Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N1/00—Electrotherapy; Circuits therefor
  • A61N1/02—Details
  • A61N1/04—Electrodes
  • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
  • A61N1/056—Transvascular endocardial electrode systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N1/00—Electrotherapy; Circuits therefor
  • A61N1/02—Details
  • A61N1/04—Electrodes
  • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
  • A61N1/056—Transvascular endocardial electrode systems
  • A61N1/057—Anchoring means; Means for fixing the head inside the heart
  • A61N1/0573—Anchoring means; Means for fixing the head inside the heart chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N1/00—Electrotherapy; Circuits therefor
  • A61N1/02—Details
  • A61N1/04—Electrodes
  • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
  • A61N1/056—Transvascular endocardial electrode systems
  • A61N2001/0585—Coronary sinus electrodes

Definitions

• FIG. 1 is a schematic drawing of a cardiac rhythm management system including a pulse generator coupled to a lead deployed in a patient's heart according to one embodiment of the present invention.
• the contact between the wall of the right atrium 22 and/or the superior vena cava 21 and the stiffened portion of the lead 14 will prevent the lead 14 from being displaced proximally from its implanted position due to forces imposed by retrograde blood flow or natural heart motion.
• the hub 188 provides a structure for engagement by a grasping tool to facilitate repositioning and/or removal of the implantable member 170 after implantation.
• any of the exemplary implantable stiffening structures described above e.g., the implantable members 90, 140
• the solid implantable member 170 may also, in other embodiments include a proximal portion or tether (in addition to or in lieu of the hub 188) similar to the previously described embodiments.
• this configuration will operate to prevent the distal end region 42 from being pushed out of the branch vessel 34.
• the sheath 194 may be deployed over the body 35 of the lead 14 using, for example, a guide catheter as described above with respect to the tubular sheath 110.
• the sheath 194 is made substantially or entirely of a polymer material.
• the flexible segment 204 is made from a polymer material having a lower durometer than the materials used for the first and second stiff segments 198, 210.
• the portions 198, 204 and 210 may be made from the same material, with the flexible segment 204 including cuts or kerfs to provide the desired flexibility.
• the sheath 194 could include a flexible coil coated with a relatively rigid material (e.g., PTFE) which is then etched or otherwise removed to form the flexible segment 204, with the remaining coated portions forming the stiff segments 198 and 210.
• a relatively rigid material e.g., PTFE
• the proximal portion 196 may be sized to extend to or near the proximal end 70 of the lead 14 and beyond the proximal end of the guide catheter used for deployment of the sheath 194.
• the proximal portion 196 provides structure for securing the sheath 194 in the desired location (e.g., via suture sleeves or other securing structure), and also to provide access to the sheath 194 to facilitate removal of the sheath 110 if desired.
• the proximal portion 196 may be omitted, and the sheath 194 may be pushed into place using a push tube.
• the sheath 194 may permanently reside on the lead body 35, or alternatively, may include structures (e.g., a hub similar to the hub 188 of the implantable member 170 adapted for a tubular sheath) for engagement by a removal tool deployed through a guide catheter.
• structures e.g., a hub similar to the hub 188 of the implantable member 170 adapted for a tubular sheath
• FIGS. 15A and 15B are partial cross-sectional views of a lead assembly including the lead 14 and an alternative implantable stiffening member 220 according to another embodiment of the present invention.
• the implantable member 220 includes first and second balloons 226 and 232, a first tube 240 fluidly connecting the balloons 226 and 232, and a second or proximal tube 246 extending proximally from the second balloon 232 and dimensioned to extend to the proximal end 70 of the lead 14.
• the proximal tube 246 includes a proximal opening 250.
• the balloons 226, 232 are adapted to contain a fluid and to change from a collapsed state for delivery to an expanded (i.e., inflated and pressurized) state for stiffening portions of the lead 14 distal and proximal, respectively, the branch vessel entrance 52.
• the balloons 226, 232 when so expanded, provide substantially the same stiffening function for fixation as the stiff segments 148 and 160 of the implantable member 140 described above.
• the tube 240 may have substantially the same flexibility characteristics as, for example, the flexible segment 154 of the implantable member 140.
