WO2012058067A1 - System and method for retrieval of an implantable medical device - Google Patents
System and method for retrieval of an implantable medical device Download PDFInfo
- Publication number
- WO2012058067A1 WO2012058067A1 PCT/US2011/056875 US2011056875W WO2012058067A1 WO 2012058067 A1 WO2012058067 A1 WO 2012058067A1 US 2011056875 W US2011056875 W US 2011056875W WO 2012058067 A1 WO2012058067 A1 WO 2012058067A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- medical device
- implantable medical
- catheter
- patient
- magnetic element
- Prior art date
Links
- 238000000034 method Methods 0.000 title abstract description 6
- 238000003780 insertion Methods 0.000 claims abstract description 13
- 230000037431 insertion Effects 0.000 claims abstract description 13
- 238000000605 extraction Methods 0.000 claims description 26
- OCDRLZFZBHZTKQ-NMUBGGKPSA-N onetine Chemical compound C[C@@H](O)[C@@]1(O)C[C@@H](C)[C@@](C)(O)C(=O)OC\C2=C\CN(C)CC[C@@H](OC1=O)C2=O OCDRLZFZBHZTKQ-NMUBGGKPSA-N 0.000 claims description 9
- 239000000284 extract Substances 0.000 claims description 3
- 210000001519 tissue Anatomy 0.000 description 22
- 238000002513 implantation Methods 0.000 description 18
- 210000005003 heart tissue Anatomy 0.000 description 13
- 238000007373 indentation Methods 0.000 description 11
- 210000003698 chordae tendineae Anatomy 0.000 description 9
- 239000000463 material Substances 0.000 description 7
- 210000005241 right ventricle Anatomy 0.000 description 6
- 210000004072 lung Anatomy 0.000 description 5
- 230000017531 blood circulation Effects 0.000 description 4
- 210000005166 vasculature Anatomy 0.000 description 4
- 230000000747 cardiac effect Effects 0.000 description 3
- 210000005240 left ventricle Anatomy 0.000 description 3
- 210000000056 organ Anatomy 0.000 description 3
- 210000005245 right atrium Anatomy 0.000 description 3
- 210000000591 tricuspid valve Anatomy 0.000 description 3
- CWYNVVGOOAEACU-UHFFFAOYSA-N Fe2+ Chemical compound [Fe+2] CWYNVVGOOAEACU-UHFFFAOYSA-N 0.000 description 2
- XEEYBQQBJWHFJM-UHFFFAOYSA-N Iron Chemical compound [Fe] XEEYBQQBJWHFJM-UHFFFAOYSA-N 0.000 description 2
- -1 but not limited to Substances 0.000 description 2
- 229910001000 nickel titanium Inorganic materials 0.000 description 2
- HLXZNVUGXRDIFK-UHFFFAOYSA-N nickel titanium Chemical compound [Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni] HLXZNVUGXRDIFK-UHFFFAOYSA-N 0.000 description 2
- 230000009972 noncorrosive effect Effects 0.000 description 2
- 210000003516 pericardium Anatomy 0.000 description 2
- 230000002093 peripheral effect Effects 0.000 description 2
- 239000010935 stainless steel Substances 0.000 description 2
- 229910001220 stainless steel Inorganic materials 0.000 description 2
- 238000002560 therapeutic procedure Methods 0.000 description 2
- 230000002792 vascular Effects 0.000 description 2
- 210000001631 vena cava inferior Anatomy 0.000 description 2
- 210000002620 vena cava superior Anatomy 0.000 description 2
- ZOXJGFHDIHLPTG-UHFFFAOYSA-N Boron Chemical compound [B] ZOXJGFHDIHLPTG-UHFFFAOYSA-N 0.000 description 1
- 229910052779 Neodymium Inorganic materials 0.000 description 1
- 229920002614 Polyether block amide Polymers 0.000 description 1
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 description 1
- 210000000709 aorta Anatomy 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 238000010009 beating Methods 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 229910052796 boron Inorganic materials 0.000 description 1
- 230000008602 contraction Effects 0.000 description 1
- 238000011161 development Methods 0.000 description 1
- 230000018109 developmental process Effects 0.000 description 1
- 238000005538 encapsulation Methods 0.000 description 1
- PCHJSUWPFVWCPO-UHFFFAOYSA-N gold Chemical compound [Au] PCHJSUWPFVWCPO-UHFFFAOYSA-N 0.000 description 1
- 239000010931 gold Substances 0.000 description 1
- 229910052737 gold Inorganic materials 0.000 description 1
- 229910052742 iron Inorganic materials 0.000 description 1
- 210000005246 left atrium Anatomy 0.000 description 1
- 239000000696 magnetic material Substances 0.000 description 1
- QEFYFXOXNSNQGX-UHFFFAOYSA-N neodymium atom Chemical compound [Nd] QEFYFXOXNSNQGX-UHFFFAOYSA-N 0.000 description 1
- 229920001343 polytetrafluoroethylene Polymers 0.000 description 1
- 239000004810 polytetrafluoroethylene Substances 0.000 description 1
- 238000009877 rendering Methods 0.000 description 1
- 229910001285 shape-memory alloy Inorganic materials 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
- 239000010936 titanium Substances 0.000 description 1
- 229910052719 titanium Inorganic materials 0.000 description 1
- WFKWXMTUELFFGS-UHFFFAOYSA-N tungsten Chemical compound [W] WFKWXMTUELFFGS-UHFFFAOYSA-N 0.000 description 1
- 229910052721 tungsten Inorganic materials 0.000 description 1
- 239000010937 tungsten Substances 0.000 description 1
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
- A61N1/372—Arrangements in connection with the implantation of stimulators
-
- 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
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/375—Constructional arrangements, e.g. casings
- A61N1/3756—Casings with electrodes thereon, e.g. leadless stimulators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
- A61N1/057—Anchoring means; Means for fixing the head inside the heart
- A61N2001/0578—Anchoring means; Means for fixing the head inside the heart having means for removal or extraction
Definitions
- the present invention relates generally to devices to remove implantable medical devices from a patient and, in particular, to such devices to remove implantable medical devices.
- Implantable medical devices such as pacemakers and cardioverter/defibrillators are well known in the art. Such implantable medical devices commonly and historically have been configured to be implanted within the patient some distance away from the heart of the patient. Pacemakers have traditionally been positioned in the musculature or other tissue of the patient's shoulder below the collar bone. Cardioverter/defibrillators are typically implanted either in the patient's side or, with recent advances in miniaturization, in the patient's shoulder. By utilizing transvenous leads to position electrodes within and in proximity of the heart, such implantable medical devices may be so positioned away from the heart and still be configured to treat cardiac conditions.
- implantable medical devices are positioned in the patient's shoulder or other relatively accessible location in the patient's body, implantation and explantation of such implantable medical devices may be relatively straight forward.
- implantable medical devices are both implanted at a relatively shallow depth and are of a size which is relatively easily manipulable for a medical professional, such implantable medical devices have not commonly required specialized tools for removal from the patient.
- Such devices may be relatively straightforwardly removed from the patient by accessing the device surgically, securing the device in the hands, disconnecting the implantable medical device from the transvenous leads and removing the implantable medical device from the patient.
- the musculature and tissue of the shoulder may provide relatively easy physical access to a leadless pacemaker or other leadless implantable medical device, locating the leadless pacemaker in the heart of the patient may make the leadless pacemaker considerably more challenging to physically access for implantation and removal from the patient relative to a device positioned in the patient's shoulder.
- Removal of a leadless pacemaker from the patient's heart may be desirable when, for instance, the power source of the leadless pacemaker has been or is about to be exhausted or in the event of patient discomfort.
- the same principle applies to other implantable medical devices.
- the leadless pacemaker must be secured and extracted. Because implantable medical devices implanted in the heart are fixed to some extent within the heart, the implantable medical device will tend to move within the patient with the beating and other movement of the heart. Thus, physically securing the implantable medical device for removal may be challenging.
- a catheter with a longitudinal lumen has been configured to be passed through the vasculature of the patient and placed in proximity of the implantable medical device within the heart of the patient.
- a magnetic element is configured to pass through the lumen of the catheter and in proximity of the implantable medical device.
- a magnet on the magnetic element is configured to magnetically attract and secure the implantable medical device. Because of the magnetic attraction, the implantable medical device may be secured in spite of the movement of the heart. After the implantable device is secured with the magnet, the implantable medical device may be extracted from the tissue of the heart and withdrawn into the lumen of the catheter. Additional instruments, such as a snare having a lasso or other mechanical grappling device and instruments to cut away encapsulation tissue, may be passed through the lumen of the catheter in order to aid extract the implantable medical device from the tissue of the patient.
- a medical device system has an implantable medical device, a catheter and a magnetic element.
- the implantable medical device has a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient, the medical device being magnetically attractable.
- the catheter has a lumen and a distal portion configured for insertion in proximity of the implantable medical device.
- the magnetic element is configured to pass through the lumen of the catheter and to magnetically engage the implantable medical device when inserted toward the distal portion of the catheter.
- the magnetic element is configured to disengage the fixation member of the implantable medical device from the tissue of the patient
- a magnetic attraction between the magnetic element and the implantable medical device is sufficient to extract the implantable medical device as the magnetic element is extracted.
- the magnetic attraction between the magnetic element and the implantable medical device is at least four Newtons.
- the fixation member is at least one tine having a fixation force securing the at least one tine to the tissue of the patient and wherein the magnetic attraction between the magnetic element and the implantable medical device is greater than the fixation force.
- the fixation member has an engaged state engaged with the tissue of the patient while implanted and an unengaged state unengaged with the tissue of the patient and wherein the fixation member changes from the engaged state to the unengaged state by operation of the magnetic element.
- the fixation member is located proximate a distal portion of the implantable medical device.
- a proximal portion of the implantable medical device is magnetically attractable to the magnetic element.
