Classifications

• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N1/00—Electrotherapy; Circuits therefor
  • A61N1/18—Applying electric currents by contact electrodes
  • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
  • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
  • A61N1/362—Heart stimulators
  • A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Definitions

• Implantable medical leads have been implanted for treating or monitoring one or more conditions of a patient. Such implantable medical leads may be adapted to allow medical devices to monitor or treat conditions or functions relating to heart, muscle, nerve, brain, stomach endocrine organs or other organs and their related functions. Implantable medical leads include electrodes and/or other elements for physiological sensing and/or therapy delivery. Implantable medical leads allow the sensing/therapy elements to be positioned at one or more target locations for those functions, while the medical devices electrically coupled to those elements via the leads are at different locations.
• Implantable medical leads e.g., distal portions of elongate (e.g., long and slender, but not necessarily stretched) implantable medical leads, may be implanted at target locations selected to detect a physiological condition of the patient and/or deliver one or more therapies.
• implantable medical leads may be delivered to locations within an atria or ventricle to sense intrinsic cardiac signals and deliver pacing or antitachyarrhythmia shock therapy from a medical device coupled to the lead.
• implantable medical leads may be tunneled to locations adjacent a spinal cord or other nerves for delivering pain therapy from a medical device coupled to the lead.
• Implantable medical leads may include anchoring components to secure a distal end of the lead at the target location.
• an implantable medical lead comprises: a connector configured to electrically communicate with processing circuitry of a medical device; an outer lead comprising: an outer lead electrode; and an outer conductor electrically connected to the outer lead electrode; an inner lead positioned within a lumen defined by the outer lead, wherein the inner lead is configured to translate within the lumen relative to the outer lead, and wherein the inner lead comprises: an inner lead electrode; and an inner conductor electrically connected to the connector, wherein the inner conductor is configured to establish electrical communication between the inner lead electrode and the connector, and wherein the connector is configured to establish electrical communication between the inner lead electrode and the processing circuitry using the inner conductor; an electrical contact electrically connected to the outer conductor; and a conductive element positioned within the lumen, wherein the conductive element is electrically connected to the connector, wherein the conductive element is configured to establish electrical communication between the connector and the electrical contact as the inner lead translates relative to the outer lead, and wherein the connector is configured to establish electrical communication between the outer lead electrode and the processing
• a system comprises: an implantable medical device; and an implantable medical lead comprising: a connector configured to electrically communicate with processing circuitry of the implantable medical device; an outer lead comprising: an outer lead electrode; and an outer conductor electrically connected to the outer lead electrode; an inner lead positioned within a lumen defined by the outer lead, wherein the inner lead is configured to translate within the lumen relative to the outer lead, and wherein the inner lead comprises: an inner lead electrode; and an inner conductor electrically connected to the connector, wherein the inner conductor is configured to establish electrical communication between the inner lead electrode and the connector, and wherein the connector is configured to establish electrical communication between the inner lead electrode and the processing circuitry using the inner conductor; an electrical contact electrically connected to the outer conductor; and a conductive element positioned within the lumen, wherein the conductive element is electrically connected to the connector, wherein the conductive element is configured to establish electrical communication between the connector and the electrical contact as the inner lead translates relative to the outer lead, and wherein the connector
• FIG. 2A is a conceptual diagram of an example implantable medical lead.
• FIG. 2B is another conceptual diagram of an example implantable medical lead.
• FIG. 3 is a conceptual diagram illustrating an example implantable medical lead including a connector, an outer lead, and an inner lead.
• FIG. 4A is a conceptual diagram illustrating an example configuration of an electrical contact, conductive element, and inner lead of an implantable medical lead.
• FIG. 4B is a conceptual diagram illustrating another example configuration of an electrical contact, conductive element, and inner lead of an implantable medical lead.
• FIG. 5 is a block diagram illustrating circuitry of an example implantable medical device.
• This disclosure describes an implantable medical lead configured to enable multi-chamber functionality for physiological sensing and/or therapy delivery in the heart of a patient.
