US20200360694A1 - Methods for electrical neuromodulation of the heart - Google Patents
Methods for electrical neuromodulation of the heart Download PDFInfo
- Publication number
- US20200360694A1 US20200360694A1 US16/937,932 US202016937932A US2020360694A1 US 20200360694 A1 US20200360694 A1 US 20200360694A1 US 202016937932 A US202016937932 A US 202016937932A US 2020360694 A1 US2020360694 A1 US 2020360694A1
- Authority
- US
- United States
- Prior art keywords
- pulmonary artery
- electrode array
- catheter
- electrodes
- right pulmonary
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
- 238000000034 method Methods 0.000 title claims abstract description 51
- 230000004007 neuromodulation Effects 0.000 title description 18
- 210000001147 pulmonary artery Anatomy 0.000 claims abstract description 134
- 230000002685 pulmonary effect Effects 0.000 claims abstract description 50
- 230000002612 cardiopulmonary effect Effects 0.000 claims description 42
- 210000005036 nerve Anatomy 0.000 claims description 40
- 230000000638 stimulation Effects 0.000 claims description 31
- 230000002567 autonomic effect Effects 0.000 claims description 19
- 206010007556 Cardiac failure acute Diseases 0.000 claims description 12
- 210000001367 artery Anatomy 0.000 claims description 6
- 230000008878 coupling Effects 0.000 claims 3
- 238000010168 coupling process Methods 0.000 claims 3
- 238000005859 coupling reaction Methods 0.000 claims 3
- 230000000747 cardiac effect Effects 0.000 description 34
- 210000003403 autonomic nervous system Anatomy 0.000 description 13
- 230000004044 response Effects 0.000 description 12
- 230000002526 effect on cardiovascular system Effects 0.000 description 6
- 210000005166 vasculature Anatomy 0.000 description 5
- 239000008280 blood Substances 0.000 description 4
- 210000004369 blood Anatomy 0.000 description 4
- 230000008859 change Effects 0.000 description 4
- 230000008713 feedback mechanism Effects 0.000 description 4
- 230000000004 hemodynamic effect Effects 0.000 description 4
- 230000002093 peripheral effect Effects 0.000 description 4
- 230000002792 vascular Effects 0.000 description 4
- 208000020446 Cardiac disease Diseases 0.000 description 3
- 206010019280 Heart failures Diseases 0.000 description 3
- 239000002671 adjuvant Substances 0.000 description 3
- 229940030602 cardiac therapy drug Drugs 0.000 description 3
- 230000000694 effects Effects 0.000 description 3
- 238000002565 electrocardiography Methods 0.000 description 3
- 208000019622 heart disease Diseases 0.000 description 3
- 230000001133 acceleration Effects 0.000 description 2
- 230000009471 action Effects 0.000 description 2
- 230000001154 acute effect Effects 0.000 description 2
- 210000000709 aorta Anatomy 0.000 description 2
- 230000001684 chronic effect Effects 0.000 description 2
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 2
- VYFYYTLLBUKUHU-UHFFFAOYSA-N dopamine Chemical compound NCCC1=CC=C(O)C(O)=C1 VYFYYTLLBUKUHU-UHFFFAOYSA-N 0.000 description 2
- 239000000835 fiber Substances 0.000 description 2
- 239000007789 gas Substances 0.000 description 2
- 230000004217 heart function Effects 0.000 description 2
- 238000003384 imaging method Methods 0.000 description 2
- 239000004041 inotropic agent Substances 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000002107 myocardial effect Effects 0.000 description 2
- 230000036284 oxygen consumption Effects 0.000 description 2
- 210000005241 right ventricle Anatomy 0.000 description 2
- 230000009885 systemic effect Effects 0.000 description 2
- 230000035488 systolic blood pressure Effects 0.000 description 2
- 238000012360 testing method Methods 0.000 description 2
- 230000007704 transition Effects 0.000 description 2
- 206010002329 Aneurysm Diseases 0.000 description 1
- 206010002383 Angina Pectoris Diseases 0.000 description 1
- 206010003840 Autonomic nervous system imbalance Diseases 0.000 description 1
- 208000031229 Cardiomyopathies Diseases 0.000 description 1
- 206010050202 Carotid sinus syndrome Diseases 0.000 description 1
- JRWZLRBJNMZMFE-UHFFFAOYSA-N Dobutamine Chemical compound C=1C=C(O)C(O)=CC=1CCNC(C)CCC1=CC=C(O)C=C1 JRWZLRBJNMZMFE-UHFFFAOYSA-N 0.000 description 1
- 206010020772 Hypertension Diseases 0.000 description 1
- 206010021137 Hypovolaemia Diseases 0.000 description 1
- 206010061216 Infarction Diseases 0.000 description 1
- 208000001089 Multiple system atrophy Diseases 0.000 description 1
- 206010031123 Orthopnoea Diseases 0.000 description 1
- 206010031127 Orthostatic hypotension Diseases 0.000 description 1
- 208000005228 Pericardial Effusion Diseases 0.000 description 1
- 230000005856 abnormality Effects 0.000 description 1
- 230000003213 activating effect Effects 0.000 description 1
- 238000009098 adjuvant therapy Methods 0.000 description 1
- 206010003119 arrhythmia Diseases 0.000 description 1
- 230000004872 arterial blood pressure Effects 0.000 description 1
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 1
- 230000002051 biphasic effect Effects 0.000 description 1
- 230000017531 blood circulation Effects 0.000 description 1
- 238000009530 blood pressure measurement Methods 0.000 description 1
- 230000036760 body temperature Effects 0.000 description 1
- 210000000748 cardiovascular system Anatomy 0.000 description 1
- 239000003795 chemical substances by application Substances 0.000 description 1
- 230000002057 chronotropic effect Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 230000006866 deterioration Effects 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000035475 disorder Diseases 0.000 description 1
- 229960001089 dobutamine Drugs 0.000 description 1
- 229960003638 dopamine Drugs 0.000 description 1
- 208000019479 dysautonomia Diseases 0.000 description 1
- 239000012777 electrically insulating material Substances 0.000 description 1
- 230000001667 episodic effect Effects 0.000 description 1
- 238000002594 fluoroscopy Methods 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 208000025339 heart septal defect Diseases 0.000 description 1
- 239000007943 implant Substances 0.000 description 1
- 230000002401 inhibitory effect Effects 0.000 description 1
- 230000000297 inotrophic effect Effects 0.000 description 1
- 208000028867 ischemia Diseases 0.000 description 1
- 210000004072 lung Anatomy 0.000 description 1
- 239000000203 mixture Substances 0.000 description 1
- 210000004165 myocardium Anatomy 0.000 description 1
- 210000004126 nerve fiber Anatomy 0.000 description 1
- 230000001272 neurogenic effect Effects 0.000 description 1
- 208000012144 orthopnea Diseases 0.000 description 1
- 239000001301 oxygen Substances 0.000 description 1
- 229910052760 oxygen Inorganic materials 0.000 description 1
- 230000036581 peripheral resistance Effects 0.000 description 1
- 230000001376 precipitating effect Effects 0.000 description 1
- 230000002265 prevention Effects 0.000 description 1
- 208000018290 primary dysautonomia Diseases 0.000 description 1
- 230000008569 process Effects 0.000 description 1
- 238000004886 process control Methods 0.000 description 1
- 208000002815 pulmonary hypertension Diseases 0.000 description 1
- 230000011514 reflex Effects 0.000 description 1
- 230000036387 respiratory rate Effects 0.000 description 1
- 230000035939 shock Effects 0.000 description 1
- 230000004936 stimulating effect Effects 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 206010042772 syncope Diseases 0.000 description 1
- 208000037905 systemic hypertension Diseases 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 238000011282 treatment Methods 0.000 description 1
- 238000002604 ultrasonography Methods 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
- 210000002620 vena cava superior Anatomy 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/36114—Cardiac control, e.g. by vagal stimulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0472—Structure-related aspects
- A61N1/0476—Array electrodes (including any electrode arrangement with more than one electrode for at least one of the polarities)
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/0551—Spinal or peripheral nerve electrodes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36135—Control systems using physiological parameters
Definitions
- the present disclosure relates generally to neuromodulation of the heart, and more particularly to methods for neuromodulation of the heart by electrically modulating the autonomic nervous system of the heart.
- Acute heart failure is a cardiac condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs.
- the condition impairs quality of life and is a leading cause of hospitalizations and mortality in the western world.
- Treating acute heart failure is typically aimed at removal of precipitating causes, prevention of deterioration in cardiac function, and control of the patient's congestive state.
- Treatments for acute heart failure include the use of inotropic agents, such as dopamine and dobutamine. These agents, however, have both chronotropic and inotropic effects and characteristically increase heart contractility at the expense of significant increments in oxygen consumption secondary to elevations in heart rate. As a result, although these inotropic agents increase myocardial contractility and improve
- Embodiments of the present disclosure provide for methods of electrical neuromodulation of the autonomic nervous system of the heart.
- the methods of the present disclosure may be useful in electrical neuromodulation of patients with cardiac disease, such as patients with acute or chronic cardiac disease.
- the methods of the present disclosure encompass neuromodulation of combinations of one or more target sites of the autonomic nervous system of the heart.
- Non-limiting examples of medical conditions that can be treated according to the present disclosure include cardiovascular medical conditions.
- the methods of the present disclosure allow for a portion of a catheter to be positioned within the vasculature of the patient in the right pulmonary artery. Once positioned, an electrode system of the catheter can provide electrical current to stimulate the autonomic nervous system surrounding the right pulmonary artery in an effort to provide adjuvant cardiac therapy to the patient.
- the present disclosure provides for a method for treating a patient having a heart with a pulmonary trunk.
- Portions of the pulmonary trunk can be defined with a right lateral plane that passes along a right luminal surface of the pulmonary trunk, a left lateral plane parallel with the right lateral plane, where the left lateral plane passes along a left luminal surface of the pulmonary trunk.
- the right lateral plane and the left lateral plane extend in a direction that generally aligns with the posterior and anterior directions of the patient's body.
- a branch point is positioned between the right lateral plane and the left lateral plane, where the branch point helps to define the beginning of a left pulmonary artery and a right pulmonary artery of the heart.
- the method further includes moving a catheter having an electrode array through the pulmonary trunk towards the branch point, where the electrode array includes one or more, preferably two or more, electrodes.
- the electrode array is positioned in the right pulmonary artery to the right of the left lateral plane, where the one or more electrodes contacts a posterior surface, a superior surface and/or an inferior surface of the right pulmonary artery to the right of the left lateral plane.
- the electrode array can be positioned in the right pulmonary artery to the right of the right lateral plane, where the one or more electrodes contacts the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery to the right of the right lateral plane.
- the method of the present disclosure further includes contacting the one or more electrodes on the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery at a position superior to (i.e., situated above) the branch point.
- the at least a portion of the catheter can also be positioned in contact with a portion of the surface defining the branch point.
- the portion of the catheter can be provided with a shape that provides an increase in surface area that can help to hold the portion of the catheter against the branch point.
- the pulmonary trunk has a diameter taken across a plane perpendicular to both the left lateral plane and the right lateral plane, where the electrode array is positioned in the right pulmonary artery to extend from a point to the right of the left lateral plane to a point about three times the diameter of the pulmonary trunk to the right of the branch point.
- the right pulmonary artery can also include a branch point that divides the right pulmonary artery into at least two additional arteries that are distal to the branch point helping to define the beginning of the left pulmonary artery and the right pulmonary artery.
- the electrode array can be positioned in the right pulmonary artery between the branch point helping to define the beginning of the left pulmonary artery and the right pulmonary artery and the branch point that divides the right pulmonary artery into at least two additional arteries.
- electrical current can be provided from or to the one or more electrodes of the electrode array.
- a value of a cardiac parameter of the patient can be measured in response to the electrical current from or to the one or more electrodes of the electrode array. From the value of the cardiac parameter, changes can be made to which of the electrodes are used to provide the electrical current in response to the value of the cardiac parameter. Changes can also be made to the nature of the electrical current provided in response to the value of the cardiac parameter. Such changes include, but are not limited to, changes in voltage, amperage, waveform, frequency and pulse width, by way of example.
- the electrodes of the one or more electrodes on the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery can be moved in response to the values of the cardiac parameter.