• FIG. 15A depicts the balloons 226, 232 in the collapsed delivery state
• FIG. 15B depicts the balloons 226, 232 coupled to the lead 14 in the expanded state for fixation.
• the balloons 226, 232 can be returned to their collapsed states by withdrawing the fluid to permit repositioning and/or removal of the implantable member 220 if desired.
• the channels 284, 286 provide flow ducts for filling the chambers 280, 282 to thereby stiffen the lead body 252 as desired.
• the fluid can be introduced into the proximal channel 286 via the proximal opening 290. Any of the fluids described above with respect to the implantable member 220 may be used to fill and stiffen the chambers 280, 282.
• the proximal channel 286 may, in some embodiments, include a closure structure for closing the proximal opening 290 to maintain fluid within the chambers 280, 282.
• the chambers 280, 282 can be placed anywhere within the wall 264 of the lead body 252.
• FIG. 17 is a partial cutaway view of the coronary sinus 31 and the cardiac branch vessel 34 showing an alternative embodiment for fixation of the distal end region 42 of the lead 14 within the cardiac branch vessel 34.
• the first fixation portion 56 is in the stiffened state, while the remainder of the lead remains relatively flexible.
• a force tending to push the distal end region 42 out of the branch vessel 34 e.g., retrograde blood flow or natural movement of the heart during the cardiac cycle
• interference caused by the branch vessel wall 67 will prevent the stiffened portion 56 from being displaced through the branch vessel entrance 52.
• the flexible segment 320 is adapted such that it can extend to or proximally beyond the proximal end 70 of the lead 14 when the stiff segment 310 is located in the distal end region 42.
• the stiff and flexible segments 310, 320 are shown to have substantially solid structures. It will be appreciated, however, that the stiff and flexible segments 310, 320 may have any structures providing the desired effect of stiffening the fixation portion 56 of the lead 14 so as to prevent spontaneous displacement of the distal end region 42 from the branch vessel in which it is implanted.
• the stiff segment 310 may have any of the structures described above with respect to the stiff segments of the implantable members 90, 140, 170.
• the implantable member 300 may be in the form of a sheath having a stiff segment for implantation over the lead body.
• the sheath may have any structure for providing the desired effect of stiffening the fixation portion 56 of the lead, including those structures described above in connection with the sheaths 110 and 194.
• the lead may be stiffened for fixation in the manner shown in FIG. 17 by including a chamber in the lead body itself adapted to contain a fluid, such as described above in connection with the lead 250. It will be appreciated that in such embodiments, no implantable member need be provided.
• the stiff segment 310 is advantageously dimensioned so as to promote contact between the stiff segment 310 and the vessel walls 66, 67.
• the stiff segment 310 desirably has a length sufficient to substantially prevent the stiffened portion 56 of the lead 14 from being maneuvered through the branch vessel entrance 52 and into the coronary sinus 31.
• the stiff segment 310 may have a length of from about 1 cm to about 5 cm. In one embodiment, the stiff segment may have a length of about 2 cm. In other embodiments, the stiff segment 310 may have a length greater than 5 cm or less than 1 cm.
• the implantable stiffening member 300 can be provided in a variety of stiff segment lengths to accommodate variations in patient coronary anatomies and/or different implantation sites. Additionally, it will be appreciated that the same sizing considerations, and thus the same flexibility in stiffening structure sizing, are applicable to all of the other embodiments illustrated above.
• fixation structures and methods of the present invention may be readily utilized for fixation of elongated leads and other implantable structures in other areas of the patient's vasculature (e.g., the pulmonary arteries).

Landscapes

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

Priority Applications (2)

Applications Claiming Priority (2)

Publications (1)

Family

ID=38543750

Family Applications (1)

Country Status (4)

Cited By (1)

Families Citing this family (33)

Citations (2)

Family Cites Families (48)

• 2006
  • 2006-06-02 US US11/422,014 patent/US8442656B2/en not_active Expired - Fee Related
• 2007
  • 2007-05-01 WO PCT/US2007/067886 patent/WO2007143305A1/en not_active Ceased
  • 2007-05-01 EP EP07761646.4A patent/EP2024014B1/en not_active Not-in-force
  • 2007-05-01 JP JP2009513361A patent/JP5108876B2/ja not_active Expired - Fee Related

Patent Citations (2)

Also Published As

Similar Documents

Legal Events