US20070021799A1 - Automatic baroreflex modulation based on cardiac activity - Google Patents
Automatic baroreflex modulation based on cardiac activity Download PDFInfo
- Publication number
- US20070021799A1 US20070021799A1 US11/482,635 US48263506A US2007021799A1 US 20070021799 A1 US20070021799 A1 US 20070021799A1 US 48263506 A US48263506 A US 48263506A US 2007021799 A1 US2007021799 A1 US 2007021799A1
- Authority
- US
- United States
- Prior art keywords
- activity
- level
- baroreflex
- baroreflex stimulation
- signal
- 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.)
- Abandoned
Links
Images
Classifications
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36114—Cardiac control, e.g. by vagal stimulation
- A61N1/36117—Cardiac control, e.g. by vagal stimulation for treating hypertension
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/02028—Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
-
- 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
-
- 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
- A61N1/0551—Spinal or peripheral nerve electrodes
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36053—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for vagal stimulation
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36114—Cardiac control, e.g. by vagal stimulation
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36125—Details of circuitry or electric components
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36135—Control systems using physiological parameters
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36146—Control systems specified by the stimulation parameters
- A61N1/36182—Direction of the electrical field, e.g. with sleeve around stimulating electrode
- A61N1/36185—Selection of the electrode configuration
-
- 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
- A61N1/37—Monitoring; Protecting
- A61N1/3702—Physiological parameters
-
- 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
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/3611—Respiration control
Definitions
- the present invention generally relates to medical devices and methods of use for the treatment and/or management of cardiovascular and renal disorders. Specifically, the present invention relates to devices and methods for controlling the baroreflex system for the treatment and/or management of cardiovascular and renal disorders and their underlying causes and conditions.
- Cardiovascular disease is a major contributor to patient illness and mortality. It also is a primary driver of health care expenditure, costing more than $326 billion each year in the United States.
- Hypertension or high blood pressure, is a major cardiovascular disorder that is estimated to affect over 50 million people in the United Sates alone. Of those with hypertension, it is reported that fewer than 30% have their blood pressure under control.
- Hypertension is a leading cause of heart failure and stroke. It is the primary cause of death in over 42,000 patients per year and is listed as a primary or contributing cause of death in over 200,000 patients per year in the U.S. Accordingly, hypertension is a serious health problem demanding significant research and development for the treatment thereof.
- Hypertension occurs when the body's smaller blood vessels (arterioles) constrict, causing an increase in blood pressure. Because the blood vessels constrict, the heart must work harder to maintain blood flow at the higher pressures. Although the body may tolerate short periods of increased blood pressure, sustained hypertension may eventually result in damage to multiple body organs, including the kidneys, brain, eyes and other tissues, causing a variety of maladies associated therewith. The elevated blood pressure may also damage the lining of the blood vessels, accelerating the process of atherosclerosis and increasing the likelihood that a blood clot may develop. This could lead to a heart attack and/or stroke. Sustained high blood pressure may eventually result in an enlarged and damaged heart (hypertrophy), which may lead to heart failure.
- Heart failure is the final common expression of a variety of cardiovascular disorders, including ischemic heart disease. It is characterized by an inability of the heart to pump enough blood to meet the body's needs and results in fatigue, reduced exercise capacity and poor survival. It is estimated that approximately 5,000,000 people in the United States suffer from heart failure, directly leading to 39,000 deaths per year and contributing to another 225,000 deaths per year. It is also estimated that greater than 400,000 new cases of heart failure are diagnosed each year. Heart failure accounts for over 900,000 hospital admissions annually, and is the most common discharge diagnosis in patients over the age of 65 years. It has been reported that the cost of treating heart failure in the United States exceeds $20 billion annually. Accordingly, heart failure is also a serious health problem demanding significant research and development for the treatment and/or management thereof.
- Heart failure results in the activation of a number of body systems to compensate for the heart's inability to pump sufficient blood. Many of these responses are mediated by an increase in the level of activation of the sympathetic nervous system, as well as by activation of multiple other neurohormonal responses.
- this sympathetic nervous system activation signals the heart to increase heart rate and force of contraction to increase the cardiac output; it signals the kidneys to expand the blood volume by retaining sodium and water; and it signals the arterioles to constrict to elevate the blood pressure.
- the cardiac, renal and vascular responses increase the workload of the heart, further accelerating myocardial damage and exacerbating the heart failure state. Accordingly, it is desirable to reduce the level of sympathetic nervous system activation in order to stop or at least minimize this vicious cycle and thereby treat or manage the heart failure.
- vasodilators to reduce the blood pressure and ease the workload of the heart
- diuretics to reduce fluid overload
- inhibitors and blocking agents of the body's neurohormonal responses and other medicaments.
- Heart transplantation has been proposed for patients who suffer from severe, refractory heart failure.
- an implantable medical device such as a ventricular assist device (VAD) may be implanted in the chest to increase the pumping action of the heart.
- a ventricular assist device VAD
- IABP intra-aortic balloon pump
- Other surgical procedures are available as well.
- the wall of the carotid sinus a structure at the bifurcation of the common carotid arteries, contains stretch receptors (baroreceptors) that are sensitive to the blood pressure. These receptors send signals via the carotid sinus nerve to the brain, which in turn regulates the cardiovascular system to maintain normal blood pressure (the baroreflex), in part through activation of the sympathetic nervous system.
- Electrical stimulation of the carotid sinus nerve has previously been proposed to reduce blood pressure and the workload of the heart in the treatment of high blood pressure and angina.
- U.S. Pat. No. 6,073,048 to Kieval et al. discloses a baroreflex modulation system and method for stimulating the baroreflex arc based on various cardiovascular and pulmonary parameters.
- each of the therapies has its own disadvantages.
- drug therapy is often incompletely effective. Some patients may be unresponsive (refractory) to medical therapy. Drugs often have unwanted side effects and may need to be given in complex regimens. These and other factors contribute to poor patient compliance with medical therapy. Drug therapy may also be expensive, adding to the health care costs associated with these disorders.
- surgical approaches are very costly, may be associated with significant patient morbidity and mortality and may not alter the natural history of the disease. Baropacing also has not gained acceptance.
- Several problems with electrical carotid sinus nerve stimulation have been reported in the medical literature. These include the invasiveness of the surgical procedure to implant the nerve electrodes, and postoperative pain in the jaw, throat, face and head during stimulation.
- the present invention provides a number of devices, systems and methods by which the blood pressure, nervous system activity, and neurohormonal activity may be selectively and controllably regulated by activating baroreceptors.
- the present invention reduces excessive blood pressure, sympathetic nervous system activation and neurohormonal activation, thereby minimizing their deleterious effects on the heart, vasculature and other organs and tissues.
- the present invention provides systems and methods for treating a patient by inducing a baroreceptor signal to effect a change in the baroreflex system (e.g., reduced heart rate, reduced blood pressure, etc.).
- the baroreceptor signal is activated or otherwise modified by selectively activating baroreceptors.
- the system and method of the present invention utilize a baroreceptor activation device positioned near a baroreceptor in the carotid sinus, aortic arch, heart, common carotid arteries, subclavian arteries, and/or brachiocephalic artery.
- the baroreceptor activation device is located in the right and/or left carotid sinus (near the bifurcation of the common carotid artery) and/or the aortic arch.
- the present invention is described with reference to the carotid sinus location.
- the baroreceptor activation device may be activated, deactivated or otherwise modulated to activate one or more baroreceptors and induce a baroreceptor signal or a change in the baroreceptor signal to thereby effect a change in the baroreflex system.
- the baroreceptor activation device may be activated, deactivated, or otherwise modulated continuously, periodically, or episodically.
- the baroreceptor activation device may comprise a wide variety of devices which utilize electrodes to directly or indirectly activate the baroreceptor.
- the baroreceptor may be activated directly, or activated indirectly via the adjacent vascular tissue.
- the baroreceptor activation device will be positioned outside the vascular wall. To maximize therapeutic efficacy, mapping methods may be employed to precisely locate or position the baroreceptor activation device.
- the present invention is directed particularly at electrical means and methods to activate baroreceptors, and various electrode designs are provided.
- the electrode designs may be particularly suitable for connection to the carotid arteries at or near the carotid sinus, and may be designed to minimize extraneous tissue stimulation. While being particularly suitable for use on the carotid arteries at or near the carotid sinus, the electrode structures and assemblies of the present invention will also find use for external placement and securement of electrodes about other arteries, and in some cases veins, having baroreceptor and other electrically activated receptors therein.
- a baroreceptor activation device or other electrode useful for a carotid sinus or other blood vessel comprises a base having one or more electrodes connected to the base.
- the base has a length sufficient to extend around at least a substantial portion of the circumference of a blood vessel, usually an artery, more usually a carotid artery at or near the carotid sinus.
- substantially portion it is meant that the base will extend over at least 25% of the vessel circumference, usually at least 50%, more usually at least 66%, and often at least 75% or over the entire circumference.
- the base is sufficiently elastic to conform to said circumference or portion thereof when placed therearound.
- the electrode connected to the base is oriented at least partly in the circumferential direction and is sufficiently stretchable to both conform to the shape of the carotid sinus when the base is conformed thereover and accommodate changes in the shape and size of the sinus as they vary over time with heart pulse and other factors, including body movement which causes the blood vessel circumference to change.
- the electrode(s) may extend over the entire length of the base, but in some cases will extend over less than 75% of the circumferential length of the base, often being less than 50% of the circumferential length, and sometimes less than 25% of the circumferential length.
- the electrode structures may cover from a small portion up to the entire circumferential length of the carotid artery or other blood vessel.
- the circumferential length of the elongate electrodes will cover at least 10% of the circumference of the blood vessel, typically being at least 25%, often at least 50%, 75%, or the entire length.
- the base will usually have first and second ends, wherein the ends are adapted to be joined, and will have sufficient structural integrity to grasp the carotid sinus.
- an extravascular electrode assembly comprises an elastic base and a stretchable electrode.
- the elastic base is adapted to be conformably attached over the outside of a target blood vessel, such as a carotid artery at or near the carotid sinus, and the stretchable electrode is secured over the elastic base and capable of expanding and contracting together with the base.
- the electrode assembly is conformable to the exterior of the carotid sinus or other blood vessel.
- the elastic base is planar, typically comprising an elastomeric sheet. While the sheet may be reinforced, the reinforcement will be arranged so that the sheet remains elastic and stretchable, at least in the circumferential direction, so that the base and electrode assembly may be placed and conformed over the exterior of the blood vessel.
- Suitable elastomeric sheets may be composed of silicone, latex, and the like.
- the assembly will usually include two or more attachment tabs extending from the elastomeric sheet at locations which allow the tabs to overlap the elastic base and/or be directly attached to the blood vessel wall when the base is wrapped around or otherwise secured over a blood vessel. In this way, the tabs may be fastened to secure the backing over the blood vessel.
- Preferred stretchable electrodes comprise elongated coils, where the coils may stretch and shorten in a spring-like manner.
- the elongated coils will be flattened over at least a portion of their lengths, where the flattened portion is oriented in parallel to the elastic base. The flattened coil provides improved electrical contact when placed against the exterior of the carotid sinus or other blood vessel.
- an extravascular electrode assembly comprises a base and an electrode structure.
- the base is adapted to be attached over the outside of a carotid artery or other blood vessel and has an electrode-carrying surface formed over at least a portion thereof.
- a plurality of attachment tabs extend away from the electrode-carrying surface, where the tabs are arranged to permit selective ones thereof to be wrapped around a blood vessel while others of the tabs may be selectively removed.
- the electrode structure on or over the electrode-carrying surface.
- the base includes at least one tab which extends longitudinally from the electrode-carrying surface and at least two tabs which extend away from the surface at opposite, transverse angles.
- the electrode-carrying surface is rectangular, and at least two longitudinally extending tabs extend from adjacent corners of the rectangular surface. The two transversely angled tabs extend at a transverse angle away from the same two corners.
- the electrode structure preferably includes one or more stretchable electrodes secured to the electrode-carrying surface.
- the stretchable electrodes are preferably elongated coils, more preferably being “flattened coils” to enhance electrical contact with the blood vessel to be treated.
- the base is preferably an elastic base, more preferably being formed from an elastomeric sheet.
- the phrase “flattened coil,” as used herein, refers to an elongate electrode structure including a plurality of successive turns where the cross-sectional profile is non-circular and which includes at least one generally flat or minimally curved face. Such coils may be formed by physically deforming (flattening) a circular coil, e.g., as shown in FIG. 24 described below.
- the flattened coils will have a cross-section that has a width in the plane of the electrode assembly greater than its height normal to the electrode assembly plane.
- the coils may be initially fabricated in the desired geometry having one generally flat (or minimally curved) face for contacting tissue.
- Fully flattened coils e.g., those having planar serpentine configurations, may also find use, but usually it will be preferred to retain at least some thickness in the direction normal to the flat or minimally curved tissue-contacting surface. Such thickness helps the coiled electrode protrude from the base and provide improved tissue contact over the entire flattened surface.
- a method for wrapping an electrode assembly over a blood vessel comprises providing an electrode assembly having an elastic base and one or more stretchable electrodes.
- the base is conformed over an exterior of the blood vessel, such as a carotid artery, and at least a portion of an electrode is stretched along with the base. Ends of the elastic base are secured together to hold the electrode assembly in place, typically with both the elastic backing and stretchable electrode remaining under at least slight tension to promote conformance to the vessel exterior.
- the electrode assembly will be located over a target site in the blood vessel, typically a target site having an electrically activated receptor.
- the electrode structures of the present invention when wrapped under tension will flex and stretch with expansions and contractions of the blood vessel.
- a presently preferred target site is a baroreceptor, particularly baroreceptors in or near the carotid sinus.
- a method for wrapping an electrode assembly over a blood vessel comprises providing an electrode assembly including a base having an electrode-carrying surface and an electrode structure on the electrode-carrying surface.
- the base is wrapped over a blood vessel, and some but not all of a plurality of attachment tags on the base are secured over the blood vessel.
- the tabs which are not used to secure an electrode assembly will be removed, typically by cutting.
- Preferred target sites are electrically activated receptors, usually baroreceptors, more usually baroreceptors on the carotid sinus.
- the use of such electrode assemblies having multiple attachment tabs is particularly beneficial when securing the electrode assembly on a carotid artery near the carotid sinus.
- the active electrode area can be positioned at any of a variety of locations on the common, internal, and/or external carotid arteries.
- the present invention comprises pressure measuring assemblies including an elastic base adapted to be mounted on the outer wall of a blood vessel under circumferential tension.
- a strain measurement sensor is positioned on the base to measure strain resulting from circumferential expansion of the vessel due to a blood pressure increase.
- the base will wrap about the entire circumference of the vessel, although only a portion of the base need be elastic.
- a smaller base may be stapled, glued, clipped or otherwise secured over a “patch” of the vessel wall to detect strain variations over the underlying surface.
- Exemplary sensors include strain gauges and micro machined sensors (MEMS).
- electrode assemblies according to the present invention comprise a base and at least three parallel elongate electrode structures secured over a surface of the base.
- the base is attachable to an outside surface of a blood vessel, such as a carotid artery, particularly a carotid artery near the carotid sinus, and has a length sufficient to extend around at least a substantial portion of the circumference of the blood vessel, typically extending around at least 25% of the circumference, usually extending around at least 50% of the circumference, preferably extending at least 66% of the circumference, and often extending around at least 75% of or the entire circumference of the blood vessel.
- the base will preferably be elastic and composed of any of the materials set forth previously.
- the at least three parallel elongate electrode structures will preferably be aligned in the circumferential direction of the base, i.e., the axis or direction of the base which will be aligned circumferentially over the blood vessel when the base is mounted on the blood vessel.
- the electrode structures will preferably be stretchable, typically being elongate coils, often being flattened elongate coils, as also described previously.
- At least an outer pair of the electrode structures will be electrically isolated from an inner electrode structure, and the outer electrode structures will preferably be arranged in a U-pattern in order to surround the inner electrode structure.
- the outer pair of electrodes can be connected using a single conductor taken from the base, and the outer electrode structures and inner electrode structure may be connected to separate poles on a power supply in order to operate in the “pseudo” tripolar mode described hereinbelow.
- the present invention provides electrode designs and methods utilizing such electrodes by which the blood pressure may be selectively and controllably regulated by inhibiting or dampening baroreceptor signals.
- the present invention reduces conditions associated with low blood pressure.
- FIG. 1 is a schematic illustration of the upper torso of a human body showing the major arteries and veins and associated anatomy.
- FIG. 2A is a cross-sectional schematic illustration of the carotid sinus and baroreceptors within the vascular wall.
- FIG. 2B is a schematic illustration of baroreceptors within the vascular wall and the baroreflex system.
- FIG. 3 is a schematic illustration of a baroreceptor activation system in accordance with the present invention.
- FIGS. 4A and 4B are schematic illustrations of a baroreceptor activation device in the form of an implantable extraluminal conductive structure which electrically induces a baroreceptor signal in accordance with an embodiment of the present invention.
- FIGS. 5A-5F are schematic illustrations of various possible arrangements of electrodes around the carotid sinus for extravascular electrical activation embodiments.
- FIG. 6 is a schematic illustration of a serpentine shaped electrode for extravascular electrical activation embodiments.
- FIG. 7 is a schematic illustration of a plurality of electrodes aligned orthogonal to the direction of wrapping around the carotid sinus for extravascular electrical activation embodiments.
- FIGS. 8-11 are schematic illustrations of various multi-channel electrodes for extravascular electrical activation embodiments.
- FIG. 12 is a schematic illustration of an extravascular electrical activation device including a tether and an anchor disposed about the carotid sinus and common carotid artery.
- FIG. 13 is a schematic illustration of an alternative extravascular electrical activation device including a plurality of ribs and a spine.
- FIG. 14 is a schematic illustration of an electrode assembly for extravascular electrical activation embodiments.
- FIG. 15 is a schematic illustration of a fragment of an alternative cable for use with an electrode assembly such as shown in FIG. 14 .
- FIG. 16 illustrates a foil strain gauge for measuring expansion force of a carotid artery or other blood vessel.
- FIG. 17 illustrates a transducer which is adhesively connected to the wall of an artery.
- FIG. 18 is a cross-sectional view of the transducer of FIG. 17 .
- FIG. 19 illustrates a first exemplary electrode assembly having an elastic base and plurality of attachment tabs.
- FIG. 20 is a more detailed illustration of the electrode-carrying surface of the electrode assembly of FIG. 19 .
- FIG. 21 is a detailed illustration of electrode coils which are present in an elongate lead of the electrode assembly of FIG. 19 .
- FIG. 22 is a detailed view of the electrode-carrying surface of an electrode assembly similar to that shown in FIG. 20 , except that the electrodes have been flattened.
- FIG. 23 is a cross-sectional view of the electrode structure of FIG. 22 .
- FIG. 24 illustrates the transition between the flattened and non-flattened regions of the electrode coil of the electrode assembly FIG. 20 .
- FIG. 25 is a cross-sectional view taken along the line 25 - 25 of FIG. 24 .
- FIG. 26 is a cross-sectional view taken along the line 26 - 26 of FIG. 24 .
- FIG. 27 is an illustration of a further exemplary electrode assembly constructed in accordance with the principles of the present invention.
- FIG. 28 illustrates the electrode assembly of FIG. 27 wrapped around the common carotid artery near the carotid bifurcation.
- FIG. 29 illustrates the electrode assembly of FIG. 27 wrapped around the internal carotid artery.
- FIG. 30 is similar to FIG. 29 , but with the carotid bifurcation having a different geometry.
- FIG. 1 is a schematic illustration of the upper torso of a human body 10 showing some of the major arteries and veins of the cardiovascular system.
- the left ventricle of the heart 11 pumps oxygenated blood up into the aortic arch 12 .
- the right subclavian artery 13 , the right common carotid artery 14 , the left common carotid artery 15 and the left subclavian artery 16 branch off the aortic arch 12 proximal of the descending thoracic aorta 17 .
- brachiocephalic artery 22 connects the right subclavian artery 13 and the right common carotid artery 14 to the aortic arch 12 .
- the right carotid artery 14 bifurcates into the right external carotid artery 18 and the right internal carotid artery 19 at the right carotid sinus 20 .
- the left carotid artery 15 similarly bifurcates into the left external carotid artery and the left internal carotid artery at the left carotid sinus.
- oxygenated blood flows into the carotid arteries 18 / 19 and the subclavian arteries 13 / 16 .
- oxygenated blood circulates through the head and cerebral vasculature and oxygen depleted blood returns to the heart 11 by way of the jugular veins, of which only the right internal jugular vein 21 is shown for sake of clarity.
- oxygenated blood circulates through the upper peripheral vasculature and oxygen depleted blood returns to the heart by way of the subclavian veins, of which only the right subclavian vein 23 is shown, also for sake of clarity.
- the heart 11 pumps the oxygen depleted blood through the pulmonary system where it is reoxygenated.
- the re-oxygenated blood returns to the heart 11 which pumps the re-oxygenated blood into the aortic arch as described above, and the cycle repeats.
- baroreceptors 30 Within the arterial walls of the aortic arch 12 , common carotid arteries 14 / 15 (near the right carotid sinus 20 and left carotid sinus), subclavian arteries 13 / 16 and brachiocephalic artery 22 there are baroreceptors 30 .
- baroreceptors 30 reside within the vascular walls of the carotid sinus 20 .
- Baroreceptors 30 are a type of stretch receptor used by the body to sense blood pressure. An increase in blood pressure causes the arterial wall to stretch, and a decrease in blood pressure causes the arterial wall to return to its original size. Such a cycle is repeated with each beat of the heart.
- baroreceptors 30 are located within the arterial wall, they are able to sense deformation of the adjacent tissue, which is indicative of a change in blood pressure.
- the baroreceptors 30 located in the right carotid sinus 20 , the left carotid sinus and the aortic arch 12 play the most significant role in sensing blood pressure that affects the baroreflex system 50 , which is described in more detail with reference to FIG. 2B .
- FIG. 2B shows a schematic illustration of baroreceptors 30 disposed in a generic vascular wall 40 and a schematic flow chart of the baroreflex system 50 .
- Baroreceptors 30 are profusely distributed within the arterial walls 40 of the major arteries discussed previously, and generally form an arbor 32 .
- the baroreceptor arbor 32 comprises a plurality of baroreceptors 30 , each of which transmits baroreceptor signals to the brain 52 via nerve 38 .
- the baroreceptors 30 are so profusely distributed and arborized within the vascular wall 40 that discrete baroreceptor arbors 32 are not readily discernable.
- FIG. 2B are primarily schematic for purposes of illustration and discussion.
- Baroreceptor signals are used to activate a number of body systems which collectively may be referred to as the baroreflex system 50 .
- Baroreceptors 30 are connected to the brain 52 via the nervous system 51 .
- the brain 52 is able to detect changes in blood pressure, which is indicative of cardiac output. If cardiac output is insufficient to meet demand (i.e., the heart 11 is unable to pump sufficient blood), the baroreflex system 50 activates a number of body systems, including the heart 11 , kidneys 53 , vessels 54 , and other organs/tissues. Such activation of the baroreflex system 50 generally corresponds to an increase in neurohormonal activity.
- the baroreflex system 50 initiates a neurohormonal sequence that signals the heart 11 to increase heart rate and increase contraction force in order to increase cardiac output, signals the kidneys 53 to increase blood volume by retaining sodium and water, and signals the vessels 54 to constrict to elevate blood pressure.
- the cardiac, renal and vascular responses increase blood pressure and cardiac output 55 , and thus increase the workload of the heart 11 . In a patient with heart failure, this further accelerates myocardial damage and exacerbates the heart failure state.
- the present invention basically provides a number of devices, systems and methods by which the baroreflex system 50 is activated to reduce excessive blood pressure, autonomic nervous system activity and neurohormonal activation.
- the present invention provides a number of devices, systems and methods by which baroreceptors 30 may be activated, thereby indicating an increase in blood pressure and signaling the brain 52 to reduce the body's blood pressure and level of sympathetic nervous system and neurohormonal activation, and increase parasypathetic nervous system activation, thus having a beneficial effect on the cardiovascular system and other body systems.
- the present invention generally provides a system including a control system 60 , a baroreceptor activation device 70 , and a sensor 80 (optional), which generally operate in the following manner.
- the sensor(s) 80 optionally senses and/or monitors a parameter (e.g., cardiovascular function) indicative of the need to modify the baroreflex system and generates a signal indicative of the parameter.
- the control system 60 generates a control signal as a function of the received sensor signal.
- the control signal activates, deactivates or otherwise modulates the baroreceptor activation device 70 .
- activation of the device 70 results in activation of the baroreceptors 30 .
- deactivation or modulation of the baroreceptor activation device 70 may cause or modify activation of the baroreceptors 30 .
- the baroreceptor activation device 70 may comprise a wide variety of devices which utilize electrical means to activate baroreceptors 30 .
- the control system 60 when the sensor 80 detects a parameter indicative of the need to modify the baroreflex system activity (e.g., excessive blood pressure), the control system 60 generates a control signal to modulate (e.g. activate) the baroreceptor activation device 70 thereby inducing a baroreceptor 30 signal that is perceived by the brain 52 to be apparent excessive blood pressure.
- the control system 60 When the sensor 80 detects a parameter indicative of normal body function (e.g., normal blood pressure), the control system 60 generates a control signal to modulate (e.g., deactivate) the baroreceptor activation device 70 .
- the baroreceptor activation device 70 may comprise a wide variety of devices which utilize electrical means to activate the baroreceptors 30 .
- the baroreceptor activation device 70 of the present invention comprises an electrode structure which directly activates one or more baroreceptors 30 by changing the electrical potential across the baroreceptors 30 . It is possible that changing the electrical potential across the tissue surrounding the baroreceptors 30 may cause the surrounding tissue to stretch or otherwise deform, thus mechanically activating the baroreceptors 30 , in which case the stretchable and elastic electrode structures of the present invention may provide significant advantages.
- the baroreceptor activation device 70 may be positioned anywhere baroreceptors 30 are present. Such potential implantation sites are numerous, such as the aortic arch 12 , in the common carotid arteries 18 / 19 near the carotid sinus 20 , in the subclavian arteries 13 / 16 , in the brachiocephalic artery 22 , or in other arterial or venous locations.
- the electrode structures of the present invention will be implanted such that they are positioned on or over a vascular structure immediately adjacent the baroreceptors 30 .
- the electrode structure of the baroreceptor activation device 70 is implanted near the right carotid sinus 20 and/or the left carotid sinus (near the bifurcation of the common carotid artery) and/or the aortic arch 12 , where baroreceptors 30 have a significant impact on the baroreflex system 50 .
- the present invention is described with reference to baroreceptor activation device 70 positioned near the carotid sinus 20 .
- the optional sensor 80 is operably coupled to the control system 60 by electric sensor cable or lead 82 .
- the sensor 80 may comprise any suitable device that measures or monitors a parameter indicative of the need to modify the activity of the baroreflex system.
- the sensor 80 may comprise a physiologic transducer or gauge that measures ECG, blood pressure (systolic, diastolic, average or pulse pressure), blood volumetric flow rate, blood flow velocity, blood pH, O 2 or CO 2 content, mixed venous oxygen saturation (SVO 2 ), vasoactivity, nerve activity, tissue activity, body movement, activity levels, respiration, or composition.
- suitable transducers or gauges for the sensor 80 include ECG electrodes, a piezoelectric pressure transducer, an ultrasonic flow velocity transducer, an ultrasonic volumetric flow rate transducer, a thermodilution flow velocity transducer, a capacitive pressure transducer, a membrane pH electrode, an optical detector (SVO 2 ), tissue impedance (electrical), or a strain gauge. Although only one sensor 80 is shown, multiple sensors 80 of the same or different type at the same or different locations may be utilized.
- An example of an implantable blood pressure measurement device that may be disposed about a blood vessel is disclosed in U.S. Pat. No. 6,106,477 to Miesel et al., the entire disclosure of which is incorporated herein by reference.
- An example of a subcutaneous ECG monitor is available from Medtronic under the trade name REVEAL ILR and is disclosed in PCT Publication No. WO 98/02209, the entire disclosure of which is incorporated herein by reference.
- Other examples are disclosed in U.S. Pat. Nos. 5,987,352 and 5,331,966, the entire disclosures of which are incorporated herein by reference. Examples of devices and methods for measuring absolute blood pressure utilizing an ambient pressure reference are disclosed in U.S. Pat. No.
- the sensor 80 is preferably positioned in a chamber of the heart 11 , or in/on a major artery such as the aortic arch 12 , a common carotid artery 14 / 15 , a subclavian artery 13 / 16 or the brachiocephalic artery 22 , such that the parameter of interest may be readily ascertained.
- the sensor 80 may be disposed inside the body such as in or on an artery, a vein or a nerve (e.g. vagus nerve), or disposed outside the body, depending on the type of transducer or gauge utilized.
- the sensor 80 may be separate from the baroreceptor activation device 70 or combined therewith. For purposes of illustration only, the sensor 80 is shown positioned on the right subclavian artery 13 .
- control system 60 includes a control block 61 comprising a processor 63 and a memory 62 .
- Control system 60 is connected to the sensor 80 by way of sensor cable 82 .
- Control system 60 is also connected to the baroreceptor activation device 70 by way of electric control cable 72 .
- the control system 60 receives a sensor signal from the sensor 80 by way of sensor cable 82 , and transmits a control signal to the baroreceptor activation device 70 by way of control cable 72 .
- the system components 60 / 70 / 80 may be directly linked via cables 72 / 82 or by indirect means such as RF signal transceivers, ultrasonic transceivers or galvanic couplings. Examples of such indirect interconnection devices are disclosed in U.S. Pat. No. 4,987,897 to Funke and U.S. Pat. No. 5,113,859 to Funke, the entire disclosures of which are incorporated herein by reference.
- the memory 62 may contain data related to the sensor signal, the control signal, and/or values and commands provided by the input device 64 .
- the memory 62 may also include software containing one or more algorithms defining one or more functions or relationships between the control signal and the sensor signal.
- the algorithm may dictate activation or deactivation control signals depending on the sensor signal or a mathematical derivative thereof.
- the algorithm may dictate an activation or deactivation control signal when the sensor signal falls below a lower predetermined threshold value, rises above an upper predetermined threshold value or when the sensor signal indicates a specific physiologic event.
- the algorithm may dynamically alter the threshold value as determined by the sensor input values.
- the baroreceptor activation device 70 activates baroreceptors 30 electrically, optionally in combination with mechanical, thermal, chemical, biological or other co-activation.
- the control system 60 includes a driver 66 to provide the desired power mode for the baroreceptor activation device 70 .
- the driver 66 may comprise a power amplifier or the like and the cable 72 may comprise electrical lead(s).
- the driver 66 may not be necessary, particularly if the processor 63 generates a sufficiently strong electrical signal for low level electrical actuation of the baroreceptor activation device 70 .
- the control system 60 may operate as a closed loop utilizing feedback from the sensor 80 , or other sensors, such as heart rate sensors which may be incorporated or the electrode assembly, or as an open loop utilizing reprogramming commands received by input device 64 .
- the closed loop operation of the control system 60 preferably utilizes some feedback from the transducer 80 , but may also operate in an open loop mode without feedback.
- Programming commands received by the input device 64 may directly influence the control signal, the output activation parameters, or may alter the software and related algorithms contained in memory 62 .
- the treating physician and/or patient may provide commands to input device 64 .
- Display 65 may be used to view the sensor signal, control signal and/or the software/data contained in memory 62 .
- the control signal generated by the control system 60 may be continuous, periodic, alternating, episodic or a combination thereof, as dictated by an algorithm contained in memory 62 .
- Continuous control signals include a constant pulse, a constant train of pulses, a triggered pulse and a triggered train of pulses.
- periodic control signals include each of the continuous control signals described above which have a designated start time (e.g., beginning of each period as designated by minutes, hours, or days in combinations of) and a designated duration (e.g., seconds, minutes, hours, or days in combinations of).
- Examples of alternating control signals include each of the continuous control signals as described above which alternate between the right and left output channels.
- Examples of episodic control signals include each of the continuous control signals described above which are triggered by an episode (e.g., activation by the physician/patient, an increase/decrease in blood pressure above a certain threshold, heart rate above/below certain levels, etc.).
- the stimulus regimen governed by the control system 60 may be selected to promote long term efficacy. It is theorized that uninterrupted or otherwise unchanging activation of the baroreceptors 30 may result in the baroreceptors and/or the baroreflex system becoming less responsive over time, thereby diminishing the long term effectiveness of the therapy. Therefore, the stimulus regimen maybe selected to activate, deactivate or otherwise modulate the baroreceptor activation device 70 in such a way that therapeutic efficacy is maintained preferably for years.
- the stimulus regimens of the present invention may be selected reduce power requirement/consumption of the system 60 .
- the stimulus regimen may dictate that the baroreceptor activation device 70 be initially activated at a relatively higher energy and/or power level, and subsequently activated at a relatively lower energy and/or power level.
- the first level attains the desired initial therapeutic effect
- the second (lower) level sustains the desired therapeutic effect long term.
- the energy required or consumed by the activation device 70 is also reduced long term. This may correlate into systems having greater longevity and/or reduced size (due to reductions in the size of the power supply and associated components).
- a first general approach for a stimulus regimen which promotes long term efficacy and reduces power requirements/consumption involves generating a control signal to cause the baroreceptor activation device 70 to have a first output level of relatively higher energy and/or power, and subsequently changing the control signal to cause the baroreceptor activation device 70 to have a second output level of relatively lower energy and/or power.
- the first output level may be selected and maintained for sufficient time to attain the desired initial effect (e.g., reduced heart rate and/or blood pressure), after which the output level may be reduced to the second level for sufficient time to sustain the desired effect for the desired period of time.
- the second output level may have a power and/or energy value of X2, wherein X2 is less than X1.
- X2 may be equal to zero, such that the first level is “on” and the second level is “off”.
- power and energy refer to two different parameters, and in some cases, a change in one of the parameters (power or energy) may not correlate to the same or similar change in the other parameter. In the present invention, it is contemplated that a change in one or both of the parameters may be suitable to obtain the desired result of promoting long term efficacy.
- each further level may increase the output energy or power to attain the desired effect, or decrease the output energy or power to retain the desired effect. For example, in some instances, it may be desirable to have further reductions in the output level if the desired effect may be sustained at lower power or energy levels. In other instances, particularly when the desired effect is diminishing or is otherwise not sustained, it may be desirable to increase the output level until the desired effect is reestablished, and subsequently decrease the output level to sustain the effect.
- the transition from each level may be a step function (e.g., a single step or a series of steps), a gradual transition over a period of time, or a combination thereof.
- the signal levels may be continuous, periodic, alternating, or episodic as discussed previously.
- the output (power or energy) level of the baroreceptor activation device 70 may be changed by adjusting the output signal voltage level, current level and/or signal duration.
- the output signal of the baroreceptor activation device 70 may be, for example, constant current or constant voltage.
- several pulse characteristics may be changed individually or in combination to change the power or energy level of the output signal.
- Such pulse characteristics include, but are not limited to: pulse amplitude (PA), pulse frequency (PF), pulse width or duration (PW), pulse waveform (square, triangular, sinusoidal, etc.), pulse polarity (for bipolar electrodes) and pulse phase (monophasic, biphasic).
- FIGS. 4A and 4B show schematic illustrations of a baroreceptor activation device 300 in the form of an extravascular electrically conductive structure or electrode 302 .
- the electrode structure 302 may comprise a coil, braid or other structure capable of surrounding the vascular wall. Alternatively, the electrode structure 302 may comprise one or more electrode patches distributed around the outside surface of the vascular wall. Because the electrode structure 302 is disposed on the outside surface of the vascular wall, intravascular delivery techniques may not be practical, but minimally invasive surgical techniques will suffice.
- the extravascular electrode structure 302 may receive electrical signals directly from the driver 66 of the control system 60 by way of electrical lead 304 , or indirectly by utilizing an inductor (not shown) as described in copending commonly assigned application Ser. No. 10/402,393 (Attorney Docket No. 21433-000420US), filed on Mar. 27, 2003, the full disclosure of which is incorporated herein by reference.
- FIGS. 5A-5F show schematic illustrations of various possible arrangements of electrodes around the carotid sinus 20 for extravascular electrical activation embodiments, such as baroreceptor activation device 300 described with reference to FIGS. 4A and 4B .
- the electrode designs illustrated and described hereinafter may be particularly suitable for connection to the carotid arteries at or near the carotid sinus, and may be designed to minimize extraneous tissue stimulation.
- the carotid arteries are shown, including the common 14 , the external 18 and the internal 19 carotid arteries.
- the location of the carotid sinus 20 may be identified by a landmark bulge 21 , which is typically located on the internal carotid artery 19 just distal of the bifurcation, or extends across the bifurcation from the common carotid artery 14 to the internal carotid artery 19 .
- the carotid sinus 20 and in particular the bulge 21 of the carotid sinus, may contain a relatively high density of baroreceptors 30 (not shown) in the vascular wall. For this reason, it may be desirable to position the electrodes 302 of the activation device 300 on and/or around the sinus bulge 21 to maximize baroreceptor responsiveness and to minimize extraneous tissue stimulation.
- the device 300 and electrodes 302 are merely schematic, and only a portion of which may be shown, for purposes of illustrating various positions of the electrodes 302 on and/or around the carotid sinus 20 and the sinus bulge 21 .
- the electrodes 302 may be monopolar, bipolar, or tripolar (anode-cathode-anode or cathode-anode-cathode sets). Specific extravascular electrode designs are described in more detail hereinafter.
- the electrodes 302 of the extravascular electrical activation device 300 extend around a portion or the entire circumference of the sinus 20 in a circular fashion. Often, it would be desirable to reverse the illustrated electrode configuration in actual use.
- the electrodes 302 of the extravascular electrical activation device 300 extend around a portion or the entire circumference of the sinus 20 in a helical fashion. In the helical arrangement shown in FIG. 5B , the electrodes 302 may wrap around the sinus 20 any number of times to establish the desired electrode 302 contact and coverage. In the circular arrangement shown in FIG. 5A , a single pair of electrodes 302 may wrap around the sinus 20 , or a plurality of electrode pairs 302 may be wrapped around the sinus 20 as shown in FIG. 5C to establish more electrode 302 contact and coverage.
- the plurality of electrode pairs 302 may extend from a point proximal of the sinus 20 or bulge 21 , to a point distal of the sinus 20 or bulge 21 to ensure activation of baroreceptors 30 throughout the sinus 20 region.
- the electrodes 302 may be connected to a single channel or multiple channels as discussed in more detail hereinafter.
- the plurality of electrode pairs 302 may be selectively activated for purposes of targeting a specific area of the sinus 20 to increase baroreceptor responsiveness, or for purposes of reducing the exposure of tissue areas to activation to maintain baroreceptor responsiveness long term.
- the electrodes 302 extend around the entire circumference of the sinus 20 in a criss cross fashion.
- the criss cross arrangement of the electrodes 302 establishes contact with both the internal 19 and external 18 carotid arteries around the carotid sinus 20 .
- the electrodes 302 extend around all or a portion of the circumference of the sinus 20 , including the internal 19 and external 18 carotid arteries at the bifurcation, and in some instances the common carotid artery 14 .
- the electrodes 302 extend around all or a portion of the circumference of the sinus 20 , including the internal 19 and external 18 carotid arteries distal of the bifurcation.
- the extravascular electrical activation devices 300 are shown to include a substrate or base structure 306 which may encapsulate and insulate the electrodes 302 and may provide a means for attachment to the sinus 20 as described in more detail hereinafter.