- the electrical current provided to or from the one or more electrodes of the electrode array can be provided as at least one pulse of electrical current to or from the one or more electrodes of the electrode array.
- Examples of such a cardiac parameter include, but are not limited to, measuring a pressure parameter, an acoustic parameter, an acceleration parameter and/or an electrical parameter (e.g., ECG) of the heart of the patient as the cardiac parameter.
- FIGS. 1A, 1B and 1C are schematic illustrations of the heart and surrounding areas having various views, where the FIGS, showing the stimulation sites according to the present disclosure.
- FIG. 2 is a perspective view of a catheter that suitable for performing the method of the present disclosure.
- FIG. 3 is a perspective view of a catheter positioned in the heart of the patient according to the present disclosure
- FIG. 4 is a block diagram of an algorithm to determine action taken by a controller microprocessor in response to sensor input according to an embodiment of a system of the present disclosure.
- Embodiments of the present disclosure provide for methods of electrical neuromodulation of the autonomic nervous system of the heart.
- the methods of the present disclosure may be useful in electrical neuromodulation of patients with cardiovascular medical conditions, such as patients with acute or chronic cardiac disease.
- the methods of the present disclosure allow for a portion of a catheter to be positioned within the vasculature of the patient in the right pulmonary artery. Once positioned, an electrode system of the catheter can provide electrical current to stimulate the autonomic nervous system surrounding the right pulmonary artery in an effort to provide adjuvant cardiac therapy to the patient.
- distal and proximal are used in the following description with respect to a position or direction relative to the treating clinician taken along the catheter of the present disclosure. “Distal” or “distally” are a position distant from or in a direction away from the clinician taken along the catheter of the present disclosure. “Proximal” and “proximally” are a position near or in a direction toward the clinician taken along the catheter of the present disclosure.
- the catheters and electrode systems provided herein include one or more electrodes, but preferably two or more electrodes, as discussed herein. It is understood that the phrase one or more electrodes can be replaced herein with two or more electrodes if desired.
- cardiovascular medical conditions can involve medical conditions related to the components of the cardiovascular system such as, for example, the heart and aorta.
- cardiovascular conditions include post-infarction rehabilitation, shock (hypovolemic, septic, neurogenic), valvular disease, heart failure, angina, microvascular ischemia, myocardial contractility disorder, cardiomyopathy, hypertension including pulmonary hypertension and systemic hypertension, orthopnea, dyspenea, orthostatic hypotension, dysautonomia, syncope, vasovagal reflex, carotid sinus hypersensitivity, pericardial effusion, heart failure, and cardiac structural abnormalities such as septal defects and wall aneurysms.
- a catheter in a preferred embodiment, can be used in conjunction with a pulmonary artery catheter, such as a Swan-Ganz type pulmonary artery catheter, to deliver transvascular neuromodulation via the pulmonary artery to an autonomic target site to treat a cardiovascular condition according to the present disclosure.
- the catheter or catheters is housed within one of the multiple lumens of a pulmonary artery catheter.
- preferred catheters include those disclosed in U.S. Provisional Patent Application 62/001,729 entitled “Catheter and Catheter System for Electrical Neuromodulation” filed on May 22, 2014; U.S. Provisional Patent Application 62/047,270 entitled “Catheter and Electrode Systems for Electrical Neuromodulation ” filed on Sep. 8, 2014; and U.S. patent application Ser. No. 14/085,311 entitled “Methods and Systems for Treating Acute Heart Failure by Neuromodulation” filed Nov. 20, 2013, where the contents of these applications are incorporated herein by reference in their entirety.
- the present disclosure provides methods for treating acute heart failure, also known as decompensated heart failure, by modulating the autonomic nervous system surrounding the right pulmonary artery in an effort to provide adjuvant cardiac therapy to the patient.
- the modulation can help by affecting heart contractility more than heart rate.
- the autonomic nervous system is modulated so as to collectively affect heart contractility more than heart rate.
- the autonomic nervous system can be impacted by electrical modulation that includes stimulating and/or inhibiting nerve fibers of the autonomic nervous system.
- a catheter having an electrode array is inserted into the pulmonary trunk and positioned at a location such that the electrode array is positioned with its electrodes in contact with the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery. From this location, electrical current can be delivered to or from the electrode array to selectively modulate the autonomic nervous system of the heart. For example, electrical current can be delivered to or from the electrode array to selectively modulate the autonomic cardiopulmonary nerves of the autonomic nervous system, which can modulate heart contractility more than heart rate.
- the electrode array is positioned at a site along the posterior wall and/or superior wall of the right pulmonary artery such that the electrical current delivered to or from the electrode array result in the greatest effect on heart contractility and the least effect on heart rate and/or oxygen consumption compared to electrical current delivered at other sites in the right pulmonary artery and/or left pulmonary artery.
- the effect on heart contractility is to increase heart contractility.
- the electrical current delivered to or from the electrode array can be in the form of a time variant electrical current.
- a time variant electrical current can be in the form of one or more of a pulse of electrical current (e.g., at least one pulse of electrical current), one or more of waveform, such as a continuous wave of electrical current, or a combination thereof.
- the present disclosure provides for a method for treating a patient having a heart with a pulmonary trunk, where portions of the pulmonary trunk can be defined with a right lateral plane that passes along a right luminal surface of the pulmonary trunk, a left lateral plane parallel with the right lateral plane, where the left lateral plane passes along a left luminal surface of the pulmonary trunk.
- the right lateral plane and the left lateral plane extend in a direction that generally aligns with the posterior and anterior directions of the heart.
- a branch point is positioned between the right lateral plane and the left lateral plane, where the branch point helps to define the beginning of a left pulmonary artery and a right pulmonary artery of the heart.
- the method further includes moving a catheter having an electrode array through the pulmonary trunk towards the branch point, where the electrode array includes one or more, preferably two or more, electrodes.
- the electrode array is positioned in the right pulmonary artery having a proximal end of the array at or to the right of the left lateral plane, where the one or more electrodes contacts the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery to the right of the left lateral plane.
- the electrode array can be positioned in the right pulmonary artery to the right of the right lateral plane, where the one or more electrodes contacts the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery to the right of the right lateral plane.
- FIGS. 1A and IB provide a schematic illustration of the human heart 100 , where portions of the heart (e.g., the aorta, the superior vena cava among other structures), including a portion of the pulmonary trunk 102 , have been removed to allow for the details discussed herein to be shown.
- FIG. 1A provides a perspective view of the heart 100 as seen from the front of the patient (viewed in a posterior direction), while Fig. IB provides a perspective view of the heart 100 as seen from the right side of the patient.
- the heart 100 includes the pulmonary trunk 102 that begins at the base of the right ventricle 104 .
- the pulmonary trunk 102 is a tubular structure approximately 3 centimeters (cm) in diameter and 5 cm in length.
- the pulmonary trunk 102 branches into the left pulmonary artery 106 and the right pulmonary artery 108 at a branch point 110 .
- the left pulmonary artery 106 and the right pulmonary artery 108 serve to deliver de-oxygenated blood to each corresponding lung.
- the branch point 110 includes a ridge 112 that extends from the posterior of the pulmonary trunk 102 .
- the branch point 110 along with the ridge 112 , provides a “Y” or “T” shaped structure that helps to define at least a portion of the left pulmonary artery 106 and the right pulmonary artery 108 .
- the branch point 110 of the pulmonary trunk 102 slopes in opposite directions. In a first direction the pulmonary trunk 102 transitions into the left pulmonary artery 106 , and in the second direction, opposite the first direction, the pulmonary trunk 102 transitions into the right pulmonary artery 108 .
- the branch point 110 may not necessarily be aligned along a longitudinal center line 114 of the pulmonary trunk 102 .
- portions of the pulmonary artery can be defined with a right lateral plane 116 that passes along a right luminal surface 118 of the pulmonary trunk 102 , a left lateral plane 120 parallel with the right lateral plane 116 , where the left lateral plane 120 passes along a left luminal surface 122 of the pulmonary artery 102 .
- the right lateral plane 116 and the left lateral plane 120 extend in both a posterior direction 124 and anterior direction 126 .
- the ridge 112 of the branch point 110 is located between the right lateral plane 116 and the left lateral plane 120 .
- the branch point 110 is positioned between the right lateral plane 116 and the left lateral plane 120 , where the branch point 110 helps to define the beginning of the left pulmonary artery 106 and the right pulmonary artery 108 of the heart 100 .
- the distance between the right lateral plane 116 and the left lateral plane 120 is approximately the diameter of the pulmonary trunk 102 (e.g., about 3 cm).
- the present disclosure provides for a method for treating a patient having a heart 100 with a pulmonary trunk 102 .
- the method includes moving a catheter having an electrode array through the pulmonary trunk 102 towards the branch point 110 .
- the electrode array of the catheter includes one or more, preferably two or more, electrodes.
- the electrode array is positioned with the proximal end of the array in the right pulmonary artery 108 or at the right of the left lateral plane 120 , where the one or more electrodes are brought into contact with the posterior surface, the superior surface and/or the inferior surface 128 of the right pulmonary artery 108 to the right of the left lateral plane 120 .
- the electrode array can be positioned with the proximal end of the array in the right pulmonary artery 108 or at the right of the right lateral plane 116 , where the one or more electrodes are brought into contact with the posterior surface, the superior surface and/or the inferior surface 128 of the right pulmonary artery 108 to the right of the right lateral plane 116 .
- FIG. 1C provides an additional illustration the posterior surface 121 , the superior surface 123 and the inferior surface 125 of the right pulmonary artery 108 discussed herein.
- the view of the heart 100 in FIG. 1C is from the right side of the patient's heart 100 .
- the posterior surface 121 , the superior surface 123 and the inferior surface 125 account for approximately three quarters of the luminal perimeter of the right pulmonary artery 108 , where the anterior surface 127 accounts for the remainder.
- the catheter 230 includes an elongate body 232 having a first end 234 and a second end 236 distal from the first end 234 .
- the elongate body 232 includes a longitudinal center axis 238 extending between the first end 234 and the second end 236 of the elongate body 232 .
- the elongate body 232 also includes a portion 240 that has three or more surfaces 242 defining a convex polygonal cross-sectional shape taken perpendicularly to the longitudinal center axis 238 .
- the convex polygonal cross-sectional shape of the elongate body 232 includes those shapes for which every internal angle is less than 180 degrees and where every line segment between two vertices of the shape remains inside or on the boundary of the shape. Examples of such shapes include, but are not limited to, triangular, rectangular (as illustrated in FIG. 1 ), square, pentagon and hexagon, among others.
- Catheter 230 further includes one or more, preferably two or more, electrodes 244 on one surface of the three or more surfaces 242 of the elongate body 232 .
- Conductive elements 246 extend through the elongate body 232 , where the conductive elements 246 can be used, as discussed herein, to conduct electrical current to combinations of the one or more electrodes 244 .
- Each of the one or more electrodes 244 is coupled to a corresponding conductive element 246 .
- the conductive elements 246 are electrically isolated from each other and extend through the elongate body 232 from each respective electrode 244 through the first end 234 of the elongate body 232 .
- the conductive elements 246 terminate at a connector port, where each of the conductive elements 246 can be releasably coupled to a stimulation system, as discussed herein. It is also possible that the conductive elements 246 are permanently coupled to the stimulation system (e.g., not releasably coupled).
- the stimulation system can be used to provide stimulation electrical current that is conducted through the conductive elements 246 and delivered across combinations of the one or more electrodes 244 .
- the one or more electrodes 244 are electrically isolated from one another, where the elongate body 232 is formed of an electrically insulating material as discussed herein. As illustrated, the one or more electrodes 244 can be located only on the one surface of the three or more surfaces 242 of the elongate body 232 .
- the one or more electrodes 244 can be configured as an array of electrodes, where the number of electrodes and their relative position to each other can vary.
- the one or more electrodes 244 can be configured to allow for electrical current to be delivered from and/or between different combinations of the one or more electrodes 244 .
- the electrodes in the array of electrodes can have a repeating pattern where the electrodes are equally spaced from each other.
- the electrodes in the array of electrodes can have a column and row configuration (as illustrated in FIG. 2 ).
