Medical electrical lead having variable bending stiffness

• US 6,556,873 B1
• Filed: 11/29/1999
• Issued: 04/29/2003
• Est. Priority Date: 11/29/1999
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Smits, Karel F. A.
• Primary Examiner(s): Jastrzab, Jeffrey R.
• Assistant Examiner(s): DROESCH, KRISTEN L
• Application Number:
  US09/449,934
• Time in Patent Office: 1,247 Days
• Field of Search: 607/115-116, 607/119, 607/122-123, 607/125-131, 600/372-375, 600/377, 600/381
• US Class Current: 607/122
• CPC Class Codes: A61N 1/0563 specially adapted for defibrillation or cardioversion
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

An elongated coronary vein lead having a variable stiffness lead body and most preferably adapted to be advanced into a selected coronary vein for delivering a pacing or defibrillation signal to a predetermined region of a patient'"'"'s heart, such as the left ventricle is disclosed. A method of pacing and/or defibrillating a patient'"'"'s heart using the lead is also described. The method of pacing or defibrillating the heart includes advancing the coronary vein lead through both the coronary sinus and into a selected coronary vein of a patient'"'"'s heart, connecting the lead to an electrical pacing source and applying electrical stimulation to a particular chamber of the patient'"'"'s heart via the implanted lead. The lead includes a variable stiffness lead body that enhances the ability of the lead to be retained in a coronary vein after the lead has been implanted therein.

Claims

1. An elongated implantable medical electrical lead for electrically stimulating a human heart or sensing electrical signals originating therefrom, comprising:

(a) a lead body having proximal and distal sections;

(b) at least one electrode for sensing or electrically stimulating the heart;

(c) a proximal end comprising an electrical connector, the connector being contiguous with the proximal section of the lead body;

(d) a distal end connected to the distal section of the lead body;

(e) at least one electrical conductor having proximal and distal ends, the distal end of the conductor being operatively connected to the at least one electrode, the proximal end of the conductor being operatively connected to the electrical connector;

wherein the distal section of the lead body comprises at least first and second adjoining segments, the first segment being relatively stiff, the second segment being relatively flexible, the first segment being disposed distally in respect of the second segment, the first and second segments being configured and dimensioned to assume a minimum stored mechanical energy implantation position when the lead is implanted within the coronary venous anatomy of the heart such that additional mechanical energy from an external source must be exerted upon the lead body along an axial direction to move the lead axially from the minimum stored mechanical energy implantation position, the distal section of the lead body having an outer diameter ranging between about 0.5 mm and about 3 mm, the lead being adapted, sized and configured for placement in one or more of a coronary vein and a coronary sinus, and,

wherein the lead body is configured and dimensioned such that when the lead is implanted within the heart the second segment is disposed in a distal portion of one of a great cardiac vein, a middle cardiac vein, a small cardiac vein, a posterior cardiac vein, an oblique left atrial vein, and an anterior cardiac vein.

2. The medical electrical lead of claim 1, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within a great cardiac vein or a posterior cardiac vein of the heart a left ventricle of the heart may be electrically stimulated.

3. The medical electrical lead of claim 1, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within an oblique left atrial vein of the heart a left atrium of the heart may be electrically stimulated.

4. The medical electrical lead of claim 1, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within a middle portion of a great cardiac vein a right ventricle of the heart may be electrically stimulated.

5. The medical electrical lead of claim 1, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within an anterior cardiac vein a left atrium of the heart may be electrically stimulated.

6. The medical electrical lead of claim 1, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within an anterior cardiac vein a left ventricle of the heart may be electrically stimulated.

7. The medical electrical lead of claim 1, wherein the at least one electrode further comprises an anode and a cathode, and wherein the lead body and the anode and the cathode are configured and dimensioned such that when the lead is appropriately implanted within a middle cardiac vein electrical stimulation of apical portions of the heart may be effected.

8. The medical electrical lead of claim 1, wherein the at least one electrode further comprises an anode and a cathode, and wherein the lead body and the anode and the cathode are configured and dimensioned such that when the lead is appropriately implanted within a posterior cardiac vein electrical stimulation of basal portions of the heart may be effected.

9. The medical electrical lead of claim 1, wherein the at least one electrode further comprises an anode and a cathode, and wherein the lead body and the anode and the cathode are configured and dimensioned such that when the lead is appropriately implanted within a great cardiac vein electrical stimulation of basal portions of the heart may be effected.