- the electrodes 302 of the activation device 300 there are a number of suitable arrangements for the electrodes 302 of the activation device 300 , relative to the carotid sinus 20 and associated anatomy.
- the electrodes 302 are wrapped around a portion of the carotid structure, which may require deformation of the electrodes 302 from their relaxed geometry (e.g., straight).
- the electrodes 302 and/or the base structure 306 may have a relaxed geometry that substantially conforms to the shape of the carotid anatomy at the point of attachment.
- the electrodes 302 and the base structure or backing 306 may be pre shaped to conform to the carotid anatomy in a substantially relaxed state.
- the electrodes 302 may have a geometry and/or orientation that reduces the amount of electrode 302 strain.
- the backing or base structure 306 may be elastic or stretchable to facilitate wrapping of and conforming to the carotid sinus or other vascular structure.
- the electrodes 302 are shown to have a serpentine or wavy shape.
- the serpentine shape of the electrodes 302 reduces the amount of strain seen by the electrode material when wrapped around a carotid structure.
- the serpentine shape of the electrodes increases the contact surface area of the electrode 302 with the carotid tissue.
- the electrodes 302 may be arranged to be substantially orthogonal to the wrap direction (i.e., substantially parallel to the axis of the carotid arteries) as shown in FIG. 7 .
- the electrodes 302 each have a length and a width or diameter, wherein the length is substantially greater than the width or diameter.
- the electrodes 302 each have a longitudinal axis parallel to the length thereof, wherein the longitudinal axis is orthogonal to the wrap direction and substantially parallel to the longitudinal axis of the carotid artery about which the device 300 is wrapped. As with the multiple electrode embodiments described previously, the electrodes 302 may be connected to a single channel or multiple channels as discussed in more detail hereinafter.
- FIGS. 8-11 schematically illustrate various multi-channel electrodes for the extravascular electrical activation device 300 .
- FIG. 8 illustrates a six (6) channel electrode assembly including six (6) separate elongate electrodes 302 extending adjacent to and parallel with each other.
- the electrodes 302 are each connected to multi-channel cable 304 . Some of the electrodes 302 may be common, thereby reducing the number of conductors necessary in the cable 304 .
- Base structure or substrate 306 may comprise a flexible and electrically insulating material suitable for implantation, such as silicone, perhaps reinforced with a flexible material such as polyester fabric.
- the base 306 may have a length suitable to wrap around all (360.degree.) or a portion (i.e., less than 360.degree.) of the circumference of one or more of the carotid arteries adjacent the carotid sinus 20 .
- the electrodes 302 may extend around a portion (i.e., less than 360.degree. such as 270.degree., 180.degree. or 90.degree.) of the circumference of one or more of the carotid arteries adjacent the carotid sinus 20 .
- the electrodes 302 may have a length that is less than (e.g., 75%, 50% or 25%) the length of the base 206 .
- the electrodes 302 may be parallel, orthogonal or oblique to the length of the base 306 , which is generally orthogonal to the axis of the carotid artery to which it is disposed about.
- the base structure or backing will be elastic (i.e., stretchable), typically being composed of at least in part of silicone, latex, or other elastomer. If such elastic structures are reinforced, the reinforcement should be arranged so that it does not interfere with the ability of the base to stretch and conform to the vascular surface.
- the electrodes 302 may comprise round wire, rectangular ribbon or foil formed of an electrically conductive and radiopaque material such as platinum.
- the base structure 306 substantially encapsulates the electrodes 302 , leaving only an exposed area for electrical connection to extravascular carotid sinus tissue.
- each electrode 302 may be partially recessed in the base 206 and may have one side exposed along all or a portion of its length for electrical connection to carotid tissue. Electrical paths through the carotid tissues may be defined by one or more pairs of the elongate electrodes 302 .
- the multi-channel electrodes 302 may be selectively activated for purposes of mapping and targeting a specific area of the carotid sinus 20 to determine the best combination of electrodes 302 (e.g., individual pair, or groups of pairs) to activate for maximum baroreceptor responsiveness, as described elsewhere herein.
- the multi-channel electrodes 302 may be selectively activated for purposes of reducing the exposure of tissue areas to activation to maintain long term efficacy as described, as described elsewhere herein. For these purposes, it may be useful to utilize more than two (2) electrode channels.
- the electrodes 302 may be connected to a single channel whereby baroreceptors are uniformly activated throughout the sinus 20 region.
- the device 300 includes sixteen (16) individual electrode pads 302 connected to 16 channel cable 304 via 4 channel connectors 303 .
- the circular electrode pads 302 are partially encapsulated by the base structure 306 to leave one face of each button electrode 302 exposed for electrical connection to carotid tissues.
- electrical paths through the carotid tissues may be defined by one or more pairs (bipolar) or groups (tripolar) of electrode pads 302 .
- the device 300 includes sixteen (16) individual circular pad electrodes 302 surrounded by sixteen (16) rings 305 , which collectively may be referred to as concentric electrode pads 302 / 305 .
- Pad electrodes 302 are connected to 17 channel cable 304 via 4 channel connectors 303
- rings 305 are commonly connected to 17 channel cable 304 via a single channel connector 307 .
- the circular shaped electrodes 302 and the rings 305 are partially encapsulated by the base structure 306 to leave one face of each pad electrode 302 and one side of each ring 305 exposed for electrical connection to carotid tissues.
- two rings 305 may surround each electrode 302 , with the rings 305 being commonly connected. With these arrangements, electrical paths through the carotid tissues may be defined between one or more pad electrode 302 /ring 305 sets to create localized electrical paths.
- the device 300 includes a control IC chip 310 connected to 3 channel cable 304 .
- the control chip 310 is also connected to sixteen (16) individual pad electrodes 302 via 4 channel connectors 303 .
- the control chip 310 permits the number of channels in cable 304 to be reduced by utilizing a coding system.
- the control system 60 sends a coded control signal which is received by chip 310 .
- the chip 310 converts the code and enables or disables selected electrode 302 pairs in accordance with the code.
- control signal may comprise a pulse wave form, wherein each pulse includes a different code.
- the code for each pulse causes the chip 310 to enable one or more pairs of electrodes, and to disable the remaining electrodes.
- the pulse is only transmitted to the enabled electrode pair(s) corresponding to the code sent with that pulse.
- Each subsequent pulse would have a different code than the preceding pulse, such that the chip 310 enables and disables a different set of electrodes 302 corresponding to the different code.
- the IC chip 310 may be connected to feedback sensor 80 , taking advantage of the same functions as described with reference to FIG. 3 .
- one or more of the electrodes 302 may be used as feedback sensors when not enabled for activation.
- a feedback sensor electrode may be used to measure or monitor electrical conduction in the vascular wall to provide data analogous to an ECG.
- such a feedback sensor electrode may be used to sense a change in impedance due to changes in blood volume during a pulse pressure to provide data indicative of heart rate, blood pressure, or other physiologic parameter.
- FIG. 12 schematically illustrates an extravascular electrical activation device 300 including a support collar or anchor 312 .
- the activation device 300 is wrapped around the internal carotid artery 19 at the carotid sinus 20
- the support collar 312 is wrapped around the common carotid artery 14 .
- the activation device 300 is connected to the support collar 312 by cables 304 , which act as a loose tether.
- the collar 312 isolates the activation device from movements and forces transmitted by the cables 304 proximal of the support collar, such as may be encountered by movement of the control system 60 and/or driver 66 .
- a strain relief (not shown) may be connected to the base structure 306 of the activation device 300 at the juncture between the cables 304 and the base 306 .
- the base structure 306 of the activation device 300 may comprise molded tube, a tubular extrusion, or a sheet of material wrapped into a tube shape utilizing a suture flap 308 with sutures 309 as shown.
- the base structure 306 may be formed of a flexible and biocompatible material such as silicone, which may be reinforced with a flexible material such as polyester fabric available under the trade name DACRON® to form a composite structure.
- the inside diameter of the base structure 306 may correspond to the outside diameter of the carotid artery at the location of implantation, for example 6 to 8 mm.
- the wall thickness of the base structure 306 may be very thin to maintain flexibility and a low profile, for example less than 1 mm. If the device 300 is to be disposed about a sinus bulge 21 , a correspondingly shaped bulge may be formed into the base structure for added support and assistance in positioning.
- the electrodes 302 may comprise round wire, rectangular ribbon or foil, formed of an electrically conductive and radiopaque material such as platinum or platinum iridium.
- the electrodes may be molded into the base structure 306 or adhesively connected to the inside diameter thereof, leaving a portion of the electrode exposed for electrical connection to carotid tissues.
- the electrodes 302 may encompass less than the entire inside circumference (e.g., 300.degree.) of the base structure 306 to avoid shorting.
- the electrodes 302 may have any of the shapes and arrangements described previously. For example, as shown in FIG. 12 , two rectangular ribbon electrodes 302 may be used, each having a width of 1 mm spaced 1.5 mm apart.
- the support collar 312 may be formed similarly to base structure 306 .
- the support collar may comprise molded tube, a tubular extrusion, or a sheet of material wrapped into a tube shape utilizing a suture flap 315 with sutures 313 as shown.
- the support collar 312 may be formed of a flexible and biocompatible material such as silicone, which may be reinforced to form a composite structure.
- the cables 304 are secured to the support collar 312 , leaving slack in the cables 304 between the support collar 312 and the activation device 300 .
- sutures 311 may be used to maintain the position of the electrical activation device 300 relative to the carotid anatomy (or other vascular site containing baroreceptors).
- Such sutures 311 may be connected to base structure 306 , and pass through all or a portion of the vascular wall.
- the sutures 311 may be threaded through the base structure 306 , through the adventitia of the vascular wall, and tied. If the base structure 306 comprises a patch or otherwise partially surrounds the carotid anatomy, the corners and/or ends of the base structure may be sutured, with additional sutures evenly distributed therebetween.
- a reinforcement material such as polyester fabric may be embedded in the silicone material.
- other fixation means may be employed such as staples or a biocompatible adhesive, for example.
- FIG. 13 schematically illustrates an alternative extravascular electrical activation device 300 including one or more electrode ribs 316 interconnected by spine 317 .
- a support collar 312 having one or more (non electrode) ribs 316 may be used to isolate the activation device 300 from movements and forces transmitted by the cables 304 proximal of the support collar 312 .
- the ribs 316 of the activation device 300 are sized to fit about the carotid anatomy, such as the internal carotid artery 19 adjacent the carotid sinus 20 .
- the ribs 316 of the support collar 312 may be sized to fit about the carotid anatomy, such as the common carotid artery 14 proximal of the carotid sinus 20 .
- the ribs 316 may be separated, placed on a carotid artery, and closed thereabout to secure the device 300 to the carotid anatomy.
- Each of the ribs 316 of the device 300 includes an electrode 302 on the inside surface thereof for electrical connection to carotid tissues.
- the ribs 316 provide insulating material around the electrodes 302 , leaving only an inside portion exposed to the vascular wall.
- the electrodes 302 are coupled to the multi-channel cable 304 through spine 317 .
- Spine 317 also acts as a tether to ribs 316 of the support collar 312 , which do not include electrodes since their function is to provide support.
- the multi-channel electrode 302 functions discussed with reference to FIGS. 8-11 are equally applicable to this embodiment.
- the ends of the ribs 316 may be connected (e.g., sutured) after being disposed about a carotid artery, or may remain open as shown. If the ends remain open, the ribs 316 may be formed of a relatively stiff material to ensure a mechanical lock around the carotid artery.
- the ribs 316 may be formed of polyethylene, polypropylene, PTFE, or other similar insulating and biocompatible material.
- the ribs 316 may be formed of a metal such as stainless steel or a nickel titanium alloy, as long as the metallic material was electrically isolated from the electrodes 302 .
- the ribs 316 may comprise an insulating and biocompatible polymeric material with the structural integrity provided by metallic (e.g., stainless steel, nickel titanium alloy, etc.) reinforcement.
- metallic e.g., stainless steel, nickel titanium alloy, etc.
- the electrodes 302 may comprise the metallic reinforcement.
- the base structure 306 comprises a silicone sheet having a length of 5.0 inches, a thickness of 0.007 inches, and a width of 0.312 inches.
- the electrodes 302 comprise platinum ribbon having a length of 0.47 inches, a thickness of 0.0005 inches, and a width of 0.040 inches.
- the electrodes 302 are adhesively connected to one side of the silicone sheet 306 .
- the electrodes 302 are connected to a modified bipolar endocardial pacing lead, available under the trade name CONIFIX from Innomedica (now BIOMEC Cardiovascular, Inc.), model number 501112.
- the proximal end of the cable 304 is connected to the control system 60 or driver 66 as described previously.
- the pacing lead is modified by removing the pacing electrode to form the cable body 304 .
- the MP35 wires are extracted from the distal end thereof to form two coils 318 positioned side by side having a diameter of about 0.020 inches.
- the coils 318 are then attached to the electrodes utilizing 316 type stainless steel crimp terminals laser welded to one end of the platinum electrodes 302 .
- the distal end of the cable 304 and the connection between the coils 318 and the ends of the electrodes 302 are encapsulated by silicone.
- the cable 304 illustrated in FIG. 14 comprises a coaxial type cable including two coaxially disposed coil leads separated into two separate coils 318 for attachment to the electrodes 302 .
- An alternative cable 304 construction is illustrated in FIG. 15 .
- FIG. 15 illustrates an alternative cable body 304 which may be formed in a curvilinear shape such as a sinusoidal configuration, prior to implantation.
- the curvilinear configuration readily accommodates a change in distance between the device 300 and the control system 60 or the driver 66 . Such a change in distance may be encountered during flexion and/or extension of the neck of the patient after implantation.
- the cable body 304 may comprise two or more conductive wires 304 a arranged coaxially or collinearly as shown.
- Each conductive wire 304 a may comprise a multifilament structure of suitable conductive material such as stainless steel or MP35N.
- An insulating material may surround the wire conductors 304 a individually and/or collectively.
- a pair of electrically conductive wires 304 a having an insulating material surrounding each wire 304 a individually is shown.
- the insulated wires 304 a may be connected by a spacer 304 b comprising, for example, an insulating material.
- An additional jacket of suitable insulating material may surround each of the conductors 304 a .
- the insulating jacket may be formed to have the same curvilinear shape of the insulated wires 304 a to help maintain the shape of the cable body 304 during implantation.
- the amplitude (A) may range from 1 mm to 10 mm, and preferably ranges from 2 mm to 3 mm.
- the wavelength (WL) of the sinusoid may range from 2 mm to 20 mm, and preferably ranges from 4 mm to 10 mm.
- the curvilinear or sinusoidal shape may be formed by a heat setting procedure utilizing a fixture which holds the cable 304 in the desired shape while the cable is exposed to heat. Sufficient heat is used to heat set the conductive wires 304 a and/or the surrounding insulating material. After cooling, the cable 304 may be removed from the fixture, and the cable 304 retains the desired shape.
- FIGS. 16-18 illustrate various transducers that may be mounted to the wall of a vessel such as a carotid artery 14 to monitor wall expansion or contraction using strain, force and/or pressure gauges.
- a vessel such as a carotid artery 14
- strain, force and/or pressure gauges An example of an implantable blood pressure measurement device that may be disposed about a blood vessel is disclosed in U.S. Pat. No. 6,106,477 to Miesel et al., the entire disclosure of which is incorporated herein by reference.
- the output from such gauges may be correlated to blood pressure and/or heart rate, for example, and may be used to provide feedback to the control system 60 as described previously herein.
- an implantable pressure measuring assembly comprises a foil strain gauge or force sensing resistor device 740 disposed about an artery such as common carotid artery 14 .
- a transducer portion 742 may be mounted to a silicone base or backing 744 which is wrapped around and sutured or otherwise attached to the artery 14 .
- the transducer 750 may be adhesively connected to the wall of the artery 14 using a biologically compatible adhesive such as cyanoacrylate as shown in FIG. 17 .
- the transducer 750 comprises a micro machined sensor (MEMS) that measures force or pressure.
- MEMS micro machined sensor
- the MEMS transducer 750 includes a micro arm 752 (shown in section in FIG. 18 ) coupled to a silicon force sensor contained over an elastic base 754 .
- a cap 756 covers the arm 752 a top portion of the base 754 .
- the base 754 include an interior opening creating access from the vessel wall 14 to the arm 752 .
- An incompressible gel 756 fills the space between the arm 752 and the vessel wall 14 such that force is transmitted to the arm upon expansion and contraction of the vessel wall.
- changes in blood pressure within the artery cause changes in vessel wall stress which are detected by the transducer and which may be correlated with the blood pressure.
- FIGS. 19-21 illustrate an alternative extravascular electrical activation device 700 , which, may also be referred to as an electrode cuff device or more generally as an “electrode assembly.” Except as described herein and shown in the drawings, device 700 may be the same in design and function as extravascular electrical activation device 300 described previously.
- electrode assembly or cuff device 700 includes coiled electrode conductors 702 / 704 embedded in a flexible support 706 .
- an outer electrode coil 702 and an inner electrode coil 704 are used to provide a pseudo tripolar arrangement, but other polar arrangements are applicable as well as described previously.
- the coiled electrodes 702 / 704 may be formed of fine round, flat or ellipsoidal wire such as 0.002 inch diameter round PtIr alloy wire wound into a coil form having a nominal diameter of 0.015 inches with a pitch of 0.004 inches, for example.
- the flexible support or base 706 may be formed of a biocompatible and flexible (preferably elastic) material such as silicone or other suitable thin walled elastomeric material having a wall thickness of 0.005 inches and a length (e.g., 2.95 inches) sufficient to surround the carotid sinus, for example.
- a biocompatible and flexible (preferably elastic) material such as silicone or other suitable thin walled elastomeric material having a wall thickness of 0.005 inches and a length (e.g., 2.95 inches) sufficient to surround the carotid sinus, for example.
- Each turn of the coil in the contact area of the electrodes 702 / 704 is exposed from the flexible support 706 and any adhesive to form a conductive path to the artery wall.
- the exposed electrodes 702 / 704 may have a length (e.g., 0.236 inches) sufficient to extend around at least a portion of the carotid sinus, for example.
- the electrode cuff 700 is assembled flat with the contact surfaces of the coil electrodes 702 / 704 tangent to the inside plane of the flexible support 706 . When the electrode cuff 700 is wrapped around the artery, the inside contact surfaces of the coiled electrodes 702 / 704 are naturally forced to extend slightly above the adjacent surface of the flexible support, thereby improving contact to the artery wall.
- the ratio of the diameter of the coiled electrodes 702 / 704 to the wire diameter is preferably large enough to allow the coil to bend and elongate without significant bending stress or torsional stress in the wire. Flexibility is a significant advantage of this design which allows the electrode cuff 700 to conform to the shape of the carotid artery and sinus, and permits expansion and contraction of the artery or sinus without encountering significant stress or fatigue.
- the flexible electrode cuff 700 may be wrapped around and stretched to conform to the shape of the carotid sinus and artery during implantation. This may be achieved without collapsing or distorting the shape of the artery and carotid sinus due to the compliance of the electrode cuff 700 .
- the flexible support 706 is able to flex and stretch with the conductor coils 702 / 704 because of the absence of fabric reinforcement in the electrode contact portion of the cuff 700 .
- the flexible support 706 By conforming to the artery shape, and by the edge of the flexible support 706 sealing against the artery wall, the amount of stray electrical field and extraneous stimulation will likely be reduced.
- the pitch of the coil electrodes 702 / 704 may be greater than the wire diameter in order to provide a space between each turn of the wire to thereby permit bending without necessarily requiring axial elongation thereof.
- the pitch of the contact coils 702 / 704 may be 0.004 inches per turn with a 0.002 inch diameter wire, which allows for a 0.002 inch space between the wires in each turn.
- the inside of the coil may be filled with a flexible adhesive material such as silicone adhesive which may fill the spaces between adjacent wire turns. By filling the small spaces between the adjacent coil turns, the chance of pinching tissue between coil turns is minimized thereby avoiding abrasion to the artery wall.
- the embedded coil electrodes 702 / 704 are mechanically captured and chemically bonded into the flexible support 706 .
- the diameter of the coil is large enough to be atraumatic to the artery wall.
- the centerline of the coil electrodes 702 / 704 lie near the neutral axis of electrode cuff structure 700 and the flexible support 706 comprises a material with isotropic elasticity such as silicone in order to minimize the shear forces on the adhesive bonds between the coil electrodes 702 / 704 and the support 706 .
- the electrode coils 702 / 704 are connected to corresponding conductive coils 712 / 714 , respectively, in an elongate lead 710 which is connected to the control system 60 .
- Anchoring wings 718 may be provided on the lead 710 to tether the lead 710 to adjacent tissue and minimize the effects or relative movement between the lead 710 and the electrode cuff 700 .
- the conductive coils 712 / 714 may be formed of 0.003 MP35N bifilar wires wound into 0.018 inch diameter coils which are electrically connected to electrode coils 702 / 704 by splice wires 716 .
- the conductive coils 712 / 714 may be individually covered by an insulating covering 718 such as silicone tubing and collectively covered by insulating covering 720 .
- the conductive material of the electrodes 702 / 704 may be a metal as described above or a conductive polymer such as a silicone material filled with metallic particles such as Pt particles.
- the polymeric electrodes may be integrally formed with the flexible support 706 with the electrode contacts comprising raised areas on the inside surface of the flexible support 706 electrically coupled to the lead 710 by wires or wire coils. The use of polymeric electrodes may be applied to other electrode design embodiments described elsewhere herein.
- Reinforcement patches 708 such as DACRON® fabric may be selectively incorporated into the flexible support 706 .
- reinforcement patches 708 may be incorporated into the ends or other areas of the flexible support 706 to accommodate suture anchors.
- the reinforcement patches 708 provide points where the electrode cuff 700 may be sutured to the vessel wall and may also provide tissue in growth to further anchor the device 700 to the exterior of the vessel wall.
- the fabric reinforcement patches 708 may extend beyond the edge of the flexible support 706 so that tissue in growth may help anchor the electrode assembly or cuff 700 to the vessel wall and may reduce reliance on the sutures to retain the electrode assembly 700 in place.
- bioadhesives such as cyanoacrylate may be employed to secure the device 700 to the vessel wall.
- an adhesive incorporating conductive particles such as Pt coated micro spheres may be applied to the exposed inside surfaces of the electrodes 702 / 704 to enhance electrical conduction to the tissue and possibly limit conduction along one axis to limit extraneous tissue stimulation.
- the reinforcement patches 708 may also be incorporated into the flexible support 706 for strain relief purposes and to help retain the coils 702 / 704 to the support 706 where the leads 710 attach to the electrode assembly 700 as well as where the outer coil 702 loops back around the inner coil 704 .
- the patches 708 are selectively incorporated into the flexible support 706 to permit expansion and contraction of the device 700 , particularly in the area of the electrodes 702 / 704 .
- the flexible support 706 is only fabric reinforced in selected areas thereby maintaining the ability of the electrode cuff 700 to stretch.
- the electrode assembly of FIGS. 19-21 can be modified to have “flattened” coil electrodes in the region of the assembly where the electrodes contact the extravascular tissue.
- an electrode-carrying surface 801 of the electrode assembly is located generally between parallel reinforcement strips or tabs 808 .
- the flattened coil section 810 will generally be exposed on a lower surface 803 of the base 806 ( FIG. 23 ) and will be covered or encapsulated by a parylene or other polymeric structure or material 802 over an upper surface 805 thereof.
- the coil is formed with a generally circular periphery 809 , as best seen in FIGS.
- the flattened coil structure is particularly beneficial since it retains flexibility, allowing the electrodes to bend, stretch, and flex together with the elastomeric base 806 , while also increasing the flat electrode area available to contact the extravascular surface.
- Electrode assembly 900 comprises an electrode base, typically an elastic base 902 , typically formed from silicone or other elastomeric material, having an electrode-carrying surface 904 and a plurality of attachment tabs 906 ( 906 a , 906 b , 906 c , and 906 d ) extending from the electrode-carrying surface.
- the attachment tabs 906 are preferably formed from the same material as the electrode-carrying surface 904 of the base 902 , but could be formed from other elastomeric materials as well. In the latter case, the base will be molded, stretched or otherwise assembled from the various pieces.
- the attachment tabs 906 are formed integrally with the remainder of the base 902 , i.e., typically being cut from a single sheet of the elastomeric material.
- the geometry of the electrode assembly 900 is selected to permit a number of different attachment modes to the blood vessel.
- the geometry of the assembly 902 of FIG. 27 is intended to permit attachment to various locations on the carotid arteries at or near the carotid sinus and carotid bifurcation.
- a number of reinforcement regions 910 are attached to different locations on the base 902 to permit suturing, clipping, stapling, or other fastening of the attachment tabs 906 to each other and/or the electrode-carrying surface 904 of the base 902 .
- a first reinforcement strip 910 a is provided over an end of the base 902 opposite to the end which carries the attachment tabs.
- Pairs of reinforcement strips 910 b and 910 c are provided on each of the axially aligned attachment tabs 906 a and 906 b , while similar pairs of reinforcement strips 910 d and 910 e are provided on each of the transversely angled attachment tabs 906 c and 906 d .
- all attachment tabs will be provided on one side of the base, preferably emanating from adjacent corners of the rectangular electrode-carrying surface 904 .
- the structure of electrode assembly 900 permits the surgeon to implant the electrode assembly so that the electrodes 920 (which are preferably stretchable, flat-coil electrodes as described in detail above), are located at a preferred location relative to the target baroreceptors.
- the preferred location may be determined, for example, as described in copending application Ser. No. 09/963,991, filed on Sep. 26, 2001, the full disclosure of which incorporated herein by reference.
- the surgeon may position the base 902 so that the electrodes 920 are located appropriately relative to the underlying baroreceptors.
- the electrodes 920 may be positioned over the common carotid artery CC as shown in FIG. 28 , or over the internal carotid artery IC, as shown in FIGS. 29 and 30 .
- the assembly 900 may be attached by stretching the base 902 and attachment tabs 906 a and 906 b over the exterior of the common carotid artery.
- the reinforcement tabs 906 a or 906 b may then be secured to the reinforcement strip 910 a , either by suturing, stapling, fastening, gluing, welding, or other well-known means. Usually, the reinforcement tabs 906 c and 906 d will be cut off at their bases, as shown at 922 and 924 , respectively.
- the bulge of the carotid sinus and the baroreceptors may be located differently with respect to the carotid bifurcation.
- the receptors may be located further up the internal carotid artery IC so that the placement of electrode assembly 900 as shown in FIG. 28 will not work.
- the assembly 900 may still be successfully attached by utilizing the transversely angled attachment tabs 906 c and 906 d rather than the central or axial tabs 906 a and 906 b .
- FIG. 29 the receptors may be located further up the internal carotid artery IC so that the placement of electrode assembly 900 as shown in FIG. 28 will not work.
- the assembly 900 may still be successfully attached by utilizing the transversely angled attachment tabs 906 c and 906 d rather than the central or axial tabs 906 a and 906 b .
- the lower tab 906 d is wrapped around the common carotid artery CC, while the upper attachment tab 906 c is wrapped around the internal carotid artery IC.
- the axial attachment tabs 906 a and 906 b will usually be cut off (at locations 926 ), although neither of them could in some instances also be wrapped around the internal carotid artery IC.
- the tabs which are used may be stretched and attached to reinforcement strip 910 a , as generally described above.
- the assembly 900 may be attached using the upper axial attachment tab 906 a and be lower transversely angled attachment tab 906 d .
- Attachment tabs 906 b and 906 c may be cut off, as shown at locations 928 and 930 , respectively.
- the elastic nature of the base 902 and the stretchable nature of the electrodes 920 permit the desired conformance and secure mounting of the electrode assembly over the carotid sinus. It would be appreciated that these or similar structures would also be useful for mounting electrode structures at other locations in the vascular system.
- anti-inflammatory agents e.g., steroid eluting electrodes
- anti-inflammatory agents e.g., steroid eluting electrodes
- Such agents reduce tissue inflammation at the chronic interface between the device (e.g., electrodes) and the vascular wall tissue, to thereby increase the efficiency of stimulus transfer, reduce power consumption, and maintain activation efficiency, for example.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Heart & Thoracic Surgery (AREA)
- Cardiology (AREA)
- Neurology (AREA)
- Neurosurgery (AREA)
- Biophysics (AREA)
- Physiology (AREA)
- Vascular Medicine (AREA)
- Physics & Mathematics (AREA)
- Pathology (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Surgery (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Electrotherapy Devices (AREA)
- Surgical Instruments (AREA)
Abstract
The present invention is a system for providing baroreceptor stimulation comprising, a sensor to sense a physiologic parameter and provide a signal indicative of the physiologic parameter, a baroreceptor stimulator, which includes, a pulse generator to provide a baroreceptor stimulation signal adapted to provide a baroreflex therapy, and a control system to receive the signal indicative of the physiologic parameter and modulate the baroreceptor stimulation signal based on the signal indicative of the physiologic parameter to change the baroreflex therapy from a first baroreflex therapy to a second baroreflex therapy.
Description
- This application is a continuation of U.S. patent application Ser. No. 10/402,911 (Attorney Docket No.: 021433-000410US), filed on Mar. 27, 2003, which (1) is a continuation-in-part of U.S. patent application Ser. No. 09/963,777 (Attorney Docket No.: 021433-000120US), filed on Sep. 26, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/671,850 (Attorney Docket No.: 021433-000100US), filed on Sep. 27, 2000, now issued as U.S. Pat. No. 6,522,926; and (ii) claims the benefit of U.S. Provisional Patent Application No. 60/368,222 (Attorney Docket No.: 021433-000400US), filed on Mar. 27, 2002, the disclosures of each of the above being hereby incorporated by reference in their entirety. The parent application for this application has incorporated by reference the disclosures of the following U.S. patent applications: U.S. patent application Ser. No. 09/964,079 (Attorney Docket No.: 021433-000110US), filed on Sep. 26, 2001, now issued as U.S. Pat. No. 6,985,774, and U.S. patent application Ser. No. 09/963,991 (Attorney Docket No.: 021433-000130US), filed on Sep. 26, 2001, now issued as U.S. Pat. No. 6,850,801, now issued as U.S. Pat. No. 6,850,801, the disclosures of which are also effectively incorporated by reference herein.
- The present invention generally relates to medical devices and methods of use for the treatment and/or management of cardiovascular and renal disorders. Specifically, the present invention relates to devices and methods for controlling the baroreflex system for the treatment and/or management of cardiovascular and renal disorders and their underlying causes and conditions.
- Cardiovascular disease is a major contributor to patient illness and mortality. It also is a primary driver of health care expenditure, costing more than $326 billion each year in the United States. Hypertension, or high blood pressure, is a major cardiovascular disorder that is estimated to affect over 50 million people in the United Sates alone. Of those with hypertension, it is reported that fewer than 30% have their blood pressure under control. Hypertension is a leading cause of heart failure and stroke. It is the primary cause of death in over 42,000 patients per year and is listed as a primary or contributing cause of death in over 200,000 patients per year in the U.S. Accordingly, hypertension is a serious health problem demanding significant research and development for the treatment thereof.
- Hypertension occurs when the body's smaller blood vessels (arterioles) constrict, causing an increase in blood pressure. Because the blood vessels constrict, the heart must work harder to maintain blood flow at the higher pressures. Although the body may tolerate short periods of increased blood pressure, sustained hypertension may eventually result in damage to multiple body organs, including the kidneys, brain, eyes and other tissues, causing a variety of maladies associated therewith. The elevated blood pressure may also damage the lining of the blood vessels, accelerating the process of atherosclerosis and increasing the likelihood that a blood clot may develop. This could lead to a heart attack and/or stroke. Sustained high blood pressure may eventually result in an enlarged and damaged heart (hypertrophy), which may lead to heart failure.
- Heart failure is the final common expression of a variety of cardiovascular disorders, including ischemic heart disease. It is characterized by an inability of the heart to pump enough blood to meet the body's needs and results in fatigue, reduced exercise capacity and poor survival. It is estimated that approximately 5,000,000 people in the United States suffer from heart failure, directly leading to 39,000 deaths per year and contributing to another 225,000 deaths per year. It is also estimated that greater than 400,000 new cases of heart failure are diagnosed each year. Heart failure accounts for over 900,000 hospital admissions annually, and is the most common discharge diagnosis in patients over the age of 65 years. It has been reported that the cost of treating heart failure in the United States exceeds $20 billion annually. Accordingly, heart failure is also a serious health problem demanding significant research and development for the treatment and/or management thereof.
- Heart failure results in the activation of a number of body systems to compensate for the heart's inability to pump sufficient blood. Many of these responses are mediated by an increase in the level of activation of the sympathetic nervous system, as well as by activation of multiple other neurohormonal responses. Generally speaking, this sympathetic nervous system activation signals the heart to increase heart rate and force of contraction to increase the cardiac output; it signals the kidneys to expand the blood volume by retaining sodium and water; and it signals the arterioles to constrict to elevate the blood pressure. The cardiac, renal and vascular responses increase the workload of the heart, further accelerating myocardial damage and exacerbating the heart failure state. Accordingly, it is desirable to reduce the level of sympathetic nervous system activation in order to stop or at least minimize this vicious cycle and thereby treat or manage the heart failure.
- A number of drug treatments have been proposed for the management of hypertension, heart failure and other cardiovascular disorders. These include vasodilators to reduce the blood pressure and ease the workload of the heart, diuretics to reduce fluid overload, inhibitors and blocking agents of the body's neurohormonal responses, and other medicaments.
- Various surgical procedures have also been proposed for these maladies. For example, heart transplantation has been proposed for patients who suffer from severe, refractory heart failure. Alternatively, an implantable medical device such as a ventricular assist device (VAD) may be implanted in the chest to increase the pumping action of the heart. Alternatively, an intra-aortic balloon pump (IABP) may be used for maintaining heart function for short periods of time, but typically no longer than one month. Other surgical procedures are available as well.
- It has been known for decades that the wall of the carotid sinus, a structure at the bifurcation of the common carotid arteries, contains stretch receptors (baroreceptors) that are sensitive to the blood pressure. These receptors send signals via the carotid sinus nerve to the brain, which in turn regulates the cardiovascular system to maintain normal blood pressure (the baroreflex), in part through activation of the sympathetic nervous system. Electrical stimulation of the carotid sinus nerve (baropacing) has previously been proposed to reduce blood pressure and the workload of the heart in the treatment of high blood pressure and angina. For example, U.S. Pat. No. 6,073,048 to Kieval et al. discloses a baroreflex modulation system and method for stimulating the baroreflex arc based on various cardiovascular and pulmonary parameters.
- Although each of these alternative approaches is beneficial in some ways, each of the therapies has its own disadvantages. For example, drug therapy is often incompletely effective. Some patients may be unresponsive (refractory) to medical therapy. Drugs often have unwanted side effects and may need to be given in complex regimens. These and other factors contribute to poor patient compliance with medical therapy. Drug therapy may also be expensive, adding to the health care costs associated with these disorders. Likewise, surgical approaches are very costly, may be associated with significant patient morbidity and mortality and may not alter the natural history of the disease. Baropacing also has not gained acceptance. Several problems with electrical carotid sinus nerve stimulation have been reported in the medical literature. These include the invasiveness of the surgical procedure to implant the nerve electrodes, and postoperative pain in the jaw, throat, face and head during stimulation. In addition, it has been noted that high voltages sometimes required for nerve stimulation may damage the carotid sinus nerves. Accordingly, there continues to be a substantial and long felt need for new devices and methods for treating and/or managing high blood pressure, heart failure and their associated cardiovascular and nervous system disorders.
- U.S. Pat. No. 6,522,926, signed to the Assignee of the present application, describes a number of systems and methods intended to activate baroreceptors in the carotid sinus and elsewhere in order to induce the baroreflex. Numerous specific approaches are described, including the use of coil electrodes placed over the exterior of the carotid sinus near the carotid bifurcation. While such electrode designs offer substantial promise, there is room for improvement in a number of specific design areas. For example, it would be desirable to provide designs which permit electrode structures to be closely and conformably secured over the exterior of a carotid sinus or other blood vessels so that efficient activation of the underlying baroreceptors can be achieved. It would be further desirable to provide specific electrode structures which can be variably positioned at different locations over the carotid sinus wall or elsewhere. At least some of these objectives will be met by these inventions described hereinbelow.
- To address hypertension, heart failure and their associated cardiovascular and nervous system disorders, the present invention provides a number of devices, systems and methods by which the blood pressure, nervous system activity, and neurohormonal activity may be selectively and controllably regulated by activating baroreceptors. By selectively and controllably activating baroreceptors, the present invention reduces excessive blood pressure, sympathetic nervous system activation and neurohormonal activation, thereby minimizing their deleterious effects on the heart, vasculature and other organs and tissues.
- The present invention provides systems and methods for treating a patient by inducing a baroreceptor signal to effect a change in the baroreflex system (e.g., reduced heart rate, reduced blood pressure, etc.). The baroreceptor signal is activated or otherwise modified by selectively activating baroreceptors. To accomplish this, the system and method of the present invention utilize a baroreceptor activation device positioned near a baroreceptor in the carotid sinus, aortic arch, heart, common carotid arteries, subclavian arteries, and/or brachiocephalic artery. Preferably, the baroreceptor activation device is located in the right and/or left carotid sinus (near the bifurcation of the common carotid artery) and/or the aortic arch. By way of example, not limitation, the present invention is described with reference to the carotid sinus location.
- Generally speaking, the baroreceptor activation device may be activated, deactivated or otherwise modulated to activate one or more baroreceptors and induce a baroreceptor signal or a change in the baroreceptor signal to thereby effect a change in the baroreflex system. The baroreceptor activation device may be activated, deactivated, or otherwise modulated continuously, periodically, or episodically. The baroreceptor activation device may comprise a wide variety of devices which utilize electrodes to directly or indirectly activate the baroreceptor. The baroreceptor may be activated directly, or activated indirectly via the adjacent vascular tissue. The baroreceptor activation device will be positioned outside the vascular wall. To maximize therapeutic efficacy, mapping methods may be employed to precisely locate or position the baroreceptor activation device.
- The present invention is directed particularly at electrical means and methods to activate baroreceptors, and various electrode designs are provided. The electrode designs may be particularly suitable for connection to the carotid arteries at or near the carotid sinus, and may be designed to minimize extraneous tissue stimulation. While being particularly suitable for use on the carotid arteries at or near the carotid sinus, the electrode structures and assemblies of the present invention will also find use for external placement and securement of electrodes about other arteries, and in some cases veins, having baroreceptor and other electrically activated receptors therein.
- In a first aspect of the present invention, a baroreceptor activation device or other electrode useful for a carotid sinus or other blood vessel comprises a base having one or more electrodes connected to the base. The base has a length sufficient to extend around at least a substantial portion of the circumference of a blood vessel, usually an artery, more usually a carotid artery at or near the carotid sinus. By “substantial portion,” it is meant that the base will extend over at least 25% of the vessel circumference, usually at least 50%, more usually at least 66%, and often at least 75% or over the entire circumference. Usually, the base is sufficiently elastic to conform to said circumference or portion thereof when placed therearound. The electrode connected to the base is oriented at least partly in the circumferential direction and is sufficiently stretchable to both conform to the shape of the carotid sinus when the base is conformed thereover and accommodate changes in the shape and size of the sinus as they vary over time with heart pulse and other factors, including body movement which causes the blood vessel circumference to change.
- Usually, at least two electrodes will be positioned circumferentially and adjacent to each other on the base. The electrode(s) may extend over the entire length of the base, but in some cases will extend over less than 75% of the circumferential length of the base, often being less than 50% of the circumferential length, and sometimes less than 25% of the circumferential length. Thus, the electrode structures may cover from a small portion up to the entire circumferential length of the carotid artery or other blood vessel. Usually, the circumferential length of the elongate electrodes will cover at least 10% of the circumference of the blood vessel, typically being at least 25%, often at least 50%, 75%, or the entire length. The base will usually have first and second ends, wherein the ends are adapted to be joined, and will have sufficient structural integrity to grasp the carotid sinus.
