Cardiac electrode with attachment fin

• US 4,765,341 A
• Filed: 08/25/1983
• Issued: 08/23/1988
• Est. Priority Date: 06/22/1981
• Status: Expired due to Fees

• Current Assignee: Mirowski Family Ventures LLC
• Original Assignee: Mieczyslaw Mirowski
• Inventors: Heilman, Marlin S., Mower, Morton M.
• Primary Examiner(s): HINDENBURG, MAX F
• Application Number:
  US06/526,208
• Time in Patent Office: 1,825 Days
• Field of Search: 128/348, 128/784, 128/785, 604/164
• US Class Current: 607/116
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium

Abstract

An implantable cardiac electrode for use in defibrillation and methods of implanting same. The electrode has a metallic mesh electrode surface surrounded by an insulating material. At the proximal end of the electrode there is defined a fin area designed to facilitate placing and securing the electrode proximate the heart. The electrode may be implanted without major surgery in a number of ways, one of which requires a specialized insertion tool which cooperates with a pocket formed in the electrode.

Claims

1. An implantable cardioverting electrode assembly for placement proximate the heart and for connection to a suitable cardioverting system, the assembly comprising:

an elongated planar body divided into forward and rearward portions;

said forward portion including a flexible electrically conductive planar electrode for placement proximate the heart, said planar body occupying substantially the entire area of said forward portion;

said rearward portion defining a planar fin adjacent to and occupying the same plane as said planar electrode for providing an electrically insulated area of substantially the same width as the remainder of said planar body for suturing the electrode assembly to tissue adjacent the heart, said fin lengthening said planar body to increase the overall stiffness of said planar body;

said fin being of sufficient length as measured along the longitudinal axis of said elongated planar body to define an insulated area that may be removed as by cutting by the user to provide a universal planar body of varying length to accommodate hearts of different sizes; and

electrical conductor means arranged to electrically connect said electrode and said cardioverting system, said electrical conductor means not forming part of said fin.

2. The assembly of claim 1 further comprising an electrical insulating element covering the surface of said planar electrode facing away from the heart.

3. The assembly of claim 2 further comprising a reinforcing mesh embedded in said electrical insulating element to provide added mechanical strength thereto.

4. The assembly of claim 1 wherein said planar electrode is formed of titanium mesh.

5. The asesmbly of claim 1 further comprising a pocket formed in the back surface of said planar body adapted to receive a leading edge of a tool used to implant said electrode assembly.

6. An electrode of the type for implantation in a patient for connection to an electrical cardioverting system, said electrode comprising:

a planar electrical conductor;

a first elongated layer of electrical insulating material, said layer being divided approximately in half by a transverse plane that is approximately perpendicular to the plane defined by said first layer to define on said first layer a first portion on one side of said transverse plane and a second portion on said first layer on the other side of said transverse plane, said first portion arranged to coincide with and entirely cover one side of said planar electrical conductor; and

a second layer of electrical insulating material of substantially the same size as said first layer, said second layer having at least one large aperture therein for exposing the central portion of said conductor, the remainder of said second layer covering a perimeter portion of said conductor and covering said second portion of said first layer, said second portion defining an insulated area free of said planar electrical conductor for suturing the electrode to tissue adjacent the heart, said second portion lengthening said electrode to increase the overall stiffness of said electrode, said second portion being of sufficient length as measured along the longitudinal axis of said elongated first layer to define an area that may be removed as by cutting by the user to provide a universal electrode of varying length to accommodate hearts of different sizes.

7. The electrode of claim 6, further comprising flexible electrical conductor means connected to said planar electrical conductor and the electrical cardioverting system.

8. The electrode of claim 7, wherein said flexible electrical conductor means comprises a lead having one end secured to said planar electrical conductor.

9. The electrode of claim 8, wherein said lead is made from silver tinsel wire.

10. The electrode of claim 8, wherein said lead is made from drawn brazed strand cable.

11. An electrode of the type for implantation in a patient for connection to an electrical cardioverting system, said electrode comprising:

a planar electrical conductor,

a first layer of electrical insulating material arranged to coincide with and entirely cover one side of said planar electrical conductor,

a second layer of electrical insulating material of substantially the same size as said first layer, said second layer having at least one large aperture therein for exposing the central portion of said conductor and covering a perimeter portion of said conductor,

flexible electrical conductor means connected to said planar electrical conductor and the electrical cardioverting system, said first and second insulating layers forming a planar fin area near said conductor means, said fin area being free of said planar electrical conductor and lying in substantially the same plane as said planar electrical conductor for suturing said electrode to tissue adjacent the heart, said fin area lengthening said electrode to increase the overall stiffness of said electrode, and

said fin area being of sufficient length as measured along the longitudinal axis of said elongated first layer to define an area that may be removed as by cutting by the user to provide a universal electrode of varying length to accommodate hearts of different sizes.

