac signal close to the contacted myocardial
tissue such that a sensed local cardiac signal is representative of an activation signal close to the contacted myocardial
tissue, the second pair of electrodes to be not in direct contact with myocardial tissue for use to sense non-local cardiac
signals such a sensed non-local cardiac signal effectively provides a superposition of a number of activation signals occurring
within the heart;

sense circuitry coupled to the first and second electrode pairs and configured to sense the at least one local cardiac signal
via the at least the first pair of electrodes and the non-local cardiac signal via the second electrode pair;

detection circuitry configured to detect a delay interval between an activation of at least one heart chamber and a ventricular
intracardiac electrogram peak and to detect a non-local QRS interval; and

a control processor configured to:
determine a temporal relationship between timing of the local signal feature and timing of the non-local signal feature, wherein
the temporal relationship includes a ratio of a time length of the delay interval and a time length of the non-local QRS interval;

determine an atrioventricular delay based on the temporal relationship; and
time delivery of one or more pacing pulses based on the temporal relationship and the atrioventricular delay.

US Pat. No. 9,314,210

METHOD AND APPARATUS FOR RATE-DEPENDENT MORPHOLOGY-BASED CARDIAC ARRHYTHMIA CLASSIFICATION

Cardiac Pacemakers, Inc.,...

1. A system for classifying cardiac arrhythmias, the system comprising:
a tachyarrhythmia detector adapted to detect an arrhythmia episode;
a template waveform input to receive template data representative of a template waveform associated with a template heart
beat, the template waveform sensed during a normal sinus rhythm;

an arrhythmic waveform input to receive arrhythmic data representative of an arrhythmic waveform associated with an arrhythmic
heart beat sensed during the detected arrhythmia episode;

an arrhythmic heart rate input to receive an arrhythmic heart rate parameter representative of an arrhythmic heart rate associated
with the detected arrhythmic episode;

a rate-dependent feature locator coupled to the template waveform input, the arrhythmic waveform input, and the arrhythmic
heart rate parameter input, the rate-dependent feature locator adapted to dynamically determine morphological feature locations
each as a function of at least the arrhythmic heart rate parameter in response to the detected arrhythmia episode, the morphological
feature locations including template feature locations each representative of timing of a plurality of template morphological
features on the template waveform and arrhythmic feature locations each representative of timing of a plurality of corresponding
arrhythmic morphological features on the arrhythmic waveform; and

a feature extracting module coupled to the rate-dependent feature locator, the feature extracting module adapted to extract
the plurality of template morphological features from the template waveform at the dynamically determined morphological feature
locations and to extract the plurality of corresponding arrhythmic morphological features from the arrhythmic waveform at
the dynamically determined morphological feature locations.

US Pat. No. 9,419,372

VENTED SET SCREW FOR IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. An implantable medical device configured to be connected to one or more implantable leads each including one or more electrodes,
the implantable medical device comprising:
electronic circuitry;
a hermetically sealed housing encapsulating the electronic circuitry; and
a header attached to the housing, the header including:
a header bore configured to receive an implantable lead of the one or more implantable leads;
a screw bore in fluid communication with the header bore;
a vented set screw placed in the screw bore, the vented set screw including an axial cavity including a portion shaped to
receive a tool; and

a seal plug placed at least partially in the screw bore and in contact with the vented set screw, the seal plug including
a seal slit allowing for access to the vented set screw by the tool,

wherein the vented set screw includes one or more venting channels providing for fluid communication between the axial cavity
and a cavity formed between the seal plug and the vented set screw, the one or more venting channels each being a hole having
an approximately circular cross-section.

US Pat. No. 9,272,135

CABLE CONDUCTOR FITTING

Cardiac Pacemakers, Inc.,...

1. A method for assembling an implantable lead, the method comprising:
placing a cable conductor within a slot of an inner fitting, the inner fitting comprising external threading that extends
over at least a portion of the inner fitting;

axially aligning a coil electrode with the inner fitting, the coil electrode having one or more filars, the one or more filars
wound in a helical pattern; and

inserting the coil electrode and the inner fitting into a lumen of an outer tubular sleeve, the lumen having internal threading,
wherein one or more of the outer tubular fitting, the coil electrode, and the inner fitting are rotated during the insertion
such that the internal threading threadably engages both of the one or more filars and the external threading, the cable conductor
is pinched within the slot as the inner fitting is inserted into the lumen, and the pinching mechanically connects the cable
conductor to the inner fitting.

US Pat. No. 9,320,906

HEART SOUNDS TEMPLATE COMPARISON TO IDENTIFY TRUE PACING MODE

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an implantable therapy circuit configured to provide a bi-ventricular pacing pulse to a subject as part of cardiac pacing
therapy, wherein the bi-ventricular pacing pulse includes providing an electrical stimulation pulse to a right ventricle and
an electrical stimulation pulse to a left ventricle;

a heart sound signal sensing circuit configured to produce a sensed heart sound signal that is representative of at least
one heart sound associated with mechanical cardiac activity of a subject;

a memory circuit configured to store one or more heart sound templates of cardiac capture; and
a comparison circuit configured to:
compare a segment of the sensed heart sound signal to a template heart sound signal representative of ventricular contraction
resulting from intrinsic depolarization and at least one of a template heart sound signal representative of right ventricle
(RV) capture only, a template heart sound signal representative of left ventricle (LV) capture only, and a template heart
sound signal representative of bi-ventricular capture;

identify ventricles in which cardiac capture was induced by the bi-ventricular pacing pulse; and
generate an indication of the ventricles in which capture was induced or an indication of no cardiac capture of a ventricle
according to the comparison and providing the indication to at least one of a user or process.

US Pat. No. 9,457,181

CARDIAC LEAD WELDING

Cardiac Pacemakers, Inc.,...

1. A method of assembling an extendable/retractable active fixation lead having a coupler and a conductive member secured
to the coupler, the conductive member having a distal region and a proximal region, the coupler including a proximal portion
configured to accommodate the distal region of the conductive member, the method comprising:
subjecting the distal region of the conductive member to heat and pressure to form a banded portion;
disposing the banded portion of the conductive member about the proximal portion of the coupler; and
welding through the banded portion of the conductive member to secure the coupler to the conductive member.

US Pat. No. 9,414,756

METHOD AND APPARATUS FOR ADJUSTING CARDIAC EVENT DETECTION THRESHOLD BASED ON DYNAMIC NOISE ESTIMATION

Cardiac Pacemakers, Inc.,...

1. A method for operating an implantable medical device, the method comprising:
sensing a cardiac signal;
producing a filtered cardiac signal having a signal frequency band by filtering the sensed cardiac signal;
producing a noise signal having a noise frequency band by filtering the sensed cardiac signal or the filtered cardiac signal,
the noise frequency band being substantially different from the signal frequency band;

producing a dynamic noise floor being a dynamic estimate of noise level in the signal frequency band using the noise signal;
producing a detection threshold using the filtered cardiac signal and the noise floor, the noise floor used as a minimum value
of the detection threshold; and

detecting cardiac electrical events using the filtered cardiac signal and the detection threshold.

US Pat. No. 9,240,648

HEADER CONTACT FOR AN IMPLANTABLE DEVICE

Cardiac Pacemakers, Inc.,...

1. An implantable medical device comprising:
a housing; and
a header mounted to the housing, the header including a header body having a bore with an electrical contact located within
the bore, wherein the electrical contact includes a helical coil spring having a helical coil formed of a plurality of coils
with an axial bore through a center area of each of the plurality of coils of the helical coil, wherein the axial bore of
the helical coil spring is aligned with a longitudinal axis of the bore and positioned and configured to receive a terminal
through a center of the axial bore at the center area of the helical coil, and wherein the helical coil includes an intermediate
section having a smaller inner diameter as compared to a diameter of a first end and a diameter of a second end of the helical
coil spring and the helical coil spring has a pitch such that adjacent filars of the helical coil spring do not touch each
other.

US Pat. No. 9,504,836

SYSTEM AND METHOD TO DELIVER THERAPY IN PRESENCE OF ANOTHER THERAPY

Cardiac Pacemakers, Inc.,...

1. A system to deliver an electrical therapy to a patient to whom another electrical therapy is also delivered, comprising:
an electrical stimulator to deliver electrical pulses to the patient for the electrical therapy; and
a controller connected to the electrical stimulator and configured to operate in a first mode to control delivery of the electrical
pulses for the electrical therapy when the other electrical therapy is not delivered and to operate in a second mode in response
to delivery of the other electrical therapy, wherein operating in the first mode includes performing a first sensing operation
and operating in the second mode includes performing a second sensing operation different from the first sensing operation.

US Pat. No. 9,357,944

IMPEDANCE MEASUREMENT AND DEMODULATION USING IMPLANTABLE DEVICE

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an implantable impedance measurement circuit, configured to be communicatively coupled to a plurality of implantable electrodes,
wherein the impedance measurement circuit includes:

an exciter circuit, configured to apply a test current between at least two of the electrodes;
a preamplifier circuit, configured to sense the voltage response to the test current;
a demodulator circuit, communicatively coupled to the preamplifier circuit,
wherein the demodulator circuit includes a four-point finite impulse response (FIR) filter;
and
wherein the impedance measurement circuit is configured to determine an impedance measurement between the electrodes using
the demodulated sensed voltage response, wherein the exciter circuit is configured to apply a two-phase test current that
is limited to two-phases per demodulation, and wherein the demodulator circuit is configured to demodulate the sensed voltage
response to the two-phase test current using the four-point FIR filter.

US Pat. No. 10,046,167

IMPLANTABLE MEDICAL DEVICE WITH RADIOPAQUE ID TAG

Cardiac Pacemakers, Inc.,...

1. A leadless cardiac pacemaker comprising:an elongated housing having a length, an energy storage section and a circuit section, the energy storage section defining a first volume that extends along a first fraction of the length of the elongated housing and the circuit section defining a second volume that extends along a second fraction of the length of the elongated housing, wherein the first faction does not overlap with the second fraction of the length of the elongated housing;
an energy source disposed within the first volume;
a circuit board disposed within the second volume but not in the first volume, the circuit board operably coupled to the energy source;
a first electrode and a second electrode each exposed along an exterior of the elongated housing and operatively coupled to the circuit board; and
an ID tag disposed on or in the energy storage section of the elongated housing, the ID tag configured to define a radiopaque manufacturer code that visually identifies a manufacturer of the leadless cardiac pacemaker.

US Pat. No. 9,352,164

MODULAR ANTITACHYARRHYTHMIA THERAPY SYSTEM

CARDIAC PACEMAKERS, INC.,...

1. A subcutaneous implantable defibrillator (SID), the SID comprising:
a housing configured to be implanted subcutaneously in a patient external to the heart of the patient;
one or more electrodes configured to be disposed external to the heart;
a shock module configured to at least partially deliver anti-tachyarrhythmia shock therapy to a patient via the one or more
electrodes;

a communication module configured to at least one of transmit or receive communication messages with a second therapy device
having a pacing therapy capability and configured to be implanted within a heart of the patient;

a sensing module configured to sense an electrical signal from the heart of the patient via the one or more electrodes; and
a controller circuit configured to:
detect a tachyarrhythmia within the sensed electrical signal;
determine, based on the detected tachyarrhythmia, to deliver anti-tachyarrhythmia shock therapy to the patient to treat the
detected tachyarrhythmia; and

transmit, via the communication module, a communication message to the second therapy device requesting the second therapy
device deliver anti-tachycardia pacing to the heart of the patient.

US Pat. No. 10,182,767

HEART FAILURE MANAGEMENT TO AVOID REHOSPITALIZATION

Cardiac Pacemakers, Inc.,...

1. A system comprising:a physiologic sensor configured to sense a physiologic signal from a subject; and
a heart failure analysis module, coupled to the physiologic sensor, the heart failure analysis module including a processor circuit configured to:
identify a first physiologic signal characteristic corresponding to the physiologic signal and preceding a hospitalization event;
receive an indication of a hospital discharge event;
identify a second physiologic signal characteristic corresponding to the physiologic signal and following the hospital discharge event;
determine whether the second physiologic signal characteristic is substantially unchanged from the first physiologic signal characteristic; and
provide a rehospitalization indication when the second physiologic signal characteristic is determined to be substantially unchanged from the first physiologic signal characteristic.

US Pat. No. 9,379,507

FEEDTHROUGH SYSTEM FOR IMPLANTABLE DEVICE COMPONENTS

Cardiac Pacemakers, Inc.,...