- In a further aspect of the present invention, an extravascular electrode assembly comprises an elastic base and a stretchable electrode. The elastic base is adapted to be conformably attached over the outside of a target blood vessel, such as a carotid artery at or near the carotid sinus, and the stretchable electrode is secured over the elastic base and capable of expanding and contracting together with the base. In this way, the electrode assembly is conformable to the exterior of the carotid sinus or other blood vessel. Preferably, the elastic base is planar, typically comprising an elastomeric sheet. While the sheet may be reinforced, the reinforcement will be arranged so that the sheet remains elastic and stretchable, at least in the circumferential direction, so that the base and electrode assembly may be placed and conformed over the exterior of the blood vessel. Suitable elastomeric sheets may be composed of silicone, latex, and the like.
- To assist in mounting the extravascular electrode over the carotid sinus or other blood vessel, the assembly will usually include two or more attachment tabs extending from the elastomeric sheet at locations which allow the tabs to overlap the elastic base and/or be directly attached to the blood vessel wall when the base is wrapped around or otherwise secured over a blood vessel. In this way, the tabs may be fastened to secure the backing over the blood vessel.
- Preferred stretchable electrodes comprise elongated coils, where the coils may stretch and shorten in a spring-like manner. In particularly preferred embodiments, the elongated coils will be flattened over at least a portion of their lengths, where the flattened portion is oriented in parallel to the elastic base. The flattened coil provides improved electrical contact when placed against the exterior of the carotid sinus or other blood vessel.
- In a further aspect of the present invention, an extravascular electrode assembly comprises a base and an electrode structure. The base is adapted to be attached over the outside of a carotid artery or other blood vessel and has an electrode-carrying surface formed over at least a portion thereof. A plurality of attachment tabs extend away from the electrode-carrying surface, where the tabs are arranged to permit selective ones thereof to be wrapped around a blood vessel while others of the tabs may be selectively removed. The electrode structure on or over the electrode-carrying surface.
- In preferred embodiments, the base includes at least one tab which extends longitudinally from the electrode-carrying surface and at least two tabs which extend away from the surface at opposite, transverse angles. In an even more preferred embodiment, the electrode-carrying surface is rectangular, and at least two longitudinally extending tabs extend from adjacent corners of the rectangular surface. The two transversely angled tabs extend at a transverse angle away from the same two corners.
- As with prior embodiments, the electrode structure preferably includes one or more stretchable electrodes secured to the electrode-carrying surface. The stretchable electrodes are preferably elongated coils, more preferably being “flattened coils” to enhance electrical contact with the blood vessel to be treated. The base is preferably an elastic base, more preferably being formed from an elastomeric sheet. The phrase “flattened coil,” as used herein, refers to an elongate electrode structure including a plurality of successive turns where the cross-sectional profile is non-circular and which includes at least one generally flat or minimally curved face. Such coils may be formed by physically deforming (flattening) a circular coil, e.g., as shown in
FIG. 24 described below. Usually, the flattened coils will have a cross-section that has a width in the plane of the electrode assembly greater than its height normal to the electrode assembly plane. Alternatively, the coils may be initially fabricated in the desired geometry having one generally flat (or minimally curved) face for contacting tissue. Fully flattened coils, e.g., those having planar serpentine configurations, may also find use, but usually it will be preferred to retain at least some thickness in the direction normal to the flat or minimally curved tissue-contacting surface. Such thickness helps the coiled electrode protrude from the base and provide improved tissue contact over the entire flattened surface. - In a still further aspect of the present invention, a method for wrapping an electrode assembly over a blood vessel comprises providing an electrode assembly having an elastic base and one or more stretchable electrodes. The base is conformed over an exterior of the blood vessel, such as a carotid artery, and at least a portion of an electrode is stretched along with the base. Ends of the elastic base are secured together to hold the electrode assembly in place, typically with both the elastic backing and stretchable electrode remaining under at least slight tension to promote conformance to the vessel exterior. The electrode assembly will be located over a target site in the blood vessel, typically a target site having an electrically activated receptor. Advantageously, the electrode structures of the present invention when wrapped under tension will flex and stretch with expansions and contractions of the blood vessel. A presently preferred target site is a baroreceptor, particularly baroreceptors in or near the carotid sinus.
- In a still further aspect of the present invention, a method for wrapping an electrode assembly over a blood vessel comprises providing an electrode assembly including a base having an electrode-carrying surface and an electrode structure on the electrode-carrying surface. The base is wrapped over a blood vessel, and some but not all of a plurality of attachment tags on the base are secured over the blood vessel. Usually, the tabs which are not used to secure an electrode assembly will be removed, typically by cutting. Preferred target sites are electrically activated receptors, usually baroreceptors, more usually baroreceptors on the carotid sinus. The use of such electrode assemblies having multiple attachment tabs is particularly beneficial when securing the electrode assembly on a carotid artery near the carotid sinus. By using particular tabs, as described in more detail below, the active electrode area can be positioned at any of a variety of locations on the common, internal, and/or external carotid arteries.
- In another aspect, the present invention comprises pressure measuring assemblies including an elastic base adapted to be mounted on the outer wall of a blood vessel under circumferential tension. A strain measurement sensor is positioned on the base to measure strain resulting from circumferential expansion of the vessel due to a blood pressure increase. Usually, the base will wrap about the entire circumference of the vessel, although only a portion of the base need be elastic. Alternatively, a smaller base may be stapled, glued, clipped or otherwise secured over a “patch” of the vessel wall to detect strain variations over the underlying surface. Exemplary sensors include strain gauges and micro machined sensors (MEMS).
- In yet another aspect, electrode assemblies according to the present invention comprise a base and at least three parallel elongate electrode structures secured over a surface of the base. The base is attachable to an outside surface of a blood vessel, such as a carotid artery, particularly a carotid artery near the carotid sinus, and has a length sufficient to extend around at least a substantial portion of the circumference of the blood vessel, typically extending around at least 25% of the circumference, usually extending around at least 50% of the circumference, preferably extending at least 66% of the circumference, and often extending around at least 75% of or the entire circumference of the blood vessel. As with prior embodiments, the base will preferably be elastic and composed of any of the materials set forth previously.
- The at least three parallel elongate electrode structures will preferably be aligned in the circumferential direction of the base, i.e., the axis or direction of the base which will be aligned circumferentially over the blood vessel when the base is mounted on the blood vessel. The electrode structures will preferably be stretchable, typically being elongate coils, often being flattened elongate coils, as also described previously.
- At least an outer pair of the electrode structures will be electrically isolated from an inner electrode structure, and the outer electrode structures will preferably be arranged in a U-pattern in order to surround the inner electrode structure. In this way, the outer pair of electrodes can be connected using a single conductor taken from the base, and the outer electrode structures and inner electrode structure may be connected to separate poles on a power supply in order to operate in the “pseudo” tripolar mode described hereinbelow.
- To address low blood pressure and other conditions requiring blood pressure augmentation, the present invention provides electrode designs and methods utilizing such electrodes by which the blood pressure may be selectively and controllably regulated by inhibiting or dampening baroreceptor signals. By selectively and controllably inhibiting or dampening baroreceptor signals, the present invention reduces conditions associated with low blood pressure.
-
FIG. 1 is a schematic illustration of the upper torso of a human body showing the major arteries and veins and associated anatomy. -
FIG. 2A is a cross-sectional schematic illustration of the carotid sinus and baroreceptors within the vascular wall. -
FIG. 2B is a schematic illustration of baroreceptors within the vascular wall and the baroreflex system. -
FIG. 3 is a schematic illustration of a baroreceptor activation system in accordance with the present invention. -
FIGS. 4A and 4B are schematic illustrations of a baroreceptor activation device in the form of an implantable extraluminal conductive structure which electrically induces a baroreceptor signal in accordance with an embodiment of the present invention. -
FIGS. 5A-5F are schematic illustrations of various possible arrangements of electrodes around the carotid sinus for extravascular electrical activation embodiments. -
FIG. 6 is a schematic illustration of a serpentine shaped electrode for extravascular electrical activation embodiments. -
FIG. 7 is a schematic illustration of a plurality of electrodes aligned orthogonal to the direction of wrapping around the carotid sinus for extravascular electrical activation embodiments. -
FIGS. 8-11 are schematic illustrations of various multi-channel electrodes for extravascular electrical activation embodiments. -
FIG. 12 is a schematic illustration of an extravascular electrical activation device including a tether and an anchor disposed about the carotid sinus and common carotid artery. -
FIG. 13 is a schematic illustration of an alternative extravascular electrical activation device including a plurality of ribs and a spine. -
FIG. 14 is a schematic illustration of an electrode assembly for extravascular electrical activation embodiments. -
FIG. 15 is a schematic illustration of a fragment of an alternative cable for use with an electrode assembly such as shown inFIG. 14 . -
FIG. 16 illustrates a foil strain gauge for measuring expansion force of a carotid artery or other blood vessel. -
FIG. 17 illustrates a transducer which is adhesively connected to the wall of an artery. -
FIG. 18 is a cross-sectional view of the transducer ofFIG. 17 . -
FIG. 19 illustrates a first exemplary electrode assembly having an elastic base and plurality of attachment tabs. -
FIG. 20 is a more detailed illustration of the electrode-carrying surface of the electrode assembly ofFIG. 19 . -
FIG. 21 is a detailed illustration of electrode coils which are present in an elongate lead of the electrode assembly ofFIG. 19 . -
FIG. 22 is a detailed view of the electrode-carrying surface of an electrode assembly similar to that shown inFIG. 20 , except that the electrodes have been flattened. -
FIG. 23 is a cross-sectional view of the electrode structure ofFIG. 22 . -
FIG. 24 illustrates the transition between the flattened and non-flattened regions of the electrode coil of the electrode assemblyFIG. 20 . -
FIG. 25 is a cross-sectional view taken along the line 25-25 ofFIG. 24 . -
FIG. 26 is a cross-sectional view taken along the line 26-26 ofFIG. 24 . -
FIG. 27 is an illustration of a further exemplary electrode assembly constructed in accordance with the principles of the present invention. -
FIG. 28 illustrates the electrode assembly ofFIG. 27 wrapped around the common carotid artery near the carotid bifurcation. -
FIG. 29 illustrates the electrode assembly ofFIG. 27 wrapped around the internal carotid artery. -
FIG. 30 is similar toFIG. 29 , but with the carotid bifurcation having a different geometry. - The following detailed description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention.
- To better understand the present invention, it may be useful to explain some of the basic vascular anatomy associated with the cardiovascular system. Refer to
FIG. 1 which is a schematic illustration of the upper torso of ahuman body 10 showing some of the major arteries and veins of the cardiovascular system. The left ventricle of theheart 11 pumps oxygenated blood up into theaortic arch 12. The rightsubclavian artery 13, the right commoncarotid artery 14, the left commoncarotid artery 15 and the leftsubclavian artery 16 branch off theaortic arch 12 proximal of the descendingthoracic aorta 17. Although relatively short, a distinct vascular segment referred to as thebrachiocephalic artery 22 connects the rightsubclavian artery 13 and the right commoncarotid artery 14 to theaortic arch 12. The rightcarotid artery 14 bifurcates into the right externalcarotid artery 18 and the right internalcarotid artery 19 at the rightcarotid sinus 20. Although not shown for purposes of clarity only, the leftcarotid artery 15 similarly bifurcates into the left external carotid artery and the left internal carotid artery at the left carotid sinus. - From the
aortic arch 12, oxygenated blood flows into thecarotid arteries 18/19 and thesubclavian arteries 13/16. From thecarotid arteries 18/19, oxygenated blood circulates through the head and cerebral vasculature and oxygen depleted blood returns to theheart 11 by way of the jugular veins, of which only the right internaljugular vein 21 is shown for sake of clarity. From thesub clavian arteries 13/16, oxygenated blood circulates through the upper peripheral vasculature and oxygen depleted blood returns to the heart by way of the subclavian veins, of which only the rightsubclavian vein 23 is shown, also for sake of clarity. Theheart 11 pumps the oxygen depleted blood through the pulmonary system where it is reoxygenated. The re-oxygenated blood returns to theheart 11 which pumps the re-oxygenated blood into the aortic arch as described above, and the cycle repeats. - Within the arterial walls of the
aortic arch 12, commoncarotid arteries 14/15 (near the rightcarotid sinus 20 and left carotid sinus),subclavian arteries 13/16 andbrachiocephalic artery 22 there arebaroreceptors 30. For example, as best seen inFIG. 2A ,baroreceptors 30 reside within the vascular walls of thecarotid sinus 20.Baroreceptors 30 are a type of stretch receptor used by the body to sense blood pressure. An increase in blood pressure causes the arterial wall to stretch, and a decrease in blood pressure causes the arterial wall to return to its original size. Such a cycle is repeated with each beat of the heart. Becausebaroreceptors 30 are located within the arterial wall, they are able to sense deformation of the adjacent tissue, which is indicative of a change in blood pressure. Thebaroreceptors 30 located in the rightcarotid sinus 20, the left carotid sinus and theaortic arch 12 play the most significant role in sensing blood pressure that affects thebaroreflex system 50, which is described in more detail with reference toFIG. 2B . - Refer now to
FIG. 2B , which shows a schematic illustration ofbaroreceptors 30 disposed in a genericvascular wall 40 and a schematic flow chart of thebaroreflex system 50.Baroreceptors 30 are profusely distributed within thearterial walls 40 of the major arteries discussed previously, and generally form anarbor 32. Thebaroreceptor arbor 32 comprises a plurality ofbaroreceptors 30, each of which transmits baroreceptor signals to thebrain 52 vianerve 38. Thebaroreceptors 30 are so profusely distributed and arborized within thevascular wall 40 thatdiscrete baroreceptor arbors 32 are not readily discernable. To this end, those skilled in the art will appreciate that thebaroreceptors 30 shown inFIG. 2B are primarily schematic for purposes of illustration and discussion. - Baroreceptor signals are used to activate a number of body systems which collectively may be referred to as the
baroreflex system 50.Baroreceptors 30 are connected to thebrain 52 via thenervous system 51. Thus, thebrain 52 is able to detect changes in blood pressure, which is indicative of cardiac output. If cardiac output is insufficient to meet demand (i.e., theheart 11 is unable to pump sufficient blood), thebaroreflex system 50 activates a number of body systems, including theheart 11,kidneys 53,vessels 54, and other organs/tissues. Such activation of thebaroreflex system 50 generally corresponds to an increase in neurohormonal activity. Specifically, thebaroreflex system 50 initiates a neurohormonal sequence that signals theheart 11 to increase heart rate and increase contraction force in order to increase cardiac output, signals thekidneys 53 to increase blood volume by retaining sodium and water, and signals thevessels 54 to constrict to elevate blood pressure. The cardiac, renal and vascular responses increase blood pressure andcardiac output 55, and thus increase the workload of theheart 11. In a patient with heart failure, this further accelerates myocardial damage and exacerbates the heart failure state. - To address the problems of hypertension, heart failure, other cardiovascular disorders and renal disorders, the present invention basically provides a number of devices, systems and methods by which the
baroreflex system 50 is activated to reduce excessive blood pressure, autonomic nervous system activity and neurohormonal activation. In particular, the present invention provides a number of devices, systems and methods by whichbaroreceptors 30 may be activated, thereby indicating an increase in blood pressure and signaling thebrain 52 to reduce the body's blood pressure and level of sympathetic nervous system and neurohormonal activation, and increase parasypathetic nervous system activation, thus having a beneficial effect on the cardiovascular system and other body systems. - With reference to
FIG. 3 , the present invention generally provides a system including acontrol system 60, abaroreceptor activation device 70, and a sensor 80 (optional), which generally operate in the following manner. The sensor(s) 80 optionally senses and/or monitors a parameter (e.g., cardiovascular function) indicative of the need to modify the baroreflex system and generates a signal indicative of the parameter. Thecontrol system 60 generates a control signal as a function of the received sensor signal. The control signal activates, deactivates or otherwise modulates thebaroreceptor activation device 70. Typically, activation of thedevice 70 results in activation of thebaroreceptors 30. Alternatively, deactivation or modulation of thebaroreceptor activation device 70 may cause or modify activation of thebaroreceptors 30. Thebaroreceptor activation device 70 may comprise a wide variety of devices which utilize electrical means to activatebaroreceptors 30. Thus, when thesensor 80 detects a parameter indicative of the need to modify the baroreflex system activity (e.g., excessive blood pressure), thecontrol system 60 generates a control signal to modulate (e.g. activate) thebaroreceptor activation device 70 thereby inducing abaroreceptor 30 signal that is perceived by thebrain 52 to be apparent excessive blood pressure. When thesensor 80 detects a parameter indicative of normal body function (e.g., normal blood pressure), thecontrol system 60 generates a control signal to modulate (e.g., deactivate) thebaroreceptor activation device 70. - As mentioned previously, the
baroreceptor activation device 70 may comprise a wide variety of devices which utilize electrical means to activate thebaroreceptors 30. Thebaroreceptor activation device 70 of the present invention comprises an electrode structure which directly activates one ormore baroreceptors 30 by changing the electrical potential across thebaroreceptors 30. It is possible that changing the electrical potential across the tissue surrounding thebaroreceptors 30 may cause the surrounding tissue to stretch or otherwise deform, thus mechanically activating thebaroreceptors 30, in which case the stretchable and elastic electrode structures of the present invention may provide significant advantages. - All of the specific embodiments of the electrode structures of the present invention are suitable for implantation, and are preferably implanted using a minimally invasive surgical approach. The
baroreceptor activation device 70 may be positioned anywhere baroreceptors 30 are present. Such potential implantation sites are numerous, such as theaortic arch 12, in the commoncarotid arteries 18/19 near thecarotid sinus 20, in thesubclavian arteries 13/16, in thebrachiocephalic artery 22, or in other arterial or venous locations. The electrode structures of the present invention will be implanted such that they are positioned on or over a vascular structure immediately adjacent thebaroreceptors 30. Preferably, the electrode structure of thebaroreceptor activation device 70 is implanted near the rightcarotid sinus 20 and/or the left carotid sinus (near the bifurcation of the common carotid artery) and/or theaortic arch 12, wherebaroreceptors 30 have a significant impact on thebaroreflex system 50. For purposes of illustration only, the present invention is described with reference tobaroreceptor activation device 70 positioned near thecarotid sinus 20. - The
optional sensor 80 is operably coupled to thecontrol system 60 by electric sensor cable or lead 82. Thesensor 80 may comprise any suitable device that measures or monitors a parameter indicative of the need to modify the activity of the baroreflex system. For example, thesensor 80 may comprise a physiologic transducer or gauge that measures ECG, blood pressure (systolic, diastolic, average or pulse pressure), blood volumetric flow rate, blood flow velocity, blood pH, O2 or CO2 content, mixed venous oxygen saturation (SVO2), vasoactivity, nerve activity, tissue activity, body movement, activity levels, respiration, or composition. Examples of suitable transducers or gauges for thesensor 80 include ECG electrodes, a piezoelectric pressure transducer, an ultrasonic flow velocity transducer, an ultrasonic volumetric flow rate transducer, a thermodilution flow velocity transducer, a capacitive pressure transducer, a membrane pH electrode, an optical detector (SVO2), tissue impedance (electrical), or a strain gauge. Although only onesensor 80 is shown,multiple sensors 80 of the same or different type at the same or different locations may be utilized. - An example of an implantable blood pressure measurement device that may be disposed about a blood vessel is disclosed in U.S. Pat. No. 6,106,477 to Miesel et al., the entire disclosure of which is incorporated herein by reference. An example of a subcutaneous ECG monitor is available from Medtronic under the trade name REVEAL ILR and is disclosed in PCT Publication No. WO 98/02209, the entire disclosure of which is incorporated herein by reference. Other examples are disclosed in U.S. Pat. Nos. 5,987,352 and 5,331,966, the entire disclosures of which are incorporated herein by reference. Examples of devices and methods for measuring absolute blood pressure utilizing an ambient pressure reference are disclosed in U.S. Pat. No. 5,810,735 to Halperin et al., U.S. Pat. No. 5,904,708 to Goedeke, and PCT Publication No. WO 00/16686 to Brockway et al., the entire disclosures of which are incorporated herein by reference. The
sensor 80 described herein may take the form of any of these devices or other devices that generally serve the same purpose. - The
sensor 80 is preferably positioned in a chamber of theheart 11, or in/on a major artery such as theaortic arch 12, a commoncarotid artery 14/15, asubclavian artery 13/16 or thebrachiocephalic artery 22, such that the parameter of interest may be readily ascertained. Thesensor 80 may be disposed inside the body such as in or on an artery, a vein or a nerve (e.g. vagus nerve), or disposed outside the body, depending on the type of transducer or gauge utilized. Thesensor 80 may be separate from thebaroreceptor activation device 70 or combined therewith. For purposes of illustration only, thesensor 80 is shown positioned on the rightsubclavian artery 13. - By way of example, the
control system 60 includes acontrol block 61 comprising aprocessor 63 and amemory 62.Control system 60 is connected to thesensor 80 by way ofsensor cable 82.Control system 60 is also connected to thebaroreceptor activation device 70 by way ofelectric control cable 72. Thus, thecontrol system 60 receives a sensor signal from thesensor 80 by way ofsensor cable 82, and transmits a control signal to thebaroreceptor activation device 70 by way ofcontrol cable 72. - The
system components 60/70/80 may be directly linked viacables 72/82 or by indirect means such as RF signal transceivers, ultrasonic transceivers or galvanic couplings. Examples of such indirect interconnection devices are disclosed in U.S. Pat. No. 4,987,897 to Funke and U.S. Pat. No. 5,113,859 to Funke, the entire disclosures of which are incorporated herein by reference. - The
memory 62 may contain data related to the sensor signal, the control signal, and/or values and commands provided by theinput device 64. Thememory 62 may also include software containing one or more algorithms defining one or more functions or relationships between the control signal and the sensor signal. The algorithm may dictate activation or deactivation control signals depending on the sensor signal or a mathematical derivative thereof. The algorithm may dictate an activation or deactivation control signal when the sensor signal falls below a lower predetermined threshold value, rises above an upper predetermined threshold value or when the sensor signal indicates a specific physiologic event. The algorithm may dynamically alter the threshold value as determined by the sensor input values. - As mentioned previously, the
baroreceptor activation device 70 activatesbaroreceptors 30 electrically, optionally in combination with mechanical, thermal, chemical, biological or other co-activation. In some instances, thecontrol system 60 includes adriver 66 to provide the desired power mode for thebaroreceptor activation device 70. For example, thedriver 66 may comprise a power amplifier or the like and thecable 72 may comprise electrical lead(s). In other instances, thedriver 66 may not be necessary, particularly if theprocessor 63 generates a sufficiently strong electrical signal for low level electrical actuation of thebaroreceptor activation device 70. - The
control system 60 may operate as a closed loop utilizing feedback from thesensor 80, or other sensors, such as heart rate sensors which may be incorporated or the electrode assembly, or as an open loop utilizing reprogramming commands received byinput device 64. The closed loop operation of thecontrol system 60 preferably utilizes some feedback from thetransducer 80, but may also operate in an open loop mode without feedback. Programming commands received by theinput device 64 may directly influence the control signal, the output activation parameters, or may alter the software and related algorithms contained inmemory 62. The treating physician and/or patient may provide commands to inputdevice 64.Display 65 may be used to view the sensor signal, control signal and/or the software/data contained inmemory 62. - The control signal generated by the
control system 60 may be continuous, periodic, alternating, episodic or a combination thereof, as dictated by an algorithm contained inmemory 62. Continuous control signals include a constant pulse, a constant train of pulses, a triggered pulse and a triggered train of pulses. Examples of periodic control signals include each of the continuous control signals described above which have a designated start time (e.g., beginning of each period as designated by minutes, hours, or days in combinations of) and a designated duration (e.g., seconds, minutes, hours, or days in combinations of). Examples of alternating control signals include each of the continuous control signals as described above which alternate between the right and left output channels. Examples of episodic control signals include each of the continuous control signals described above which are triggered by an episode (e.g., activation by the physician/patient, an increase/decrease in blood pressure above a certain threshold, heart rate above/below certain levels, etc.). - The stimulus regimen governed by the
control system 60 may be selected to promote long term efficacy. It is theorized that uninterrupted or otherwise unchanging activation of thebaroreceptors 30 may result in the baroreceptors and/or the baroreflex system becoming less responsive over time, thereby diminishing the long term effectiveness of the therapy. Therefore, the stimulus regimen maybe selected to activate, deactivate or otherwise modulate thebaroreceptor activation device 70 in such a way that therapeutic efficacy is maintained preferably for years. - In addition to maintaining therapeutic efficacy over time, the stimulus regimens of the present invention may be selected reduce power requirement/consumption of the
system 60. As will be described in more detail hereinafter, the stimulus regimen may dictate that thebaroreceptor activation device 70 be initially activated at a relatively higher energy and/or power level, and subsequently activated at a relatively lower energy and/or power level. The first level attains the desired initial therapeutic effect, and the second (lower) level sustains the desired therapeutic effect long term. By reducing the energy and/or power levels after the desired therapeutic effect is initially attained, the energy required or consumed by theactivation device 70 is also reduced long term. This may correlate into systems having greater longevity and/or reduced size (due to reductions in the size of the power supply and associated components). - A first general approach for a stimulus regimen which promotes long term efficacy and reduces power requirements/consumption involves generating a control signal to cause the
baroreceptor activation device 70 to have a first output level of relatively higher energy and/or power, and subsequently changing the control signal to cause thebaroreceptor activation device 70 to have a second output level of relatively lower energy and/or power. The first output level may be selected and maintained for sufficient time to attain the desired initial effect (e.g., reduced heart rate and/or blood pressure), after which the output level may be reduced to the second level for sufficient time to sustain the desired effect for the desired period of time. - For example, if the first output level has a power and/or energy value of X1, the second output level may have a power and/or energy value of X2, wherein X2 is less than X1. In some instances, X2 may be equal to zero, such that the first level is “on” and the second level is “off”. It is recognized that power and energy refer to two different parameters, and in some cases, a change in one of the parameters (power or energy) may not correlate to the same or similar change in the other parameter. In the present invention, it is contemplated that a change in one or both of the parameters may be suitable to obtain the desired result of promoting long term efficacy.
- It is also contemplated that more than two levels may be used. Each further level may increase the output energy or power to attain the desired effect, or decrease the output energy or power to retain the desired effect. For example, in some instances, it may be desirable to have further reductions in the output level if the desired effect may be sustained at lower power or energy levels. In other instances, particularly when the desired effect is diminishing or is otherwise not sustained, it may be desirable to increase the output level until the desired effect is reestablished, and subsequently decrease the output level to sustain the effect.
- The transition from each level may be a step function (e.g., a single step or a series of steps), a gradual transition over a period of time, or a combination thereof. In addition, the signal levels may be continuous, periodic, alternating, or episodic as discussed previously.
- In electrical activation using a non modulated signal, the output (power or energy) level of the
baroreceptor activation device 70 may be changed by adjusting the output signal voltage level, current level and/or signal duration. The output signal of thebaroreceptor activation device 70 may be, for example, constant current or constant voltage. In electrical activation embodiments using a modulated signal, wherein the output signal comprises, for example, a series of pulses, several pulse characteristics may be changed individually or in combination to change the power or energy level of the output signal. Such pulse characteristics include, but are not limited to: pulse amplitude (PA), pulse frequency (PF), pulse width or duration (PW), pulse waveform (square, triangular, sinusoidal, etc.), pulse polarity (for bipolar electrodes) and pulse phase (monophasic, biphasic). - In electrical activation wherein the output signal comprises a pulse train, several other signal characteristics may be changed in addition to the pulse characteristics described above, as described in copending application Ser. No. 09/964,079, the full disclosure of which is incorporated herein by reference.