12. The electrode of claim 11 wherein said planar electrical conductor is formed of titanium mesh.

13. The electrode of claim 11 wherein said planar electrical conductor is formed of an expanded platinum sheet.

14. A method of implanting and securing a cardioverting electrode proximate the human heart, the electrode having a proximal attachment fin, said method comprising the steps of:

providing a cardioverting electrode divided into forward and rearward portions, said forward portion including a flexible electrically conductive planar electrode which occupies substantially the entire area of said forward portion, said rearward portion including a planar fin adjacent to and occupying the same plane as the planar electrode for providing an insulated area of substantially the same width as the remainder of the planar electrode, said fin lengthening the cardioverting electrode to increase the overall stiffness of the cardioverting electrode, said fin being of sufficient length as measured along the longitudinal axis of said elongated planar body to define an area that may be removed as by cutting by the user to provide a universal electrode of varying length to accommodate hearts of different sizes;

making a skin incision in the upper abdominal wall, said skin incision terminating at the soft tissue surrounding the heart;

inserting said cardioverting electrode having an electrically conductive area into said incision, and locating said conductive area of said electrode proximate the heart surface;

securing said cardioverting electrode to the soft tissue by using at least two spaced-apart sutures on the accessible rearward portion of the fin of the cardioverting electrode that is spaced from said conductive area; and

altering the length of the fin to accommodate the heart to which the cardioverting electrode is secured.

15. The method of claim 14, wherein one of said sutures is on the proximal edge of the electrode and another of said sutures is on a side edge of the electrode.

16. The method of claim 14, wherein said soft tissue is the inferior side of the heart'"'"'s pericardium between the pericardium and the diaphragm.

17. A method of implanting and securing a cardioverting electrode proximate the human heart, the electrode having a proximal attachment fin, and implanting and securing a cardioverting catheter electrode in the heart, the method comprising the steps of:

providing a cardioverting electrode divided into forward and rearward portions, said forward portion including a flexible electrically conductive planar electrode that occupies substantially the entire area of said forward portion, said rearward portion including a planar fin adjacent to and occupying the same plane as the planar electrode for providing an insulated area of substantially the same width as the remainder of the planar electrode, said fin lengthening the cardioverting electrode to increase the overall stiffness of the cardioverting electrode, said fin being of sufficient length as measured along the longitudinal axis of said elongated planar body to define an area that may be removed as by cutting by the user to provide a universal electrode of varying length to accommodate hearts of different sizes;

making a skin incision in the upper abdominal wall, said skin incision terminating at the soft tissue surrounding the heart;

inserting said cardioverting electrode having an electrically conductive area into said incision, and locating said conductive area of said electrode proximate the heart surface;

securing said cardioverting electrode to the soft tissue by using at least two spaced-apart sutures on the accessible rearward portion of the fin of the cardioverting electrode that is spaced from said conductive area;

altering the length of the fin to accommodate the heart to which the cardioverting electrode is secured;

inserting a needle of predetermined cross section into the right innominate vein of the patient;

inserting a guide wire having an external diameter less than the internal diameter of the needle into the needle;

directing the guide wire into the vein until the end of the guide wire reaches the superior vena cava;

removing the needle and leaving the guide wire in place;

causing the guide wire to guide a tubular member contained within a flexible cannula to the superior vena cava;

removing the guide wire, when an end of the flexible cannula is in the superior vena cava;

inserting the catheter electrode into the cannula, the cannula guiding the tip of the catheter electrode to the superior vena cava; and

removing the cannula, when the tip of the catheter electrode is in the superior vena cava.

18. The method of claim 17, wherein said cannula has a pair of opposed weak spots disposed longitudinally along the substantial length of the cannula, the proximal end of the cannula having a pair of opposed tabs, and wherein said cannula removing step comprises:

withdrawing the cannula a short distance from the introduction site; and

pulling the tabs away from each other to cause the cannula to break into along the weak spots.

19. An implantable cardioverting electrode assembly for placement proximate the heart and for connection to a suitable cardioverting system, the assembly comprising:

an elongated planar body divided into forward and rearward portions;

said forward portion including a flexible electrically conductive planar electrode for placement proximate the heart, said planar electrode occupying substantially the entire area of said forward portion;

said rearward portion defining a planar fin adjacent to and occupying the same plane as said planar electrode for providing an insulated area of substantially the same width as the remainder of said planar body for suturing the electrode assembly to tissue adjacent the heart, said fin being of sufficient length as measured along the longitudinal axis of said elongated planar body to define an area that may be removed as by cutting by the user to provide a universal electrode of varying length to accommodate hearts of different sizes, said fin lengthening said planar body to increase the overall stiffness of said planar body, said forward and rearward portions being defined by the same insulating material, said planar electrode being positioned within said insulating material and confined to the forward portion of said body; and

electrical conductor means arranged to electrically connect said electrode and said cardioverting system, said planar electrode not forming part of said fin means.

20. An electrode of the type for implantation in a patient for connection to an electrical cardioverting system, said electrode comprising:

a planar electrical conductor;

a first elongated layer of electrical insulating material, said layer being divided approximately in half by a transverse plane that is approximately perpendicular to the plane defined by said first layer to define on said first layer a first portion on one side of said transverse plane and a second portion on said first layer on the other side of said transverse plane, said first portion arranged to coincide with and entirely cover one side of said planar electrical conductor; and

a second layer of electrical insulating material of substantially the same size as said first layer, said second layer having at least one large aperture therein for exposing the central portion of said conductor, the remainder of said second layer covering a perimeter portion of said conductor and covering said second portion of said first layer, said planar electrical conductor being disposed between said first and second layers in the area of said first portion, said second portion defining an insulated area free of said planar electrical conductor for suturing the electrode to tissue adjacent the heart, said second portion lengthening said electrode to increase the overall stiffness of said electrode, said second portion being of sufficient length as measured along the longitudinal axis of said elongated first layer to define an area that may be removed as by cutting by the user to provide a universal electrodes of varying length to accommodate hearts of different sizes.