349results about "Transvascular endocardial electrodes" patented technology

A composite wire suitable for use as a pacing or biostimulation lead has improved durability when compared to currently available materials. Specifically, a lead includes a superelastic wire including, e.g., nitinol. The wire is coated with polyimide and subsequently wound into a strand, cable, coil, or helically stranded tube. This wound structure is thermomechanically treated to shape-set the wire construct and retain a desired wound and shaped configuration, without adversely affecting the integrity of the polyimide coating.

A delivery system and method are described that include a catheter and an active wire. The catheter has a catheter body that defines a primary lumen and a secondary lumen therethrough, which are spaced apart from each other. A distal end of the catheter body is configured to be located within a chamber of a heart proximate to myocardial tissue at a site of interest (SOI). The primary lumen has a greater cross-sectional size than the secondary lumen. The primary lumen is configured to receive at least a portion of an IMD therein and to permit the portion of the IMD to move relative to the catheter. The active wire is configured to extend through the secondary lumen so that a distal end of the active wire projects beyond the distal end of the catheter body to pierce the myocardial tissue at the SOI.

Disclosed herein are systems and methods for locating and identifying nerves innervating the wall of arteries such as the renal artery. The present invention identifies areas on vessel walls that are innervated with nerves; provides indication on whether energy is delivered accurately to a targeted nerve; and provides immediate post-procedural assessment of the effect of energy delivered to the nerve. The methods includes evaluating a change in physiological parameters after energy is delivered to an arterial wall; and determining the type of nerve that the energy was directed to (sympathetic or parasympathetic or none) based on the evaluated results. The system includes at least a device for delivering energy to the wall of blood vessel; sensors for detecting physiological signals from a subject; and indicators to display results obtained using said method. Also provided are catheters for performing the mapping and ablating functions.

Systems, devices, and methods for promoting a patient's volume return to the heart and cardiac pre-load by inducing constriction of at least a portion of the splanchnic bed of the patient are described herein. Constriction of at least a portion of the splanchnic bed is induced via electrical stimulation to splanchnic nerve fibers of one or more splanchnic nerves. Electrical stimulation to splanchnic nerve fibers is delivered using at least one intravenous electrode disposed within a vein of the patient proximate to the splanchnic nerve fibers.

Transvascular diaphragm pacing systems (TDPS) and methods are disclosed for providing respiratory therapy to a patient. The TDPS can provide rapid insertion and deployment of endovascular pacing electrodes in critically ill patients who require intubation and invasive PPMV in order to support the physiological requirements of the human ventilatory system. The systems and methods make best use of the contractile properties of the diaphragm muscle and prevent muscle disuse and muscle atrophy. This can be carried out by engaging the phrenic nerves using patterned functional electrical stimulation applied to endovascular electrodes that are temporarily and reversibly inserted in central veins of the patient, such as the left subclavian vein and the superior vena cava. The TDPS can be designed to seamlessly interface with any commercially available positive-pressure ventilatory assistance / support equipment such as is commonly in use in hospital intensive care units (ICU) for treating critically ill patients with breathing insufficiencies, pain, trauma, sepsis or neurological diseases or deficits.

A biostimulator and a biostimulator system for septal pacing, is described. The biostimulator includes an articulation to allow an electrode axis of a pacing electrode to be directed differently than a housing axis of a housing. The housing contains electrical circuitry that is electrically connected to the pacing electrode. The differently directed axes allow the pacing electrode to affix to target tissue of an interventricular septal wall of a heart when the housing of the biostimulator is located near an apex of the heart. The articulation can include a flexible portion of an extension, a hinge, or a tether. Other embodiments are also described and claimed.

A method for manufacturing an implantable lead including an elongated lead body with a plurality of wires and an electrically isolating outer layer, wherein the method comprises:Providing a sleeve having a sealed end and an open cavity opposite the sealed end and including electrically conducting material;Pulling at least one wire out of the lead body;Positioning the pulled end of the at least one wire within the cavity of the sleeve;Forming the sleeve using a pressing tool such that the volume of the cavity is reduced, that the wire is fixed within the sleeve and that an electrical connection of the at least one wire and the formed sleeve is established;Attaching a contact element to the lead body such that the contact element fixes the formed sleeve at the lead body and establishes an electrical connection to the sleeve.

