A differential discrete-time signal processing channel differentially processes cardiac signals in an implantable cardiac rhythm management device. Such signal processing effectively uses downsampling to uses lower bias currents, thereby saving power and prolonging the life of the implanted device, and also reduces clock feedthrough, provides a wider dynamic range and better rejection of power supply noise. The device includes a continuous-time buffer, a decimator/averager and/or other filter and/or amplifier circuits, and an analog-to-digital converter, each configured for processing differential signals. The device also includes an operational transconductance amplifier (OTA), for the discrete-time differential signal processing. The OTA provides, among other things, an output common mode adjustment circuit and an offset compensation circuit.