Apparatus and Methods for Placing Leads Using Direct Visualization

• US 20070083217A1
• Filed: 08/16/2006
• Published: 04/12/2007
• Est. Priority Date: 05/30/2002
• Status: Active Grant

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Inventors: Leeflang, Stephen, Mourlas, Nicholas, Eversull, Christian
• Granted Patent: US 8,956,280 B2
• Time in Patent Office: Days
• US Class Current: 606/114
• CPC Class Codes: A61B 1/00073 with externally grooved shaft
• CPC Class Codes: A61B 1/00082 Balloons
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/0051 with controlled bending of insertion part
• CPC Class Codes: A61B 1/0057 Constructional details of force transmission elements, e.g. control wires
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/05 characterised by the image sensor, e.g. camera, being in the distal end portion
• CPC Class Codes: A61B 1/051 Details of CCD assembly
• CPC Class Codes: A61B 1/053 being detachable
• CPC Class Codes: A61B 1/3137 for examination of the interior of blood vessels
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61M 2025/0177 having external means for receiving guide wires, wires or stiffening members, e.g. loops, clamps or lateral tubes
• CPC Class Codes: A61M 25/09 Guide wires
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/057 : Anchoring means; Means for fixing the head inside the heart
• CPC Class Codes: A61N 1/0587 : Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/059 : Anchoring means

Abstract

An apparatus for imaging a body structure within a body cavity includes a catheter including proximal and distal ends, an imaging element on the distal end, and an extension extending distally from the distal end for contacting a surface of a body cavity into which the catheter is introduced. The extension has a length to maintain the optical imaging element away from the surface. Optionally, a transparent member, e.g., an expandable balloon, may be attached to the distal end of the tubular member and the extension to isolate the imaging element from contact with fluid within the body cavity. During use, the catheter is inserted into a chamber of a beating heart, and the extension and/or balloon is placed against the wall of the chamber. Sufficient force is applied to stabilize the imaging element relative to the wall while the heart is beating.

Claims

1. A method for delivering a lead within a body cavity, comprising:

placing a distal end of an imaging device against a wall of a tissue structure adjacent a body cavity;

manipulating the distal end relative to the wall of the tissue structure to identify a target site;

delivering a distal end of an elongate rail via the imaging device to the target site;

securing the distal end of the elongate rail to the target site;

removing the imaging catheter;

advancing a lead via the elongate rail to the target site; and

securing the lead relative to the target site.

2. The method of claim 1, wherein the body cavity comprises a right ventricle of a heart, and the target site comprises a location on the right ventricular septum.

3. The method of claim 1, wherein the body cavity comprises a pericardial cavity of a heart, and the target site comprises a location on the epicardium of the heart.

4. The method of claim 1, wherein the elongate rail comprises a guidewire.

5. The method of claim 1, wherein the distal end of the elongate rail is delivered through a lumen of the imaging device.

6. The method of claim 5, wherein the lead is advanced over the elongate rail.

7. The method of claim 1, wherein the elongate rail comprises a fixation element on the distal end for securing the distal end of the elongate rail to the target site.

8. The method of claim 7, wherein the active fixation element comprises at least one of a helical screw, an adhesive, a hook, a pincher, and a barb.

9. The method of claim 1, wherein the imaging device is removed after securing the distal end of the elongate rail to the target site.

10. The method of claim 1, wherein the imaging device is removed before advancing the lead via the elongate rail.

11. The method of claim 1, further comprising removing the elongate rail from the body cavity after securing the lead relative to the target site.

12. The method of claim 1, wherein the elongate rail remains secured to the target site after securing the lead relative to the target site.

13. The method of claim 1, wherein the lead is secured to the distal end of the elongate rail, thereby securing the lead relative to the target site.

14. The method of claim 1, wherein the elongate rail comprises a tubular member, and wherein delivering a distal end of the elongate rail via the imaging device comprises advancing a distal end of the tubular member over the imaging device.

15. The method of claim 14, wherein the lead is advanced through the tubular member to the target site.

16. A method for delivering a lead within a body cavity, comprising:

introducing an imaging catheter through one or more body lumens;

using the imaging catheter to identify a delivery location for a lead;

introducing a distal end of an elongate rail via the imaging catheter to the identified delivery location;

securing the distal end of the rail at the delivery location;

delivering a lead via the rail to the delivery location; and

securing the lead relative to the delivery location.

17. The method of claim 16, wherein the delivery location comprises a location within a chamber of a heart.

18. The method of claim 17, wherein the delivery location comprises a location on the right ventricular septum.

19. The method of claim 16, wherein the elongate locating member comprises at least one of a guidewire and a sheath.

20. The method of claim 16, wherein the distal end of the elongate rail comprises a fixation element for securing the distal end at the delivery location.

21. A method for delivering a medical device within a body cavity, comprising:

introducing an imaging catheter into a thoracic cavity adjacent a heart of a patient;

imaging a surface of the heart using the imaging catheter to identify a delivery location for a lead;

introducing a distal end of an elongate rail via the imaging catheter to the delivery location;

securing the distal end of the elongate rail to the delivery location;

delivering a lead via the elongate rail to the delivery location; and

securing the lead relative to the delivery location.

22. The method of claim 21, wherein the delivery location comprises a location on the epicardium of the heart.

23. A system for delivering a lead into a body cavity of a patient, comprising:

an imaging device comprising a proximal end, a distal end sized for introduction into a body cavity, first and second lumens extending between the proximal and distal ends, and an imaging assembly for imaging beyond the distal end;

an elongate rail comprising a proximal end, a distal end sized for introduction through the first lumen of the imaging device, the elongate rail comprising a fixation element on the distal end for securing the distal end to a delivery location within a body cavity; and

a lead comprising a proximal end, a distal end sized for introduction through the second lumen of the imaging device, and one or more electrodes on the distal end.