- the electrodes in the array of electrodes can have a concentric radial pattern, where the electrodes are positioned so as to form concentric rings of the electrodes. Other patterns are possible, where such patterns can either be repeating patterns or random patterns.
- the one or more electrodes 244 have an exposed face 248 .
- the exposed face 248 of the electrode 244 provides the opportunity for the electrode 244 , when implanted in the right pulmonary artery of the patient, as discussed herein, can be placed into proximity and/or in contact with the vascular tissue of the right pulmonary artery of the patient, as opposed to facing into the volume of blood in the right pulmonary artery.
- the electrodes 244 can be placed into direct proximity to and/or in contact with the right pulmonary artery. This allows the electrical current from or to the one or more electrodes 244 to be directed into the tissue adjacent the implant location, instead of being directed into the blood volume.
- the exposed face 248 of the one or more electrodes 244 can have a variety of shapes.
- the exposed face 248 can have a flat planar shape.
- the exposed face 248 of the electrodes 244 can be co-planar with the one surface of the three or more surfaces 242 of the elongate body 230 .
- the exposed face 248 of the electrodes 244 can have a semi-hemispherical shape.
- Other shapes for the exposed face 248 of the electrodes 244 can include semi-cylindrical, wave-shaped, and zig-zag-shaped.
- the exposed face 248 of the electrodes 244 can also include one or more anchor structures. Examples of such anchor structures include hooks that can optionally include a barb. Similarly, the electrodes can be shaped to also act as anchor structures.
- the one surface of the three or more surfaces 242 of the elongate body 102 that include the exposed face 248 of the one or more electrodes 244 can further include anchor structures 250 that extend above the one surface of the three or more surfaces 242 .
- the anchor structures 250 can include portions that can contact the vascular tissue in such a way that the movement of the one or more electrodes 244 at the location where they contact the vascular tissue is minimized.
- the anchor structures 250 can have a variety of shapes that may help to achieve this goal.
- the anchor structures 250 can have a conical shape, where the vertex of the conical shape can contact the vascular tissue.
- the anchor structures 250 can have a hook configuration (with or without a barb).
- one or more of the anchor structures 250 can be configured as an electrode.
- the elongate body 232 of catheter 230 can also include a portion 254 with a circular cross-section shape taken perpendicularly to the longitudinal center axis 238 .
- the elongate body 232 of catheter 230 also includes a surface 256 defining a guide-wire lumen 258 that extends through the elongate body 232 .
- the guide-wire lumen 258 has a diameter that is sufficiently large to allow the guide wire to freely pass through the guide-wire lumen 258 .
- the guide-wire lumen 258 can be positioned concentrically relative the longitudinal center axis 238 of the elongate body 232 .
- the guide-wire lumen 258 is positioned eccentrically relative the longitudinal center axis 230 of the elongate body 232 .
- the guide-wire lumen 258 will have a wall thickness 260 taken perpendicularly to the longitudinal center axis that is greater than a wall thickness 262 of a remainder of the catheter taken perpendicularly to the longitudinal center axis.
- the differences in wall thickness 260 and 262 help to provide the elongate body 232 with a preferential direction in which to bend.
- the wall thickness 260 of the elongate body 232 being greater than the wall thickness 262 will cause the side of the elongate body 232 with the greater wall thickness to preferentially have the larger radius of curvature when the elongate body 232 bends.
- the exposed face 248 of the electrodes 244 on the side of the elongate body 232 having the great wall thickness (e.g., wall thickness 260 ), the one or more electrodes 244 can be more easily and predictably brought into contact with the luminal surface of the right pulmonary artery.
- the catheter 230 shown in FIG. 2 can be positioned in the right pulmonary artery of the patient, as described herein.
- a pulmonary artery catheter is introduced into the vasculature through a percutaneous incision and guided to the right ventricle using known techniques.
- the pulmonary artery catheter can be inserted into the vasculature via a peripheral vein of the neck or chest (e.g., as with a Swan-Ganz catheter). Changes in a patient's electrocardiography and/or pressure signals from the vasculature can be used to guide and locate the pulmonary artery catheter within the patient's heart.
- a guide wire can be introduced into the patient via the pulmonary artery guide catheter, where the guide wire is advanced into the right pulmonary artery.
- the catheter 230 can be advanced over the guide wire so as to position the catheter 230 in the right pulmonary artery of the patient, as described herein.
- imaging modalities can be used in positioning the guide wire of the present disclosure in the right pulmonary artery of the patient. Such imaging modalities include, but are not limited to, fluoroscopy, ultrasound, electromagnetic, electropotential modalities.
- FIG. 3 provides a perspective view of the catheter 330 positioned in the heart 300 of the patient, where the one or more of the electrodes 344 are contacting the posterior surface 321 and/or superior surface 323 of, for example, the right pulmonary artery 308 .
- FIG. 3 also illustrates the one or more of the electrodes 344 contacting the posterior surface 321 and/or superior surface 323 of the right pulmonary artery 308 at a position that is superior to the branch point 310 .
- FIG. 3 further illustrates that at least a portion of the catheter 330 is positioned in contact with a portion of the surface defining the branch point 310 .
- the pulmonary trunk 302 has a diameter 356 taken across a plane 358 perpendicular to both the left lateral plane 320 and the right lateral plane 316 .
- the electrode array of the catheter 330 is positioned in an area 360 that extends distally no more than three times the diameter of the pulmonary trunk 302 to the right of the branch point 310 . This area 360 is shown with cross-hatching in FIG. 3 .
- the right pulmonary artery 308 can also include a branch point 362 that divides the right pulmonary artery 308 into at least two additional arteries 364 that are distal to the branch point 310 defining the left pulmonary artery 306 and the right pulmonary artery 308 .
- the electrode array can be positioned between the branch point 310 defining the left pulmonary artery 306 and the right pulmonary artery 308 and the branch point 362 that divides the right pulmonary artery 308 into at least two additional arteries 364 .
- electrical current can be provided from or to one or more of the electrodes 344 .
- a value of a non-cardiac parameter of the patient can be measured in response to the electrical current from or to one or more of the electrodes 344 .
- changes can be made to which of the one or more electrodes are used to provide the electrical current in response to the value of the cardiac parameter.
- Changes can also be made to the nature of the electrical current provided in response to the value of the non-cardiac parameter.
- Such changes include, but are not limited to, changes in voltage, amperage, waveform, frequency and pulse width by way of example. It is possible to change combinations of electrodes used and the nature of the electrical current provided by the electrodes.
- the electrodes of the one or more electrodes on the posterior surface of the right pulmonary artery can be moved in response to one or more of the values of the non-cardiac parameter.
- cardiac parameter include, but are not limited to, measuring a pressure parameter, an acoustic parameter, an acceleration parameter and/or an electrical parameter (e.g., ECG) of the heart of the patient as the cardiac parameter.
- ECG electrical parameter
- An example of such a pressure parameter can include, but is not limited to, measuring a maximum systolic pressure of the heart of the patient as the pressure parameter.
- Other suitable cardiac parameters are discussed herein.
- Moving the electrodes of the one or more electrodes on the posterior and/or superior surface of the right pulmonary artery in response to one or more of the values of the cardiac parameter can be done by physically moving the one or more electrodes of the catheter 330 to a different position on the posterior and/or superior surface of the right pulmonary artery, electronically moving which electrodes of the one or more electrodes are being used to provide the electrical current from or to the electrode array (while not physically moving the one or more electrodes of the catheter 330 ) or a combination of these two actions.
- neuromodulation can be accomplished by applying electrical current to the right pulmonary artery.
- neuromodulation of the present disclosure includes applying the electrical current to the posterior and/or superior wall of the right pulmonary artery.
- the electrical current is thereby applied to the autonomic cardiopulmonary nerves surrounding the right pulmonary artery.
- These autonomic cardiopulmonary nerves can include the right autonomic cardiopulmonary nerves and the left autonomic cardiopulmonary nerves.
- the right autonomic cardiopulmonary nerves include the right dorsal medial cardiopulmonary nerve and the right dorsal lateral cardiopulmonary nerve.
- the left autonomic cardiopulmonary nerves include the left ventral cardiopulmonary nerve, the left dorsal medial cardiopulmonary nerve, the left dorsal lateral cardiopulmonary nerve, and the left stellate cardiopulmonary nerve.
- the one or more electrodes of the catheter are contacting the posterior surface of the right pulmonary artery. From this location, the electrical current delivered through the one or more electrodes may be better able to treat and/or provide therapy (including adjuvant therapy) to the patient experiencing a variety of cardiovascular medical conditions, such as acute heart failure.
- the electrical current can elicit responses from the autonomic nervous system that may help to modulate a patient's cardiac contractility.
- the electrical current is intended to affect heart contractility more than the heart rate, thereby helping to improving hemodynamic control while possibly minimizing unwanted systemic effects.
- the stimulation system is electrically coupled to the one or more electrodes via the conductive elements, where the stimulation system can be used to deliver the electrical current to the autonomic cardiopulmonary fibers surrounding the right pulmonary artery.
- the stimulation system is used to operate and supply the electrical current to the one or more electrodes of the catheter.
- the stimulation system controls the various parameters of the electrical current delivered across the one or more electrodes.
- Such parameters include control of each electrodes polarity (e.g., used as a cathode or an anode), pulsing mode (e.g., unipolar, bi-polar and/or multi-polar), a pulse width, an amplitude, a frequency, a voltage, a current, a duration, a wavelength and/or a waveform associated with the electrical current.
- the stimulation system may operate and supply the electrical current to different combinations and numbers of the one or more electrodes, including the reference electrodes.
- the stimulation system can be external to the patient's body for use by the professional to program the stimulation system and to monitor its performance. Alternatively, the stimulation system could be internal to the patient's body. When located within the patient, the housing of the stimulation system can be used as a reference electrode for both sensing and unipolar pulsing mode.
- the stimulation system can be used to help identify a preferred location for the position of the one or more electrodes along the posterior, superior and/or inferior surfaces of the right pulmonary artery.
- the one or more electrodes of the catheter are introduced into the patient and tests of various locations along the posterior, superior and/or inferior surfaces of the right pulmonary artery using the stimulation system are conducted so as to identify a preferred location for the electrodes.
- the stimulation system can be used to initiate and adjust the parameters of the electrical current. Such parameters include, but are not limited to, terminating, increasing, decreasing, or changing the rate or pattern of the electrical current.
- the stimulation system can also deliver electrical current that is episodic, continuous, phasic, in clusters, intermittent, upon demand by the patient or medical personnel, or preprogrammed to respond to a signal, or portion of a signal, sensed from the patient.
- the electrical current can have a voltage of about 0.1 microvolts to about 75 volts (V), where voltage values of 1 V to 50 V, or 0.1 V to 10 V are also possible.
- the electrical current can also have an amplitude of about 1 milliamps to about 40 milliamps.
- the electrical current can be delivered at a frequency of about 1 Hertz (Hz) to about 100,000 Hz, where frequency values of about 2 Hz to about 200 Hz are also possible.
- the electrical current can have a pulse width of about 100 microseconds to about 100 milliseconds.
- the electrical current can also have a variety of waveforms, such as for example, square wave, biphasic square wave, sine wave, or other electrically safe and feasible combinations.
- the electrical current may be applied to multiple target sites simultaneously or sequentially.
- An open-loop or closed-loop feedback mechanism may be used in conjunction with the present disclosure.
- a professional can monitor cardiac parameters and changes to the cardiac parameters of the patient. Based on the cardiac parameters the professional can adjust the parameters of the electrical current applied to autonomic cardiopulmonary fibers.
- cardiac parameters monitored include arterial blood pressure, central venous pressure, capillary pressure, systolic pressure variation, blood gases, cardiac output, systemic vascular resistance, pulmonary artery wedge pressure, gas composition of the patient's exhaled breath and/or mixed venous oxygen saturation.
- Cardiac parameters can be monitored by an electrocardiogram, invasive hemodynamics, an echocardiogram, or blood pressure measurement or other devices known in the art to measure cardiac function. Other parameters such as body temperature and respiratory rate can also be monitored and processed as part of the feedback mechanism.
- the cardiac parameters of the patient are received and processed by the stimulation system, as discussed herein, where the parameters of the electrical current are adjusted based at least in part on the cardiac parameters.
- a sensor is used to detect a cardiac parameter and generate a sensor signal.
