Apparatus and method for endoscopic cardiac mapping and lead placement

• US 20040153098A1
• Filed: 10/29/2003
• Published: 08/05/2004
• Est. Priority Date: 08/10/1999
• Status: Active Grant

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Inventors: Westlund, Randy W., Chin, Albert K., Davis, John W.
• Granted Patent: US 7,526,342 B2
• Time in Patent Office: Days
• US Class Current: 606/129
• CPC Class Codes: A61B 1/00094 Suction openings
• CPC Class Codes: A61B 17/00008 Vein tendon strippers tube strippers A61M1/83
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/061 hollow or tubular
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/308 with suction cups
• CPC Class Codes: A61B 2017/320044 Blunt dissectors
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2090/036 : abutting on tissue or skin
• CPC Class Codes: A61B 2090/062 : penetration depth
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers

Abstract

Apparatus and surgical methods establish temporary suction attachment to a target site on the surface of a beating heart for analyzing electrical signals or hemodynamic responses to applied signals at the target sites for enhancing the accuracy of placement of cardiac electrodes at selected sites and for enhancing accurate placement of a surgical instrument maintained in alignment with the suction attachment. A suction port on the distal end of a supporting cannula carries surface-contacting electrodes and provides suction attachment to facilitate temporary positioning of the electrodes in contact with tissue at the target site, and a clamping and release mechanism to facilitate anchoring a cardiac electrode on the moving surface of a beating heart at a selected site. Analyses of sensed signals or responses to applied signals at target sites promote epicardial mapping of a patient'"'"'s heart for determining optimum sites at which to attach cardiac electrodes.

Claims

1. A method for fixing a cardiac electrode on an exterior of a patient'"'"'s heart, comprising the steps for:

temporarily positioning an electrode at target locations about the heart;

sensing electrical signals on the electrode at different locations about the heart;

analyzing a selected parameter from the electrical signals sensed on the electrode at the different locations;

determining from the analysis of a selected parameter a preferred one of the different locations for attachment of a cardiac electrode; and

fixing a cardiac electrode on the exterior of the patient'"'"'s heart at the preferred one location.

2. The method according to claim 1 in which temporary positioning of the electrode includes suction attachment to the epicardium with the electrode in contact therewith.

3. The method according to claim 1 in which analyzing a selected parameter includes determining the maximum interval between left and right ventricular contractions.

4. The method according to claim 1 in which analyzing a selected parameter includes determining a maximum depolarization interval.

5. The method according to claim 1 in which fixing the cardiac electrode includes forming temporary suction attachment to the epicardium with the cardiac electrode retained thereby at the preferred one location;

and

fixing the cardiac electrode to the preferred one location on the epicardium.

6. The method according to claim 5 in which fixing the cardiac electrode includes rotating a helical distal end thereof into the epicardium in response to rotation of the cardiac electrode from a location therealong proximal the distal end thereof and spaced away from the patient.

7. A method for fixing a cardiac electrode on an exterior of a patient'"'"'s heart, comprising the steps for:

temporarily positioning an electrode at different target locations about the heart;

supplying pacing signals to the electrode at each target location;

detecting activity of the patient'"'"'s heart in response to pacing signals applied thereto at each target location;

analyzing the detected activity to determine a preferred one of the different locations for applying pacing signals; and

fixing a cardiac electrode on the exterior of the patient'"'"'s heart at the preferred one location for supplying pacing signals thereto.

8. The method according to claim 7 in which temporary positioning of the electrode includes suction attachment to the epicardium with the electrode in contact therewith.

9. The method according to claim 7 in which analyzing the detected activity includes monitoring one of mitral valve regurgitation and fraction of volume ejected in response to applied pacing signals.

10. The method according to claim 7 in which fixing a cardiac electrode includes forming temporary suction attachment to the epicardium with the cardiac electrode retained thereby at the preferred one location;

and

fixing the cardiac electrode to the preferred one location on the epicardium.

11. The method according to claim 10 in which fixing the cardiac electrode includes rotating a helical distal end thereof into the epicardium in response to rotation of the cardiac electrode from a location therealong proximal the distal end thereof and spaced away from the patient.