1. A method for manufacturing an implantable medical device having a first and second component, the method comprising:
forming a nailhead having a protruded tip, the nailhead extending from an aperture in an encasement of the first component
and connected to a terminal conductor adapted to electrically connect to circuitry within the encasement;

forming a ribbon wire having a distal end adapted to electrically connect to the second component and a proximal end having
a pattern including an aperture through the ribbon wire sized to fit over the protruded tip; and

connecting the proximal end of the ribbon wire to the protruded tip of the nailhead, wherein connecting the proximal end of
the ribbon wire to the protruded tip includes snap-fitting the pattern of the ribbon wire to the protruded tip of the nailhead.

US Pat. No. 9,168,382

METHOD AND APPARATUS FOR SELECTIVE HIS BUNDLE PACING

Cardiac Pacemakers, Inc.,...

1. A system for pacing a heart having conduction tissue including a His bundle and myocardial tissue, comprising:
a pacing output circuit configured to deliver cardiac pacing pulses to a target portion of the conductive tissue;
a sensing circuit configured to sense one or more signals indicative of one or more responses of the heart to the delivery
of each pulse of the cardiac pacing pulses; and

a control circuit coupled to the pacing output circuit and the sensing circuit, the control circuit configured to control
the delivery of the cardiac pacing pulses using pacing parameters and including:

a capture verification circuit configured to perform a selective capture verification including detection of conductive tissue
responses and myocardial responses using the sensed one or more signals, the conductive tissue responses each representative
of excitation of the target portion of the conductive tissue directly resulting from the delivery of the each pulse, the myocardial
responses each representative of excitation of portions of the myocardial tissue directly resulting from the delivery of the
each pulse; and

a parameter adjuster configured to adjust at least one parameter of the pacing parameters using an outcome of the selective
capture verification such that the conductive tissue responses are detected and the myocardial responses are not detected.

US Pat. No. 10,058,708

HEART FAILURE EVENT DETECTION USING MINIMUM HEART RATE

Cardiac Pacemakers, Inc.,...

1. A congestive heart failure (CHF) event predictor method comprising:obtaining information indicative of cardiac intervals of a heart when a cardiac rhythm management device enforces a lower rate pacing limit for the heart;
identifying a first characteristic minimum heart rate using the information indicative of the cardiac intervals obtained when the cardiac rhythm management device enforces the lower rate pacing limit; and
determining a CHF event predictor using the identified first characteristic minimum heart rate.

US Pat. No. 9,504,822

INDUCTIVE ELEMENT FOR PROVIDING MRI COMPATIBILITY IN AN IMPLANTABLE MEDICAL DEVICE LEAD

Cardiac Pacemakers, Inc.,...

1. A lead adapter configured to electrically and mechanically connect a lead to an implantable pulse generator, the lead having
one or more electrodes and a connector, the lead adapter comprising:
a port configured to receive the connector of the lead into a lumen of the lead adapter;
a connector configured to be inserted into the pulse generator; and
an inductive element, the inductive element entirely circumferentially surrounding at least a portion of the lumen such that
the inductive element entirely circumferentially surrounds at least a portion of the connector of the lead when the connector
of the lead is received within the lumen, wherein the inductive element does not directly electrically connect to any conductor
of the lead when the connector of the lead is received within the lumen.

US Pat. No. 9,370,659

INTUITED DELIVERY OF AUTONOMIC MODULATION THERAPY

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
delivering intermittent neural stimulation (INS) therapy to an autonomic neural target of a patient, the INS therapy including
neural stimulation (NS) ON times alternating with NS OFF times, wherein delivering INS therapy includes delivering at least
one NS burst of NS pulses during each of the NS ON times, wherein for a given NS OFF time and subsequent NS ON time, delivering
INS therapy includes:

monitoring a plurality of cardiac cycles during the NS OFF time;
using the monitored plurality of cardiac cycles to predict cardiac event timing during the subsequent NS ON time; and
controlling delivery of the INS therapy using the predicted cardiac event timing to time NS burst delivery of at least one
NS burst for the subsequent NS ON time based on the predicted cardiac event timing.

US Pat. No. 9,492,658

GUIDE CATHETER OCCLUSION BALLOON WITH ACTIVE INFLATION

Cardiac Pacemakers, Inc.,...

1. A guide catheter for delivery of an implantable lead, the guide catheter comprising:
a tubular body having a proximal end, a distal end, and a main lumen that extends from the proximal end to the distal end,
the main lumen dimensioned to allow the implantable lead to move within the main lumen, the tubular body comprising:

a jacket defining an exterior surface of the tubular body; and
a plurality of inflation tubes embedded within the jacket;
wherein an outer circumferential profile of the tubular body has a bump and the plurality of inflation tubes extend underneath
the bump along the tubular body;

a balloon mounted on the distal end of the tubular body, each of the plurality of inflation tubes in communication with the
balloon, the balloon inflatable to at least partially occlude the coronary vein of the heart; and

a hub mounted on the proximal end of the tubular body, the hub providing access to the main lumen and the plurality of inflation
tubes.

US Pat. No. 9,480,849

METHOD OF OVERMOULDING TOP MOUNTED SEAL PLUG CAVITIES

Cardiac Pacemakers, Inc.,...

1. A method comprising:
providing a mold defining a mold cavity for receiving material to be molded into a molded part, wherein the mold comprises
silicone;

positioning an insert at least partially in the mold such that a portion of the insert defines a portion of the mold cavity,
wherein the insert comprises polyoxymethylene;

positioning a pin in the mold cavity such that the pin extends from the insert and into the mold cavity, wherein the pin defines
a shape of a hole of the molded part;

injecting the material into the mold cavity to substantially fill the mold cavity to form the molded part;
removing the molded part from the mold; and
removing the insert and the pin from the molded part.

US Pat. No. 9,452,283

CUFF ELECTRODE WITH INTEGRATED TENDRIL

Cardiac Pacemakers, Inc.,...

1. A neurostimulation lead comprising:
a lead body having a proximal portion and a distal portion;
a first conductor extending through the lead body; and
an electrode cuff secured relative to the distal portion of the lead body, the electrode cuff including:
a cuff body having a first region and a second region;
a first tendril extending substantially perpendicularly from an edge of the first region of the cuff body;
a second tendril extending substantially perpendicularly from an edge of the second region of the cuff body; and
a first electrode disposed on the cuff body and electrically connected to the first conductor,
wherein at least one of the first tendril and the second tendril is configured to overlap the cuff body.

US Pat. No. 9,364,662

IMPLANTABLE LEAD HAVING A LUMEN WITH A WEAR-RESISTANT LINER

Cardiac Pacemakers, Inc.,...

18. An implantable lead comprising:
a lead body having a proximal end portion and a distal end portion, the lead body including an insulative member having a
lumen extending longitudinally through the proximal end portion and the distal end portion, and a generally tubular liner
disposed coaxially with the lumen within the insulative member, wherein the liner includes a plurality of longitudinally-spaced
cylindrical segments and a plurality of connecting struts, at least one of the connecting struts extending between and connecting
adjacent cylindrical segments;

an electrode disposed along the lead body in the distal end portion thereof;
a conductor disposed within the lumen and electrically coupled to the electrode; and
a terminal connector coupled to the proximal end portion of the lead body and to the conductor, the terminal connector configured
to provide an electrical and mechanical connection of the implantable lead with an implantable medical device;

wherein the liner defines an inner surface adjacent to the conductor and against which the conductor can bear.

US Pat. No. 9,269,498

SINTERED CAPACITOR ELECTRODE INCLUDING MULTIPLE THICKNESSES

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a capacitor case sealed to retain electrolyte;
a first electrode disposed in the capacitor case;
a conductor coupled to the first electrode in electrical communication with the conductor, the conductor sealingly extending
through the capacitor case to a terminal disposed on an exterior of the capacitor case, with the terminal in electrical communication
with the first electrode;

a second electrode disposed in the capacitor case in a stack with the first electrode and adjacent the first electrode, the
second electrode having a second electrode thickness;

a first separator disposed between the first electrode and the second electrode and having a first separator thickness;
a third electrode disposed in the capacitor in the stack with the first electrode and the second electrode and adjacent the
second electrode, the third electrode in electrical communication with the first electrode and including a first sintered
portion of a first thickness, and a second portion of a second thickness larger than the first thickness;

a second separator disposed between the third electrode and the second electrode and having a second separator thickness;
and

a second terminal disposed on the exterior of the capacitor case and in electrical communication with the second electrode,
with the terminal and the second terminal electrically isolated from one another,

wherein the second thickness of the third electrode is substantially equivalent to a total thickness of the first thickness
of the third electrode plus the second electrode thickness plus the first separator thickness plus the second separator thickness.

US Pat. No. 10,143,385

METHODS AND APPARATUS FOR STRATIFYING RISK OF HEART FAILURE DECOMPENSATION

Cardiac Pacemakers, Inc.,...

1. A medical device, comprising:a signal analyzer circuit, including:
a patient status input unit configured to receive at least a first demographic characteristic indicator and a second demographic characteristic indicator of a patient, the second demographic characteristic indicator non-identical to the first demographic characteristic indicator;
a signal receiver circuit configured to receive one or more physiologic signals of the patient;
a signal metrics generator circuit configured to generate a plurality of signal metrics from the one or more physiologic signals, including to generate a first set of one or more signal metrics in response to the first demographic characteristic indicator meeting at least one first specified criterion, and to generate a second set of signal metrics in response to the second demographic characteristic indicator meeting at least one second specified criterion; and
a patient-specific signal metric selector circuit configured to select a subset of patient-specific signal metrics from the first and second sets of signal metrics using signal metric performance measures of at least one metric from the first and second sets of signal metrics; and
a risk stratification circuit configured to generate a composite risk index using the selected subset of patient-specific signal metrics, the composite risk index indicative of the probability of the patient later developing an event indicative of worsening of heart failure, the risk stratification circuit comprising a risk report generator configured to generate a report to inform a user of an elevated risk of the patient developing the event indicative of worsening of heart failure.

US Pat. No. 9,480,850

LEADLESS CARDIAC PACEMAKER AND RETRIEVAL DEVICE

Cardiac Pacemakers, Inc.,...

1. An assembly for retrieving an implantable cardiac pacing device, comprising:
an implantable cardiac pacing device having a housing, an electrode positioned proximate a distal end of the housing, and
a docking member extending from a proximal end of the housing opposite the distal end, the docking member including a head
portion and a neck portion extending between the housing and the head portion; and

a retrieval system including:
a retrieval catheter having a proximal end, a distal end, and a lumen extending into the retrieval catheter from the distal
end; and

a retrieval device advanceable from the distal end of the retrieval catheter, the retrieval device having a grasping mechanism
configured to capture the docking member to draw the implantable cardiac pacing device into the lumen of the retrieval catheter;

wherein the grasping mechanism is expandable from a first position to a second position, the grasping mechanism being biased
toward the first position in an equilibrium condition;

wherein the grasping mechanism is configured to surround and pass over the head portion of the docking member in the second
position, and be contracted toward the first position to capture the docking member with the grasping mechanism;

wherein the grasping mechanism includes an inflatable balloon;
wherein the inflatable balloon includes an annular portion defining a distal opening extending proximally into the balloon;
and

wherein the inflatable balloon includes a resilient annular ring extending around a rim of the distal opening.

US Pat. No. 9,339,658

ADAPTIVE EVENT STORAGE IN IMPLANTABLE DEVICE

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
an implantable physiological data monitor, configured to monitor one or more physiological data parameters;
a processor, coupled to the implantable physiological data monitor, the processor configured to,
detect an episode beginning condition using a first physiological data parameter monitored by the implantable physiological
data monitor, wherein the episode beginning condition is indicative of beginning of a present pathological episode; and

detect an episode ending condition monitored by the implantable physiological data monitor, wherein the episode ending condition
is indicative of the ending of the present pathological episode;

a rolling memory buffer configured to continually store a fixed segment of a second physiological data parameter monitored
by the implantable physiological data monitor;

a static memory buffer configured to store a time segment of a third physiological data parameter monitored by the implantable
physiological data monitor based on a triggering event associated with the detecting of the episode ending condition; and

a memory configured to store data retained in the static memory buffer and associate the data retained in the static memory
with the data retained in the rolling memory buffer for later use by the processor or for output to an external device.

US Pat. No. 9,227,073

DYNAMIC MORPHOLOGY BASED ATRIAL AUTOMATIC THRESHOLD

Cardiac Pacemakers, Inc.,...

