Method and system for implanting self-anchoring epicardial defibrillation electrodes

• US 4,991,578 A
• Filed: 04/04/1989
• Issued: 02/12/1991
• Est. Priority Date: 04/04/1989
• Status: Expired due to Fees

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories), Dimed, Inc.
• Original Assignee: Siemens Pacesetter, Inc. (Abbott Laboratories)
• Inventors: Cohen, Donald M.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): Getzow, Scott M.
• Application Number:
  US07/333,391
• Time in Patent Office: 679 Days
• Field of Search: 128/419 D, 128/785, 128/784, 128/786, 128/419 P, 604/21, 604/53
• US Class Current: 607/2
• 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 2017/306 holding by means of suction
• CPC Class Codes: A61M 25/01 Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 2001/0578 having means for removal or extraction

Abstract

A method and system for positioning a defibrillation electrode within the pericardial space of a mammal is disclosed which includes means for distending the pericardium from the heart by injecting a small volume of fluid into the pericardium. A needle having a lumen therethrough is inserted from a sub-xiphoid or other percutaneous position into the body tissue until a tip thereof punctures the distended pericardium at a selected location. A guide wire is inserted into the pericardium through the lumen of the needle, and while the guide wire remains in the pericardial space, the needle is removed. A sheath is introduced over the guide wire, with the aid of a dilator, and inserted into the tissue until one end thereof is positioned within the pericardium. The defibrillation lead, with its electrode in a retracted position, is inserted through the sheath until the electrode is likewise positioned within the pericardium, whereupon the electrode is deployed in order to make contact with a large area of tissue within the pericardium. Additional leads and electrodes may be introduced and deployed in a like manner.

Claims

1. A method of percutaneously implanting a defibrillation lead within the intrapericardial space of a patient'"'"'s heart, the defibrillation lead having a distal electrode, a body, and proximal connection means capable of making electrical contact to an implantable defibrillation device, the method comprising the steps of:

distending the pericardium from the epicardium by injecting a small volume of fluid into the pericardium, so that pericardial effusion results;

percutaneously perforating the pericardium by advancing a perforation device having a lumen therethrough towards the distended pericardium until the fluid flows out of the lumen, thereby indicating that the pericardium wall has been perforated;

inserting a guide wire into the pericardium through the lumen of the perforation device until a distal end thereof is positioned within the pericardium;

enlarging the perforated opening in the pericardium by inserting an introducer over the guide wire and into the tissue; and

inserting the distal electrode of the defibrillation lead within the introducer until the distal electrode is likewise positioned within the pericardium.

2. The method of claim 1 wherein the step of distending the pericardium comprises:

transvenously attaching a screw-in catheter to the right atrial lateral wall;

advancing a stylet having a tip through the catheter until the tip contacts the atrial wall;

puncturing the atrial wall with the tip of the stylet; and

infusing the small volume of fluid through the catheter into the pericardium.

3. The method of claim 1 wherein the step of perforating the pericardium comprises:

plugging the lumen of the perforation device with a relatively rigid rod prior to inserting the perforation device, the rigid rod preventing tissue coring as the perforation device is inserted;

inserting the perforation device and rod only until a tip of the perforation device is abutted against the pericardium;

removing the rigid rod from the lumen; and

perforating the pericardium at the point where the perforation device tip is abutted against the pericardium, thereby making an opening in the pericardium through which the perforation device tip may be inserted.

4. The method of claim 3 wherein the step of perforating the pericardium at the point where the perforation device is abutted against the pericardium further comprises inserting a cutting device into the lumen and cutting an opening through the pericardium wall using the cutting device.

5. The method of claim 1 wherein the step of inserting the guide wire into the distended pericardium comprises inserting the guide wire into the distended pericardium from a sub-xiphoid position.

6. The method of claim 1 wherein the step of inserting the guide wire into the distended pericardium comprises inserting the guide wire into the distended pericardium from an intercostal position.

7. The method of claim 1 further comprising the step of tunneling the body of the defibrillation lead to a desired tissue location, whereat the proximal connection means of the defibrillation lead may be connected to a desired defibrillation device.

8. The method of claim 1 wherein the step of inserting the distal electrode into the pericardium further comprises the step of anchoring the distal electrode within the pericardium.