- the system additionally has a snare having a distal portion and configured for insertion, the snare having a mechanical engaging member proximate the distal portion of the snare, the snare being configured to pass through the catheter and mechanically engage the implantable medical device
- the snare is configured to pass through the catheter and mechanically engage the implantable medical device while the magnetic element has magnetically engaged the implantable medical device.
- the magnetic element when the magnetic element is magnetically engaged with the implantable medical device, the magnetic element provides, at least in part, a physical guide for the snare to mechanically engage the implantable medical device.
- the fixation member has at least one tine having a fixation force securing the at least one tine to the tissue of the patient and wherein the mechanical engaging member mechanically engages the implantable medical device proximate the second portion of the implantable medical device with a connection force greater than the fixation force of the at least one tine.
- the mechanical engaging member comprises a lasso.
- the fixation member is located proximate a first end of the implantable medical device and wherein the implantable medical device further comprises a magnetic component positioned proximate a second end of the implantable medical device opposite the first end providing the magnetic attraction.
- the magnetic component of the implantable medical device comprises a magnet.
- the catheter and the magnetic element are configured to be inserted transvenously.
- a medical device extraction system for a implantable medical device having a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient, the medical device being magnetically attractable has a catheter and a magnetic element.
- the catheter has a lumen and a distal portion configured for insertion in a proximity of the implantable medical device.
- the magnetic element is configured to pass through the lumen of the catheter and to magnetically engage the implantable medical device when inserted toward the distal portion of the catheter.
- a method extracts a magnetically attractable implantable medical device having a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient.
- a catheter having a lumen and a distal portion is inserted in proximity of the implantable medical device.
- a magnetic element is inserted through the lumen of the catheter.
- the implantable medical device is magnetically engaged when the magnetic element is inserted toward the distal portion of the catheter.
- the implantable medical device is removed by extracting the magnetic element.
- the fixation member of the implantable medical device is disengaged from the tissue of the patient.
- the removing step is accomplished with the magnetic attraction between the magnetic element and the implantable medical device being sufficient to hold the implantable medical device as the magnetic element is extracted.
- the implantable medical device is mechanically engaged with a snare inserted through the lumen of the catheter.
- the inserting a catheter step, the inserting a magnetic element step and the removing step are performed trans venously.
- Figure 1 is a partial cross-sectional depiction of a human heart
- Figure 2 illustrates a leadless pacemaker
- Figure 3 illustrates an implantable medical device implantation and extraction system
- Figure 4 is the device implantation and extraction system of Figure 3 engaged with the leadless pacemaker of Figure 2;
- Figure 5 illustrates the leadless pacemaker of Figure 2 having been positioned in association with the device implantation and extraction system of Figure 3;
- Figure 6 illustrates an alternative embodiment of a medical device implantation and extraction system
- Figure 7 illustrates the device implantation and extraction system of Figure 6 engaged with the leadless pacemaker of Figure 2;
- Figure 8 is a flowchart for utilizing a device extraction system
- FIG. 9 is a flowchart for utilizing a device implantation system. DESCRIPTION
- FIG. 1 is a cutaway depiction of human heart 10.
- Arrows 12 illustrate the flow of blood through heart 10.
- Right atrium 14 is accessed by superior vena cava 16 and inferior vena cava 18.
- Blood flows from right atrium 14 to right ventricle 20 through tricuspid valve 22.
- Chordae tendineae 24 in right ventricle 20 act to keep tricuspid valve 22 closed during the contraction of the right ventricle 20.
- the blood flows back to left atrium 26 and then into left ventricle 28. From left ventricle 28 blood flows to the body via aorta 30.
- FIG. 2 shows leadless pacemaker 32 which is configured to be transvenously implantable within heart 10.
- Leadless pacemaker 32 may be further or alternatively be configured to be inserted non-transvenously, variably into heart 10, in the epicardium or pericardium, in proximity of heart 10, within the patient's peripheral vascular system, lungs or elsewhere within the patient.
- Leadless pacemaker 32 may incorporate various internal componentry (not illustrated) common to implantable pacemakers known in the art, including a controller, a power source, sensors, therapy circuitry, telemetry circuitry and other electronics useful for operating leadless pacemaker.
- Implantable medical devices such as cardioverter/defibrillators configured to be leadless implantable medical devices may be substituted for leadless pacemaker 32.
- housing 34 is generally cylindrical, though alternative configurations are also envisioned. In various embodiments, housing 34 is made of non-corrosive materials. In an embodiment, housing 34 is made of titanium. In alternative embodiments, housing 34 is made of ferrous or other magnetically attractive materials. In such embodiments, housing 34 may be covered in a non-bioreactive or non-corrosive material to make leadless pacemaker 32 safe for implantation in heart 10. Electrode 36 is configured to deliver pacing energy generated by the therapy circuitry and the internal power source to heart 10. Additional electrodes 36 may be positioned as needed on housing 34 to deliver a therapeutic output to heart 10. [41] One or more tines 38 create a fixation member and are configured to engage tissue in heart 10 to secure leadless pacemaker 32 within heart 10.
- tines 38 are positioned proximate first end 39 of leadless pacemaker 32.
- tines 38 are configured to ensnare chordae tendineae 24 within right ventricle 20, securing leadless pacemaker 32 within heart 10.
- tines 38 may engage cardiac tissue in or around tricuspid valve 22, left ventricle 28 or elsewhere in heart 10.
- tines 38 may engage tissue in the epicardial space, lung and vasculature. When engaged with chordae tendineae 24 or any patient tissue, tines 38 exert a fixation force which maintains leadless pacemaker 32 within heart 10.
- tines 38 are made from material which is flexible to achieve multiple positions but resiliently biased in a configuration which allows tines 38 to be ensnared in chordae tendineae 24 or other tissue of heart 10.
- tines 38 are formed from a shape memory alloy.
- tines 38 are formed from Nitinol.
- Projection 40 incorporates magnet 42 and indentation 44.
- projection 40 is generally cylindrical and positioned proximate second end 41 of leadless pacemaker 32.
- projection 40, along with indentation 44, are alternatively shaped to facilitate a mechanical or connection force with an implantable medical device system discussed in detail below.
- indentation 44 is not incorporated in projection 40.
- projection 40 is not incorporated in leadless pacemaker 32.
- magnet 42 is incorporated into housing 34. In further alternative embodiments where housing 34 is ferrous or which otherwise creates a magnetic attraction with a magnet, magnet 42 is not incorporated.
- magnet 42 is substituted with a magnetic component which is attracted to a magnet but which is not itself a magnet.
- projection 40 and indentation 44 are incorporated in leadless pacemaker 32. In alternative embodiments, projection 40 and/or indentation 44 are not incorporated in leadless pacemaker 32.
- FIG. 3 is a cutaway view of implantable medical device implantation and extraction system 46.
- Implantation and extraction system 46 incorporates catheter 48 and magnetic element 50.
- catheter 48 incorporates body catheter 52 and fairing 54, both of which incorporate a continuous lumen 56 extending the length of catheter 48.
- Lumen 56 is sized to contain at least element 50 and to allow element 50 to move longitudinally within lumen 56 and project out of opening 57 at distal end 59.
- fairing 54 is sized and configured to admit and contain leadless pacemaker 32 within lumen 56 so that tines 38 may not engage tissue of heart 10 or of a patient's vasculature.
- catheter incorporates body catheter 52 and not fairing 54 as a separate component.
- lumen 56 in body catheter 52 may be large enough to admit leadless pacemaker 32.
- lumen in body catheter 52 may not be large enough to admit leadless pacemaker 32, limiting leadless pacemaker 32 to being positioned in fairing 54.
- Catheter 48 is sized to pass through superior vena cava 16 or inferior vena cava 18 and right atrium 14 and into right ventricle 20.
- catheter 48 is approximately one hundred twenty (120) centimeters long and a maximum external diameter at fairing 54 of 0.73 centimeters.
- lumen 56 has a width of 0.20 centimeters along body catheter 52 and 0.68 centimeters within fairing 54.
- catheter 48 is made from materials including, but not limited to, polytetrafluoroethylene, polyether block amide, stainless steel and tungsten.
- Element 50 is configured to secure leadless pacemaker 32 using magnet 58 positioned on distal tip 60 of element 50.
- magnet 58 is made from neodymium, iron and boron.
- magnet 58 is made from any material which may be developed to create a magnetic attraction with magnet 42 of leadless pacemaker 32 sufficient to secure leadless pacemaker 32 to element 50.
- magnet 58 is an electromagnet.
- magnet 58 of element 50 is strong enough to engage the magnetic material of leadless pacemaker 32 to element 50.
- magnet 58 is a bar magnet or elongate magnet with opposing poles.
- magnet 42 of leadless pacemaker 32 is also a bar magnet or elongate magnet with opposing poles. Where both magnet 42 and magnet 58 are bar or elongate magnets, magnets 42 and 58 may be rotationally fixed with respect to one another when magnetically engaged. In alternative embodiments, magnets 42 and 58 are not bar magnets but are sufficiently strong as to prevent rotation with respect to one another when magnetically engaged. In such embodiments, element 50 may be utilized to rotate leadless pacemaker 32, for instance, when tines 38 or an alternative fixation member such as a screw or helix, may be secured to, or disengaged from cardiac tissue through rotation.
- element 50 has magnet 58 strong enough to engage leadless pacemaker 32 with a magnetic force stronger than the fixation force between tines 38 and chordae tendineae 24.
- element 50 has magnet 58 weak enough to disengage magnet 58 from leadless pacemaker 32 without disengaging leadless pacemaker 32 from cardiac tissue.
- each tine 38 creates a fixation force of approximately one Newton.
- magnet 58 creates less magnetic attraction with leadless pacemaker 32 than one-quarter (1/4) Newtons, while for explantation magnet 58 creates greater than four (4) Newtons of magnetic attraction with leadless pacemaker 32.
- FIG. 4 illustrates magnet 58 of element 50 having established a magnetic force with magnet 42 of leadless pacemaker 32.
- system 46 may act to extract leadless pacemaker 32 from heart 10.
