Methods of facilitating positioning of electrodes

• US 10,172,549 B2
• Filed: 02/09/2018
• Issued: 01/08/2019
• Est. Priority Date: 03/09/2016
• Status: Active Grant

• Current Assignee: Cardionomic, Inc.
• Original Assignee: Cardionomic, Inc.
• Inventors: Waldhauser, Steven L., Christian, Steven C.
• Primary Examiner(s): Woo, Julian W
• Application Number:
  US15/893,038
• Publication Number:
  US 20180168503A1
• Time in Patent Office: 333 Days
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00267 having a basket shaped structure
• CPC Class Codes: A61B 2018/00279 deployable
• CPC Class Codes: A61B 2018/00285 Balloons
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2562/0247 Pressure sensors
• CPC Class Codes: A61B 2562/028 Microscale sensors, e.g. electromechanical sensors [MEMS]
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/02158 provided with two or more sensor elements
• CPC Class Codes: A61B 5/0823 Detecting or evaluating cough events
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/6859 with multiple distal splines
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/487 : involving fluoroscopy
• CPC Class Codes: A61M 2025/0003 : having an additional lumen transmitting fluid pressure to the outside for measurement
• CPC Class Codes: A61M 25/10 : Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00
• CPC Class Codes: A61N 1/0558 : Anchoring or fixation means therefor
• CPC Class Codes: A61N 1/056 : Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0573 : chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• CPC Class Codes: A61N 1/36017 : with leads or electrodes penetrating the skin
• CPC Class Codes: A61N 1/36114 : Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 : for treating hypertension
• CPC Class Codes: A61N 1/36135 : using physiological parameters
• CPC Class Codes: A61N 1/36139 : with automatic adjustment
• CPC Class Codes: A61N 1/36146 : specified by the stimulation parameters
• CPC Class Codes: A61N 1/36185 : Selection of the electrode configuration
• CPC Class Codes: A61N 1/3627 : for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36585 : controlled by two or more physical parameters
• CPC Class Codes: A61N 2001/058 : Fixing tools

Abstract

A device includes a handle, an expandable structure including a plurality of splines extending from a proximal hub to a distal hub, a first electrode on a first spline of the plurality of splines, an outer tube extending from the handle to the proximal hub, and a shaft extending through the outer tube from the handle to the distal hub. The expandable structure has a collapsed state and a self-expanded state. The handle is configured to retract the shaft. Retracting the shaft may expand the expandable structure outward of the self-expanded state.

Claims

1. A method of using the trachea to facilitate positioning of electrodes in the right pulmonary artery, the method comprising:

identifying under fluoroscopy a trachea bifurcating into a right pulmonary bronchus and a left pulmonary bronchus;

identifying under fluoroscopy a pulmonary artery bifurcating into a right pulmonary artery and a left pulmonary artery;

identifying a plane of bifurcation of the trachea, the plane of bifurcation of the trachea being along the right pulmonary artery;

identifying a plane of bifurcation of the pulmonary artery, the plane of bifurcation of the trachea spaced from the plane of bifurcation of the pulmonary artery by a gap spanning the right pulmonary artery;

expanding an expandable structure comprising stimulation electrodes in the right pulmonary artery along the gap and a first distance from the plane of bifurcation of the trachea;

applying a signal to the stimulation electrodes to stimulate targeted nerves;

after applying the signal, detecting a respiratory side effect; and

after detecting the respiratory side effect, expanding the expandable structure comprising the stimulation electrodes in the right pulmonary artery along the gap and a second distance from the plane of bifurcation of the trachea, the second distance being greater than the first distance.

2. The method of claim 1, wherein the respiratory side effect comprises cough.

3. The method of claim 1, wherein expanding the expandable structure comprises allowing the expandable structure to self-expand.

4. The method of claim 3, wherein expanding the expandable structure comprises, after allowing the expandable structure to self-expand, further expanding the expandable structure.

5. The method of claim 1, wherein the nerves comprise at least one of the right dorsal medial common peroneal nerve, the right stellate CPN, or the left lateral cardiac nerve.

6. The method of claim 1, wherein the first distance is between 2 mm and 8 mm.

7. The method of claim 1, wherein the first distance is between 10% and 100% of a length of the right pulmonary artery and 8 mm.

8. A method of using the trachea to facilitate positioning of electrodes in the right pulmonary artery, the method comprising:

identifying a trachea bifurcating into a right pulmonary bronchus and a left pulmonary bronchus;

identifying a plane of bifurcation of the trachea;

positioning stimulation electrodes in a right pulmonary artery a distance from the plane of bifurcation of the trachea, the distance being between 2 mm and 8 mm;

applying a signal to the stimulation electrodes to stimulate targeted nerves;

after applying the signal, detecting a respiratory side effect; and

after detecting the respiratory side effect, positioning the stimulation electrodes in the right pulmonary artery a second distance from the plane of bifurcation of the trachea, the second distance being greater than the distance.

9. The method of claim 8, wherein identifying the trachea is under fluoroscopy.

10. The method of claim 8, wherein the respiratory side effect comprises cough.

11. The method of claim 10, wherein the second distance is between 4 mm and 8 mm.

12. The method of claim 11, wherein the nerves comprise at least one of the right dorsal medial common peroneal nerve, the right stellate CPN, or the left lateral cardiac nerve.

13. The method of claim 8, wherein the distance is between 10% and 100% of a length of the right pulmonary artery and 8 mm.

14. A method of using the trachea to facilitate positioning of electrodes in the right pulmonary artery, the method comprising:

identifying a trachea;

positioning stimulation electrodes in a right pulmonary artery a distance from the trachea, the distance being between 2 mm and 8 mm;

applying a signal to the stimulation electrodes to stimulate targeted nerves;

after applying the signal, detecting a respiratory side effect; and

after detecting the respiratory side effect, positioning the stimulation electrodes in the right pulmonary artery a second distance from the trachea, the second distance being greater than the distance.

15. The method of claim 14, wherein identifying the trachea is under fluoroscopy.

16. The method of claim 14, wherein the respiratory side effect comprises cough.

17. The method of claim 16, wherein the second distance is between 4 mm and 8 mm.

18. The method of claim 17, wherein the nerves comprise at least one of the right dorsal medial common peroneal nerve, the right stellate CPN, or the left lateral cardiac nerve.

19. The method of claim 14, wherein the second distance is between 4 mm and 8 mm.

20. The method of claim 14, wherein the distance is between 10% and 100% of a length of the right pulmonary artery and 8 mm.