-
FIGS. 4A and 4B show schematic illustrations of abaroreceptor activation device 300 in the form of an extravascular electrically conductive structure orelectrode 302. Theelectrode structure 302 may comprise a coil, braid or other structure capable of surrounding the vascular wall. Alternatively, theelectrode structure 302 may comprise one or more electrode patches distributed around the outside surface of the vascular wall. Because theelectrode structure 302 is disposed on the outside surface of the vascular wall, intravascular delivery techniques may not be practical, but minimally invasive surgical techniques will suffice. Theextravascular electrode structure 302 may receive electrical signals directly from thedriver 66 of thecontrol system 60 by way ofelectrical lead 304, or indirectly by utilizing an inductor (not shown) as described in copending commonly assigned application Ser. No. 10/402,393 (Attorney Docket No. 21433-000420US), filed on Mar. 27, 2003, the full disclosure of which is incorporated herein by reference. - Refer now to
FIGS. 5A-5F which show schematic illustrations of various possible arrangements of electrodes around thecarotid sinus 20 for extravascular electrical activation embodiments, such asbaroreceptor activation device 300 described with reference toFIGS. 4A and 4B . The electrode designs illustrated and described hereinafter may be particularly suitable for connection to the carotid arteries at or near the carotid sinus, and may be designed to minimize extraneous tissue stimulation. - In
FIGS. 5A-5F , the carotid arteries are shown, including the common 14, the external 18 and the internal 19 carotid arteries. The location of thecarotid sinus 20 may be identified by alandmark bulge 21, which is typically located on the internalcarotid artery 19 just distal of the bifurcation, or extends across the bifurcation from the commoncarotid artery 14 to the internalcarotid artery 19. - The
carotid sinus 20, and in particular thebulge 21 of the carotid sinus, may contain a relatively high density of baroreceptors 30 (not shown) in the vascular wall. For this reason, it may be desirable to position theelectrodes 302 of theactivation device 300 on and/or around thesinus bulge 21 to maximize baroreceptor responsiveness and to minimize extraneous tissue stimulation. - It should be understood that the
device 300 andelectrodes 302 are merely schematic, and only a portion of which may be shown, for purposes of illustrating various positions of theelectrodes 302 on and/or around thecarotid sinus 20 and thesinus bulge 21. In each of the embodiments described herein, theelectrodes 302 may be monopolar, bipolar, or tripolar (anode-cathode-anode or cathode-anode-cathode sets). Specific extravascular electrode designs are described in more detail hereinafter. - In
FIG. 5A , theelectrodes 302 of the extravascularelectrical activation device 300 extend around a portion or the entire circumference of thesinus 20 in a circular fashion. Often, it would be desirable to reverse the illustrated electrode configuration in actual use. InFIG. 5B , theelectrodes 302 of the extravascularelectrical activation device 300 extend around a portion or the entire circumference of thesinus 20 in a helical fashion. In the helical arrangement shown inFIG. 5B , theelectrodes 302 may wrap around thesinus 20 any number of times to establish the desiredelectrode 302 contact and coverage. In the circular arrangement shown inFIG. 5A , a single pair ofelectrodes 302 may wrap around thesinus 20, or a plurality of electrode pairs 302 may be wrapped around thesinus 20 as shown inFIG. 5C to establishmore electrode 302 contact and coverage. - The plurality of electrode pairs 302 may extend from a point proximal of the
sinus 20 orbulge 21, to a point distal of thesinus 20 orbulge 21 to ensure activation ofbaroreceptors 30 throughout thesinus 20 region. Theelectrodes 302 may be connected to a single channel or multiple channels as discussed in more detail hereinafter. The plurality of electrode pairs 302 may be selectively activated for purposes of targeting a specific area of thesinus 20 to increase baroreceptor responsiveness, or for purposes of reducing the exposure of tissue areas to activation to maintain baroreceptor responsiveness long term. - In
FIG. 5D , theelectrodes 302 extend around the entire circumference of thesinus 20 in a criss cross fashion. The criss cross arrangement of theelectrodes 302 establishes contact with both the internal 19 and external 18 carotid arteries around thecarotid sinus 20. Similarly, inFIG. 5E , theelectrodes 302 extend around all or a portion of the circumference of thesinus 20, including the internal 19 and external 18 carotid arteries at the bifurcation, and in some instances the commoncarotid artery 14. InFIG. 5F , theelectrodes 302 extend around all or a portion of the circumference of thesinus 20, including the internal 19 and external 18 carotid arteries distal of the bifurcation. InFIGS. 5E and 5F , the extravascularelectrical activation devices 300 are shown to include a substrate orbase structure 306 which may encapsulate and insulate theelectrodes 302 and may provide a means for attachment to thesinus 20 as described in more detail hereinafter. - From the foregoing discussion with reference to
FIGS. 5A-5F , it should be apparent that there are a number of suitable arrangements for theelectrodes 302 of theactivation device 300, relative to thecarotid sinus 20 and associated anatomy. In each of the examples given above, theelectrodes 302 are wrapped around a portion of the carotid structure, which may require deformation of theelectrodes 302 from their relaxed geometry (e.g., straight). To reduce or eliminate such deformation, theelectrodes 302 and/or thebase structure 306 may have a relaxed geometry that substantially conforms to the shape of the carotid anatomy at the point of attachment. In other words, theelectrodes 302 and the base structure or backing 306 may be pre shaped to conform to the carotid anatomy in a substantially relaxed state. Alternatively, theelectrodes 302 may have a geometry and/or orientation that reduces the amount ofelectrode 302 strain. Optionally, as described in more detail below, the backing orbase structure 306 may be elastic or stretchable to facilitate wrapping of and conforming to the carotid sinus or other vascular structure. - For example, in
FIG. 6 , theelectrodes 302 are shown to have a serpentine or wavy shape. The serpentine shape of theelectrodes 302 reduces the amount of strain seen by the electrode material when wrapped around a carotid structure. In addition, the serpentine shape of the electrodes increases the contact surface area of theelectrode 302 with the carotid tissue. As an alternative, theelectrodes 302 may be arranged to be substantially orthogonal to the wrap direction (i.e., substantially parallel to the axis of the carotid arteries) as shown inFIG. 7 . In this alternative, theelectrodes 302 each have a length and a width or diameter, wherein the length is substantially greater than the width or diameter. Theelectrodes 302 each have a longitudinal axis parallel to the length thereof, wherein the longitudinal axis is orthogonal to the wrap direction and substantially parallel to the longitudinal axis of the carotid artery about which thedevice 300 is wrapped. As with the multiple electrode embodiments described previously, theelectrodes 302 may be connected to a single channel or multiple channels as discussed in more detail hereinafter. - Refer now to
FIGS. 8-11 which schematically illustrate various multi-channel electrodes for the extravascularelectrical activation device 300.FIG. 8 illustrates a six (6) channel electrode assembly including six (6) separateelongate electrodes 302 extending adjacent to and parallel with each other. Theelectrodes 302 are each connected tomulti-channel cable 304. Some of theelectrodes 302 may be common, thereby reducing the number of conductors necessary in thecable 304. - Base structure or
substrate 306 may comprise a flexible and electrically insulating material suitable for implantation, such as silicone, perhaps reinforced with a flexible material such as polyester fabric. The base 306 may have a length suitable to wrap around all (360.degree.) or a portion (i.e., less than 360.degree.) of the circumference of one or more of the carotid arteries adjacent thecarotid sinus 20. Theelectrodes 302 may extend around a portion (i.e., less than 360.degree. such as 270.degree., 180.degree. or 90.degree.) of the circumference of one or more of the carotid arteries adjacent thecarotid sinus 20. To this end, theelectrodes 302 may have a length that is less than (e.g., 75%, 50% or 25%) the length of the base 206. Theelectrodes 302 may be parallel, orthogonal or oblique to the length of thebase 306, which is generally orthogonal to the axis of the carotid artery to which it is disposed about. Preferably, the base structure or backing will be elastic (i.e., stretchable), typically being composed of at least in part of silicone, latex, or other elastomer. If such elastic structures are reinforced, the reinforcement should be arranged so that it does not interfere with the ability of the base to stretch and conform to the vascular surface. - The
electrodes 302 may comprise round wire, rectangular ribbon or foil formed of an electrically conductive and radiopaque material such as platinum. Thebase structure 306 substantially encapsulates theelectrodes 302, leaving only an exposed area for electrical connection to extravascular carotid sinus tissue. For example, eachelectrode 302 may be partially recessed in the base 206 and may have one side exposed along all or a portion of its length for electrical connection to carotid tissue. Electrical paths through the carotid tissues may be defined by one or more pairs of theelongate electrodes 302. - In all embodiments described with reference to
FIGS. 8-11 , themulti-channel electrodes 302 may be selectively activated for purposes of mapping and targeting a specific area of thecarotid sinus 20 to determine the best combination of electrodes 302 (e.g., individual pair, or groups of pairs) to activate for maximum baroreceptor responsiveness, as described elsewhere herein. In addition, themulti-channel electrodes 302 may be selectively activated for purposes of reducing the exposure of tissue areas to activation to maintain long term efficacy as described, as described elsewhere herein. For these purposes, it may be useful to utilize more than two (2) electrode channels. Alternatively, theelectrodes 302 may be connected to a single channel whereby baroreceptors are uniformly activated throughout thesinus 20 region. - An alternative multi-channel electrode design is illustrated in
FIG. 9 . In this embodiment, thedevice 300 includes sixteen (16)individual electrode pads 302 connected to 16channel cable 304 via 4channel connectors 303. In this embodiment, thecircular electrode pads 302 are partially encapsulated by thebase structure 306 to leave one face of eachbutton electrode 302 exposed for electrical connection to carotid tissues. With this arrangement, electrical paths through the carotid tissues may be defined by one or more pairs (bipolar) or groups (tripolar) ofelectrode pads 302. - A variation of the multi-channel pad type electrode design is illustrated in
FIG. 10 . In this embodiment, thedevice 300 includes sixteen (16) individualcircular pad electrodes 302 surrounded by sixteen (16) rings 305, which collectively may be referred to asconcentric electrode pads 302/305.Pad electrodes 302 are connected to 17channel cable 304 via 4channel connectors 303, and rings 305 are commonly connected to 17channel cable 304 via a single channel connector 307. In this embodiment, the circular shapedelectrodes 302 and the rings 305 are partially encapsulated by thebase structure 306 to leave one face of eachpad electrode 302 and one side of each ring 305 exposed for electrical connection to carotid tissues. As an alternative, two rings 305 may surround eachelectrode 302, with the rings 305 being commonly connected. With these arrangements, electrical paths through the carotid tissues may be defined between one ormore pad electrode 302/ring 305 sets to create localized electrical paths. - Another variation of the multi-channel pad electrode design is illustrated in
FIG. 11 . In this embodiment, thedevice 300 includes acontrol IC chip 310 connected to 3channel cable 304. Thecontrol chip 310 is also connected to sixteen (16)individual pad electrodes 302 via 4channel connectors 303. Thecontrol chip 310 permits the number of channels incable 304 to be reduced by utilizing a coding system. Thecontrol system 60 sends a coded control signal which is received bychip 310. Thechip 310 converts the code and enables or disables selectedelectrode 302 pairs in accordance with the code. - For example, the control signal may comprise a pulse wave form, wherein each pulse includes a different code. The code for each pulse causes the
chip 310 to enable one or more pairs of electrodes, and to disable the remaining electrodes. Thus, the pulse is only transmitted to the enabled electrode pair(s) corresponding to the code sent with that pulse. Each subsequent pulse would have a different code than the preceding pulse, such that thechip 310 enables and disables a different set ofelectrodes 302 corresponding to the different code. Thus, virtually any number of electrode pairs may be selectively activated usingcontrol chip 310, without the need for a separate channel incable 304 for eachelectrode 302. By reducing the number of channels incable 304, the size and cost thereof may be reduced. - Optionally, the
IC chip 310 may be connected tofeedback sensor 80, taking advantage of the same functions as described with reference toFIG. 3 . In addition, one or more of theelectrodes 302 may be used as feedback sensors when not enabled for activation. For example, such a feedback sensor electrode may be used to measure or monitor electrical conduction in the vascular wall to provide data analogous to an ECG. Alternatively, such a feedback sensor electrode may be used to sense a change in impedance due to changes in blood volume during a pulse pressure to provide data indicative of heart rate, blood pressure, or other physiologic parameter. - Refer now to
FIG. 12 which schematically illustrates an extravascularelectrical activation device 300 including a support collar oranchor 312. In this embodiment, theactivation device 300 is wrapped around the internalcarotid artery 19 at thecarotid sinus 20, and thesupport collar 312 is wrapped around the commoncarotid artery 14. Theactivation device 300 is connected to thesupport collar 312 bycables 304, which act as a loose tether. With this arrangement, thecollar 312 isolates the activation device from movements and forces transmitted by thecables 304 proximal of the support collar, such as may be encountered by movement of thecontrol system 60 and/ordriver 66. As an alternative to supportcollar 312, a strain relief (not shown) may be connected to thebase structure 306 of theactivation device 300 at the juncture between thecables 304 and thebase 306. With either approach, the position of thedevice 300 relative to the carotid anatomy may be better maintained despite movements of other parts of the system. - In this embodiment, the
base structure 306 of theactivation device 300 may comprise molded tube, a tubular extrusion, or a sheet of material wrapped into a tube shape utilizing asuture flap 308 withsutures 309 as shown. Thebase structure 306 may be formed of a flexible and biocompatible material such as silicone, which may be reinforced with a flexible material such as polyester fabric available under the trade name DACRON® to form a composite structure. The inside diameter of thebase structure 306 may correspond to the outside diameter of the carotid artery at the location of implantation, for example 6 to 8 mm. The wall thickness of thebase structure 306 may be very thin to maintain flexibility and a low profile, for example less than 1 mm. If thedevice 300 is to be disposed about asinus bulge 21, a correspondingly shaped bulge may be formed into the base structure for added support and assistance in positioning. - The electrodes 302 (shown in phantom) may comprise round wire, rectangular ribbon or foil, formed of an electrically conductive and radiopaque material such as platinum or platinum iridium. The electrodes may be molded into the
base structure 306 or adhesively connected to the inside diameter thereof, leaving a portion of the electrode exposed for electrical connection to carotid tissues. Theelectrodes 302 may encompass less than the entire inside circumference (e.g., 300.degree.) of thebase structure 306 to avoid shorting. Theelectrodes 302 may have any of the shapes and arrangements described previously. For example, as shown inFIG. 12 , tworectangular ribbon electrodes 302 may be used, each having a width of 1 mm spaced 1.5 mm apart. - The
support collar 312 may be formed similarly tobase structure 306. For example, the support collar may comprise molded tube, a tubular extrusion, or a sheet of material wrapped into a tube shape utilizing asuture flap 315 withsutures 313 as shown. Thesupport collar 312 may be formed of a flexible and biocompatible material such as silicone, which may be reinforced to form a composite structure. Thecables 304 are secured to thesupport collar 312, leaving slack in thecables 304 between thesupport collar 312 and theactivation device 300. - In all embodiments described herein, it may be desirable to secure the activation device to the vascular wall using sutures or other fixation means. For example, sutures 311 may be used to maintain the position of the
electrical activation device 300 relative to the carotid anatomy (or other vascular site containing baroreceptors).Such sutures 311 may be connected tobase structure 306, and pass through all or a portion of the vascular wall. For example, thesutures 311 may be threaded through thebase structure 306, through the adventitia of the vascular wall, and tied. If thebase structure 306 comprises a patch or otherwise partially surrounds the carotid anatomy, the corners and/or ends of the base structure may be sutured, with additional sutures evenly distributed therebetween. In order to minimize the propagation of a hole or a tear through thebase structure 306, a reinforcement material such as polyester fabric may be embedded in the silicone material. In addition to sutures, other fixation means may be employed such as staples or a biocompatible adhesive, for example. - Refer now to
FIG. 13 which schematically illustrates an alternative extravascularelectrical activation device 300 including one ormore electrode ribs 316 interconnected byspine 317. Optionally, asupport collar 312 having one or more (non electrode)ribs 316 may be used to isolate theactivation device 300 from movements and forces transmitted by thecables 304 proximal of thesupport collar 312. - The
ribs 316 of theactivation device 300 are sized to fit about the carotid anatomy, such as the internalcarotid artery 19 adjacent thecarotid sinus 20. Similarly, theribs 316 of thesupport collar 312 may be sized to fit about the carotid anatomy, such as the commoncarotid artery 14 proximal of thecarotid sinus 20. Theribs 316 may be separated, placed on a carotid artery, and closed thereabout to secure thedevice 300 to the carotid anatomy. - Each of the
ribs 316 of thedevice 300 includes anelectrode 302 on the inside surface thereof for electrical connection to carotid tissues. Theribs 316 provide insulating material around theelectrodes 302, leaving only an inside portion exposed to the vascular wall. Theelectrodes 302 are coupled to themulti-channel cable 304 throughspine 317.Spine 317 also acts as a tether toribs 316 of thesupport collar 312, which do not include electrodes since their function is to provide support. Themulti-channel electrode 302 functions discussed with reference toFIGS. 8-11 are equally applicable to this embodiment. - The ends of the
ribs 316 may be connected (e.g., sutured) after being disposed about a carotid artery, or may remain open as shown. If the ends remain open, theribs 316 may be formed of a relatively stiff material to ensure a mechanical lock around the carotid artery. For example, theribs 316 may be formed of polyethylene, polypropylene, PTFE, or other similar insulating and biocompatible material. Alternatively, theribs 316 may be formed of a metal such as stainless steel or a nickel titanium alloy, as long as the metallic material was electrically isolated from theelectrodes 302. As a further alternative, theribs 316 may comprise an insulating and biocompatible polymeric material with the structural integrity provided by metallic (e.g., stainless steel, nickel titanium alloy, etc.) reinforcement. In this latter alternative, theelectrodes 302 may comprise the metallic reinforcement. - Refer now to
FIG. 14 which schematically illustrates a specific example of an electrode assembly for an extravascularelectrical activation device 300. In this specific example, thebase structure 306 comprises a silicone sheet having a length of 5.0 inches, a thickness of 0.007 inches, and a width of 0.312 inches. Theelectrodes 302 comprise platinum ribbon having a length of 0.47 inches, a thickness of 0.0005 inches, and a width of 0.040 inches. Theelectrodes 302 are adhesively connected to one side of thesilicone sheet 306. - The
electrodes 302 are connected to a modified bipolar endocardial pacing lead, available under the trade name CONIFIX from Innomedica (now BIOMEC Cardiovascular, Inc.), model number 501112. The proximal end of thecable 304 is connected to thecontrol system 60 ordriver 66 as described previously. The pacing lead is modified by removing the pacing electrode to form thecable body 304. The MP35 wires are extracted from the distal end thereof to form twocoils 318 positioned side by side having a diameter of about 0.020 inches. Thecoils 318 are then attached to the electrodes utilizing 316 type stainless steel crimp terminals laser welded to one end of theplatinum electrodes 302. The distal end of thecable 304 and the connection between thecoils 318 and the ends of theelectrodes 302 are encapsulated by silicone. - The
cable 304 illustrated inFIG. 14 comprises a coaxial type cable including two coaxially disposed coil leads separated into twoseparate coils 318 for attachment to theelectrodes 302. Analternative cable 304 construction is illustrated inFIG. 15 .FIG. 15 illustrates analternative cable body 304 which may be formed in a curvilinear shape such as a sinusoidal configuration, prior to implantation. The curvilinear configuration readily accommodates a change in distance between thedevice 300 and thecontrol system 60 or thedriver 66. Such a change in distance may be encountered during flexion and/or extension of the neck of the patient after implantation. - In this alternative embodiment, the
cable body 304 may comprise two or moreconductive wires 304 a arranged coaxially or collinearly as shown. Eachconductive wire 304 a may comprise a multifilament structure of suitable conductive material such as stainless steel or MP35N. An insulating material may surround thewire conductors 304 a individually and/or collectively. For purposes of illustration only, a pair of electricallyconductive wires 304 a having an insulating material surrounding eachwire 304 a individually is shown. Theinsulated wires 304 a may be connected by aspacer 304 b comprising, for example, an insulating material. An additional jacket of suitable insulating material may surround each of theconductors 304 a. The insulating jacket may be formed to have the same curvilinear shape of theinsulated wires 304 a to help maintain the shape of thecable body 304 during implantation. - If a sinusoidal configuration is chosen for the curvilinear shape, the amplitude (A) may range from 1 mm to 10 mm, and preferably ranges from 2 mm to 3 mm. The wavelength (WL) of the sinusoid may range from 2 mm to 20 mm, and preferably ranges from 4 mm to 10 mm. The curvilinear or sinusoidal shape may be formed by a heat setting procedure utilizing a fixture which holds the
cable 304 in the desired shape while the cable is exposed to heat. Sufficient heat is used to heat set theconductive wires 304 a and/or the surrounding insulating material. After cooling, thecable 304 may be removed from the fixture, and thecable 304 retains the desired shape. - Refer now to
FIGS. 16-18 which illustrate various transducers that may be mounted to the wall of a vessel such as acarotid artery 14 to monitor wall expansion or contraction using strain, force and/or pressure gauges. An example of an implantable blood pressure measurement device that may be disposed about a blood vessel is disclosed in U.S. Pat. No. 6,106,477 to Miesel et al., the entire disclosure of which is incorporated herein by reference. The output from such gauges may be correlated to blood pressure and/or heart rate, for example, and may be used to provide feedback to thecontrol system 60 as described previously herein. InFIG. 16 , an implantable pressure measuring assembly comprises a foil strain gauge or forcesensing resistor device 740 disposed about an artery such as commoncarotid artery 14. Atransducer portion 742 may be mounted to a silicone base or backing 744 which is wrapped around and sutured or otherwise attached to theartery 14. - Alternatively, the
transducer 750 may be adhesively connected to the wall of theartery 14 using a biologically compatible adhesive such as cyanoacrylate as shown inFIG. 17 . In this embodiment, thetransducer 750 comprises a micro machined sensor (MEMS) that measures force or pressure. TheMEMS transducer 750 includes a micro arm 752 (shown in section inFIG. 18 ) coupled to a silicon force sensor contained over anelastic base 754. Acap 756 covers the arm 752 a top portion of thebase 754. The base 754 include an interior opening creating access from thevessel wall 14 to thearm 752. Anincompressible gel 756 fills the space between thearm 752 and thevessel wall 14 such that force is transmitted to the arm upon expansion and contraction of the vessel wall. In both cases, changes in blood pressure within the artery cause changes in vessel wall stress which are detected by the transducer and which may be correlated with the blood pressure. - Refer now to
FIGS. 19-21 which illustrate an alternative extravascularelectrical activation device 700, which, may also be referred to as an electrode cuff device or more generally as an “electrode assembly.” Except as described herein and shown in the drawings,device 700 may be the same in design and function as extravascularelectrical activation device 300 described previously. - As seen in
FIGS. 19 and 20 , electrode assembly orcuff device 700 includes coiledelectrode conductors 702/704 embedded in aflexible support 706. In the embodiment shown, anouter electrode coil 702 and aninner electrode coil 704 are used to provide a pseudo tripolar arrangement, but other polar arrangements are applicable as well as described previously. Thecoiled electrodes 702/704 may be formed of fine round, flat or ellipsoidal wire such as 0.002 inch diameter round PtIr alloy wire wound into a coil form having a nominal diameter of 0.015 inches with a pitch of 0.004 inches, for example. The flexible support orbase 706 may be formed of a biocompatible and flexible (preferably elastic) material such as silicone or other suitable thin walled elastomeric material having a wall thickness of 0.005 inches and a length (e.g., 2.95 inches) sufficient to surround the carotid sinus, for example. - Each turn of the coil in the contact area of the
electrodes 702/704 is exposed from theflexible support 706 and any adhesive to form a conductive path to the artery wall. The exposedelectrodes 702/704 may have a length (e.g., 0.236 inches) sufficient to extend around at least a portion of the carotid sinus, for example. Theelectrode cuff 700 is assembled flat with the contact surfaces of thecoil electrodes 702/704 tangent to the inside plane of theflexible support 706. When theelectrode cuff 700 is wrapped around the artery, the inside contact surfaces of the coiledelectrodes 702/704 are naturally forced to extend slightly above the adjacent surface of the flexible support, thereby improving contact to the artery wall. - The ratio of the diameter of the coiled
electrodes 702/704 to the wire diameter is preferably large enough to allow the coil to bend and elongate without significant bending stress or torsional stress in the wire. Flexibility is a significant advantage of this design which allows theelectrode cuff 700 to conform to the shape of the carotid artery and sinus, and permits expansion and contraction of the artery or sinus without encountering significant stress or fatigue. In particular, theflexible electrode cuff 700 may be wrapped around and stretched to conform to the shape of the carotid sinus and artery during implantation. This may be achieved without collapsing or distorting the shape of the artery and carotid sinus due to the compliance of theelectrode cuff 700. Theflexible support 706 is able to flex and stretch with the conductor coils 702/704 because of the absence of fabric reinforcement in the electrode contact portion of thecuff 700. By conforming to the artery shape, and by the edge of theflexible support 706 sealing against the artery wall, the amount of stray electrical field and extraneous stimulation will likely be reduced. - The pitch of the
coil electrodes 702/704 may be greater than the wire diameter in order to provide a space between each turn of the wire to thereby permit bending without necessarily requiring axial elongation thereof. For example, the pitch of the contact coils 702/704 may be 0.004 inches per turn with a 0.002 inch diameter wire, which allows for a 0.002 inch space between the wires in each turn. The inside of the coil may be filled with a flexible adhesive material such as silicone adhesive which may fill the spaces between adjacent wire turns. By filling the small spaces between the adjacent coil turns, the chance of pinching tissue between coil turns is minimized thereby avoiding abrasion to the artery wall. Thus, the embeddedcoil electrodes 702/704 are mechanically captured and chemically bonded into theflexible support 706. In the unlikely event that acoil electrode 702/704 comes loose from thesupport 706, the diameter of the coil is large enough to be atraumatic to the artery wall. Preferably, the centerline of thecoil electrodes 702/704 lie near the neutral axis ofelectrode cuff structure 700 and theflexible support 706 comprises a material with isotropic elasticity such as silicone in order to minimize the shear forces on the adhesive bonds between thecoil electrodes 702/704 and thesupport 706. - The electrode coils 702/704 are connected to corresponding
conductive coils 712/714, respectively, in anelongate lead 710 which is connected to thecontrol system 60. Anchoringwings 718 may be provided on thelead 710 to tether thelead 710 to adjacent tissue and minimize the effects or relative movement between the lead 710 and theelectrode cuff 700. As seen inFIG. 21 , theconductive coils 712/714 may be formed of 0.003 MP35N bifilar wires wound into 0.018 inch diameter coils which are electrically connected to electrodecoils 702/704 bysplice wires 716. Theconductive coils 712/714 may be individually covered by an insulatingcovering 718 such as silicone tubing and collectively covered by insulatingcovering 720. - The conductive material of the
electrodes 702/704 may be a metal as described above or a conductive polymer such as a silicone material filled with metallic particles such as Pt particles. In this latter embodiment, the polymeric electrodes may be integrally formed with theflexible support 706 with the electrode contacts comprising raised areas on the inside surface of theflexible support 706 electrically coupled to thelead 710 by wires or wire coils. The use of polymeric electrodes may be applied to other electrode design embodiments described elsewhere herein. -
Reinforcement patches 708 such as DACRON® fabric may be selectively incorporated into theflexible support 706. For example,reinforcement patches 708 may be incorporated into the ends or other areas of theflexible support 706 to accommodate suture anchors. Thereinforcement patches 708 provide points where theelectrode cuff 700 may be sutured to the vessel wall and may also provide tissue in growth to further anchor thedevice 700 to the exterior of the vessel wall. For example, thefabric reinforcement patches 708 may extend beyond the edge of theflexible support 706 so that tissue in growth may help anchor the electrode assembly orcuff 700 to the vessel wall and may reduce reliance on the sutures to retain theelectrode assembly 700 in place. As a substitute for or in addition to the sutures and tissue in growth, bioadhesives such as cyanoacrylate may be employed to secure thedevice 700 to the vessel wall. In addition, an adhesive incorporating conductive particles such as Pt coated micro spheres may be applied to the exposed inside surfaces of theelectrodes 702/704 to enhance electrical conduction to the tissue and possibly limit conduction along one axis to limit extraneous tissue stimulation. - The
reinforcement patches 708 may also be incorporated into theflexible support 706 for strain relief purposes and to help retain thecoils 702/704 to thesupport 706 where theleads 710 attach to theelectrode assembly 700 as well as where theouter coil 702 loops back around theinner coil 704. Preferably, thepatches 708 are selectively incorporated into theflexible support 706 to permit expansion and contraction of thedevice 700, particularly in the area of theelectrodes 702/704. In particular, theflexible support 706 is only fabric reinforced in selected areas thereby maintaining the ability of theelectrode cuff 700 to stretch. - Referring now to
FIGS. 22-26 , the electrode assembly ofFIGS. 19-21 can be modified to have “flattened” coil electrodes in the region of the assembly where the electrodes contact the extravascular tissue. As shown inFIG. 22 , an electrode-carryingsurface 801 of the electrode assembly, is located generally between parallel reinforcement strips ortabs 808. The flattenedcoil section 810 will generally be exposed on alower surface 803 of the base 806 (FIG. 23 ) and will be covered or encapsulated by a parylene or other polymeric structure ormaterial 802 over anupper surface 805 thereof. The coil is formed with a generallycircular periphery 809, as best seen inFIGS. 24 and 26 , and may be mechanically flattened, typically over a silicone or other supportinginsert 815, as best seen inFIG. 25 . The use of the flattened coil structure is particularly beneficial since it retains flexibility, allowing the electrodes to bend, stretch, and flex together with theelastomeric base 806, while also increasing the flat electrode area available to contact the extravascular surface. - Referring now to
FIGS. 27-30 , anadditional electrode assembly 900 constructed in accordance with the principles of the present invention will be described.Electrode assembly 900 comprises an electrode base, typically anelastic base 902, typically formed from silicone or other elastomeric material, having an electrode-carryingsurface 904 and a plurality of attachment tabs 906 (906 a, 906 b, 906 c, and 906 d) extending from the electrode-carrying surface. The attachment tabs 906 are preferably formed from the same material as the electrode-carryingsurface 904 of thebase 902, but could be formed from other elastomeric materials as well. In the latter case, the base will be molded, stretched or otherwise assembled from the various pieces. In the illustrated embodiment, the attachment tabs 906 are formed integrally with the remainder of thebase 902, i.e., typically being cut from a single sheet of the elastomeric material. - The geometry of the
electrode assembly 900, and in particular the geometry of thebase 902, is selected to permit a number of different attachment modes to the blood vessel. In particular, the geometry of theassembly 902 ofFIG. 27 is intended to permit attachment to various locations on the carotid arteries at or near the carotid sinus and carotid bifurcation. - A number of reinforcement regions 910 (910 a, 910 b, 910 c, 910 d, and 910 e) are attached to different locations on the base 902 to permit suturing, clipping, stapling, or other fastening of the attachment tabs 906 to each other and/or the electrode-carrying
surface 904 of thebase 902. In the preferred embodiment intended for attachment at or around the carotid sinus, afirst reinforcement strip 910 a is provided over an end of the base 902 opposite to the end which carries the attachment tabs. Pairs of reinforcement strips 910 b and 910 c are provided on each of the axially alignedattachment tabs attachment tabs surface 904. - The structure of
electrode assembly 900 permits the surgeon to implant the electrode assembly so that the electrodes 920 (which are preferably stretchable, flat-coil electrodes as described in detail above), are located at a preferred location relative to the target baroreceptors. The preferred location may be determined, for example, as described in copending application Ser. No. 09/963,991, filed on Sep. 26, 2001, the full disclosure of which incorporated herein by reference. - Once the preferred location for the
electrodes 920 of theelectrode assembly 900 is determined, the surgeon may position the base 902 so that theelectrodes 920 are located appropriately relative to the underlying baroreceptors. Thus, theelectrodes 920 may be positioned over the common carotid artery CC as shown inFIG. 28 , or over the internal carotid artery IC, as shown inFIGS. 29 and 30 . InFIG. 28 , theassembly 900 may be attached by stretching thebase 902 andattachment tabs reinforcement tabs reinforcement strip 910 a, either by suturing, stapling, fastening, gluing, welding, or other well-known means. Usually, thereinforcement tabs - In other cases, the bulge of the carotid sinus and the baroreceptors may be located differently with respect to the carotid bifurcation. For example, as shown in
FIG. 29 , the receptors may be located further up the internal carotid artery IC so that the placement ofelectrode assembly 900 as shown inFIG. 28 will not work. Theassembly 900, however, may still be successfully attached by utilizing the transversely angledattachment tabs axial tabs FIG. 29 , thelower tab 906 d is wrapped around the common carotid artery CC, while theupper attachment tab 906 c is wrapped around the internal carotid artery IC. Theaxial attachment tabs reinforcement strip 910 a, as generally described above. - Referring to
FIG. 30 , in instances where the carotid bifurcation has less of an angle, theassembly 900 may be attached using the upperaxial attachment tab 906 a and be lower transversely angledattachment tab 906 d.Attachment tabs locations base 902 and the stretchable nature of theelectrodes 920 permit the desired conformance and secure mounting of the electrode assembly over the carotid sinus. It would be appreciated that these or similar structures would also be useful for mounting electrode structures at other locations in the vascular system. - In most activation device embodiments described herein, it may be desirable to incorporate anti-inflammatory agents (e.g., steroid eluting electrodes) such as described in U.S. Pat. No. 4,711,251 to Stokes, U.S. Pat. No. 5,522,874 to Gates and U.S. Pat. No. 4,972,848 to Di Domenico et al., the entire disclosures of which are incorporated herein by reference. Such agents reduce tissue inflammation at the chronic interface between the device (e.g., electrodes) and the vascular wall tissue, to thereby increase the efficiency of stimulus transfer, reduce power consumption, and maintain activation efficiency, for example.
- Those skilled in the art will recognize that the present invention may be manifested in a variety of forms other than the specific embodiments described and contemplated herein. Accordingly, departures in form and detail may be made without departing from the scope and spirit of the present invention as described in the appended claims.
Claims (34)
1. A system for providing baroreflex stimulation, comprising:
a cardiac activity monitor to sense cardiac activity and provide a signal indicative of the cardiac activity; and
a baroreflex stimulator, including:
a pulse generator to provide a baroreflex stimulation signal adapted to provide a baroreflex therapy; and
a modulator to receive the signal indicative of the cardiac activity and modulate the baroreflex stimulation signal based on the signal indicative of the cardiac activity to change the baroreflex therapy from a first baroreflex therapy to a second baroreflex therapy.
2. The system of claim 1 , wherein the baroreflex stimulation signal has a characteristic selected from the set of: an amplitude, a frequency, a burst frequency and a morphology and the modulator includes a modulator to modulate the characteristic based on the signal indicative of the cardiac activity.
3. The system of claim 1 , wherein the cardiac activity monitor includes a heart rate sensor, and the signal indicative of the cardiac activity includes a heart rate signal.
4. The system of claim 1 , wherein the cardiac activity monitor includes a respiration monitor, and the signal indicative of the cardiac activity includes a respiration signal.
5. The system of claim 4 , wherein the respiration monitor includes a monitor selected from the set of: a tidal volume monitor and a minute ventilation monitor.
6. The system of claim 1 , wherein the cardiac activity monitor includes an acceleration sensor, and the signal indicative of the cardiac activity includes an acceleration signal.
7. The system of claim 1 , wherein: the cardiac activity monitor includes a combination of two or more of the following sensors: a heart rate sensor; a minute ventilation sensor; and an acceleration sensor; and the signal indicative of the cardiac activity includes a composite of two or more of the following signals: a heart rate signal; a minute ventilation signal; and an acceleration signal.
8. The system of claim 1 , wherein the cardiac activity monitor includes a sensor to sense at least one pressure parameter, and the signal indicative of the cardiac activity includes a signal indicative of the at least one pressure parameter.
9. The system of claim 8 , wherein the at least one pressure parameter is selected from the set of: mean arterial pressure, pulse pressure, end systolic pressure and end diastolic pressure.
10. The system of claim 1 , wherein the cardiac activity monitor includes a stroke volume monitor, and the signal indicative of the cardiac activity includes a signal indicative of the stroke volume.
11. The system of claim 1 , wherein the cardiac activity monitor includes a monitor to measure at least one electrogram measurement, and the signal indicative of the cardiac activity includes a signal indicative of the at least one electrogram measurement.
12. The system of claim 1 , wherein the cardiac activity monitor includes a monitor to measure at least one electrocardiogram (ECG) measurement, and the signal indicative of the cardiac activity includes a signal indicative of the at least one ECG measurement.
13. The system of claim 1 , further comprising an implantable medical device, wherein the implantable medical device includes the cardiac activity monitor and the baroreflex stimulator.
14. A baroreflex stimulator, comprising:
an implantable pulse generator to provide a baroreflex stimulation signal adapted to provide a baroreflex therapy; and
means for modulating the baroreflex stimulation signal based on a signal indicative of cardiac activity to change the baroreflex therapy from a first baroreflex therapy to a second baroreflex therapy.
15. The baroreflex stimulator of claim 14 , wherein the means for modulating the baroreflex stimulation signal includes means for modulating the baroreflex stimulation signal based on a parameter selected from the set of: heart rate, respiration, tidal volume, and acceleration.
16. The baroreflex stimulator of claim 14 , wherein the means for modulating the baroreflex stimulation signal based on respiration includes means for modulating the baroreflex stimulation based on minute ventilation.
17. The baroreflex stimulator of claim 14 , wherein the baroreflex stimulation signal has a characteristic selected from the set of: an amplitude, a frequency, a duty cycle and a morphology an amplitude, and the means for modulating the baroreflex stimulation signal includes means for adjusting the characteristic of the baroreflex stimulation signal.
18. A method for operating an implantable medical device, comprising:
receiving a signal regarding an activity level; and
setting a baroreflex stimulation level for a baroreflex stimulator of the device based on the signal regarding the activity level.
19. The method of claim 18 , further comprising determining whether the activity level is rest or exercise, wherein setting the baroreflex stimulation level includes applying baroreflex stimulation during rest and withdrawing baroreflex stimulation during exercise.
20. The method of claim 18 , further comprising determining whether the activity level is a first activity level or a second activity level where the first activity level is higher than the second activity, wherein setting the baroreflex stimulation level includes setting a first baroreflex stimulation level when the activity level is determined to be the second activity level and setting a second baroreflex stimulation level when the activity level is determined to be the first activity level, wherein the first baroreflex stimulation level is higher than the second baroreflex stimulation level.
21. The method of claim 18 , wherein: the activity level is one of a plurality of activity levels and the baroreflex stimulation level is one of a plurality of baroreflex stimulation levels; and the baroreflex stimulation levels have an inverse relationship with the activity levels such that an incremental increase in the activity level corresponds with an incremental decrease in the baroreflex stimulation level.
22. The method of claim 18 , further comprising comparing the activity parameter to a target activity parameter, wherein setting the baroreflex stimulation level includes increasing the baroreflex stimulation level when the acquired activity parameter is lower than the target parameter and decreasing the baroreflex stimulation level when the acquired activity parameter is higher than the target parameter.
23. The method of claim 18 , wherein: receiving the signal regarding an activity level includes sensing a heart rate using a sensor of the implantable medical device; and setting the baroreflex stimulation level includes setting the baroreflex stimulation level based on the heart rate.
24. The method of claim 18 , wherein: receiving the signal regarding an activity level includes sensing respiration using a sensor of the implantable medical device; and setting the baroreflex stimulation level includes setting the baroreflex stimulation level based on the respiration.
25. The method of claim 24 , wherein sensing respiration includes sensing tidal volume, and setting the baroreflex stimulation level based on the respiration includes setting the baroreflex stimulation level based on the tidal volume.
26. The method of claim 24 , wherein sensing respiration includes sensing minute ventilation, and setting the baroreflex stimulation level based on the respiration includes setting the baroreflex stimulation level based on the minute ventilation.
27. The method of claim 18 , wherein: receiving the signal regarding an activity level includes sensing acceleration using a sensor of the implantable medical device; and setting the baroreflex stimulation level includes setting the baroreflex stimulation level based on the acceleration.
28. A method, comprising:
determining an activity level;
setting a baroreflex stimulation level based on the activity level; and
applying baroreflex stimulation at the baroreflex stimulation level.
29. The method of claim 28 , wherein: determining the activity level includes determining whether the activity level is rest or exercise; and setting the baroreflex stimulation level based on the activity level includes providing a signal to apply baroreflex stimulation during rest and withdraw baroreflex stimulation during exercise.
30. The method of claim 28 , wherein: determining the activity level includes determining whether the activity level is a first activity level or a second activity level, wherein the first activity level is higher than the second activity level; and setting the baroreflex stimulation level based on the activity level includes setting a first baroreflex stimulation level when the activity level is determined to be the second activity level, and setting a second baroreflex stimulation level when the activity level is determined to be the first activity level, wherein the first baroreflex stimulation level is higher than the second baroreflex stimulation level.
31. The method of claim 28 , wherein: the activity level is one of a plurality of activity levels and the baroreflex stimulation level is one of a plurality of baroreflex stimulation levels; and the baroreflex stimulation levels have an inverse relationship with the activity levels such that an incremental increase in the activity level corresponds with an incremental decrease in the baroreflex stimulation level.
32. The method of claim 28 , further comprising comparing the activity parameter to a cardiac activity parameter, wherein setting the baroreflex stimulation level based on the activity level includes increasing the baroreflex stimulation level when the acquired activity parameter is lower than the target parameter and decreasing the baroreflex stimulation level when the acquired activity parameter is higher than the target parameter.
33. A system for providing baroreceptor stimulation, comprising:
a sensor to sense a physiologic parameter and provide a signal indicative of the physiologic parameter; and
a baroreceptor stimulator, including:
a pulse generator to provide a baroreceptor stimulation signal adapted to provide a baroreflex therapy; and
a control system to receive the signal indicative of the physiologic parameter and modify the baroreceptor stimulation signal based on the signal indicative of the physiologic parameter.