- the sensor signal is processed by a sensor signal processor, which provides a control signal to a signal generator.
- the signal generator in turn, can generate a response to the control signal by activating or adjusting one or more of the parameters of the electrical current applied by the catheter to the patient.
- the control signal can initiate, terminate, increase, decrease or change the parameters of the electrical current.
- the one or more electrodes of the catheter may be used as a sensor a recording electrode. When necessary these sensing or recording electrodes may delivery electrical current as discussed herein.
- the stimulation system can also monitor to determine if the one or more electrodes have dislodged from their position within the right pulmonary artery. For example, impedance values can be used to determine whether the one or more electrodes have dislodged from their position within the right pulmonary artery. If changes in the impedance values indicate that the one or more electrodes have dislodged from their position within the right pulmonary artery, a warning signal is produced by the stimulation system and the electrical current is stopped.
- FIG. 4 provides an illustration of the stimulation system provided for in U.S. Provisional Patent Application 62/001,729 entitled “Catheter and Catheter System for Electrical Neuromodulation” filed on May 22, 2014.
- the stimulation system 470 includes an input/output connector 472 that can releasably join the conductive elements of the catheter of the present disclosure. It is also possible that the conductive elements are permanently coupled to the stimulation system (e.g., not releasably coupled). An input from the sensor can also be releasably coupled to the input/output connector 472 so as to receive the sensor signal(s) discussed herein.
- the input/output connector 472 is connected to an analog to digital converter 474 .
- the output of the analog to digital converter 474 is connected to a microprocessor 476 through a peripheral bus 478 including address, data and control lines.
- Microprocessor 476 can process the sensor data, when present, in different ways depending on the type of sensor in use.
- the microprocessor 476 can also control, as discussed herein, the pulse control output generator 480 that delivers the electrical current to the one or more electrodes via the input/output connector 472 .
- the parameters of the electrical current can be controlled and adjusted, as needed, by instructions programmed in a memory 482 and executed by a programmable pulse generator 484 .
- the instructions in memory 482 for the programmable pulse generator 484 can be set and/or modified based on input from the closed-looped system, via the microprocessor 476 .
- the instructions in memory 482 for the programmable pulse generator 484 can also be set and/or modified through inputs from a professional via an input 486 connected through the peripheral bus 478 . Examples of such an input include a keyboard with a display screen or through a touch screen (not shown), as are known.
- the stimulation system 470 can also include a communications port 488 that connects to the peripheral bus 478 , where data and/or programming instructions can be received by the microprocessor 476 and/or the memory 482 .
- the stimulation system 470 can also include a power source 490 .
- the power source 490 can be a battery or a power source supplied from an external power supply (e.g., an AC/DC power converter coupled to an AC source).
- the programmable pulse generator 482 can also include a housing 492 .
- the microprocessor 476 can execute one or more algorithms in order to provide stimulation with closed loop feedback control.
- the microprocessor 476 can also be controlled by a professional via the input 486 to initiate, terminate and/or change (e.g., adjust) the parameters of the electrical current.
- the closed loop feedback control can be used to help maintain one or more of a patient's cardiac parameters at or within a threshold value or range programmed into memory 482 . For example, under closed loop feedback control measured cardiac parameter value(s) can be compared and then it can be determine whether or not the measured value(s) lies outside a threshold value or a pre-determined range of values.
- the closed loop feedback control continues to monitor the cardiac parameter value(s) and repeats the comparison on a regular interval. If, however, the cardiac parameter value(s) from a sensor indicate that one or more cardiac parameters are outside of the threshold value or the pre-determined range of values one or more of the parameters of the electrical current will be adjusted by the microprocessor 476 .
- the adjustments can be made using process control logic (e.g., fuzzy logic, negative feedback, etc.) so as to maintain control of the pulse control output generator 480 .
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Heart & Thoracic Surgery (AREA)
- Neurosurgery (AREA)
- Neurology (AREA)
- Cardiology (AREA)
- Physiology (AREA)
- Biophysics (AREA)
- Vascular Medicine (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
- Electrotherapy Devices (AREA)
Abstract
Description
- The present disclosure relates generally to neuromodulation of the heart, and more particularly to methods for neuromodulation of the heart by electrically modulating the autonomic nervous system of the heart.
- Acute heart failure is a cardiac condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. The condition impairs quality of life and is a leading cause of hospitalizations and mortality in the western world. Treating acute heart failure is typically aimed at removal of precipitating causes, prevention of deterioration in cardiac function, and control of the patient's congestive state.
- Treatments for acute heart failure include the use of inotropic agents, such as dopamine and dobutamine. These agents, however, have both chronotropic and inotropic effects and characteristically increase heart contractility at the expense of significant increments in oxygen consumption secondary to elevations in heart rate. As a result, although these inotropic agents increase myocardial contractility and improve
- hemodynamics, clinical trials have consistently demonstrated excess mortality caused by cardiac arrhythmias and increase in the myocardium consumption.
- As such, there is a need for a method of selectively and locally treating acute heart failure and otherwise achieving hemodynamic control without causing untoward systemic effect.
- Embodiments of the present disclosure provide for methods of electrical neuromodulation of the autonomic nervous system of the heart. The methods of the present disclosure, for example, may be useful in electrical neuromodulation of patients with cardiac disease, such as patients with acute or chronic cardiac disease. The methods of the present disclosure encompass neuromodulation of combinations of one or more target sites of the autonomic nervous system of the heart. Non-limiting examples of medical conditions that can be treated according to the present disclosure include cardiovascular medical conditions.
- As discussed herein, the methods of the present disclosure allow for a portion of a catheter to be positioned within the vasculature of the patient in the right pulmonary artery. Once positioned, an electrode system of the catheter can provide electrical current to stimulate the autonomic nervous system surrounding the right pulmonary artery in an effort to provide adjuvant cardiac therapy to the patient.
- As discussed herein, the present disclosure provides for a method for treating a patient having a heart with a pulmonary trunk. Portions of the pulmonary trunk can be defined with a right lateral plane that passes along a right luminal surface of the pulmonary trunk, a left lateral plane parallel with the right lateral plane, where the left lateral plane passes along a left luminal surface of the pulmonary trunk. The right lateral plane and the left lateral plane extend in a direction that generally aligns with the posterior and anterior directions of the patient's body.
- A branch point is positioned between the right lateral plane and the left lateral plane, where the branch point helps to define the beginning of a left pulmonary artery and a right pulmonary artery of the heart. The method further includes moving a catheter having an electrode array through the pulmonary trunk towards the branch point, where the electrode array includes one or more, preferably two or more, electrodes. The electrode array is positioned in the right pulmonary artery to the right of the left lateral plane, where the one or more electrodes contacts a posterior surface, a superior surface and/or an inferior surface of the right pulmonary artery to the right of the left lateral plane. In an additional embodiment, the electrode array can be positioned in the right pulmonary artery to the right of the right lateral plane, where the one or more electrodes contacts the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery to the right of the right lateral plane.
- The method of the present disclosure further includes contacting the one or more electrodes on the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery at a position superior to (i.e., situated above) the branch point. The at least a portion of the catheter can also be positioned in contact with a portion of the surface defining the branch point. In this embodiment, the portion of the catheter can be provided with a shape that provides an increase in surface area that can help to hold the portion of the catheter against the branch point.
- In an additional embodiment, the pulmonary trunk has a diameter taken across a plane perpendicular to both the left lateral plane and the right lateral plane, where the electrode array is positioned in the right pulmonary artery to extend from a point to the right of the left lateral plane to a point about three times the diameter of the pulmonary trunk to the right of the branch point. The right pulmonary artery can also include a branch point that divides the right pulmonary artery into at least two additional arteries that are distal to the branch point helping to define the beginning of the left pulmonary artery and the right pulmonary artery. The electrode array can be positioned in the right pulmonary artery between the branch point helping to define the beginning of the left pulmonary artery and the right pulmonary artery and the branch point that divides the right pulmonary artery into at least two additional arteries.
- Once in position, electrical current can be provided from or to the one or more electrodes of the electrode array. A value of a cardiac parameter of the patient can be measured in response to the electrical current from or to the one or more electrodes of the electrode array. From the value of the cardiac parameter, changes can be made to which of the electrodes are used to provide the electrical current in response to the value of the cardiac parameter. Changes can also be made to the nature of the electrical current provided in response to the value of the cardiac parameter. Such changes include, but are not limited to, changes in voltage, amperage, waveform, frequency and pulse width, by way of example. In addition, the electrodes of the one or more electrodes on the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery can be moved in response to the values of the cardiac parameter. The electrical current provided to or from the one or more electrodes of the electrode array can be provided as at least one pulse of electrical current to or from the one or more electrodes of the electrode array. Examples of such a cardiac parameter include, but are not limited to, measuring a pressure parameter, an acoustic parameter, an acceleration parameter and/or an electrical parameter (e.g., ECG) of the heart of the patient as the cardiac parameter.
-
FIGS. 1A, 1B and 1C are schematic illustrations of the heart and surrounding areas having various views, where the FIGS, showing the stimulation sites according to the present disclosure. -
FIG. 2 is a perspective view of a catheter that suitable for performing the method of the present disclosure. -
FIG. 3 is a perspective view of a catheter positioned in the heart of the patient according to the present disclosure -
FIG. 4 is a block diagram of an algorithm to determine action taken by a controller microprocessor in response to sensor input according to an embodiment of a system of the present disclosure. - Embodiments of the present disclosure provide for methods of electrical neuromodulation of the autonomic nervous system of the heart. The methods of the present disclosure, for example, may be useful in electrical neuromodulation of patients with cardiovascular medical conditions, such as patients with acute or chronic cardiac disease. As discussed herein, the methods of the present disclosure allow for a portion of a catheter to be positioned within the vasculature of the patient in the right pulmonary artery. Once positioned, an electrode system of the catheter can provide electrical current to stimulate the autonomic nervous system surrounding the right pulmonary artery in an effort to provide adjuvant cardiac therapy to the patient.
- The Figures herein follow a numbering convention in which the first digit or digits correspond to the drawing Figure number and the remaining digits identify an element or component in the drawing. Similar elements or components between different Figures may be identified by the use of similar digits. For example, 1 10 may reference element “10” in
FIG. 1 , and a similar element may be referenced as 210 inFIG. 2 . As will be appreciated, elements shown in the various embodiments herein can be added, exchanged, and/or eliminated so as to provide any number of additional embodiments of the present disclosure. - The terms “distal” and “proximal” are used in the following description with respect to a position or direction relative to the treating clinician taken along the catheter of the present disclosure. “Distal” or “distally” are a position distant from or in a direction away from the clinician taken along the catheter of the present disclosure. “Proximal” and “proximally” are a position near or in a direction toward the clinician taken along the catheter of the present disclosure.
- The catheters and electrode systems provided herein include one or more electrodes, but preferably two or more electrodes, as discussed herein. It is understood that the phrase one or more electrodes can be replaced herein with two or more electrodes if desired.
- With respect to treating cardiovascular medical conditions, such medical conditions can involve medical conditions related to the components of the cardiovascular system such as, for example, the heart and aorta. Non-limiting examples of cardiovascular conditions include post-infarction rehabilitation, shock (hypovolemic, septic, neurogenic), valvular disease, heart failure, angina, microvascular ischemia, myocardial contractility disorder, cardiomyopathy, hypertension including pulmonary hypertension and systemic hypertension, orthopnea, dyspenea, orthostatic hypotension, dysautonomia, syncope, vasovagal reflex, carotid sinus hypersensitivity, pericardial effusion, heart failure, and cardiac structural abnormalities such as septal defects and wall aneurysms.
- In a preferred embodiment, a catheter, as discussed herein, can be used in conjunction with a pulmonary artery catheter, such as a Swan-Ganz type pulmonary artery catheter, to deliver transvascular neuromodulation via the pulmonary artery to an autonomic target site to treat a cardiovascular condition according to the present disclosure. Specifically, in this preferred embodiment, the catheter (or catheters) is housed within one of the multiple lumens of a pulmonary artery catheter. Examples of preferred catheters include those disclosed in U.S. Provisional Patent Application 62/001,729 entitled “Catheter and Catheter System for Electrical Neuromodulation” filed on May 22, 2014; U.S. Provisional Patent Application 62/047,270 entitled “Catheter and Electrode Systems for Electrical Neuromodulation ” filed on Sep. 8, 2014; and U.S. patent application Ser. No. 14/085,311 entitled “Methods and Systems for Treating Acute Heart Failure by Neuromodulation” filed Nov. 20, 2013, where the contents of these applications are incorporated herein by reference in their entirety.