A delivery device (40) includes a first handle portion and a second handle portion. The first handle portion includes an inner shaft deflection mechanism (44). An inner shaft (46) is coupled to the first handle portion. The inner shaft is configured to deflect in a first deflection plane in response to actuation of the inner shaft deflection mechanism. The second handle portion includes an outer shaft deflection mechanism. The second handle portion is configured to rotate relative to the first handle portion. An outer shaft is coupled to the second handle portion. The outer shaft surrounds at least a portion of the inner shaft. The outer shaft is configured to deflect in a second deflection plane in response to actuation of the outer shaft deflection mechanism. Rotation of the second handle portion relative to the first handle portion causes the second deflection plane to rotate relative to the first deflection plane.

A biostimulator (100) includes a housing (302) having a longitudinal axis (304) and containing an electronics compartment (306). A pacing element (108) is coupled to the housing (302). The pacing element (108) includes a flexible conductor (410) extending along the longitudinal axis (304). A fixation element mount (311) is mounted on the housing (302). The fixation element mount (311) includes a distal mount end (430). A fixation element (106) is mounted on the fixation element mount (311). The fixation element (106) extends about the longitudinal axis (304). A radiopaque marker (502) has a distal marker end (504) longitudinally aligned with the distal mount end (430) of the fixation element mount (311). Other embodiments are also described and claimed.

An attachment device for coupling a biostimulator to a delivery system includes a case, a tether dock, and a filament. The case has a wall, a first end, and a second end opposite the first end. The wall defines a passage and a slot. The passage extends between the first end and the second end. The slot extends through the wall such that the passage is accessible through the slot. The tether dock extends from second end of the case. The tether dock defines a groove extending therethrough. The filament has a fixed end and free end. The fixed end is attached to the first end of the case. The free end includes a bulb that is selectively receivable in the passage of the case through the slot.

An implantable lead for use with an implantable medical device (IMD) includes a tubular lead body having a proximal portion including a proximal end, a distal portion including a distal end opposite the proximal end, and an intermediate portion between the proximal portion and the distal portion. A helical electrode extends distally from the distal end of the tubular lead body. At least one atrial electrode is disposed in the intermediate portion of the tubular lead body. At least one electrical conductor extends through the tubular lead body and is mechanically and electrically coupled to the helical electrode and the at least one atrial electrode. The intermediate portion may have a pre-formed bend configured to urge the at least one atrial electrode against a surface of the right atrium when the lead is implanted. A distal pre-formed bend located in the distal portion of the tubular lead body may be configured to bias a plurality of pacing / sensing electrodes towards a surface of a right ventricle. A distal pre-formed bend located in the distal portion of the tubular lead body may be configured to bias the helical electrode and at least one pacing / sensing against a surface of a right ventricle.

In some examples, controlling delivery of CRT includes controlling an implantable medical device to deliver ventricular pacing according to a sequence of different values of a CRT parameter and acquire first and second electrograms from respective first and second electrode vectors. For each value of the CRT parameter, a value of a comparison metric of a first activation interval between a first fiducial point of a cardiac cycle detected in the first electrogram and an occurrence of a second fiducial point of the cardiac cycle and a second activation interval between the first fiducial point and the occurrence of the second fiducial point detected in the second electrogram can be determined. A target value of the comparison metric can be identified and an updated value of the CRT parameter determined based on the target value. The system can then control the IMD to deliver ventricular pacing at the updated value of the CRT parameter.

Systems and method for ambulatory cardiac pacing are provided. A method may include providing an implantable medical device and a medical lead and inserting the medical lead into a vein of a patient and securing the holder adjacent to an insertion site of the medical lead. The method may include selecting a pacing algorithm from among a first pacing algorithm configured to provide intermittent pacing support and a second pacing algorithm configured to provide continuous pacing support, for execution by the implantable medical device.

An introductory lead system can include a first implantable lead having a first electrode and a second implantable lead having a second electrode guided to an implant site by the first implantable lead. The second electrode can be implanted in a patient's heart at the same implant site as the first electrode or at a second implant site. The introductory lead system can be delivered to one or more implant sites using various methods, including at the Koch triangle for ventricular free wall to atrium (VfA) therapy, at the right ventricular septal wall for dual bundle branch pacing, or in the coronary vasculature for left-sided sensing and pacing.

A stabilizer sleeve is disclosed for use with cardiac implantable electronic device leads. The sleeve comprises a tubular body sized to receive the lead and shaped to bias the lead toward a desired anatomical location, thereby reducing migration, dislodgement, and interference with cardiac structures. The sleeve may be introduced with the lead as a unitary assembly or added after lead placement. Various embodiments include a slitted body for expansion, radiopaque markers for visualization, detachable nose-cone tips for guidewire tracking, and antimicrobial coatings. The sleeve may be formed of polymers, alloys, or composite materials, and may include features such as texturing or anchoring projections for tissue engagement. Applications include positioning within a tricuspid valve commissure to minimize regurgitation and stabilizing left ventricular leads within branches of the coronary sinus. The device and methods described provide improved long-term stability and performance of implanted cardiac leads.

A medical system configured to impart a torque to a medical device within a patient. The medical system includes a driver including a driver body supporting a torque coupler. A snare is configured to engage the medical device. The torque coupler is configured to receive the medical device within a coupler volume. The snare and / or the torque coupler are configured to exert forces on the medical device such that the torque coupler imparts a torque to a retrieval structure of the medical device, causing rotation of the medical device. In examples, the medical device includes an attachment member configured to engage or disengage tissue when the medical device rotates. The medical system may include a delivery catheter configured to deliver and / or retrieve the torque coupler, snare, and / or the medical device.

Apparatus, systems, and methods are provided for placing pacing leads or other devices within a patient's heart. In an exemplary embodiment, the apparatus includes a tubular member comprising a flexible distal portion defining a curvilinear shape in a relaxed state including a curved first region defining a first radius lying within a first plane, a substantially straight second region extending from the first curved region defining a first length, and a curved third region extending from the second region defining a second radius smaller than the first radius.

A tether handle assembly comprising: a first element coupled to a proximal end of a pull shaft and comprising: an elongate body; one or more first features; and a second element configured to hold the elongate body, the second element comprising: a housing defining a recess; and one or more second features disposed within the recess, wherein the first element is configured to rotate to transition between a locked orientation and an unlocked orientation, wherein when in the locked orientation, the one or more first features are configured to interface with the one or more second features to inhibit movement of the first element relative to the second element, wherein when in the unlocked orientation, the first element is configured to move relative to the second element along the longitudinal axis and apply a force along the pull shaft.

In some instances, a tethered head assembly of a delivery system includes an inner retainer and an outer retainer defining an orifice comprising a container configured to receive an attachment member of a medical device, a passage, and a recess. The inner retainer is movable within the recess between a second position and a first position, in which the passage is sized to receive the attachment member, and in the first position, the passage is sized to prevent the attachment member from passing through. A tethered handle assembly defines a channel, a force transmitter within the channel, a slidable member partially received at a first end of the channel, and a button partially received at a second end of the channel. A distally directed force applied to the button causes the force transmitter to apply a proximally directed force to the slidable member, thereby moving the slidable member and the attached tether proximally.

The present invention relates to a fixation tool for clamping and rotating a lead terminal pin of a medical implantable cardiac lead. The fixation tool comprises a handle portion and a jaw portion, wherein opposing inner surfaces of a pair of jaws of the jaw portion are shaped to form a cavity system between the pair of jaws, the cavity system comprising a first cavity located proximal to an opening at the distal end of the jaw portion and having a first width between the opposing inner surfaces and being shaped to clamp a first lead terminal pin of a first diameter, and a second cavity located proximal to the first cavity and having a second width between the opposing inner surfaces, smaller than the first width and adapted to clamp, together with the first cavity, a second lead terminal pin of a second diameter larger than the first diameter.

Disclosed is a medical instrument for delivering pulse stimulation. The medical instrument comprises at least one ventricular electrode wire and a control device. The ventricular electrode wire is configured to be arranged at a myocardial position, and the control device is configured to execute a pulse stimulation control method. The pulse stimulation control method comprises the following steps: acquiring a far-field electrocardiogram and an in-vivo near-field myocardial electrocardiogram corresponding to the myocardial position; and according to an R wave in the far-field electrocardiogram and an R wave in the in-vivo near-field myocardial electrocardiogram, determining whether CCM pulse stimulation is delivered to the myocardial position or not. The medical instrument for delivering pulse stimulation provided in the present invention can ensure the timeliness, safety and effectiveness of CCM pulse stimulation to the heart of a patient.

The invention relates to a device for assisting in the handling and implantation of at least one electrode support(s) for a cardiac device, in particular a cardiac pacing device, said at least one electrode support(s) comprising a distal end and a proximal end, the proximal end comprising at least one connector configured to be in electrical connection with at least one portion of the distal end, characterized in that said device comprises: - a body, preferably one-piece, configured to cover at least one portion of said at least one connector, - at least one receiving portion for a means of temporary electrical connection, such as a crocodile clip, said at least one receiving portion being electrically conductive, - at least one connection element in electrical connection with said at least one receiving portion, said at least one connection element being in controlled tangential contact with said at least one connector.The invention also relates to the use of this device for the transfer of electrical signals into or from a cardiac stimulation device electrode, as well as a method for assembling this device.

