Renal nerve stimulation method and apparatus for treatment of patients

• US 20050234523A1
• Filed: 06/03/2005
• Published: 10/20/2005
• Est. Priority Date: 04/08/2002
• Status: Active Grant

• Current Assignee: Medtronic Ardian Luxembourg SARL (Medtronic Plc)
• Original Assignee: Medtronic Ardian Luxembourg SARL (Medtronic Plc)
• Inventors: Levin, Howard R., Gelfand, Mark
• Granted Patent: US 8,150,518 B2
• Time in Patent Office: Days
• US Class Current: 607/42
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• 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 2018/00404 Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/00434 Neural system
• CPC Class Codes: A61B 2018/00511 Kidney
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61M 1/3627 Degassing devices; Buffer reservoirs; Drip chambers; Blood filters
• CPC Class Codes: A61M 2210/1082 Kidney
• CPC Class Codes: A61M 5/142 Pressure infusion, e.g. using pumps
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/326 for promoting growth of cells, e.g. bone cells
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• 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 1/36125 Details of circuitry or electric components
• CPC Class Codes: A61N 1/36135 using physiological parameters
• 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 1/40 : Applying electric fields by inductive or capacitive coupling microwave apparatus A61N5/00; Applying radio-frequency signals
• CPC Class Codes: A61N 1/403 : for thermotherapy, e.g. hyperthermia
• CPC Class Codes: A61N 5/00 : Radiation therapy ultrasound therapy A61N7/00; devices or apparatus applicable to both therapy and diagnosis A61B6/00

Abstract

A method and apparatus for treatment of heart failure, hypertension and renal failure by stimulating the renal nerve. The goal of therapy is to reduce sympathetic activity of the renal nerve. Therapy is accomplished by at least partially blocking the nerve with drug infusion or electrostimulation. Apparatus can be permanently implanted or catheter based.

Claims

1-43. -43. (canceled)

44. A method of treating cardio-renal disease, comprising:

positioning an electrode at least proximate to a renal nerve of a patient; and

applying an electric field to the renal nerve via the electrode in a manner that alters neural activity along the renal nerve.

45. The method of claim 44 wherein the neural activity comprises efferent activity along a portion of a renal nerve.

46. The method of claim 44 wherein the neural activity comprises afferent activity along a portion of the renal nerve.

47. The method of claim 44 wherein the neural activity comprises:

afferent and efferent activity along a portion of the renal nerve.

48. The method of claim 44 wherein the electric field modulates at least one of urine production and blood pressure in the patient.

49. The method of claim 48 wherein the electric field modulates renin in the patient.

50. The method of claim 48 wherein the electric field modulates vasoconstriction in the patient.

51. The method of claim 44 wherein the electrode further comprises an anode and a cathode.

52. The method of claim 51 further comprising placing the electrode such that the anode is between a kidney of the patient and the cathode.

53. The method of claim 51 wherein placing the electrode further comprises positioning the anode laterally of the cathode.

54. The method of claim 51 further comprising arranging the anode and cathode to form a cathodal nerve block along the renal nerve.

55. The method of claim 44 further comprising placing the electrode in a renal vessel proximate to the renal nerve.

56. The method of claim 55 wherein the electrode further comprises an anode and a cathode, and wherein placing the electrode further comprises placing the anode and cathode in the renal vessel proximate to the renal nerve.

57. The method of claim 55 wherein the renal nerve has a longitudinal section, and wherein at least a portion of the electric field extends along the longitudinal section.

58. The method of claim 44 further comprising placing the electrode in tissue proximate to the renal nerve.

59. The method of claim 58 wherein the electrode further comprises an anode and a cathode, and wherein placing the electrode further comprises placing the anode and cathode in tissue proximate to the renal nerve.

60. The method of claim 58 wherein the renal nerve has a longitudinal section, and wherein at least a portion of the electric field extends along the longitudinal section.

61. The method of claim 44 wherein the renal nerve has a longitudinal section, and wherein at least a portion of the electric field extends along the longitudinal section of the renal nerve.

62. The method of claim 44 wherein the electrode comprises an anode and a cathode, and wherein the method further comprise passing an electric current from the anode to the cathode to impede neural activity along the renal nerve.

63. The method of claim 44, further comprising sensing a physiological parameter.

64. The method of claim 63 wherein the physiological parameter is at least one of blood pressure, blood flow, and cardiac pulses.

65. The method of claim 63, further comprising modulating the electric field in response to the sensed physiological parameter.