- The present disclosure provides methods for treating acute heart failure, also known as decompensated heart failure, by modulating the autonomic nervous system surrounding the right pulmonary artery in an effort to provide adjuvant cardiac therapy to the patient. The modulation can help by affecting heart contractility more than heart rate. In a preferred embodiment, the autonomic nervous system is modulated so as to collectively affect heart contractility more than heart rate. The autonomic nervous system can be impacted by electrical modulation that includes stimulating and/or inhibiting nerve fibers of the autonomic nervous system.
- According to the methods of the present disclosure and as will be discussed more fully herein, a catheter having an electrode array is inserted into the pulmonary trunk and positioned at a location such that the electrode array is positioned with its electrodes in contact with the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery. From this location, electrical current can be delivered to or from the electrode array to selectively modulate the autonomic nervous system of the heart. For example, electrical current can be delivered to or from the electrode array to selectively modulate the autonomic cardiopulmonary nerves of the autonomic nervous system, which can modulate heart contractility more than heart rate. Preferably, the electrode array is positioned at a site along the posterior wall and/or superior wall of the right pulmonary artery such that the electrical current delivered to or from the electrode array result in the greatest effect on heart contractility and the least effect on heart rate and/or oxygen consumption compared to electrical current delivered at other sites in the right pulmonary artery and/or left pulmonary artery. In certain embodiments, the effect on heart contractility is to increase heart contractility.
- As used herein, the electrical current delivered to or from the electrode array can be in the form of a time variant electrical current. Preferably such a time variant electrical current can be in the form of one or more of a pulse of electrical current (e.g., at least one pulse of electrical current), one or more of waveform, such as a continuous wave of electrical current, or a combination thereof.
- As will be discussed more fully herein, the present disclosure provides for a method for treating a patient having a heart with a pulmonary trunk, where portions of the pulmonary trunk can be defined with a right lateral plane that passes along a right luminal surface of the pulmonary trunk, a left lateral plane parallel with the right lateral plane, where the left lateral plane passes along a left luminal surface of the pulmonary trunk. The right lateral plane and the left lateral plane extend in a direction that generally aligns with the posterior and anterior directions of the heart.
- A branch point is positioned between the right lateral plane and the left lateral plane, where the branch point helps to define the beginning of a left pulmonary artery and a right pulmonary artery of the heart. The method further includes moving a catheter having an electrode array through the pulmonary trunk towards the branch point, where the electrode array includes one or more, preferably two or more, electrodes. The electrode array is positioned in the right pulmonary artery having a proximal end of the array at or to the right of the left lateral plane, where the one or more electrodes contacts the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery to the right of the left lateral plane. In an additional embodiment, the electrode array can be positioned in the right pulmonary artery to the right of the right lateral plane, where the one or more electrodes contacts the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery to the right of the right lateral plane.
-
FIGS. 1A and IB provide a schematic illustration of thehuman heart 100, where portions of the heart (e.g., the aorta, the superior vena cava among other structures), including a portion of thepulmonary trunk 102, have been removed to allow for the details discussed herein to be shown.FIG. 1A provides a perspective view of theheart 100 as seen from the front of the patient (viewed in a posterior direction), while Fig. IB provides a perspective view of theheart 100 as seen from the right side of the patient. As illustrated, theheart 100 includes thepulmonary trunk 102 that begins at the base of theright ventricle 104. In an adult, thepulmonary trunk 102 is a tubular structure approximately 3 centimeters (cm) in diameter and 5 cm in length. Thepulmonary trunk 102 branches into the leftpulmonary artery 106 and the rightpulmonary artery 108 at abranch point 110. The leftpulmonary artery 106 and the rightpulmonary artery 108 serve to deliver de-oxygenated blood to each corresponding lung. - The
branch point 110 includes aridge 112 that extends from the posterior of thepulmonary trunk 102. As illustrated, thebranch point 110, along with theridge 112, provides a “Y” or “T” shaped structure that helps to define at least a portion of the leftpulmonary artery 106 and the rightpulmonary artery 108. For example, from theridge 112, thebranch point 110 of thepulmonary trunk 102 slopes in opposite directions. In a first direction thepulmonary trunk 102 transitions into the leftpulmonary artery 106, and in the second direction, opposite the first direction, thepulmonary trunk 102 transitions into the rightpulmonary artery 108. Thebranch point 110 may not necessarily be aligned along alongitudinal center line 114 of thepulmonary trunk 102. - As illustrated in
FIG. 1A , portions of the pulmonary artery can be defined with a rightlateral plane 116 that passes along a rightluminal surface 118 of thepulmonary trunk 102, a leftlateral plane 120 parallel with the rightlateral plane 116, where the leftlateral plane 120 passes along a leftluminal surface 122 of thepulmonary artery 102. As illustrated, the rightlateral plane 116 and the leftlateral plane 120 extend in both aposterior direction 124 andanterior direction 126. As illustrated, theridge 112 of thebranch point 110 is located between the rightlateral plane 116 and the leftlateral plane 120. As discussed herein, thebranch point 110 is positioned between the rightlateral plane 116 and the leftlateral plane 120, where thebranch point 110 helps to define the beginning of the leftpulmonary artery 106 and the rightpulmonary artery 108 of theheart 100. The distance between the rightlateral plane 116 and the leftlateral plane 120 is approximately the diameter of the pulmonary trunk 102 (e.g., about 3 cm). - As discussed herein, the present disclosure provides for a method for treating a patient having a
heart 100 with apulmonary trunk 102. The method includes moving a catheter having an electrode array through thepulmonary trunk 102 towards thebranch point 110. As discussed herein, the electrode array of the catheter includes one or more, preferably two or more, electrodes. The electrode array is positioned with the proximal end of the array in the rightpulmonary artery 108 or at the right of the leftlateral plane 120, where the one or more electrodes are brought into contact with the posterior surface, the superior surface and/or theinferior surface 128 of the rightpulmonary artery 108 to the right of the leftlateral plane 120. In an additional embodiment, the electrode array can be positioned with the proximal end of the array in the rightpulmonary artery 108 or at the right of the rightlateral plane 116, where the one or more electrodes are brought into contact with the posterior surface, the superior surface and/or theinferior surface 128 of the rightpulmonary artery 108 to the right of the rightlateral plane 116. -
FIG. 1C provides an additional illustration theposterior surface 121, thesuperior surface 123 and theinferior surface 125 of the rightpulmonary artery 108 discussed herein. As illustrated, the view of theheart 100 inFIG. 1C is from the right side of the patient'sheart 100. As illustrated, theposterior surface 121, thesuperior surface 123 and theinferior surface 125 account for approximately three quarters of the luminal perimeter of the rightpulmonary artery 108, where theanterior surface 127 accounts for the remainder. - Referring now to
FIG. 2 , there is shown a perspective view of acatheter 230 that is suitable for performing the method of the present disclosure. Thecatheter 230 includes anelongate body 232 having afirst end 234 and asecond end 236 distal from thefirst end 234. - As illustrated, the
elongate body 232 includes alongitudinal center axis 238 extending between thefirst end 234 and thesecond end 236 of theelongate body 232. Theelongate body 232 also includes aportion 240 that has three ormore surfaces 242 defining a convex polygonal cross-sectional shape taken perpendicularly to thelongitudinal center axis 238. - As used herein, the convex polygonal cross-sectional shape of the
elongate body 232 includes those shapes for which every internal angle is less than 180 degrees and where every line segment between two vertices of the shape remains inside or on the boundary of the shape. Examples of such shapes include, but are not limited to, triangular, rectangular (as illustrated inFIG. 1 ), square, pentagon and hexagon, among others. -
Catheter 230 further includes one or more, preferably two or more,electrodes 244 on one surface of the three ormore surfaces 242 of theelongate body 232.Conductive elements 246 extend through theelongate body 232, where theconductive elements 246 can be used, as discussed herein, to conduct electrical current to combinations of the one ormore electrodes 244. Each of the one ormore electrodes 244 is coupled to a correspondingconductive element 246. Theconductive elements 246 are electrically isolated from each other and extend through theelongate body 232 from eachrespective electrode 244 through thefirst end 234 of theelongate body 232. Theconductive elements 246 terminate at a connector port, where each of theconductive elements 246 can be releasably coupled to a stimulation system, as discussed herein. It is also possible that theconductive elements 246 are permanently coupled to the stimulation system (e.g., not releasably coupled). The stimulation system can be used to provide stimulation electrical current that is conducted through theconductive elements 246 and delivered across combinations of the one ormore electrodes 244. The one ormore electrodes 244 are electrically isolated from one another, where theelongate body 232 is formed of an electrically insulating material as discussed herein. As illustrated, the one ormore electrodes 244 can be located only on the one surface of the three ormore surfaces 242 of theelongate body 232. - There can be a variety of the number and the configuration of the one or
more electrodes 244 on the one surface of the three ormore surfaces 242 of theelongate body 232. For example, as illustrated, the one ormore electrodes 244 can be configured as an array of electrodes, where the number of electrodes and their relative position to each other can vary. As discussed herein, the one ormore electrodes 244 can be configured to allow for electrical current to be delivered from and/or between different combinations of the one ormore electrodes 244. So, for example, the electrodes in the array of electrodes can have a repeating pattern where the electrodes are equally spaced from each other. For example, the electrodes in the array of electrodes can have a column and row configuration (as illustrated inFIG. 2 ). Alternatively, the electrodes in the array of electrodes can have a concentric radial pattern, where the electrodes are positioned so as to form concentric rings of the electrodes. Other patterns are possible, where such patterns can either be repeating patterns or random patterns. - As illustrated, the one or
more electrodes 244 have an exposedface 248. The exposedface 248 of theelectrode 244 provides the opportunity for theelectrode 244, when implanted in the right pulmonary artery of the patient, as discussed herein, can be placed into proximity and/or in contact with the vascular tissue of the right pulmonary artery of the patient, as opposed to facing into the volume of blood in the right pulmonary artery. As the one ormore electrodes 244 are located on one surface of the three ormore surfaces 242 of theelongate body 232, theelectrodes 244 can be placed into direct proximity to and/or in contact with the right pulmonary artery. This allows the electrical current from or to the one ormore electrodes 244 to be directed into the tissue adjacent the implant location, instead of being directed into the blood volume. - The exposed
face 248 of the one ormore electrodes 244 can have a variety of shapes. For example, the exposedface 248 can have a flat planar shape. In this embodiment, the exposedface 248 of theelectrodes 244 can be co-planar with the one surface of the three ormore surfaces 242 of theelongate body 230. In an alternative embodiment, the exposedface 248 of theelectrodes 244 can have a semi-hemispherical shape. Other shapes for the exposedface 248 of theelectrodes 244 can include semi-cylindrical, wave-shaped, and zig-zag-shaped. The exposedface 248 of theelectrodes 244 can also include one or more anchor structures. Examples of such anchor structures include hooks that can optionally include a barb. Similarly, the electrodes can be shaped to also act as anchor structures. - In an additional embodiment, the one surface of the three or
more surfaces 242 of theelongate body 102 that include the exposedface 248 of the one ormore electrodes 244 can further includeanchor structures 250 that extend above the one surface of the three ormore surfaces 242. As illustrated, theanchor structures 250 can include portions that can contact the vascular tissue in such a way that the movement of the one ormore electrodes 244 at the location where they contact the vascular tissue is minimized. Theanchor structures 250 can have a variety of shapes that may help to achieve this goal. For example, theanchor structures 250 can have a conical shape, where the vertex of the conical shape can contact the vascular tissue. In an additional embodiment, theanchor structures 250 can have a hook configuration (with or without a barb). In an additional embodiment, one or more of theanchor structures 250 can be configured as an electrode. As illustrated, theelongate body 232 ofcatheter 230 can also include aportion 254 with a circular cross-section shape taken perpendicularly to thelongitudinal center axis 238. Theelongate body 232 ofcatheter 230 also includes asurface 256 defining a guide-wire lumen 258 that extends through theelongate body 232. The guide-wire lumen 258 has a diameter that is sufficiently large to allow the guide wire to freely pass through the guide-wire lumen 258. The guide-wire lumen 258 can be positioned concentrically relative thelongitudinal center axis 238 of theelongate body 232. - Alternatively, and as illustrated in