9. The method of claim 8 wherein the step of anchoring the distal electrode within the pericardium comprises the step of stimulating a fibrosis attachment site within the pericardium whereat the distal electrode may be anchored.

10. The method of claim 9 wherein the defibrillation lead further comprises a heating element at its distal tip, and wherein the step of anchoring the distal electrode within the pericardium further comprises acutely attaching the distal electrode to the heart by selectively energizing the heating element.

11. The method of claim 8 wherein the step of anchoring the distal electrode within the pericardium comprises the step of capturing an autologous blood clot on the distal electrode and coagulating it to the pericardium.

12. The method of claim 11 further comprising the step of creating a small lesion on the pericardium to promote adhesion of the coagulated blood clot thereto.

13. The method of claim 12 wherein the steps of coagulating the blood clot and creating a small lesion of the pericardium further comprise selectively applying energy from an external source to the site of attachment.

14. The method of claim 13 wherein the step of applying external energy to the site of attachment comprises directing microwave energy from an external microwave source on the site of attachment.

15. The method of claim 13 wherein the step of applying external energy to the site of attachment comprises directing laser energy form an external laser source to the site of attachment.

16. The method of claim 13 wherein the defibrillation lead further comprises a heating element at its distal tip at the site of attachment and electrical means for directing electrical energy to the heating element, and wherein the step of applying external energy to the site of attachment comprises applying electrical energy to the heating element through said electrical means.

17. The method of claim 1 wherein the defibrillation lead comprises a deployable defibrillation lead having a retracted position wherein the distal electrode thereof is maintained in a retracted position, and a deployed position wherein the distal electrode is extended so as to provide a larger electrode surface area, and further wherein the step of inserting the distal electrode of the defibrillation lead comprises inserting the distal electrode through the introducer while in its retracted position and extending the distal electrode to its deployed position after the distal electrode has been inserted within the pericardium.

18. A method of positioning at least one defibrillation lead within the pericardium of a mammal, the defibrillation lead having deployable distal electrode means for selectively placing an electrode in contact with a desired tissue area when the electrode is deployed, and for selectively maintaining the electrode in a retracted position, thereby facilitating the movement and positioning of the electrode until the electrode is positioned at a desired tissue location, the method comprising the steps of:

(a) injecting a fluid between the heart and the pericardium, thereby extending the pericardium away from the heart;

(b) percutaneously inserting a guide wire having a lumen therethrough into the extended pericardium at a desired tissue contact location until the fluid injected between the heart and the pericardium flows out of the lumen, thereby indicating that the pericardium wall has been perforated;

(c) placing a sheath introducer into the pericardium over the guide wire;

(d) inserting the electrode, in its retracted position, within the pericardium through the sheath introducer; and

(e) deploying the electrode within the pericardium, whereby the electrode makes contact with a large tissue area at the desired tissue contact location within the pericardium.

19. The method of claim 18 wherein the step of injecting a fluid between the heart and the pericardium comprises:

transvenously attaching a screw-in catheter to the right atrial lateral wall of the heart;

advancing a stylet through the catheter until a tip of the stylet contacts the atrial wall;

puncturing a small hole in the atrial wall with the tip of the stylet; and

injecting the fluid through the catheter and through the punctured hole in the atrial wall into the space between the heart and the pericardium.

20. The method of claim 18 wherein the step of percutaneously inserting the guide wire comprises inserting the guide wire into the distended pericardium from a sub-xiphoid position.

21. The method of claim 18 wherein the step of deploying the electrode further comprises recording the ECG of said mammal to aid in correctly positioning the electrode.

22. A method for anchoring a distal electrode of a defibrillation lead within the pericardium comprising the steps of:

(a) capturing an autologous blood clot on the distal electrode;

(b) inserting the distal electrode within the pericardium; and

(c) coagulating the blood clot to tissue within the pericardium.

23. The method of claim 22 wherein step (c) further comprises creating a small lesion in the tissue at the desired attachment site within the pericardium to promote adhesion of the coagulated blood clot thereto.

24. The method of claim 23 wherein step (c) further comprises applying external energy to the desired attachment site to create said lesion.

