Devices and methods for transluminal or transthoracic interstitial electrode placement
First Claim
1. A method for implantation of an electrode at an intended location outside of the lumen of a blood vessel or other anatomical conduit within the a human or veterinary patient, the method comprising the steps of:
- a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetration will advance from the catheter body;
b) positioning the catheter body in the blood vessel or other anatomical conduit;
c) using the orientation element to position and rotationally orient the catheter body such that when the penetration is subsequently advanced the penetration will substantially enter the intended location where the electrode is to be implanted; and
, thereafter, d) implanting a pacing electrode at the intended location by at least one of the following procedures;
i) advancing a pacing electrode through the lumen of the penetration and into the intended extravascular location;
or, ii) advancing a guidewire through the penetration and into the intended extravascular location and, thereafter, advancing the pacing electrode over the guidewire and into the intended implantation location;
or, iii) advancing a guidewire through the penetration and into the intended extravascular location, advancing a tract enlarging apparatus over the guidewire and using the tract enlarging apparatus to enlarge the tract created by the penetration and/or the guidewire and, thereafter, advancing the pacing electrode over the guidewire and through the enlarged penetration tract to the intended implantation location.
2 Assignments
0 Petitions
Accused Products
Abstract
Methods and devices for implanting pacing electrodes or other apparatus, or for delivering substances, to the heart of other tissues within the body. A guided tissue penetrating catheter is inserted into a body lumen (e.g., blood vessel) or into a body cavity or space (e.g., the pericardial space) and a penetrator is advanced from the catheter to a target location. In some embodiments, a substance or an apparatus (such as an electrode) may be delivered through a lumen in the penetrator. In other embodiments, a guidewire may be advanced through the penetrator, the penetrating catheter may then be removed and an apparatus (e.g., electrode) may then be advanced over that guidewire. Also disclosed are various implantable electrodes and electrode anchoring apparatus.
274 Citations
48 Claims
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1. A method for implantation of an electrode at an intended location outside of the lumen of a blood vessel or other anatomical conduit within the a human or veterinary patient, the method comprising the steps of:
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a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetration will advance from the catheter body;
b) positioning the catheter body in the blood vessel or other anatomical conduit;
c) using the orientation element to position and rotationally orient the catheter body such that when the penetration is subsequently advanced the penetration will substantially enter the intended location where the electrode is to be implanted; and
, thereafter,d) implanting a pacing electrode at the intended location by at least one of the following procedures;
i) advancing a pacing electrode through the lumen of the penetration and into the intended extravascular location;
or,ii) advancing a guidewire through the penetration and into the intended extravascular location and, thereafter, advancing the pacing electrode over the guidewire and into the intended implantation location;
or,iii) advancing a guidewire through the penetration and into the intended extravascular location, advancing a tract enlarging apparatus over the guidewire and using the tract enlarging apparatus to enlarge the tract created by the penetration and/or the guidewire and, thereafter, advancing the pacing electrode over the guidewire and through the enlarged penetration tract to the intended implantation location. - View Dependent Claims (2, 3, 4, 5, 6, 8, 9, 10)
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7. A method for positioning an electrode in contact with the wall of a blood vessel or other anatomical conduit, the method comprising the steps of:
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a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a tissue penetrator advanceable from the catheter body, iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetration will advance from the catheter body; and
, an electrode on the outer surface of the catheter body;
b) positioning the catheter body in the blood vessel or other anatomical conduit;
c) using the orientation element to position and rotationally orient the catheter body such that, when the penetration is subsequently advanced, the penetration will pass into or through the wall of the blood vessel or other anatomical conduit at a location adjacent to the location at which it is desired for the electrode to contact the wall of the vessel or anatomical conduit;
d) advancing the penetration into or through the wall of the blood vessel or other anatomical conduit at a location adjacent to the location at which it is desired for the electrode to contact the wall of the vessel or anatomical conduit;
e) causing the penetration to become substantially anchored in tissue so as to resist pull out of the penetration; and
,f) drawing the catheter body against the wall of the blood vessel or other anatomical conduit such that the electrode located on the outer surface of the catheter body is held in abutting contact with the wall of the blood vessel or anatomical conduit.
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11. A system comprising:
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a) a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a tissue penertator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetration will advance from the catheter body; and
,b) an anchoring member for anchoring the penetration within tissue. - View Dependent Claims (12, 13, 14, 15, 16)
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17. A system comprising:
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an implantable anchoring member; and
,an elongate, transluminally insertable electrode member that is insertable through a body lumen and into the anchoring member such that the anchoring member resists undesired movement or extraction of the electrode member. - View Dependent Claims (18, 19, 20)
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21. A transluminal method for inserting a working apparatus into the pericardial space in a human or veterinary patient, said method comprising the steps of:
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a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetration will advance from the catheter body;
b) advancing the tissue penetrating catheter into the cardiac vasculature;
c) using the orientation element to position the catheter such that when the penetration is subsequently advanced from the catheter the penetration will penetrate into the pericardial space; and
d) advancing the working apparatus through the hollow penetration and into the pericardial space. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40)
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41. A transthoracic method for injecting a substance or introducing a working apparatus into the heart, said method comprising the steps of:
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a) providing a providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator advanceable from the catheter body and iii) an orientation element useable to predetermine the specific trajectory or direction in which the penetration will advance from the catheter body;
b) forming an opening through the thoracic wall;
c) inserting the tissue penetrating catheter through the opening in the thoracic wall and through the pericardium into the pericardial space;
d) using the orientation element to position the catheter such that when the penetration is subsequently advanced from the catheter the penetration will penetrate to a sub-epicardial target location;
e) advancing the penetration from the catheter and through the epicardium; and
f) delivering the substance or advancing the working apparatus through the hollow penetration and into the sub-epicardial target location. - View Dependent Claims (42, 43, 44, 45, 46, 47, 48)
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Specification