FIG. 2 , the guide-wire lumen 258 is positioned eccentrically relative thelongitudinal center axis 230 of theelongate body 232. When the guide-wire lumen 258 is positioned eccentrically relative thelongitudinal center axis 238 the guide-wire lumen 258 will have awall thickness 260 taken perpendicularly to the longitudinal center axis that is greater than awall thickness 262 of a remainder of the catheter taken perpendicularly to the longitudinal center axis. For this configuration, the differences inwall thickness elongate body 232 with a preferential direction in which to bend. For example, thewall thickness 260 of theelongate body 232 being greater than thewall thickness 262 will cause the side of theelongate body 232 with the greater wall thickness to preferentially have the larger radius of curvature when theelongate body 232 bends. By positioning the exposedface 248 of theelectrodes 244 on the side of theelongate body 232 having the great wall thickness (e.g., wall thickness 260), the one ormore electrodes 244 can be more easily and predictably brought into contact with the luminal surface of the right pulmonary artery. - The
catheter 230 shown inFIG. 2 can be positioned in the right pulmonary artery of the patient, as described herein. To accomplish this, a pulmonary artery catheter is introduced into the vasculature through a percutaneous incision and guided to the right ventricle using known techniques. For example, the pulmonary artery catheter can be inserted into the vasculature via a peripheral vein of the neck or chest (e.g., as with a Swan-Ganz catheter). Changes in a patient's electrocardiography and/or pressure signals from the vasculature can be used to guide and locate the pulmonary artery catheter within the patient's heart. Once in the proper location, a guide wire can be introduced into the patient via the pulmonary artery guide catheter, where the guide wire is advanced into the right pulmonary artery. Using the guide-wire lumen, thecatheter 230 can be advanced over the guide wire so as to position thecatheter 230 in the right pulmonary artery of the patient, as described herein. Various imaging modalities can be used in positioning the guide wire of the present disclosure in the right pulmonary artery of the patient. Such imaging modalities include, but are not limited to, fluoroscopy, ultrasound, electromagnetic, electropotential modalities. -
FIG. 3 provides a perspective view of thecatheter 330 positioned in theheart 300 of the patient, where the one or more of theelectrodes 344 are contacting theposterior surface 321 and/orsuperior surface 323 of, for example, the rightpulmonary artery 308.FIG. 3 also illustrates the one or more of theelectrodes 344 contacting theposterior surface 321 and/orsuperior surface 323 of the rightpulmonary artery 308 at a position that is superior to thebranch point 310.FIG. 3 further illustrates that at least a portion of thecatheter 330 is positioned in contact with a portion of the surface defining thebranch point 310. - As illustrated, the pulmonary trunk 302 has a
diameter 356 taken across aplane 358 perpendicular to both the leftlateral plane 320 and the rightlateral plane 316. In a preferred embodiment, the electrode array of thecatheter 330 is positioned in anarea 360 that extends distally no more than three times the diameter of the pulmonary trunk 302 to the right of thebranch point 310. Thisarea 360 is shown with cross-hatching inFIG. 3 . - The right
pulmonary artery 308 can also include abranch point 362 that divides the rightpulmonary artery 308 into at least twoadditional arteries 364 that are distal to thebranch point 310 defining the leftpulmonary artery 306 and the rightpulmonary artery 308. - As illustrated, the electrode array can be positioned between the
branch point 310 defining the leftpulmonary artery 306 and the rightpulmonary artery 308 and thebranch point 362 that divides the rightpulmonary artery 308 into at least twoadditional arteries 364. - Once in position, electrical current can be provided from or to one or more of the
electrodes 344. Using the first sensor 352 a value of a non-cardiac parameter of the patient can be measured in response to the electrical current from or to one or more of theelectrodes 344. From the value of the non-cardiac parameter, changes can be made to which of the one or more electrodes are used to provide the electrical current in response to the value of the cardiac parameter. Changes can also be made to the nature of the electrical current provided in response to the value of the non-cardiac parameter. Such changes include, but are not limited to, changes in voltage, amperage, waveform, frequency and pulse width by way of example. It is possible to change combinations of electrodes used and the nature of the electrical current provided by the electrodes. In addition, the electrodes of the one or more electrodes on the posterior surface of the right pulmonary artery can be moved in response to one or more of the values of the non-cardiac parameter. Examples of such a cardiac parameter include, but are not limited to, measuring a pressure parameter, an acoustic parameter, an acceleration parameter and/or an electrical parameter (e.g., ECG) of the heart of the patient as the cardiac parameter. An example of such a pressure parameter can include, but is not limited to, measuring a maximum systolic pressure of the heart of the patient as the pressure parameter. Other suitable cardiac parameters are discussed herein. - Moving the electrodes of the one or more electrodes on the posterior and/or superior surface of the right pulmonary artery in response to one or more of the values of the cardiac parameter can be done by physically moving the one or more electrodes of the
catheter 330 to a different position on the posterior and/or superior surface of the right pulmonary artery, electronically moving which electrodes of the one or more electrodes are being used to provide the electrical current from or to the electrode array (while not physically moving the one or more electrodes of the catheter 330) or a combination of these two actions. - As discussed herein, neuromodulation according to the present disclosure can be accomplished by applying electrical current to the right pulmonary artery. Preferably, neuromodulation of the present disclosure includes applying the electrical current to the posterior and/or superior wall of the right pulmonary artery. The electrical current is thereby applied to the autonomic cardiopulmonary nerves surrounding the right pulmonary artery. These autonomic cardiopulmonary nerves can include the right autonomic cardiopulmonary nerves and the left autonomic cardiopulmonary nerves. The right autonomic cardiopulmonary nerves include the right dorsal medial cardiopulmonary nerve and the right dorsal lateral cardiopulmonary nerve. The left autonomic cardiopulmonary nerves include the left ventral cardiopulmonary nerve, the left dorsal medial cardiopulmonary nerve, the left dorsal lateral cardiopulmonary nerve, and the left stellate cardiopulmonary nerve.
- As illustrated and discussed in reference to
FIG. 3 , the one or more electrodes of the catheter are contacting the posterior surface of the right pulmonary artery. From this location, the electrical current delivered through the one or more electrodes may be better able to treat and/or provide therapy (including adjuvant therapy) to the patient experiencing a variety of cardiovascular medical conditions, such as acute heart failure. The electrical current can elicit responses from the autonomic nervous system that may help to modulate a patient's cardiac contractility. The electrical current is intended to affect heart contractility more than the heart rate, thereby helping to improving hemodynamic control while possibly minimizing unwanted systemic effects. - As discussed herein, the stimulation system is electrically coupled to the one or more electrodes via the conductive elements, where the stimulation system can be used to deliver the electrical current to the autonomic cardiopulmonary fibers surrounding the right pulmonary artery. The stimulation system is used to operate and supply the electrical current to the one or more electrodes of the catheter. The stimulation system controls the various parameters of the electrical current delivered across the one or more electrodes. Such parameters include control of each electrodes polarity (e.g., used as a cathode or an anode), pulsing mode (e.g., unipolar, bi-polar and/or multi-polar), a pulse width, an amplitude, a frequency, a voltage, a current, a duration, a wavelength and/or a waveform associated with the electrical current. The stimulation system may operate and supply the electrical current to different combinations and numbers of the one or more electrodes, including the reference electrodes. The stimulation system can be external to the patient's body for use by the professional to program the stimulation system and to monitor its performance. Alternatively, the stimulation system could be internal to the patient's body. When located within the patient, the housing of the stimulation system can be used as a reference electrode for both sensing and unipolar pulsing mode.
- As discussed herein, the stimulation system can be used to help identify a preferred location for the position of the one or more electrodes along the posterior, superior and/or inferior surfaces of the right pulmonary artery. To this end, the one or more electrodes of the catheter are introduced into the patient and tests of various locations along the posterior, superior and/or inferior surfaces of the right pulmonary artery using the stimulation system are conducted so as to identify a preferred location for the electrodes. During such a test, the stimulation system can be used to initiate and adjust the parameters of the electrical current. Such parameters include, but are not limited to, terminating, increasing, decreasing, or changing the rate or pattern of the electrical current. The stimulation system can also deliver electrical current that is episodic, continuous, phasic, in clusters, intermittent, upon demand by the patient or medical personnel, or preprogrammed to respond to a signal, or portion of a signal, sensed from the patient.
- By way of example, the electrical current can have a voltage of about 0.1 microvolts to about 75 volts (V), where voltage values of 1 V to 50 V, or 0.1 V to 10 V are also possible. The electrical current can also have an amplitude of about 1 milliamps to about 40 milliamps. The electrical current can be delivered at a frequency of about 1 Hertz (Hz) to about 100,000 Hz, where frequency values of about 2 Hz to about 200 Hz are also possible. The electrical current can have a pulse width of about 100 microseconds to about 100 milliseconds. The electrical current can also have a variety of waveforms, such as for example, square wave, biphasic square wave, sine wave, or other electrically safe and feasible combinations. The electrical current may be applied to multiple target sites simultaneously or sequentially.
- An open-loop or closed-loop feedback mechanism may be used in conjunction with the present disclosure. For the open-loop feedback mechanism, a professional can monitor cardiac parameters and changes to the cardiac parameters of the patient. Based on the cardiac parameters the professional can adjust the parameters of the electrical current applied to autonomic cardiopulmonary fibers. Non-limiting examples of cardiac parameters monitored include arterial blood pressure, central venous pressure, capillary pressure, systolic pressure variation, blood gases, cardiac output, systemic vascular resistance, pulmonary artery wedge pressure, gas composition of the patient's exhaled breath and/or mixed venous oxygen saturation. Cardiac parameters can be monitored by an electrocardiogram, invasive hemodynamics, an echocardiogram, or blood pressure measurement or other devices known in the art to measure cardiac function. Other parameters such as body temperature and respiratory rate can also be monitored and processed as part of the feedback mechanism.
- In a closed-loop feedback mechanism, the cardiac parameters of the patient are received and processed by the stimulation system, as discussed herein, where the parameters of the electrical current are adjusted based at least in part on the cardiac parameters. As discussed herein, a sensor is used to detect a cardiac parameter and generate a sensor signal. The sensor signal is processed by a sensor signal processor, which provides a control signal to a signal generator. The signal generator, in turn, can generate a response to the control signal by activating or adjusting one or more of the parameters of the electrical current applied by the catheter to the patient. The control signal can initiate, terminate, increase, decrease or change the parameters of the electrical current. It is possible for the one or more electrodes of the catheter to be used as a sensor a recording electrode. When necessary these sensing or recording electrodes may delivery electrical current as discussed herein.
- The stimulation system can also monitor to determine if the one or more electrodes have dislodged from their position within the right pulmonary artery. For example, impedance values can be used to determine whether the one or more electrodes have dislodged from their position within the right pulmonary artery. If changes in the impedance values indicate that the one or more electrodes have dislodged from their position within the right pulmonary artery, a warning signal is produced by the stimulation system and the electrical current is stopped.
- As suitable example of a stimulation system for use with the catheter in the method of the present disclosure can be found in U.S. Provisional Patent Application 62/001,729 entitled “Catheter and Catheter System for Electrical Neuromodulation” filed on May 22, 2014; U.S. Provisional Patent Application 62/047,270 entitled “Catheter and Electrode Systems for Electrical Neuromodulation ” filed on Sep. 8, 2014; and U.S. patent application Ser. No. 14/085,311 entitled “Methods and Systems for Treating Acute Heart Failure by Neuromodulation” filed Nov. 20, 2013.