34. A baroreceptor stimulator, comprising:
an implantable pulse generator to provide a baroreceptor stimulation signal adapted to provide a baroreflex therapy; and
means for modulating the baroreceptor stimulation signal based on a signal indicative of a physiologic parameter to modify the baroreflex therapy.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/482,635 US20070021799A1 (en) | 2000-09-27 | 2006-07-07 | Automatic baroreflex modulation based on cardiac activity |
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/671,850 US6522926B1 (en) | 2000-09-27 | 2000-09-27 | Devices and methods for cardiovascular reflex control |
US09/963,777 US7158832B2 (en) | 2000-09-27 | 2001-09-26 | Electrode designs and methods of use for cardiovascular reflex control devices |
US36822202P | 2002-03-27 | 2002-03-27 | |
US10/402,911 US7499742B2 (en) | 2001-09-26 | 2003-03-27 | Electrode structures and methods for their use in cardiovascular reflex control |
US11/482,635 US20070021799A1 (en) | 2000-09-27 | 2006-07-07 | Automatic baroreflex modulation based on cardiac activity |
Related Parent Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/963,777 Continuation-In-Part US7158832B2 (en) | 2000-09-27 | 2001-09-26 | Electrode designs and methods of use for cardiovascular reflex control devices |
US10/402,911 Continuation US7499742B2 (en) | 2000-09-27 | 2003-03-27 | Electrode structures and methods for their use in cardiovascular reflex control |
Publications (1)
Publication Number | Publication Date |
---|---|
US20070021799A1 true US20070021799A1 (en) | 2007-01-25 |
Family
ID=38045446
Family Applications (23)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/402,911 Expired - Lifetime US7499742B2 (en) | 2000-09-27 | 2003-03-27 | Electrode structures and methods for their use in cardiovascular reflex control |
US11/428,143 Abandoned US20070021794A1 (en) | 2000-09-27 | 2006-06-30 | Baroreflex Therapy for Disordered Breathing |
US11/428,131 Abandoned US20070021792A1 (en) | 2000-09-27 | 2006-06-30 | Baroreflex Modulation Based On Monitored Cardiovascular Parameter |
US11/482,357 Expired - Lifetime US7813812B2 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulator with integrated pressure sensor |
US11/482,662 Abandoned US20070038262A1 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulation system to reduce hypertension |
US11/482,225 Expired - Fee Related US8060206B2 (en) | 2000-09-27 | 2006-07-07 | Baroreflex modulation to gradually decrease blood pressure |
US11/482,574 Abandoned US20070021798A1 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulation to treat acute myocardial infarction |
US11/482,358 Abandoned US20070021790A1 (en) | 2000-09-27 | 2006-07-07 | Automatic baroreflex modulation responsive to adverse event |
US11/482,635 Abandoned US20070021799A1 (en) | 2000-09-27 | 2006-07-07 | Automatic baroreflex modulation based on cardiac activity |
US11/482,453 Abandoned US20070021797A1 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulation synchronized to circadian rhythm |
US11/535,666 Abandoned US20070106340A1 (en) | 2000-09-27 | 2006-09-27 | Electrode structures and methods for their use in cardiovascular reflex control |
US11/933,268 Abandoned US20080167694A1 (en) | 2000-09-27 | 2007-10-31 | Automatic neural stimulation based on activity |
US11/956,685 Abandoned US20080097540A1 (en) | 2001-09-26 | 2007-12-14 | Ecg input to implantable pulse generator using carotid sinus leads |
US12/359,209 Abandoned US20090228065A1 (en) | 2001-09-26 | 2009-01-23 | Implantable vascular structures and methods for their use |
US12/731,104 Abandoned US20100191303A1 (en) | 2000-09-27 | 2010-03-24 | Automatic baroreflex modulation responsive to adverse event |
US12/762,891 Expired - Fee Related US8718789B2 (en) | 2000-09-27 | 2010-04-19 | Electrode structures and methods for their use in cardiovascular reflex control |
US13/025,718 Abandoned US20110172734A1 (en) | 2000-09-27 | 2011-02-11 | Baroreflex modulation based on monitored cardiovascular parameter |
US13/300,232 Expired - Fee Related US9044609B2 (en) | 2000-09-27 | 2011-11-18 | Electrode structures and methods for their use in cardiovascular reflex control |
US13/480,063 Expired - Fee Related US8712531B2 (en) | 2000-09-27 | 2012-05-24 | Automatic baroreflex modulation responsive to adverse event |
US13/690,016 Expired - Fee Related US8880190B2 (en) | 2000-09-27 | 2012-11-30 | Electrode structures and methods for their use in cardiovascular reflex control |
US14/700,369 Expired - Lifetime US9427583B2 (en) | 2000-09-27 | 2015-04-30 | Electrode structures and methods for their use in cardiovascular reflex control |
US15/223,747 Abandoned US20170001013A1 (en) | 2000-09-27 | 2016-07-29 | Electrode structures and methods for their use in cardiovascular reflex control |
US16/548,519 Abandoned US20200114153A1 (en) | 2000-09-27 | 2019-08-22 | Electrode structures and methods for their use in cardiovascular reflex control |
Family Applications Before (8)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/402,911 Expired - Lifetime US7499742B2 (en) | 2000-09-27 | 2003-03-27 | Electrode structures and methods for their use in cardiovascular reflex control |
US11/428,143 Abandoned US20070021794A1 (en) | 2000-09-27 | 2006-06-30 | Baroreflex Therapy for Disordered Breathing |
US11/428,131 Abandoned US20070021792A1 (en) | 2000-09-27 | 2006-06-30 | Baroreflex Modulation Based On Monitored Cardiovascular Parameter |
US11/482,357 Expired - Lifetime US7813812B2 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulator with integrated pressure sensor |
US11/482,662 Abandoned US20070038262A1 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulation system to reduce hypertension |
US11/482,225 Expired - Fee Related US8060206B2 (en) | 2000-09-27 | 2006-07-07 | Baroreflex modulation to gradually decrease blood pressure |
US11/482,574 Abandoned US20070021798A1 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulation to treat acute myocardial infarction |
US11/482,358 Abandoned US20070021790A1 (en) | 2000-09-27 | 2006-07-07 | Automatic baroreflex modulation responsive to adverse event |
Family Applications After (14)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US11/482,453 Abandoned US20070021797A1 (en) | 2000-09-27 | 2006-07-07 | Baroreflex stimulation synchronized to circadian rhythm |
US11/535,666 Abandoned US20070106340A1 (en) | 2000-09-27 | 2006-09-27 | Electrode structures and methods for their use in cardiovascular reflex control |
US11/933,268 Abandoned US20080167694A1 (en) | 2000-09-27 | 2007-10-31 | Automatic neural stimulation based on activity |
US11/956,685 Abandoned US20080097540A1 (en) | 2001-09-26 | 2007-12-14 | Ecg input to implantable pulse generator using carotid sinus leads |
US12/359,209 Abandoned US20090228065A1 (en) | 2001-09-26 | 2009-01-23 | Implantable vascular structures and methods for their use |
US12/731,104 Abandoned US20100191303A1 (en) | 2000-09-27 | 2010-03-24 | Automatic baroreflex modulation responsive to adverse event |
US12/762,891 Expired - Fee Related US8718789B2 (en) | 2000-09-27 | 2010-04-19 | Electrode structures and methods for their use in cardiovascular reflex control |
US13/025,718 Abandoned US20110172734A1 (en) | 2000-09-27 | 2011-02-11 | Baroreflex modulation based on monitored cardiovascular parameter |
US13/300,232 Expired - Fee Related US9044609B2 (en) | 2000-09-27 | 2011-11-18 | Electrode structures and methods for their use in cardiovascular reflex control |
US13/480,063 Expired - Fee Related US8712531B2 (en) | 2000-09-27 | 2012-05-24 | Automatic baroreflex modulation responsive to adverse event |
US13/690,016 Expired - Fee Related US8880190B2 (en) | 2000-09-27 | 2012-11-30 | Electrode structures and methods for their use in cardiovascular reflex control |
US14/700,369 Expired - Lifetime US9427583B2 (en) | 2000-09-27 | 2015-04-30 | Electrode structures and methods for their use in cardiovascular reflex control |
US15/223,747 Abandoned US20170001013A1 (en) | 2000-09-27 | 2016-07-29 | Electrode structures and methods for their use in cardiovascular reflex control |
US16/548,519 Abandoned US20200114153A1 (en) | 2000-09-27 | 2019-08-22 | Electrode structures and methods for their use in cardiovascular reflex control |
Country Status (1)
Country | Link |
---|---|
US (23) | US7499742B2 (en) |
Cited By (81)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20050143779A1 (en) * | 2003-12-24 | 2005-06-30 | Cardiac Pacemakers, Inc. | Baroreflex modulation based on monitored cardiovascular parameter |
US20050149133A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Sensing with compensation for neural stimulator |
US20050149132A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Automatic baroreflex modulation based on cardiac activity |
US20050149131A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex modulation to gradually decrease blood pressure |
US20050149156A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Lead for stimulating the baroreceptors in the pulmonary artery |
US20050149128A1 (en) * | 2003-12-24 | 2005-07-07 | Heil Ronald W.Jr. | Barorflex stimulation system to reduce hypertension |
US20050149143A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex stimulator with integrated pressure sensor |
US20050149126A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex stimulation to treat acute myocardial infarction |
US20050149130A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex stimulation synchronized to circadian rhythm |
US20050251212A1 (en) * | 2000-09-27 | 2005-11-10 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US20060106429A1 (en) * | 2004-11-18 | 2006-05-18 | Cardiac Pacemakers, Inc. | System and method for closed-loop neural stimulation |
US20060135998A1 (en) * | 2004-11-18 | 2006-06-22 | Imad Libbus | System and method for closed-loop neural stimulation |
US20060224188A1 (en) * | 2005-04-05 | 2006-10-05 | Cardiac Pacemakers, Inc. | Method and apparatus for synchronizing neural stimulation to cardiac cycles |
US20070021797A1 (en) * | 2000-09-27 | 2007-01-25 | Cvrx, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US20070060972A1 (en) * | 2000-09-27 | 2007-03-15 | Cvrx, Inc. | Devices and methods for cardiovascular reflex treatments |
US20070142864A1 (en) * | 2003-12-24 | 2007-06-21 | Imad Libbus | Automatic neural stimulation modulation based on activity |
US20070142871A1 (en) * | 2005-12-20 | 2007-06-21 | Cardiac Pacemakers, Inc. | Implantable device for treating epilepsy and cardiac rhythm disorders |
US20070185543A1 (en) * | 2000-09-27 | 2007-08-09 | Cvrx, Inc. | System and method for sustained baroreflex stimulation |
US20080015659A1 (en) * | 2003-12-24 | 2008-01-17 | Yi Zhang | Neurostimulation systems and methods for cardiac conditions |
US20080033501A1 (en) * | 2005-07-25 | 2008-02-07 | Yossi Gross | Elliptical element for blood pressure reduction |
US20080171923A1 (en) * | 2000-09-27 | 2008-07-17 | Cvrx, Inc. | Assessing autonomic activity using baroreflex analysis |
US20080215117A1 (en) * | 2005-07-25 | 2008-09-04 | Yossi Gross | Electrical Stimulation of Blood Vessels |
US20080289920A1 (en) * | 2007-05-24 | 2008-11-27 | Hoerbiger-Origa Holding Ag | Pneumatic cylinder with a self-adjusting end position damping arrangement, and method for self-adjusting end position damping |
US20090076340A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Cardiac Monitor with Advanced Sensing Capabilities |
US20090076346A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Tracking and Security for Adherent Patient Monitor |
US20090076397A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Emergency Patient Monitor |
US20090076410A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | System and Methods for Wireless Body Fluid Monitoring |
US20090076405A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device for Respiratory Monitoring |
US20090076401A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Injectable Physiological Monitoring System |
US20090076336A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Medical Device Automatic Start-up Upon Contact to Patient Tissue |
US20090076345A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device with Multiple Physiological Sensors |
US20090076341A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Athletic Monitor |
US20090076350A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Data Collection in a Multi-Sensor Patient Monitor |
US20090076559A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device for Cardiac Rhythm Management |
US20090076342A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Multi-Sensor Device with Empathic Monitoring |
US20090210330A1 (en) * | 2008-02-19 | 2009-08-20 | Chia-Chieh Chen | Payroll system and method |
US20090234418A1 (en) * | 2000-09-27 | 2009-09-17 | Kieval Robert S | Devices and methods for cardiovascular reflex control via coupled electrodes |
US20090234410A1 (en) * | 2008-03-12 | 2009-09-17 | Corventis, Inc. | Heart Failure Decompensation Prediction Based on Cardiac Rhythm |
US20090264792A1 (en) * | 2008-04-18 | 2009-10-22 | Corventis, Inc. | Method and Apparatus to Measure Bioelectric Impedance of Patient Tissue |
US20090306734A1 (en) * | 2005-03-11 | 2009-12-10 | Julia Moffitt | Combined neural stimulation and cardiac resynchronization therapy |
US7657312B2 (en) | 2003-11-03 | 2010-02-02 | Cardiac Pacemakers, Inc. | Multi-site ventricular pacing therapy with parasympathetic stimulation |
US20100121399A1 (en) * | 2005-04-05 | 2010-05-13 | Mccabe Aaron | Closed loop neural stimulation synchronized to cardiac cycles |
US20100191310A1 (en) * | 2008-07-29 | 2010-07-29 | Corventis, Inc. | Communication-Anchor Loop For Injectable Device |
US20100249874A1 (en) * | 2000-09-27 | 2010-09-30 | Bolea Stephen L | Baroreflex therapy for disordered breathing |
US20100274321A1 (en) * | 2003-12-24 | 2010-10-28 | Imad Libbus | Baroreflex activation therapy with conditional shut off |
US20100286741A1 (en) * | 2003-12-24 | 2010-11-11 | Imad Libbus | Cardiac rhythm management device with neural sensor |
US20110009692A1 (en) * | 2007-12-26 | 2011-01-13 | Yossi Gross | Nitric oxide generation to treat female sexual dysfunction |
US20110077729A1 (en) * | 2009-09-29 | 2011-03-31 | Vascular Dynamics Inc. | Devices and methods for control of blood pressure |
US20110112592A1 (en) * | 2005-04-20 | 2011-05-12 | Imad Libbus | Neural stimulation system to prevent simultaneous energy discharges |
US20110118773A1 (en) * | 2005-07-25 | 2011-05-19 | Rainbow Medical Ltd. | Elliptical device for treating afterload |
US20110137370A1 (en) * | 2008-01-31 | 2011-06-09 | Enopace Biomedical Ltd. | Thoracic aorta and vagus nerve stimulation |
US20110144470A1 (en) * | 2009-12-14 | 2011-06-16 | Corventis, Inc. | Body adherent patch with electronics for physiologic monitoring |
US20110178416A1 (en) * | 2005-07-25 | 2011-07-21 | Vascular Dynamics Inc. | Devices and methods for control of blood pressure |
US20110213408A1 (en) * | 2005-07-25 | 2011-09-01 | Vascular Dynamics Inc. | Devices and methods for control of blood pressure |
US8126560B2 (en) | 2003-12-24 | 2012-02-28 | Cardiac Pacemakers, Inc. | Stimulation lead for stimulating the baroreceptors in the pulmonary artery |
US8131359B2 (en) | 2005-05-10 | 2012-03-06 | Cardiac Pacemakers, Inc. | System and method to deliver therapy in presence of another therapy |
US8406868B2 (en) | 2010-04-29 | 2013-03-26 | Medtronic, Inc. | Therapy using perturbation and effect of physiological systems |
US8478397B2 (en) | 2005-03-23 | 2013-07-02 | Cardiac Pacemakers, Inc. | System to provide myocardial and neural stimulation |
US8538535B2 (en) | 2010-08-05 | 2013-09-17 | Rainbow Medical Ltd. | Enhancing perfusion by contraction |
US8548585B2 (en) | 2009-12-08 | 2013-10-01 | Cardiac Pacemakers, Inc. | Concurrent therapy detection in implantable medical devices |
US8620425B2 (en) | 2010-04-29 | 2013-12-31 | Medtronic, Inc. | Nerve signal differentiation in cardiac therapy |
US8626290B2 (en) | 2008-01-31 | 2014-01-07 | Enopace Biomedical Ltd. | Acute myocardial infarction treatment by electrical stimulation of the thoracic aorta |
US8639327B2 (en) | 2010-04-29 | 2014-01-28 | Medtronic, Inc. | Nerve signal differentiation in cardiac therapy |
US8649863B2 (en) | 2010-12-20 | 2014-02-11 | Rainbow Medical Ltd. | Pacemaker with no production |
US8706223B2 (en) | 2011-01-19 | 2014-04-22 | Medtronic, Inc. | Preventative vagal stimulation |
US8718763B2 (en) | 2011-01-19 | 2014-05-06 | Medtronic, Inc. | Vagal stimulation |
US8725259B2 (en) | 2011-01-19 | 2014-05-13 | Medtronic, Inc. | Vagal stimulation |
US8781582B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
US8781583B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
US8790259B2 (en) | 2009-10-22 | 2014-07-29 | Corventis, Inc. | Method and apparatus for remote detection and monitoring of functional chronotropic incompetence |
US8855783B2 (en) | 2011-09-09 | 2014-10-07 | Enopace Biomedical Ltd. | Detector-based arterial stimulation |
US8965498B2 (en) | 2010-04-05 | 2015-02-24 | Corventis, Inc. | Method and apparatus for personalized physiologic parameters |
US9314635B2 (en) | 2003-12-24 | 2016-04-19 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation responsive to adverse event |
US9386991B2 (en) | 2012-02-02 | 2016-07-12 | Rainbow Medical Ltd. | Pressure-enhanced blood flow treatment |
US9526637B2 (en) | 2011-09-09 | 2016-12-27 | Enopace Biomedical Ltd. | Wireless endovascular stent-based electrodes |
US9592136B2 (en) | 2005-07-25 | 2017-03-14 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US9642726B2 (en) | 2005-07-25 | 2017-05-09 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US10779965B2 (en) | 2013-11-06 | 2020-09-22 | Enopace Biomedical Ltd. | Posts with compliant junctions |
US11369794B2 (en) | 2005-05-25 | 2022-06-28 | Cardiac Pacemakers, Inc. | Implantable neural stimulator with mode switching |
US11400299B1 (en) | 2021-09-14 | 2022-08-02 | Rainbow Medical Ltd. | Flexible antenna for stimulator |
US11724109B2 (en) | 2004-10-12 | 2023-08-15 | Cardiac Pacemakers, Inc. | System and method for sustained baroreflex stimulation |
Families Citing this family (297)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7158830B2 (en) * | 1998-05-08 | 2007-01-02 | Cardiac Pacemakers, Inc. | Method and apparatus for optimizing stroke volume during DDD resynchronization therapy using adjustable atrio-ventricular delays |
US7110817B2 (en) * | 1998-05-08 | 2006-09-19 | Cardiac Pacemakers, Inc. | Method and apparatus for optimizing ventricular synchrony during DDD resynchronization therapy using adjustable atrio-ventricular delays |
US20080177365A1 (en) * | 2000-09-27 | 2008-07-24 | Cvrx, Inc. | Method and apparatus for electronically switching electrode configuration |
US20080167699A1 (en) * | 2000-09-27 | 2008-07-10 | Cvrx, Inc. | Method and Apparatus for Providing Complex Tissue Stimulation Parameters |
US6973349B2 (en) | 2001-12-05 | 2005-12-06 | Cardiac Pacemakers, Inc. | Method and apparatus for minimizing post-infarct ventricular remodeling |
US20070129761A1 (en) | 2002-04-08 | 2007-06-07 | Ardian, Inc. | Methods for treating heart arrhythmia |
US6978174B2 (en) * | 2002-04-08 | 2005-12-20 | Ardian, Inc. | Methods and devices for renal nerve blocking |
US8145317B2 (en) | 2002-04-08 | 2012-03-27 | Ardian, Inc. | Methods for renal neuromodulation |
US9308043B2 (en) | 2002-04-08 | 2016-04-12 | Medtronic Ardian Luxembourg S.A.R.L. | Methods for monopolar renal neuromodulation |
US9308044B2 (en) | 2002-04-08 | 2016-04-12 | Medtronic Ardian Luxembourg S.A.R.L. | Methods for therapeutic renal neuromodulation |
US8774922B2 (en) | 2002-04-08 | 2014-07-08 | Medtronic Ardian Luxembourg S.A.R.L. | Catheter apparatuses having expandable balloons for renal neuromodulation and associated systems and methods |
US7756583B2 (en) | 2002-04-08 | 2010-07-13 | Ardian, Inc. | Methods and apparatus for intravascularly-induced neuromodulation |
US8131371B2 (en) | 2002-04-08 | 2012-03-06 | Ardian, Inc. | Methods and apparatus for monopolar renal neuromodulation |
US20110207758A1 (en) * | 2003-04-08 | 2011-08-25 | Medtronic Vascular, Inc. | Methods for Therapeutic Renal Denervation |
US20140018880A1 (en) | 2002-04-08 | 2014-01-16 | Medtronic Ardian Luxembourg S.A.R.L. | Methods for monopolar renal neuromodulation |
US20080213331A1 (en) | 2002-04-08 | 2008-09-04 | Ardian, Inc. | Methods and devices for renal nerve blocking |
US8150519B2 (en) | 2002-04-08 | 2012-04-03 | Ardian, Inc. | Methods and apparatus for bilateral renal neuromodulation |
US7162303B2 (en) * | 2002-04-08 | 2007-01-09 | Ardian, Inc. | Renal nerve stimulation method and apparatus for treatment of patients |
US7853333B2 (en) | 2002-04-08 | 2010-12-14 | Ardian, Inc. | Methods and apparatus for multi-vessel renal neuromodulation |
US8347891B2 (en) | 2002-04-08 | 2013-01-08 | Medtronic Ardian Luxembourg S.A.R.L. | Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen |
US7617005B2 (en) | 2002-04-08 | 2009-11-10 | Ardian, Inc. | Methods and apparatus for thermally-induced renal neuromodulation |
US7653438B2 (en) | 2002-04-08 | 2010-01-26 | Ardian, Inc. | Methods and apparatus for renal neuromodulation |
US9636174B2 (en) | 2002-04-08 | 2017-05-02 | Medtronic Ardian Luxembourg S.A.R.L. | Methods for therapeutic renal neuromodulation |
US7620451B2 (en) | 2005-12-29 | 2009-11-17 | Ardian, Inc. | Methods and apparatus for pulsed electric field neuromodulation via an intra-to-extravascular approach |
US8774913B2 (en) | 2002-04-08 | 2014-07-08 | Medtronic Ardian Luxembourg S.A.R.L. | Methods and apparatus for intravasculary-induced neuromodulation |
US8145316B2 (en) | 2002-04-08 | 2012-03-27 | Ardian, Inc. | Methods and apparatus for renal neuromodulation |
US8175711B2 (en) | 2002-04-08 | 2012-05-08 | Ardian, Inc. | Methods for treating a condition or disease associated with cardio-renal function |
US20070135875A1 (en) | 2002-04-08 | 2007-06-14 | Ardian, Inc. | Methods and apparatus for thermally-induced renal neuromodulation |
US7189204B2 (en) | 2002-12-04 | 2007-03-13 | Cardiac Pacemakers, Inc. | Sleep detection using an adjustable threshold |
AU2002953440A0 (en) * | 2002-12-19 | 2003-01-09 | Unisearch Limited | A method of treating a stiffened vessel |
US20060111626A1 (en) * | 2003-03-27 | 2006-05-25 | Cvrx, Inc. | Electrode structures having anti-inflammatory properties and methods of use |
US20070060971A1 (en) * | 2003-07-21 | 2007-03-15 | Ofer Glasberg | Hepatic device for treatment or glucose detection |
US8002553B2 (en) | 2003-08-18 | 2011-08-23 | Cardiac Pacemakers, Inc. | Sleep quality data collection and evaluation |
US8606356B2 (en) | 2003-09-18 | 2013-12-10 | Cardiac Pacemakers, Inc. | Autonomic arousal detection system and method |
US7887493B2 (en) * | 2003-09-18 | 2011-02-15 | Cardiac Pacemakers, Inc. | Implantable device employing movement sensing for detecting sleep-related disorders |
ATE413902T1 (en) * | 2003-08-18 | 2008-11-15 | Cardiac Pacemakers Inc | PATIENT MONITORING SYSTEM |
US20050085874A1 (en) * | 2003-10-17 | 2005-04-21 | Ross Davis | Method and system for treating sleep apnea |
US7480532B2 (en) * | 2003-10-22 | 2009-01-20 | Cvrx, Inc. | Baroreflex activation for pain control, sedation and sleep |
US7215997B2 (en) * | 2003-12-22 | 2007-05-08 | Cardiac Pacemakers, Inc. | Dynamic device therapy control for treating post myocardial infarction patients |
US8126559B2 (en) | 2004-11-30 | 2012-02-28 | Cardiac Pacemakers, Inc. | Neural stimulation with avoidance of inappropriate stimulation |
US7668594B2 (en) | 2005-08-19 | 2010-02-23 | Cardiac Pacemakers, Inc. | Method and apparatus for delivering chronic and post-ischemia cardiac therapies |
US20050149129A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baropacing and cardiac pacing to control output |
JP4337595B2 (en) * | 2004-03-25 | 2009-09-30 | 株式会社島津製作所 | Load cell |
US7260431B2 (en) * | 2004-05-20 | 2007-08-21 | Cardiac Pacemakers, Inc. | Combined remodeling control therapy and anti-remodeling therapy by implantable cardiac device |
US7596413B2 (en) * | 2004-06-08 | 2009-09-29 | Cardiac Pacemakers, Inc. | Coordinated therapy for disordered breathing including baroreflex modulation |
US7747323B2 (en) | 2004-06-08 | 2010-06-29 | Cardiac Pacemakers, Inc. | Adaptive baroreflex stimulation therapy for disordered breathing |
WO2006012050A2 (en) * | 2004-06-30 | 2006-02-02 | Cvrx, Inc. | Connection structures for extra-vascular electrode lead body |
WO2006012033A2 (en) * | 2004-06-30 | 2006-02-02 | Cvrx, Inc. | Lockout connector arrangement for implantable medical device |
US7999806B2 (en) * | 2004-07-23 | 2011-08-16 | Panasonic Corporation | Three-dimensional shape drawing device and three-dimensional shape drawing method |
US20060074453A1 (en) * | 2004-10-04 | 2006-04-06 | Cvrx, Inc. | Baroreflex activation and cardiac resychronization for heart failure treatment |
US20070083239A1 (en) * | 2005-09-23 | 2007-04-12 | Denise Demarais | Methods and apparatus for inducing, monitoring and controlling renal neuromodulation |
US7937143B2 (en) * | 2004-11-02 | 2011-05-03 | Ardian, Inc. | Methods and apparatus for inducing controlled renal neuromodulation |
US8565867B2 (en) | 2005-01-28 | 2013-10-22 | Cyberonics, Inc. | Changeable electrode polarity stimulation by an implantable medical device |
US8260426B2 (en) | 2008-01-25 | 2012-09-04 | Cyberonics, Inc. | Method, apparatus and system for bipolar charge utilization during stimulation by an implantable medical device |
US9314633B2 (en) | 2008-01-25 | 2016-04-19 | Cyberonics, Inc. | Contingent cardio-protection for epilepsy patients |
US7555341B2 (en) * | 2005-04-05 | 2009-06-30 | Cardiac Pacemakers, Inc. | System to treat AV-conducted ventricular tachyarrhythmia |
US7499748B2 (en) * | 2005-04-11 | 2009-03-03 | Cardiac Pacemakers, Inc. | Transvascular neural stimulation device |
US7395119B2 (en) * | 2005-05-19 | 2008-07-01 | Cvrx, Inc. | Implantable electrode assembly having reverse electrode configuration |
US7584004B2 (en) * | 2005-06-13 | 2009-09-01 | Cardiac Pacemakers, Inc. | Vascularly stabilized peripheral nerve cuff assembly |
US20110238133A1 (en) * | 2005-07-25 | 2011-09-29 | Rainbow Medical Ltd. | Electrical stimulation of the eye |
US7822486B2 (en) | 2005-08-17 | 2010-10-26 | Enteromedics Inc. | Custom sized neural electrodes |
US20070142879A1 (en) * | 2005-12-20 | 2007-06-21 | The Cleveland Clinic Foundation | Apparatus and method for modulating the baroreflex system |
US7616990B2 (en) | 2005-10-24 | 2009-11-10 | Cardiac Pacemakers, Inc. | Implantable and rechargeable neural stimulator |
JP2009515632A (en) * | 2005-11-17 | 2009-04-16 | コーニンクレッカ フィリップス エレクトロニクス エヌ ヴィ | Blood flow sensor with acoustic coupling detector |
US8874238B2 (en) * | 2005-11-22 | 2014-10-28 | Cochlear Limited | Conformal electrode pad for a stimulating medical device |
US7596414B2 (en) * | 2005-12-05 | 2009-09-29 | Boston Scientific Neuromodulation Corporation | Cuff electrode arrangement for nerve stimulation and methods of treating disorders |
US8109879B2 (en) * | 2006-01-10 | 2012-02-07 | Cardiac Pacemakers, Inc. | Assessing autonomic activity using baroreflex analysis |
US7996079B2 (en) | 2006-01-24 | 2011-08-09 | Cyberonics, Inc. | Input response override for an implantable medical device |
US7467016B2 (en) * | 2006-01-27 | 2008-12-16 | Cyberonics, Inc. | Multipolar stimulation electrode with mating structures for gripping targeted tissue |
EP1981584B1 (en) * | 2006-02-03 | 2015-05-13 | Interventional Autonomics Corporation | Intravascular device for neuromodulation |
US20070191904A1 (en) * | 2006-02-14 | 2007-08-16 | Imad Libbus | Expandable stimulation electrode with integrated pressure sensor and methods related thereto |
WO2007098202A2 (en) * | 2006-02-16 | 2007-08-30 | Imthera Medical, Inc. | An rfid based apparatus, system, and method for therapeutic treatment of a patient |
ES2573323T3 (en) | 2006-03-29 | 2016-06-07 | Dignity Health | Electrical stimulation of cranial nerve microburst for the treatment of medical conditions |
US7974706B2 (en) * | 2006-03-30 | 2011-07-05 | Boston Scientific Neuromodulation Corporation | Electrode contact configurations for cuff leads |
US20080004673A1 (en) * | 2006-04-03 | 2008-01-03 | Cvrx, Inc. | Implantable extravascular electrostimulation system having a resilient cuff |
US7869885B2 (en) * | 2006-04-28 | 2011-01-11 | Cyberonics, Inc | Threshold optimization for tissue stimulation therapy |
US7962220B2 (en) | 2006-04-28 | 2011-06-14 | Cyberonics, Inc. | Compensation reduction in tissue stimulation therapy |
US8968204B2 (en) * | 2006-06-12 | 2015-03-03 | Transonic Systems, Inc. | System and method of perivascular pressure and flow measurement |
US20080046054A1 (en) * | 2006-06-23 | 2008-02-21 | Cvrx, Inc. | Implantable electrode assembly utilizing a belt mechanism for sutureless attachment |
US8170668B2 (en) | 2006-07-14 | 2012-05-01 | Cardiac Pacemakers, Inc. | Baroreflex sensitivity monitoring and trending for tachyarrhythmia detection and therapy |
US7908018B2 (en) * | 2006-09-06 | 2011-03-15 | Cardiomems, Inc. | Flexible electrode |
US8620422B2 (en) * | 2006-09-28 | 2013-12-31 | Cvrx, Inc. | Electrode array structures and methods of use for cardiovascular reflex control |
WO2008045877A2 (en) * | 2006-10-10 | 2008-04-17 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Electrode tip and ablation system |
US20080091255A1 (en) * | 2006-10-11 | 2008-04-17 | Cardiac Pacemakers | Implantable neurostimulator for modulating cardiovascular function |
US7869867B2 (en) | 2006-10-27 | 2011-01-11 | Cyberonics, Inc. | Implantable neurostimulator with refractory stimulation |
US8019401B1 (en) * | 2006-12-04 | 2011-09-13 | Smithmarks, Inc. | Stretchable electrode and method of making physiologic measurements |
WO2008070189A2 (en) | 2006-12-06 | 2008-06-12 | The Cleveland Clinic Foundation | Method and system for treating acute heart failure by neuromodulation |
US20080161887A1 (en) * | 2006-12-28 | 2008-07-03 | Cvrx, Inc. | Noble metal electrodes with nanostructures |
WO2008090485A1 (en) * | 2007-01-25 | 2008-07-31 | Nxp B.V. | A sensor module for a catheter |
ES2430613T3 (en) | 2007-01-29 | 2013-11-21 | Simon Fraser University | Transvascular Neurostimulation Apparatus |
US8442639B2 (en) * | 2007-02-13 | 2013-05-14 | Cardiac Pacemakers, Inc. | Systems and methods for electrical stimulation of blood vessels |
US7937147B2 (en) * | 2007-02-28 | 2011-05-03 | Cardiac Pacemakers, Inc. | High frequency stimulation for treatment of atrial fibrillation |
US8615296B2 (en) * | 2007-03-06 | 2013-12-24 | Cardiac Pacemakers, Inc. | Method and apparatus for closed-loop intermittent cardiac stress augmentation pacing |
US8150521B2 (en) * | 2007-03-15 | 2012-04-03 | Cvrx, Inc. | Methods and devices for controlling battery life in an implantable pulse generator |
US7974701B2 (en) * | 2007-04-27 | 2011-07-05 | Cyberonics, Inc. | Dosing limitation for an implantable medical device |
US20090132002A1 (en) * | 2007-05-11 | 2009-05-21 | Cvrx, Inc. | Baroreflex activation therapy with conditional shut off |
US8271080B2 (en) | 2007-05-23 | 2012-09-18 | Cardiac Pacemakers, Inc. | Decongestive therapy titration for heart failure patients using implantable sensor |
US8594794B2 (en) | 2007-07-24 | 2013-11-26 | Cvrx, Inc. | Baroreflex activation therapy with incrementally changing intensity |
CA2697822A1 (en) | 2007-10-09 | 2009-04-16 | Imthera Medical, Inc. | Apparatus, system, and method for selective stimulation |
EP2211980B1 (en) * | 2007-10-10 | 2015-01-07 | Sorin CRM SAS | Neurostimulator and method for regulating the same |
US8352033B2 (en) | 2007-10-15 | 2013-01-08 | Mark Kroll | Apparatus and methods for measuring defibrillation lead impedance via a high magnitude, short duration current pulse |
US20090112962A1 (en) * | 2007-10-31 | 2009-04-30 | Research In Motion Limited | Modular squaring in binary field arithmetic |
US7949398B1 (en) * | 2007-12-27 | 2011-05-24 | Pacesetter, Inc. | Acquiring nerve activity from carotid body and/or sinus |
US7848816B1 (en) * | 2007-12-27 | 2010-12-07 | Pacesetter, Inc. | Acquiring nerve activity from carotid body and/or sinus |
WO2009086536A1 (en) | 2007-12-28 | 2009-07-09 | Cvrx, Inc. | Measurement of patient physiological parameters |
US20100305392A1 (en) * | 2008-01-31 | 2010-12-02 | Enopace Biomedical Ltd. | Thoracic aorta and vagus nerve stimulation |
US9005106B2 (en) | 2008-01-31 | 2015-04-14 | Enopace Biomedical Ltd | Intra-aortic electrical counterpulsation |
US8140155B2 (en) * | 2008-03-11 | 2012-03-20 | Cardiac Pacemakers, Inc. | Intermittent pacing therapy delivery statistics |
US7925352B2 (en) | 2008-03-27 | 2011-04-12 | Synecor Llc | System and method for transvascularly stimulating contents of the carotid sheath |
JP5552585B2 (en) | 2008-04-17 | 2014-07-16 | アポロ エンドサージェリー,インコーポレイティド | IMPORTABLE ACCESS PORT DEVICE AND MOUNTING SYSTEM |
US9023063B2 (en) | 2008-04-17 | 2015-05-05 | Apollo Endosurgery, Inc. | Implantable access port device having a safety cap |
US8204603B2 (en) | 2008-04-25 | 2012-06-19 | Cyberonics, Inc. | Blocking exogenous action potentials by an implantable medical device |
US8958870B2 (en) * | 2008-04-29 | 2015-02-17 | Medtronic, Inc. | Therapy program modification |
US20110160827A1 (en) * | 2008-05-02 | 2011-06-30 | Medtronic. Inc. | Electrode lead system |
US8401652B2 (en) | 2008-06-16 | 2013-03-19 | Cvrx, Inc. | Devices and methods for treatment of heart failure and associated conditions |
US8321024B2 (en) | 2008-06-16 | 2012-11-27 | Cvrx, Inc. | Devices and methods for treatment of heart failure and associated conditions |
US8768469B2 (en) | 2008-08-08 | 2014-07-01 | Enteromedics Inc. | Systems for regulation of blood pressure and heart rate |
US9089700B2 (en) | 2008-08-11 | 2015-07-28 | Cibiem, Inc. | Systems and methods for treating dyspnea, including via electrical afferent signal blocking |
WO2010042404A1 (en) | 2008-10-09 | 2010-04-15 | Imthera Medical, Inc. | Method of stimulating a hypoglossal nerve for controlling the position of a patient's tongue |
US8457747B2 (en) | 2008-10-20 | 2013-06-04 | Cyberonics, Inc. | Neurostimulation with signal duration determined by a cardiac cycle |
US20100114195A1 (en) * | 2008-10-31 | 2010-05-06 | Medtronic, Inc. | Implantable medical device including extravascular cardiac stimulation and neurostimulation capabilities |
US8548593B2 (en) * | 2008-11-10 | 2013-10-01 | Cardiac Pacemakers, Inc. | Distal end converter for a medical device lead |
US8652129B2 (en) | 2008-12-31 | 2014-02-18 | Medtronic Ardian Luxembourg S.A.R.L. | Apparatus, systems, and methods for achieving intravascular, thermally-induced renal neuromodulation |
US20100191304A1 (en) * | 2009-01-23 | 2010-07-29 | Scott Timothy L | Implantable Medical Device for Providing Chronic Condition Therapy and Acute Condition Therapy Using Vagus Nerve Stimulation |
US8285374B2 (en) * | 2009-02-25 | 2012-10-09 | University Of Utah Research Foundation | Methods and systems for treating ventricular arrhythmias |
US8406871B2 (en) * | 2009-02-25 | 2013-03-26 | University Of Utah Research Foundation | Methods and systems for treating cardiac arrhythmias |
WO2010138228A1 (en) | 2009-05-26 | 2010-12-02 | Cardiac Pacemakers, Inc. | Helically formed coil for a neural cuff electrode |
US8958873B2 (en) * | 2009-05-28 | 2015-02-17 | Cardiac Pacemakers, Inc. | Method and apparatus for safe and efficient delivery of cardiac stress augmentation pacing |
US8825158B2 (en) * | 2009-08-25 | 2014-09-02 | Lamda Nu, Llc | Method and apparatus for detection of lead conductor anomalies using dynamic electrical parameters |
US8708979B2 (en) | 2009-08-26 | 2014-04-29 | Apollo Endosurgery, Inc. | Implantable coupling device |
US8715158B2 (en) * | 2009-08-26 | 2014-05-06 | Apollo Endosurgery, Inc. | Implantable bottom exit port |
US8506532B2 (en) * | 2009-08-26 | 2013-08-13 | Allergan, Inc. | System including access port and applicator tool |
US8812104B2 (en) * | 2009-09-23 | 2014-08-19 | Cardiac Pacemakers, Inc. | Method and apparatus for automated control of pacing post-conditioning |
KR20120101650A (en) | 2009-11-10 | 2012-09-14 | 임테라 메디칼, 인코포레이티드 | System for stimulating a hypoglossal nerve for controlling the position of a patient's tongue |
US20110196195A1 (en) * | 2010-02-05 | 2011-08-11 | Allergan, Inc. | Implantable subcutaneous access port |
US8882728B2 (en) * | 2010-02-10 | 2014-11-11 | Apollo Endosurgery, Inc. | Implantable injection port |
EP3338736B1 (en) * | 2010-03-09 | 2020-04-29 | Solinas Medical Inc. | Self-closing devices |
US8478428B2 (en) * | 2010-04-23 | 2013-07-02 | Cyberonics, Inc. | Helical electrode for nerve stimulation |
US20110270025A1 (en) | 2010-04-30 | 2011-11-03 | Allergan, Inc. | Remotely powered remotely adjustable gastric band system |
US8992415B2 (en) | 2010-04-30 | 2015-03-31 | Apollo Endosurgery, Inc. | Implantable device to protect tubing from puncture |
US20110270021A1 (en) | 2010-04-30 | 2011-11-03 | Allergan, Inc. | Electronically enhanced access port for a fluid filled implant |
US20120041258A1 (en) | 2010-08-16 | 2012-02-16 | Allergan, Inc. | Implantable access port system |
US20130150685A1 (en) * | 2010-08-23 | 2013-06-13 | Landy Aaron Toth | System and method for monitoring a surgical site |