1. A method for determining a cardiac response to atrial pacing, comprising:
delivering one or more sub-capture threshold pacing pulses to an atrium of a heart via a medical device;
determining a pacing artifact threshold based on peak values of one or more pacing artifact signals sensed in the atrium following
each of the sub-capture threshold pacing pulses;

delivering a plurality of pacing pulses to the atrium of the heart via the medical device;
determining a capture detection threshold based on peak values of one or more evoked response signals sensed in the atrium;
comparing a peak value of a cardiac signal sensed following an atrial pacing pulse to the pacing artifact threshold and the
capture detection threshold; and

discriminating between capture, noncapture, and fusion of the atrium based at least in part on the comparison, wherein capture
is determined if the peak value of the sensed cardiac signal is greater than the capture detection threshold, noncapture is
determined if the peak value is less than or equal to the pacing artifact threshold, and fusion is determined if the peak
value is greater than the pacing artifact threshold and is outside of a peak timing interval.

US Pat. No. 9,220,900

SYSTEMS AND METHODS FOR AVOIDING NEURAL STIMULATION HABITUATION

Cardiac Pacemakers, Inc.,...

1. A computer-implemented system comprising:
an external programmer, comprising:
a programming computer configured to execute using a processor program code that is stored in a memory, comprising:
a plurality of therapy routines stored in the memory that each comprise different sets of stimulation parameters that cooperatively
define stimulation cycles of continuously-cycling, intermittent and periodic electrical pulses simultaneously delivered at
a periodic duty cycle with an unchanging cycle not triggered by physiological markers in a manner that results in creation
and propagation of action potentials within neuronal fibers comprising a vagus nerve of a patient to both efferently activate
the heart's intrinsic nervous system and afferently activate the patient's central reflexes; and

a user interface comprising input controls and a visual display and configured to display the therapy routines to the patient
and to select the set of stimulation parameters in the therapy profile chosen by the patient; and

an implantable neurostimulator configured to communicate with the external device, comprising a lead and electrically coupled
to the neurostimulator, which is configured to therapeutically stimulate the vagus nerve through the lead by creating and
propagating the action potentials with a pulse generator as specified by the selected set of stimulation parameters stored
in the memory.

US Pat. No. 9,132,275

AUTOMATIC DETERMINATION OF CHRONOTROPIC INCOMPETENCE USING ATRIAL PACING AT REST

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an implantable cardiac signal sensing circuit configured to provide an electrical cardiac signal representative of cardiac
activity of a subject;

an implantable therapy circuit configured to deliver electrical pacing stimulation energy to a heart of a subject; and
a controller circuit, communicatively coupled to the cardiac signal sensing circuit and the therapy circuit, including a chronotropic
incompetence detection circuit configured to:

initiate pacing of an atrium of the subject at a rate higher than a device-indicated rate or a sensed intrinsic rate;
monitor a time interval between a paced event in the atrium and a sensed intrinsic event in the ventricle (paced AV interval);
initiate an increase in the pacing rate while continuing the monitoring of the paced AV interval;
calculate a change in paced AV intervals between a highest paced rate used in the monitoring and a lowest paced rate used
in the monitoring;

indicate that the paced AV intervals are evidence of chronotropic incompetence when the calculated change in the paced AV
intervals exceeds a specified threshold AV interval change value; and

provide an indication of chronotropic incompetence to a user or process.

US Pat. No. 9,586,048

METHODS AND APPARATUS FOR APNEA THERAPY STIMULATION

Cardiac Pacemakers, Inc.,...

1. A method for apnea directed therapy, the method comprising:
receiving a signal indicative of a real-time or near real-time apnea event for a patient;
processing the signal to classify the apnea event as a mixed central sleep apnea (CSA)/obstructive sleep apnea (OSA) event;
using the classified apnea event to select appropriate electrical stimulation therapy to be applied to the patient during
the apnea event to treat the classified apnea event; and

applying the electrical stimulation therapy in a closed loop system.

US Pat. No. 9,186,061

SYSTEM AND METHOD FOR EVALUATING A PATIENT STATUS FOR USE IN HEART FAILURE ASSESSMENT

Cardiac Pacemakers, Inc.,...

1. A system for evaluating a patient status for use in heart failure assessment, comprising:
an implantable medical device configured to periodically collect patient data on a long-term, daily basis, wherein the implantable
medical device is further configured to store a collected measures set containing a portion of the patient data;

a comparison module configured to receive the collected measures set and compare the collected measures set to a second collected
measures set containing comparison data to determine a trend in the patient data;

an analysis module configured to generate a patient status indicator based on the trend; and
a feedback module configured to provide a notification of a potential medical concern based on the patient status indicator,
wherein the patient data comprises the number of device interventions made, the type of device interventions made, and the
relative success of any interventions made on a per heartbeat or binned average basis.

US Pat. No. 9,486,622

FIXATION AND STRAIN RELIEF ELEMENT FOR TEMPORARY THERAPY DELIVERY DEVICE

Cardiac Pacemakers, Inc.,...

8. A fixation device configured to releasably secure a temporary neurostimulation lead relative to an entry point on a patient,
the device comprising:
a polymeric device body having a lower surface and a upper surface;
a dermatologically safe adhesive disposed on the lower surface for releasably securing the fixation device to the patient
proximate the entry point;

a strain relief member arranged on the upper surface of the polymeric device body and having a groove configured to engage
the temporary neurostimulation lead within the groove, the groove being spirally arranged around a circumference and continuous
along a length of the strain relief member; and

a lead fixation structure formed on the upper surface having a curved channel configured to frictionally engage with the strain
relief member to releasably secure the temporary neurostimulation lead.

US Pat. No. 9,333,354

NEURAL STIMULATION MODULATION BASED ON MONITORED CARDIOVASCULAR PARAMETER

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
delivering vagus nerve stimulation in a recurring succession of stimulation cycles, each cycle including a stimulation on
portion and a stimulation off portion, wherein a burst of pulses is delivered during the stimulation on portion and no stimulation
is delivered during the stimulation off portion, wherein a duty cycle of the stimulation cycles represents a ratio of a duration
of the stimulation on portion to a cycle duration;

sensing a physiological parameter selected from a group of parameters consisting of: heart rate, blood pressure and respiration;
and

adjusting the duty cycle of the stimulation cycles based on the sensed physiological parameter.

US Pat. No. 9,289,615

INTERCONNECT FOR IMPLANTABLE MEDICAL DEVICE HEADER

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a pre-formed header that is biocompatible and that defines a first channel, a second channel, a third channel, and a fourth
channel, the pre-formed header including a first header terminal, the first header terminal in electrical communication with
a first lead terminal of the pre-formed header, the pre-formed header including a second header terminal, the second header
terminal in electrical communication with a second lead terminal of the pre-formed header;

a flex harness flexed into a shape deformed to fit the pre-formed header, the flex harness including a first conductor including
a first connection terminal, a second conductor including a second connection terminal, a third conductor including a third
connection terminal, and a fourth conductor including a fourth connection terminal, the flex harness including a pre-formed
alignment wherein the first conductor is disposed in the first channel, the second conductor is disposed in the second channel,
the third conductor is disposed in the third channel, and the fourth conductor is disposed in the fourth channel, with the
first conductor conductively coupled between the first header terminal and the first connection terminal and with the second
conductor conductively coupled between the second header terminal and the second connection terminal;

wherein the first, second, third, and fourth conductors are physically coupled to a top, upper surface of a removable common
element that defines a longitudinal axis, the first, second, third, and fourth conductors are in spaced alignment along the
longitudinal axis, and the first, second, third, and fourth conductors each extend in a direction perpendicular to the longitudinal
axis; and

an over-molded layer that is biocompatible and disposed over the pre-formed header and the flex harness with the first, second,
third, and fourth conductors disposed between the pre-formed header and the over-molding layer;

wherein the over-molded layer encapsulates the first conductor into the first channel, encapsulates the second conductor into
the second channel, encapsulates the third conductor in the third channel, and the over-molded layer encapsulates the fourth
conductor in the fourth channel.

US Pat. No. 9,265,969

METHODS FOR MODULATING CELL FUNCTION

Cardiac Pacemakers, Inc.,...

1. A method for treating hypertension, the method comprising:
delivering a viral vector to a body tissue of a patient, wherein the body tissue includes one or more neurons;
wherein the viral vector includes a transgene, the transgene including a neuron-specific promoter and a gene encoding a nerve
modulation protein, the transgene also including a second gene encoding an enzyme that converts a non-toxic form of a therapeutic
agent to a toxic form;

infecting the neurons with the viral vector;
implanting a light source adjacent to the cell bodies of the one or more neurons; and
emitting light from the light source;
monitoring the patient for a change in blood pressure; and
if a change in blood pressure is observed, administering the non-toxic form of the therapeutic agent to the body tissue;
wherein the enzyme converts the non-toxic form of the therapeutic agent to the toxic form.

US Pat. No. 9,101,773

CROSS-CHANNEL NOISE DETECTOR IN IMPLANTABLE MEDICAL DEVICES

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
a primary cardiac signal sensing circuit configured to sense at least a first cardiac signal, the primary cardiac signal sensing
circuit including or configured to be coupled to at least first and second implantable electrodes;

at least one secondary cardiac signal sensing circuit configured to sense at least a second cardiac signal, the secondary
cardiac signal sensing circuit including or configured to be coupled to at least a third implantable electrode, different
from the first and second electrode, configured to deliver high-energy shock therapy; and

an arrhythmia detection circuit communicatively coupled to the primary and secondary cardiac signal sensing circuits, wherein
the arrhythmia detection circuit is configured to:

detect an episode of tachyarrhythmia using the primary sensing circuit;
determine a measure of one-to-one correspondence of one or more depolarization events sensed with the primary sensing circuit
to one or more depolarization events sensed with the secondary sensing circuit during the detected episode of tachyarrhythmia;
and

generate an indication of whether a detected rhythm is indicative of noise or is indicative of tachyarrhythmia according to
the determined measure of correspondence.

US Pat. No. 9,065,144

ELECTRODE INCLUDING A 3D FRAMEWORK FORMED OF FLUORINATED CARBON

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a battery case sealed to retain electrolyte;
an electrode disposed in the battery case, the electrode comprising a 3D framework defining open cells within the electrode
disposed along three axes, the 3D framework including elements defining the open cells that each include a conductive carbon
core at least partially surrounded by a fluorinated carbon electrochemically active portion, wherein a plurality of the conductive
carbon cores form an electrically conductive network that serves as a current collector, with each of the conductive carbon
cores of each element of the 3D framework being interior to the element's respective surrounding fluorinated carbon active
portion of the 3D framework, wherein at least some of the open cells within the 3D framework are in fluid communication with
other open cells in the 3D framework via a plurality of pores in the 3D framework;

a conductor electrically coupled to the electrode and in electrical communication with the electrically conductive network
and sealingly extending through the battery case to a terminal disposed on an exterior of the battery case;

a further electrode disposed in the battery case;
a separator disposed between the electrode and the further electrode; and
a further terminal disposed on the exterior of the battery case and in electrical communication with the further electrode,
with the terminal and the further terminal electrically isolated from one another.

US Pat. No. 9,668,713

THIRD HEART SOUND ACTIVITY INDEX FOR HEART FAILURE MONITORING

Cardiac Pacemakers, Inc.,...

1. A medical system, comprising:
a heart sound sensor configured to sense a heart sound signal;
a heart sound detector configured to detect a second heart sound (S2) and a third heart sound (S3) from the heart sound signal,
wherein, to detect the S3, the heart sound detector is configured to: determine an S2 timing estimate dynamically adjusted
based on a heart rate; determine an S3 window that begins at a delay with respect to the determined S2 timing estimate; and
to detect the S3 using the sensed heart sound signal in the S3 window;

a heart sound analyzer circuit coupled to the heart sound detector, the heart sound analyzer configured to:
generate an S3 index from the heart sound signal over a specified measurement period that includes a plurality of heart beats;
and

generate a trend of the S3 index over a plurality of the specified measurement periods, the trend of the S3 index indicative
of a degree of change of the S3 index over time; and

a heart failure detector circuit configured to detect a condition indicative of worsening heart failure using the trend of
the S3 index.