- leadless pacemaker 32 may be freed from being secured to heart 10, upon which leadless pacemaker 32 may be retracted into lumen 56 in fairing 54, rendering tines 38 ineffective to engage heart 10 tissue or the vasculature of the patient.
- a longitudinal force may be exerted on leadless pacemaker 32 in order to push leadless pacemaker 32 from fairing 54 and allow tines 38 to engage cardiac tissue.
- FIG. 5 is a cutaway illustration of leadless pacemaker 32 having been contained within fairing 54 of system 46.
- leadless pacemaker 32 may be pre-positioned in fairing 54 prior to be egested near cardiac tissue.
- leadless pacemaker 32 may have been pulled from engagement with cardiac tissue.
- tines 38 tend to move from an implanted state, in which tines 38 are curled to engage cardiac tissue, to an extracted state in which tines 38 are generally straight, allowing tines 38 to be freed from cardiac tissue.
- tines 38 are prevented from engaging with patient tissue, thereby reducing a likelihood of leadless pacemaker 32 from becoming dislodged from system 46.
- Fairing 54 is sized so that tines 38 remain in the extraction or unengaged state, extending generally straight outward from housing 34, in contrast with tines 38 implanted state, generally curled out from housing 34 so as to engage cardiac tissue.
- Figure 6 is implantable medical device implantation and extraction system 146 incorporating catheter 48, element 50 and snare 162.
- catheter 48 and element 50 are configured to function as described in detail above.
- the magnetic force created between magnet 58 of element 50 and magnet 42 of leadless pacemaker 32 may be supplemented by a mechanical or connection force created by engaging protrusion 40 of leadless pacemaker 32 with a mechanical engaging member such as lasso 164 of snare 162.
- lumen 56 of catheter 48 is sized to admit and allow to move longitudinally both element 50 and snare 162.
- element 50 may provide a guide or rail for snare 162.
- element 50 acts as a guide by circumscribing lasso 164 around element 50.
- element 50 is configured to magnetically engage leadless pacemaker 32 in order to fix leadless pacemaker 32 with respect to system 146. Then snare 162 may be extended through lumen 56 and around protrusion 40.
- lasso 164 may be tightened in order exert a mechanical or connection force on leadless pacemaker 32.
- Indentation 44 may help provide relatively greater mechanical or connection force on leadless pacemaker 32 than may be attained without indentation 44.
- the mechanical or connection force exerted on protrusion 40 of leadless pacemaker 32 may be greater than the fixation force exerted by tines 38 being engaged with chordae tendineae 24, allowing leadless pacemaker 32 to be extracted from heart 10 in the same manner described above.
- snare 162 is comprised of the same materials as element 50.
- lasso 164 is made from nitinol, stainless steel and gold. Lasso 164 is contractable around projection 40 by manipulating a proximal end of lasso 164 (not pictured) which extends through snare 162 and which is manipulable by a user. By pulling on the proximal end of lasso 162, lasso 162 may be tightened about projection 40 so as to exert the mechanical or connection force on projection 40.
- lasso 164 may be tightened about any part of housing 34. In such embodiments, it may be relatively more difficult for lasso 164 to exert a mechanical or connection force than where projection 40 with indentation 44 is provided, though by applying relatively greater force to lasso 164 than may be applied to projection 40 with indentation 44, sufficient mechanical or connection force may be exerted on leadless pacemaker to disengage tines 38 from cardiac tissue.
- Figure 8 is a flowchart for extracting leadless pacemaker 32 from heart 10 using system 46 or system 146.
- the flowchart may be readily adapted for utilizing system 46 or system 146 for extracting an implantable medical device from other locations within a patient, such as the lungs or other organs.
- the extraction is transvenous.
- Catheter 48 is inserted (800) into heart 10 and proximate leadless pacemaker 32.
- Magnetic element 50 is inserted (802) through lumen 56 of catheter 48.
- the insertion (800, 802) of catheter 48 and magnetic element 50 occur simultaneously.
- simultaneous insertion occurs by inserting magnetic element 50 into lumen 56 prior to inserting either catheter 48 or magnetic element 50, and then inserting both catheter 48 and magnetic element 50 into the patient at the same time.
- Magnet 58 is then used to magnetically engage (804) magnet 42 of leadless pacemaker 32 when element 50 projects through or approaches opening 57 at distal end 59 of catheter.
- lasso 164 is utilized to mechanically engage (806) leadless pacemaker 32, in various embodiments projection 40 at indentation 44.
- Tines 38 are disengaged (808) from cardiac tissue and leadless pacemaker 32 is removed (810) from heart 10 by extracting element 50 and, in embodiments with snare 162, snare 162 through catheter 48.
- leadless pacemaker 32 is withdrawn into fairing 54 and catheter 48 is removed.
- element 50 and optionally snare 162 are removed the length of lumen 56 in order to extract leadless pacemaker 32, whereupon catheter 48 is extracted from the patient.
- FIG. 9 is a flowchart for implanting leadless pacemaker 32 in heart 10 using system 46 or system 146.
- implantation is transvenous.
- Catheter 48 is inserted (900) into heart 10 and proximate patient tissue such as cardiac trabeculae.
- Leadless pacemaker 32 is inserted (902) into lumen 56 of catheter 48.
- leadless pacemaker 32 is inserted into lumen 56 of catheter 48 prior to catheter 48 being inserted into the patient.
- catheter 48 may be inserted first and then leadless pacemaker 32 inserted into lumen 56.
- Magnetic element 50 is inserted (904) into lumen 56 of catheter 48.
- the insertion (900, 904) of catheter 48 and element 50 occur simultaneously.
- simultaneous insertion occurs by inserting element 50 into lumen 56 prior to inserting either catheter 48 or element 50, and then inserting both catheter 48 and element 50 into the patient at the same time.
- Magnetic element 50 magnetically engages (906) leadless pacemaker 32.
- the insertion (900) of catheter 48, the insertion (902) of leadless pacemaker 32 into lumen 56, the insertion (904) of magnetic element 50 into lumen 56 and the magnetic engagement (906) of leadless pacemaker 32 with magnetic element 50 may occur in any sequence convenient for use.
- Leadless pacemaker 32 is egested (908) from catheter 48, in an embodiment by causing magnetic element 50 to exert a pushing force on leadless pacemaker 32.
- tines 38 engage chordae tendineae 24.
- Magnetic element 50 is disengaged (910) from leadless pacemaker 32, and catheter 48 and magnetic element 50 are withdrawn (912) from the patient, leaving leadless pacemaker 32 engaged with cardiac tissue.
- the engagement of tines 38 with chordae tendineae 24 may be tested (912) by exerting a pulling force on leadless pacemaker 32 less than the magnetic attraction between magnet 58 and leadless pacemaker 32. If tines 38 do not separate from chordae tendineae 24 then leadless pacemaker may be deemed successfully implanted.
Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (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)
- Media Introduction/Drainage Providing Device (AREA)
- Electrotherapy Devices (AREA)
Abstract
System and method for extracting an implantable medical device. An implantable medical device has a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient, the medical device being magnetically attractable. A catheter has a lumen and a distal portion configured for insertion in proximity of the implantable medical device. A magnetic element is configured to pass through the lumen of the catheter and to magnetically engage the implantable medical device when inserted toward the distal portion of the catheter.
Description
SYSTEM AND METHOD FOR RETRIEVAL OF AN
IMPLANTABLE MEDICAL DEVICE
FIELD
[1] The present invention relates generally to devices to remove implantable medical devices from a patient and, in particular, to such devices to remove implantable medical devices.
BACKGROUND
[2] Electrically active implantable medical devices such as pacemakers and cardioverter/defibrillators are well known in the art. Such implantable medical devices commonly and historically have been configured to be implanted within the patient some distance away from the heart of the patient. Pacemakers have traditionally been positioned in the musculature or other tissue of the patient's shoulder below the collar bone. Cardioverter/defibrillators are typically implanted either in the patient's side or, with recent advances in miniaturization, in the patient's shoulder. By utilizing transvenous leads to position electrodes within and in proximity of the heart, such implantable medical devices may be so positioned away from the heart and still be configured to treat cardiac conditions.
[3] Because such implantable medical devices are positioned in the patient's shoulder or other relatively accessible location in the patient's body, implantation and explantation of such implantable medical devices may be relatively straight forward. In particular, because such implantable medical devices are both implanted at a relatively shallow depth and are of a size which is relatively easily manipulable for a medical professional, such implantable medical devices have not commonly required specialized tools for removal from the patient. Such devices may be relatively straightforwardly removed from the patient by accessing the device surgically, securing the device in the hands, disconnecting the implantable medical device from the transvenous leads and removing the implantable medical device from the patient.
[4] Recently, however, miniaturization of implantable cardiac devices, particularly pacemakers, has allowed devices to be manufactured of a size small enough to permit implantation of the device within the heart of the patient or within other organs or parts of the body with similar space constraints, such as the epicardium, the pericardium, the lungs and the peripheral vascular system. Such developments may reduce the discomfort a patient may experience having an implantable medical device implanted at a relatively shallow depth in their shoulder and obviate the need for invasive trans venous leads. Pacemakers with these qualities may be referred to as leadless pacemakers. However, while the musculature and tissue of the shoulder may provide relatively easy physical access to a leadless pacemaker or other leadless implantable medical device, locating the leadless pacemaker in the heart of the patient may make the leadless pacemaker considerably more challenging to physically access for implantation and removal from the patient relative to a device positioned in the patient's shoulder.
SUMMARY
[5] Removal of a leadless pacemaker from the patient's heart may be desirable when, for instance, the power source of the leadless pacemaker has been or is about to be exhausted or in the event of patient discomfort. The same principle applies to other implantable medical devices. In addition, beyond the challenges posed by being relatively more difficult to physically access, once access to the heart of the patient or other space- constricted organ or portion of the patient's body has been gained, the leadless pacemaker must be secured and extracted. Because implantable medical devices implanted in the heart are fixed to some extent within the heart, the implantable medical device will tend to move within the patient with the beating and other movement of the heart. Thus, physically securing the implantable medical device for removal may be challenging. In addition, because the implantable medical device is so fixed within the heart there may be a tendency to resist removal.