WO2012149511A2 (en) | 2011-04-28 | 2012-11-01 | Synecor Llc | Neuromodulation systems and methods for treating acute heart failure syndromes |
US20120065460A1 (en) | 2010-09-14 | 2012-03-15 | Greg Nitka | Implantable access port system |
JP5577469B2 (en) | 2010-09-15 | 2014-08-20 | カーディアック ペースメイカーズ, インコーポレイテッド | Automatic selection of lead configuration for neural stimulation leads |
JP6046041B2 (en) | 2010-10-25 | 2016-12-14 | メドトロニック アーディアン ルクセンブルク ソシエテ ア レスポンサビリテ リミテ | Devices, systems, and methods for neuromodulation therapy evaluation and feedback |
US9457186B2 (en) | 2010-11-15 | 2016-10-04 | Bluewind Medical Ltd. | Bilateral feedback |
US9186504B2 (en) | 2010-11-15 | 2015-11-17 | Rainbow Medical Ltd | Sleep apnea treatment |
US9068556B2 (en) | 2010-11-26 | 2015-06-30 | Vestas Wind Systems A/S | Pilot circuitry for controlling the emergency feathering of a wind turbine |
US20120158086A1 (en) * | 2010-12-17 | 2012-06-21 | Medtronic, Inc. | Aortic pacing to reduce heart rate |
WO2012092364A2 (en) | 2010-12-28 | 2012-07-05 | G & L Consulting, Llc | Method for sympathetic rebalancing of patient |
US8821373B2 (en) | 2011-05-10 | 2014-09-02 | Apollo Endosurgery, Inc. | Directionless (orientation independent) needle injection port |
US9980645B1 (en) * | 2011-06-21 | 2018-05-29 | Case Western Reserve University | High-contact density electrode and fabrication technique for an implantable cuff design |
JP2014516640A (en) | 2011-06-28 | 2014-07-17 | カーディアック ペースメイカーズ, インコーポレイテッド | Strain relief mechanism for lead of implantable medical device |
WO2013006295A1 (en) | 2011-07-07 | 2013-01-10 | Cardiac Pacemakers, Inc. | Insulation and stability features for an implantable medical device lead |
CA2878396A1 (en) | 2011-07-11 | 2013-02-28 | Interventional Autonomics Corporation | System and method for neuromodulation |
US20130072995A1 (en) | 2011-07-11 | 2013-03-21 | Terrance Ransbury | Catheter system for acute neuromodulation |
US9446240B2 (en) | 2011-07-11 | 2016-09-20 | Interventional Autonomics Corporation | System and method for neuromodulation |
US10022263B2 (en) | 2011-07-14 | 2018-07-17 | Cook Medical Technologies Llc | Sling-based treatment of obstructive sleep apnea |
US9433722B2 (en) * | 2011-08-09 | 2016-09-06 | Abbott Cardiovascular Systems Inc. | Vascular shield and delivery system |
US8801597B2 (en) | 2011-08-25 | 2014-08-12 | Apollo Endosurgery, Inc. | Implantable access port with mesh attachment rivets |
US8934992B2 (en) | 2011-09-01 | 2015-01-13 | Inspire Medical Systems, Inc. | Nerve cuff |
CA2852707A1 (en) | 2011-10-19 | 2013-04-25 | Sympara Medical Inc. | Methods and devices for treating hypertension |
US9199069B2 (en) | 2011-10-20 | 2015-12-01 | Apollo Endosurgery, Inc. | Implantable injection port |
US8923973B2 (en) | 2011-11-10 | 2014-12-30 | Rainbow Medical Ltd. | Blood flow control element |
US8858421B2 (en) | 2011-11-15 | 2014-10-14 | Apollo Endosurgery, Inc. | Interior needle stick guard stems for tubes |
US9089395B2 (en) | 2011-11-16 | 2015-07-28 | Appolo Endosurgery, Inc. | Pre-loaded septum for use with an access port |
US10328253B2 (en) * | 2011-11-30 | 2019-06-25 | Medtronic, Inc. | Medical electrical stimulation lead including expandable coiled fixation element |
US8918191B2 (en) | 2011-12-07 | 2014-12-23 | Cyberonics, Inc. | Implantable device for providing electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction with bounded titration |
US8630709B2 (en) | 2011-12-07 | 2014-01-14 | Cyberonics, Inc. | Computer-implemented system and method for selecting therapy profiles of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction |
US10188856B1 (en) | 2011-12-07 | 2019-01-29 | Cyberonics, Inc. | Implantable device for providing electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction |
US8918190B2 (en) | 2011-12-07 | 2014-12-23 | Cyberonics, Inc. | Implantable device for evaluating autonomic cardiovascular drive in a patient suffering from chronic cardiac dysfunction |
US8600505B2 (en) | 2011-12-07 | 2013-12-03 | Cyberonics, Inc. | Implantable device for facilitating control of electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction |
US8577458B1 (en) | 2011-12-07 | 2013-11-05 | Cyberonics, Inc. | Implantable device for providing electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction with leadless heart rate monitoring |
US8700150B2 (en) | 2012-01-17 | 2014-04-15 | Cyberonics, Inc. | Implantable neurostimulator for providing electrical stimulation of cervical vagus nerves for treatment of chronic cardiac dysfunction with bounded titration |
US8571654B2 (en) | 2012-01-17 | 2013-10-29 | Cyberonics, Inc. | Vagus nerve neurostimulator with multiple patient-selectable modes for treating chronic cardiac dysfunction |
EP3556427B1 (en) | 2012-03-05 | 2022-06-08 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus |
CA2865242A1 (en) | 2012-03-08 | 2013-09-12 | Medtronic Ardian Luxembourg S.A.R.L. | Biomarker sampling in the context of neuromodulation devices and associated systems and methods |
AU2013230781B2 (en) | 2012-03-08 | 2015-12-03 | Medtronic Af Luxembourg S.A.R.L. | Ovarian neuromodulation and associated systems and methods |
US8774940B2 (en) * | 2012-03-08 | 2014-07-08 | Advanced Neuromodulation Systems, Inc. | Paddle lead body with insertion tab |
JP6026567B2 (en) | 2012-03-21 | 2016-11-16 | カーディアック ペースメイカーズ, インコーポレイテッド | System and method for stimulating the vagus nerve |
US20130303876A1 (en) | 2012-03-28 | 2013-11-14 | Mark Gelfand | Carotid body modulation planning and assessment |
US9681836B2 (en) | 2012-04-23 | 2017-06-20 | Cyberonics, Inc. | Methods, systems and apparatuses for detecting seizure and non-seizure states |
CN107693114A (en) | 2012-04-24 | 2018-02-16 | 西比姆公司 | The catheter in blood vessel and method extractd for carotid body |
US11395921B2 (en) * | 2012-04-29 | 2022-07-26 | Nuxcel2 Llc | Intravascular electrode arrays for neuromodulation |
US20130304102A1 (en) * | 2012-05-09 | 2013-11-14 | Vascular Dynamics, Inc. | Methods and apparatus for stimulating stretch receptors in the vasculature |
US8812103B2 (en) | 2012-06-01 | 2014-08-19 | Lamda Nu, Llc | Method for detecting and treating insulation lead-to-housing failures |
GB201209771D0 (en) * | 2012-06-01 | 2012-07-18 | Bioinduction Ltd | Precision delivery of electrical therapy |
EP2854681A4 (en) | 2012-06-01 | 2016-02-17 | Cibiem Inc | Percutaneous methods and devices for carotid body ablation |
US9272150B2 (en) | 2012-06-01 | 2016-03-01 | Lambda Nu Technology Llc | Method for detecting and localizing insulation failures of implantable device leads |
WO2013181660A1 (en) | 2012-06-01 | 2013-12-05 | Cibiem, Inc. | Methods and devices for cryogenic carotid body ablation |
CA2877049C (en) | 2012-06-21 | 2022-08-16 | Simon Fraser University | Transvascular diaphragm pacing systems and methods of use |
US9283033B2 (en) | 2012-06-30 | 2016-03-15 | Cibiem, Inc. | Carotid body ablation via directed energy |
US8688212B2 (en) | 2012-07-20 | 2014-04-01 | Cyberonics, Inc. | Implantable neurostimulator-implemented method for managing bradycardia through vagus nerve stimulation |
US9283379B2 (en) | 2012-10-02 | 2016-03-15 | Cardiac Pacemakers, Inc. | Pinch to open cuff electrode |
WO2014055408A1 (en) | 2012-10-02 | 2014-04-10 | Cardiac Pacemakers, Inc. | Pinch to open cuff electrode |
US10314736B2 (en) | 2012-10-16 | 2019-06-11 | Cook Medical Technologies Llc | Method and apparatus for treating obstructive sleep apnea (OSA) |
US20140110296A1 (en) | 2012-10-19 | 2014-04-24 | Medtronic Ardian Luxembourg S.A.R.L. | Packaging for Catheter Treatment Devices and Associated Devices, Systems, and Methods |
US9452290B2 (en) | 2012-11-09 | 2016-09-27 | Cyberonics, Inc. | Implantable neurostimulator-implemented method for managing tachyarrhythmia through vagus nerve stimulation |
US9643008B2 (en) | 2012-11-09 | 2017-05-09 | Cyberonics, Inc. | Implantable neurostimulator-implemented method for enhancing post-exercise recovery through vagus nerve stimulation |
US8923964B2 (en) | 2012-11-09 | 2014-12-30 | Cyberonics, Inc. | Implantable neurostimulator-implemented method for enhancing heart failure patient awakening through vagus nerve stimulation |
US9675799B2 (en) | 2012-12-05 | 2017-06-13 | Lambda Nu Technology Llc | Method and apparatus for implantable cardiac lead integrity analysis |
JP6026674B2 (en) | 2012-12-28 | 2016-11-16 | カーディアック ペースメイカーズ, インコーポレイテッド | Stimulation cuff and implantable device |
US20140214143A1 (en) * | 2013-01-31 | 2014-07-31 | Ronnie Levy | Electrostimulation in treating cerebrovascular conditions |
US9320889B2 (en) | 2013-02-13 | 2016-04-26 | Cardiac Pacemakers, Inc. | Cuff electrode with integrated tendril |
US20160023016A1 (en) * | 2013-03-11 | 2016-01-28 | Giorgio Bonmassar | Eletromagnetic cortical stimulation device |
US9643011B2 (en) | 2013-03-14 | 2017-05-09 | Cyberonics, Inc. | Implantable neurostimulator-implemented method for managing tachyarrhythmic risk during sleep through vagus nerve stimulation |
US10039919B2 (en) | 2013-04-30 | 2018-08-07 | Lambda Nu Technology Llc | Methods and apparatus for detecting and localizing partial conductor failures of implantable device leads |
US9486624B2 (en) | 2013-06-13 | 2016-11-08 | Lambda Nu Technology Llc | Detection of implantable lead failures by differential EGM analysis |
WO2014204980A1 (en) * | 2013-06-18 | 2014-12-24 | Cardiac Pacemakers, Inc. | System and method for mapping baroreceptors |
US10118031B2 (en) | 2013-06-28 | 2018-11-06 | Lambda Nu Technology Llc | Method and apparatus for implantable cardiac lead integrity analysis |
CN105377361B (en) | 2013-07-14 | 2018-09-14 | 心脏起搏器股份公司 | The multi-electrode conducting wire with backing for machinery/pressoreceptor stimulation |
WO2015017749A1 (en) | 2013-08-01 | 2015-02-05 | Mohan P Arun | Tissue adjustment implant |
CN105392433B (en) | 2013-08-05 | 2019-02-19 | 库克医学技术有限责任公司 | Medical device and its application method with releasable tubular element |
EP3030167A4 (en) | 2013-08-07 | 2017-03-22 | Cibiem, Inc. | Carotid body ablation via directed energy |
US10166386B2 (en) * | 2013-10-14 | 2019-01-01 | The Board Of Regents Of The University Of Oklahoma | Implantable electrode assembly |
US9999773B2 (en) | 2013-10-30 | 2018-06-19 | Cyberonics, Inc. | Implantable neurostimulator-implemented method utilizing multi-modal stimulation parameters |
EP4241830A3 (en) | 2013-11-07 | 2023-10-04 | SafeOp Surgical, Inc. | Systems and methods for detecting nerve function |
JP6456382B2 (en) | 2013-11-22 | 2019-01-23 | ラングペーサー メディカル インコーポレイテッドLungpacer Medical Inc. | catheter |
US9839785B2 (en) | 2013-12-13 | 2017-12-12 | Cardiac Pacemakers, Inc. | Surgical instrument for implanting leads for baroreceptor stimulation therapy |
EP3498156B1 (en) * | 2013-12-20 | 2024-06-12 | St. Jude Medical, Cardiology Division, Inc. | Coaxial electrode catheters for extracting electrophysiologic parameters |
US9511228B2 (en) | 2014-01-14 | 2016-12-06 | Cyberonics, Inc. | Implantable neurostimulator-implemented method for managing hypertension through renal denervation and vagus nerve stimulation |
EP3566743B1 (en) | 2014-01-21 | 2021-03-10 | Lungpacer Medical Inc. | Systems for optimization of multi-electrode nerve pacing |
EP2898920B1 (en) | 2014-01-24 | 2018-06-06 | Cook Medical Technologies LLC | Articulating balloon catheter |
US10029091B2 (en) | 2014-02-20 | 2018-07-24 | Cardiac Pacemakers, Inc. | Apparatus for baroreceptor stimulation therapy |
US10499908B2 (en) | 2014-03-04 | 2019-12-10 | Maquet Cardiovascular Llc | Surgical implant and method and instrument for installing the same |
WO2015134682A1 (en) | 2014-03-04 | 2015-09-11 | Maquet Cardiovascular Llc | Surgical implant and method and instrument for installing the same |
EP3116408B1 (en) | 2014-03-12 | 2018-12-19 | Cibiem, Inc. | Ultrasound ablation catheter |
US9713719B2 (en) | 2014-04-17 | 2017-07-25 | Cyberonics, Inc. | Fine resolution identification of a neural fulcrum for the treatment of chronic cardiac dysfunction |
US9415224B2 (en) | 2014-04-25 | 2016-08-16 | Cyberonics, Inc. | Neurostimulation and recording of physiological response for the treatment of chronic cardiac dysfunction |
US9272143B2 (en) | 2014-05-07 | 2016-03-01 | Cyberonics, Inc. | Responsive neurostimulation for the treatment of chronic cardiac dysfunction |
US9636500B2 (en) | 2014-03-25 | 2017-05-02 | Lambda Nu Technology Llc | Active surveillance of implanted medical leads for lead integrity |
US9409024B2 (en) | 2014-03-25 | 2016-08-09 | Cyberonics, Inc. | Neurostimulation in a neural fulcrum zone for the treatment of chronic cardiac dysfunction |
US9950169B2 (en) | 2014-04-25 | 2018-04-24 | Cyberonics, Inc. | Dynamic stimulation adjustment for identification of a neural fulcrum |
US10194979B1 (en) | 2014-03-28 | 2019-02-05 | Medtronic Ardian Luxembourg S.A.R.L. | Methods for catheter-based renal neuromodulation |
US9980766B1 (en) | 2014-03-28 | 2018-05-29 | Medtronic Ardian Luxembourg S.A.R.L. | Methods and systems for renal neuromodulation |
US10194980B1 (en) | 2014-03-28 | 2019-02-05 | Medtronic Ardian Luxembourg S.A.R.L. | Methods for catheter-based renal neuromodulation |
CN111790047B (en) | 2014-05-22 | 2022-09-27 | 卡迪诺米克公司 | Catheter and catheter system for electrical neuromodulation |
US9974563B2 (en) | 2014-05-28 | 2018-05-22 | Cook Medical Technologies Llc | Medical devices having a releasable member and methods of using the same |
EP2957225A1 (en) * | 2014-06-18 | 2015-12-23 | STBL Medical Research AG | Strain gauge device and equipment with such strain gauge devices |
JP6306211B2 (en) | 2014-06-19 | 2018-04-04 | カーディアック ペースメイカーズ, インコーポレイテッド | Baroreceptor mapping system |
US9913661B2 (en) | 2014-08-04 | 2018-03-13 | Cook Medical Technologies Llc | Medical devices having a releasable tubular member and methods of using the same |
US9770599B2 (en) | 2014-08-12 | 2017-09-26 | Cyberonics, Inc. | Vagus nerve stimulation and subcutaneous defibrillation system |
US9533153B2 (en) | 2014-08-12 | 2017-01-03 | Cyberonics, Inc. | Neurostimulation titration process |
US9737716B2 (en) | 2014-08-12 | 2017-08-22 | Cyberonics, Inc. | Vagus nerve and carotid baroreceptor stimulation system |
CA2957967C (en) | 2014-08-15 | 2018-11-27 | Axonics Modulation Technologies, Inc. | Systems and methods for neurostimulation electrode configurations based on neural localization |
WO2016025913A1 (en) | 2014-08-15 | 2016-02-18 | Axonics Modulation Technologies, Inc. | Electromyographic lead positioning and stimulation titration in a nerve stimulation system for treatment of overactive bladder |
JP6779860B2 (en) | 2014-08-15 | 2020-11-04 | アクソニクス モジュレーション テクノロジーズ インコーポレイテッド | Integrated EMG clinician programming device for use with implantable neurostimulators |
US10702176B2 (en) | 2014-08-22 | 2020-07-07 | Children's Medical Center Corporation | Multielectrode ECG sensor |
US9572975B2 (en) | 2014-09-02 | 2017-02-21 | Cardiac Pacemakers, Inc. | Paddle leads configured for suture fixation |
AU2015315658B2 (en) | 2014-09-08 | 2019-05-23 | CARDIONOMIC, Inc. | Catheter and electrode systems for electrical neuromodulation |
WO2016040038A1 (en) | 2014-09-08 | 2016-03-17 | CARDIONOMIC, Inc. | Methods for electrical neuromodulation of the heart |
US9504832B2 (en) | 2014-11-12 | 2016-11-29 | Cyberonics, Inc. | Neurostimulation titration process via adaptive parametric modification |
WO2016108246A1 (en) * | 2014-12-29 | 2016-07-07 | Singh Ajoy I | A system and method for treating artery |
CN107206241B (en) | 2015-01-05 | 2019-02-15 | 卡迪诺米克公司 | Heart, which is adjusted, promotes method and system |
US10039466B2 (en) * | 2015-01-28 | 2018-08-07 | City University Of Hong Kong | Apparatus for detection of electrical signals of a biological subject and electrode thereof, and method of manufacture thereof |
US20180073515A1 (en) * | 2015-03-20 | 2018-03-15 | Mitsubishi Heavy Industries, Ltd. | Centrifugal compressor and supercharger comprising same |
US20170042551A1 (en) | 2015-08-13 | 2017-02-16 | The Brain Protection Company PTY LTD | Implantable damping devices for treating dementia and associated systems and methods of use |
US10252069B1 (en) | 2015-11-19 | 2019-04-09 | Lambda Nu Technology Llc | Micro-charge ICD lead testing method and apparatus |
US11058378B2 (en) * | 2016-02-03 | 2021-07-13 | Globus Medical, Inc. | Portable medical imaging system |
US10814127B2 (en) | 2016-02-05 | 2020-10-27 | Boston Scientific Neuromodulation Corporation | Slotted sleeve neurostimulation device |
US10485969B2 (en) | 2016-02-19 | 2019-11-26 | Boston Scientific Neuromodulation Corporation | Electrical stimulation cuff devices and systems |
CN109310863A (en) | 2016-03-09 | 2019-02-05 | 卡迪诺米克公司 | Cardiac contractility neural stimulation system and method |
AU2017240582A1 (en) | 2016-04-01 | 2018-11-22 | Cardiac Pacemakers, Inc. | Systems and methods for detecting worsening heart failure |
US10493269B2 (en) | 2016-06-02 | 2019-12-03 | Boston Scientific Neuromodulation Corporation | Leads for electrostimulation of peripheral nerves and other targets |
EP3452163A1 (en) | 2016-07-29 | 2019-03-13 | Boston Scientific Neuromodulation Corporation | Systems and methods for making and using an electrical stimulation system for peripheral nerve stimulation |
US11986321B2 (en) | 2016-09-22 | 2024-05-21 | Safeop Surgical, Inc. | System and method for detecting and removing periodic non-physiological artifact from evoked potentials |
CN206576856U (en) | 2016-11-26 | 2017-10-24 | 张霞玲 | A kind of adjustable neurostimulation probe in direction |
WO2018102773A1 (en) | 2016-12-02 | 2018-06-07 | Boston Scientific Neuromodulation Corporation | Methods and systems for selecting stimulation parameters for electrical stimulation devices |
JP7187473B2 (en) | 2017-03-22 | 2022-12-12 | セーフオプ サージカル インコーポレイテッド | Medical system and method for detecting changes in electrophysiological evoked potentials |
US10543364B2 (en) | 2017-04-07 | 2020-01-28 | Lambda Nu Technology Llc | Detection of lead electrode dislodgement using cavitary electrogram |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
EP3760280A1 (en) * | 2017-06-16 | 2021-01-06 | Alphatec Spine, Inc. | Systems, methods, and devices for detecting the threshold of nerve-muscle response using variable frequency stimulation |
US11331215B2 (en) * | 2017-06-19 | 2022-05-17 | Medicool Technologies Inc. | Implantable thermal therapy devices |
CN111093572A (en) | 2017-06-29 | 2020-05-01 | 库克医学技术有限责任公司 | Implantable medical device for repositioning tissue |
EP3645107B1 (en) | 2017-06-30 | 2022-08-31 | Lungpacer Medical Inc. | Systems for prevention, moderation, and/or treatment of cognitive injury |
WO2019020984A1 (en) * | 2017-07-28 | 2019-01-31 | Galvani Bioelectronics Limited | Electrode devices and methods of manufacturing |
US10195429B1 (en) | 2017-08-02 | 2019-02-05 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10940308B2 (en) | 2017-08-04 | 2021-03-09 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
EP3664889B1 (en) | 2017-08-11 | 2024-02-21 | Inspire Medical Systems, Inc. | Cuff electrode |
WO2019055434A1 (en) | 2017-09-13 | 2019-03-21 | CARDIONOMIC, Inc. | Neurostimulation systems and methods for affecting cardiac contractility |
US20190117970A1 (en) * | 2017-10-23 | 2019-04-25 | Cardiac Pacemakers, Inc. | Electric field shaping leads for treatment of cancer |
EP3700620B1 (en) * | 2017-10-23 | 2022-08-03 | Mayo Foundation for Medical Education and Research | Systems for electroporation |
US20190175908A1 (en) | 2017-12-11 | 2019-06-13 | Lungpacer Medical Inc. | Systems and methods for strengthening a respiratory muscle |
CN112839602A (en) | 2018-08-13 | 2021-05-25 | 卡迪诺米克公司 | System and method for influencing cardiac contractility and/or relaxation |
WO2020097331A1 (en) | 2018-11-08 | 2020-05-14 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
CN109907741B (en) * | 2019-03-06 | 2022-04-01 | 智美康民(珠海)健康科技有限公司 | Three-dimensional pulse wave display method and device, computer equipment and storage medium |
SG11202111619WA (en) | 2019-05-06 | 2021-11-29 | Cardionomic Inc | Systems and methods for denoising physiological signals during electrical neuromodulation |
EP3968932A4 (en) | 2019-05-16 | 2023-01-18 | Lungpacer Medical Inc. | Systems and methods for sensing and stimulation |
US11439829B2 (en) | 2019-05-24 | 2022-09-13 | Axonics, Inc. | Clinician programmer methods and systems for maintaining target operating temperatures |
US11848090B2 (en) | 2019-05-24 | 2023-12-19 | Axonics, Inc. | Trainer for a neurostimulator programmer and associated methods of use with a neurostimulation system |
US11771900B2 (en) | 2019-06-12 | 2023-10-03 | Lungpacer Medical Inc. | Circuitry for medical stimulation systems |
US11406827B2 (en) * | 2019-11-08 | 2022-08-09 | Meagan Medical, Inc. | Spinal cord stimulation with interferential current using multiple beat signals |
US12011252B2 (en) * | 2021-04-19 | 2024-06-18 | Teliatry, Inc. | Sensors for in-vivo measurements |
CN117795415A (en) * | 2021-06-16 | 2024-03-29 | 拉瓦勒大学 | Electrode structure for fresnel lens device |
WO2023139079A1 (en) * | 2022-01-24 | 2023-07-27 | Koninklijke Philips N.V. | Sympathetic nervous system response to stimulation of carotid bodies for patient stratification in renal denervation |
Citations (94)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3645267A (en) * | 1969-10-29 | 1972-02-29 | Medtronic Inc | Medical-electronic stimulator, particularly a carotid sinus nerve stimulator with controlled turn-on amplitude rate |
US3650277A (en) * | 1969-02-24 | 1972-03-21 | Lkb Medical Ab | Apparatus for influencing the systemic blood pressure in a patient by carotid sinus nerve stimulation |
US3870051A (en) * | 1972-04-27 | 1975-03-11 | Nat Res Dev | Urinary control |
US3943936A (en) * | 1970-09-21 | 1976-03-16 | Rasor Associates, Inc. | Self powered pacers and stimulators |
US4014318A (en) * | 1973-08-20 | 1977-03-29 | Dockum James M | Circulatory assist device and system |
US4256094A (en) * | 1979-06-18 | 1981-03-17 | Kapp John P | Arterial pressure control system |
US4323073A (en) * | 1978-09-11 | 1982-04-06 | Cos Electronics Corporation | Apparatus and method for controlling the application of therapeutic direct current to living tissue |
US4331157A (en) * | 1980-07-09 | 1982-05-25 | Stimtech, Inc. | Mutually noninterfering transcutaneous nerve stimulation and patient monitoring |
US4525074A (en) * | 1983-08-19 | 1985-06-25 | Citizen Watch Co., Ltd. | Apparatus for measuring the quantity of physical exercise |
US4573481A (en) * | 1984-06-25 | 1986-03-04 | Huntington Institute Of Applied Research | Implantable electrode array |
US4586501A (en) * | 1982-10-21 | 1986-05-06 | Michel Claracq | Device for partly occluding a vessel in particular the inferior vena cava and inherent component of this device |
US4590946A (en) * | 1984-06-14 | 1986-05-27 | Biomed Concepts, Inc. | Surgically implantable electrode for nerve bundles |
US4640286A (en) * | 1984-11-02 | 1987-02-03 | Staodynamics, Inc. | Optimized nerve fiber stimulation |
US4641664A (en) * | 1984-04-13 | 1987-02-10 | Siemens Aktiengesellschaft | Endocardial electrode arrangement |
US4664120A (en) * | 1986-01-22 | 1987-05-12 | Cordis Corporation | Adjustable isodiametric atrial-ventricular pervenous lead |
US4719921A (en) * | 1985-08-28 | 1988-01-19 | Raul Chirife | Cardiac pacemaker adaptive to physiological requirements |
US4739762A (en) * | 1985-11-07 | 1988-04-26 | Expandable Grafts Partnership | Expandable intraluminal graft, and method and apparatus for implanting an expandable intraluminal graft |
US4800882A (en) * | 1987-03-13 | 1989-01-31 | Cook Incorporated | Endovascular stent and delivery system |
US4813418A (en) * | 1987-02-02 | 1989-03-21 | Staodynamics, Inc. | Nerve fiber stimulation using symmetrical biphasic waveform applied through plural equally active electrodes |
US4825871A (en) * | 1984-03-27 | 1989-05-02 | Societe Anonyme Dite: Atesys | Defibrillating or cardioverting electric shock system including electrodes |
US4828544A (en) * | 1984-09-05 | 1989-05-09 | Quotidian No. 100 Pty Limited | Control of blood flow |
US4830003A (en) * | 1988-06-17 | 1989-05-16 | Wolff Rodney G | Compressive stent and delivery system |
US4832038A (en) * | 1985-06-05 | 1989-05-23 | The Board Of Trustees Of University Of Illinois | Apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis |
US4917092A (en) * | 1988-07-13 | 1990-04-17 | Medical Designs, Inc. | Transcutaneous nerve stimulator for treatment of sympathetic nerve dysfunction |
US4930517A (en) * | 1989-04-25 | 1990-06-05 | Massachusetts Institute Of Technology | Method and apparatus for physiologic system identification |
US4987897A (en) * | 1989-09-18 | 1991-01-29 | Medtronic, Inc. | Body bus medical device communication system |
US5025807A (en) * | 1983-09-14 | 1991-06-25 | Jacob Zabara | Neurocybernetic prosthesis |
US5078736A (en) * | 1990-05-04 | 1992-01-07 | Interventional Thermodynamics, Inc. | Method and apparatus for maintaining patency in the body passages |
US5086787A (en) * | 1989-12-06 | 1992-02-11 | Medtronic, Inc. | Steroid eluting intramuscular lead |
US5092332A (en) * | 1990-02-22 | 1992-03-03 | Medtronic, Inc. | Steroid eluting cuff electrode for peripheral nerve stimulation |
US5113869A (en) * | 1990-08-21 | 1992-05-19 | Telectronics Pacing Systems, Inc. | Implantable ambulatory electrocardiogram monitor |
US5113859A (en) * | 1988-09-19 | 1992-05-19 | Medtronic, Inc. | Acoustic body bus medical device communication system |
US5117826A (en) * | 1987-02-02 | 1992-06-02 | Staodyn, Inc. | Combined nerve fiber and body tissue stimulation apparatus and method |
US5181911A (en) * | 1991-04-22 | 1993-01-26 | Shturman Technologies, Inc. | Helical balloon perfusion angioplasty catheter |
US5199428A (en) * | 1991-03-22 | 1993-04-06 | Medtronic, Inc. | Implantable electrical nerve stimulator/pacemaker with ischemia for decreasing cardiac workload |
US5203326A (en) * | 1991-12-18 | 1993-04-20 | Telectronics Pacing Systems, Inc. | Antiarrhythmia pacer using antiarrhythmia pacing and autonomic nerve stimulation therapy |
US5215089A (en) * | 1991-10-21 | 1993-06-01 | Cyberonics, Inc. | Electrode assembly for nerve stimulation |
US5222971A (en) * | 1990-10-09 | 1993-06-29 | Scimed Life Systems, Inc. | Temporary stent and methods for use and manufacture |
US5282468A (en) * | 1990-06-07 | 1994-02-01 | Medtronic, Inc. | Implantable neural electrode |
US5295959A (en) * | 1992-03-13 | 1994-03-22 | Medtronic, Inc. | Autoperfusion dilatation catheter having a bonded channel |
US5299589A (en) * | 1992-05-12 | 1994-04-05 | Guardian Products, Inc. | Orthopedic crutch with adjustable hand grip |
US5304206A (en) * | 1991-11-18 | 1994-04-19 | Cyberonics, Inc. | Activation techniques for implantable medical device |
US5314453A (en) * | 1991-12-06 | 1994-05-24 | Spinal Cord Society | Position sensitive power transfer antenna |
US5318592A (en) * | 1991-09-12 | 1994-06-07 | BIOTRONIK, Mess- und Therapiegerate GmbH & Co., Ingenieurburo Berlin | Cardiac therapy system |
US5324310A (en) * | 1992-07-01 | 1994-06-28 | Medtronic, Inc. | Cardiac pacemaker with auto-capture function |
US5324325A (en) * | 1991-06-27 | 1994-06-28 | Siemens Pacesetter, Inc. | Myocardial steroid releasing lead |
US5408744A (en) * | 1993-04-30 | 1995-04-25 | Medtronic, Inc. | Substrate for a sintered electrode |
US5411540A (en) * | 1993-06-03 | 1995-05-02 | Massachusetts Institute Of Technology | Method and apparatus for preferential neuron stimulation |
US5509888A (en) * | 1994-07-26 | 1996-04-23 | Conceptek Corporation | Controller valve device and method |
US5522874A (en) * | 1994-07-28 | 1996-06-04 | Gates; James T. | Medical lead having segmented electrode |
US5522854A (en) * | 1994-05-19 | 1996-06-04 | Duke University | Method and apparatus for the prevention of arrhythmia by nerve stimulation |
US5529067A (en) * | 1994-08-19 | 1996-06-25 | Novoste Corporation | Methods for procedures related to the electrophysiology of the heart |
US5634878A (en) * | 1993-09-17 | 1997-06-03 | Eska Medical Gmbh & Co. | Implantable device for selectively opening and closing a tubular organ of the body |
US5707400A (en) * | 1995-09-19 | 1998-01-13 | Cyberonics, Inc. | Treating refractory hypertension by nerve stimulation |
US5715837A (en) * | 1996-08-29 | 1998-02-10 | Light Sciences Limited Partnership | Transcutaneous electromagnetic energy transfer |
US5725471A (en) * | 1994-11-28 | 1998-03-10 | Neotonus, Inc. | Magnetic nerve stimulator for exciting peripheral nerves |
US5725563A (en) * | 1993-04-21 | 1998-03-10 | Klotz; Antoine | Electronic device and method for adrenergically stimulating the sympathetic system with respect to the venous media |
US5727558A (en) * | 1996-02-14 | 1998-03-17 | Hakki; A-Hamid | Noninvasive blood pressure monitor and control device |
US5741316A (en) * | 1996-12-02 | 1998-04-21 | Light Sciences Limited Partnership | Electromagnetic coil configurations for power transmission through tissue |
US5766236A (en) * | 1996-04-19 | 1998-06-16 | Detty; Gerald D. | Electrical stimulation support braces |
US5766527A (en) * | 1993-10-29 | 1998-06-16 | Medtronic, Inc. | Method of manufacturing medical electrical lead |
US5861012A (en) * | 1994-08-16 | 1999-01-19 | Medtronic, Inc. | Atrial and ventricular capture detection and threshold-seeking pacemaker |
US5861015A (en) * | 1997-05-05 | 1999-01-19 | Benja-Athon; Anuthep | Modulation of the nervous system for treatment of pain and related disorders |
US5876422A (en) * | 1998-07-07 | 1999-03-02 | Vitatron Medical B.V. | Pacemaker system with peltier cooling of A-V node for treating atrial fibrillation |
US5891181A (en) * | 1995-12-23 | 1999-04-06 | Zhu; Qiang | Blood pressure depressor |
US5904708A (en) * | 1998-03-19 | 1999-05-18 | Medtronic, Inc. | System and method for deriving relative physiologic signals |
US5913876A (en) * | 1996-02-20 | 1999-06-22 | Cardiothoracic Systems, Inc. | Method and apparatus for using vagus nerve stimulation in surgery |
US5916239A (en) * | 1996-03-29 | 1999-06-29 | Purdue Research Foundation | Method and apparatus using vagal stimulation for control of ventricular rate during atrial fibrillation |
US6016449A (en) * | 1997-10-27 | 2000-01-18 | Neuropace, Inc. | System for treatment of neurological disorders |
US6023642A (en) * | 1997-05-08 | 2000-02-08 | Biogenics Ii, Llc | Compact transcutaneous electrical nerve stimulator |
US6052623A (en) * | 1998-11-30 | 2000-04-18 | Medtronic, Inc. | Feedthrough assembly for implantable medical devices and methods for providing same |
US6058331A (en) * | 1998-04-27 | 2000-05-02 | Medtronic, Inc. | Apparatus and method for treating peripheral vascular disease and organ ischemia by electrical stimulation with closed loop feedback control |
US6061596A (en) * | 1995-11-24 | 2000-05-09 | Advanced Bionics Corporation | Method for conditioning pelvic musculature using an implanted microstimulator |
US6178349B1 (en) * | 1999-04-15 | 2001-01-23 | Medtronic, Inc. | Drug delivery neural stimulation device for treatment of cardiovascular disorders |
US6208894B1 (en) * | 1997-02-26 | 2001-03-27 | Alfred E. Mann Foundation For Scientific Research And Advanced Bionics | System of implantable devices for monitoring and/or affecting body parameters |
US6231516B1 (en) * | 1997-10-14 | 2001-05-15 | Vacusense, Inc. | Endoluminal implant with therapeutic and diagnostic capability |
US20020005982A1 (en) * | 2000-07-17 | 2002-01-17 | Rolf Borlinghaus | Arrangement for spectrally sensitive reflected-light and transmitted-light microscopy |
US6522926B1 (en) * | 2000-09-27 | 2003-02-18 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US20030040785A1 (en) * | 2001-08-21 | 2003-02-27 | Maschino Steve E. | Circumneural electrode assembly |
US20030060857A1 (en) * | 2000-09-27 | 2003-03-27 | Perrson Bruce J. | Electrode designs and methods of use for cardiovascular reflex control devices |
US20030060858A1 (en) * | 2000-09-27 | 2003-03-27 | Kieval Robert S. | Stimulus regimens for cardiovascular reflex control |
US20030060848A1 (en) * | 2001-09-26 | 2003-03-27 | Kieval Robert S. | Mapping methods for cardiovascular reflex control devices |
US6564101B1 (en) * | 1998-02-02 | 2003-05-13 | The Trustees Of Columbia University In The City Of New York | Electrical system for weight loss and laparoscopic implanation thereof |
US20030100924A1 (en) * | 2001-04-20 | 2003-05-29 | Foreman Robert D. | Cardiac neuromodulation and methods of using same |
US20040010303A1 (en) * | 2001-09-26 | 2004-01-15 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US20040019364A1 (en) * | 2000-09-27 | 2004-01-29 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control via coupled electrodes |
US20040034391A1 (en) * | 2002-08-16 | 2004-02-19 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with respiration synchronous optimization of cardiac performance using atrial cycle length |
US6701186B2 (en) * | 2001-09-13 | 2004-03-02 | Cardiac Pacemakers, Inc. | Atrial pacing and sensing in cardiac resynchronization therapy |
US6704598B2 (en) * | 2001-05-23 | 2004-03-09 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system selecting between multiple same-chamber electrodes for delivering cardiac therapy |
US20040062852A1 (en) * | 2002-09-30 | 2004-04-01 | Medtronic, Inc. | Method for applying a drug coating to a medical device |
US20040102818A1 (en) * | 2002-11-26 | 2004-05-27 | Hakky Said I. | Method and system for controlling blood pressure |
US20050021092A1 (en) * | 2003-06-09 | 2005-01-27 | Yun Anthony Joonkyoo | Treatment of conditions through modulation of the autonomic nervous system |
US20060089678A1 (en) * | 2002-03-14 | 2006-04-27 | Alon Shalev | Technique for blood pressure regulation |
US7192403B2 (en) * | 2001-08-17 | 2007-03-20 | Russell Ted W | Methods, apparatus and articles-of-manufacture for noninvasive measurement and monitoring of peripheral blood flow, perfusion, cardiac output biophysic stress and cardiovascular condition |
Family Cites Families (256)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3309924A (en) * | 1964-06-22 | 1967-03-21 | Universtity Of California | Electromagnetic flow meter |
US3421511A (en) * | 1965-12-10 | 1969-01-14 | Medtronic Inc | Implantable electrode for nerve stimulation |
US3593718A (en) | 1967-07-13 | 1971-07-20 | Biocybernetics Inc | Physiologically controlled cardiac pacer |
US3522811A (en) * | 1969-02-13 | 1970-08-04 | Medtronic Inc | Implantable nerve stimulator and method of use |
DE1947017C3 (en) * | 1969-09-17 | 1979-01-18 | Vereinigte Flugtechnische Werkefokker Gmbh, 2800 Bremen | Shuttle valve with a control valve used for switching |
USRE30366E (en) | 1970-09-21 | 1980-08-12 | Rasor Associates, Inc. | Organ stimulator |
US3835864A (en) * | 1970-09-21 | 1974-09-17 | Rasor Ass Inc | Intra-cardiac stimulator |
EP0047013B1 (en) | 1980-09-02 | 1986-01-22 | Medtronic, Inc. | Subcutaneously implantable lead with drug dispenser means |
US4364922A (en) * | 1980-10-14 | 1982-12-21 | University Of Virginia Alumni Patents Foundation | Adenosine antagonists in the treatment and diagnosis of A-V node conduction disturbances |
US4481953A (en) | 1981-11-12 | 1984-11-13 | Cordis Corporation | Endocardial lead having helically wound ribbon electrode |
US4551862A (en) | 1982-12-15 | 1985-11-12 | Haber Terry M | Prosthetic sphincter |
US4531943A (en) | 1983-08-08 | 1985-07-30 | Angiomedics Corporation | Catheter with soft deformable tip |
US4702254A (en) | 1983-09-14 | 1987-10-27 | Jacob Zabara | Neurocybernetic prosthesis |
US4867164A (en) | 1983-09-14 | 1989-09-19 | Jacob Zabara | Neurocybernetic prosthesis |
US4887608A (en) | 1986-01-31 | 1989-12-19 | Boston Scientific Corporation | Method and apparatus for estimating tissue damage |
US4682583A (en) | 1984-04-13 | 1987-07-28 | Burton John H | Inflatable artificial sphincter |
US4628942A (en) | 1984-10-11 | 1986-12-16 | Case Western Reserve University | Asymmetric shielded two electrode cuff |
US4860751A (en) | 1985-02-04 | 1989-08-29 | Cordis Corporation | Activity sensor for pacemaker control |
US4881939A (en) | 1985-02-19 | 1989-11-21 | The Johns Hopkins University | Implantable helical cuff |
US4862361A (en) | 1985-06-05 | 1989-08-29 | Massachusetts Institute Of Technology | Methods and apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis |
US4770177A (en) | 1986-02-18 | 1988-09-13 | Telectronics N.V. | Apparatus and method for adjusting heart/pacer relative to changes in venous diameter during exercise to obtain a required cardiac output. |
US4762820A (en) | 1986-03-03 | 1988-08-09 | Trustees Of Boston University | Therapeutic treatment for congestive heart failure |
US4709690A (en) | 1986-04-21 | 1987-12-01 | Habley Medical Technology Corporation | Implantable blood flow and occlusion pressure sensing sphincteric system |
US4762130A (en) | 1987-01-15 | 1988-08-09 | Thomas J. Fogarty | Catheter with corkscrew-like balloon |
US5010893A (en) * | 1987-01-15 | 1991-04-30 | Siemens-Pacesetter, Inc. | Motion sensor for implanted medical device |
US4969458A (en) | 1987-07-06 | 1990-11-13 | Medtronic, Inc. | Intracoronary stent and method of simultaneous angioplasty and stent implant |
US4791931A (en) | 1987-08-13 | 1988-12-20 | Pacesetter Infusion, Ltd. | Demand pacemaker using an artificial baroreceptor reflex |