US Pat. No. 9,440,078

NEURAL STIMULATION MODULATION BASED ON MONITORED CARDIOVASCULAR PARAMETER

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
delivering vagus nerve stimulation in a recurring succession of stimulation cycles, each cycle including a stimulation on
portion and a stimulation off portion, wherein a burst of pulses is delivered during the stimulation on portion and no stimulation
is delivered during the stimulation off portion, wherein a duty cycle of the stimulation cycles represents a ratio of a duration
of the stimulation on portion to a cycle duration;

sensing a physiological parameter selected from a group of parameters consisting of: heart rate, blood pressure and respiration;
and

adjusting the duty cycle of the stimulation cycles based on the sensed physiological parameter.

US Pat. No. 9,393,405

WIRELESS TISSUE ELECTROSTIMULATION

Cardiac Pacemakers, Inc.,...

1. A wireless electrostimulation device, comprising:
an implantable seed having a proximal end, a distal end, and a longitudinal axis extending from the proximal end to the distal
end;

the implantable seed including a proximal portion having a distally extending opening defined at least in part by a side wall;
a tissue attachment mechanism positioned proximate the distal end of the implantable seed, the tissue attachment mechanism
configured to secure the implantable seed to cardiac tissue;

a first electrostimulation electrode configured to contact cardiac tissue when the implantable seed is secured to cardiac
tissue;

a second electrostimulation electrode;
wherein the first and second electrostimulation electrodes form an electrostimulation circuit to provide an electrical stimulus
to cardiac tissue; and

a retention pin located proximate the proximal end of the implantable seed, the retention pin extending across the opening
in the proximal portion of the implantable seed and secured to the side wall on opposing sides of the opening.

US Pat. No. 9,511,235

SEAL PLUG

Cardiac Pacemakers, Inc.,...

1. A pulse generator for use in cardiac rhythm management, the pulse generator comprising:
a device housing containing pulse generator circuitry; and
a header comprising:
a core assembly including a core and a collar coupled to the core, the core assembly defining:
a terminal hole extending through the core assembly to allow insertion of a lead terminal into the core assembly; and
a set screw hole extending through the core assembly from a core interior to a core outer surface, wherein the core has a
core hole defining a hole inner portion of the set screw hole and the collar has a collar hole defining a hole outer portion
of the set screw hole, wherein the core outer surface is nearer the hole outer portion than the hole inner portion, and wherein
a first distance across the hole outer portion is less than a second distance across the hole inner portion;

an epoxy outer layer overmolded over the core assembly; and
a seal plug positioned in the set screw hole, wherein the seal plug has a plug outer portion aligned with the hole outer portion
and a plug inner portion aligned with the hole inner portion, wherein a third distance across the plug outer portion is less
than a fourth distance across the plug inner portion, and wherein a top of the seal plug is exposed by the epoxy outer layer.

US Pat. No. 9,504,833

AUTONOMIC MODULATION USING TRANSIENT RESPONSE WITH INTERMITTENT NEURAL STIMULATION

Cardiac Pacemakers, Inc.,...

1. A method comprising:
using a neural stimulator system to deliver neural stimulation therapy, wherein
the neural stimulation therapy includes a plurality of neural stimulation bursts,
each neural stimulation burst includes a plurality of neural stimulation pulses, and
successive neural stimulation bursts are separated by a time without neural stimulation pulses;
evaluating, using the neural stimulator system, an evoked response to the neural stimulation bursts of the neural stimulation
therapy, wherein evaluating the evoked response includes:

sensing the evoked response to the neural stimulation bursts, wherein sensing the evoked response includes sensing at least
one physiological parameter affected by the neural stimulation bursts; and

performing a statistical analysis of the evoked response to the plurality of neural stimulation bursts to determine if the
neural stimulation bursts provide a desired evoked response for the neural stimulation therapy; and

performing an action using the neural stimulation system including:
changing neural stimulation parameters for the neural stimulation therapy if the evoked response does not provide the desired
evoked response, or

recording results of the statistical analysis for access by a clinician.

US Pat. No. 9,492,674

LEADLESS CARDIAC PACEMAKER WITH DELIVERY AND/OR RETRIEVAL FEATURES

Cardiac Pacemakers, Inc.,...

1. An implantable leadless cardiac pacing device comprising:
a housing having a proximal end and a distal end;
an electrode positioned proximate the distal end of the housing configured to be positioned adjacent cardiac tissue; and
a docking member extending from the proximal end of the housing along a longitudinal axis of the housing, the docking member
configured to facilitate retrieval of the implantable leadless cardiac pacing device;

the docking member including a head portion and a neck portion extending between the housing and the head portion;
the head portion having a radial dimension from the longitudinal axis and the neck portion having a radial dimension from
the longitudinal axis less than the radial dimension of the head portion;

the head portion including a plurality of radially extending spokes extending radially outward from the longitudinal axis
of the housing;

wherein each spoke includes a base portion proximate the longitudinal axis of the housing and a free end extending radially
outward from the base portion, wherein a width of each spoke increases from the base portion toward the free end of the spoke.

US Pat. No. 9,114,265

METHOD AND APPARATUS FOR ENABLING DATA COMMUNICATION BETWEEN AN IMPLANTABLE MEDICAL DEVICE AND A PATIENT MANAGEMENT SYSTEM

Cardiac Pacemakers, Inc.,...

1. An apparatus comprising:
an antenna; and
a frequency and protocol agile transceiver, coupled to the antenna, and adapted for:
configuring the frequency and protocol agile transceiver for communication with an implantable medical device using the antenna
and a first wireless communications link; and

reconfiguring the frequency and protocol agile transceiver for communication with a host computer using the antenna and a
second wireless communications link,

wherein the first wireless communication link is configured for substantially shorter communication range than the second
wireless communication link.

US Pat. No. 9,101,770

HYPERTENSION THERAPY DEVICE WITH LONGEVITY MANAGEMENT

Cardiac Pacemakers, Inc.,...

1. A system for treating hypertension, comprising:
a stimulator configured to generate stimulation pulses;
a memory circuit configured to store one or more stimulation parameters including a therapy-on period during which the stimulation
pulses are programmed to be delivered, a therapy-off period during which no stimulation pulse is programmed to be delivered,
and a therapy on-off pattern including a combination of a sequence of therapy-on periods with variable durations and a sequence
of therapy-off periods with variable durations; and

a controller circuit connected to the stimulator and the memory circuit, the controller circuit configured to:
receive a power-saving command;
time one or both of the therapy-on period and the therapy-off period; and
schedule the delivery of the stimulation pulses to a target site according to the therapy on-off pattern in response to a
power-saving command.

US Pat. No. 9,277,885

IMPLANTABLE CARDIAC DEVICE WITH DYSPNEA MEASUREMENT

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
a respiration sensor configured to sense respiration of a patient;
an activity sensor configured to sense an activity level of the patient;
a controller operatively coupled to the respiration sensor and the activity sensor, the controller configured to:
determine a patient index based at least part on the sensed respiration of the patient;
detect a physiological condition based on the determined patient index being beyond a threshold, wherein the threshold is
based at least in part on the sensed activity level of the patient; and

provide an output based, at least in part, on the detected physiological condition.

US Pat. No. 9,254,100

LOGGING DAILY AVERAGE METABOLIC ACTIVITY USING A MOTION SENSOR

Cardiac Pacemakers, Inc.,...

1. A system comprising:
an activity detector, configured to:
detect a physical movement by a subject; and
measure exertion data, indicating an exertion level of the subject, measured from the detected physical movement by the subject;
a processor circuit, coupled to the activity detector, the processor configured to analyze the exertion data from the activity
detector, the processor configured to determine a metabolic stress indicator derived from an integration or area under the
curve calculation of the measured exertion data occurring during the exertion within a time period; and

an alert response module operatively coupled to the processor circuit, the alert response module configured to generate an
alert in response to the metabolic stress indicator meeting a specified criterion.

US Pat. No. 9,149,639

SYSTEMS FOR USING A PULMONARY ARTERY ELECTRODE

Cardiac Pacemakers, Inc.,...

1. A system comprising an implantable medical device (IMD) and a lead configured to be connected to the IMD, the lead comprising:
a lead body having an end adapted to connect to the IMD and a distal portion adapted to be securely positioned in a pulmonary
artery;

the lead body being adapted to be fed into the right atrium, through a tricuspid valve, into a right ventricle, and through
a pulmonary valve; and

the distal portion of the lead body being adapted to be secured within a pulmonary artery, the distal portion including at
least one electrode adapted to be positioned within the pulmonary artery when the distal portion is secured within the pulmonary
artery, wherein the IMD is adapted to use the at least one electrode to:

apply neural stimulation to a neural stimulation target when the distal portion is secured within the pulmonar artery; and
capture atrial tissue when the distal portion is secured within the pulmonary artery, or sense an intrinsic atrial electrical
event when the distal portion is secured within the pulmonary artery, or both capture atrial tissue and sense an intrinsic
atrial electrical event when the distal portion is secured within the pulmonary artery.

US Pat. No. 9,126,044

AUTONOMIC MODULATION USING TRANSIENT RESPONSE WITH INTERMITTENT NEURAL STIMULATION

Cardiac Pacemakers, Inc.,...

1. A method for operating an implantable neural stimulator to deliver a neural stimulation therapy to an autonomic neural
target, the method comprising:
using the implantable neural stimulator to deliver the neural stimulation therapy to the autonomic neural target, wherein:
the neural stimulation therapy includes a plurality of neural stimulation bursts;
each neural stimulation burst includes a plurality of neural stimulation pulses; and
successive neural stimulation bursts are separated by a time without neural stimulation pulses;
evaluating an evoked response to the neural stimulation bursts of the neural stimulation therapy, wherein evaluating the evoked
response includes:

sensing the evoked response to the neural stimulation bursts, wherein sensing the evoked response includes sensing at least
one physiological parameter affected by the neural stimulation bursts;

comparing the sensed evoked response against a baseline; and
determining if the evoked response substantially returns to the baseline between successive neural stimulation bursts of the
neural stimulation therapy; and

performing an action including:
automatically changing neural stimulation parameters for the neural stimulation therapy if the evoked response does not substantially
return to the baseline; or

recording results of the comparison in a memory of the implantable neural stimulator for access by a clinician.

US Pat. No. 10,086,202

PATIENT CONTROL OF THERAPY SUSPENSION

Cardiac Pacemakers, Inc.,...

1. A method performed by an implantable medical device (IMD) to deliver a therapy to a patient, the method comprising:enabling at least one feature of a trigger response controller that is configured to respond to a trigger, the IMD including the trigger response controller and the MD is configured to deliver the therapy when the at least one feature is enabled to respond to the trigger and when the at least one feature is not enabled to respond to the trigger, the at least one feature of the trigger response controller including automatically interrupting the therapy in response to a detected trigger and automatically restoring the therapy after a defined time after the detected trigger, wherein enabling includes enabling under control of a patient or a caregiver to the patient;
delivering the therapy to the patient;
detecting a trigger that is controlled by the patient or the caregiver to the patient; and
determining if the at least one feature is enabled, and automatically implementing the at least one enabled feature of the trigger response controller in response to the detected trigger when the at least one feature is enabled, including automatically interrupting the therapy in response to the detected trigger and automatically restoring the therapy after the defined period after the detected trigger.

US Pat. No. 9,839,781

INTRACARDIAC IMPEDANCE AND ITS APPLICATIONS

Cardiac Pacemakers, Inc.,...

1. A medical device comprising:
a controller circuit configured to:
receive a sensed cardiac cycle and an intracardiac impedance signal;
determine at least two of:
a cardiac-cycle-to-cardiac-cycle change in a value of a baseline intracardiac impedance value calculated, for a particular
cardiac cycle, to represent the baseline intracardiac impedance for that particular cardiac cycle;

a cardiac-cycle-to-cardiac-cycle change in a value of maximum intracardiac impedance value calculated, for a particular cardiac
cycle, to represent the maximum intracardiac impedance value for that particular cardiac cycle; or

a cardiac-cycle-to-cardiac-cyclea change in a slope value of an intracardiac impedance waveform signal, for a particular cardiac
cycle, the slope value measured at a time corresponding to one-half of a time interval over which a maximum intracardiac impedance
change occurs during the particular cardiac cycle; and

generate an indication that the measured at least two of the cardiac-cycle-to-cardiac-cycle changes represent heart failure
(HF) decompensation when the changes occur absent detection of an intervening event during the measuring of the intracardiac
impedance parameters.

US Pat. No. 9,468,769

METHOD AND APPARATUS FOR INDICATION-BASED PROGRAMMING OF CARDIAC RHYTHM MANAGEMENT DEVICES

Cardiac Pacemakers, Inc.,...