• the implantable medical lead is configured to establish electrical communication between an outer lead and a connector and an inner lead and the connector.
• the connector is configured to electrically communicate with processing circuitry of a medical device.
• the implantable medical lead may be configured to penetrate the septum of a patient’s heart in order to deliver electrical stimulations to activate a left bundle branch (LBB), other conduction system tissues, and/or or other ventricular tissues of the heart.
• LBB left bundle branch
• the connector includes at least a first conductor and a second conductor (i.e., in some cases, the connector includes more than two conductors, such as four conductors).
• the connector may be configured to electrically isolate each of the conductors; for example, the first conductor may be electrically isolated from the second conductor.
• the inner conductor includes conductive fillers
• the first conductor may be electrically connected to a first conductive filler of the inner conductor
• the second conductor may be electrically connected to a second conductive filler of the inner conductor.
• the implantable medical lead may be configured to establish electric communication between the second conductive filler and the outer conductor.
• the electrical contact is configured to translate relative to the outer lead when the inner lead translates relative to the outer lead.
• the electrical contact is substantially secured to the inner lead such that translation of the inner lead relative to the outer lead causes the translation of the electrical contact relative to the outer lead.
• the electrical contact may be configured to substantially maintain electrical communication between the outer conductor and the connector (e.g., via the conductive element) as the inner lead causes the translation of the electrical contact.
• Advantages of such a configuration include, for example, reducing the number of surgical tools required to pace/sense several locations (e.g., dual bundle pacing), avoiding the introduction of foreign material into the body of a patient, reducing standard lead implant complications, reducing migration/conduction issues with the implantable medical lead, achieving a patient-specific insertion depth of the implantable medical lead due to the adjustable translation of an inner lead, etc.
• One or more of these advantages may simplify implantation of medical device system 100 and improve patient outcomes.
• Implantable medical lead 102 may be configured to establish electric communication between outer conductor 130 (including the electrodes supported by outer lead 112) and connector 110 via an electrical contact 140 and a conductive element 142.
• Electrical contact 140 which may also be referred to as a long electrode, may be mechanically supported by a portion of inner lead body 121; for example, electrical contact 140 may be positioned within lumen 138 and surround inner lead body 121. As shown in FIGS. 2A and 2B, the diameter of the portion of inner lead body 121 mechanically supporting electrical contact 140 may be different from the diameter of other portions of inner lead body 121.
• electrical contact 140 may be formed as a tube defining a passage within which inner lead body 121 is positioned. In general, electrical contact 140 may be electrically insulated from inner conductor 122 by inner lead body 121. Electrical contact 140 may include a platinum-iridium alloy, a conductive polymer, and/or the like.
• FIG. 3 is a conceptual diagram illustrating implantable medical lead 102 electrically connected to connector 110.
• Connector 110 may be configured to deliver electrical stimulation from a therapy delivery circuitry of medical device 111, which in examples is a pacemaker or defibrillator, to implantable medical lead 102. Additionally, or alternatively, connector 110 may be configured to deliver electrical signals from heart 108 sensed by implantable medical lead 102 to sensing circuitry of medical device 111.
• medical device 111 is an implantable cardioverter defibrillator (ICD)
• implantable medical lead 102 may be configured to deliver electric shocks to heart 108 in response to an event such as a heart attack or ventricular tachycardia.
• medical device 111 may provide both pacing and defibrillation capabilities, and may perform biventricular or other multi-site resynchronization therapies, such as cardiac resynchronization therapy (CRT).
• CTR cardiac resynchronization therapy
• First conductor 148 may be configured to electrically connect with one of conductive fillers 125 of inner conductor 122, such as conductive filler 125 A.
• Second conductor 150 may be configured to electrically connect with another one of conductive fillers 125 of inner conductor 12, such as conductive filler 125B.
• first conductor 148 is mechanically coupled to conductive filler 125A
• second conductor 150 is mechanically coupled to conductive filler 125B.
• First conductor 148 and second conductor 150 may be mechanically coupled to conductive fillers 125 using a solder, a weld, a crimp, another appropriate technique, or a combination thereof.
