EP1511426A2 - Systeme et procede ameliores de positionnement de dispositifs medicaux implantables - Google Patents

Systeme et procede ameliores de positionnement de dispositifs medicaux implantables

Info

Publication number
EP1511426A2
EP1511426A2 EP02786708A EP02786708A EP1511426A2 EP 1511426 A2 EP1511426 A2 EP 1511426A2 EP 02786708 A EP02786708 A EP 02786708A EP 02786708 A EP02786708 A EP 02786708A EP 1511426 A2 EP1511426 A2 EP 1511426A2
Authority
EP
European Patent Office
Prior art keywords
lead
infrared light
catheter
elongated shaft
light
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP02786708A
Other languages
German (de)
English (en)
Inventor
David L. Thompson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medtronic Inc
Original Assignee
Medtronic Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US10/087,949 external-priority patent/US20030092995A1/en
Application filed by Medtronic Inc filed Critical Medtronic Inc
Publication of EP1511426A2 publication Critical patent/EP1511426A2/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A61B1/3137—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for examination of the interior of blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/373—Surgical systems with images on a monitor during operation using light, e.g. by using optical scanners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems
    • A61N1/057—Anchoring means; Means for fixing the head inside the heart
    • A61N2001/0578—Anchoring means; Means for fixing the head inside the heart having means for removal or extraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems
    • A61N2001/0585—Coronary sinus electrodes