12. Apparatus for performing a surgical procedure on the heart of a patient through a working cavity in tissue between the heart and an entry incision, the apparatus comprising:

an instrument including a guide channel that houses a cardiac lead to extend between distal and proximal ends thereof, and including a suction port positioned on the distal end of the instrument for contacting a target site on the heart;

a suction channel within the instrument connected to the suction port and disposed to connect to a source of suction;

at least one electrode disposed on a surface of the suction port that contacts the heart;

the guide channel being reconfigurable to release the cardiac lead therefrom for leaving the cardiac lead anchored to the heart as the instrument is removed away from the cardiac lead.

13. Apparatus according to claim 12 in which the guide channel is axially slidable relative to the suction port for extending a distal end of the cardiac lead to contact the heart.

14. Apparatus according to claim 12 in which the guide channel includes an elongated slot extending between distal and proximal ends thereof for selectively releasing the cardiac lead retained therein.

15. Apparatus according to claim 14 in which the elongated slot is exposable by proximally sliding an upper segment of the guide channel relative to a lower segment thereof that is positioned relative to the suction port for exposing the slot in the lower segment between distal and proximal ends thereof.

16. Apparatus according to claim 12 in which the one electrode on said surface of the suction port is connected to a conductor that extends between the distal and proximal ends of the instrument.

17. Apparatus for performing a surgical procedure on the heart of a patient through a working cavity in tissue between the heart and an entry incision, the apparatus comprising:

an endoscopic cannula configured for passing through the entry incision and working cavity toward the heart;

a suction attachment supported by the endoscopic cannula for contacting a target site on the heart under visualization through the endoscope;

an electrode positioned on a surface of the suction attachment that is disposed to contact the heart; and

a support channel for a cardiac lead that is disposed on the suction attachment and that is selectively configurable as a closed channel for confining a cardiac lead therein or as an open channel for releasing a cardiac lead therefrom.

18. Apparatus according to claim 17 including a conductor connected to the electrode and extending along the support channel to a proximal end thereof for connecting the electrode to a utilization circuit.

19. A surgical procedure for the placement of a cardiac lead in the heart of a patient under visualization through an endoscope by a delivery device including a cardiac lead clamp, a guide channel and a needle and at least one angled suction port at the distal end of a closed cannula of the delivery device, the surgical procedure comprising:

attaching the suction port of the delivery device to the patient'"'"'s heart in response to applied suction for stabilizing the delivery device against the surface of the heart;

advancing the needle forward from the delivery device to create an incision in the heart;

clamping the cardiac lead into place by the cardiac lead clamp;

advancing the guide channel containing the cardiac lead along the needle into the heart incision;

visualizing through the endoscope the placement of the cardiac lead into the heart;

anchoring the cardiac lead to the heart;

removing suction to release the delivery device containing the needle and guide channel from the heart;

unclamping the cardiac lead from the cardiac lead clamp;

removing the guide channel from the delivery device while withdrawing the needle from the heart;

removing the delivery device from the patient; and

removing the endoscope assembly from the patient while leaving the cardiac lead securely anchored in the heart.

20. The surgical procedure of claim 19 wherein anchoring further comprises:

rotating the cardiac lead from a location proximal the distal end and thereof spaced from the patient.

21. The surgical procedure of claim 19 wherein visualizing further comprises:

partially withdrawing the guide channel sufficiently to expose a position of the cardiac lead near the distal end thereof.

22. An apparatus for the placement of a cardiac lead in a heart of a patient, the apparatus comprising:

an endoscope assembly to provide visualization during placement of the cardiac lead;

an instrument channel eccentrically attached to the endoscope assembly; and

a delivery device for delivering and placing a cardiac lead in a heart of a patient, the delivery device comprising;

a housing;

an elongated body attached to the housing and extending distally therefrom;

a needle slidable along the elongated body for insertion into a heart;

a clamp disposed within the housing for selectively grasping the cardiac lead;

an actuation arm slidable disposed within the housing; and

a guide channel attached to the actuation arm and slidable along the needle to contain a cardiac lead during placement of the cardiac lead into the heart.

23. The delivery device of claim 22 wherein the elongated body further comprises:

at least one angled suction port at the distal end of the elongated body for suction attachment to the surface of the heart.

24. The delivery device of claim 22 wherein the guide channel is angled at the distal end.

25. The delivery device of claim 22 wherein the guide channel is disposed to selectively confine the cardiac lead.

26. The delivery device of claim 22 wherein the guide channel is a substantially hollow tubular body.

27. The delivery device of claim 22 wherein the guide channel is a substantially planar body.

28. The delivery device of claim 22 wherein the needle is a substantially hollow tubular body.