- For example,
FIG. 4 provides an illustration of the stimulation system provided for in U.S. Provisional Patent Application 62/001,729 entitled “Catheter and Catheter System for Electrical Neuromodulation” filed on May 22, 2014. As shown inFIG. 4 , thestimulation system 470 includes an input/output connector 472 that can releasably join the conductive elements of the catheter of the present disclosure. It is also possible that the conductive elements are permanently coupled to the stimulation system (e.g., not releasably coupled). An input from the sensor can also be releasably coupled to the input/output connector 472 so as to receive the sensor signal(s) discussed herein. - The input/
output connector 472 is connected to an analog todigital converter 474. The output of the analog todigital converter 474 is connected to amicroprocessor 476 through aperipheral bus 478 including address, data and control lines.Microprocessor 476 can process the sensor data, when present, in different ways depending on the type of sensor in use. Themicroprocessor 476 can also control, as discussed herein, the pulsecontrol output generator 480 that delivers the electrical current to the one or more electrodes via the input/output connector 472. - The parameters of the electrical current can be controlled and adjusted, as needed, by instructions programmed in a
memory 482 and executed by aprogrammable pulse generator 484. The instructions inmemory 482 for theprogrammable pulse generator 484 can be set and/or modified based on input from the closed-looped system, via themicroprocessor 476. The instructions inmemory 482 for theprogrammable pulse generator 484 can also be set and/or modified through inputs from a professional via aninput 486 connected through theperipheral bus 478. Examples of such an input include a keyboard with a display screen or through a touch screen (not shown), as are known. Thestimulation system 470 can also include acommunications port 488 that connects to theperipheral bus 478, where data and/or programming instructions can be received by themicroprocessor 476 and/or thememory 482. - Input from either a professional via the
input 486, thecommunications port 488 or from the closed-looped system via themicroprocessor 476 can be used to change (e.g., adjust) the parameters of the electrical current. Thestimulation system 470 can also include apower source 490. Thepower source 490 can be a battery or a power source supplied from an external power supply (e.g., an AC/DC power converter coupled to an AC source). Theprogrammable pulse generator 482 can also include ahousing 492. - The
microprocessor 476 can execute one or more algorithms in order to provide stimulation with closed loop feedback control. Themicroprocessor 476 can also be controlled by a professional via theinput 486 to initiate, terminate and/or change (e.g., adjust) the parameters of the electrical current. The closed loop feedback control can be used to help maintain one or more of a patient's cardiac parameters at or within a threshold value or range programmed intomemory 482. For example, under closed loop feedback control measured cardiac parameter value(s) can be compared and then it can be determine whether or not the measured value(s) lies outside a threshold value or a pre-determined range of values. If the measured cardiac parameter value(s) do not fall outside of the threshold value or the predetermined range of values, the closed loop feedback control continues to monitor the cardiac parameter value(s) and repeats the comparison on a regular interval. If, however, the cardiac parameter value(s) from a sensor indicate that one or more cardiac parameters are outside of the threshold value or the pre-determined range of values one or more of the parameters of the electrical current will be adjusted by themicroprocessor 476. The adjustments can be made using process control logic (e.g., fuzzy logic, negative feedback, etc.) so as to maintain control of the pulsecontrol output generator 480. - The foregoing description and examples has been set forth merely to illustrate the disclosure and are not intended as being limiting. Each of the disclosed aspects and embodiments of the present disclosure may be considered individually or in combination with other aspects, embodiments, and variations of the disclosure. In addition, unless otherwise specified, none of the steps of the methods of the present disclosure are confined to any particular order of performance. Modifications of the disclosed embodiments incorporating the spirit and substance of the disclosure may occur to persons skilled in the art and such modifications are within the scope of the present disclosure. Furthermore, all references cited herein are incorporated by reference in their entirety.
Claims (21)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US16/937,932 US20200360694A1 (en) | 2014-09-08 | 2020-07-24 | Methods for electrical neuromodulation of the heart |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201462047313P | 2014-09-08 | 2014-09-08 | |
PCT/US2015/047780 WO2016040038A1 (en) | 2014-09-08 | 2015-08-31 | Methods for electrical neuromodulation of the heart |
US15/446,881 US10722716B2 (en) | 2014-09-08 | 2017-03-01 | Methods for electrical neuromodulation of the heart |
US16/937,932 US20200360694A1 (en) | 2014-09-08 | 2020-07-24 | Methods for electrical neuromodulation of the heart |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/446,881 Continuation US10722716B2 (en) | 2014-09-08 | 2017-03-01 | Methods for electrical neuromodulation of the heart |
Publications (1)
Publication Number | Publication Date |
---|---|
US20200360694A1 true US20200360694A1 (en) | 2020-11-19 |
Family
ID=54106006
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/446,881 Active 2036-02-29 US10722716B2 (en) | 2014-09-08 | 2017-03-01 | Methods for electrical neuromodulation of the heart |
US16/937,932 Pending US20200360694A1 (en) | 2014-09-08 | 2020-07-24 | Methods for electrical neuromodulation of the heart |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/446,881 Active 2036-02-29 US10722716B2 (en) | 2014-09-08 | 2017-03-01 | Methods for electrical neuromodulation of the heart |
Country Status (4)
Country | Link |
---|---|
US (2) | US10722716B2 (en) |
EP (1) | EP3194017A1 (en) |
AU (2) | AU2015315570B2 (en) |
WO (1) | WO2016040038A1 (en) |
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11077298B2 (en) | 2018-08-13 | 2021-08-03 | CARDIONOMIC, Inc. | Partially woven expandable members |
US11229398B2 (en) | 2016-03-09 | 2022-01-25 | CARDIONOMIC, Inc. | Electrode assemblies for neurostimulation treatment |
US11559687B2 (en) | 2017-09-13 | 2023-01-24 | CARDIONOMIC, Inc. | Methods for detecting catheter movement |
US11607176B2 (en) | 2019-05-06 | 2023-03-21 | CARDIONOMIC, Inc. | Systems and methods for denoising physiological signals during electrical neuromodulation |
US11986650B2 (en) | 2006-12-06 | 2024-05-21 | The Cleveland Clinic Foundation | Methods and systems for treating acute heart failure by neuromodulation |
Families Citing this family (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CA2946791C (en) | 2014-05-22 | 2023-09-19 | CARDIONOMIC, Inc. | Catheter and catheter system for electrical neuromodulation |
WO2016040037A1 (en) | 2014-09-08 | 2016-03-17 | CARDIONOMIC, Inc. | Catheter and electrode systems for electrical neuromodulation |
CN109568786A (en) | 2015-01-05 | 2019-04-05 | 卡迪诺米克公司 | Heart, which is adjusted, promotes method and system |
WO2020102086A1 (en) * | 2018-11-15 | 2020-05-22 | Applied Medical Resources Corporation | Laparoscopic grasper with force-limiting grasping mechanism |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060089694A1 (en) * | 2004-10-21 | 2006-04-27 | Cardiac Pacemakers, Inc. | Delivery system and method for pulmonary artery leads |
US20080071178A1 (en) * | 2006-09-15 | 2008-03-20 | Cardiac Pacemakers, Inc. | Anchor for an implantable sensor |
US20090171411A1 (en) * | 2006-12-06 | 2009-07-02 | The Cleveland Clinic Foundation | Method and System for Treating Acute Heart Failure by Neuromodulation |
US20090228078A1 (en) * | 2007-12-12 | 2009-09-10 | Yunlong Zhang | System for stimulating autonomic targets from pulmonary artery |
US7925352B2 (en) * | 2008-03-27 | 2011-04-12 | Synecor Llc | System and method for transvascularly stimulating contents of the carotid sheath |
US20130072995A1 (en) * | 2011-07-11 | 2013-03-21 | Terrance Ransbury | Catheter system for acute neuromodulation |
Family Cites Families (365)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5190546A (en) | 1983-10-14 | 1993-03-02 | Raychem Corporation | Medical devices incorporating SIM alloy elements |
US5067957A (en) | 1983-10-14 | 1991-11-26 | Raychem Corporation | Method of inserting medical devices incorporating SIM alloy elements |
US4718423A (en) | 1986-10-17 | 1988-01-12 | Spectramed, Inc. | Multiple-function cardiovascular catheter system with very high lumenal efficiency and no crossovers |
US5365926A (en) | 1986-11-14 | 1994-11-22 | Desai Jawahar M | Catheter for mapping and ablation and method therefor |
US4947866A (en) | 1988-02-16 | 1990-08-14 | Medtronic, Inc. | Medical electrical lead |
US4950227A (en) | 1988-11-07 | 1990-08-21 | Boston Scientific Corporation | Stent delivery system |
US5224491A (en) | 1991-01-07 | 1993-07-06 | Medtronic, Inc. | Implantable electrode for location within a blood vessel |
US5345936A (en) | 1991-02-15 | 1994-09-13 | Cardiac Pathways Corporation | Apparatus with basket assembly for endocardial mapping |
US5156154A (en) | 1991-03-08 | 1992-10-20 | Telectronics Pacing Systems, Inc. | Monitoring the hemodynamic state of a patient from measurements of myocardial contractility using doppler ultrasound techniques |
US5197978B1 (en) | 1991-04-26 | 1996-05-28 | Advanced Coronary Tech | Removable heat-recoverable tissue supporting device |
US5213098A (en) | 1991-07-26 | 1993-05-25 | Medtronic, Inc. | Post-extrasystolic potentiation stimulation with physiologic sensor feedback |
US5259387A (en) | 1991-09-09 | 1993-11-09 | Quinton Instrument Company | ECG muscle artifact filter system |
EP0633798B1 (en) | 1992-03-31 | 2003-05-07 | Boston Scientific Corporation | Vascular filter |
US5782239A (en) | 1992-06-30 | 1998-07-21 | Cordis Webster, Inc. | Unique electrode configurations for cardiovascular electrode catheter with built-in deflection method and central puller wire |
JPH08504333A (en) | 1992-09-25 | 1996-05-14 | イーピー・テクノロジーズ・インコーポレーテッド | Electrode-supported splines for the cardiac system |
US5336244A (en) | 1992-10-07 | 1994-08-09 | Medtronic, Inc. | Temperature sensor based capture detection for a pacer |
US5383852A (en) | 1992-12-04 | 1995-01-24 | C. R. Bard, Inc. | Catheter with independent proximal and distal control |
US5462527A (en) | 1993-06-29 | 1995-10-31 | C.R. Bard, Inc. | Actuator for use with steerable catheter |
US5611777A (en) | 1993-05-14 | 1997-03-18 | C.R. Bard, Inc. | Steerable electrode catheter |
IL116699A (en) | 1996-01-08 | 2001-09-13 | Biosense Ltd | Method of constructing cardiac map |
US5431649A (en) | 1993-08-27 | 1995-07-11 | Medtronic, Inc. | Method and apparatus for R-F ablation |
WO1995010978A1 (en) | 1993-10-19 | 1995-04-27 | Ep Technologies, Inc. | Segmented electrode assemblies for ablation of tissue |
JPH07178176A (en) | 1993-12-24 | 1995-07-18 | Terumo Corp | Catheter |
US6216043B1 (en) | 1994-03-04 | 2001-04-10 | Ep Technologies, Inc. | Asymmetric multiple electrode support structures |