1. An external system for programming an implantable medical device for a patient, the system comprising:
an indication-based programming device configured to receive patient-specific information and device-specific information
and automatically produce values of a set of operational parameters of a plurality of programmable parameters using the patient-specific
information and the device-specific information, the patient-specific information including the patient's electronic medical
records including a symptom or circumstance that indicates advisability of one or more medical treatments deliverable by the
implantable medical device, the device-specific information including a device type of the implantable medical device, the
device type associated with the plurality of programmable parameters;

a telemetry circuit configured to communicate with the implantable medical device;
a device identification module configured to identify the device type using information received from the implantable medical
device via telemetry; and

a user interface coupled to the indication-based programming device, the user interface including an election input device
configured to receive a user election to modify the automatically produced values of a set of operational parameters, wherein
the election input device is further configured to present the user with one or more ranges encompassing one or more operational
parameter values alternative to the automatically produced values, wherein the one or more alternative operational parameter
values encompassed by the one or more ranges are within predetermined safety limits.

US Pat. No. 9,393,417

SYSTEMS AND METHODS FOR USING SENSED PRESSURE FOR NEURO CARDIAC THERAPY

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
delivering a vagal stimulation therapy (VST) to a vagus nerve of a patient, wherein delivering the VST includes delivering
a therapeutically-effective intensity of neural stimulation to treat a condition, wherein the therapeutically-effective intensity
of neural stimulation causes laryngeal vibrations;

performing a stimulation capture confirmation process multiple times and intermittently during delivery of the VST, wherein
performing the stimulation capture confirmation process includes detecting laryngeal vibrations to determine whether the VST
is capturing the vagus nerve, wherein detecting laryngeal vibrations includes detecting laryngeal vibrations when the VST
does not cause cough and further includes:

sensing pressure using an implantable pressure sensor configured to sense pressure in a cervical region in the patient caused
by the laryngeal vibrations, wherein sensing pressure includes sensing pressure a plurality of times to provide a plurality
of sensed pressure values; and

analyzing variability of a plurality of the sensed pressure values to determine whether the VST causes laryngeal vibrations,
including whether the VST causes laryngeal vibrations when the VST does not cause cough, and thereby determine whether the
VST is capturing the vagus nerve; and

controlling the VST based on whether the VST is capturing the vagus nerve; and
detecting whether the VST is causing cough, including analyzing the variability of the plurality of the sensed pressure values
to confirm the cough; and

maintaining the therapeutically-effective intensity of the neural stimulation for the VST during the stimulation capture confirmation
process, including controlling the intensity based on the variability of the plurality of the sensed pressure values to avoid
causing cough while capturing the vagus nerve.

US Pat. No. 9,351,647

INDICATION-BASED WORSENING HF ALERT

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
a user input configured to:
receive a user selection of a heart failure symptom to indicate whether a heart failure symptom is or has been present, wherein
the heart failure symptom includes at least one of dyspnea, edema, or weight change; and

receive a user selection of a heart failure (HF) comorbidity to indicate whether an HF comorbidity is or has been present;
and

a heart failure (HF) status processor, coupled to the user input, the HF status processor configured to determine a heart
failure status using information about the user selection of the heart failure symptom and information received from a physiological
patient status parameter detector, the information received from the physiological patient status parameter detector including
information about a first physiological patient status parameter and a different second physiological patient status parameter;

wherein the HF status processor configured to determine the heart failure status is further configured to controllably adjust
the heart failure status determination, wherein controllably adjusting the heart failure status determination comprises:

adjusting a first weight for the information about the first physiological patient status parameter relative to a second weight
for the information about the different second physiological patient status parameter; and

using the information obtained from the first and second physiological patient status parameters in conjunction with the first
and second weights.

US Pat. No. 9,333,344

IMPLANTABLE DEVICE LEAD INCLUDING A DISTAL ELECTRODE ASSEMBLY WITH A COILED COMPONENT

Cardiac Pacemakers, Inc.,...

1. A medical device lead configured to connect to an implantable pulse generator, the lead comprising:
an insulative body having a proximal region with a proximal end, and a distal region with a distal end;
a connector coupled to the proximal end of the insulative body of the lead configured to electrically and mechanically connect
the lead to the implantable pulse generator;

a conductor extending through the insulative body, a proximal end of the conductor electrically connected to the connector;
and

a metal housing that at least partially houses a fixation helix, the housing having a proximal end and a distal end, and
a coil extending around the housing, the coil having a proximal end that is distal of the proximal end of the housing, the
coil further having a distal end that is proximal of the distal end of the housing.

US Pat. No. 9,289,594

LEADS INCORPORATING A LASER PROCESSED ELECTRODE

Cardiac Pacemakers, Inc.,...

1. A method of preparing an electrode for use with an implantable medical lead, the electrode including a metallic surface,
the method comprising:
forming macrostructures in the metallic surface by removing material from the metallic structure, the macrostructures having
an average major dimension that is in the range of about 5 micrometers to about 200 micrometers including subjecting the metallic
surface to an ultrafast laser having a pulse width of less than about 15 picoseconds; and

forming nanostructures by redepositing removed material on the macrostructures resulting from the forming of the macrostructures,
the nanostructures having an average major dimension that is in the range of about 100 nanometers to about 2 micrometers.

US Pat. No. 9,232,900

SYSTEM AND METHOD FOR ANALYZING A PATIENT STATUS FOR CONGESTIVE HEART FAILURE FOR USE IN AUTOMATED PATIENT CARE

Cardiac Pacemakers, Inc.,...

1. A system providing physiometry for use in remote automated congestive heart failure patient management, comprising:
a medical devise having:
one or more sensors to directly sense raw physiometry for a patient;
sensing circuitry to regularly monitor and record the raw physiometry as collected device measures;
memory to temporarily store the collected device measures pending interrogation by an externally interfaceable device; and
a telemetry interface to provide access to the collected device measures; and
a processor to derive measures from the collected device measures,
the system defining at least one hysteresis parameter to temporally define a threshold for change in a pathophysiology indicative
of congestive heart failure;

a diagnostic module configured to receive at least a portion of the collected device measures and derived measures, quantify
the pathophysioloy indicative of congestive heart failure, and to quantify a pathophysiology indicative of respiratory distress
based on the collected device measures and the derived measures, wherein the diagnostic module is configured to qualify the
pathophysiology indicative of congestive heart failure based on the quantified pathophysiology indicative of respiratory distress
and the at least one hysteresis parameter wherein the hysteresis parameter defines that the quantified pathophysiology indicative
of congestive heart failure does not change the temporary change in pathophysiology indicative of congestive heart failure
but upon a persistence of change; and

a database remote from the medical device wherein the database is configured to receive and store at least some derived measures
felevant to the pathophysiology indicative of congestive heart failure, wherein the database is configured to receive the
measures from a network server.

US Pat. No. 9,216,292

DYNAMIC MORPHOLOGY BASED ATRIAL AUTOMATIC THRESHOLD

Cardiac Pacemakers, Inc.,...

1. A method of operating an implantable cardiac rhythm device to deliver pacing to an atrium, the method, comprising:
delivering atrial pacing;
using a post ventricular refractory period (PVARP) having a first PVARP duration during cardiac cycles of the atrial pacing
in which an atrial pace captures the atrium;

using an A-A interval having a first A-A interval duration between cardiac cycles of the atrial pacing in which the atrial
pace captures the atrium; and

using a PVARP having a second PVARP duration and using an A-A interval having a second A-A interval duration during cardiac
cycles of the atrial pacing in which the atrial pace does not capture the atrium, wherein the second PVARP duration is greater
than the first duration PVARP and the second A-A interval duration is greater than the first A-A interval duration.

US Pat. No. 9,149,641

LEFT VENTRICULAR PACING PROTECTION IN THE CONTEXT OF MULTI-SITE LEFT VENTRICULAR PACING

Cardiac Pacemakers, Inc.,...

1. A cardiac pacing device, comprising:
pulse generation circuitry for generating pacing pulses;
sensing circuitry for sensing cardiac electrical activity;
a controller for detecting cardiac events that define pacing timing intervals and for controlling the delivery of pacing pulses
in accordance with a programmed mode;

a switch matrix operable by the controller for connecting the pulse generation circuitry and sensing circuitry to selected
electrodes in order to form selected sensing and pacing channels;

wherein the controller is programmed to:
sense cardiac activity through a right ventricular sensing channel;
schedule delivery of paces through left ventricular pacing channels to a plurality of left ventricular pacing sites during
a cardiac cycle interval that is reset by a right ventricular sense;

initiate a pace-initiated left ventricular protective period after a left ventricular pace to any of the left ventricular
pacing sites, wherein during the pace-initiated left ventricular protective period the first scheduled pace to each of the
plurality of left ventricular pacing sites is delivered and subsequent left ventricular paces to the plurality of left ventricular
pacing sites are inhibited;

when a left ventricular pace is delivered during the pace-initiated left ventricular period, extend the pace-initiated left
ventricular protective period by an amount shorter than its original duration.

US Pat. No. 9,123,470

IMPLANTABLE ENERGY STORAGE DEVICE INCLUDING A CONNECTION POST TO CONNECT MULTIPLE ELECTRODES

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a capacitor case sealed to retain electrolyte;
a first electrode disposed in the capacitor case, the first electrode comprising a substrate with a sintered portion on a
side of the substrate, the sintered portion bordering a connection portion on the side of the substrate, the connection portion
substantially free of sintering;

a connection post connected to the substrate at the connection portion, wherein the connection post comprises an elongate
post that is pierced through the connection portion;

a first electrode terminal disposed on an exterior of the capacitor case in electrical communication with the connection post
and the first electrode;

a second electrode disposed in the capacitor case;
a separator disposed between the second electrode and a first electrode; and
a second electrode terminal disposed on an exterior of the capacitor case and in electrical communication with the second
electrode, with the first electrode terminal and the second electrode terminal electrically isolated from one another;

wherein the case includes a dish portion and lid portion, with the connection post fixed to the dish portion and extending
out of an interior of the dish portion, wherein the connection post is capped with an electrically insulative cap.

US Pat. No. 9,814,429

SYSTEM AND METHOD FOR DISCRIMINATION OF CENTRAL AND OBSTRUCTIVE DISORDERED BREATHING EVENTS

Cardiac Pacemakers, Inc.,...

1. A method of operating an implantable device to classify disordered breathing events of a patient, comprising:
sensing respiration with a respiration sensor and generating a respiration signal indicating patient respiration cycles;
sensing chest wall motion with a motion sensor and generating a motion signal indicating chest wall motion associated with
inspiratory effort;

detecting disordered breathing based on the respiration signal using a disordered breathing detector;
time correlating the motion signal with the respiration signal using a processor of the implantable device;
classifying the disordered breathing event as a central disordered breathing event in response to the motion signal remaining
below a motion threshold during a time period in which the respiration signal remains below an inspiration threshold; or

classifying the disordered breathing event as an obstructive disordered breathing event in response to the motion signal rising
above the motion threshold during a time period in which the respiration signal remains below the inspiration threshold; and

delivering a therapy to treat disordered breathing based on the classification of the disordered breathing event with a therapy
delivery unit coupled to the processor.

US Pat. No. 9,649,495

METHOD AND APPARATUS FOR PACING DURING REVASCULARIZATION

Cardiac Pacemakers, Inc.,...

1. A system for use during revascularization procedure, comprising:
a percutaneous transluminal vascular intervention (PTVI) device including:
a proximal end portion including one or more pacing connectors;
a distal end portion configured for intravascular placement, the distal end portion including a tip and an angioplasty device
having a first end approximately adjacent to the tip and a second end;

an elongate body coupled between the proximal end portion and the second end of the angioplasty device; and
one or more pacing electrodes incorporated onto the distal end portion and electrically connected to the one or more pacing
connectors; and

a pacemaker configured to be connected to the one or more pacing connectors of the PTVI device and deliver pacing pulses to
the one or more pacing electrodes.

US Pat. No. 9,446,253

ENERGY ADAPTIVE COMMUNICATION FOR MEDICAL DEVICES

Cardiac Pacemakers, Inc.,...

1. A medical device comprising:
a communication module configured to deliver a plurality of pulses to tissue of a patient, where each pulse comprises an amount
of energy;

a control module operatively coupled to the communication module, the control module configured to:
for each delivered pulse, determine whether the delivered pulse produces an unwanted stimulation of the patient;
change the amount of energy of the plurality of pulses over time so as to identify an amount of energy that corresponds to
an unwanted stimulation threshold for the pulses;

set a maximum energy value for communication pulses that is below the unwanted stimulation threshold; and
deliver communication pulses below the maximum energy value during communication with another device.