Definitions

  • This invention relates to implantable medical device systems, and in particular to a device and method for the placement and control of an implantable medical device into specific cardiovasculature locations such as the distal vasculature system of the coronary sinus.
  • Implantable medical electrical stimulation and/or sensing leads is well known in the fields of cardiac stimulation and monitoring.
  • Endocardial leads are placed through a transvenous route to place one or more sensing and/or stimulation electrodes in a desired location within a heart chamber or interconnecting vasculature.
  • a delivery system may include a guide catheter, stylet, guidewire, steerable sheath, and/or an equivalent delivery mechanism.
  • leads and/or other implantable medical devices may be positioned within the right atrium and/or ventricle to provide therapies for cardiac ailments.
  • IMD implantable medical devices
  • certain cardiac disfunctions such as heart failure may be effectively treated by positioning leads, catheters, and/or IMDs adjacent to, or within, the left side of the heart.
  • cardiac resynchronization therapy may be accomplished by pacing both the left and right ventricles.
  • Left ventricular pacing pulses may be delivered via a lead positioned within the coronary sinus or a branch cardiac vein in proximity to the left ventricle.
  • a distal end of the device is advanced through the superior vena cava, into the right atrium, through the valve of the coronary sinus, and into the coronary sinus.
  • the device may be further advanced into a coronary vein communicating 02 36331
  • the coronary sinus such as the cardiac great vein, the middle cardiac vein, the posterial lateral cardiac vein, or the anterial lateral cardiac vein as examples.
  • pacing leads or other types of leads, at other locations within the heart for various reasons. For example, it may be desirable to locate such leads in the right ventricular outflow tract (RVOT), the Bundle of His, or the triangle of Koch, as such alternates may enhance the effectiveness of the heart therapy delivered to such sites.
  • RVT right ventricular outflow tract
  • Bundle of His the Bundle of His
  • the triangle of Koch may enhance the effectiveness of the heart therapy delivered to such sites.
  • a guide catheter is navigated into the desired location in the vasculature.
  • a lead is then fed through the inner lumen of the catheter such that the lead electrode(s) are positioned at predetermined locations.
  • the guide catheter may then be withdrawn. This type of approach is described in commonly assigned U.S. Patent Numbers 6,006,137, 5,246,014, and 5,851 ,226 incorporated herein by reference in their entireties.
  • the disclosed system includes a pusher mechanism that is adapted to slidably engage a guidewire that has previously been placed at a desired implant site.
  • the pusher mechanism couples to a lead body to allow the pusher to guide the lead over the guidewire to the desired implant site.
  • a significant challenge involves the location and navigation of a guide device, such as a catheter or guide wire, into the coronary sinus. Anomalies in the vascular anatomy, their small size, and the number of branch veins associated with the anatomy make locating the desired path challenging.
  • Radiopaque dye This dye may be injected into the venous anatomy so that the chambers of the heart and the related vasculature system are visible using a fluoroscopic device. This procedure, sometimes referred to as a "venogram", allows the surgeon to locate the coronary sinus, its distal vasculature, or other anatomical structure when performing an implant procedure.
  • fluoro visible media it may be undesirable to use fluoro visible media during an implant process for several reasons.
  • the use of fluoroscopy exposes the patient, implant surgeon and assistants to radiation.
  • the use of protective lead aprons prevents or limits exposure to the physician and his attending staff, but their heavy weight is problematic for long and/or several procedures daily.
  • a fluoroscope of the type needed for obtaining the fluoro-visible image may not be available.
  • obtaining the venogram adds additional steps to the implant procedure, lengthening the time required to complete the procedure, increases the cost of the procedure and increases the risk of infection and complications to the patient.
  • That patent describes the use of an infrared imagining system that is capable of transmitting light into an environment containing opaque or semi-opaque fluids such as blood.
  • a lead delivery method is not disclosed.
  • the present invention provides a visual catheter guide system to navigate and position a medical device within the coronary sinus and branch veins, such as the cardiac great vein, the middle cardiac vein, the posterial lateral cardiac vein, the anterial lateral cardiac vein and similar other cardiac vasculature.
  • the system enables continuous visual imaging of the deployment, location and vascular environment of the catheter inside the cardiac network of vasculatory system.
  • a shaft adapted to be positioned within the cardiac vein or coronary artery incorporates a fiber optic cable suitable for transmitting light.
  • an infrared light source transfers infrared light down the cable.
  • An optical head assembly coupled to the cable is implemented as a transceiver for the infrared light.
  • sensing systems receive the infrared light from the body using optical assemblies.
  • An image is generated indicating the position of the distal portion of the elongated shaft, in addition to monitoring navigation on a real-time visual basis.
  • the vision system may incorporate an ablation system for navigation and placement of an ablation electrode in a human heart.
  • Another embodiment includes an implementation of a laser lead extraction system to view and remove a cardiac lead from the heart. Further, proper positioning of an ablation catheter prior to the application of ablation energy is enabled using the scheme and structure of the present invention.
  • FIG. 1 depicts an infrared endoscope system connected to a catheter delivery system having a distal end positioned in a coronary vein;
  • FIG. 2 depicts a catheter delivery system of the present invention;
  • FIG. 3 A is a cross section of the catheter delivery system of FIG. 1;
  • FIG. 3B is a cross section of a first alternative embodiment of the catheter delivery system of FIG. 1;
  • FIG. 3C is a cross section of a second alternative embodiment of the catheter delivery system of FIG. 1;
  • FIG. 4 is a cross section of an alternative implementation of the catheter delivery system of FIG. 1;
  • FIG. 5 is an alternative delivery system for use with the vision system of FIG. 1; and FIG. 6 depicts an additional alternative embodiment of the present invention.
  • the delivery and positioning of this left ventricular lead in the coronary sinus vasculature system is problematic.
  • the claimed invention allows the rapid, accurate and easy deployment and positioning of a lead in the coronary sinus, distal coronary sinus, great cardiac vein, the middle cardiac vein, the posterial lateral cardiac vein, the anterial lateral cardiac vein or other distal vasculature.
  • FIG. 1 illustrates a human heart 10 in cross section with the right atrium 12, right ventricle 14, left atrium 16, left ventricle 18, coronary sinus ostium 22 and superior vena cava 24 shown.
  • FIG. 1 further illustrates the catheter guide system 20 shown in FIG. 2 disposed within the patient's vascular system with the distal section (not shown) of the catheter seated within the patient's coronary sinus ostium 22.
  • the catheter guide system 20 has been introduced from the cephalic vein (not shown) and advanced through the superior vena cava 24 and into the right atrium 12.
  • catheter guide system 20 coupled to a system 100 for transferring infrared light to the distal end of the catheter, capturing the reflected light, and displaying an image for use by an implanting physician.
  • This catheter uses technology disclosed in U.S. Patent No. 6,178,346, incorporated herein by reference, to transmit light through opaic fluids such as blood.
  • System 100 includes a laser diode 106 and infrared camera 112. Light reflected from within the coronary sinus is received by an optical head
  • the image processing unit 120 uses known image processing techniques to enhance the image created by the reflected and scattering light to provide a view of the cardiac vasculature.
  • the image processing unit 120 is connected with electrical cable 122 to the central processing unit or CPU 130, which reconfigures the signals and transmits these signals through an electrical cable 122 to a video processor 126 which processes the signals for video imaging.
  • video recorder 128 may also be coupled to the video processor 126. 02 36331
  • the system of FIG. 1 may be used to position catheter guide system 20 within the coronary sinus and branch veins such as the cardiac great vein, the middle cardiac vein, the posterial lateral cardiac vein, or the anterial lateral cardiac vein.
  • structures may be visualized at a distance of 4-5 millimeters through blood. Wavelengths of approximately 2.1 microns would also be suitable for this embodiment. This region permits viewing arterial structures about 10 millimeters through blood. Higher wavelength regions (e.g., 3.8-4.4, 4.7-5.3, and 7-10) would generate more accurate images but also result in more rigid catheter designs because of the larger-sized optical fibers required in this embodiment.
  • FIG. 1 may be used to position catheter guide system 20 within the coronary sinus and branch veins such as the cardiac great vein, the middle cardiac vein, the posterial lateral cardiac vein, or the anterial lateral cardiac vein.
  • the invention includes a guide catheter system 20 such as disclosed in U.S. Patent No. 6,021,340, incorporated herein by reference in its entirety.
  • the catheter includes an elongated shaft 31, a distal shaft section 36, a proximal shaft section 34, an inner lumen 32 and a control handle 30 on the proximal end of the shaft 31.
  • a port 38 is provided in the distal end of the catheter shaft 36 that is in fluid communication with the inner lumen 32.
  • the distal shaft section 36 is controllable in a 3D manner via the proximal handle 30 as described in the '340 patent.
  • the catheter shaft 31 contains optical fibers to transmit infrared light from the vision system 100 to a lens 40 and transmits reflected light back to the vision system 100 for processing and displaying vasculature structures.
  • Catheter 20 may optionally contain distally located sense/pace electrodes for the verification and confirmation of proper location.
  • FIG. 3A shows a cross sectional view of the guide catheter system 20 of FIGS. 1 and 2.
  • the catheter body 52 contains several lumens 50 containing optical fibers for the transmission of infrared light from a proximal source 106 to a lens 40 on the distal end of the catheter and for the reflected light to be returned to the infrared camera 112.
  • a pacing or defibrillation lead 62 is shown in a central lumen 56.
  • the catheter guide system 20 is used to deliver the distal end of the catheter to a desired location and then a lead is threaded through lumen 56 to deliver the lead to the proper location. This method allows the use of very small diameter lead systems because a stylet lumen is not required in the lead body construction.