10. The medical electrical lead of claim 1, wherein the ratio of the bending stiffness of the first segment (S_bs) in respect of the second segment (S_bf) is defined by the equation:

$1.5\le <br><br>\frac{S_{\mathrm{bs}}}{S_{\mathrm{bf}}}\le <br><br>100.$

11. The medical electrical lead of claim 1, wherein the ratio of the bending stiffness of the first segment (S_bs) in respect of the second segment (S_bf) is defined by the equation:

$2\le <br><br>\frac{S_{\mathrm{bs}}}{S_{\mathrm{bf}}}\le <br><br>10.$

12. The medical electrical lead of claim 1, wherein the bending stiffness the first segment (S_bs) is at least two times that of the bending stiffness of the second segment (S_bf).

13. The medical electrical lead of claim 1, wherein the ratio of the bending stiffness of the first segment (S_bs) in respect of the second segment (S_bf) is selected from the group consisting of at least about 2.2, at least about 2.4, at least about 2.6, at least about 2.8, at least about 3.0, at least about 4, at least about 5, at least about 6, at least about 7, at least about 8, at least about 9, at least about 10, at least about 20, at least about 30, at least about 40, at least about 50, at least about 100.

14. The medical electrical lead of claim 1, wherein a fixation device is attached to the lead body.

15. The medical electrical lead of claim 14, wherein the fixation device is selected from the group consisting of a helical screw, a barb, a hook, at least one tine, and at least one arm.

16. The medical electrical lead of claim 14, wherein the fixation device is disposed near the distal end.

17. The medical electrical lead of claim 1, wherein the lead body is configured to permit three dimensional bending thereof along at least two pre-determined bending planes.

18. The medical electrical lead of claim 1, wherein the first and second segments comprise means for changing the bending stiffness of the lead body as a function of axial distance x selected from the group consisting of varying the bending modulus as a function of axial distance x of the material from which the lead body is formed, varying the density as a function of axial distance x of the material from which the lead body is formed, varying the composition as a function of axial distance x of a polymer from which the lead body is formed, varying the amount of cross-linking as a function of axial distance x in a polymer from which the lead body is formed, varying the flexule moduli as a function of axial distance x of the material from which the lead body is formed, varying the amount of a first polymer included, blended or mixed in a second polymer as a function of axial distance x, a shape-memory alloy member capable of having its bending stiffness be varied through selective activation of pre-determined portions thereof as a function of axial distance x, varying the composition of polymers included in the lead body as a function of axial distance x.

19. An elongated implantable medical electrical lead for electrically stimulating a human heart or sensing electrical signals originating therefrom, comprising:

(a) a lead body having proximal and distal sections;

(b) at least one electrode for sensing or electrically stimulating the heart;

(c) a proximal end comprising an electrical connector, the connector being contiguous with the proximal section of the lead body;

(d) a distal end connected to the distal section of the lead body;

(e) at least one electrical conductor having proximal and distal ends, the distal end of the conductor being operatively connected to the at least one electrode, the proximal end of the conductor being operatively connected to the electrical connector;

wherein the distal section of the lead body comprises at least first and second segments, the first segment having a bending stiffness S_b1, the second segment having a bending stiffness S_b2, S_b1, being greater than S_b2, the first segment being disposed distally in respect of the second segment, the first segment and the second segment being configured and characterized such that a distally directed force is imparted to the distal end of the lead when the first and second segments are subjected to a bending moment resulting in a sufficient curvature of the lead body, the bending moment being provided by an external force applied to the lead, the distal section of the lead body having an outer diameter ranging between about 0.5 mm and about 3 mm, the lead being adapted, sized and configured for placement in one or more of a coronary vein and a coronary sinus, and,

wherein the lead body is configured and dimensioned such that when the lead is implanted within the heart the second segment is disposed in a distal portion of one of a great cardiac vein, a middle cardiac vein, a small cardiac vein, a posterior cardiac vein, an oblique left atrial vein, and an anterior cardiac vein.

20. The medical electrical lead of claim 19, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within a great cardiac vein or a posterior cardiac vein of the heart a left ventricle of the heart may be electrically stimulated.

21. The medical electrical lead of claim 19, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within an oblique left atrial vein of the heart a left atrium of the heart may be electrically stimulated.

22. The medical electrical lead of claim 19, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within a middle portion of a great cardiac vein a right ventricle of the heart may be electrically stimulated.