US Pat. No. 9,420,959

DETECTING HEART FAILURE BY MONITORING THE TIME SEQUENCE OF PHYSIOLOGICAL CHANGES

Cardiac Pacemakers, Inc.,...

1. A system for monitoring a worsening heart failure condition, comprising:
a state machine circuit, configured to receive information about different first and second physiological characteristics
of a subject, wherein the state machine comprises:

a state sequence of at least first, second, and third states, wherein a state represents a physiological status of the subject,
at least one of the first, second, and third states correspond to a thoracic fluid status of the subject or a respiration
status of the subject, and at least one of the first, second, and third states correspond to a non-fluid related status or
non-respiration related status of the subject;

a first forward state transition from the first state to the second state in response to a first transition trigger;
a first reverse state transition from the second state to the first state in response to first of expiration of a first timer
and ceasing of the first transition trigger prior to expiration of the first timer;

a second forward state transition from the second to the third state in response to a second transition trigger; and
a second reverse state transition from the third state to the second state in response to first of expiration of a second
timer and ceasing of the second transition trigger prior to expiration of the first timer.

US Pat. No. 9,402,563

DISCRIMINATION OF APNEA TYPE BY MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. A method for apnea discrimination, the method comprising:
sensing an impedance-based tidal volume signal to monitor a respiratory cycle of a patient;
detecting a reduction in tidal swing using the sensed impendence to detect an apnea event; and
when the apnea event is detected, comparing a shape of the sensed signal to a stored signal shape to determine whether the
apnea event is primarily an obstructive sleep apnea (OSA) event or primarily a central sleep apnea (CSA) event.

US Pat. No. 9,308,375

CARDIAC RESPONSE CLASSIFICATION USING MULTISITE SENSING AND PACING

Cardiac Pacemakers, Inc.,...

1. A method of determining a cardiac response to a pacing pulse, comprising:
delivering two or more initialization pacing pulses to a heart using a first electrode combination of a plurality of electrodes
that are electrically coupled to the heart, wherein the two or more initialization pacing pulses are provided at a pacing
energy that is sufficient to result in capture of the heart;

sensing for a cardiac response following each of the two or more initialization pacing pulses using a second electrode combination;
for each of the two or more initialization pacing pulses, determining a delay interval between when an initialization pacing
pulse was delivered using the first electrode combination until when a corresponding cardiac response was sensed using the
second electrode combination;

following delivery of the two or more initialization pacing pulses:
delivering a pacing pulse to the heart using the first electrode combination;
sensing a cardiac response to the pacing pulse using the second electrode combination;
positioning a classification window according to a predetermined signal template morphology feature, wherein the positioning
includes beginning the classification window a predetermined time delay following the pacing pulse, wherein the time delay
is predetermined using the determined delay interval of the two or more initialization pulses; and

classifying the cardiac response to the pacing pulse as one of a captured response and a non-captured response, the classifying
step including: determining if the sensed cardiac response to the pacing pulse includes the predetermined signal morphology
feature within the classification window.

US Pat. No. 9,295,847

MONITORING RIGHT VENTRICULAR HEMODYNAMIC FUNCTION DURING PACING OPTIMIZATION

Cardiac Pacemakers, Inc.,...

1. A cardiac rhythm management system, comprising
pacing therapy circuitry configured to deliver cardiac resynchronization therapy (CRT) pacing using specified pacing parameters;
a pressure sensor adapted for disposition in the pulmonary artery to measure pulmonary artery pressure;
a right ventricular function analysis module configured to determine right ventricular function achieved during the pacing
based up on the measured pulmonary artery pressure; and

a controller configured to generate a signal responsive to a change in the right ventricular function during the pacing and
to modify the specified pacing parameters to improve right ventricular function when the right ventricular function has degraded
to a specified extent.

US Pat. No. 9,265,949

METHOD AND APPARATUS FOR CONTROLLING CARDIAC THERAPY BASED ON ELECTROMECHANICAL TIMING

Cardiac Pacemakers, Inc.,...

18. An implantable cardiac device, comprising:
means for detecting electrical depolarization of a patient's ventricular tissue;
means for detecting mechanical cardiac activity of the ventricular tissue resulting from the electrical depolarization;
means for determining a timing relationship between the detected electrical depolarization and the detected mechanical cardiac
activity; and

means for controlling a therapy delivered to the patient based on the timing relationship to treat at least one of intraventricular
dyssynchrony and dyssynchrony between the left and right ventricles.

US Pat. No. 9,254,389

ELECTRICAL INHIBITION OF THE PHRENIC NERVE DURING CARDIAC PACING

Cardiac Pacemakers, Inc.,...

11. A method for avoiding unwanted stimulation of a phrenic nerve during cardiac pacing, comprising:
determining a desired nerve traffic inhibition time to inhibit nerve traffic in the phrenic nerve, wherein determining the
desired nerve traffic inhibition time includes using a desired pace time for the cardiac pacing to determine the desired nerve
traffic inhibition time; and

inhibiting nerve traffic in the phrenic nerve at the desired nerve traffic inhibition time by delivering an electrical waveform
to the phrenic nerve that modifies excitability of nerve axons in the phrenic nerve to inhibit nerve traffic in the phrenic
nerve.

US Pat. No. 9,220,891

CARDIAC ELECTRODE ANCHORING SYSTEM

Cardiac Pacemakers, Inc.,...

1. An apparatus for inserting an electrode into a myocardium of the heart, the apparatus comprising:
an anchor including a tip portion configured to penetrate the myocardium in a first orientation and at least one rod-shaped
portion configured to anchor against an outside surface of the heart in a second orientation;

a tension element having a proximal end and a distal end, the distal end fastened to the anchor; and
an electrode having an inner guide channel to accommodate the tension element and having a pole at an end adapted for stimulating
the myocardium, the electrode and the tension element configured such that the electrode can be threaded over the proximal
end of the tension element and slideably advanced over the tension element towards the anchor during implantation, the guide
channel disposed at a connection point such that the tension element is attachable to the electrode and having a proximal
opening adapted to allow the proximal end of the tension element to exit therethrough, the proximal opening being closed by
a medical adhesive;

wherein the anchor and the tension element are configured to couple to the electrode, thereby chronically retaining the distal
end of the electrode in the heart after implantation.

US Pat. No. 9,186,522

NEURAL STIMULATION SYSTEMS, DEVICES AND METHODS

Cardiac Pacemakers, Inc.,...

1. A method, comprising:
chronically performing a prophylactic neural stimulation therapy;
in response to a therapy trigger, delivering an arrhythmia therapy, wherein delivering the other therapy includes temporarily
delivering therapeutic neural stimulation as part of the other therapy;

determining when an arrhythmia has terminated, and responding to termination of the arrhythmia by initiating a post-therapy
neural stimulation that has a programmed duration, wherein stimulation in the post-therapy neural stimulation is distinct
from stimulation in the prophylactic neural stimulation therapy; and

upon completion of the other therapy, chronically performing the prophylactic neural stimulation therapy.

US Pat. No. 9,089,275

SENSITIVITY AND SPECIFICITY OF PULMONARY EDEMA DETECTION WHEN USING TRANSTHORACIC IMPEDANCE

Cardiac Pacemakers, Inc.,...

1. A system comprising:
an implantable thoracic impedance measurement circuit, adapted to sense a plurality of thoracic impedance signal values from
a subject;

a processor, coupled with the thoracic impedance measurement circuit to accept the plurality of thoracic impedance signal
values; and

a statistical analysis module adapted to compute a mean and a standard deviation of the plurality of thoracic impedance signal
values,

wherein the processor is adapted to extract from the thoracic impedance signal values one or more thoracic impedance signal
values that fall within a boundary that is specified at less than or equal to a standard deviation from the mean thoracic
impedance and to use the extracted thoracic impedance signal values to determine a pulmonary edema indication.

US Pat. No. 10,029,107

LEADLESS DEVICE WITH OVERMOLDED COMPONENTS

CARDIAC PACEMAKERS, INC.,...

1. An electronics module in an Implantable Medical Device (IMD), the electronics module comprising:a plurality of electrical components connected to form a circuit that includes a terminal; a potting material supporting the plurality of electrical components, wherein
the plurality of electrical components and the potting material form a circuit sub-module, wherein the terminal is accessible from outside of the circuit sub-module; and
a metallic layer provided on an outer surface of the circuit sub-module, wherein the metallic layer conforms to the outer surface of the circuit sub-module, and the terminal is accessible from outside of the metallic layer; wherein
the circuit includes a second terminal, and wherein the second terminal is accessible from outside of the circuit sub-module.

US Pat. No. 9,808,631

COMMUNICATION BETWEEN A PLURALITY OF MEDICAL DEVICES USING TIME DELAYS BETWEEN COMMUNICATION PULSES TO DISTINGUISH BETWEEN SYMBOLS

Cardiac Pacemakers, Inc.,...

1. A method for communicating between a plurality of medical devices, the method comprising:
generating, with a first medical device, a first non-pacing communication pulse at a first time and a second non-pacing communication
pulse at a second time;

receiving, with a second medical device, the first non-pacing communication pulse at a third time and the second non-pacing
communication pulse at a fourth time;

determining, by the second medical device, one of three or more symbols based at least in part on the time difference between
the third time and the fourth time, wherein:

a “0” symbol is determined if the difference between the third time and the fourth time is in a range of 350 to 450 microseconds;
a “1” symbol is determined if the difference between the third time and the fourth time is in a range of 550 to 700 microseconds;
and

a synchronization symbol is determined if the difference between the third time and the fourth time is in a range of 800 to
1100 microseconds.

US Pat. No. 9,364,193

HEART SOUND TRACKING SYSTEM AND METHOD

Cardiac Pacemakers, Inc.,...

1. A method for identifying a heart sound in a heart sound waveform, the method comprising:
identifying one or more first candidate heart sounds in a first heart sound waveform, each of the one or more first candidate
heart sounds including corresponding first time and first energy features;

identifying two or more second candidate heart sounds in a second heart sound waveform, each of the two or more second candidate
heart sounds including corresponding second time and second energy features; and

using a cost analysis circuit:
determining a temporal cost for each of the second time features of the two or more second candidate heart sounds relative
to each of the first time features of the one or more first candidate heart sounds;

determining a score for each of the two or more second candidate heart sounds using the determined temporal cost for each
candidate; and

discriminating between the two or more second candidate heart sounds, based on the determined scores, to provide an identifier
indicating a detected heart sound.

US Pat. No. 9,345,873

LEAD WITH TEXTURED INSULATIVE LAYER

Cardiac Pacemakers, Inc.,...

1. An implantable medical lead comprising:
a lead body having a conductor lumen having a substantially smooth inner surface;
a conductor assembly extending through the conductor lumen, the conductor assembly including a conductor member and an outer
insulative layer disposed about the conductor member, the outer insulative layer including a textured external surface; and

an electrode on the lead body coupled to the conductor member,
wherein the textured external surface has a surface roughness average greater than 16 microinches and the inner surface of
the conductor lumen has a surface roughness average less than 10 microinches.

US Pat. No. 9,278,221

PACING AND SENSING VECTORS

Cardiac Pacemakers, Inc.,...

16. A system for using with a lead implanted at or near a left ventricle of a heart, the system comprising a controller circuit
configured to deliver pacing signals to the heart via a first left ventricular (LV) electrode and a second LV electrode, wherein
the first LV electrode and the second LV electrode are the same electrical polarity and are electrically isolated.

US Pat. No. 9,192,317

IMPLANTABLE ACTIVE FIXATION LEAD WITH BIODEGRADABLE HELICAL TIP

Cardiac Pacemakers, Inc.,...

1. An implantable medical device comprising:
a housing having a distal end and a proximal end;
a coupler rotatably disposed within the housing, the coupler having a proximal end and a distal end; and
a helical electrode fixedly secured to the distal end of the coupler and configured with the coupler to translate relative
to the housing between fully extended and fully retracted positions, the helical electrode comprising:

a proximal axial length portion that comprises a non-degradable material having a first surface;
a distal axial length portion that comprises a biodegradable material having a second surface that is complementary to the
first surface; and

an interface between the biodegradable material and the non-degradable material including the first surface and the second
surface, wherein the second surface comprises a convex surface and the first surface comprises a concave surface that is complementary
to the convex surface.

US Pat. No. 9,155,896

METHOD AND APPARATUS FOR IMPROVING CARDIAC EFFICIENCY BASED ON MYOCARDIAL OXYGEN CONSUMPTION

Cardiac Pacemakers, Inc.,...