  • FIG. 1 shows a cross sectional view of the guide catheter system 20 of FIGS. 1 and 2.
  • the catheter body 52 contains several lumens 50 containing optical fibers for the transmission of infrared light from a proximal source 106 to a lens
  • 3B shows an alternative cross sectional view of the guide catheter system 20 of FIGS. 1 and 2.
  • the catheter body 52 contains several lumens 50 containing optical fibers for the transmission of infrared light from a proximal source 106 to the distal end of the catheter and for the reflected light to be returned to the infrared camera 112.
  • a guide wire 54 is shown in a central lumen 56. This method allows the distal end of a guide wire to be positioned in the correct location, a lead body is tracked over the wire and the wire is then withdrawn.
  • FIG.3C shows a cross sectional view of the guide catheter system 20 of FIGS.1 and 2 containing an alternative embodiment of catheter body construction.
  • the catheter body 52 contains a single lumen 50 containing optical fibers for the transmission of infrared light from a proximal source 106 to the distal end of the catheter.
  • an active pixel sensor is positioned to receive light reflected from the coronary sinus vasculature system.
  • the active pixel sensor is as substantially described in U.S. Patent Nos. 6,204,524, 6,243,131, and published application No. 2001/0055832.
  • the '524 and '131 patents and '832 application are incorporated herein by reference in their entireties.
  • Lumen 58 contains several insulated electrical wires 60 for providing power to the sensor and return signals depicting the field of view of the active pixel sensor.
  • a guide wire 54 is shown in a central lumen 56. The operation of delivering a lead via a properly positioned guide wire is as described above.
  • This catheter design allows for a smaller, more flexible catheter design allowing it to reach smaller and more distal vasculature. Additionally, larger optical fibers may be used to allow a larger wavelength infrared light source (i.e., 3.8 4.4, 4.7-5.3, and 7-10 microns) to be used providing for images with improved clarity and increased accuracy.
  • FIG. 4 depicts an alternative method of lead placement in the coronary sinus (see FIGS. 1, 2, 3B and 3C).
  • a guide wire is advanced into the coronary sinus ostium and advanced through the vasculature system to the proper location for pacing and defibrillation lead placement as is well known in the art.
  • the guide wire 314 is advanced under visual control by the system shown in FIG. 2 and herein described above.
  • an over the wire pacing or defibrillation lead 306 can be inserted and then the lead passed over the guide wire 314 through lumen 322 until it is properly positioned.
  • FIG. 5 depicts another embodiment, whereby the vision system described above is incorporated into an ablation system as described in U.S. Patent No. 6,325,797 for accurate location of the ablation electrode in a human heart 10.
  • the '797 patent describes a catheter assembly and method for treatment of cardiac arrhythmia, for example, atrial fibrillation, by electrically isolating a vessel, such as a pulmonary vein 204, from a chamber, such as the left atrium 16.
  • the catheter assembly includes a catheter body 202 and at least one electrode 208.
  • the distal portion of the catheter 202 extends from an intermediate portion (inserted from the inferior vena cava 200) and forms a substantially closed loop transverse to the longitudinal axis with the at least one electrode 208 disposed along the loop.
  • the loop is axially directed into contact with the chamber wall about the pulmonary vessel ostium 204.
  • the electrode ablates a continuous lesion pattern about the vessel ostium 204, thereby electrically isolating the vessel from the chamber.
  • additional lumens filled with optical fibers may be employed as described above to allow the visualization of the location of the catheter 202 via a lens 206 located at the distal end of catheter 202.
  • the visualization will allow the proper positioning of the ablation electrode(s) in a fixed and proper location (for example, the pulmonary vein ostium 204).
  • FIG. 6 depicts yet another embodiment incorporating the vision system as described above into a lead extraction device as substantially described in U.S. Patent Nos. 5,423,806 and 5,674,217, both to Wahlstrom, et al. which utilizes laser light to separate an implanted object, such as a pacemaker lead, from fibrous scar tissue and thereby permit the implanted object to be extracted from a body.
  • the extraction device features a catheter 406 having a central lumen 414 dimensioned so a pacemaker lead will fit within. The catheter 406 is thereby guided by the lead.
  • the catheter 406 has at least one optical fiber 412 to emit laser light 402 from the distal end 408 and thereby separate the lead from fibrous scar tissue.
  • the lead may be separated along its length, as well as separated at its distal end from fibrous scar tissue, thereby permitting the lead to be readily extracted from the body.
  • additional fibers 412 may be employed as described above to allow the visualization of the location and the rapid positioning of the catheter in relation to the fibrous scar tissue or bone that may be holding the lead body in a fixed location.
  • the present invention provides a system and method for utilizing an infrared imaging system for placing leads or any other device within the coronary sinus, branch cardiac veins and/or specific locations in the heart.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Robotics (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Surgical Instruments (AREA)
  • Laser Surgery Devices (AREA)
  • Electrotherapy Devices (AREA)

Abstract

L'invention porte sur un dispositif et un procédé de déploiement d'un conducteur dans un passage tortueux tel que le ventricule gauche ou le réseau vasculaire du sinus coronarien. A cet effet on insère un cathéter muni de fibres optiques dans la vasculature du patient en s'aidant d'un fil guide ou équivalent. Les fibres optiques amènent de la lumière IR sur une tête optique située à l'extrémité distale du cathéter. La lumière réfléchie par le réseau vasculaire est recueillie puis transmise via les fibres optiques à une caméra IR qui prend les images. En variante, on peut placer un détecteur actif de pixels à l'extrémité distale du conducteur pour recueillir et transmettre les images à un dispositif d'affichage extérieur au patient. Une sélection adéquate le la longueur d'onde du dispositif IR permet de visualiser les objets à travers des fluides corporels opaques. Une autre exécution permet de visualiser un conducteur cardiaque en vue d'une extraction au laser, et encore une autre, de positionner correctement un cathéter d'ablation avant excitation.
EP02786708A 2002-02-28 2002-11-13 Systeme et procede ameliores de positionnement de dispositifs medicaux implantables Withdrawn EP1511426A2 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US87949 2002-02-28
US10/087,949 US20030092995A1 (en) 2001-11-13 2002-02-28 System and method of positioning implantable medical devices
PCT/US2002/036331 WO2003073942A2 (fr) 2002-02-28 2002-11-13 Systeme et procede ameliores de positionnement de dispositifs medicaux implantables

Publications (1)

Publication Number Publication Date
EP1511426A2 true EP1511426A2 (fr) 2005-03-09

Family

ID=27787582

Family Applications (1)

Application Number Title Priority Date Filing Date
EP02786708A Withdrawn EP1511426A2 (fr) 2002-02-28 2002-11-13 Systeme et procede ameliores de positionnement de dispositifs medicaux implantables

Country Status (4)

Country Link
EP (1) EP1511426A2 (fr)
JP (1) JP2005518861A (fr)
CA (1) CA2467385A1 (fr)
WO (1) WO2003073942A2 (fr)

Families Citing this family (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8956280B2 (en) 2002-05-30 2015-02-17 Intuitive Surgical Operations, Inc. Apparatus and methods for placing leads using direct visualization
EP1870018A3 (fr) 2002-05-30 2008-08-06 The Board of Trustees of The Leland Stanford Junior University Appareils et procédé pour l'accès au sinus coronaire
MX2007005921A (es) * 2004-11-17 2007-10-08 Johnson & Johnson Aparato para evaluacion en tiemo real de ablacion de tejido.
US11478152B2 (en) 2005-02-02 2022-10-25 Intuitive Surgical Operations, Inc. Electrophysiology mapping and visualization system
US8078266B2 (en) 2005-10-25 2011-12-13 Voyage Medical, Inc. Flow reduction hood systems
US10064540B2 (en) 2005-02-02 2018-09-04 Intuitive Surgical Operations, Inc. Visualization apparatus for transseptal access
US8137333B2 (en) 2005-10-25 2012-03-20 Voyage Medical, Inc. Delivery of biological compounds to ischemic and/or infarcted tissue
US20080015569A1 (en) 2005-02-02 2008-01-17 Voyage Medical, Inc. Methods and apparatus for treatment of atrial fibrillation
US9510732B2 (en) 2005-10-25 2016-12-06 Intuitive Surgical Operations, Inc. Methods and apparatus for efficient purging
US8221310B2 (en) 2005-10-25 2012-07-17 Voyage Medical, Inc. Tissue visualization device and method variations
US9055906B2 (en) 2006-06-14 2015-06-16 Intuitive Surgical Operations, Inc. In-vivo visualization systems
EP2063781A4 (fr) 2006-09-01 2010-07-28 Voyage Medical Inc Système de cartographie et de visualisation d'électrophysiologie
US20080097476A1 (en) 2006-09-01 2008-04-24 Voyage Medical, Inc. Precision control systems for tissue visualization and manipulation assemblies
US10004388B2 (en) 2006-09-01 2018-06-26 Intuitive Surgical Operations, Inc. Coronary sinus cannulation
US8758229B2 (en) 2006-12-21 2014-06-24 Intuitive Surgical Operations, Inc. Axial visualization systems
US8657805B2 (en) 2007-05-08 2014-02-25 Intuitive Surgical Operations, Inc. Complex shape steerable tissue visualization and manipulation catheter
US8357145B2 (en) 2007-11-12 2013-01-22 Boston Scientific Neuromodulation Corporation Implanting medical devices
US9468364B2 (en) 2008-11-14 2016-10-18 Intuitive Surgical Operations, Inc. Intravascular catheter with hood and image processing systems

Family Cites Families (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6243131B1 (en) 1991-05-13 2001-06-05 Interactive Pictures Corporation Method for directly scanning a rectilinear imaging element using a non-linear scan
US5246014A (en) 1991-11-08 1993-09-21 Medtronic, Inc. Implantable lead system
CA2223990C (fr) 1995-06-07 2007-01-30 Cardima, Inc. Sonde-guide destinee au sinus coronaire
EP1166721A3 (fr) * 1995-10-13 2003-12-03 Transvascular, Inc. Dispositif pour opérations transvasculaires
US5851226A (en) 1996-10-22 1998-12-22 Medtronic, Inc. Temporary transvenous endocardial lead
GB9707414D0 (en) * 1997-04-11 1997-05-28 Imperial College Anatomical probe
US6006137A (en) 1998-03-06 1999-12-21 Medtronic, Inc. Method for single elecrode bi-atrial pacing
US5902331A (en) 1998-03-10 1999-05-11 Medtronic, Inc. Arrangement for implanting an endocardial cardiac lead
US6178346B1 (en) 1998-10-23 2001-01-23 David C. Amundson Infrared endoscopic imaging in a liquid with suspended particles: method and apparatus
US6204524B1 (en) 1999-07-14 2001-03-20 Micron Technology, Inc. CMOS imager with storage capacitor

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO03073942A2 *

Also Published As

Publication number Publication date
CA2467385A1 (fr) 2003-09-12
WO2003073942A2 (fr) 2003-09-12
WO2003073942A3 (fr) 2005-01-13
JP2005518861A (ja) 2005-06-30

Similar Documents

Publication Publication Date Title
US20030092995A1 (en) System and method of positioning implantable medical devices
EP1511426A2 (fr) Systeme et procede ameliores de positionnement de dispositifs medicaux implantables
US20220218390A1 (en) Access devices and methods for treatment of medical conditions and delivery of injectables
US20050020914A1 (en) Coronary sinus access catheter with forward-imaging
US9101374B1 (en) Method for guiding an ablation catheter based on real time intracardiac electrical signals and apparatus for performing the method
US6241726B1 (en) Catheter system having a tip section with fixation means
WO2003053491A9 (fr) Catheter d'acces au sinus coronaire avec imagerie frontale
US7794444B2 (en) Catheter system and methods for delivery of therapeutic cells to cardiac tissue
US5779715A (en) Lead extraction system and methods thereof
US20100331854A1 (en) Device and method for performing treatment in a pericardial space
US20070208389A1 (en) Coronary Sinus Locater Method and Apparatus for Biventricular Pacing
JP2009532127A (ja) 心臓処置時の画像化およびナビゲーションのための電磁コイルを備える入れ子式カテーテル
WO2001003764A1 (fr) Catheter avec moyen d'insertion d'extremite distale
EP2410922A1 (fr) Appareil permettant de réaliser des procédures diagnostiques et/ou thérapeutiques
US20220031385A1 (en) Automatically performing irreversible electroporation ablation during heart refractory period
CN109498132B (zh) 用于取回体内自主胶囊的移出组件
WO2005007228A1 (fr) Systeme de guidage a marquage ultrasonique pour electrode de stimulation de coeur gauche
Shepard et al. Challenges and solutions for difficult implantations of CRT devices: the role of new technology and techniques
US11027141B2 (en) Pericardial implantable cardioverter defibrillator
US20240075303A1 (en) Systems and methods for direct visualization of a tissue location, such as an endocardial location
WO1996010367A1 (fr) Dispositifs et procedes d'ablation de tissu organique
JP2024503664A (ja) マイクロカテーテル

Legal Events

Date Code Title Description
PUAI Public reference made under article 153(3) epc to a published international application that has entered the european phase

Free format text: ORIGINAL CODE: 0009012

17P Request for examination filed

Effective date: 20040922

AK Designated contracting states

Kind code of ref document: A2

Designated state(s): AT BE BG CH CY CZ DE DK EE ES FI FR GB GR IE IT LI LU MC NL PT SE SK TR

STAA Information on the status of an ep patent application or granted ep patent

Free format text: STATUS: THE APPLICATION IS DEEMED TO BE WITHDRAWN

18D Application deemed to be withdrawn

Effective date: 20060530