US4886062A (en) | 1987-10-19 | 1989-12-12 | Medtronic, Inc. | Intravascular radially expandable stent and method of implant |
US4819662A (en) * | 1987-10-26 | 1989-04-11 | Cardiac Pacemakers, Inc. | Cardiac electrode with drug delivery capabilities |
US4934368A (en) | 1988-01-21 | 1990-06-19 | Myo/Kinetics Systems, Inc. | Multi-electrode neurological stimulation apparatus |
US4926875A (en) | 1988-01-25 | 1990-05-22 | Baylor College Of Medicine | Implantable and extractable biological sensor probe |
CA1327838C (en) | 1988-06-13 | 1994-03-15 | Fred Zacouto | Implantable device to prevent blood clotting disorders |
US4960133A (en) | 1988-11-21 | 1990-10-02 | Brunswick Manufacturing Co., Inc. | Esophageal electrode |
US4960129A (en) * | 1988-12-05 | 1990-10-02 | Trustees Of The University Of Pennsylvania | Methods of observing autonomic neural stimulation and diagnosing cardiac dynamical dysfunction using heartbeat interval data to analyze cardioventilatory interactions |
US4915113A (en) * | 1988-12-16 | 1990-04-10 | Bio-Vascular, Inc. | Method and apparatus for monitoring the patency of vascular grafts |
US4940065A (en) * | 1989-01-23 | 1990-07-10 | Regents Of The University Of California | Surgically implantable peripheral nerve electrode |
US4967159A (en) * | 1989-02-23 | 1990-10-30 | Abbott Laboratories | Self-balancing reflectometer |
US5114423A (en) | 1989-05-15 | 1992-05-19 | Advanced Cardiovascular Systems, Inc. | Dilatation catheter assembly with heated balloon |
US4972848A (en) | 1989-08-23 | 1990-11-27 | Medtronic, Inc. | Medical electrical lead with polymeric monolithic controlled release device and method of manufacture |
US5031621A (en) | 1989-12-06 | 1991-07-16 | Grandjean Pierre A | Nerve electrode with biological substrate |
US5040533A (en) * | 1989-12-29 | 1991-08-20 | Medical Engineering And Development Institute Incorporated | Implantable cardiovascular treatment device container for sensing a physiological parameter |
US5265608A (en) | 1990-02-22 | 1993-11-30 | Medtronic, Inc. | Steroid eluting electrode for peripheral nerve stimulation |
US5203348A (en) | 1990-06-06 | 1993-04-20 | Cardiac Pacemakers, Inc. | Subcutaneous defibrillation electrodes |
DE4019002A1 (en) | 1990-06-13 | 1992-01-02 | Siemens Ag | ELECTRODE ARRANGEMENT FOR A DEFIBRILLATOR |
US5282844A (en) * | 1990-06-15 | 1994-02-01 | Medtronic, Inc. | High impedance, low polarization, low threshold miniature steriod eluting pacing lead electrodes |
US5158078A (en) | 1990-08-14 | 1992-10-27 | Medtronic, Inc. | Rate responsive pacemaker and methods for optimizing its operation |
US5134997A (en) | 1990-08-14 | 1992-08-04 | Medtronic, Inc. | Rate responsive pacemaker and pacing method |
US5154170A (en) | 1990-08-14 | 1992-10-13 | Medtronic, Inc. | Optimization for rate responsive cardiac pacemaker |
US5680590A (en) | 1990-09-21 | 1997-10-21 | Parti; Michael | Simulation system and method of using same |
US5111815A (en) * | 1990-10-15 | 1992-05-12 | Cardiac Pacemakers, Inc. | Method and apparatus for cardioverter/pacer utilizing neurosensing |
FR2671010B1 (en) | 1990-12-27 | 1993-07-09 | Ela Medical Sa | ENDOCARDIAC PROBE PROVIDED WITH AN ACTIVE FIXING MEMBER |
US5224491A (en) | 1991-01-07 | 1993-07-06 | Medtronic, Inc. | Implantable electrode for location within a blood vessel |
US5170802A (en) | 1991-01-07 | 1992-12-15 | Medtronic, Inc. | Implantable electrode for location within a blood vessel |
US5088787A (en) * | 1991-01-30 | 1992-02-18 | Creative Extruded Products, Inc. | Auto window molding |
US5154182A (en) | 1991-02-15 | 1992-10-13 | Siemens Pacesetter, Inc. | Drug or steroid releasing patch electrode for an implantable arrhythmia treatment system |
US5437285A (en) * | 1991-02-20 | 1995-08-01 | Georgetown University | Method and apparatus for prediction of sudden cardiac death by simultaneous assessment of autonomic function and cardiac electrical stability |
US5269303A (en) * | 1991-02-22 | 1993-12-14 | Cyberonics, Inc. | Treatment of dementia by nerve stimulation |
US5144960A (en) | 1991-03-20 | 1992-09-08 | Medtronic, Inc. | Transvenous defibrillation lead and method of use |
JP2655204B2 (en) | 1991-04-05 | 1997-09-17 | メドトロニック インコーポレーテッド | Implantable medical device |
US5251634A (en) * | 1991-05-03 | 1993-10-12 | Cyberonics, Inc. | Helical nerve electrode |
US5335657A (en) | 1991-05-03 | 1994-08-09 | Cyberonics, Inc. | Therapeutic treatment of sleep disorder by nerve stimulation |
US5299569A (en) * | 1991-05-03 | 1994-04-05 | Cyberonics, Inc. | Treatment of neuropsychiatric disorders by nerve stimulation |
JPH07501233A (en) | 1991-08-09 | 1995-02-09 | サイベロニクス,インク. | Treatment of anxiety disorders with nerve stimulation |
US5282488A (en) * | 1991-11-18 | 1994-02-01 | Eastman Kodak Company | Interchangeable fluid path module |
US5358514A (en) | 1991-12-18 | 1994-10-25 | Alfred E. Mann Foundation For Scientific Research | Implantable microdevice with self-attaching electrodes |
JPH05245215A (en) | 1992-03-03 | 1993-09-24 | Terumo Corp | Heart pace maker |
IT1259358B (en) * | 1992-03-26 | 1996-03-12 | Sorin Biomedica Spa | IMPLANTABLE DEVICE FOR DETECTION AND CONTROL OF THE SYMPATHIC-VAGAL TONE |
US5330507A (en) | 1992-04-24 | 1994-07-19 | Medtronic, Inc. | Implantable electrical vagal stimulation for prevention or interruption of life threatening arrhythmias |
US5387234A (en) * | 1992-05-21 | 1995-02-07 | Siemens-Elema Ab | Medical electrode device |
AU663948B2 (en) | 1992-06-12 | 1995-10-26 | Kabushiki Kaisha Advance | Electrical stimulator |
US5330515A (en) | 1992-06-17 | 1994-07-19 | Cyberonics, Inc. | Treatment of pain by vagal afferent stimulation |
US5255296A (en) | 1992-06-24 | 1993-10-19 | Westinghouse Electric Corp. | Collecting and recirculating condensate in a nuclear reactor containment |
US5243980A (en) | 1992-06-30 | 1993-09-14 | Medtronic, Inc. | Method and apparatus for discrimination of ventricular and supraventricular tachycardia |
DE669839T1 (en) | 1992-10-01 | 1996-10-10 | Cardiac Pacemakers | STENT-LIKE STRUCTURE FOR DEFLICTION ELECTRODES. |
US5325870A (en) | 1992-12-16 | 1994-07-05 | Angeion Corporation | Multiplexed defibrillation electrode apparatus |
US5431171A (en) | 1993-06-25 | 1995-07-11 | The Regents Of The University Of California | Monitoring fetal characteristics by radiotelemetric transmission |
US5411531A (en) * | 1993-09-23 | 1995-05-02 | Medtronic, Inc. | Method and apparatus for control of A-V interval |
US5731288A (en) * | 1993-10-22 | 1998-03-24 | University Of Southern California | Compositions containing contortrostatin and methods for the use thereof |
US5527159A (en) | 1993-11-10 | 1996-06-18 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Rotary blood pump |
US5545132A (en) | 1993-12-21 | 1996-08-13 | C. R. Bard, Inc. | Helically grooved balloon for dilatation catheter and method of using |
US5458626A (en) | 1993-12-27 | 1995-10-17 | Krause; Horst E. | Method of electrical nerve stimulation for acceleration of tissue healing |
US6255296B1 (en) | 1994-01-11 | 2001-07-03 | Endomatrix, Inc. | Composition and method for treating a patient susceptible to or suffering from a cardiovascular disorder or disease |
US5501703A (en) * | 1994-01-24 | 1996-03-26 | Medtronic, Inc. | Multichannel apparatus for epidural spinal cord stimulator |
US5782891A (en) | 1994-06-16 | 1998-07-21 | Medtronic, Inc. | Implantable ceramic enclosure for pacing, neurological, and other medical applications in the human body |
EP0688579B1 (en) | 1994-06-24 | 2001-08-22 | St. Jude Medical AB | Device for heart therapy |
US5695468A (en) | 1994-09-16 | 1997-12-09 | Scimed Life Systems, Inc. | Balloon catheter with improved pressure source |
DE4433111A1 (en) * | 1994-09-16 | 1996-03-21 | Fraunhofer Ges Forschung | Cuff electrode |
US5531778A (en) | 1994-09-20 | 1996-07-02 | Cyberonics, Inc. | Circumneural electrode assembly |
US5540734A (en) | 1994-09-28 | 1996-07-30 | Zabara; Jacob | Cranial nerve stimulation treatments using neurocybernetic prosthesis |
US5551953A (en) | 1994-10-31 | 1996-09-03 | Alza Corporation | Electrotransport system with remote telemetry link |
US5540735A (en) | 1994-12-12 | 1996-07-30 | Rehabilicare, Inc. | Apparatus for electro-stimulation of flexing body portions |
US5571150A (en) * | 1994-12-19 | 1996-11-05 | Cyberonics, Inc. | Treatment of patients in coma by nerve stimulation |
US5531766A (en) | 1995-01-23 | 1996-07-02 | Angeion Corporation | Implantable cardioverter defibrillator pulse generator kite-tail electrode system |
US5741319A (en) | 1995-01-27 | 1998-04-21 | Medtronic, Inc. | Biocompatible medical lead |
CA2211844C (en) | 1995-02-27 | 2001-01-30 | Medtronic, Inc. | External patient reference sensor |
US5535752A (en) | 1995-02-27 | 1996-07-16 | Medtronic, Inc. | Implantable capacitive absolute pressure and temperature monitor system |
US5593431A (en) * | 1995-03-30 | 1997-01-14 | Medtronic, Inc. | Medical service employing multiple DC accelerometers for patient activity and posture sensing and method |
US5715637A (en) * | 1995-04-27 | 1998-02-10 | Pan-Brick, Inc. | Prefabricated composite building panel with improved fire retardancy |
US5775331A (en) | 1995-06-07 | 1998-07-07 | Uromed Corporation | Apparatus and method for locating a nerve |
US6350242B1 (en) * | 1995-09-28 | 2002-02-26 | Data Sciences International, Inc. | Respiration monitoring system based on sensed physiological parameters |
US5694939A (en) * | 1995-10-03 | 1997-12-09 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Autogenic-feedback training exercise (AFTE) method and system |
US5700282A (en) | 1995-10-13 | 1997-12-23 | Zabara; Jacob | Heart rhythm stabilization using a neurocybernetic prosthesis |
US5683430A (en) * | 1995-11-16 | 1997-11-04 | Ael Industries, Inc. | Status monitor for anomaly detection in implanted devices and method |
US6073048A (en) * | 1995-11-17 | 2000-06-06 | Medtronic, Inc. | Baroreflex modulation with carotid sinus nerve stimulation for the treatment of heart failure |
US5989230A (en) * | 1996-01-11 | 1999-11-23 | Essex Technology, Inc. | Rotate to advance catheterization system |
US6051017A (en) * | 1996-02-20 | 2000-04-18 | Advanced Bionics Corporation | Implantable microstimulator and systems employing the same |
US5651378A (en) | 1996-02-20 | 1997-07-29 | Cardiothoracic Systems, Inc. | Method of using vagal nerve stimulation in surgery |
US5776178A (en) | 1996-02-21 | 1998-07-07 | Medtronic, Inc. | Medical electrical lead with surface treatment for enhanced fixation |
US5987746A (en) | 1996-02-21 | 1999-11-23 | Medtronic, Inc. | Method of making medical electrical lead |
US5824021A (en) | 1996-04-25 | 1998-10-20 | Medtronic Inc. | Method and apparatus for providing feedback to spinal cord stimulation for angina |
US6449507B1 (en) | 1996-04-30 | 2002-09-10 | Medtronic, Inc. | Method and system for nerve stimulation prior to and during a medical procedure |
US6006134A (en) | 1998-04-30 | 1999-12-21 | Medtronic, Inc. | Method and device for electronically controlling the beating of a heart using venous electrical stimulation of nerve fibers |
AU3304997A (en) | 1996-05-31 | 1998-01-05 | Southern Illinois University | Methods of modulating aspects of brain neural plasticity by vagus nerve stimulation |
WO1998002209A2 (en) | 1996-07-11 | 1998-01-22 | Medtronic, Inc. | Minimally invasive implantable device for monitoring physiologic events |
US5800464A (en) * | 1996-10-03 | 1998-09-01 | Medtronic, Inc. | System for providing hyperpolarization of cardiac to enhance cardiac function |
US5814079A (en) | 1996-10-04 | 1998-09-29 | Medtronic, Inc. | Cardiac arrhythmia management by application of adnodal stimulation for hyperpolarization of myocardial cells |
US6110098A (en) | 1996-12-18 | 2000-08-29 | Medtronic, Inc. | System and method of mechanical treatment of cardiac fibrillation |
US5814089A (en) | 1996-12-18 | 1998-09-29 | Medtronic, Inc. | Leadless multisite implantable stimulus and diagnostic system |
US5895416A (en) * | 1997-03-12 | 1999-04-20 | Medtronic, Inc. | Method and apparatus for controlling and steering an electric field |
US5938596A (en) * | 1997-03-17 | 1999-08-17 | Medtronic, Inc. | Medical electrical lead |
US5954761A (en) | 1997-03-25 | 1999-09-21 | Intermedics Inc. | Implantable endocardial lead assembly having a stent |
US5899933A (en) * | 1997-06-16 | 1999-05-04 | Axon Engineering, Inc. | Nerve cuff electrode carrier |
US6123725A (en) | 1997-07-11 | 2000-09-26 | A-Med Systems, Inc. | Single port cardiac support apparatus |
ES2283020T3 (en) * | 1997-07-16 | 2007-10-16 | Metacure Nv | SMOOTH MUSCLE CONTROLLER. |
US6141590A (en) * | 1997-09-25 | 2000-10-31 | Medtronic, Inc. | System and method for respiration-modulated pacing |
US5967986A (en) | 1997-11-25 | 1999-10-19 | Vascusense, Inc. | Endoluminal implant with fluid flow sensing capability |
US6585763B1 (en) | 1997-10-14 | 2003-07-01 | Vascusense, Inc. | Implantable therapeutic device and method |
US6409674B1 (en) | 1998-09-24 | 2002-06-25 | Data Sciences International, Inc. | Implantable sensor with wireless communication |
US5807258A (en) | 1997-10-14 | 1998-09-15 | Cimochowski; George E. | Ultrasonic sensors for monitoring the condition of a vascular graft |
SE511823C2 (en) * | 1997-11-07 | 1999-12-06 | Ericsson Telefon Ab L M | Data communication networks and method related thereto |
US5991667A (en) | 1997-11-10 | 1999-11-23 | Vitatron Medical, B.V. | Pacing lead with porous electrode for stable low threshold high impedance pacing |
US6064596A (en) * | 1997-12-26 | 2000-05-16 | Samsung Electronics Co., Ltd. | Nonvolatile integrated circuit memory devices and methods of operating same |
US6193996B1 (en) * | 1998-04-02 | 2001-02-27 | 3M Innovative Properties Company | Device for the transdermal delivery of diclofenac |
US6086527A (en) | 1998-04-02 | 2000-07-11 | Scimed Life Systems, Inc. | System for treating congestive heart failure |
US6161047A (en) * | 1998-04-30 | 2000-12-12 | Medtronic Inc. | Apparatus and method for expanding a stimulation lead body in situ |
US6206914B1 (en) * | 1998-04-30 | 2001-03-27 | Medtronic, Inc. | Implantable system with drug-eluting cells for on-demand local drug delivery |
US5928272A (en) | 1998-05-02 | 1999-07-27 | Cyberonics, Inc. | Automatic activation of a neurostimulator device using a detection algorithm based on cardiac activity |
ATE484247T1 (en) * | 1998-06-01 | 2010-10-15 | Kyphon S Rl | UNFOLDABLE, PRE-FORMED STRUCTURES FOR UNFOLDING IN REGIONS WITHIN THE BODY |
WO1999065561A1 (en) | 1998-06-19 | 1999-12-23 | Cordis Webster, Inc. | Method and apparatus for transvascular treatment of tachycardia and fibrillation |
US6141588A (en) | 1998-07-24 | 2000-10-31 | Intermedics Inc. | Cardiac simulation system having multiple stimulators for anti-arrhythmia therapy |
DE19847446B4 (en) * | 1998-10-08 | 2010-04-22 | Biotronik Gmbh & Co. Kg | Nerve electrode assembly |
US6564102B1 (en) | 1998-10-26 | 2003-05-13 | Birinder R. Boveja | Apparatus and method for adjunct (add-on) treatment of coma and traumatic brain injury with neuromodulation using an external stimulator |
US6668191B1 (en) | 1998-10-26 | 2003-12-23 | Birinder R. Boveja | Apparatus and method for electrical stimulation adjunct (add-on) therapy of atrial fibrillation, inappropriate sinus tachycardia, and refractory hypertension with an external stimulator |
US6356788B2 (en) | 1998-10-26 | 2002-03-12 | Birinder Bob Boveja | Apparatus and method for adjunct (add-on) therapy for depression, migraine, neuropsychiatric disorders, partial complex epilepsy, generalized epilepsy and involuntary movement disorders utilizing an external stimulator |
US20030212440A1 (en) | 2002-05-09 | 2003-11-13 | Boveja Birinder R. | Method and system for modulating the vagus nerve (10th cranial nerve) using modulated electrical pulses with an inductively coupled stimulation system |
US6205359B1 (en) * | 1998-10-26 | 2001-03-20 | Birinder Bob Boveja | Apparatus and method for adjunct (add-on) therapy of partial complex epilepsy, generalized epilepsy and involuntary movement disorders utilizing an external stimulator |
US9061139B2 (en) * | 1998-11-04 | 2015-06-23 | Greatbatch Ltd. | Implantable lead with a band stop filter having a capacitor in parallel with an inductor embedded in a dielectric body |
US6701176B1 (en) * | 1998-11-04 | 2004-03-02 | Johns Hopkins University School Of Medicine | Magnetic-resonance-guided imaging, electrophysiology, and ablation |
IT1305062B1 (en) * | 1998-12-23 | 2001-04-10 | Leonardo Cammilli | SINGLE INTRODUCTION CATHETER FOR MULTISITE STIMULATION OF THE FOUR CARDIAC CHAMBERS FOR TREATMENT OF PATHOLOGIES SUCH AS |
US6077227A (en) | 1998-12-28 | 2000-06-20 | Medtronic, Inc. | Method for manufacture and implant of an implantable blood vessel cuff |
US6106477A (en) | 1998-12-28 | 2000-08-22 | Medtronic, Inc. | Chronically implantable blood vessel cuff with sensor |
US6909917B2 (en) * | 1999-01-07 | 2005-06-21 | Advanced Bionics Corporation | Implantable generator having current steering means |
US6077298A (en) | 1999-02-20 | 2000-06-20 | Tu; Lily Chen | Expandable/retractable stent and methods thereof |
US6210339B1 (en) | 1999-03-03 | 2001-04-03 | Endosonics Corporation | Flexible elongate member having one or more electrical contacts |
US6161029A (en) | 1999-03-08 | 2000-12-12 | Medtronic, Inc. | Apparatus and method for fixing electrodes in a blood vessel |
US6438409B1 (en) | 1999-03-25 | 2002-08-20 | Medtronic, Inc. | Methods of characterizing ventricular operations and applications thereof |
US6324421B1 (en) | 1999-03-29 | 2001-11-27 | Medtronic, Inc. | Axis shift analysis of electrocardiogram signal parameters especially applicable for multivector analysis by implantable medical devices, and use of same |
US6128526A (en) | 1999-03-29 | 2000-10-03 | Medtronic, Inc. | Method for ischemia detection and apparatus for using same |
US6115628A (en) | 1999-03-29 | 2000-09-05 | Medtronic, Inc. | Method and apparatus for filtering electrocardiogram (ECG) signals to remove bad cycle information and for use of physiologic signals determined from said filtered ECG signals |
US6115630A (en) | 1999-03-29 | 2000-09-05 | Medtronic, Inc. | Determination of orientation of electrocardiogram signal in implantable medical devices |
US6253110B1 (en) | 1999-04-27 | 2001-06-26 | Medtronic Inc | Method for tissue stimulation and fabrication of low polarization implantable stimulation electrode |
US6341236B1 (en) * | 1999-04-30 | 2002-01-22 | Ivan Osorio | Vagal nerve stimulation techniques for treatment of epileptic seizures |
US6178352B1 (en) | 1999-05-07 | 2001-01-23 | Woodside Biomedical, Inc. | Method of blood pressure moderation |
US7840278B1 (en) | 1999-06-25 | 2010-11-23 | Puskas John D | Devices and methods for vagus nerve stimulation |
US6473644B1 (en) * | 1999-10-13 | 2002-10-29 | Cyberonics, Inc. | Method to enhance cardiac capillary growth in heart failure patients |
US6438428B1 (en) * | 1999-10-27 | 2002-08-20 | Axelgaard Manufacturing Co., Ltd. | Electrical stimulation compress |
US6942622B1 (en) | 1999-11-10 | 2005-09-13 | Pacesetter, Inc. | Method for monitoring autonomic tone |
EP1106202A3 (en) * | 1999-11-30 | 2004-03-31 | BIOTRONIK Mess- und Therapiegeräte GmbH & Co Ingenieurbüro Berlin | Electrode for intravascular stimulation, cardioversion and /or defibrillation |
US6611713B2 (en) | 1999-11-30 | 2003-08-26 | Patrick Schauerte | Implantable device for diagnosing and distinguishing supraventricular and ventricular tachycardias |
US6415183B1 (en) | 1999-12-09 | 2002-07-02 | Cardiac Pacemakers, Inc. | Method and apparatus for diaphragmatic pacing |
US6371922B1 (en) | 2000-04-07 | 2002-04-16 | Cardiac Pacemakers, Inc. | Method for measuring baroreflex sensitivity and therapy optimization in heart failure patients |
US6826428B1 (en) * | 2000-04-11 | 2004-11-30 | The Board Of Regents Of The University Of Texas System | Gastrointestinal electrical stimulation |
US6442413B1 (en) | 2000-05-15 | 2002-08-27 | James H. Silver | Implantable sensor |
JP3762198B2 (en) * | 2000-07-11 | 2006-04-05 | キヤノン株式会社 | Image forming apparatus |
US6584362B1 (en) | 2000-08-30 | 2003-06-24 | Cardiac Pacemakers, Inc. | Leads for pacing and/or sensing the heart from within the coronary veins |
US20020103516A1 (en) * | 2000-09-20 | 2002-08-01 | Patwardhan Ravish Vinay | Carotid sinus nerve stimulation for epilepsy control |
US8086314B1 (en) | 2000-09-27 | 2011-12-27 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US20080167699A1 (en) | 2000-09-27 | 2008-07-10 | Cvrx, Inc. | Method and Apparatus for Providing Complex Tissue Stimulation Parameters |
US7840271B2 (en) | 2000-09-27 | 2010-11-23 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US20080177365A1 (en) | 2000-09-27 | 2008-07-24 | Cvrx, Inc. | Method and apparatus for electronically switching electrode configuration |
US7623926B2 (en) * | 2000-09-27 | 2009-11-24 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US20070185542A1 (en) | 2002-03-27 | 2007-08-09 | Cvrx, Inc. | Baroreflex therapy for disordered breathing |
JP2004512104A (en) * | 2000-10-26 | 2004-04-22 | メドトロニック・インコーポレーテッド | Method and apparatus for protecting heart tissue from seizures |
WO2002045791A2 (en) * | 2000-10-26 | 2002-06-13 | Medtronic, Inc. | Method and apparatus for electrically stimulating the nervous system to improve ventricular dysfunction, heart failure, and other cardiac comditions |
JP2004512127A (en) | 2000-11-01 | 2004-04-22 | スリーエム イノベイティブ プロパティズ カンパニー | Electrical detection and / or signal application device |
US7785323B2 (en) | 2000-12-04 | 2010-08-31 | Boston Scientific Scimed, Inc. | Loop structure including inflatable therapeutic device |
US6925342B2 (en) * | 2000-12-05 | 2005-08-02 | Koninklijke Philips Electronics N.V. | System and method for protecting digital media |
US6589214B2 (en) * | 2000-12-06 | 2003-07-08 | Rex Medical, L.P. | Vascular introducer sheath with retainer |
US6591140B2 (en) * | 2000-12-14 | 2003-07-08 | Mayo Foundation For Medical Education And Research | Apparatus and system for stimulating mouth muscles |
US6445953B1 (en) | 2001-01-16 | 2002-09-03 | Kenergy, Inc. | Wireless cardiac pacing system with vascular electrode-stents |
AU2002250250A1 (en) | 2001-03-01 | 2002-09-19 | Three Arch Partners | Intravascular device for treatment of hypertension |
US20020128700A1 (en) * | 2001-03-08 | 2002-09-12 | Cross Thomas E. | Lead with adjustable angular and spatial relationships between electrodes |
US6748272B2 (en) | 2001-03-08 | 2004-06-08 | Cardiac Pacemakers, Inc. | Atrial interval based heart rate variability diagnostic for cardiac rhythm management system |
US6597951B2 (en) | 2001-03-16 | 2003-07-22 | Cardiac Pacemakers, Inc. | Automatic selection from multiple cardiac optimization protocols |
US20020151051A1 (en) * | 2001-03-27 | 2002-10-17 | Sheng Feng Li | Compositions and methods for isolating genes comprising subcellular localization sequences |
US6766189B2 (en) | 2001-03-30 | 2004-07-20 | Cardiac Pacemakers, Inc. | Method and apparatus for predicting acute response to cardiac resynchronization therapy |
US20070191895A1 (en) * | 2001-04-20 | 2007-08-16 | Foreman Robert D | Activation of cardiac alpha receptors by spinal cord stimulation produces cardioprotection against ischemia, arrhythmias, and heart failure |
US6894204B2 (en) * | 2001-05-02 | 2005-05-17 | 3M Innovative Properties Company | Tapered stretch removable adhesive articles and methods |
EP1395335A1 (en) * | 2001-05-29 | 2004-03-10 | Medtronic, Inc. | Closed-loop neuromodulation for prevention and treatment of cardiac conditions |
AU2002321273A1 (en) * | 2001-07-27 | 2003-02-17 | Impella Cardiotechnik Ag | Neurostimulation unit for immobilizing the heart during cardiosurgical operations |
US6622041B2 (en) | 2001-08-21 | 2003-09-16 | Cyberonics, Inc. | Treatment of congestive heart failure and autonomic cardiovascular drive disorders |
US7885709B2 (en) * | 2001-08-31 | 2011-02-08 | Bio Control Medical (B.C.M.) Ltd. | Nerve stimulation for treating disorders |
US7778711B2 (en) | 2001-08-31 | 2010-08-17 | Bio Control Medical (B.C.M.) Ltd. | Reduction of heart rate variability by parasympathetic stimulation |
US6718212B2 (en) * | 2001-10-12 | 2004-04-06 | Medtronic, Inc. | Implantable medical electrical lead with light-activated adhesive fixation |
US6934583B2 (en) | 2001-10-22 | 2005-08-23 | Pacesetter, Inc. | Implantable lead and method for stimulating the vagus nerve |
US6859667B2 (en) * | 2001-11-07 | 2005-02-22 | Cardiac Pacemakers, Inc. | Multiplexed medical device lead with standard header |
US7286878B2 (en) * | 2001-11-09 | 2007-10-23 | Medtronic, Inc. | Multiplexed electrode array extension |
US6768923B2 (en) | 2001-12-05 | 2004-07-27 | Cardiac Pacemakers, Inc. | Apparatus and method for ventricular pacing triggered by detection of early ventricular excitation |
US6909916B2 (en) * | 2001-12-20 | 2005-06-21 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with arrhythmia classification and electrode selection |
US6666826B2 (en) | 2002-01-04 | 2003-12-23 | Cardiac Pacemakers, Inc. | Method and apparatus for measuring left ventricular pressure |
US7155284B1 (en) * | 2002-01-24 | 2006-12-26 | Advanced Bionics Corporation | Treatment of hypertension |
US20030149450A1 (en) | 2002-02-01 | 2003-08-07 | Mayberg Marc R. | Brainstem and cerebellar modulation of cardiovascular response and disease |
US7236821B2 (en) | 2002-02-19 | 2007-06-26 | Cardiac Pacemakers, Inc. | Chronically-implanted device for sensing and therapy |
JP3643564B2 (en) | 2002-02-19 | 2005-04-27 | コーリンメディカルテクノロジー株式会社 | Autonomic nerve function evaluation device |
US6937896B1 (en) | 2002-02-26 | 2005-08-30 | Pacesetter, Inc. | Sympathetic nerve stimulator and/or pacemaker |
AU2003220599A1 (en) | 2002-03-27 | 2003-10-13 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control via coupled electrodes |
TW524670B (en) * | 2002-04-01 | 2003-03-21 | Ind Tech Res Inst | Non-invasive apparatus system for monitoring autonomic nervous system and uses thereof |
US6922585B2 (en) | 2002-04-05 | 2005-07-26 | Medtronic, Inc. | Method and apparatus for predicting recurring ventricular arrhythmias |
US8204591B2 (en) | 2002-05-23 | 2012-06-19 | Bio Control Medical (B.C.M.) Ltd. | Techniques for prevention of atrial fibrillation |
US8036745B2 (en) | 2004-06-10 | 2011-10-11 | Bio Control Medical (B.C.M.) Ltd. | Parasympathetic pacing therapy during and following a medical procedure, clinical trauma or pathology |
US7321793B2 (en) * | 2003-06-13 | 2008-01-22 | Biocontrol Medical Ltd. | Vagal stimulation for atrial fibrillation therapy |
US20050065553A1 (en) * | 2003-06-13 | 2005-03-24 | Omry Ben Ezra | Applications of vagal stimulation |
US7277761B2 (en) | 2002-06-12 | 2007-10-02 | Pacesetter, Inc. | Vagal stimulation for improving cardiac function in heart failure or CHF patients |
US7139607B1 (en) | 2002-06-12 | 2006-11-21 | Pacesetter, Inc. | Arrhythmia discrimination |
US7123961B1 (en) | 2002-06-13 | 2006-10-17 | Pacesetter, Inc. | Stimulation of autonomic nerves |
US7228179B2 (en) | 2002-07-26 | 2007-06-05 | Advanced Neuromodulation Systems, Inc. | Method and apparatus for providing complex tissue stimulation patterns |
US7313445B2 (en) | 2002-09-26 | 2007-12-25 | Medtronic, Inc. | Medical lead with flexible distal guidewire extension |
US7010337B2 (en) * | 2002-10-24 | 2006-03-07 | Furnary Anthony P | Method and apparatus for monitoring blood condition and cardiopulmonary function |
US20030229380A1 (en) | 2002-10-31 | 2003-12-11 | Adams John M. | Heart failure therapy device and method |
US6942686B1 (en) * | 2002-11-01 | 2005-09-13 | Coaxia, Inc. | Regulation of cerebral blood flow by temperature change-induced vasodilatation |
US7092755B2 (en) * | 2003-03-18 | 2006-08-15 | Pacesetter, Inc. | System and method of cardiac pacing during sleep apnea |
US20060111626A1 (en) | 2003-03-27 | 2006-05-25 | Cvrx, Inc. | Electrode structures having anti-inflammatory properties and methods of use |
US7647106B2 (en) | 2003-04-23 | 2010-01-12 | Medtronic, Inc. | Detection of vasovagal syncope |
US7082336B2 (en) | 2003-06-04 | 2006-07-25 | Synecor, Llc | Implantable intravascular device for defibrillation and/or pacing |
US7480532B2 (en) | 2003-10-22 | 2009-01-20 | Cvrx, Inc. | Baroreflex activation for pain control, sedation and sleep |
US7155295B2 (en) | 2003-11-07 | 2006-12-26 | Paracor Medical, Inc. | Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing |
AU2004293030A1 (en) | 2003-11-20 | 2005-06-09 | Angiotech International Ag | Electrical devices and anti-scarring agents |
US7706884B2 (en) * | 2003-12-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US8126560B2 (en) | 2003-12-24 | 2012-02-28 | Cardiac Pacemakers, Inc. | Stimulation lead for stimulating the baroreceptors in the pulmonary artery |
US8024050B2 (en) | 2003-12-24 | 2011-09-20 | Cardiac Pacemakers, Inc. | Lead for stimulating the baroreceptors in the pulmonary artery |
US7643875B2 (en) | 2003-12-24 | 2010-01-05 | Cardiac Pacemakers, Inc. | Baroreflex stimulation system to reduce hypertension |
US7509166B2 (en) | 2003-12-24 | 2009-03-24 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation responsive to adverse event |
US7486991B2 (en) | 2003-12-24 | 2009-02-03 | Cardiac Pacemakers, Inc. | Baroreflex modulation to gradually decrease blood pressure |
US20050149132A1 (en) | 2003-12-24 | 2005-07-07 | Imad Libbus | Automatic baroreflex modulation based on cardiac activity |
US20050149129A1 (en) | 2003-12-24 | 2005-07-07 | Imad Libbus | Baropacing and cardiac pacing to control output |
US20050149133A1 (en) | 2003-12-24 | 2005-07-07 | Imad Libbus | Sensing with compensation for neural stimulator |
US7647114B2 (en) | 2003-12-24 | 2010-01-12 | Cardiac Pacemakers, Inc. | Baroreflex modulation based on monitored cardiovascular parameter |
US7869881B2 (en) | 2003-12-24 | 2011-01-11 | Cardiac Pacemakers, Inc. | Baroreflex stimulator with integrated pressure sensor |
US7460906B2 (en) | 2003-12-24 | 2008-12-02 | Cardiac Pacemakers, Inc. | Baroreflex stimulation to treat acute myocardial infarction |
US20060004417A1 (en) * | 2004-06-30 | 2006-01-05 | Cvrx, Inc. | Baroreflex activation for arrhythmia treatment |
US8175705B2 (en) | 2004-10-12 | 2012-05-08 | Cardiac Pacemakers, Inc. | System and method for sustained baroreflex stimulation |
US7236861B2 (en) | 2005-02-16 | 2007-06-26 | Lockheed Martin Corporation | Mission planning system with asynchronous request capability |
US8401665B2 (en) | 2005-04-01 | 2013-03-19 | Boston Scientific Neuromodulation Corporation | Apparatus and methods for detecting position and migration of neurostimulation leads |
US7930038B2 (en) * | 2005-05-27 | 2011-04-19 | Cardiac Pacemakers, Inc. | Tubular lead electrodes and methods |
US8109879B2 (en) | 2006-01-10 | 2012-02-07 | Cardiac Pacemakers, Inc. | Assessing autonomic activity using baroreflex analysis |
US20070191904A1 (en) | 2006-02-14 | 2007-08-16 | Imad Libbus | Expandable stimulation electrode with integrated pressure sensor and methods related thereto |
-
2003
- 2003-03-27 US US10/402,911 patent/US7499742B2/en not_active Expired - Lifetime
-
2006
- 2006-06-30 US US11/428,143 patent/US20070021794A1/en not_active Abandoned
- 2006-06-30 US US11/428,131 patent/US20070021792A1/en not_active Abandoned
- 2006-07-07 US US11/482,357 patent/US7813812B2/en not_active Expired - Lifetime
- 2006-07-07 US US11/482,662 patent/US20070038262A1/en not_active Abandoned
- 2006-07-07 US US11/482,225 patent/US8060206B2/en not_active Expired - Fee Related
- 2006-07-07 US US11/482,574 patent/US20070021798A1/en not_active Abandoned
- 2006-07-07 US US11/482,358 patent/US20070021790A1/en not_active Abandoned
- 2006-07-07 US US11/482,635 patent/US20070021799A1/en not_active Abandoned
- 2006-07-07 US US11/482,453 patent/US20070021797A1/en not_active Abandoned
- 2006-09-27 US US11/535,666 patent/US20070106340A1/en not_active Abandoned
-
2007
- 2007-10-31 US US11/933,268 patent/US20080167694A1/en not_active Abandoned
- 2007-12-14 US US11/956,685 patent/US20080097540A1/en not_active Abandoned
-
2009
- 2009-01-23 US US12/359,209 patent/US20090228065A1/en not_active Abandoned
-
2010
- 2010-03-24 US US12/731,104 patent/US20100191303A1/en not_active Abandoned
- 2010-04-19 US US12/762,891 patent/US8718789B2/en not_active Expired - Fee Related
-
2011
- 2011-02-11 US US13/025,718 patent/US20110172734A1/en not_active Abandoned
- 2011-11-18 US US13/300,232 patent/US9044609B2/en not_active Expired - Fee Related
-
2012
- 2012-05-24 US US13/480,063 patent/US8712531B2/en not_active Expired - Fee Related
- 2012-11-30 US US13/690,016 patent/US8880190B2/en not_active Expired - Fee Related
-
2015
- 2015-04-30 US US14/700,369 patent/US9427583B2/en not_active Expired - Lifetime
-
2016
- 2016-07-29 US US15/223,747 patent/US20170001013A1/en not_active Abandoned
-
2019
- 2019-08-22 US US16/548,519 patent/US20200114153A1/en not_active Abandoned
Patent Citations (100)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3650277A (en) * | 1969-02-24 | 1972-03-21 | Lkb Medical Ab | Apparatus for influencing the systemic blood pressure in a patient by carotid sinus nerve stimulation |
US3645267A (en) * | 1969-10-29 | 1972-02-29 | Medtronic Inc | Medical-electronic stimulator, particularly a carotid sinus nerve stimulator with controlled turn-on amplitude rate |
US3943936A (en) * | 1970-09-21 | 1976-03-16 | Rasor Associates, Inc. | Self powered pacers and stimulators |
US3870051A (en) * | 1972-04-27 | 1975-03-11 | Nat Res Dev | Urinary control |
US4014318A (en) * | 1973-08-20 | 1977-03-29 | Dockum James M | Circulatory assist device and system |
US4323073A (en) * | 1978-09-11 | 1982-04-06 | Cos Electronics Corporation | Apparatus and method for controlling the application of therapeutic direct current to living tissue |
US4256094A (en) * | 1979-06-18 | 1981-03-17 | Kapp John P | Arterial pressure control system |
US4331157A (en) * | 1980-07-09 | 1982-05-25 | Stimtech, Inc. | Mutually noninterfering transcutaneous nerve stimulation and patient monitoring |
US4586501A (en) * | 1982-10-21 | 1986-05-06 | Michel Claracq | Device for partly occluding a vessel in particular the inferior vena cava and inherent component of this device |
US4525074A (en) * | 1983-08-19 | 1985-06-25 | Citizen Watch Co., Ltd. | Apparatus for measuring the quantity of physical exercise |
US5025807A (en) * | 1983-09-14 | 1991-06-25 | Jacob Zabara | Neurocybernetic prosthesis |
US4825871A (en) * | 1984-03-27 | 1989-05-02 | Societe Anonyme Dite: Atesys | Defibrillating or cardioverting electric shock system including electrodes |
US4641664A (en) * | 1984-04-13 | 1987-02-10 | Siemens Aktiengesellschaft | Endocardial electrode arrangement |
US4590946A (en) * | 1984-06-14 | 1986-05-27 | Biomed Concepts, Inc. | Surgically implantable electrode for nerve bundles |
US4573481A (en) * | 1984-06-25 | 1986-03-04 | Huntington Institute Of Applied Research | Implantable electrode array |
US4828544A (en) * | 1984-09-05 | 1989-05-09 | Quotidian No. 100 Pty Limited | Control of blood flow |
US4640286A (en) * | 1984-11-02 | 1987-02-03 | Staodynamics, Inc. | Optimized nerve fiber stimulation |
US4803988A (en) * | 1984-11-02 | 1989-02-14 | Staodynamics, Inc. | Nerve fiber stimulation using plural equally active electrodes |
US4832038A (en) * | 1985-06-05 | 1989-05-23 | The Board Of Trustees Of University Of Illinois | Apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis |
US4719921A (en) * | 1985-08-28 | 1988-01-19 | Raul Chirife | Cardiac pacemaker adaptive to physiological requirements |
US4739762A (en) * | 1985-11-07 | 1988-04-26 | Expandable Grafts Partnership | Expandable intraluminal graft, and method and apparatus for implanting an expandable intraluminal graft |
US4739762B1 (en) * | 1985-11-07 | 1998-10-27 | Expandable Grafts Partnership | Expandable intraluminal graft and method and apparatus for implanting an expandable intraluminal graft |
US4664120A (en) * | 1986-01-22 | 1987-05-12 | Cordis Corporation | Adjustable isodiametric atrial-ventricular pervenous lead |
US4813418A (en) * | 1987-02-02 | 1989-03-21 | Staodynamics, Inc. | Nerve fiber stimulation using symmetrical biphasic waveform applied through plural equally active electrodes |
US5117826A (en) * | 1987-02-02 | 1992-06-02 | Staodyn, Inc. | Combined nerve fiber and body tissue stimulation apparatus and method |
US4800882A (en) * | 1987-03-13 | 1989-01-31 | Cook Incorporated | Endovascular stent and delivery system |
US4830003A (en) * | 1988-06-17 | 1989-05-16 | Wolff Rodney G | Compressive stent and delivery system |
US4917092A (en) * | 1988-07-13 | 1990-04-17 | Medical Designs, Inc. | Transcutaneous nerve stimulator for treatment of sympathetic nerve dysfunction |
US5113859A (en) * | 1988-09-19 | 1992-05-19 | Medtronic, Inc. | Acoustic body bus medical device communication system |
US4930517A (en) * | 1989-04-25 | 1990-06-05 | Massachusetts Institute Of Technology | Method and apparatus for physiologic system identification |
US4987897A (en) * | 1989-09-18 | 1991-01-29 | Medtronic, Inc. | Body bus medical device communication system |
US5086787A (en) * | 1989-12-06 | 1992-02-11 | Medtronic, Inc. | Steroid eluting intramuscular lead |
