Devices and methods for vagus nerve stimulation
First Claim
1. A device for electrically stimulating the vagus nerve of a patient, comprising:
- an elongated body member of sufficient length to extend from a point outside of a patient to a location within one of the trachea, esophagus, and internal jugular vein of said patient, said elongated body member having a proximal end and a distal end, said body member having an outer diameter adjacent said distal end of said body member smaller than the inner diameter of said one of said trachea, said esophagus, and said internal jugular vein;
an expandable support member adjacent said distal end of said body member, said expandable support member normally being contracted to an outer diameter smaller than the inner diameter of said one of said trachea, said esophagus, and said internal jugular vein, and said expandable support member being selectively expandable when said distal end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein to contact the wall of said one of said trachea, said esophagus, and said internal jugular vein around substantially the entire circumference of said expandable support member; and
an electrode mounted on said expandable support member, at least a portion of said electrode being disposed on said portion of said expandable support member that contacts said wall of said one of said trachea, said esophagus, and said internal jugular vein when said expandable support member is inserted into said one of said trachea, said esophagus, and said internal jugular vein and expanded; and
means for placing said electrode in conductive communication with a source of electrical energy so as to energize said electrode;
whereby when said distal end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein, and said expandable support member is expanded, said electrode is firmly imposed against said wall of said one of said trachea, said esophagus, and said internal jugular vein.
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Accused Products
Abstract
The present invention relates to apparatus and methods for electrically inducing and pharmacologically maintaining cardiac asystole. The present invention combines electrostimulation of the vagus nerve to transiently arrest the heart, and the administration of a pharmaceutical composition that suppresses the tendency of the heart to escape from the induced asystolic state. The present invention provides an apparatus to interrogate the response of a heart to an electric pulse applied to the vagus nerve and to select the optimum location of an electrode and pulse to arrest the heart. The present invention further provides embodiments of catheter and tube electrode devices that incorporate expanding electrodes intended to contact the interior walls of blood vessels or anatomic structures in which the electrode devices are implanted. The present invention also provides cutaneous array electrodes that may be used non-invasively to stimulate the vagus nerve.
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Citations
128 Claims
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1. A device for electrically stimulating the vagus nerve of a patient, comprising:
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an elongated body member of sufficient length to extend from a point outside of a patient to a location within one of the trachea, esophagus, and internal jugular vein of said patient, said elongated body member having a proximal end and a distal end, said body member having an outer diameter adjacent said distal end of said body member smaller than the inner diameter of said one of said trachea, said esophagus, and said internal jugular vein;
an expandable support member adjacent said distal end of said body member, said expandable support member normally being contracted to an outer diameter smaller than the inner diameter of said one of said trachea, said esophagus, and said internal jugular vein, and said expandable support member being selectively expandable when said distal end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein to contact the wall of said one of said trachea, said esophagus, and said internal jugular vein around substantially the entire circumference of said expandable support member; and
an electrode mounted on said expandable support member, at least a portion of said electrode being disposed on said portion of said expandable support member that contacts said wall of said one of said trachea, said esophagus, and said internal jugular vein when said expandable support member is inserted into said one of said trachea, said esophagus, and said internal jugular vein and expanded; and
means for placing said electrode in conductive communication with a source of electrical energy so as to energize said electrode;
whereby when said distal end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein, and said expandable support member is expanded, said electrode is firmly imposed against said wall of said one of said trachea, said esophagus, and said internal jugular vein. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 128)
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46. A device for electrically stimulating the vagus nerve of a patient, comprising:
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an elongated body member having a proximal end and a distal end, said elongated body member being of sufficient length to extend from a point outside of a patient to a location within one of the trachea, esophagus, and internal jugular vein of said patient and having a diameter adjacent a forward end of said body member sufficiently small so as not to contact the entire wall of said one of said trachea, esophagus, and internal jugular vein when inserted therein;
a normally expanded, selectively contractible support member adjacent said distal end of said body member;
said support member in its normally expanded configuration having an outer circumference sufficient to contact substantially the entire inner circumference of said one of said trachea, said esophagus, and said internal jugular vein when said distal end of said body member is positioned within said one of said trachea, said esophagus, and said internal jugular vein;
said support member being selectively contractible when said distal end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein so as not to contact the entire wall of said one of said trachea, said esophagus, and said internal jugular vein;
means operatively associated with said support member and operable from outside said patient for selectively contracting said support member and for permitting said support member to return to its normal, expanded configuration;
an electrode mounted on said support member, at least a portion of said electrode being disposed on a portion of said support member that contacts said wall of said one of said trachea, said esophagus, and said internal jugular vein when said support member is inserted into said one of said trachea, said esophagus, and said internal jugular vein and permitted to expand to its normal configuration; and
