Implantable electrodes for accomplishing ventricular defibrillation and pacing and method of electrode implantation and utilization
First Claim
1. The combination of an implantable cardioverting electrode and pacing electrode, the combination comprising:
- conductive base electrode means for associating with the base of the heart;
conductive apex electrode means of substantially frustoconical shape throughout at least a portion thereof, for lying adjacent but exterior to the apex of the heart and conforming to the contours thereof; and
an auxiliary electrode insulated from both said base and said apex electrodes and extending from the surface of one of said base or said apex electrodes in the direction of the heart, said auxiliary electrode serving to deliver pacing energy to the heart.
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Accused Products
Abstract
Disclosed are several embodiments of an electrode system for ventricular defibrillation, and the methods of using and implanting the electrode system. In one embodiment, the electrodes are in a generally base-apex configuration having a split conformal base electrode residing above the base of the ventricles (a transecting plane separating the atria from the ventricles) in the region of the atria and a conformal apex electrode in the form of a rotated conic section residing at the apex of the heart. In another embodiment, defibrillation is accomplished by the apex electrode acting against a catheter electrode situated high in the heart or in the superior vena cava.
The electrodes themselves are in the form of planar metallic mesh elements adapted to lie in contact with body tissue on an active surface, insulated on the opposite surface. In another embodiment, the conductive portions of the respective electrodes are developed from metallic plates, exposed on one surface and insulated on the other. The electrodes may be split, or may entirely surround the base and apex of the heart.
The disclosed electrode system is well adapted for easy implantation during an open heart surgery, or in a separate operation which can be performed in the mediastinal space without intrusion of the pleural space. The electrode system may be implanted for immediate stand-by defibrillation, or may be implanted during open heart surgery, used for post-operative monitoring, pacing and defibrillation, should the need arise, and then subcutaneously implanted for future association with an automatic defibrillating pulse generator. When employed after open heart surgery, the electrode system is preferably equipped with independent atrial and ventricular pacer electrodes.
Also disclosed are techniques for fixing the electrode system to the surrounding body tissue, and electrode leads which may be removed after the implanted electrodes have served their desired function, without disturbing the electrodes themselves.
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Citations
31 Claims
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1. The combination of an implantable cardioverting electrode and pacing electrode, the combination comprising:
- conductive base electrode means for associating with the base of the heart;
conductive apex electrode means of substantially frustoconical shape throughout at least a portion thereof, for lying adjacent but exterior to the apex of the heart and conforming to the contours thereof; and
an auxiliary electrode insulated from both said base and said apex electrodes and extending from the surface of one of said base or said apex electrodes in the direction of the heart, said auxiliary electrode serving to deliver pacing energy to the heart.
- conductive base electrode means for associating with the base of the heart;
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2. An electrode system for cardiovering a malfunctioning heart, the electrode system comprising:
- first conductive electrode means for associating with a heart in the region of its base;
second conductive electrode means for associating with the heart in the region of its apex, said second electrode means having first and second conductive surfaces;
insulation means for insulating the first conductive surface of said second electrode means; and
first and second electrode leads in electrical contact with the respective first and second electrode means, for applying cardioverting electrical energy between said first and second electrode means for discharge through said heart;
the second conductive surface of said second electrode means adapted to lie in contact with the heart, and being in a substantially frustoconical shape throughout at least a portion thereof; and
the insulation means adapted to face away from the heart, and being in a substantially rotated parabola shape. - View Dependent Claims (3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
- first conductive electrode means for associating with a heart in the region of its base;
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14. An electrode for use in a system for cardioverting a malfunctioning heart, the electrode comprising:
- conductive means having first and second conductive surfaces;
insulation means for insulating the first conductive surface;
an electrode lead in electrical connection with said conductive means, for applying cardioverting electrical energy to said conductive means for discharge through a heart;
said second conductive surface adapted to lie in contact with the heart, and being of a substantially frustoconical shape throughout at least a portion thereof; and
said insulation means adapted to face away from the heart, and being of a substantially rotated parabola shape. - View Dependent Claims (15, 16, 17, 18, 19, 20)
- conductive means having first and second conductive surfaces;
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21. A method of implanting and utilizing an electrode system for cardioverting a malfunctioning heart, the method comprising the steps of:
- opening the chest of a patient;
positioning a first electrode in the region of the base of the heart;
positioning a second permanent conformal electrode around the exterior surface of the apex of the heart;
drawing electrical leads from said first and second electrodes outside the body of the patient;
closing the chest of said patient with the proximal ends of said electrical leads lying outside the skin of the patient;
connecting said electrical leads to post-operative defibrillating electronics;
subsequently incising the patient after said post-operative period;
implanting a cardioverting pulse generator;
connecting the pulse generator to the proximal ends of said electrical leads and closing the incision with said electrical leads and said pulse generator beneath the skin of said patient. - View Dependent Claims (22, 23, 24, 25)
- opening the chest of a patient;
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26. A method for implanting cardioverting electrodes, the method consisting of the steps of:
- forming a first cardioverting electrode adapted to associate with the base of the heart;
forming a second substantially frustoconical cardioverting electrode conforming to the natural shape of the apex of the heart;
positioning said first electrode in association with the heart in the region of the base thereof;
inserting said second electrode through an incision in the pericardium; and
positioning said second electrode around the apex of the heart in the pericardial space. - View Dependent Claims (27, 28, 29)
- forming a first cardioverting electrode adapted to associate with the base of the heart;
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30. A method for implanting permanent cardioverting electrodes in a patient whose heart may require cardioversion, the method comprising the steps of:
- implanting a first permanent cardiac electrode in the vicinity of the base of the heart;
incising the patient to expose the heart;
implanting a second permanent conformal electrode about and in contact with the periphery of the apex of the heart;
implanting a pulse generator capable of delivering cardioverting pulses to the heart through the first and second electrodes;
connecting said first and second electrodes to said pulse generator; and
closing the incision made in the patient. - View Dependent Claims (31)
- implanting a first permanent cardiac electrode in the vicinity of the base of the heart;
Specification