23. The medical electrical lead of claim 19, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within an anterior cardiac vein a left atrium of the heart may be electrically stimulated.

24. The medical electrical lead of claim 19, wherein the lead body and the at least one electrode are configured and dimensioned such that when the lead is appropriately implanted within an anterior cardiac vein a left ventricle of the heart may be electrically stimulated.

25. The medical electrical lead of claim 19, wherein the at least one electrode further comprises an anode and a cathode, and wherein the lead body and the anode and the cathode are configured and dimensioned such that when the lead is appropriately implanted within a middle cardiac vein electrical stimulation of apical portions of the heart may be effected.

26. The medical electrical lead of claim 19, wherein the at least one electrode further comprises an anode and a cathode, and wherein the lead body and the anode and the cathode are configured and dimensioned such that when the lead is appropriately implanted within a posterior cardiac vein electrical stimulation of basal portions of the heart may be effected.

27. The medical electrical lead of claim 19, wherein the at least one electrode further comprises an anode and a cathode, and wherein the lead body and the anode and the cathode are configured and dimensioned such that when the lead is appropriately implanted within a great cardiac vein electrical stimulation of basal portions of the heart may be effected.

28. The medical electrical lead of claim 19, wherein the ratio of the bending stiffness of the first segment (S_bs) in respect of the second segment (S_bf) is defined by the equation:

$1.5\le <br><br>\frac{S_{\mathrm{bs}}}{S_{\mathrm{bf}}}\le <br><br>100.$

29. The medical electrical lead of claim 19, wherein the ratio of the bending stiffness of the first segment (S_bs) in respect of the second segment (S_bf) is defined by the equation:

$2\le <br><br>\frac{S_{\mathrm{bs}}}{S_{\mathrm{bf}}}\le <br><br>10.$

30. The medical electrical lead of claim 19, wherein the bending stiffness of the first segment (S_bs) is at least two times that of the bending stiffness of the second segment (S_bf).

31. The medical electrical lead of claim 19, wherein the ratio of the bending stiffness of the first segment (S_bs) in respect of the second segment (S_bf) is selected from the group consisting of at least about 2.2, at least about 2.4, at least about 2.6, at least about 2.8, at least about 3.0, at least about 4, at least about 5, at least about 6, at least about 7, at least about 8, at least about 9, at least about 10, at least about 20, at least about 30, at least about 40, at least about 50, and at least about 100.

32. The medical electrical lead of claim 19, wherein a fixation device is attached to the lead body.

33. The medical electrical lead of claim 32, wherein the fixation device is selected from the group consisting of a helical screw, a barb, a hook, at least one tine, and at least one arm.

34. The medical electrical lead of claim 32, wherein the fixation device is disposed near the distal end.

35. The medical electrical lead of claim 19, wherein the lead body is configured to permit three dimensional bending thereof along at least two pre-determined bending planes.

36. The medical electrical lead of claim 19, wherein the at least one electrode and the lead body are dimensioned and configured such that when the lead is appropriately implanted within a venous portion of the heart the rotationally asymmetric segment may be employed by a physician to orient placement of the at least one electrode such that the electrode is pressed against or directed towards a selected portion of the heart.

37. The medical electrical lead of claim 19, wherein the lead body comprises a first asymmetric cross-section configured for implantation in a first preferred orientation in pre-determined distal-most portions of the heart'"'"'s venous anatomy where bending radii are small, a second asymmetric cross-section configured for implantation in a second preferred orientation different from the first orientation in pre-determined portions of the heart'"'"'s venous anatomy located proximal from the distal-most portions thereof.

38. The medical electrical lead of claim 19, wherein the first and second segments comprise means for changing the bending stiffness of the lead body as a function of axial distance x selected from the group consisting of varying the bending modulus as a function of axial distance x of the material from which the lead body is formed, varying the density as a function of axial distance x of the material from which the lead body is formed, varying the composition as a function of axial distance x of a polymer from which the lead body is formed, varying the amount of cross-linking as a function of axial distance x in a polymer from which the lead body is formed, varying the flexule moduli as a function of axial distance x of the material from which the lead body is formed, varying the amount of a first polymer included, blended or mixed in a second polymer as a function of axial distance x, a shape-memory alloy member capable of having its bending stiffness be varied through selective activation of pre-determined portions thereof as a function of axial distance x, varying the composition of polymers included in the lead body as a function of axial distance x.