66. The method of claim 44, wherein positioning the electrode comprises implanting the electrode in a vessel near the renal nerve by fixing the electrode to the vessel.

67. The method of claim 66, wherein implanting the electrode further comprises implanting an anode and a cathode in the vessel near the renal nerve by fixing the anode and cathode to the vessel.

68. The method of claim 44 wherein positioning the electrode comprises fixing the electrode in tissue near the renal nerve.

69. The method of claim 68 wherein fixing the electrode further comprises fixing an anode and a cathode in tissue near the renal nerve.

70. The method of claim 44 wherein positioning the electrode comprises inserting a catheter having the electrode into a vessel such that electrode is proximate to the renal nerve.

72. The method of claim 70, further comprising:

terminating the electric field; and

removing the catheter from the patient after terminating the electric field.

73. The method of claim 44 wherein positioning the electrode comprises inserting a device having the electrode into tissue of the patient such that the electrode is adjacent to the renal nerve.

74. The method of claim 73 wherein the electrode further comprises an anode and a cathode, and wherein inserting the device further comprises inserting the device into tissue of the patient such that the anode and the cathode are adjacent to the renal nerve.

75. The method of claim 73, further comprising:

terminating the electric field; and

removing the device from the patient after terminating the electric field.

76. The method of claim 44, wherein the electric field is arranged relative to the renal nerve such that current in the electric field travels in a direction opposite to at least one of efferent signals and afferent signals in the renal nerve.

71. The method of 70 wherein the electrode further comprises an anode and a cathode, and wherein inserting the catheter further comprises inserting the catheter into the vessel such that the anode and the cathode are proximate to the renal nerve.

77. An apparatus for treating a patient, comprising:

an electrode configured to be percutaneously positioned in the patient so that the electrode is at least proximate to a renal nerve of the patient;

an energy generator operatively coupled to the electrode; and

a controller configured to operate instructions that cause the energy generator to generate an electric field via the electrode that impedes neural activity along the renal nerve.

78. The apparatus of claim 77 wherein the electrode is configured to be placed proximate to the renal nerve of the patient.

79. The apparatus of claim 78 wherein the electrode comprises first and second electrical contacts configured to be placed proximate to the renal nerve of the patient.

80. The apparatus of claim 77 wherein the electrode is configured to be placed in a renal vessel of the patient.

81. The apparatus of claim 80 wherein the electrode comprises first and second electrical contacts configured to be placed in the renal vessel of the patient and produce an elongated electric field having a longitudinal dimension extending along the renal vessel.

82. The apparatus of claim 77 wherein the electrode comprises first and second electrical contacts electrically coupled to the energy generator in a bipolar configuration.

83. The apparatus of claim 77 wherein the electrode comprises a first electrical contact, a second electrical contact, and a third electrical contact, and wherein the first and second electrical contacts are electrically coupled to deliver the electric field to a renal nerve of the patient.

84. The apparatus of claim 83 wherein the third electrical contact comprises a sensor for detecting a physiological parameter of the patient.

85. The apparatus of claim 84 wherein the physiological parameter is at least one of blood pressure, blood flow rate, and cardiac pulses, and wherein the energy generator further contains instructions configured to modulate the electric field according to the detected physiological parameter.

86. The apparatus of claim 83 wherein the third electrical contact is configured to deliver a pacing signal to the renal nerve.

87. The apparatus of claim 77, further comprising a sensor for detecting a physiological parameter of the patient, and wherein the instructions are configured to cause the controller to modulate the electric field according to the detected physiological parameter.

88. The apparatus of claim 77 wherein the instructions are configured to cause the controller to generate the electric field in a manner that impedes efferent neural activity along a portion of a renal nerve of the patient.

89. The apparatus of claim 77 wherein the instructions are configured to cause the controller to generate the electric field in a manner that impedes afferent neural activity along a portion of the renal nerve.

90. The apparatus of claim 77 wherein the instructions are configured to cause the controller to generate the electric field in a manner that impedes efferent and afferent neural activity along a portion of the renal nerve.

91. The apparatus of claim 77 wherein the instructions are configured to cause the controller to generate the electric field in a manner that modulates at least one of urine production and blood pressure.

92. The apparatus of claim 77 wherein the instructions are configured to cause the controller to generate the electric field in a manner that modulates renin in the patient.

93. The apparatus of claim 77 wherein the instructions are configured to cause the controller to generate the electric field in a manner that modulates vasoconstriction in the patient.