US5092332A (en) * | 1990-02-22 | 1992-03-03 | Medtronic, Inc. | Steroid eluting cuff electrode for peripheral nerve stimulation |
US5078736A (en) * | 1990-05-04 | 1992-01-07 | Interventional Thermodynamics, Inc. | Method and apparatus for maintaining patency in the body passages |
US5282468A (en) * | 1990-06-07 | 1994-02-01 | Medtronic, Inc. | Implantable neural electrode |
US5113869A (en) * | 1990-08-21 | 1992-05-19 | Telectronics Pacing Systems, Inc. | Implantable ambulatory electrocardiogram monitor |
US5222971A (en) * | 1990-10-09 | 1993-06-29 | Scimed Life Systems, Inc. | Temporary stent and methods for use and manufacture |
US5199428A (en) * | 1991-03-22 | 1993-04-06 | Medtronic, Inc. | Implantable electrical nerve stimulator/pacemaker with ischemia for decreasing cardiac workload |
US5181911A (en) * | 1991-04-22 | 1993-01-26 | Shturman Technologies, Inc. | Helical balloon perfusion angioplasty catheter |
US5324325A (en) * | 1991-06-27 | 1994-06-28 | Siemens Pacesetter, Inc. | Myocardial steroid releasing lead |
US5318592A (en) * | 1991-09-12 | 1994-06-07 | BIOTRONIK, Mess- und Therapiegerate GmbH & Co., Ingenieurburo Berlin | Cardiac therapy system |
US5215089A (en) * | 1991-10-21 | 1993-06-01 | Cyberonics, Inc. | Electrode assembly for nerve stimulation |
US5304206A (en) * | 1991-11-18 | 1994-04-19 | Cyberonics, Inc. | Activation techniques for implantable medical device |
US5314453A (en) * | 1991-12-06 | 1994-05-24 | Spinal Cord Society | Position sensitive power transfer antenna |
US5203326A (en) * | 1991-12-18 | 1993-04-20 | Telectronics Pacing Systems, Inc. | Antiarrhythmia pacer using antiarrhythmia pacing and autonomic nerve stimulation therapy |
US5295959A (en) * | 1992-03-13 | 1994-03-22 | Medtronic, Inc. | Autoperfusion dilatation catheter having a bonded channel |
US5299589A (en) * | 1992-05-12 | 1994-04-05 | Guardian Products, Inc. | Orthopedic crutch with adjustable hand grip |
US5324310A (en) * | 1992-07-01 | 1994-06-28 | Medtronic, Inc. | Cardiac pacemaker with auto-capture function |
US5725563A (en) * | 1993-04-21 | 1998-03-10 | Klotz; Antoine | Electronic device and method for adrenergically stimulating the sympathetic system with respect to the venous media |
US5408744A (en) * | 1993-04-30 | 1995-04-25 | Medtronic, Inc. | Substrate for a sintered electrode |
US5411540A (en) * | 1993-06-03 | 1995-05-02 | Massachusetts Institute Of Technology | Method and apparatus for preferential neuron stimulation |
US5634878A (en) * | 1993-09-17 | 1997-06-03 | Eska Medical Gmbh & Co. | Implantable device for selectively opening and closing a tubular organ of the body |
US5766527A (en) * | 1993-10-29 | 1998-06-16 | Medtronic, Inc. | Method of manufacturing medical electrical lead |
US5522854A (en) * | 1994-05-19 | 1996-06-04 | Duke University | Method and apparatus for the prevention of arrhythmia by nerve stimulation |
US5509888A (en) * | 1994-07-26 | 1996-04-23 | Conceptek Corporation | Controller valve device and method |
US5522874A (en) * | 1994-07-28 | 1996-06-04 | Gates; James T. | Medical lead having segmented electrode |
US5861012A (en) * | 1994-08-16 | 1999-01-19 | Medtronic, Inc. | Atrial and ventricular capture detection and threshold-seeking pacemaker |
US5529067A (en) * | 1994-08-19 | 1996-06-25 | Novoste Corporation | Methods for procedures related to the electrophysiology of the heart |
US5725471A (en) * | 1994-11-28 | 1998-03-10 | Neotonus, Inc. | Magnetic nerve stimulator for exciting peripheral nerves |
US5707400A (en) * | 1995-09-19 | 1998-01-13 | Cyberonics, Inc. | Treating refractory hypertension by nerve stimulation |
US6061596A (en) * | 1995-11-24 | 2000-05-09 | Advanced Bionics Corporation | Method for conditioning pelvic musculature using an implanted microstimulator |
US5891181A (en) * | 1995-12-23 | 1999-04-06 | Zhu; Qiang | Blood pressure depressor |
US5727558A (en) * | 1996-02-14 | 1998-03-17 | Hakki; A-Hamid | Noninvasive blood pressure monitor and control device |
US6050952A (en) * | 1996-02-14 | 2000-04-18 | Hakki; A-Hamid | Method for noninvasive monitoring and control of blood pressure |
US5913876A (en) * | 1996-02-20 | 1999-06-22 | Cardiothoracic Systems, Inc. | Method and apparatus for using vagus nerve stimulation in surgery |
US5916239A (en) * | 1996-03-29 | 1999-06-29 | Purdue Research Foundation | Method and apparatus using vagal stimulation for control of ventricular rate during atrial fibrillation |
US5766236A (en) * | 1996-04-19 | 1998-06-16 | Detty; Gerald D. | Electrical stimulation support braces |
US5715837A (en) * | 1996-08-29 | 1998-02-10 | Light Sciences Limited Partnership | Transcutaneous electromagnetic energy transfer |
US5741316A (en) * | 1996-12-02 | 1998-04-21 | Light Sciences Limited Partnership | Electromagnetic coil configurations for power transmission through tissue |
US6208894B1 (en) * | 1997-02-26 | 2001-03-27 | Alfred E. Mann Foundation For Scientific Research And Advanced Bionics | System of implantable devices for monitoring and/or affecting body parameters |
US5861015A (en) * | 1997-05-05 | 1999-01-19 | Benja-Athon; Anuthep | Modulation of the nervous system for treatment of pain and related disorders |
US6023642A (en) * | 1997-05-08 | 2000-02-08 | Biogenics Ii, Llc | Compact transcutaneous electrical nerve stimulator |
US6231516B1 (en) * | 1997-10-14 | 2001-05-15 | Vacusense, Inc. | Endoluminal implant with therapeutic and diagnostic capability |
US6016449A (en) * | 1997-10-27 | 2000-01-18 | Neuropace, Inc. | System for treatment of neurological disorders |
US6564101B1 (en) * | 1998-02-02 | 2003-05-13 | The Trustees Of Columbia University In The City Of New York | Electrical system for weight loss and laparoscopic implanation thereof |
US5904708A (en) * | 1998-03-19 | 1999-05-18 | Medtronic, Inc. | System and method for deriving relative physiologic signals |
US6058331A (en) * | 1998-04-27 | 2000-05-02 | Medtronic, Inc. | Apparatus and method for treating peripheral vascular disease and organ ischemia by electrical stimulation with closed loop feedback control |
US5876422A (en) * | 1998-07-07 | 1999-03-02 | Vitatron Medical B.V. | Pacemaker system with peltier cooling of A-V node for treating atrial fibrillation |
US6052623A (en) * | 1998-11-30 | 2000-04-18 | Medtronic, Inc. | Feedthrough assembly for implantable medical devices and methods for providing same |
US6178349B1 (en) * | 1999-04-15 | 2001-01-23 | Medtronic, Inc. | Drug delivery neural stimulation device for treatment of cardiovascular disorders |
US20020005982A1 (en) * | 2000-07-17 | 2002-01-17 | Rolf Borlinghaus | Arrangement for spectrally sensitive reflected-light and transmitted-light microscopy |
US6522926B1 (en) * | 2000-09-27 | 2003-02-18 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US6985774B2 (en) * | 2000-09-27 | 2006-01-10 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US20030060857A1 (en) * | 2000-09-27 | 2003-03-27 | Perrson Bruce J. | Electrode designs and methods of use for cardiovascular reflex control devices |
US20030060858A1 (en) * | 2000-09-27 | 2003-03-27 | Kieval Robert S. | Stimulus regimens for cardiovascular reflex control |
US20040019364A1 (en) * | 2000-09-27 | 2004-01-29 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control via coupled electrodes |
US20030100924A1 (en) * | 2001-04-20 | 2003-05-29 | Foreman Robert D. | Cardiac neuromodulation and methods of using same |
US6704598B2 (en) * | 2001-05-23 | 2004-03-09 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system selecting between multiple same-chamber electrodes for delivering cardiac therapy |
US7192403B2 (en) * | 2001-08-17 | 2007-03-20 | Russell Ted W | Methods, apparatus and articles-of-manufacture for noninvasive measurement and monitoring of peripheral blood flow, perfusion, cardiac output biophysic stress and cardiovascular condition |
US20030040785A1 (en) * | 2001-08-21 | 2003-02-27 | Maschino Steve E. | Circumneural electrode assembly |
US6701186B2 (en) * | 2001-09-13 | 2004-03-02 | Cardiac Pacemakers, Inc. | Atrial pacing and sensing in cardiac resynchronization therapy |
US20040010303A1 (en) * | 2001-09-26 | 2004-01-15 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US20030060848A1 (en) * | 2001-09-26 | 2003-03-27 | Kieval Robert S. | Mapping methods for cardiovascular reflex control devices |
US6850801B2 (en) * | 2001-09-26 | 2005-02-01 | Cvrx, Inc. | Mapping methods for cardiovascular reflex control devices |
US20060089678A1 (en) * | 2002-03-14 | 2006-04-27 | Alon Shalev | Technique for blood pressure regulation |
US20040034391A1 (en) * | 2002-08-16 | 2004-02-19 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with respiration synchronous optimization of cardiac performance using atrial cycle length |
US6876881B2 (en) * | 2002-08-16 | 2005-04-05 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system with respiration synchronous optimization of cardiac performance using atrial cycle length |
US20040062852A1 (en) * | 2002-09-30 | 2004-04-01 | Medtronic, Inc. | Method for applying a drug coating to a medical device |
US20040102818A1 (en) * | 2002-11-26 | 2004-05-27 | Hakky Said I. | Method and system for controlling blood pressure |
US20050021092A1 (en) * | 2003-06-09 | 2005-01-27 | Yun Anthony Joonkyoo | Treatment of conditions through modulation of the autonomic nervous system |
Cited By (209)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9427583B2 (en) | 2000-09-27 | 2016-08-30 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US8086314B1 (en) | 2000-09-27 | 2011-12-27 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US8060206B2 (en) | 2000-09-27 | 2011-11-15 | Cvrx, Inc. | Baroreflex modulation to gradually decrease blood pressure |
US8290595B2 (en) | 2000-09-27 | 2012-10-16 | Cvrx, Inc. | Method and apparatus for stimulation of baroreceptors in pulmonary artery |
US7949400B2 (en) | 2000-09-27 | 2011-05-24 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control via coupled electrodes |
US7840271B2 (en) | 2000-09-27 | 2010-11-23 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US7813812B2 (en) | 2000-09-27 | 2010-10-12 | Cvrx, Inc. | Baroreflex stimulator with integrated pressure sensor |
US20100249874A1 (en) * | 2000-09-27 | 2010-09-30 | Bolea Stephen L | Baroreflex therapy for disordered breathing |
US20100191303A1 (en) * | 2000-09-27 | 2010-07-29 | Cvrx, Inc. | Automatic baroreflex modulation responsive to adverse event |
US20050251212A1 (en) * | 2000-09-27 | 2005-11-10 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US20100179614A1 (en) * | 2000-09-27 | 2010-07-15 | Kieval Robert S | Devices and methods for cardiovascular reflex control |
US20100174347A1 (en) * | 2000-09-27 | 2010-07-08 | Kieval Robert S | Devices and methods for cardiovascular reflex control via coupled electrodes |
US8583236B2 (en) | 2000-09-27 | 2013-11-12 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US20070021797A1 (en) * | 2000-09-27 | 2007-01-25 | Cvrx, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US20070021792A1 (en) * | 2000-09-27 | 2007-01-25 | Cvrx, Inc. | Baroreflex Modulation Based On Monitored Cardiovascular Parameter |
US20070021794A1 (en) * | 2000-09-27 | 2007-01-25 | Cvrx, Inc. | Baroreflex Therapy for Disordered Breathing |
US20070060972A1 (en) * | 2000-09-27 | 2007-03-15 | Cvrx, Inc. | Devices and methods for cardiovascular reflex treatments |
US8606359B2 (en) | 2000-09-27 | 2013-12-10 | Cvrx, Inc. | System and method for sustained baroreflex stimulation |
US20090234418A1 (en) * | 2000-09-27 | 2009-09-17 | Kieval Robert S | Devices and methods for cardiovascular reflex control via coupled electrodes |
US20070185543A1 (en) * | 2000-09-27 | 2007-08-09 | Cvrx, Inc. | System and method for sustained baroreflex stimulation |
US8712531B2 (en) | 2000-09-27 | 2014-04-29 | Cvrx, Inc. | Automatic baroreflex modulation responsive to adverse event |
US8718789B2 (en) | 2000-09-27 | 2014-05-06 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US8838246B2 (en) | 2000-09-27 | 2014-09-16 | Cvrx, Inc. | Devices and methods for cardiovascular reflex treatments |
US8880190B2 (en) | 2000-09-27 | 2014-11-04 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US20080171923A1 (en) * | 2000-09-27 | 2008-07-17 | Cvrx, Inc. | Assessing autonomic activity using baroreflex analysis |
US20080172101A1 (en) * | 2000-09-27 | 2008-07-17 | Cvrx, Inc. | Non-linear electrode array |
US20080177350A1 (en) * | 2000-09-27 | 2008-07-24 | Cvrx, Inc. | Expandable Stimulation Electrode with Integrated Pressure Sensor and Methods Related Thereto |
US9044609B2 (en) | 2000-09-27 | 2015-06-02 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US20080215111A1 (en) * | 2000-09-27 | 2008-09-04 | Cvrx, Inc. | Devices and Methods for Cardiovascular Reflex Control |
US20080097540A1 (en) * | 2001-09-26 | 2008-04-24 | Cvrx, Inc. | Ecg input to implantable pulse generator using carotid sinus leads |
US20100125307A1 (en) * | 2003-11-03 | 2010-05-20 | Pastore Joseph M | Multi-site ventricular pacing therapy with parasympathetic stimulation |
US8571655B2 (en) | 2003-11-03 | 2013-10-29 | Cardiac Pacemakers, Inc. | Multi-site ventricular pacing therapy with parasympathetic stimulation |
US7657312B2 (en) | 2003-11-03 | 2010-02-02 | Cardiac Pacemakers, Inc. | Multi-site ventricular pacing therapy with parasympathetic stimulation |
US8874211B2 (en) | 2003-12-23 | 2014-10-28 | Cardiac Pacemakers, Inc. | Hypertension therapy based on activity and circadian rhythm |
US20110082514A1 (en) * | 2003-12-23 | 2011-04-07 | Imad Libbus | Hypertension therapy based on activity and circadian rhythm |
US8805501B2 (en) | 2003-12-24 | 2014-08-12 | Cardiac Pacemakers, Inc. | Baroreflex stimulation to treat acute myocardial infarction |
US8131373B2 (en) | 2003-12-24 | 2012-03-06 | Cardiac Pacemakers, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US9314635B2 (en) | 2003-12-24 | 2016-04-19 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation responsive to adverse event |
US9265948B2 (en) | 2003-12-24 | 2016-02-23 | Cardiac Pacemakers, Inc. | Automatic neural stimulation modulation based on activity |
US10342978B2 (en) | 2003-12-24 | 2019-07-09 | Cardiac Pacemakers, Inc. | Vagus nerve stimulation responsive to a tachycardia precursor |
US9020595B2 (en) | 2003-12-24 | 2015-04-28 | Cardiac Pacemakers, Inc. | Baroreflex activation therapy with conditional shut off |
US8126560B2 (en) | 2003-12-24 | 2012-02-28 | Cardiac Pacemakers, Inc. | Stimulation lead for stimulating the baroreceptors in the pulmonary artery |
US20080228238A1 (en) * | 2003-12-24 | 2008-09-18 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation based on cardiac activity |
US10369367B2 (en) | 2003-12-24 | 2019-08-06 | Cardiac Pacemakers, Inc. | System for providing stimulation pattern to modulate neural activity |
US8818513B2 (en) | 2003-12-24 | 2014-08-26 | Cardiac Pacemakers, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US8805513B2 (en) | 2003-12-24 | 2014-08-12 | Cardiac Pacemakers, Inc. | Neural stimulation modulation based on monitored cardiovascular parameter |
US8121693B2 (en) | 2003-12-24 | 2012-02-21 | Cardiac Pacemakers, Inc. | Baroreflex stimulation to treat acute myocardial infarction |
US20080021507A1 (en) * | 2003-12-24 | 2008-01-24 | Cardiac Pacemakers, Inc. | Sensing with compensation for neural stimulator |
US20080015659A1 (en) * | 2003-12-24 | 2008-01-17 | Yi Zhang | Neurostimulation systems and methods for cardiac conditions |
US8639322B2 (en) | 2003-12-24 | 2014-01-28 | Cardiac Pacemakers, Inc. | System and method for delivering myocardial and autonomic neural stimulation |
US8626301B2 (en) | 2003-12-24 | 2014-01-07 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation based on cardiac activity |
US20090143838A1 (en) * | 2003-12-24 | 2009-06-04 | Imad Libbus | Baroreflex modulation to gradually decrease blood pressure |
US8626282B2 (en) | 2003-12-24 | 2014-01-07 | Cardiac Pacemakers, Inc. | Baroreflex modulation to gradually change a physiological parameter |
US20050143779A1 (en) * | 2003-12-24 | 2005-06-30 | Cardiac Pacemakers, Inc. | Baroreflex modulation based on monitored cardiovascular parameter |
US11154716B2 (en) | 2003-12-24 | 2021-10-26 | Cardiac Pacemakers, Inc. | System for providing stimulation pattern to modulate neural activity |
US20070142864A1 (en) * | 2003-12-24 | 2007-06-21 | Imad Libbus | Automatic neural stimulation modulation based on activity |
US20050149133A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Sensing with compensation for neural stimulator |
US20050149132A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Automatic baroreflex modulation based on cardiac activity |
US7647114B2 (en) | 2003-12-24 | 2010-01-12 | Cardiac Pacemakers, Inc. | Baroreflex modulation based on monitored cardiovascular parameter |
US9440078B2 (en) | 2003-12-24 | 2016-09-13 | Cardiac Pacemakers, Inc. | Neural stimulation modulation based on monitored cardiovascular parameter |
US20100185255A1 (en) * | 2003-12-24 | 2010-07-22 | Imad Libbus | Baroreflex stimulation synchronized to circadian rhythm |
US8195289B2 (en) | 2003-12-24 | 2012-06-05 | Cardiac Pacemakers, Inc. | Baroreflex stimulation system to reduce hypertension |
US9950170B2 (en) | 2003-12-24 | 2018-04-24 | Cardiac Pacemakers, Inc. | System for providing stimulation pattern to modulate neural activity |
US9561373B2 (en) | 2003-12-24 | 2017-02-07 | Cardiac Pacemakers, Inc. | System to stimulate a neural target and a heart |
US9409025B2 (en) | 2003-12-24 | 2016-08-09 | Cardiac Pacemakers, Inc. | Cardiac rhythm management device with neural sensor |
US7706884B2 (en) | 2003-12-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US20050149130A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex stimulation synchronized to circadian rhythm |
US8024050B2 (en) | 2003-12-24 | 2011-09-20 | Cardiac Pacemakers, Inc. | Lead for stimulating the baroreceptors in the pulmonary artery |
US7783353B2 (en) | 2003-12-24 | 2010-08-24 | Cardiac Pacemakers, Inc. | Automatic neural stimulation modulation based on activity and circadian rhythm |
US20050149126A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex stimulation to treat acute myocardial infarction |
US20050149143A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex stimulator with integrated pressure sensor |
US20100274321A1 (en) * | 2003-12-24 | 2010-10-28 | Imad Libbus | Baroreflex activation therapy with conditional shut off |
US20100286741A1 (en) * | 2003-12-24 | 2010-11-11 | Imad Libbus | Cardiac rhythm management device with neural sensor |
US20050149128A1 (en) * | 2003-12-24 | 2005-07-07 | Heil Ronald W.Jr. | Barorflex stimulation system to reduce hypertension |
US7869881B2 (en) | 2003-12-24 | 2011-01-11 | Cardiac Pacemakers, Inc. | Baroreflex stimulator with integrated pressure sensor |
US8473076B2 (en) | 2003-12-24 | 2013-06-25 | Cardiac Pacemakers, Inc. | Lead for stimulating the baroreceptors in the pulmonary artery |
US8457746B2 (en) | 2003-12-24 | 2013-06-04 | Cardiac Pacemakers, Inc. | Implantable systems and devices for providing cardiac defibrillation and apnea therapy |
US20090048641A1 (en) * | 2003-12-24 | 2009-02-19 | Cardiac Pacemakers, Inc. | Baroreflex stimulation to treat acute myocardial infarction |
US20110106216A1 (en) * | 2003-12-24 | 2011-05-05 | Imad Libbus | Baroreflex stimulator with integrated pressure sensor |
US8442640B2 (en) | 2003-12-24 | 2013-05-14 | Cardiac Pacemakers, Inc. | Neural stimulation modulation based on monitored cardiovascular parameter |
US8285389B2 (en) | 2003-12-24 | 2012-10-09 | Cardiac Pacemakers, Inc. | Automatic neural stimulation modulation based on motion and physiological activity |
US20050149156A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Lead for stimulating the baroreceptors in the pulmonary artery |
US8000793B2 (en) | 2003-12-24 | 2011-08-16 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation based on cardiac activity |
US8321023B2 (en) | 2003-12-24 | 2012-11-27 | Cardiac Pacemakers, Inc. | Baroreflex modulation to gradually decrease blood pressure |
US20050149131A1 (en) * | 2003-12-24 | 2005-07-07 | Imad Libbus | Baroreflex modulation to gradually decrease blood pressure |
US11724109B2 (en) | 2004-10-12 | 2023-08-15 | Cardiac Pacemakers, Inc. | System and method for sustained baroreflex stimulation |
US8332047B2 (en) | 2004-11-18 | 2012-12-11 | Cardiac Pacemakers, Inc. | System and method for closed-loop neural stimulation |
US8396560B2 (en) | 2004-11-18 | 2013-03-12 | Cardiac Pacemakers, Inc. | System and method for closed-loop neural stimulation |
US20060135998A1 (en) * | 2004-11-18 | 2006-06-22 | Imad Libbus | System and method for closed-loop neural stimulation |
US10029099B2 (en) | 2004-11-18 | 2018-07-24 | Cardiac Pacemakers, Inc. | System and method for closed-loop neural stimulation |
US20060106429A1 (en) * | 2004-11-18 | 2006-05-18 | Cardiac Pacemakers, Inc. | System and method for closed-loop neural stimulation |
US20090306734A1 (en) * | 2005-03-11 | 2009-12-10 | Julia Moffitt | Combined neural stimulation and cardiac resynchronization therapy |
US8131362B2 (en) | 2005-03-11 | 2012-03-06 | Cardiac Pacemakers, Inc. | Combined neural stimulation and cardiac resynchronization therapy |
US8478397B2 (en) | 2005-03-23 | 2013-07-02 | Cardiac Pacemakers, Inc. | System to provide myocardial and neural stimulation |
US20090228060A1 (en) * | 2005-04-05 | 2009-09-10 | Imad Libbus | Method and apparatus for synchronizing neural stimulation to cardiac cycles |
US20100121399A1 (en) * | 2005-04-05 | 2010-05-13 | Mccabe Aaron | Closed loop neural stimulation synchronized to cardiac cycles |
US8452398B2 (en) | 2005-04-05 | 2013-05-28 | Cardiac Pacemakers, Inc. | Method and apparatus for synchronizing neural stimulation to cardiac cycles |
US9962548B2 (en) | 2005-04-05 | 2018-05-08 | Cardiac Pacemakers, Inc. | Closed loop neural stimulation synchronized to cardiac cycles |
US20060224188A1 (en) * | 2005-04-05 | 2006-10-05 | Cardiac Pacemakers, Inc. | Method and apparatus for synchronizing neural stimulation to cardiac cycles |
US8406876B2 (en) | 2005-04-05 | 2013-03-26 | Cardiac Pacemakers, Inc. | Closed loop neural stimulation synchronized to cardiac cycles |
US9211412B2 (en) | 2005-04-05 | 2015-12-15 | Cardiac Pacemakers, Inc. | Closed loop neural stimulation synchronized to cardiac cycles |
US20110112592A1 (en) * | 2005-04-20 | 2011-05-12 | Imad Libbus | Neural stimulation system to prevent simultaneous energy discharges |
US8831718B2 (en) | 2005-04-20 | 2014-09-09 | Cardiac Pacemakers, Inc. | Neural stimulation system to prevent simultaneous energy discharges |
US8805494B2 (en) | 2005-05-10 | 2014-08-12 | Cardiac Pacemakers, Inc. | System and method to deliver therapy in presence of another therapy |
US9504836B2 (en) | 2005-05-10 | 2016-11-29 | Cardiac Pacemakers, Inc. | System and method to deliver therapy in presence of another therapy |
US8504149B2 (en) | 2005-05-10 | 2013-08-06 | Cardiac Pacemakers, Inc. | System and method to deliver therapy in presence of another therapy |
US8131359B2 (en) | 2005-05-10 | 2012-03-06 | Cardiac Pacemakers, Inc. | System and method to deliver therapy in presence of another therapy |
US11369794B2 (en) | 2005-05-25 | 2022-06-28 | Cardiac Pacemakers, Inc. | Implantable neural stimulator with mode switching |
US11890476B2 (en) | 2005-05-25 | 2024-02-06 | Cardiac Pacemakers, Inc. | Implantable neural stimulator with mode switching |
US11197992B2 (en) | 2005-07-25 | 2021-12-14 | Enopace Biomedical Ltd. | Electrical stimulation of blood vessels |
US9457174B2 (en) | 2005-07-25 | 2016-10-04 | Vascular Dynamics, Inc. | Elliptical element for blood pressure reduction |
US20080215117A1 (en) * | 2005-07-25 | 2008-09-04 | Yossi Gross | Electrical Stimulation of Blood Vessels |
US20080033501A1 (en) * | 2005-07-25 | 2008-02-07 | Yossi Gross | Elliptical element for blood pressure reduction |
US9642726B2 (en) | 2005-07-25 | 2017-05-09 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US9592136B2 (en) | 2005-07-25 | 2017-03-14 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US9550048B2 (en) | 2005-07-25 | 2017-01-24 | Vascular Dynamics, Inc. | Elliptical element for blood pressure reduction |
US20110118773A1 (en) * | 2005-07-25 | 2011-05-19 | Rainbow Medical Ltd. | Elliptical device for treating afterload |
US10384043B2 (en) | 2005-07-25 | 2019-08-20 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US20110213408A1 (en) * | 2005-07-25 | 2011-09-01 | Vascular Dynamics Inc. | Devices and methods for control of blood pressure |
US8862243B2 (en) | 2005-07-25 | 2014-10-14 | Rainbow Medical Ltd. | Electrical stimulation of blood vessels |
US20110178416A1 (en) * | 2005-07-25 | 2011-07-21 | Vascular Dynamics Inc. | Devices and methods for control of blood pressure |
US9125567B2 (en) | 2005-07-25 | 2015-09-08 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US9125732B2 (en) | 2005-07-25 | 2015-09-08 | Vascular Dynamics, Inc. | Devices and methods for control of blood pressure |
US8923972B2 (en) | 2005-07-25 | 2014-12-30 | Vascular Dynamics, Inc. | Elliptical element for blood pressure reduction |
US20070142871A1 (en) * | 2005-12-20 | 2007-06-21 | Cardiac Pacemakers, Inc. | Implantable device for treating epilepsy and cardiac rhythm disorders |
US20080289920A1 (en) * | 2007-05-24 | 2008-11-27 | Hoerbiger-Origa Holding Ag | Pneumatic cylinder with a self-adjusting end position damping arrangement, and method for self-adjusting end position damping |
US9538960B2 (en) | 2007-09-14 | 2017-01-10 | Medtronic Monitoring, Inc. | Injectable physiological monitoring system |
US20090076401A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Injectable Physiological Monitoring System |
US8249686B2 (en) | 2007-09-14 | 2012-08-21 | Corventis, Inc. | Adherent device for sleep disordered breathing |
US8285356B2 (en) | 2007-09-14 | 2012-10-09 | Corventis, Inc. | Adherent device with multiple physiological sensors |
US20090076363A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device with Multiple Physiological Sensors |
US10599814B2 (en) | 2007-09-14 | 2020-03-24 | Medtronic Monitoring, Inc. | Dynamic pairing of patients to data collection gateways |
US8684925B2 (en) | 2007-09-14 | 2014-04-01 | Corventis, Inc. | Injectable device for physiological monitoring |
US10405809B2 (en) | 2007-09-14 | 2019-09-10 | Medtronic Monitoring, Inc | Injectable device for physiological monitoring |
US20090076344A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Multi-Sensor Patient Monitor to Detect Impending Cardiac Decompensation |
US8374688B2 (en) | 2007-09-14 | 2013-02-12 | Corventis, Inc. | System and methods for wireless body fluid monitoring |
US20090076343A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Energy Management for Adherent Patient Monitor |
US10028699B2 (en) | 2007-09-14 | 2018-07-24 | Medtronic Monitoring, Inc. | Adherent device for sleep disordered breathing |
US20090076340A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Cardiac Monitor with Advanced Sensing Capabilities |
US9770182B2 (en) | 2007-09-14 | 2017-09-26 | Medtronic Monitoring, Inc. | Adherent device with multiple physiological sensors |
US8460189B2 (en) | 2007-09-14 | 2013-06-11 | Corventis, Inc. | Adherent cardiac monitor with advanced sensing capabilities |
US8790257B2 (en) | 2007-09-14 | 2014-07-29 | Corventis, Inc. | Multi-sensor patient monitor to detect impending cardiac decompensation |
US9579020B2 (en) | 2007-09-14 | 2017-02-28 | Medtronic Monitoring, Inc. | Adherent cardiac monitor with advanced sensing capabilities |
US20090076559A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device for Cardiac Rhythm Management |
US20090076364A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device for Sleep Disordered Breathing |
US20090076342A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Multi-Sensor Device with Empathic Monitoring |
US20090076348A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Injectable Device for Physiological Monitoring |
US20090076346A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Tracking and Security for Adherent Patient Monitor |
US20090076349A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Multi-Sensor Device with Implantable Device Communication Capabilities |
US8116841B2 (en) | 2007-09-14 | 2012-02-14 | Corventis, Inc. | Adherent device with multiple physiological sensors |
US20090076397A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Emergency Patient Monitor |
US20090073991A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Dynamic Pairing of Patients to Data Collection Gateways |
US20090076350A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Data Collection in a Multi-Sensor Patient Monitor |
US20090076410A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | System and Methods for Wireless Body Fluid Monitoring |
US8897868B2 (en) | 2007-09-14 | 2014-11-25 | Medtronic, Inc. | Medical device automatic start-up upon contact to patient tissue |
US20090076405A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device for Respiratory Monitoring |
US9411936B2 (en) | 2007-09-14 | 2016-08-09 | Medtronic Monitoring, Inc. | Dynamic pairing of patients to data collection gateways |
US20090076341A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Athletic Monitor |
US20090076345A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Adherent Device with Multiple Physiological Sensors |
US8591430B2 (en) | 2007-09-14 | 2013-11-26 | Corventis, Inc. | Adherent device for respiratory monitoring |
US20090076336A1 (en) * | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Medical Device Automatic Start-up Upon Contact to Patient Tissue |
US9186089B2 (en) | 2007-09-14 | 2015-11-17 | Medtronic Monitoring, Inc. | Injectable physiological monitoring system |
US20110009692A1 (en) * | 2007-12-26 | 2011-01-13 | Yossi Gross | Nitric oxide generation to treat female sexual dysfunction |
US20110137370A1 (en) * | 2008-01-31 | 2011-06-09 | Enopace Biomedical Ltd. | Thoracic aorta and vagus nerve stimulation |
US8626290B2 (en) | 2008-01-31 | 2014-01-07 | Enopace Biomedical Ltd. | Acute myocardial infarction treatment by electrical stimulation of the thoracic aorta |
US8626299B2 (en) | 2008-01-31 | 2014-01-07 | Enopace Biomedical Ltd. | Thoracic aorta and vagus nerve stimulation |
US20090210330A1 (en) * | 2008-02-19 | 2009-08-20 | Chia-Chieh Chen | Payroll system and method |
US8718752B2 (en) | 2008-03-12 | 2014-05-06 | Corventis, Inc. | Heart failure decompensation prediction based on cardiac rhythm |
US20090234410A1 (en) * | 2008-03-12 | 2009-09-17 | Corventis, Inc. | Heart Failure Decompensation Prediction Based on Cardiac Rhythm |
US20090264792A1 (en) * | 2008-04-18 | 2009-10-22 | Corventis, Inc. | Method and Apparatus to Measure Bioelectric Impedance of Patient Tissue |
US8412317B2 (en) | 2008-04-18 | 2013-04-02 | Corventis, Inc. | Method and apparatus to measure bioelectric impedance of patient tissue |
US20100191310A1 (en) * | 2008-07-29 | 2010-07-29 | Corventis, Inc. | Communication-Anchor Loop For Injectable Device |
CN102227190A (en) * | 2008-09-26 | 2011-10-26 | 血管动力学公司 | Devices and methods for control of blood pressure |
US20110077729A1 (en) * | 2009-09-29 | 2011-03-31 | Vascular Dynamics Inc. | Devices and methods for control of blood pressure |
US9615757B2 (en) | 2009-10-22 | 2017-04-11 | Medtronic Monitoring, Inc. | Method and apparatus for remote detection and monitoring of functional chronotropic incompetence |
US10779737B2 (en) | 2009-10-22 | 2020-09-22 | Medtronic Monitoring, Inc. | Method and apparatus for remote detection and monitoring of functional chronotropic incompetence |
US8790259B2 (en) | 2009-10-22 | 2014-07-29 | Corventis, Inc. | Method and apparatus for remote detection and monitoring of functional chronotropic incompetence |
US8548585B2 (en) | 2009-12-08 | 2013-10-01 | Cardiac Pacemakers, Inc. | Concurrent therapy detection in implantable medical devices |
US9227068B2 (en) | 2009-12-08 | 2016-01-05 | Cardiac Pacemakers, Inc. | Concurrent therapy detection in implantable medical devices |
US9451897B2 (en) | 2009-12-14 | 2016-09-27 | Medtronic Monitoring, Inc. | Body adherent patch with electronics for physiologic monitoring |
US20110144470A1 (en) * | 2009-12-14 | 2011-06-16 | Corventis, Inc. | Body adherent patch with electronics for physiologic monitoring |
US9173615B2 (en) | 2010-04-05 | 2015-11-03 | Medtronic Monitoring, Inc. | Method and apparatus for personalized physiologic parameters |
US8965498B2 (en) | 2010-04-05 | 2015-02-24 | Corventis, Inc. | Method and apparatus for personalized physiologic parameters |
US8620425B2 (en) | 2010-04-29 | 2013-12-31 | Medtronic, Inc. | Nerve signal differentiation in cardiac therapy |
US8639327B2 (en) | 2010-04-29 | 2014-01-28 | Medtronic, Inc. | Nerve signal differentiation in cardiac therapy |
US11129988B2 (en) | 2010-04-29 | 2021-09-28 | Medtronic, Inc. | Nerve signal differentiation in cardiac therapy |
US8888699B2 (en) | 2010-04-29 | 2014-11-18 | Medtronic, Inc. | Therapy using perturbation and effect of physiological systems |
US8423134B2 (en) | 2010-04-29 | 2013-04-16 | Medtronic, Inc. | Therapy using perturbation and effect of physiological systems |
US10207112B2 (en) | 2010-04-29 | 2019-02-19 | Medtronic, Inc. | Cardiac therapy including vagal stimulation |
US9468764B2 (en) | 2010-04-29 | 2016-10-18 | Medtronic, Inc. | Nerve signal differentiation in cardiac therapy |
US8406868B2 (en) | 2010-04-29 | 2013-03-26 | Medtronic, Inc. | Therapy using perturbation and effect of physiological systems |
CN103338709A (en) * | 2010-05-05 | 2013-10-02 | 血管动力学公司 | Devices and methods for control of blood pressure |
US9649487B2 (en) | 2010-08-05 | 2017-05-16 | Enopace Biomedical Ltd. | Enhancing perfusion by contraction |
US8538535B2 (en) | 2010-08-05 | 2013-09-17 | Rainbow Medical Ltd. | Enhancing perfusion by contraction |
US8649863B2 (en) | 2010-12-20 | 2014-02-11 | Rainbow Medical Ltd. | Pacemaker with no production |
US8706223B2 (en) | 2011-01-19 | 2014-04-22 | Medtronic, Inc. | Preventative vagal stimulation |
US9211413B2 (en) | 2011-01-19 | 2015-12-15 | Medtronic, Inc. | Preventing use of vagal stimulation parameters |
US8718763B2 (en) | 2011-01-19 | 2014-05-06 | Medtronic, Inc. | Vagal stimulation |
US9155893B2 (en) | 2011-01-19 | 2015-10-13 | Medtronic, Inc. | Use of preventative vagal stimulation in treatment of acute myocardial infarction or ischemia |
US8725259B2 (en) | 2011-01-19 | 2014-05-13 | Medtronic, Inc. | Vagal stimulation |
US8781582B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
US8781583B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
US9526637B2 (en) | 2011-09-09 | 2016-12-27 | Enopace Biomedical Ltd. | Wireless endovascular stent-based electrodes |
US10828181B2 (en) | 2011-09-09 | 2020-11-10 | Enopace Biomedical Ltd. | Annular antenna |
US8855783B2 (en) | 2011-09-09 | 2014-10-07 | Enopace Biomedical Ltd. | Detector-based arterial stimulation |
US9386991B2 (en) | 2012-02-02 | 2016-07-12 | Rainbow Medical Ltd. | Pressure-enhanced blood flow treatment |
US11432949B2 (en) | 2013-11-06 | 2022-09-06 | Enopace Biomedical Ltd. | Antenna posts |
US10779965B2 (en) | 2013-11-06 | 2020-09-22 | Enopace Biomedical Ltd. | Posts with compliant junctions |
US11400299B1 (en) | 2021-09-14 | 2022-08-02 | Rainbow Medical Ltd. | Flexible antenna for stimulator |
Also Published As
Publication number | Publication date |
---|---|
US7499742B2 (en) | 2009-03-03 |
US20070021790A1 (en) | 2007-01-25 |
US20120130447A1 (en) | 2012-05-24 |
US20070038255A1 (en) | 2007-02-15 |
US20070021792A1 (en) | 2007-01-25 |
US8060206B2 (en) | 2011-11-15 |
US20040010303A1 (en) | 2004-01-15 |
US20080167694A1 (en) | 2008-07-10 |
US20070021794A1 (en) | 2007-01-25 |
US8718789B2 (en) | 2014-05-06 |
US20130090700A1 (en) | 2013-04-11 |
US20070021796A1 (en) | 2007-01-25 |
US8880190B2 (en) | 2014-11-04 |
US20170001013A1 (en) | 2017-01-05 |
US20070021797A1 (en) | 2007-01-25 |
US20070106340A1 (en) | 2007-05-10 |
US20100222831A1 (en) | 2010-09-02 |
US20080097540A1 (en) | 2008-04-24 |
US20090228065A1 (en) | 2009-09-10 |
US9044609B2 (en) | 2015-06-02 |
US20200114153A1 (en) | 2020-04-16 |
US20070021798A1 (en) | 2007-01-25 |
US20110172734A1 (en) | 2011-07-14 |
US20100191303A1 (en) | 2010-07-29 |
US20150238763A1 (en) | 2015-08-27 |
US9427583B2 (en) | 2016-08-30 |
US20070038262A1 (en) | 2007-02-15 |
US7813812B2 (en) | 2010-10-12 |
US8712531B2 (en) | 2014-04-29 |
US20120232613A1 (en) | 2012-09-13 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US20200114153A1 (en) | Electrode structures and methods for their use in cardiovascular reflex control | |
EP1487535B1 (en) | Electrode structures for use in cardiovascular reflex control | |
US20080177364A1 (en) | Self-locking electrode assembly usable with an implantable medical device | |
US20080177366A1 (en) | Cuff electrode arrangement for nerve stimulation and methods of treating disorders | |
US7499747B2 (en) | External baroreflex activation | |
US20100249874A1 (en) | Baroreflex therapy for disordered breathing |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: CVRX, INC., MINNESOTA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KIEVAL, ROBERT S.;BURNS, MATTHEW M.;SERDAR, DAVID J.;REEL/FRAME:018566/0304;SIGNING DATES FROM 20061004 TO 20061005 |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |