Transvascular neural stimulation device

• US 20060229677A1
• Filed: 04/11/2005
• Published: 10/12/2006
• Est. Priority Date: 04/11/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Moffitt, Julia, Libbus, Imad
• Granted Patent: US 7,499,748 B2
• Time in Patent Office: Days
• US Class Current: 607/2
• CPC Class Codes: A61M 31/00 Devices for introducing or retaining media, e.g. remedies, in cavities of the body A61M25/00 takes precedence ; introducing or retaining ophthalmic products into the ocular cavities A61F9/0008
• CPC Class Codes: A61N 1/0558 Anchoring or fixation means therefor
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3629 in combination with non-electric therapy
• CPC Class Codes: A61N 1/37217 characterised by the communication link, e.g. acoustic or tactile
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient

Abstract

This document discusses, among other things, apparatus, systems, and methods for transvascularly stimulation of a nerve or nerve trunk. In an example, an apparatus is configured to transvascularly stimulate a nerve trunk through a blood vessel. The apparatus includes an expandable electrode that is chronically implantable in a blood vessel proximate a nerve trunk. The expandable electrode is configured to abut a predetermined surface area of the vessel wall along a predetermined length of the vessel. An electrical lead is coupled to the expandable electrode. An implantable pulse generator is coupled to the lead and configured to deliver an electrical stimulation signal to the electrode through the lead. In an example method, an electrical signal is delivered from an implanted medical device to an electrode chronically implanted in a blood vessel proximate a nerve trunk to transvascularly deliver neural stimulation from the electrode to the nerve trunk.

Claims

1. An implantable apparatus comprising:

an expandable electrode chronically implantable in a blood vessel, the expandable electrode configured to abut an intravascular surface of the blood vessel proximate a nerve trunk;

an electrical lead coupled to the expandable electrode; and

an implantable pulse generator coupled to the lead and configured to deliver an electrical stimulation signal to the electrode through the lead, wherein the apparatus is configured to transvascularly stimulate the nerve trunk through the blood vessel.

2. The apparatus of claim 1, wherein the electrode is configured to be implanted in a blood vessel proximate a peripheral nerve trunk.

3. The apparatus of claim 2, wherein the electrode is configured to be implanted in a blood vessel proximate a sympathetic nerve.

4. The apparatus of claim 2, wherein the electrode is configured to be implanted in a blood vessel proximate a parasympathetic nerve.

5. The apparatus of claim 2, wherein the electrode is configured to be implanted in a blood vessel proximate a vagal cardiac nerve.

6. The apparatus of claim 5, wherein the electrode is configured to be implanted in the coronary sinus.

7. The apparatus of claim 5, wherein the electrode is configured to be implanted in the superior vena cava (SVC).

8. The apparatus of claim 2, wherein the electrode is configured to be implanted in an azygos vein.

9. The apparatus of claim 2, wherein the electrode is configured to be implanted in an internal jugular vein.

10. The apparatus of claim 1, wherein the expandable electrode is configured to abut a predetermined surface area of the vessel wall along a predetermined length of the vessel.

11. The apparatus of claim 10, wherein the predetermined length is about 1 centimeter.

12. The apparatus of claim 1, wherein the expandable electrode includes a mesh, at least part of the mesh being conductive.

13. The apparatus of claim 1, wherein the expandable electrode includes a drug-eluting component that is configured to be implanted inside the blood vessel.

14. A system comprising:

an expandable electrode implantable in a blood vessel proximate a target nerve on an extravascular surface of the blood vessel;

a lead assembly coupled to the expandable electrode; and

an implantable device coupled to the lead assembly, the implantable device including a controller circuit to communicate with a neural stimulator, a telemetry circuit to communicate with the controller circuit and an external module, a memory circuit to communicate with the controller circuit, and computer-readable instructions embedded in the memory circuit, the computer-readable instructions being operable on by the controller to deliver a programmable electric pulse therapy from the neural stimulator through the expandable electrode to the target nerve.

15. The system of claim 14, wherein the system is configured to deliver an electric pulse therapy sufficient to elicit depolarization of the nerve.

16. The system of claim 14, wherein the expandable electrode includes a stent.

17. The system of claim 16, wherein the stent is configured for implantation proximate a vagal cardiac nerve.

18. The system of claim 14, wherein the electrode is implantable in a blood vessel proximate a parasympathetic nerve and the instructions are operable on by the controller to deliver a programmable electric pulse therapy to transvascularly stimulate the parasympathetic nerve to inhibit cardiac remodeling.

19. The system of claim 14, wherein the electrode is implantable in a blood vessel proximate a sympathetic nerve and the instructions are operable on by the controller transvascularly stimulate the sympathetic nerve to provide antibradycardia therapy.

20. The system of claim 14, wherein the electrode is implantable in a blood vessel proximate a parasympathetic nerve and the instructions are operable on the controller to transvascularly stimulate the parasympathetic nerve to deliver antiarrhythmia therapy following myocardial infarction.

21. A method comprising:

delivering an electrical signal from an implanted medical device to an electrode chronically implanted in a blood vessel proximate a nerve trunk to transvascularly deliver neural stimulation from the electrode to the nerve trunk.

22. The method of claim 21, further comprising chronically implanting the electrode in a blood vessel proximate a peripheral nerve trunk.

23. The method of claim 22, wherein chronically implanting the electrode proximate a peripheral nerve trunk includes implanting the electrode in a blood vessel proximate a sympathetic nerve.

24. The method of claim 22, wherein chronically implanting the electrode proximate a peripheral nerve trunk includes implanting the electrode in a blood vessel proximate a parasympathetic nerve.

25. The method of claim 24, wherein chronically implanting the electrode includes implanting the electrode in a blood vessel proximate a vagal cardiac nerve, and wherein delivering a stimulation signal to the electrode transvascularly stimulates the vagal cardiac nerve.

26. The method of claim 25, wherein chronically implanting the electrode includes implanting the electrode in the superior vena cava (SVC) proximate the vagal cardiac nerve.

27. The method of claim 25, wherein chronically implanting the electrode includes implanting the electrode in the coronary sinus proximate the vagal cardiac nerve.

28. The method of claim 22, further comprising chronically implanting the electrode in an azygos vein proximate a vagal cardiac nerve.

29. The method of claim 28, wherein chronically implanting the electrode includes implanting the electrode in an azygos vein proximate a superior vena cava.

30. The method of claim 21, further comprising chronically implanting the electrode in an internal jugular vein.

31. The method of claim 21, further comprising forming an expandable electrode having an expanded diameter dimensioned configured to fix the electrode in place in the blood vessel by frictional forces.

32. The method of claim 31, wherein the expandable electrode is a stent.

33. The method of claim 31, wherein the expandable electrode includes a drug-eluting coating that prevents inflammation of stimulated tissue.

34. The method of claim 21, wherein delivering an electrical signal includes delivering approximately 20 hertz pulse train to the electrode.

35. The method of claim 21, wherein delivering an electrical signal includes transvascularly stimulating a parasympathetic nerve with the electrode to inhibit cardiac remodeling.

36. The method of claim 21, wherein delivering an electrical signal includes transvascularly stimulating a sympathetic nerve to deliver an antibradycardia therapy.

37. The method of claim 21, further wherein delivering an electrical signal includes transvascularly stimulating a parasympathetic nerve to deliver an antiarrhythmia therapy following a myocardial infarction.

38. The method of claim 21, further comprising sensing a physiologic property and delivering an electrical signal to the electrode to transvascularly deliver neural stimulation responsive to the sensed physiologic property.

39. The method of claim 21, wherein the nerve trunk is a cardiac peripheral nerve trunk.