[6] An implantable medical device implantation and extraction system has been developed to address these challenges. A catheter with a longitudinal lumen has been configured to be passed through the vasculature of the patient and placed in proximity of the implantable medical device within the heart of the patient. A magnetic element is configured to pass through the lumen of the catheter and in proximity of the implantable medical device. A magnet on the magnetic element is configured to magnetically attract and secure the implantable medical device. Because of the magnetic attraction, the implantable medical device may be secured in spite of the movement of the heart. After the implantable device is secured with the magnet, the implantable medical device may be extracted from the tissue of the heart and withdrawn into the lumen of the catheter. Additional instruments, such as a snare having a lasso or other mechanical grappling device and instruments to cut away encapsulation tissue, may be passed through the lumen of the catheter in order to aid extract the implantable medical device from the tissue of the patient.
[7] In an embodiment, a medical device system has an implantable medical device, a catheter and a magnetic element. The implantable medical device has a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient, the medical device being magnetically attractable. The catheter has a lumen and a distal portion configured for insertion in proximity of the implantable medical device. The magnetic element is configured to pass through the lumen of the catheter and to magnetically engage the implantable medical device when inserted toward the distal portion of the catheter.
[8] In an embodiment, the magnetic element is configured to disengage the fixation member of the implantable medical device from the tissue of the patient
[9] In an embodiment, a magnetic attraction between the magnetic element and the implantable medical device is sufficient to extract the implantable medical device as the magnetic element is extracted.
[10] In an embodiment, the magnetic attraction between the magnetic element and the implantable medical device is at least four Newtons.
[11] In an embodiment, the fixation member is at least one tine having a fixation force securing the at least one tine to the tissue of the patient and wherein the magnetic attraction between the magnetic element and the implantable medical device is greater than the fixation force.
[12] In an embodiment, the fixation member has an engaged state engaged with the tissue of the patient while implanted and an unengaged state unengaged with the tissue of the patient and wherein the fixation member changes from the engaged state to the unengaged state by operation of the magnetic element.
[13] In an embodiment, the fixation member is located proximate a distal portion of the implantable medical device.
[14] In an embodiment, a proximal portion of the implantable medical device is magnetically attractable to the magnetic element.
[15] In an embodiment, the system additionally has a snare having a distal portion and configured for insertion, the snare having a mechanical engaging member proximate the distal portion of the snare, the snare being configured to pass through the catheter and mechanically engage the implantable medical device
[16] In an embodiment, the snare is configured to pass through the catheter and mechanically engage the implantable medical device while the magnetic element has magnetically engaged the implantable medical device.
[17] In an embodiment, when the magnetic element is magnetically engaged with the implantable medical device, the magnetic element provides, at least in part, a physical guide for the snare to mechanically engage the implantable medical device.
[18] In an embodiment, the fixation member has at least one tine having a fixation force securing the at least one tine to the tissue of the patient and wherein the mechanical engaging member mechanically engages the implantable medical device proximate the second portion of the
implantable medical device with a connection force greater than the fixation force of the at least one tine.
[19] In an embodiment, the mechanical engaging member comprises a lasso.
[20] In an embodiment, the fixation member is located proximate a first end of the implantable medical device and wherein the implantable medical device further comprises a magnetic component positioned proximate a second end of the implantable medical device opposite the first end providing the magnetic attraction.
[21] In an embodiment, the magnetic component of the implantable medical device comprises a magnet.
[22] In an embodiment, the catheter and the magnetic element are configured to be inserted transvenously.
[23] In an embodiment, a medical device extraction system for a implantable medical device having a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient, the medical device being magnetically attractable, has a catheter and a magnetic element. The catheter has a lumen and a distal portion configured for insertion in a proximity of the implantable medical device. The magnetic element is configured to pass through the lumen of the catheter and to magnetically engage the implantable medical device when inserted toward the distal portion of the catheter.
[24] In an embodiment, a method extracts a magnetically attractable implantable medical device having a fixation member operatively coupled to the housing having an engaged state configured to engage tissue of a patient. A catheter having a lumen and a distal portion is inserted in proximity of the implantable medical device. A magnetic element is inserted through the lumen of the catheter. The implantable medical device is magnetically engaged when the magnetic element is inserted toward the distal portion of the catheter. The implantable medical device is removed by extracting the magnetic element.
[25] In an embodiment, after the magnetically engaging step, the fixation member of the implantable medical device is disengaged from the tissue of the patient.
[26] In an embodiment, the removing step is accomplished with the magnetic attraction between the magnetic element and the implantable medical device being sufficient to hold the implantable medical device as the magnetic element is extracted.
[27] In an embodiment, after the magnetic element is magnetically engaged, the implantable medical device is mechanically engaged with a snare inserted through the lumen of the catheter.
[28] In an embodiment, the inserting a catheter step, the inserting a magnetic element step and the removing step are performed trans venously.
FIGURES
[29] Figure 1 is a partial cross-sectional depiction of a human heart;
[30] Figure 2 illustrates a leadless pacemaker;
[31] Figure 3 illustrates an implantable medical device implantation and extraction system;
[32] Figure 4 is the device implantation and extraction system of Figure 3 engaged with the leadless pacemaker of Figure 2;
[33] Figure 5 illustrates the leadless pacemaker of Figure 2 having been positioned in association with the device implantation and extraction system of Figure 3;
[34] Figure 6 illustrates an alternative embodiment of a medical device implantation and extraction system;
[35] Figure 7 illustrates the device implantation and extraction system of Figure 6 engaged with the leadless pacemaker of Figure 2;
[36] Figure 8 is a flowchart for utilizing a device extraction system; and
[37] Figure 9 is a flowchart for utilizing a device implantation system.
DESCRIPTION
[38] Figure 1 is a cutaway depiction of human heart 10. Arrows 12 illustrate the flow of blood through heart 10. Right atrium 14 is accessed by superior vena cava 16 and inferior vena cava 18. Blood flows from right atrium 14 to right ventricle 20 through tricuspid valve 22. Chordae tendineae 24 in right ventricle 20 act to keep tricuspid valve 22 closed during the contraction of the right ventricle 20. After blood flows from right ventricle 20 to the lungs (not pictured), the blood flows back to left atrium 26 and then into left ventricle 28. From left ventricle 28 blood flows to the body via aorta 30.
[39] Figure 2 shows leadless pacemaker 32 which is configured to be transvenously implantable within heart 10. Leadless pacemaker 32 may be further or alternatively be configured to be inserted non-transvenously, variably into heart 10, in the epicardium or pericardium, in proximity of heart 10, within the patient's peripheral vascular system, lungs or elsewhere within the patient. Leadless pacemaker 32 may incorporate various internal componentry (not illustrated) common to implantable pacemakers known in the art, including a controller, a power source, sensors, therapy circuitry, telemetry circuitry and other electronics useful for operating leadless pacemaker. Implantable medical devices such as cardioverter/defibrillators configured to be leadless implantable medical devices may be substituted for leadless pacemaker 32.
[40] As illustrated, housing 34 is generally cylindrical, though alternative configurations are also envisioned. In various embodiments, housing 34 is made of non-corrosive materials. In an embodiment, housing 34 is made of titanium. In alternative embodiments, housing 34 is made of ferrous or other magnetically attractive materials. In such embodiments, housing 34 may be covered in a non-bioreactive or non-corrosive material to make leadless pacemaker 32 safe for implantation in heart 10. Electrode 36 is configured to deliver pacing energy generated by the therapy circuitry and the internal power source to heart 10. Additional electrodes 36 may be positioned as needed on housing 34 to deliver a therapeutic output to heart 10.
[41] One or more tines 38 create a fixation member and are configured to engage tissue in heart 10 to secure leadless pacemaker 32 within heart 10. In various embodiments, alternative fixation members may be applied as known in the art, including screws and helixes. In the illustrated embodiment, tines 38 are positioned proximate first end 39 of leadless pacemaker 32. In various embodiments, tines 38 are configured to ensnare chordae tendineae 24 within right ventricle 20, securing leadless pacemaker 32 within heart 10. Alternatively, tines 38 may engage cardiac tissue in or around tricuspid valve 22, left ventricle 28 or elsewhere in heart 10. In further alternative embodiments, tines 38 may engage tissue in the epicardial space, lung and vasculature. When engaged with chordae tendineae 24 or any patient tissue, tines 38 exert a fixation force which maintains leadless pacemaker 32 within heart 10. In various embodiments, tines 38 are made from material which is flexible to achieve multiple positions but resiliently biased in a configuration which allows tines 38 to be ensnared in chordae tendineae 24 or other tissue of heart 10. In various embodiments, tines 38 are formed from a shape memory alloy. In an embodiment, tines 38 are formed from Nitinol.
[42] Projection 40, e.g., a post, incorporates magnet 42 and indentation 44. As illustrated, projection 40 is generally cylindrical and positioned proximate second end 41 of leadless pacemaker 32. In alternative embodiments, projection 40, along with indentation 44, are alternatively shaped to facilitate a mechanical or connection force with an implantable medical device system discussed in detail below. In alternative embodiments, indentation 44 is not incorporated in projection 40. In alternative embodiments, projection 40 is not incorporated in leadless pacemaker 32. In such embodiments, magnet 42 is incorporated into housing 34. In further alternative embodiments where housing 34 is ferrous or which otherwise creates a magnetic attraction with a magnet, magnet 42 is not incorporated. Alternatively, magnet 42 is substituted with a magnetic component which is attracted to a magnet but which is not itself a magnet. In various such embodiments, projection 40 and indentation 44 are incorporated in leadless pacemaker 32. In alternative embodiments,
projection 40 and/or indentation 44 are not incorporated in leadless pacemaker 32.
