Devices and methods for transluminal or transthoracic interstitial electrode placement
First Claim
1. A method for implantation of an electrode at an intended location outside of the lumen of a blood vessel or other anatomical conduit within the a human or veterinary patient, the method comprising the steps of:
- a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator that is moveable from a retracted position within the catheter body to an extended position wherein it extends laterally from the catheter body and iii) an orientation element useable while the penetrator is in its retracted position to determine the lateral direction in which the penetrator will subsequently advance from the catheter body as it is moved to its extended position;
b) positioning the catheter body in the blood vessel or other anatomical conduit;
c) using the orientation element while the penetrator is in its retracted position to adjust the rotational orientation of the catheter body as needed to substantially ensure that subsequent movement of the penetrator to its extended position will cause the penetrator to enter the intended location where the electrode is to be implanted;
d) advancing the penetrator into the intended location where the electrode is to be implanted and, thereafter,e) implanting an electrode at the intended location by at least one of the following procedures;
i) advancing a pacing electrode trough the lumen of the penetrator and into the intended extravascular location;
or,ii) advancing a guidewire through the penetrator and into the intended location and, thereafter, advancing the electrode over the guidewire and into the intended location;
or,iii) advancing a guidewire through the penetrator and into the intended location, advancing a tract enlarging apparatus over the guidewire and using the tract enlarging apparatus to enlarge the tract created by the penetrator and/or the guidewire and, thereafter, advancing the electrode over the guidewire and through the enlarged penetration tract to the intended location.
2 Assignments
0 Petitions
Accused Products
Abstract
Methods and devices for implanting pacing electrodes or other apparatus, or for delivering substances, to the heart of other tissues within the body. A guided tissue penetrating catheter is inserted into a body lumen (e.g., blood vessel) or into a body cavity or space (e.g., the pericardial space) and a penetrator is advanced from the catheter to a target location. In some embodiments, a substance or an apparatus (such as an electrode) may be delivered through a lumen in the penetrator. In other embodiments, a guidewire may be advanced through the penetrator, the penetrating catheter may then be removed and an apparatus (e.g., electrode) may then be advanced over that guidewire. Also disclosed are various implantable electrodes and electrode anchoring apparatus.
-
Citations
44 Claims
-
1. A method for implantation of an electrode at an intended location outside of the lumen of a blood vessel or other anatomical conduit within the a human or veterinary patient, the method comprising the steps of:
-
a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator that is moveable from a retracted position within the catheter body to an extended position wherein it extends laterally from the catheter body and iii) an orientation element useable while the penetrator is in its retracted position to determine the lateral direction in which the penetrator will subsequently advance from the catheter body as it is moved to its extended position; b) positioning the catheter body in the blood vessel or other anatomical conduit; c) using the orientation element while the penetrator is in its retracted position to adjust the rotational orientation of the catheter body as needed to substantially ensure that subsequent movement of the penetrator to its extended position will cause the penetrator to enter the intended location where the electrode is to be implanted; d) advancing the penetrator into the intended location where the electrode is to be implanted and, thereafter, e) implanting an electrode at the intended location by at least one of the following procedures; i) advancing a pacing electrode trough the lumen of the penetrator and into the intended extravascular location;
or,ii) advancing a guidewire through the penetrator and into the intended location and, thereafter, advancing the electrode over the guidewire and into the intended location;
or,iii) advancing a guidewire through the penetrator and into the intended location, advancing a tract enlarging apparatus over the guidewire and using the tract enlarging apparatus to enlarge the tract created by the penetrator and/or the guidewire and, thereafter, advancing the electrode over the guidewire and through the enlarged penetration tract to the intended location. - View Dependent Claims (2, 3, 4, 5, 6)
-
-
7. A method for positioning an electrode in contact with the wall of a blood vessel or other anatomical conduit, the method comprising the steps of:
-
a) providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator that is moveable from a retracted position within the catheter body to an extended position wherein it extends laterally from the catheter body and iii) an orientation element useable while the penetrator is in its retracted position to determine the lateral direction in which the penetrator ill subsequently advance from the catheter body as it is moved to its extended position; b) positioning the catheter body in the blood vessel or other anatomical conduit; c) using the orientation element while the penetrator is in its retracted position to adjust the rotational orientation of the catheter body as needed to substantially ensure that subsequent movement of the penetrator to its extended position will cause the penetrator to pass into or through the wall of the blood vessel or other anatomical conduit at a location adjacent to the location at which it is desired for the electrode to contact the wall of the vessel or anatomical conduit; d) advancing the penetrator into or through the wall of the blood vessel or other anatomical conduit at a location adjacent to the location at which it is desired for the electrode to contact the wall of the vessel or anatomical conduit; e) causing the penetrator to become substantially anchored in tissue so as to resist pull our of the penetrator; and
,f) drawing the catheter body against the wall of the blood vessel or other anatomical conduit such that the electrode located on the outer surface of the catheter body is held in abutting contact with the wall of the blood vessel or anatomical conduit. - View Dependent Claims (8, 9, 10)
-
-
11. A system comprising:
-
a) a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a tissue penertator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetrator will advance from the catheter body; and
,b) an anchoring member for anchoring the penetrator within tissue, said anchoring member being formed or positioned on the penetrator. - View Dependent Claims (12, 13, 14)
-
-
15. A system comprising:
-
an implantable anchoring member; and
,an elongate, transluminally insertable electrode member that is insertable through a body lumen and into the anchoring member such that The anchoring member resists undesired movement or extraction of the electrode member; wherein the anchoring member is a radially expandable member that, when radially expanded within tissue, engages the tissue and remains implanted therein in a substantially fixed position. - View Dependent Claims (16, 17)
-
-
18. A transluminal method for inserting a working apparatus into the pericardial space in a human or veterinary patient, said method comprising the steps of:
-
a) providing a providing a tissue penetrating catheter that comprises i) an elongate catheter body, ii) a hollow tissue penetrator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetrator will advance from the catheter body; b) advancing the tissue penetrating catheter into the cardiac vasculature; c) using the orientation element to position the catheter such that when the penetrator is subsequently advanced from the catheter the penetrator will penetrate into the pericardial space; and d) advancing the working apparatus through the hollow penetrator and into the pericardial space, wherein the working apparatus comprises an anchoring member for anchoring the working apparatus to the heart while the working apparatus is positioned in the pericardial space. - View Dependent Claims (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36)
-
-
37. A transthoracic method for injecting a substance or introducing a working apparatus into the heart, said method comprising the steps of:
-
a) providing a tissue penetrating catheter that comprises i) aa elongate catheter body, ii) a hollow tissue penertator advanceable from the catheter body and iii) an orientation element useable to pre-determine the specific trajectory or direction in which the penetrator will advance from the catheter body; b) forming an opening through the thoracic wall; c) inserting the tissue penetrating catheter through the opening in the thoracic wall and though the pericardium into the pericardial space; d) using the orientation element to position the catheter such that when the penetrator is subsequently advanced from the catheter the penetrator will penetrate to a sub-epicardial target location; e) advancing the penetrator from the catheter and through the epicardium; and f) delivering the substance or advancing the working apparatus through the hollow penetrator and into the sub-epicardial target location. - View Dependent Claims (38, 39, 40, 41, 42, 43, 44)
-
Specification