39. The medical electrical lead of claim 19, wherein the distal section of the lead body comprises a plurality of first and second segments having first and second lengths, respectively, and wherein the second segments are configured and dimensioned to be located in or along first curves having first radii of curvature in a venous anatomy of the heart, and wherein the first segments are configured and dimensioned to be located in or along second curves having second radii of curvature, the first radii being smaller than the second radii.

40. A method of electrically stimulating a patient'"'"'s heart with an implantable cardiac stimulator and an elongated implantable medical electrical lead, the lead comprising a lead body having proximal and distal sections, at least one electrode for sensing or electrically stimulating the heart, a proximal end comprising an electrical connector, the connector being contiguous with the proximal section of the lead body, a distal end connected to the distal section of the lead body, at least one electrical conductor having proximal and distal ends, the distal end of the conductor being operatively connected to the at least one electrode, the proximal end of the conductor being operatively connected to the electrical connector, wherein the distal section of the lead body comprises at least first and second adjoining segments, the first segment being relatively stiff, the second segment being relatively flexible, the first and second segments being configured and dimensioned to assume a minimum stored mechanical energy implantation position when the lead is implanted within the coronary venous anatomy of the heart such that additional mechanical energy from an external source must be exerted upon the lead body along an axial direction to move the lead axially from the minimum stored mechanical energy implantation position, the first segment being disposed distally in respect of the second segment, the distal section of the lead body having an outer diameter ranging between about 0.5 mm and about 3 mm, the lead being adapted, sized and configured for placement in one or more of a coronary vein and a coronary sinus, the method comprising:

(a) providing the cardiac stimulator;

(b) providing the medical electrical lead;

(c) transvenously inserting and positioning the lead through a coronary sinus and into a coronary vein in the heart,

(d) operatively connecting the connector of the lead to the cardiac stimulator; and

(e) delivering at least one electrical pulse originating in the cardiac stimulator through the lead and the at least one electrode to the heart.

41. The method of claim 40, wherein the at least one electrical pulse is a pacing pulse, the method further comprising delivering a pacing pulse to the heart.

42. The method of claim 40, wherein the at least one electrical pulse is a defibrllation pulse, the method further comprising delivering a pacing pulse to the heart.

43. The method of claim 40, the method further comprising employing a stylet when inserting and positioning the lead in the heart.

44. The method of claim 40, the method further comprising employing a guide catheter when introducing the lead into the coronary sinus.

45. The method of claim 44, the method further comprising removing the guide catheter after the lead has been inserted through the coronary sinus.

46. A method of electrically stimulating a patient'"'"'s heart with an implantable cardiac stimulator and an elongated implantable medical electrical lead, the lead comprising a lead body having proximal and distal sections, at least one electrode for sensing or electrically stimulating the heart, a proximal end comprising an electrical connector, the connector being contiguous with the proximal section of the lead body, a distal end connected to the distal section of the lead body, at least one electrical conductor having proximal and distal ends, the distal end of the conductor being operatively connected to the at least one electrode, the proximal end of the conductor being operatively connected to the electrical connector, wherein the distal section of the lead body comprises at least first and second adjoining segments, the first segment being relatively stiff, the second segment being relatively flexible, the first and second segments being configured to impart a distally directed force to the distal end of the lead when the segments are subjected to a bending moment resulting in a sufficient curvature of the distal section of the lead body, the first segment being disposed distally in respect of the second segment, the distal section of the lead body having an outer diameter ranging between about 0.5 mm and about 3 mm, the lead being adapted, sized and configured for placement in one or more of a coronary vein and a coronary sinus, the method comprising:

(a) providing the cardiac stimulator;

(b) providing the medical electrical lead;

(c) transvenously inserting and positioning the lead through a coronary sinus and into a coronary vein in the heart,

(d) operatively connecting the connector of the lead to the cardiac stimulator; and

(e) delivering at least one electrical pulse originating in the cardiac stimulator through the lead and the at least one electrode to the heart.

47. The method of claim 46, wherein the at least one electrical pulse is a pacing pulse, the method further comprising delivering a pacing pulse to the heart.

48. The method of claim 46, wherein the at least one electrical pulse is a defibrillation pulse, the method further comprising delivering a pacing pulse to the heart.

49. The method of claim 46, the method further comprising employing a stylet when inserting and positioning the lead in the heart.

50. The method of claim 46, the method further comprising employing a guide catheter when introducing the lead into the coronary sinus.

51. The method of claim 50, the method further comprising removing the guide catheter after the lead has been inserted through the coronary sinus.