1. A method of improving cardiac efficiency, comprising:
measuring, patient-internally in at least one of a coronary vein and the great cardiac vein of the patient's heart, oxygen
saturation indicative of oxygen usage of myocardial tissue of the heart;

measuring cardiac stroke volume;
calculating a cardiac efficiency parameter based on the measured oxygen saturation and the measured stroke volume;
adjusting a cardiac electrical therapy to cause a change of the measured oxygen saturation;
calculating a change in the cardiac efficiency parameter resulting from the cardiac electrical therapy adjustment;
determining whether the adjustment in the cardiac electrical therapy decreased or increased cardiac efficiency based on the
calculated change in the cardiac efficiency parameter; and

selecting the adjusted cardiac electrical therapy for delivery if the adjustment of the cardiac electrical therapy was determined
to increase cardiac efficiency, wherein at least some of the steps of calculating the cardiac efficiency parameter, calculating
the change, determining, and selecting are performed at least in part by circuitry.

US Pat. No. 9,129,749

SINTERED ELECTRODES TO STORE ENERGY IN AN IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a capacitor case sealed to retain electrolyte, the capacitor case inner surface defining a conductive substrate;
a first electrode comprising a plurality of first electrode material portions disposed in the capacitor case, the plurality
of first electrode material portions comprising a sintered portion disposed on a second substrate, wherein the plurality of
first electrode material portions are disposed onto the second substrate, in a nested configuration, with at least a first
first electrode portion having a different area than a second first electrode portion;

a conductor coupled to the second substrate in electrical communication with the sintered portion, the conductor seatingly
extending through the capacitor case to a terminal disposed on an exterior of the capacitor case with the terminal in electrical
communication with the sintered portion;

a second electrode disposed in the capacitor case, the second electrode comprising a sintered portion disposed on the conductive
substrate on the inner surface of the capacitor case;

a separator disposed between the first electrode and the second electrode; and
a second terminal disposed on the exterior of the capacitor case and in electrical communication with the second electrode,
with the terminal and the second terminal electrically isolated from one another.

US Pat. No. 9,427,588

METHOD AND APPARATUS TO PERFORM ELECTRODE COMBINATION SELECTION

Cardiac Pacemakers, Inc.,...

1. A patient external device, comprising:
communication circuitry for receiving sensed data, wherein the sensed data comprises information associated with a capture
threshold for each of two or more electrode combinations and information associated with a phrenic nerve activation for each
of the two or more electrode combinations;

a user interface comprising a display;
a controller operatively coupled to the communications circuitry and the display, the controller configured to:
access the information received via the communication circuitry and display an indication of a capture threshold and an indication
of phrenic nerve activation for each of two or more electrode combinations on the display;

accept a selection of one of the two or more displayed electrode combinations from a user via the user interface; and
program an implantable device via the communication circuitry to use the selected electrode combination to delivery therapy.

US Pat. No. 9,399,136

IMPLANTABLE MEDICAL DEVICE WITH CONTROL OF NEURAL STIMULATION BASED ON BATTERY STATUS

Cardiac Pacemakers, Inc.,...

1. An implantable medical device, comprising:
a battery;
a battery monitoring circuit coupled to the battery, the battery monitoring circuit configured to measure a battery parameter
indicative of an energy level of the battery;

a neural stimulation circuit configured to deliver neural stimulation for modulating neural activities;
a cardiac stimulation circuit configured to deliver cardiac stimulation including one or more of cardiac pacing or defibrillation;
and

a control circuit coupled to the battery monitoring circuit, the neural stimulation circuit, and the cardiac stimulation circuit,
the control circuit configured to:

set a current power mode of the implantable medical device to a first predetermined reduced-power operation mode of a plurality
of predetermined power modes in response to the battery parameter indicating that the energy level of the battery has fallen
below a first energy level threshold;

reduce a power consumption required for delivering the neural stimulation without reducing a power consumption required for
delivering the cardiac stimulation during the first predetermined reduced-power operation mode;

set a current power mode of the implantable medical device to a second predetermined reduced-power operation mode of the plurality
of predetermined power modes in response to the battery parameter indicating that the energy level of the battery has fallen
below a second energy level threshold; and

reduce the power consumption required for delivering the neural stimulation and the power consumption required for delivering
the cardiac stimulation during the second predetermined reduced-power operation mode.

US Pat. No. 9,327,113

ACTIVE FIXATION LEAD HAVING A ROTATABLE CURVE

Cardiac Pacemakers, Inc.,...

1. An implantable lead having a proximal section, a distal section, and a curved section between the proximal section and
the distal section, the implantable lead comprising:
an outer tubular portion extending from the proximal section to the distal section, the outer tubular portion defining an
exterior surface of the implantable lead, the outer tubular portion having a bias such that the implantable lead assumes a
curved shape along the curved section;

an inner tubular portion extending within the outer tubular portion, the inner tubular portion comprising an inner coil conductor
and an inner polymer jacket over the inner coil conductor along the curved section, the inner coil conductor extending from
the proximal section to the distal section and having a steeper filar pitch along the curved section than along the proximal
section, the inner polymer jacket having a plurality of slots along the curved section that increases the flexibility of the
inner tubular portion; and

an active fixation element on the distal end, the active fixation element in electrical connection with the inner coil conductor,
the active fixation element configured to affix to tissue by rotation of the inner tubular portion relative to the outer tubular
member.

US Pat. No. 9,265,431

METHODS AND APPARATUS FOR CONTROLLING NEUROSTIMULATION USING EVOKED PHYSIOLOGIC EVENTS

Cardiac Pacemakers, Inc.,...

1. A system for delivering neurostimulation to a body having a vagus nerve and a laryngeal muscle, the system comprising:
a stimulation output circuit configured to deliver neurostimulation pulses to the vagus nerve;
an evoked muscular response detection circuit configured to receive a laryngeal signal representative of activities of the
laryngeal muscle including evoked muscular responses being responses of the laryngeal muscle evoked by the neurostimulation
pulses and detect the evoked muscular responses by comparing the laryngeal signal to one or more detection thresholds; and

a control circuit configured to compare the detected evoked muscular responses to a stored baseline response and including
a sensing parameter adjustor configured to adjust the one or more detection thresholds in response to the detected evoked
muscular responses deviating from the stored baseline response, the stored baseline response established during an initial
setup of the system.

US Pat. No. 9,162,063

CONTROL OF NEURAL MODULATION THERAPY USING CERVICAL IMPEDANCE

Cardiac Pacemakers, Inc.,...

1. A method comprising:
detecting fluctuations in a cervical vessel dimension of a patient, wherein detecting the fluctuations includes measuring
a cervical impedance of the patient over time;

determining pulsatile information using the detected fluctuations in the cervical vessel dimension of the patient; and
providing a neural modulation therapy coordination with a characteristic of the pulsatile information.

US Pat. No. 9,555,253

METHOD AND APPARATUS FOR PHRENIC STIMULATION DETECTION

Cardiac Pacemakers, Inc.,...

1. A method of controlling operation of a medical device, the method comprising:
delivering a pulse with a predetermined pulse energy as part of a cardiac capture threshold test;
determining if the delivered pulse produced phrenic stimulation;
continuing the capture threshold test when it is determined that the delivered pulse did not produce phrenic stimulation;
and

halting the capture threshold test when detecting, using the medical device, that the delivered pulse did produce phrenic
stimulation.

US Pat. No. 9,480,834

MULTIPOLAR CONDUCTOR FOR AN IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

1. A medical device lead comprising:
a flexible body having a proximal region with a proximal end, and a distal region with a distal end;
a connector coupled to the proximal end of the flexible body of the lead to electrically and mechanically connect the lead
to an implantable pulse generator;

a plurality of electrodes in the distal region of the flexible body; and
a composite wire having a proximal end electrically coupled to the connector, the composite wire including:
an inner conductor element;
a plurality of outer conductor elements; and
an insulative layer that is adjacent to and circumferentially surrounds the inner conductor element the insulative layer having
an outer circumferential surface,

wherein a distal end of each of the inner conductor element and the plurality of outer conductor elements is connected to
one of the plurality of electrodes, each of the plurality of outer conductor elements includes an inner surface adjacent to
the insulative layer and an outer surface on a side opposite the inner surface, a surface area of the inner surface is less
than a surface area of the outer surface, the insulative layer is located radially between the inner conductor element and
each of the plurality of outer conductor elements, and the entire inner surface of each of the plurality of outer conductor
elements is located radially outward from and in direct contact with the outer circumferential surface of the insulative layer.

US Pat. No. 9,482,016

SHIPMENT AND INSTALLATION OF PRE-HUNG DOORS DEVICE AND METHOD

Cardiac Pacemakers, Inc.,...

1. A door stabilization device, comprising:
a clip component comprising a first side portion, a second side portion, and a back portion, the first side portion and second
side portions extending from a surface of the back portion, the back portion defining a clip aperture, the clip component
configured to fit onto an edge of a door using a compression fit between the first side portion and the second side portion;

a first fastener portion comprising a shaft portion and a head portion, the first fastener portion configured to extend through
the clip aperture and at least partially into a latchbolt aperture defined by the door; and

a second fastener portion configured to mate with the first fastener portion, the second fastener portion configured to fit
at least partially within the latchbolt aperture and a door knob bore defined by the door,

wherein when the first fastener portion extends through the clip aperture and is mated with the second fastener portion, the
back portion of the clip component is positioned in between the head portion of the first fastener portion and at least a
portion of the second fastener portion.

US Pat. No. 9,457,192

SYSTEMS AND METHODS FOR MONITORING NEUROSTIMULATION DOSING

Cardiac Pacemakers, Inc.,...

1. An implantable medical device, comprising:
a neural stimulator configured to deliver a neurostimulation therapy with a neural stimulation pulse frequency, wherein a
dose of the neurostimulation therapy is provided by a number of neurostimulation pulses over a period of time, wherein the
neural stimulator includes a clock with an oscillator, a hardware state machine operationally connected to the clock to provide
pulse timing control signals, and pulse circuitry configured to receive the timing control signals and deliver neurostimulation
pulses with a pulse frequency controlled using the timing control signals, the pulse circuitry including a frequency output
limiter configured to avoid excessive charge delivery, wherein the frequency output limiter is configured to block a pulse
from being issued only for a limited period of time after a preceding pulse, and thereby allow a subsequent pulse after the
limited period of time.

US Pat. No. 9,421,385

THERAPY DELIVERY ARCHITECTURE FOR IMPLANTABLE MEDICAL DEVICE

Cardiac Pacemakers, Inc.,...

15. An implantable medical device comprising:
at least one processor; and
at least one memory circuit;
wherein the at least one memory circuit includes instructions that, when performed by the at least one processor, cause the
implantable medical device to:

controllably connect a first power supply circuit to one or more electrostimulation output nodes to deliver a first electrostimulation
therapy or controllably connect a second power supply circuit to one or more of the electrostimulation output nodes to deliver
a second electrostimulation therapy in response to a control signal specifying an electrostimulation therapy and using an
electrostimulation therapy output circuit coupled to an electrostimulation therapy control circuit and the first and second
power supply circuits; and

provide or maintain a charge-balance condition for the electrostimulation therapies by establishing a first return path when
the first electrostimulation therapy is selected and a second return path when the second electrostimulation therapy is selected,
the first return path having a capacitance between at least one of the electrostimulation output nodes and a reference node
to passively bleed charges to provide or maintain the charge-balanced condition during the first electrostimulation therapy
using an electrostimulation therapy return circuit coupled to the electrostimulation therapy control circuit, the second return
path having a capacitance between at least one of the electrostimulation output nodes and the reference node to passively
bleed charges to provide or maintain the charge-balanced condition during the second electrostimulation therapy using the
electrostimulation therapy return circuit coupled to the electrostimulation therapy control circuit;

wherein each of the electrostimulation output nodes is configured to couple to one or more implantable electrodes.

US Pat. No. 9,357,935

SYSTEMS AND METHODS TO IDENTIFY CARDIAC DYSYNCHRONY

Cardiac Pacemakers, Inc.,...

1. A method comprising:
identifying a patient condition comprising cardiac dysynchrony at intrinsic rates above a threshold using an implantable medical
device;

notifying a clinical user of the identified condition;
identifying a therapy appropriate for the identified condition; and
presenting the clinical user with a selectable option to implement the therapy appropriate for the identified patient condition;wherein identifying cardiac dysynchrony comprises analyzing at least one of heart rate variability data and cardiac output
data and determining from the analysis that cardiac synchrony requires a heart rate that is greater than at least one of a
programmed maximum tracking rate, a programmed maximum sensor rate and a programmed maximum pacing rate in a cardiac rhythm
management device.