25. The method of claim 24 wherein said defibrillation lead further comprises electrical means for directing electrical energy to the distal electrode thereof, and wherein the step of applying external energy to the site of attachment comprises applying electrical energy to the site of attachment through said electrical means.

26. The method of claim 24 wherein the step of applying external energy to the site of attachment comprises guiding microwave energy from an external source to the site of attachment.

27. The method of claim 24 wherein the step of applying external energy to the site of attachment comprises selectively guiding electromagnetic energy from an external source to the site of attachment.

28. A system for implanting a defibrillation lead in a mammal, the mammal having a heart surrounded by a pericardium, the system comprising:

a defibrillation lead having a deployable distal electrode that selectively assumes a retracted position adapted to promote the positioning of the distal electrode without having the distal electrode becoming entangled with body tissue, and an extended position adapted to promote contact with body tissue over a large area, the defibrillation lead having deployment means for extending the distal electrode to its extended position;

means for injecting a fluid between the heart and the pericardium, thereby extending the pericardium away from the heart;

a perforation device having a lumen therethrough, the perforation device being sub-xiphoidally inserted toward the extended pericardium until the fluid flows out of the lumen, thereby indicating that the extended pericardium wall has been perforated; and

insertion means for inserting the defibrillation lead, with its deployable distal electrode in its retracted position, into the pericardium until the distal electrode is positioned at a desired location within the pericardium.

29. The system of claim 28 wherein the defibrillation lead comprises anchoring means for anchoring the distal electrode to the body tissue.

30. The system of claim 29 wherein said anchoring means comprises means for capturing a blood clot on the distal electrode and means for coagulating said blood clot to desired tissue within the pericardium.

31. The system of claim 30 further comprising means for making a small lesion within the pericardium, said blood clot adhering to said small lesion as coagulation occurs.

32. The system of claim 29 wherein said anchoring means comprises a heater element within the distal electrode and means for applying electrical energy thereto, and wherein heat generated by said heater element creates a fibrosis attachment site within the pericardium whereat the distal electrode is anchored.

33. The system of claim 28 wherein the perforation device comprises:

a blunt needle having a removable, rigid rod therethrough, the rod being capable of preventing tissue coring as the needle is advance into the pericardium.

34. The system of claim 28 wherein the perforation device comprises:

a housing; and

a cutting device within the housing, the cutting device having a sharp cutting tip, a rigid body portion and a flexible, compressible coupling portion located between the body portion and the tip, the coupling portion being capable of transferring longitudinal forces from the body portion to the tip while in the housing, and further being capable of buckling without the lateral support of the housing.

35. The system of claim 28 wherein the perforation device comprises:

a percutaneous insertion needle;

a catheter having a blunt soft tip, the catheter being guided to the pericardium over the insertion needle;

a cutting device recessed with the catheter;

means for applying suction between the catheter tip and the pericardium so that the pericardium is pulled into the catheter tip and impaled on the cutting device, thereby perforating the pericardium.

36. The system of claim 35 wherein the perforation device further comprises:

a remotely activated fixation device located within the catheter for fixating the catheter tip against the pericardium when the fixation device is activated.

37. A defibrillation lead system comprising:

a sheath;

means for passing said sheath through a pericardium surrounding a heart from a percutaneous position;

a defibrillation lead having a distal electrode, said defibrillation lead being of a size that allows it to be slidably inserted through said sheath until said distal electrode resides within the pericardium; and

means for anchoring said distal electrode to a desired location within the pericardium, said anchoring means comprising means for stimulating a fibrosis attachment site.

38. The lead system of claim 37 wherein said anchoring means comprises means for capturing a blood clot on said distal electrode and means for coagulating said blood clot to a desired attachment site within the pericardium.

39. The lead system of claim 38 wherein said anchoring means further comprises means for creating a small lesion in the body tissue at the desired attachment site, which small lesion promotes the adhesion of the coagulated blood clot thereto.

40. The lead system of claim 37 wherein said anchoring means comprises means for passing platelets or whole blood near said distal electrode and means for coagulating said platelets or whole blood to a desired attachment site within the pericardium.

41. The lead system of claim 40 wherein said anchoring means further comprises means for creating a small lesion in the body tissue at the desired attachment site, which small lesion promotes the adhesion of the coagulated blood clot thereto.