Method and system for placement of electrical lead inside heart

• US 8,409,219 B2
• Filed: 09/30/2009
• Issued: 04/02/2013
• Est. Priority Date: 06/18/2004
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kelley, James F., Yang, Zhongping C., Stewart, Mark T.
• Primary Examiner(s): Hughes, S. Thomas
• Assistant Examiner(s): SZPIRA, JULIE ANN
• Application Number:
  US12/570,390
• Publication Number:
  US 20100042110A1
• Time in Patent Office: 1,280 Days
• Field of Search: 606/129, 606/139, 607/122.119
• US Class Current: 606/129
• CPC Class Codes: A61B 17/12 for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord specially adapted for vas deferens or fallopian tubes A61F6/20; materials for ligaturing blood vessels A61L17/00
• CPC Class Codes: A61B 17/12009 Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
• CPC Class Codes: A61B 17/128 for applying or removing clamps or clips
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/12018 Elastic band ligators
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61N 1/059 Anchoring means

Abstract

A method of placing an electrical lead of an implantable cardiac device inside a heart of a patient. The method includes securing a tool to an atrial appendage of the heart to hold onto the atrial appendage, piercing the atrial appendage, and creating an aperture in the atrial appendage while holding the atrial appendage with the tool. The method also includes moving a distal end of the electrical lead into the heart through the aperture in the atrial appendage and into a ventricle of the heart. Furthermore, the method includes coupling the distal end of the electrical lead to cardiac tissue in the ventricle and delivering an electrical signal to the cardiac tissue in the ventricle of the heart to maintain a predetermined heartbeat of the heart.

Claims

1. A method of placing an electrical lead of an implantable cardiac device inside a ventricle of a heart of a patient, the lead adapted to deliver electrical signals from the device to cardiac tissue inside the ventricle in order to maintain a predetermined heartbeat, and the method comprising:

introducing a tool through a chest wall of the patient;

securing the introduced tool to an outer surface of an atrial appendage of the heart to hold onto the atrial appendage;

piercing a wall of the atrial appendage to create an aperture through the wall of the atrial appendage while holding the atrial appendage with the tool;

moving a distal end of the electrical lead through the chest wall and into the heart through the aperture in the atrial appendage; and

coupling the distal end of the electrical lead to cardiac tissue in the ventricle.

2. The method of claim 1, wherein securing the tool to the atrial appendage includes hooking the tool onto the atrial appendage.

3. The method of claim 1, wherein securing the tool to the atrial appendage includes pinching the outer surface of the atrial appendage with the tool.

4. The method of claim 1, wherein securing the tool to the atrial appendage includes adhering the tool to the atrial appendage.

5. The method of claim 1, wherein securing the tool to the atrial appendage includes holding the atrial appendage by suction.

6. The method of claim 1, further comprising introducing a distal end of a catheter through the chest wall and the secured tool, the distal end of the catheter having a piercing member operably coupled thereto;

and wherein piercing the wall of the atrial appendage is accomplished with the piercing member.

7. The method of claim 6, further comprising withdrawing the piercing member from the distal end of the catheter and out of a proximal end of the catheter, after piercing the wall of the atrial appendage;

and wherein moving the distal end of the lead through the chest wall and into the heart though the aperture in the atrial appendage is accomplished by advancing the lead through the catheter.

8. The method of claim 1, wherein the atrial appendage comprises a left atrial appendage.

9. The method of claim 1, wherein the ventricle having cardiac tissue, to which the distal end of the electrical lead is coupled, comprises a left ventricle.

10. The method of claim 1, further comprising mounting an abutment member within the aperture, such that a lumen of, the abutment member receives the electrical lead, when the lead is moved through the aperture, and the abutment member is positioned between cardiac tissue and the electrical lead.

11. The method of claim 10, further comprising applying a compression device around an extension portion of the mounted abutment member, after coupling the distal end of the electrical lead, the extension portion being located outside the heart, and the applied compression device holding the lead in place relative to the heart.

12. The method of claim 10, further comprising fixing the wall of the atrial appendage, in proximity to the aperture, between a resilient ring, which is fitted over an outer surface of the atrial appendage, and a neck of the abutment member.

13. The method of claim 1, further comprising:

manipulating the tool to pull the atrial appendage within an expanded a resilient ring that is releasably coupled to arms of the tool, after securing the tool to the outer surface of the atrial appendage; and

actuating the arms of the tool so that the resilient ring recovers and contacts the atrial appendage thereby substantially occluding the atrial appendage.

14. The method of claim 1, further comprising:

introducing a catheter through the chest wall, the secured tool and the aperture;

steering the introduced catheter to the ventricle;

guiding the electrical lead through the catheter to the ventricle; and

withdrawing the catheter from the heart after coupling the distal end of the electrical lead to the cardiac tissue.

15. A method for maintaining a predetermined heartbeat of a patient, the method comprising:

introducing a tool through a chest wall of the patient;

securing the introduced tool to an outer surface of a left atrial appendage of the heart to hold onto the left atrial appendage;

piercing a wall of the atrial appendage with a piercing tool that is operably coupled to the tool to create an aperture through the wall of the left atrial appendage while holding onto the left atrial appendage;

moving a distal end of an electrical lead through the chest wall and the aperture and into a left ventricle of the heart via a passage in the tool, while holding onto the left atrial appendage;

mounting a sleeve within the aperture, such that a lumen of the sleeve receives the electrical lead, when moved through the aperture, the sleeve preventing direct contact between the heart and the electrical lead;

compressing the sleeve to hold the electrical lead in place relative to the heart;

connecting the distal end of the electrical lead to cardiac tissue inside the left ventricle of the heart;

connecting the electrical lead to an implantable cardiac device;

delivering an electrical signal to the cardiac tissue via the electrical lead to maintain the predetermined heartbeat;

manipulating the tool to resiliently stretch a resilient ring over an outer surface of the left atrial appendage; and

manipulating the tool to release the resilient ring to resiliently recover and occlude the left atrial appendage.