[43] Figure 3 is a cutaway view of implantable medical device implantation and extraction system 46. Implantation and extraction system 46 incorporates catheter 48 and magnetic element 50. As illustrated, catheter 48 incorporates body catheter 52 and fairing 54, both of which incorporate a continuous lumen 56 extending the length of catheter 48. Lumen 56 is sized to contain at least element 50 and to allow element 50 to move longitudinally within lumen 56 and project out of opening 57 at distal end 59. As illustrated, fairing 54 is sized and configured to admit and contain leadless pacemaker 32 within lumen 56 so that tines 38 may not engage tissue of heart 10 or of a patient's vasculature. In various alternative embodiments, catheter incorporates body catheter 52 and not fairing 54 as a separate component. In such embodiments, lumen 56 in body catheter 52 may be large enough to admit leadless pacemaker 32. In embodiments incorporating fairing 56, lumen in body catheter 52 may not be large enough to admit leadless pacemaker 32, limiting leadless pacemaker 32 to being positioned in fairing 54.
[44] Catheter 48 is sized to pass through superior vena cava 16 or inferior vena cava 18 and right atrium 14 and into right ventricle 20. In an embodiment, catheter 48 is approximately one hundred twenty (120) centimeters long and a maximum external diameter at fairing 54 of 0.73 centimeters. In an embodiment, lumen 56 has a width of 0.20 centimeters along body catheter 52 and 0.68 centimeters within fairing 54. In various embodiments, catheter 48 is made from materials including, but not limited to, polytetrafluoroethylene, polyether block amide, stainless steel and tungsten.
[45] Element 50 is configured to secure leadless pacemaker 32 using magnet 58 positioned on distal tip 60 of element 50. In various embodiments, magnet 58 is made from neodymium, iron and boron. Alternatively, magnet 58 is made from any material which may be developed to create a magnetic attraction with magnet 42 of leadless pacemaker 32 sufficient to secure leadless pacemaker 32 to element 50. In an embodiment, magnet 58 is an
electromagnet. In embodiments where leadless pacemaker 32 does not incorporate magnet 42, magnet 58 of element 50 is strong enough to engage the magnetic material of leadless pacemaker 32 to element 50.
[46] In various embodiments, magnet 58 is a bar magnet or elongate magnet with opposing poles. In various such embodiments, magnet 42 of leadless pacemaker 32 is also a bar magnet or elongate magnet with opposing poles. Where both magnet 42 and magnet 58 are bar or elongate magnets, magnets 42 and 58 may be rotationally fixed with respect to one another when magnetically engaged. In alternative embodiments, magnets 42 and 58 are not bar magnets but are sufficiently strong as to prevent rotation with respect to one another when magnetically engaged. In such embodiments, element 50 may be utilized to rotate leadless pacemaker 32, for instance, when tines 38 or an alternative fixation member such as a screw or helix, may be secured to, or disengaged from cardiac tissue through rotation.
[47] As illustrated, for explantation, element 50 has magnet 58 strong enough to engage leadless pacemaker 32 with a magnetic force stronger than the fixation force between tines 38 and chordae tendineae 24. For implantation, element 50 has magnet 58 weak enough to disengage magnet 58 from leadless pacemaker 32 without disengaging leadless pacemaker 32 from cardiac tissue. In various embodiments, each tine 38 creates a fixation force of approximately one Newton. In embodiments with four tines 38, then, for implantation magnet 58 creates less magnetic attraction with leadless pacemaker 32 than one-quarter (1/4) Newtons, while for explantation magnet 58 creates greater than four (4) Newtons of magnetic attraction with leadless pacemaker 32.
[48] Figure 4 illustrates magnet 58 of element 50 having established a magnetic force with magnet 42 of leadless pacemaker 32. By establishing a stronger magnetic force than the fixation force, system 46 may act to extract leadless pacemaker 32 from heart 10. By applying the magnetic force between magnet 58 of element 50 and magnet 42 of leadless pacemaker 32 and then pulling on or otherwise exerting a longitudinal force on element 50 which may exert a force on leadless pacemaker 32
which tends to pull tines 38 out of the cardiac tissue, leadless pacemaker 32 may be freed from being secured to heart 10, upon which leadless pacemaker 32 may be retracted into lumen 56 in fairing 54, rendering tines 38 ineffective to engage heart 10 tissue or the vasculature of the patient. Similarly, by pushing on or otherwise exerting a longitudinal force on element 50, a longitudinal force may be exerted on leadless pacemaker 32 in order to push leadless pacemaker 32 from fairing 54 and allow tines 38 to engage cardiac tissue.
[49] Figure 5 is a cutaway illustration of leadless pacemaker 32 having been contained within fairing 54 of system 46. For an implantation procedure, leadless pacemaker 32 may be pre-positioned in fairing 54 prior to be egested near cardiac tissue. For an explantation procedure, leadless pacemaker 32 may have been pulled from engagement with cardiac tissue. During extraction of leadless pacemaker 32, tines 38 tend to move from an implanted state, in which tines 38 are curled to engage cardiac tissue, to an extracted state in which tines 38 are generally straight, allowing tines 38 to be freed from cardiac tissue. Within fairing 54 tines 38 are prevented from engaging with patient tissue, thereby reducing a likelihood of leadless pacemaker 32 from becoming dislodged from system 46. Fairing 54 is sized so that tines 38 remain in the extraction or unengaged state, extending generally straight outward from housing 34, in contrast with tines 38 implanted state, generally curled out from housing 34 so as to engage cardiac tissue.
[50] Figure 6 is implantable medical device implantation and extraction system 146 incorporating catheter 48, element 50 and snare 162. In the embodiment of system 146, catheter 48 and element 50 are configured to function as described in detail above. However, the magnetic force created between magnet 58 of element 50 and magnet 42 of leadless pacemaker 32 may be supplemented by a mechanical or connection force created by engaging protrusion 40 of leadless pacemaker 32 with a mechanical engaging member such as lasso 164 of snare 162.
[51] In the embodiment of system 146, lumen 56 of catheter 48 is sized to admit and allow to move longitudinally both element 50 and snare 162. In
various embodiments, element 50 may provide a guide or rail for snare 162. In an embodiment, element 50 acts as a guide by circumscribing lasso 164 around element 50. As in system 46, element 50 is configured to magnetically engage leadless pacemaker 32 in order to fix leadless pacemaker 32 with respect to system 146. Then snare 162 may be extended through lumen 56 and around protrusion 40.
[52] As illustrated in Figure 7, when positioned around indentation 44 of protrusion 40, lasso 164 may be tightened in order exert a mechanical or connection force on leadless pacemaker 32. Indentation 44 may help provide relatively greater mechanical or connection force on leadless pacemaker 32 than may be attained without indentation 44. Either in combination with the magnetic force exerted by element 50 or without the magnetic force, the mechanical or connection force exerted on protrusion 40 of leadless pacemaker 32 may be greater than the fixation force exerted by tines 38 being engaged with chordae tendineae 24, allowing leadless pacemaker 32 to be extracted from heart 10 in the same manner described above.
[53] In various embodiments of system 146, snare 162 is comprised of the same materials as element 50. In various embodiments, lasso 164 is made from nitinol, stainless steel and gold. Lasso 164 is contractable around projection 40 by manipulating a proximal end of lasso 164 (not pictured) which extends through snare 162 and which is manipulable by a user. By pulling on the proximal end of lasso 162, lasso 162 may be tightened about projection 40 so as to exert the mechanical or connection force on projection 40.
[54] In alternative embodiments in which projection 40 is not incorporated into leadless pacemaker 32, lasso 164 may be tightened about any part of housing 34. In such embodiments, it may be relatively more difficult for lasso 164 to exert a mechanical or connection force than where projection 40 with indentation 44 is provided, though by applying relatively greater force to lasso 164 than may be applied to projection 40 with indentation 44, sufficient mechanical or connection force may be exerted on leadless pacemaker to disengage tines 38 from cardiac tissue.
[55] Figure 8 is a flowchart for extracting leadless pacemaker 32 from heart 10 using system 46 or system 146. The flowchart may be readily adapted for utilizing system 46 or system 146 for extracting an implantable medical device from other locations within a patient, such as the lungs or other organs. In various embodiments, the extraction is transvenous. Catheter 48 is inserted (800) into heart 10 and proximate leadless pacemaker 32. Magnetic element 50 is inserted (802) through lumen 56 of catheter 48. In various embodiments, the insertion (800, 802) of catheter 48 and magnetic element 50 occur simultaneously. In one such embodiment, simultaneous insertion occurs by inserting magnetic element 50 into lumen 56 prior to inserting either catheter 48 or magnetic element 50, and then inserting both catheter 48 and magnetic element 50 into the patient at the same time.
[56] Magnet 58 is then used to magnetically engage (804) magnet 42 of leadless pacemaker 32 when element 50 projects through or approaches opening 57 at distal end 59 of catheter. Optionally, and in embodiments incorporating system 146 with snare 162, lasso 164 is utilized to mechanically engage (806) leadless pacemaker 32, in various embodiments projection 40 at indentation 44. Tines 38 are disengaged (808) from cardiac tissue and leadless pacemaker 32 is removed (810) from heart 10 by extracting element 50 and, in embodiments with snare 162, snare 162 through catheter 48. In embodiments with fairing 54, leadless pacemaker 32 is withdrawn into fairing 54 and catheter 48 is removed. In embodiments without fairing 54, element 50 (and optionally snare 162) are removed the length of lumen 56 in order to extract leadless pacemaker 32, whereupon catheter 48 is extracted from the patient.
[57] Figure 9 is a flowchart for implanting leadless pacemaker 32 in heart 10 using system 46 or system 146. In various embodiments, implantation is transvenous. Catheter 48 is inserted (900) into heart 10 and proximate patient tissue such as cardiac trabeculae. Leadless pacemaker 32 is inserted (902) into lumen 56 of catheter 48. Variably, leadless pacemaker 32 is inserted into lumen 56 of catheter 48 prior to catheter 48 being inserted into the patient. Alternatively, where lumen 56 is adequately wide
over a complete length of catheter 48, catheter 48 may be inserted first and then leadless pacemaker 32 inserted into lumen 56.