US Pat. No. 9,265,936

LEAD ASSEMBLY AND RELATED METHODS

Cardiac Pacemakers, Inc.,...

1. A lead assembly comprising:
a lead body including elongate tubing extending from a first end portion to a second end portion and having an intermediate
portion therebetween;

at least one electrode coil disposed along the lead body;
the at least one electrode coil comprising a plurality of filars and having at least one laser weld portion formed of two
or more of the filars; and

at least one coating disposed along the at least one electrode coil including the at least one laser weld portion, the at
least one electrode coil is defined in part by a longitudinal axis;

wherein the at least one laser weld portion forms a surface for promoting adhesion of the at least one coating to the at least
one electrode coil.

US Pat. No. 9,093,683

METHOD AND APPARATUS FOR POROUS INSULATIVE FILM FOR INSULATING ENERGY SOURCE LAYERS

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
an anode having an elongate ribbon shape;
a cathode having an elongate ribbon shape having a long side and a short side, the cathode disposed adjacent to and in alignment
with the anode, the cathode having at least one edge on the short side offset from a corresponding edge of the anode;

a separator disposed between the anode and the cathode; and
an edge film positioned at the edge on the short side of the cathode that is offset from the corresponding edge of the anode,
the edge film located between and contacting both the cathode and the separator such that the edge film is positioned and
configured to prevent the edge on the short side of the cathode from damaging the separator or the anode as the anode and
cathode are wound together into a roll.

US Pat. No. 9,084,898

METHOD AND DEVICE FOR PROVIDING ANTI-TACHYARRHYTHMIA THERAPY

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
at least one sensor input adapted to receive at least one sensed signal associated with a tachyarrhythmia;
a feature set extractor adapted to extract at least two features from the at least one sensed signal associated with the tachyarrhythmia;
a feature set generator adapted to form a feature set using the at least two features extracted by the feature set extractor;
at least one generator adapted for use to selectively apply a shock therapy, an anti-tachycardia pacing (ATP) therapy, and
a neural stimulation (NS) therapy; and

a controller adapted to respond to the feature set, the controller being adapted to initiate the shock therapy when the feature
set corresponds to criteria for applying the shock therapy, initiate the ATP therapy when the feature set corresponds to criteria
for applying the ATP therapy, and initiate the NS therapy when the feature set corresponds to criteria for applying the NS
therapy, wherein the controller is configured to detect a ventricular tachycardia (VT), characterize the detected VT to distinguish
between a moderately fast rate and a very fast rate, distinguish between a stable rhythm and an unstable rhythm and distinguish
among significantly unstable hemodynamics, stable hemodynamics, and modest hemodynamic compromise, and initiate the NS therapy
when the detected VT is characterized by a combination of all of the following: a moderately fast rate, an unstable rhythm
and a modest hemodynamic compromise.

US Pat. No. 9,572,975

PADDLE LEADS CONFIGURED FOR SUTURE FIXATION

Cardiac Pacemakers, Inc.,...

1. An implantable lead comprising:
an elongated lead body having a proximal portion and a distal portion;
at least one conductor extending within the elongated lead body;
at least one electrode electrically connected to the at least one conductor; and
a paddle attached to the distal portion of the lead body, the paddle comprising:
a main panel;
a ridge on a periphery of the main panel; and
a raised pattern of traces, the main panel comprising a first face and a second face opposite the first face, each of the
at least one electrode exposed on the first face but not exposed on the second face, wherein the paddle is thicker along the
ridge than along the main panel; and the raised pattern of traces is formed on the second face.

US Pat. No. 9,504,821

CONSTRUCTION OF AN MRI-SAFE TACHYCARDIA LEAD

Cardiac Pacemakers, Inc.,...

1. A medical device lead, comprising:
a lead body including a tubular member having a proximal end, a distal end, and a conductor lumen extending therebetween,
the tubular member made of an electrically insulative material;

an electrical conductor extending within the conductor lumen from the proximal end of the tubular member toward the distal
end of the tubular member;

a tubular conductive element disposed over the tubular member of the lead body between the proximal and distal ends thereof,
the tubular conductive element including a first segment, a second segment extending distally from the first segment, and
a third segment extending distally from the second segment, each of the segments having one or more kerfs formed radially
therethrough in a predetermined configuration so as to affect an electrical impedance of the respective segment, wherein the
one or more kerfs in each of the first and second segments are configured so that the first and second segments have a higher
electrical impedance than the third segment, so that the first and second segments of the tubular conductive element are operable
to inhibit induced currents in the tubular conductive element in the presence of an external source of electromagnetic energy,
and wherein the electrical conductor is mechanically and electrically coupled to the tubular conductive element; and

a layer of insulative material disposed over the first and second segments of the tubular conductive element,
wherein an outer surface of the third segment of the tubular conductive element is uninsulated so that the third segment can
be operable as a shocking electrode.

US Pat. No. 9,424,997

SYSTEMS AND METHODS TO CONNECT SINTERED ALUMINUM ELECTRODES OF AN ENERGY STORAGE DEVICE

Cardiac Pacemakers, Inc.,...

1. An apparatus, comprising:
a case;
an electrode located within the case, the electrode including a sintered material deposited on a conductive substrate, the
conductive substrate having a substrate flexibility greater than a material flexibility of the sintered material, the substrate
including a first tab extending from a first location along a perimeter of the substrate;

a separator disposed in a capacitor stack in alignment with the electrode;
a second electrode disposed in the capacitor stack in alignment, the second electrode including a second tab extending from
the first location along a perimeter of the second substrate; and

a conductive interconnect physically and electrically coupling the first tab and the second tab within the case, the first
tab and the second tab each adapted to deform to accommodate displacement of the electrode with respect to the second electrode.

US Pat. No. 9,302,092

MULTI-FUNCTION LEAD IMPLANT TOOL

Cardiac Pacemakers, Inc.,...

1. An implant tool for use with an implantable lead, the implant tool comprising:
a main body having a distal clamping section, a proximal section, and an interior lumen, the distal clamping section including
an opening adapted to frictionally receive a terminal boot of the implantable lead;

a plurality of spring contact members coupled to the main body and exposed on an exterior of the implant tool; and
a knob mechanism coupled to the main body, the knob mechanism slidably actuatable along a central axis of the implant tool
between a first position configured to frictionally engage a terminal pin of the implantable lead and a second position configured
to disengage the implant tool from the terminal pin to facilitate torque release, the knob mechanism connected to the main
body in each of the first and second positions, the knob mechanism configured to rotate relative to the main body when in
the first position to rotate the terminal pin relative to the terminal boot, the knob mechanism slidably actuatable between
the first and second positions independent of relative rotation between the knob mechanism and the main body, wherein the
knob mechanism slides along the central axis, farther away from the main body, when slidably actuated from the first position
to the second position.

US Pat. No. 10,111,986

PRODUCTION OF IN SITU CROSSLINKABLE POLYISOBUTYLENE-POLYURETHANE NANOFIBERS AND COATINGS

Cardiac Pacemakers, Inc.,...

1. A method for making an implantable medical device including a polyisobutylene-polyurethane block copolymer, the method comprising:polymerizing a polyisobutylene diol, a diisocyanate, a chain extender, and optionally a polyether diol, in a solvent system to form a polyisobutylene-polyurethane block copolymer solution;
depositing the polyisobutylene-polyurethane block copolymer solution onto at least a portion of the implantable medical device; and
evaporating the solvent system from the deposited polyisobutylene-polyurethane block copolymer solution wherein the solvent system includes one or more solvents components present during the polymerization step and the depositing step.

US Pat. No. 9,272,151

ADAPTIVE PHRENIC NERVE STIMULATION DETECTION

Cardiac Pacemakers, Inc.,...

1. A system, comprising:
a cardiac pulse generator configured to generate cardiac pacing pulses to pace the heart, wherein the cardiac pulse generator
is configured to generate cardiac pacing pulses throughout a range of cardiac pacing energy outputs, wherein:

cardiac pacing energy outputs above a myocardial capture threshold capture myocardia for a cardiac tissue stimulation therapy,
and

cardiac pacing energy outputs above a pace-induced phrenic nerve stimulation (PS) threshold, which is larger than the myocardial
capture threshold, induce PS which is undesirable for the cardiac tissue stimulation therapy;

a sensor configured to sense a physiological signal for use in detecting PS, wherein an amplitude of the physiological signal
is dependent on the cardiac pacing energy output such that increasing cardiac pacing energy output increases the amplitude
and decreasing cardiac pacing energy output decreases the amplitude;

a storage for storing a patient-specific PS template of patient-specific PS features for use to detect PS beats, wherein the
PS beats are cardiac paces that induce PS; and

a phrenic nerve stimulation detector configured to create the patient-specific PS template and use the template to detect
PS beats, including:

control the cardiac pulse generator to intentionally deliver a PS beat, including generate cardiac pacing pulses with a large
cardiac pacing energy output that is significantly larger than the PS threshold, detect the patient-specific PS features for
the patient by analyzing the physiologic signal that results from the intentionally-delivered PS beat, and store the patient-specific
PS features for the template in the storage;

control the cardiac pulse generator to decrease the pacing energy output from the large energy output to a smaller cardiac
pacing energy output; and

use the patient-specific PS features for the template in the storage to analyze the physiologic signal for detecting PS beats
when the heart is paced using cardiac pacing pulses with the smaller cardiac pacing energy output.

US Pat. No. 9,248,295

METHODS AND APPARATUS FOR PREDICTING ACUTE RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY AT A GIVEN STIMULATION SITE

Cardiac Pacemakers, Inc.,...

1. A cardiac device, comprising:
sensing circuitry connectable to an electrode for detecting an intrinsic ventricular depolarization, wherein the electrode
is adapted for placement at a stimulation site;

pulse generation circuitry connectable to the electrode for delivering pacing pulses to the stimulation site;
a controller programmed to measure a time interval between a first deflection and a maximum deflection of the intrinsic ventricular
depolarization as detected from the electrode;

wherein the controller is further programmed to compare the measured time interval to a threshold and to compute an atrioventricular
delay for delivering pacing pulses to the stimulation site in accordance with whether the interval is less than or greater
than the threshold.

US Pat. No. 9,149,631

CARDIAC LEAD PLACEMENT USING MULTIPLE SPATIALLY DISTRIBUTED SENSORS

Cardiac Pacemakers, Inc.,...

1. A cardiac lead placement method, comprising:
positioning at least one reference sensor at a right heart location of a patient's heart, the right heart location in either
a right atrium or a right ventricle;

advancing a cardiac lead apparatus comprising at least one lead apparatus sensor to a plurality of left heart locations, the
plurality of left heart locations in either a left ventricle or a coronary venous pathway;

for each of the plurality of left heart locations, measuring, using the reference sensor and the lead apparatus sensor, a
distance parameter indicative of a distance between the at least one reference sensor at the right heart location and the
at least one lead apparatus sensor at the left heart location;

determining which of the plurality of left heart locations is furthest from the right heart location based on the distance
parameter measured for each of the plurality of left heart locations;

selecting one of the plurality of left heart locations as a pacing site, the selected left heart location selected based on
having been determined to be the furthest from the right heart location relative to the other of the plurality of left heart
locations; and

producing a physician perceivable output indicating the selection of the one of the plurality of left heart location as the
pacing site.

US Pat. No. 9,138,199

METHOD AND APPARATUS FOR DETECTING SUBAUDIBLE CARDIAC VIBRATIONS

Cardiac Pacemakers, Inc.,...

1. A system for monitoring a patient and presenting diagnostic information to a user, the system comprising:
a vibration sensor configured to sense a physiological signal indicative of mechanical vibrations in a sensing frequency range
including audible and subaudible frequency ranges;

a further sensor configured to sense a further physiological signal;
a processing circuit coupled to the vibration sensor, the processing circuit configured to produce one or more presentation
signals representing the mechanical vibrations in a presentation frequency range including at least one subaudible frequency
range of the sensing frequency range using the physiological signal and the further physiological signal; and

a user interface coupled to the processing circuit, the user interface configured to present the one or more presentation
signals to the user,

wherein the further sensor includes electrocardiographic electrodes configured to sense an electrocardiographic signal, and
the processing circuit includes a signal conditioning circuit configured to perform ensemble averaging of the heart sound
signal using the ECG signal.