means for placing said electrode in conductive communication with a source of electrical energy so as to energize said electrode;
whereby when said support member is contracted and said distal end of said body member is inserted into said one of the trachea or esophagus or internal jugular vein and said electrode support section is then permitted to expand to its normal configuration, said electrode is firmly imposed against said wall of said one of the trachea or esophagus or internal jugular vein. - View Dependent Claims (47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59)
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60. A device for electrically stimulating the vagus nerve of a patient, comprising:
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an elongated body member of sufficient length to extend from a point outside of a patient to a location within one of the trachea, esophagus, and internal jugular vein of said patient and having an outer diameter adjacent a forward end of said body member smaller than the inner diameter of said one of said trachea, said esophagus, and said internal jugular vein;
an expandable frame adjacent a distal end of said body member, said expandable frame normally being contracted to an outer diameter smaller than the inner diameter of said one of said trachea, said esophagus, and said internal jugular vein, and said expandable frame being selectively expandable when said forward end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein to contact the wall of said one of said trachea, said esophagus, and said internal jugular vein around substantially the entire circumference of said expandable wire frame;
said expandable frame being formed from at least one wire which is electrically uninsulated at a location which contacts the wall of said one of said trachea, said esophagus, and said internal jugular vein when said forward end of said body member is inserted into said one of said trachea, said esophagus, and said internal jugular vein and expanded to contact the wall of said one of said trachea, said esophagus, and said internal jugular vein, and means for placing said electrode in conductive communication with a source of electrical energy so as to energize said electrode. - View Dependent Claims (61, 62, 63, 64, 65, 66, 67, 68, 69)
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70. A device for electrically stimulating the vagus nerve of a patient, comprising:
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an elongated body member of sufficient length to extend from a point outside of a patient to a location within one of the trachea, esophagus, and internal jugular vein of said patient and having a diameter adjacent a forward end of said body member sufficiently small so as not to contact the entire wall of said one of the trachea, esophagus, and internal jugular vein when inserted therein;
a normally expanded, selectively contractible wire frame adjacent a forward end of said body member, said wire frame being formed from at least one wire, said wire frame in a contracted state having a diameter adjacent a forward end of said body member sufficiently small so as not to contact the entire wall of said one of the trachea, esophagus, and internal jugular vein when inserted therein, and said wire frame being configured such that when said forward end of said body member is inserted into said one of the trachea or esophagus or internal jugular vein and permitted to expand to a normal configuration, said wire frame contacts the wall of said one of the trachea or esophagus or internal jugular vein; and
means for placing said at least one wire of said wire frame in conductive communication with a source of electrical energy so as to electrically energize said one wire;
whereby when said forward end of said body member is inserted into said one of the trachea, esophagus, and internal jugular vein and said wire frame is permitted to expand to its normal configuration, said at least one wire is firmly imposed against said wall of said one of the trachea, esophagus, and internal jugular vein. - View Dependent Claims (71, 72, 73, 74, 75, 76, 77, 78)
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79. A device for electrically stimulating the vagus nerve of a patient, comprising:
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an electrode positionable adjacent a vagus nerve of a patient;
an electrical pulse generator in conductive communication with said electrode, said pulse generator being capable of generating an electrical stimulus effective to cause controlled intermittent asystole when transmitted to said electrode and thereby communicated to said vagus nerve;
a cardiac monitoring device; and
a cardiac pacer for pacing the heart of said patient out of asystole;
whereby said patient'"'"'s heart can be put into asystole by actuating said electrical pulse generator and paced out of asystole by said cardiac pacer. - View Dependent Claims (80, 81, 82, 83, 84, 85, 86, 87)
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88. An apparatus comprising:
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a plurality of individually actuatable electrodes positioned within one or more of the trachea, the esophagus, and a jugular vein, on the skin of a patient, or in the tissues of a patient adjacent a nerve;
control means conductively associated with each of said plurality of electrodes for transmitting an electrical stimulus to each of said plurality of electrodes in turn so as to stimulate said nerve;
a cardiac monitoring means for sensing an induced cardiac response resulting from said electric stimulus applied to each of said plurality of electrodes to stimulate said nerve; and
means operatively associated with said cardiac monitoring means for identifying which of said plurality of electrodes is most effective in inducing controlled intermittent asystole when an electric pulse is applied to it. - View Dependent Claims (89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113)
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114. A process for determining which one of a plurality of individually actuatable electrodes is most effective in causing controlled, intermittent asystole, comprising the steps of:
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positioning a plurality of individually actuatable electrodes in the vicinity of at least one vagus nerve of a patient;
transmitting an electric pulse to each of said plurality of individually actuatable electrodes, one at a time, to stimulate said vagus nerve;
sampling the induced cardiac response resulting from said electric pulses applied to each of said plurality of individually actuatable electrodes so as to identify a preferred electrode that is the most effective in producing controlled intermittent asystole; and
actuating said preferred electrode to apply an electrical stimulus to said vagus nerve. - View Dependent Claims (115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127)
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Specification