• Memory 186 may include any volatile, non-volatile, magnetic, optical, or electrical media, such as a random access memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM), electrically-erasable programmable ROM (EEPROM), flash memory, or any other digital media.
• RAM random access memory
• ROM read-only memory
• NVRAM non-volatile RAM
• EEPROM electrically-erasable programmable ROM
• flash memory or any other digital media.
• processing circuitry 176 may receive (e.g., from an external device), via communication circuitry 184, a respective value for each of a plurality of cardiac sensing parameters, cardiac therapy parameters (e.g., cardiac pacing parameters), and/or electrode vectors. Processing circuitry 176 may store such parameters and/or electrode vectors in memory 186.
• connector 110 includes connector body 147 mechanically supporting first conductor 148 and second conductor 150.
• Connector body 147 may maintain first conductor 148 and second conductor 150 substantially stationary relative to each other.
• Connector body 147 may electrically insulate at least some portion of first conductor 148 from second conductor 150, and vice- versa.
• Connector 110 may energize, via first conductor 148 and second conductor 150 (and other conductors of connector 110), outer lead electrode 116 and inner lead electrode 118 (and other electrodes of implantable medical lead 102) by delivering electrical stimulation from therapy delivery circuitry 180 of medical device 111.
• First conductor 148 may electrically connect with conductive filler 125A of inner conductor
• second conductor 150 may electrically connect with conductive filler 125B.
• First conductor 148 and second conductor 150 may maintain electrical connection with inner conductor 122 while inner lead 114 translates relative to outer lead 112.
• inner lead 114 may translate relative to outer lead 112 (604).
• inner lead 114 is configured to receive a force that causes inner lead 114 to translate relative to outer lead 112.
• Inner lead 114 and/or outer lead 112 may be configured such that a physician may control a depth to which inner lead 114 penetrates the tissue (e.g., ventricular tissues), allowing inner lead 114 to be substantially positioned at a predetermined location based on, for example, pace mapping.
• inner lead 114 may translate relative to outer lead 112 when inner lead 114 rotates relative to inner lead 112.
• Inner lead 114 may be electrically connected to connector 110 to enable electrical communication as inner lead 114 translates relative to outer lead 112. Electrical contact 140 and conductive element 142 may enable inner lead 114 to maintain electrical communication with connector 110 while inner lead 114 translates relative to outer lead 112. In this way, both outer lead 112 and inner lead 114 may electrically communicate with a single connector (e.g., connector 110), and inner lead 114 may translate (e.g., slide) relative to outer lead 112 while outer lead 112 and inner lead 114 maintain electrical communication with connector 110.
• a single connector e.g., connector 110
• inner lead 114 may translate (e.g., slide) relative to outer lead 112 while outer lead 112 and inner lead 114 maintain electrical communication with connector 110.
• the techniques described in this disclosure may be implemented, at least in part, in hardware, software, firmware or any combination thereof.
• various aspects of the techniques may be implemented within one or more processors, including one or more microprocessors, DSPs, ASICs, FPGAs, or any other equivalent integrated or discrete logic circuitry, as well as any combinations of such components, embodied in programmers, such as clinician or patient programmers, medical devices, or other devices.
• the functions described in this disclosure may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored, as one or more instructions or code, on a computer-readable medium and executed by a hardware-based processing unit.
• Computer- readable media may include computer-readable storage media forming a tangible, non- transitory medium. Instructions may be executed by one or more processors, such as one or more DSPs, ASICs, FPGAs, general purpose microprocessors, or other equivalent integrated or discrete logic circuitry. Accordingly, the term “processor,” as used herein may refer to one or more of any of the foregoing structures or any other structure suitable for implementation of the techniques described herein.
• the techniques of this disclosure may be implemented in a wide variety of devices or apparatuses, including an IMD, an external programmer, a combination of an IMD and external programmer, an integrated circuit (IC) or a set of ICs, and/or discrete electrical circuitry, residing in an IMD and/or external programmer.

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• Health & Medical Sciences (AREA)
• Heart & Thoracic Surgery (AREA)
• Cardiology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Radiology & Medical Imaging (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Hospice & Palliative Care (AREA)
• Vascular Medicine (AREA)
• Electrotherapy Devices (AREA)

Applications Claiming Priority (3)

Publications (1)

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• 2022
  • 2022-08-08 EP EP22758273.1A patent/EP4392122A1/de active Pending
  • 2022-08-08 WO PCT/IB2022/057369 patent/WO2023026122A1/en active Application Filing

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