[58] Magnetic element 50 is inserted (904) into lumen 56 of catheter 48. In various embodiments, the insertion (900, 904) of catheter 48 and element 50 occur simultaneously. In one such embodiment, simultaneous insertion occurs by inserting element 50 into lumen 56 prior to inserting either catheter 48 or element 50, and then inserting both catheter 48 and element 50 into the patient at the same time. Magnetic element 50 magnetically engages (906) leadless pacemaker 32. The insertion (900) of catheter 48, the insertion (902) of leadless pacemaker 32 into lumen 56, the insertion (904) of magnetic element 50 into lumen 56 and the magnetic engagement (906) of leadless pacemaker 32 with magnetic element 50 may occur in any sequence convenient for use.
[59] Leadless pacemaker 32 is egested (908) from catheter 48, in an embodiment by causing magnetic element 50 to exert a pushing force on leadless pacemaker 32. As leadless pacemaker 32 emerges from catheter 48, tines 38 engage chordae tendineae 24. Magnetic element 50 is disengaged (910) from leadless pacemaker 32, and catheter 48 and magnetic element 50 are withdrawn (912) from the patient, leaving leadless pacemaker 32 engaged with cardiac tissue. Optionally, prior to disengaging (910) magnetic element 50 from leadless pacemaker 32, the engagement of tines 38 with chordae tendineae 24 may be tested (912) by exerting a pulling force on leadless pacemaker 32 less than the magnetic attraction between magnet 58 and leadless pacemaker 32. If tines 38 do not separate from chordae tendineae 24 then leadless pacemaker may be deemed successfully implanted.
Claims
A medical device extraction system for a implantable medical device having a fixation member operatively coupled to said housing having an engaged state configured to engage tissue of a patient, said medical device being magnetically attractable, comprising:
a catheter having a lumen and a distal portion configured for insertion in a proximity of said implantable medical device; and
a magnetic element being configured to pass through said lumen of said catheter and to magnetically engage said implantable medical device when inserted toward said distal portion of said catheter.
The medical device extraction system of claim 1 wherein said medical device extraction system is configured to disengage said fixation member of said implantable medical device from said tissue of said patient and extract said implantable medical device from said patient.
The medical device system as in claim 1 wherein said snare is configured to pass through said catheter and mechanically engage said implantable medical device while said magnetic element has magnetically engaged said implantable medical device.
The medical device extraction system as in claim 1 wherein a magnetic attraction between said magnetic element and said implantable medical device is sufficient to extract said implantable medical device as said magnetic element is extracted.
The medical device extraction system as in claim 4 wherein said fixation member is at least one tine having a fixation force securing said at least one tine to said tissue of said patient and wherein said magnetic attraction between said magnetic element and said implantable medical device is greater than said fixation force.
6. The medical device extraction system as in claim 1 wherein said fixation member has an engaged state engaged with said tissue of said patient while implanted and an unengaged state unengaged with said tissue of said patient and wherein said fixation member changes from said engaged state to said unengaged state by operation of said magnetic element.
7. The medical device extraction system as in claim 1 wherein said fixation member is located proximate a distal portion of said implantable medical device.
8. The medical device extraction system as in claim 7 wherein a proximal portion of said implantable medical device is magnetically attractable to said magnetic element.
9. The medical device extraction system as in claim 1 further comprising a snare having a distal portion and configured for insertion, said snare having a mechanical engaging member proximate said distal portion of said snare, said snare being configured to pass through said catheter and mechanically engage said implantable medical device.
10. The medical device system as in claim 9 wherein said snare is configured to pass through said catheter and mechanically engage said implantable medical device while said magnetic element has magnetically engaged said implantable medical device.
11. The medical device system as in claim 10 wherein, when said magnetic element is magnetically engaged with said implantable medical device, said magnetic element provides, at least in part, a physical guide for said snare to mechanically engage said implantable medical device.
12. The medical device extraction system as in claim 9 wherein said fixation member comprises at least one tine having a fixation force and wherein said mechanical engaging member mechanically engages said implantable medical device proximate said second portion of said implantable medical device with a connection force greater than said fixation force of said at least one tine.
13. The medical device extraction system as in claim 1 wherein said fixation member is located proximate a first end of said implantable medical device and wherein said implantable medical device further comprises a magnetic component positioned proximate a second end of said implantable medical device opposite said first end providing said magnetic attraction.
14. A medical device system, comprising:
said medical extraction system of claim 1 ; and
said implantable medical device having said fixation member operatively coupled to said housing having said engaged state configured to engage said tissue of said patient, said medical device being magnetically attractable.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/915,745 US20120109148A1 (en) | 2010-10-29 | 2010-10-29 | System and method for retrieval of an implantable medical device |
US12/915,745 | 2010-10-29 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2012058067A1 true WO2012058067A1 (en) | 2012-05-03 |
Family
ID=44906415
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2011/056875 WO2012058067A1 (en) | 2010-10-29 | 2011-10-19 | System and method for retrieval of an implantable medical device |
Country Status (2)
Country | Link |
---|---|
US (1) | US20120109148A1 (en) |
WO (1) | WO2012058067A1 (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2015023474A1 (en) * | 2013-08-16 | 2015-02-19 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker and retrieval device |
FR3026648A1 (en) * | 2014-10-06 | 2016-04-08 | Sorin Crm Sas | INTRACORPORAL CAPSULE EXPLANATION ACCESSORY |
Families Citing this family (121)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9775982B2 (en) | 2010-12-29 | 2017-10-03 | Medtronic, Inc. | Implantable medical device fixation |
US10112045B2 (en) * | 2010-12-29 | 2018-10-30 | Medtronic, Inc. | Implantable medical device fixation |
US10485435B2 (en) | 2012-03-26 | 2019-11-26 | Medtronic, Inc. | Pass-through implantable medical device delivery catheter with removeable distal tip |
US10071243B2 (en) | 2013-07-31 | 2018-09-11 | Medtronic, Inc. | Fixation for implantable medical devices |
US9393427B2 (en) | 2013-08-16 | 2016-07-19 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker with delivery and/or retrieval features |
ES2666373T3 (en) | 2013-08-16 | 2018-05-04 | Cardiac Pacemakers, Inc. | Management devices for wireless heart devices |
EP3033141B1 (en) | 2013-08-16 | 2017-10-11 | Cardiac Pacemakers, Inc. | Leadless cardiac pacing devices |
US9480850B2 (en) | 2013-08-16 | 2016-11-01 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker and retrieval device |
US9492674B2 (en) | 2013-08-16 | 2016-11-15 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker with delivery and/or retrieval features |
US10722723B2 (en) | 2013-08-16 | 2020-07-28 | Cardiac Pacemakers, Inc. | Delivery devices and methods for leadless cardiac devices |
US10842993B2 (en) | 2013-08-16 | 2020-11-24 | Cardiac Pacemakers, Inc. | Leadless cardiac pacing devices |
WO2015106007A1 (en) | 2014-01-10 | 2015-07-16 | Cardiac Pacemakers, Inc. | Methods and systems for improved communication between medical devices |
US9592391B2 (en) | 2014-01-10 | 2017-03-14 | Cardiac Pacemakers, Inc. | Systems and methods for detecting cardiac arrhythmias |
WO2015168155A1 (en) | 2014-04-29 | 2015-11-05 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker with retrieval features |
US10080887B2 (en) | 2014-04-29 | 2018-09-25 | Cardiac Pacemakers, Inc. | Leadless cardiac pacing devices including tissue engagement verification |
US9526909B2 (en) | 2014-08-28 | 2016-12-27 | Cardiac Pacemakers, Inc. | Medical device with triggered blanking period |
EP3485939B1 (en) | 2014-10-22 | 2020-07-15 | Cardiac Pacemakers, Inc. | Delivery devices for leadless cardiac devices |
CN106852124A (en) | 2014-10-22 | 2017-06-13 | 心脏起搏器股份公司 | For the delivery device and method of leadless cardiac equipment |
EP3253450B1 (en) | 2015-02-06 | 2021-03-24 | Cardiac Pacemakers, Inc. | System for treating cardiac arrhythmias |
WO2016126968A1 (en) | 2015-02-06 | 2016-08-11 | Cardiac Pacemakers, Inc. | Systems and methods for safe delivery of electrical stimulation therapy |
US10046167B2 (en) | 2015-02-09 | 2018-08-14 | Cardiac Pacemakers, Inc. | Implantable medical device with radiopaque ID tag |