Systems and methods are disclosed to determine an indication of a predicted response of a patient to at least one of cardiac resynchronization therapy (CRT) or multi-site pacing (MSP) therapy based on a patient metric determined using received physiologic information of the patient including at least one of heart sound information or respiration information from a first time period prior to the CRT or MSP therapy.

Example systems, devices, and techniques are disclosed. An example system includes an implantable medical device (IMD) configured to obtain the cardiac EGM of the patient. The IMD is configured to determine, based on the cardiac EGM, a first event and a second ventricular event. The IMD is configured to determine a first time interval between the first event and the second ventricular event satisfies a first time interval threshold, indicating a short interval event pair. The IMD is configured to determine whether the short interval event pair is a result of oversensing. The IMD is configured to increment or refrain from incrementing a counter based on the determination of whether the short interval event pair is the result of oversensing. The IMD is configured to determine, based at least in part on a count of the counter, whether to send a lead integrity alert.

A system comprising: a first electrode; a second electrode; signal generation circuitry coupled to the first electrode and the second electrode; and processing circuitry configured to: determine a timing of one or more events of a heart of a patient; determine, based on the timing of the one or more events, a first stimulation timing for a first stimulation signal; determine, based on the timing of the one or more events, a second stimulation timing for a second stimulation signal, the second stimulation signal being different from the first stimulation signal; cause the signal generation circuitry to deliver, based on the first simulation timing, the first stimulation signal to a heart of a patient via the first electrode; and cause the signal generation circuitry to deliver, based on the second stimulation timing, the second stimulation signal to a diaphragm of the patient via the second electrode.

The invention relates to a programming device for programming an implantable medical device for stimulating a human or animal heart. In operation, the following steps are performed: a) allowing selection of one of at least two electrode lead configurations of the implantable medical device (1) for stimulating the human or animal heart (7), wherein the at least two electrode lead configurations comprise a second electrode lead configuration, wherein at least one electrode lead (4) of the implantable medical device (1) is connected to an electrode lead port (3) of the implantable medical device (1), the electrode lead port (3) being configured to receive an electrode lead (4) for stimulating a second heart region or for detecting electrical signals at the second heart region, wherein the second heart region is part of a ventricular conduction system of the heart (7), wherein the at least one electrode lead (4) is implanted or is intended to be implanted in the second heart region; b) generating and releasing a notification signal if the second electrode lead configuration is selected.

A cardiac electrode assembly. The inventive electrode assembly includes an active fixation device, such as a helical electrode configured to screw into the myocardium or a vessel wall. The invention also includes an array of two or more reversed tines. The reverse tines bear against the heart wall or vessel wall and inhibit unwanted distal motion of the electrode assembly. Various deployment devices that aid in the installation of the inventive electrode assembly are also described.

Systems, devices, and methods for electroporation ablation therapy are disclosed, with a protection device for isolating electronic circuitry, devices, and / or other components from a set of electrodes during a cardiac ablation procedure. A system can include a first set of electrodes disposable near cardiac tissue of a heart and a second set of electrodes disposable in contact with patient anatomy. The system can further include a signal generator configured to generate a pulse waveform, where the signal generator coupled to the first set of electrodes and configured to repeatedly deliver the pulse waveform to the first set of electrodes. The system can further include a protection device configured to selectively couple and decouple an electronic device to the second set of electrodes.

A delivery system and method are described that include a catheter (102) and a stylet (200). The catheter (102) defines a delivery lumen (146) therethrough. The stylet (200) extends through the delivery lumen (146) of the catheter (102) and is movable relative to the catheter (102). The stylet (200) includes a tip section (220) at a distal end (212) of the stylet (200). The tip section (220) selectively transitions between a narrow state and a flared state. The tip section (220) in the flared state has a greater lateral extension than the tip section (220) in the narrow state. The tip section (220) in the narrow state is configured to project beyond a distal end (116) of the catheter (102) to pierce cardiac tissue. The tip section (220) is configured to transition from the narrow state to the flared state to anchor the stylet (200) to the cardiac tissue.

The invention relates to an implantable medical device for stimulating a human or animal heart. The implantable medical device comprises at least one electrode (20, 21) that comprises a distal bipole (203) and is designed and arranged to be implanted within the septum (13) of the heart (1) to be stimulated. During operation, the implantable medical device performs the following step: a) delivering a left bundle branch area pacing stimulation and a cardiac contractility modulation stimulation to the heart (1) to be stimulated, wherein the cardiac contractility modulation stimulation is delivered temporally offset to the left bundle branch area pacing stimulation.