CN107530002B (en) | 2015-03-04 | 2021-04-30 | 心脏起搏器股份公司 | System and method for treating cardiac arrhythmias |
WO2016149262A1 (en) | 2015-03-18 | 2016-09-22 | Cardiac Pacemakers, Inc. | Communications in a medical device system with link quality assessment |
US10050700B2 (en) | 2015-03-18 | 2018-08-14 | Cardiac Pacemakers, Inc. | Communications in a medical device system with temporal optimization |
US9853743B2 (en) | 2015-08-20 | 2017-12-26 | Cardiac Pacemakers, Inc. | Systems and methods for communication between medical devices |
CN108136187B (en) | 2015-08-20 | 2021-06-29 | 心脏起搏器股份公司 | System and method for communication between medical devices |
US9956414B2 (en) | 2015-08-27 | 2018-05-01 | Cardiac Pacemakers, Inc. | Temporal configuration of a motion sensor in an implantable medical device |
US9968787B2 (en) | 2015-08-27 | 2018-05-15 | Cardiac Pacemakers, Inc. | Spatial configuration of a motion sensor in an implantable medical device |
CN108136189B (en) | 2015-08-28 | 2021-10-15 | 心脏起搏器股份公司 | System for behavioral response signal detection and therapy delivery |
US10159842B2 (en) | 2015-08-28 | 2018-12-25 | Cardiac Pacemakers, Inc. | System and method for detecting tamponade |
US10226631B2 (en) | 2015-08-28 | 2019-03-12 | Cardiac Pacemakers, Inc. | Systems and methods for infarct detection |
US10092760B2 (en) | 2015-09-11 | 2018-10-09 | Cardiac Pacemakers, Inc. | Arrhythmia detection and confirmation |
CN108136185B (en) | 2015-10-08 | 2021-08-31 | 心脏起搏器股份公司 | Apparatus and method for adjusting pacing rate in an implantable medical device |
WO2017087661A1 (en) | 2015-11-20 | 2017-05-26 | Cardiac Pacemakers, Inc. | Delivery devices and methods for leadless cardiac devices |
EP3377174B1 (en) | 2015-11-20 | 2019-08-28 | Cardiac Pacemakers, Inc. | Delivery systems for leadless cardiac devices |
WO2017106693A1 (en) | 2015-12-17 | 2017-06-22 | Cardiac Pacemakers, Inc. | Conducted communication in a medical device system |
US10905886B2 (en) | 2015-12-28 | 2021-02-02 | Cardiac Pacemakers, Inc. | Implantable medical device for deployment across the atrioventricular septum |
US10583303B2 (en) | 2016-01-19 | 2020-03-10 | Cardiac Pacemakers, Inc. | Devices and methods for wirelessly recharging a rechargeable battery of an implantable medical device |
US10463853B2 (en) | 2016-01-21 | 2019-11-05 | Medtronic, Inc. | Interventional medical systems |
US10099050B2 (en) | 2016-01-21 | 2018-10-16 | Medtronic, Inc. | Interventional medical devices, device systems, and fixation components thereof |
WO2017136548A1 (en) | 2016-02-04 | 2017-08-10 | Cardiac Pacemakers, Inc. | Delivery system with force sensor for leadless cardiac device |
WO2017173275A1 (en) | 2016-03-31 | 2017-10-05 | Cardiac Pacemakers, Inc. | Implantable medical device with rechargeable battery |
WO2017173166A1 (en) * | 2016-03-31 | 2017-10-05 | Cardiac Pacemakers, Inc. | Extraction devices configued to extract chronically implanted medical devices |
JP6692920B2 (en) * | 2016-03-31 | 2020-05-13 | 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 | Implantable medical device configured for deployment within a patient's heart chamber and implantable medical device configured for deployment within a patient's body |
US10328272B2 (en) | 2016-05-10 | 2019-06-25 | Cardiac Pacemakers, Inc. | Retrievability for implantable medical devices |
US10668294B2 (en) | 2016-05-10 | 2020-06-02 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker configured for over the wire delivery |
US10542964B2 (en) | 2016-05-25 | 2020-01-28 | Medtronic, Inc. | Interventional medical device retrieval |
CN109414582B (en) | 2016-06-27 | 2022-10-28 | 心脏起搏器股份公司 | Cardiac therapy system for resynchronization pacing management using subcutaneous sensing of P-waves |
US11207527B2 (en) | 2016-07-06 | 2021-12-28 | Cardiac Pacemakers, Inc. | Method and system for determining an atrial contraction timing fiducial in a leadless cardiac pacemaker system |
WO2018009392A1 (en) | 2016-07-07 | 2018-01-11 | Cardiac Pacemakers, Inc. | Leadless pacemaker using pressure measurements for pacing capture verification |
EP3487579B1 (en) | 2016-07-20 | 2020-11-25 | Cardiac Pacemakers, Inc. | System for utilizing an atrial contraction timing fiducial in a leadless cardiac pacemaker system |
CN109562269B (en) | 2016-08-19 | 2023-08-11 | 心脏起搏器股份公司 | Transseptal implantable medical device |
EP3503970B1 (en) | 2016-08-24 | 2023-01-04 | Cardiac Pacemakers, Inc. | Cardiac resynchronization using fusion promotion for timing management |
EP3503799B1 (en) | 2016-08-24 | 2021-06-30 | Cardiac Pacemakers, Inc. | Integrated multi-device cardiac resynchronization therapy using p-wave to pace timing |
US10905889B2 (en) | 2016-09-21 | 2021-02-02 | Cardiac Pacemakers, Inc. | Leadless stimulation device with a housing that houses internal components of the leadless stimulation device and functions as the battery case and a terminal of an internal battery |
US10758737B2 (en) | 2016-09-21 | 2020-09-01 | Cardiac Pacemakers, Inc. | Using sensor data from an intracardially implanted medical device to influence operation of an extracardially implantable cardioverter |
US10994145B2 (en) | 2016-09-21 | 2021-05-04 | Cardiac Pacemakers, Inc. | Implantable cardiac monitor |
WO2018081275A1 (en) | 2016-10-27 | 2018-05-03 | Cardiac Pacemakers, Inc. | Multi-device cardiac resynchronization therapy with timing enhancements |
US10413733B2 (en) | 2016-10-27 | 2019-09-17 | Cardiac Pacemakers, Inc. | Implantable medical device with gyroscope |
EP3532159B1 (en) | 2016-10-27 | 2021-12-22 | Cardiac Pacemakers, Inc. | Implantable medical device delivery system with integrated sensor |
CN109890458B (en) | 2016-10-27 | 2023-08-11 | 心脏起搏器股份公司 | Implantable medical device with pressure sensor |
US10561330B2 (en) | 2016-10-27 | 2020-02-18 | Cardiac Pacemakers, Inc. | Implantable medical device having a sense channel with performance adjustment |
US10434314B2 (en) | 2016-10-27 | 2019-10-08 | Cardiac Pacemakers, Inc. | Use of a separate device in managing the pace pulse energy of a cardiac pacemaker |
JP6719024B2 (en) | 2016-10-31 | 2020-07-08 | 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 | Implantable medical device for activity level pacing |
JP6843235B2 (en) | 2016-10-31 | 2021-03-17 | 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 | Systems and methods for activity level pacing |
US10583301B2 (en) | 2016-11-08 | 2020-03-10 | Cardiac Pacemakers, Inc. | Implantable medical device for atrial deployment |
WO2018089308A1 (en) | 2016-11-09 | 2018-05-17 | Cardiac Pacemakers, Inc. | Systems, devices, and methods for setting cardiac pacing pulse parameters for a cardiac pacing device |
US10881869B2 (en) | 2016-11-21 | 2021-01-05 | Cardiac Pacemakers, Inc. | Wireless re-charge of an implantable medical device |
CN109963618B (en) | 2016-11-21 | 2023-07-04 | 心脏起搏器股份公司 | Leadless cardiac pacemaker with multi-mode communication |
US10639486B2 (en) | 2016-11-21 | 2020-05-05 | Cardiac Pacemakers, Inc. | Implantable medical device with recharge coil |
WO2018093605A1 (en) | 2016-11-21 | 2018-05-24 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker providing cardiac resynchronization therapy |
CN109996585B (en) | 2016-11-21 | 2023-06-13 | 心脏起搏器股份公司 | Implantable medical device with magnetically permeable housing and induction coil disposed around the housing |
US11198013B2 (en) | 2016-11-21 | 2021-12-14 | Cardiac Pacemakers, Inc. | Catheter and leadless cardiac devices including electrical pathway barrier |
EP3541460B1 (en) | 2016-11-21 | 2020-12-23 | Cardiac Pacemakers, Inc. | Delivery devices and wall apposition sensing |
WO2018125791A1 (en) | 2016-12-27 | 2018-07-05 | Cardiac Pacemakers, Inc. | Leadless delivery catheter with conductive pathway |
CN110114114B (en) | 2016-12-27 | 2023-05-02 | 心脏起搏器股份公司 | Delivery devices and methods for leadless cardiac devices |
US10806931B2 (en) | 2016-12-27 | 2020-10-20 | Cardiac Pacemakers, Inc. | Delivery devices and methods for leadless cardiac devices |
US10485981B2 (en) | 2016-12-27 | 2019-11-26 | Cardiac Pacemakers, Inc. | Fixation methods for leadless cardiac devices |
US11207532B2 (en) | 2017-01-04 | 2021-12-28 | Cardiac Pacemakers, Inc. | Dynamic sensing updates using postural input in a multiple device cardiac rhythm management system |
CN110225779B (en) | 2017-01-26 | 2023-04-04 | 心脏起搏器股份公司 | Delivery device for leadless cardiac devices |
EP3573708B1 (en) | 2017-01-26 | 2021-03-10 | Cardiac Pacemakers, Inc. | Leadless implantable device with detachable fixation |
US10029107B1 (en) | 2017-01-26 | 2018-07-24 | Cardiac Pacemakers, Inc. | Leadless device with overmolded components |
EP3573706A1 (en) | 2017-01-26 | 2019-12-04 | Cardiac Pacemakers, Inc. | Intra-body device communication with redundant message transmission |
WO2018165377A1 (en) | 2017-03-10 | 2018-09-13 | Cardiac Pacemakers, Inc. | Fixation for leadless cardiac devices |
US10737092B2 (en) | 2017-03-30 | 2020-08-11 | Cardiac Pacemakers, Inc. | Delivery devices and methods for leadless cardiac devices |
US10821288B2 (en) | 2017-04-03 | 2020-11-03 | Cardiac Pacemakers, Inc. | Cardiac pacemaker with pacing pulse energy adjustment based on sensed heart rate |
US10905872B2 (en) | 2017-04-03 | 2021-02-02 | Cardiac Pacemakers, Inc. | Implantable medical device with a movable electrode biased toward an extended position |
US11577085B2 (en) | 2017-08-03 | 2023-02-14 | Cardiac Pacemakers, Inc. | Delivery devices and methods for leadless cardiac devices |
WO2019036568A1 (en) | 2017-08-18 | 2019-02-21 | Cardiac Pacemakers, Inc. | Implantable medical device with a flux concentrator and a receiving coil disposed about the flux concentrator |
CN111032148B (en) | 2017-08-18 | 2024-04-02 | 心脏起搏器股份公司 | Implantable medical device with pressure sensor |
EP3456379B1 (en) | 2017-09-15 | 2020-03-11 | Sorin CRM SAS | Explantation assembly for retrieving intracorporeal autonomous capsules |
CN111107899B (en) | 2017-09-20 | 2024-04-02 | 心脏起搏器股份公司 | Implantable medical device with multiple modes of operation |
US11185703B2 (en) | 2017-11-07 | 2021-11-30 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker for bundle of his pacing |
EP3717059A1 (en) | 2017-12-01 | 2020-10-07 | Cardiac Pacemakers, Inc. | Methods and systems for detecting atrial contraction timing fiducials within a search window from a ventricularly implanted leadless cardiac pacemaker |
US11813463B2 (en) | 2017-12-01 | 2023-11-14 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker with reversionary behavior |
US11071870B2 (en) | 2017-12-01 | 2021-07-27 | Cardiac Pacemakers, Inc. | Methods and systems for detecting atrial contraction timing fiducials and determining a cardiac interval from a ventricularly implanted leadless cardiac pacemaker |
US11260216B2 (en) | 2017-12-01 | 2022-03-01 | Cardiac Pacemakers, Inc. | Methods and systems for detecting atrial contraction timing fiducials during ventricular filling from a ventricularly implanted leadless cardiac pacemaker |
US11529523B2 (en) | 2018-01-04 | 2022-12-20 | Cardiac Pacemakers, Inc. | Handheld bridge device for providing a communication bridge between an implanted medical device and a smartphone |
EP3735293B1 (en) | 2018-01-04 | 2022-03-09 | Cardiac Pacemakers, Inc. | Dual chamber pacing without beat-to-beat communication |
US11154706B1 (en) * | 2018-01-31 | 2021-10-26 | Newpace Ltd. | Pill pacemaker with Bi-V pacing, DDD pacing and AAI with DDD backup pacing |
WO2019173789A1 (en) | 2018-03-09 | 2019-09-12 | Pacesetter, Inc. | Leadless pacemaker having attachment feature |
US11400296B2 (en) | 2018-03-23 | 2022-08-02 | Medtronic, Inc. | AV synchronous VfA cardiac therapy |
US11235159B2 (en) | 2018-03-23 | 2022-02-01 | Medtronic, Inc. | VFA cardiac resynchronization therapy |
WO2019183514A1 (en) | 2018-03-23 | 2019-09-26 | Medtronic, Inc. | Vfa cardiac therapy for tachycardia |
JP2022501085A (en) | 2018-09-26 | 2022-01-06 | メドトロニック,インコーポレイテッド | Capturing in ventricular cardiac therapy from the atria |
JP2022506927A (en) | 2018-11-02 | 2022-01-17 | グレイ・マター・メディカル・プロダクツ | Rail tension extraction device |
US11951313B2 (en) | 2018-11-17 | 2024-04-09 | Medtronic, Inc. | VFA delivery systems and methods |
US11679265B2 (en) | 2019-02-14 | 2023-06-20 | Medtronic, Inc. | Lead-in-lead systems and methods for cardiac therapy |
USD894396S1 (en) | 2019-03-08 | 2020-08-25 | Pacesetter, Inc. | Leadless biostimulator attachment feature |
US11759632B2 (en) | 2019-03-28 | 2023-09-19 | Medtronic, Inc. | Fixation components for implantable medical devices |
US11446510B2 (en) | 2019-03-29 | 2022-09-20 | Cardiac Pacemakers, Inc. | Systems and methods for treating cardiac arrhythmias |
CN113660977A (en) | 2019-03-29 | 2021-11-16 | 心脏起搏器股份公司 | System and method for treating cardiac arrhythmias |
US11697025B2 (en) | 2019-03-29 | 2023-07-11 | Medtronic, Inc. | Cardiac conduction system capture |
US11213676B2 (en) | 2019-04-01 | 2022-01-04 | Medtronic, Inc. | Delivery systems for VfA cardiac therapy |
US11712188B2 (en) | 2019-05-07 | 2023-08-01 | Medtronic, Inc. | Posterior left bundle branch engagement |
US11305127B2 (en) | 2019-08-26 | 2022-04-19 | Medtronic Inc. | VfA delivery and implant region detection |
CN114364431A (en) | 2019-09-11 | 2022-04-15 | 心脏起搏器股份公司 | Tool and system for implanting and/or retrieving a leadless cardiac pacing device having a helical fixation member |
US11571582B2 (en) | 2019-09-11 | 2023-02-07 | Cardiac Pacemakers, Inc. | Tools and systems for implanting and/or retrieving a leadless cardiac pacing device with helix fixation |
US11813466B2 (en) | 2020-01-27 | 2023-11-14 | Medtronic, Inc. | Atrioventricular nodal stimulation |
US11911168B2 (en) | 2020-04-03 | 2024-02-27 | Medtronic, Inc. | Cardiac conduction system therapy benefit determination |
US11813464B2 (en) | 2020-07-31 | 2023-11-14 | Medtronic, Inc. | Cardiac conduction system evaluation |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6370434B1 (en) * | 2000-02-28 | 2002-04-09 | Cardiac Pacemakers, Inc. | Cardiac lead and method for lead implantation |
US20050033394A1 (en) * | 2003-08-08 | 2005-02-10 | Medtronic, Inc. | Medical electrical lead anchoring |
US20060247753A1 (en) * | 2005-04-29 | 2006-11-02 | Wenger William K | Subcutaneous lead fixation mechanisms |
US20060271109A1 (en) * | 2005-05-25 | 2006-11-30 | Advanced Bionics Corporation | Implantable microstimulator with dissecting tip and/or retrieving anchor and methods of manufacture and use |
WO2009039400A1 (en) * | 2007-09-20 | 2009-03-26 | Nanostim, Inc. | Leadless cardiac pacemaker with secondary fixation capability |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5697936A (en) * | 1988-11-10 | 1997-12-16 | Cook Pacemaker Corporation | Device for removing an elongated structure implanted in biological tissue |
US7618435B2 (en) * | 2003-03-04 | 2009-11-17 | Nmt Medical, Inc. | Magnetic attachment systems |
US8066715B2 (en) * | 2007-10-03 | 2011-11-29 | Cook Medical Technologies Llc | Magnetic stent removal |
-
2010
- 2010-10-29 US US12/915,745 patent/US20120109148A1/en not_active Abandoned
-
2011
- 2011-10-19 WO PCT/US2011/056875 patent/WO2012058067A1/en active Application Filing
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6370434B1 (en) * | 2000-02-28 | 2002-04-09 | Cardiac Pacemakers, Inc. | Cardiac lead and method for lead implantation |
US20050033394A1 (en) * | 2003-08-08 | 2005-02-10 | Medtronic, Inc. | Medical electrical lead anchoring |
US20060247753A1 (en) * | 2005-04-29 | 2006-11-02 | Wenger William K | Subcutaneous lead fixation mechanisms |
US20060271109A1 (en) * | 2005-05-25 | 2006-11-30 | Advanced Bionics Corporation | Implantable microstimulator with dissecting tip and/or retrieving anchor and methods of manufacture and use |
WO2009039400A1 (en) * | 2007-09-20 | 2009-03-26 | Nanostim, Inc. | Leadless cardiac pacemaker with secondary fixation capability |
Cited By (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2015023474A1 (en) * | 2013-08-16 | 2015-02-19 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker and retrieval device |
CN105744987A (en) * | 2013-08-16 | 2016-07-06 | 心脏起搏器股份公司 | Leadless cardiac pacemaker and retrieval device |
JP2016527989A (en) * | 2013-08-16 | 2016-09-15 | 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 | Leadless cardiac pacemaker and collection device |
US9700732B2 (en) | 2013-08-16 | 2017-07-11 | Cardiac Pacemakers, Inc. | Leadless cardiac pacemaker and retrieval device |
CN105744987B (en) * | 2013-08-16 | 2019-01-15 | 心脏起搏器股份公司 | Leadless cardiac pacemaker and fetch equipment |
FR3026648A1 (en) * | 2014-10-06 | 2016-04-08 | Sorin Crm Sas | INTRACORPORAL CAPSULE EXPLANATION ACCESSORY |
EP3006082A1 (en) * | 2014-10-06 | 2016-04-13 | Sorin CRM SAS | Accessory for explantation of an intracorporeal capsule |
US10314613B2 (en) | 2014-10-06 | 2019-06-11 | Sorin Crm Sas | Explantation accessory for an intracorporeal capsule |
US11076886B2 (en) | 2014-10-06 | 2021-08-03 | Sorin Crm Sas | Explantation accessory for an intracorporeal capsule |
Also Published As
Publication number | Publication date |
---|---|
US20120109148A1 (en) | 2012-05-03 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US9504820B2 (en) | System and method for implantation of an implantable medical device | |
US20120109148A1 (en) | System and method for retrieval of an implantable medical device | |
US11338130B2 (en) | Delivery of cardiac stimulation devices | |
US10960216B2 (en) | Extraction devices configued to extract chronically implanted medical devices | |
US7908015B2 (en) | Subcutaneously implantable lead including distal fixation mechanism | |
JP5174007B2 (en) | Cardiac stimulation wired electrode assembly | |
US8504156B2 (en) | Holding members for implantable cardiac stimulation devices | |
US20040173222A1 (en) | Magnetic pellets and external electromagnetic device for assisting left ventricular contraction, method of pellet insertion, and method of ventricular electromagnetic assistance | |
US10357647B2 (en) | Tunneling tool | |
US10434307B2 (en) | Methods and devices for subcutaneous lead implantation | |
US20090163927A1 (en) | Delivery tools and methods for intravascular implantable devices | |
US11154706B1 (en) | Pill pacemaker with Bi-V pacing, DDD pacing and AAI with DDD backup pacing | |
US20150196752A1 (en) | Epicardial lead placement apparatus, systems, and methods | |
US20230017564A1 (en) | Tether assemblies for medical device retrieval systems |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
121 | Ep: the epo has been informed by wipo that ep was designated in this application |
Ref document number: 11778739 Country of ref document: EP Kind code of ref document: A1 |
|
NENP | Non-entry into the national phase |
Ref country code: DE |
|
122 | Ep: pct application non-entry in european phase |
Ref document number: 11778739 Country of ref document: EP Kind code of ref document: A1 |