US5968040A (en) | 1994-03-04 | 1999-10-19 | Ep Technologies, Inc. | Systems and methods using asymmetric multiple electrode arrays |
US5423881A (en) | 1994-03-14 | 1995-06-13 | Medtronic, Inc. | Medical electrical lead |
US5598848A (en) | 1994-03-31 | 1997-02-04 | Ep Technologies, Inc. | Systems and methods for positioning multiple electrode structures in electrical contact with the myocardium |
US5564434A (en) | 1995-02-27 | 1996-10-15 | Medtronic, Inc. | Implantable capacitive absolute pressure and temperature sensor |
US6059810A (en) | 1995-05-10 | 2000-05-09 | Scimed Life Systems, Inc. | Endovascular stent and method |
US7167748B2 (en) | 1996-01-08 | 2007-01-23 | Impulse Dynamics Nv | Electrical muscle controller |
US8825152B2 (en) | 1996-01-08 | 2014-09-02 | Impulse Dynamics, N.V. | Modulation of intracellular calcium concentration using non-excitatory electrical signals applied to the tissue |
US6363279B1 (en) | 1996-01-08 | 2002-03-26 | Impulse Dynamics N.V. | Electrical muscle controller |
US8321013B2 (en) | 1996-01-08 | 2012-11-27 | Impulse Dynamics, N.V. | Electrical muscle controller and pacing with hemodynamic enhancement |
US9289618B1 (en) | 1996-01-08 | 2016-03-22 | Impulse Dynamics Nv | Electrical muscle controller |
IL119261A0 (en) | 1996-09-17 | 1996-12-05 | New Technologies Sa Ysy Ltd | Electrical muscle controller |
JP4175662B2 (en) | 1996-01-08 | 2008-11-05 | インパルス ダイナミクス エヌ.ヴイ. | Electric muscle control device |
IL125424A0 (en) | 1998-07-20 | 1999-03-12 | New Technologies Sa Ysy Ltd | Pacing with hemodynamic enhancement |
US6317631B1 (en) | 1996-01-08 | 2001-11-13 | Impulse Dynamics N.V. | Controlling heart performance using a non-excitatory electric field |
US6415178B1 (en) | 1996-09-16 | 2002-07-02 | Impulse Dynamics N.V. | Fencing of cardiac muscles |
US5853411A (en) | 1996-01-19 | 1998-12-29 | Ep Technologies, Inc. | Enhanced electrical connections for electrode structures |
FR2796562B1 (en) | 1996-04-04 | 2005-06-24 | Medtronic Inc | TECHNIQUES FOR STIMULATING LIVING TISSUE AND RECORDING WITH LOCAL CONTROL OF ACTIVE SITES |
WO1997037720A1 (en) | 1996-04-04 | 1997-10-16 | Medtronic, Inc. | Living tissue stimulation and recording techniques |
US6006134A (en) | 1998-04-30 | 1999-12-21 | Medtronic, Inc. | Method and device for electronically controlling the beating of a heart using venous electrical stimulation of nerve fibers |
US5711316A (en) | 1996-04-30 | 1998-01-27 | Medtronic, Inc. | Method of treating movement disorders by brain infusion |
AU3357197A (en) | 1996-09-16 | 1998-04-02 | Impulse Dynamics (Israel) Ltd. | Cardiac output controller |
US6463324B1 (en) | 1996-09-16 | 2002-10-08 | Impulse Dynamics N. V. | Cardiac output enhanced pacemaker |
ZA976113B (en) | 1996-09-16 | 1998-03-19 | New Technologies Sa Ysy Ltd | Drug-device combination for controlling the contractility of muscles. |
US5755766A (en) | 1997-01-24 | 1998-05-26 | Cardiac Pacemakers, Inc. | Open-ended intravenous cardiac lead |
US5954761A (en) | 1997-03-25 | 1999-09-21 | Intermedics Inc. | Implantable endocardial lead assembly having a stent |
US5948007A (en) | 1997-04-30 | 1999-09-07 | Medtronic, Inc. | Dual channel implantation neurostimulation techniques |
US6547788B1 (en) | 1997-07-08 | 2003-04-15 | Atrionx, Inc. | Medical device with sensor cooperating with expandable member |
EP0996482B1 (en) | 1997-07-16 | 2007-02-14 | Metacure NV | Smooth muscle controller |
US6071308A (en) | 1997-10-01 | 2000-06-06 | Boston Scientific Corporation | Flexible metal wire stent |
US6231516B1 (en) | 1997-10-14 | 2001-05-15 | Vacusense, Inc. | Endoluminal implant with therapeutic and diagnostic capability |
US6058331A (en) | 1998-04-27 | 2000-05-02 | Medtronic, Inc. | Apparatus and method for treating peripheral vascular disease and organ ischemia by electrical stimulation with closed loop feedback control |
US6319241B1 (en) | 1998-04-30 | 2001-11-20 | Medtronic, Inc. | Techniques for positioning therapy delivery elements within a spinal cord or a brain |
US6447478B1 (en) | 1998-05-15 | 2002-09-10 | Ronald S. Maynard | Thin-film shape memory alloy actuators and processing methods |
US6428537B1 (en) | 1998-05-22 | 2002-08-06 | Scimed Life Systems, Inc. | Electrophysiological treatment methods and apparatus employing high voltage pulse to render tissue temporarily unresponsive |
US6740113B2 (en) | 1998-05-29 | 2004-05-25 | Scimed Life Systems, Inc. | Balloon expandable stent with a self-expanding portion |
US7198635B2 (en) | 2000-10-17 | 2007-04-03 | Asthmatx, Inc. | Modification of airways by application of energy |
US6292695B1 (en) | 1998-06-19 | 2001-09-18 | Wilton W. Webster, Jr. | Method and apparatus for transvascular treatment of tachycardia and fibrillation |
US6036697A (en) | 1998-07-09 | 2000-03-14 | Scimed Life Systems, Inc. | Balloon catheter with balloon inflation at distal end of balloon |
US6950689B1 (en) | 1998-08-03 | 2005-09-27 | Boston Scientific Scimed, Inc. | Dynamically alterable three-dimensional graphical model of a body region |
US5997563A (en) | 1998-09-28 | 1999-12-07 | Medtronic, Inc. | Implantable stent having variable diameter |
IL126905A0 (en) | 1998-11-05 | 1999-09-22 | Impulse Dynamics Ltd | Multi-electrode catheter |
US6292693B1 (en) | 1998-11-06 | 2001-09-18 | Impulse Dynamics N.V. | Contractility enhancement using excitable tissue control and multi-site pacing |
US6675043B1 (en) | 1998-11-06 | 2004-01-06 | Impulse Dynamics N.V. | Sensor-based regulation of excitable tissue control of the heart |
US6725093B1 (en) | 1998-11-06 | 2004-04-20 | Impulse Dynamics N.V. | Regulation of excitable tissue control of the heart based on physiological input |
US6587721B1 (en) | 1998-11-06 | 2003-07-01 | Impulse Dynamics N.V. | Trigger-based regulation of excitable tissue control of the heart |
US6254610B1 (en) | 1999-05-24 | 2001-07-03 | Impulse Dynamics N.V. | Device and method for dragging and positioning a member within a duct in a body |
US6152882A (en) | 1999-01-26 | 2000-11-28 | Impulse Dynamics N.V. | Apparatus and method for chronic measurement of monophasic action potentials |
US6161029A (en) | 1999-03-08 | 2000-12-12 | Medtronic, Inc. | Apparatus and method for fixing electrodes in a blood vessel |
US6136021A (en) | 1999-03-23 | 2000-10-24 | Cardiac Pacemakers, Inc. | Expandable electrode for coronary venous leads |
US6263242B1 (en) | 1999-03-25 | 2001-07-17 | Impulse Dynamics N.V. | Apparatus and method for timing the delivery of non-excitatory ETC signals to a heart |
US6370430B1 (en) | 1999-03-25 | 2002-04-09 | Impulse Dynamics N.V. | Apparatus and method for controlling the delivery of non-excitatory cardiac contractility modulating signals to a heart |
US6522904B1 (en) | 1999-03-30 | 2003-02-18 | Impulse Dynamics N.V. | Bipolar sensor for muscle tissue action potential duration estimation |
DE60032751T2 (en) | 1999-04-05 | 2007-11-08 | The Regents Of The University Of California, Oakland | ENDOMYOCARDIAL UNPHASE ACTION POTENTIAL FOR EARLY DETECTION OF MYOCARDIUM PATHOLOGY |
US6353762B1 (en) | 1999-04-30 | 2002-03-05 | Medtronic, Inc. | Techniques for selective activation of neurons in the brain, spinal cord parenchyma or peripheral nerve |
US6292704B1 (en) | 1999-05-25 | 2001-09-18 | Impulse Dynamics N. V. | High capacitance myocardial electrodes |
US6442424B1 (en) | 1999-05-26 | 2002-08-27 | Impulse Dynamics N.V. | Local cardiac motion control using applied electrical signals |
US6304777B1 (en) | 1999-05-26 | 2001-10-16 | Impulse Dynamics N.V. | Induction of cardioplegia applied electrical signals |
AU4776000A (en) | 1999-05-26 | 2000-12-18 | Impulse Dynamic Nv | Shockless defibrillation |
US6285906B1 (en) | 1999-05-26 | 2001-09-04 | Impulse Dynamics N. V. | Muscle contraction assist device |
US7092753B2 (en) | 1999-06-04 | 2006-08-15 | Impulse Dynamics Nv | Drug delivery device |
US7171263B2 (en) | 1999-06-04 | 2007-01-30 | Impulse Dynamics Nv | Drug delivery device |
US7190997B1 (en) | 1999-06-04 | 2007-03-13 | Impulse Dynamics Nv | Drug delivery device |
US6223072B1 (en) | 1999-06-08 | 2001-04-24 | Impulse Dynamics N.V. | Apparatus and method for collecting data useful for determining the parameters of an alert window for timing delivery of ETC signals to a heart under varying cardiac conditions |
US6233487B1 (en) | 1999-06-08 | 2001-05-15 | Impulse Dynamics N.V. | Apparatus and method for setting the parameters of an alert window used for timing the delivery of ETC signals to a heart under varying cardiac conditions |
CA2376903A1 (en) | 1999-06-25 | 2001-01-04 | Emory University | Devices and methods for vagus nerve stimulation |
US6348045B1 (en) | 1999-07-12 | 2002-02-19 | Impulse Dynamics N.V. | Catheter with distal-end engaging means |
US6335538B1 (en) | 1999-07-23 | 2002-01-01 | Impulse Dynamics N.V. | Electro-optically driven solid state relay system |
CA2314517A1 (en) | 1999-07-26 | 2001-01-26 | Gust H. Bardy | System and method for determining a reference baseline of individual patient status for use in an automated collection and analysis patient care system |
US7303526B2 (en) | 1999-08-09 | 2007-12-04 | Cardiokinetix, Inc. | Device for improving cardiac function |
US6360126B1 (en) | 1999-08-20 | 2002-03-19 | Impulse Dynamics N.V. | Apparatus and method for controlling the delivery of contractility modulating non-excitatory signals to the heart |
US6360123B1 (en) | 1999-08-24 | 2002-03-19 | Impulse Dynamics N.V. | Apparatus and method for determining a mechanical property of an organ or body cavity by impedance determination |
US6993385B1 (en) | 1999-10-25 | 2006-01-31 | Impulse Dynamics N.V. | Cardiac contractility modulation device having anti-arrhythmic capabilities and a method of operating thereof |
AU1049901A (en) | 1999-10-25 | 2001-05-08 | Impulse Dynamics N.V. | Cardiac contractility modulation device having anti-arrhythmic capabilities and a method of operating thereof |
US7027863B1 (en) | 1999-10-25 | 2006-04-11 | Impulse Dynamics N.V. | Device for cardiac therapy |
US6295475B1 (en) | 1999-10-27 | 2001-09-25 | Pacesetter, Inc. | Single-pass atrial ventricular lead with multiple atrial ring electrodes and a selective atrial electrode adaptor for the coronary sinus region |
US6662055B1 (en) | 1999-12-17 | 2003-12-09 | Impulse Dynamics Nv | Multi-electrode intravascular lead |
IL133592A0 (en) | 1999-12-19 | 2001-04-30 | Impulse Dynamics Ltd | Fluid phase electrode lead |
US6480737B1 (en) | 1999-12-29 | 2002-11-12 | Impulse Dynamics Nv | Field delivery safety system using detection of atypical ECG |
US20060085046A1 (en) | 2000-01-20 | 2006-04-20 | Ali Rezai | Methods of treating medical conditions by transvascular neuromodulation of the autonomic nervous system |
US6600953B2 (en) | 2000-12-11 | 2003-07-29 | Impulse Dynamics N.V. | Acute and chronic electrical signal therapy for obesity |
US7096070B1 (en) | 2000-02-09 | 2006-08-22 | Transneuronix, Inc. | Medical implant device for electrostimulation using discrete micro-electrodes |
AU5062601A (en) | 2000-04-18 | 2001-10-30 | Impulse Dynamics N.V. | Method and device for inserting leads into coronary veins |
US6754532B1 (en) | 2000-04-28 | 2004-06-22 | Medtronic, Inc. | Coronary sinus flow regulated pacing |
EP1284781B1 (en) | 2000-05-04 | 2017-10-11 | Impulse Dynamics N.V. | Signal delivery through the right ventricular septum |
US6712831B1 (en) | 2000-06-16 | 2004-03-30 | Aaron V. Kaplan | Methods and apparatus for forming anastomotic sites |
US20040215233A1 (en) | 2000-06-16 | 2004-10-28 | Magenta Medical Corporation | Methods and apparatus for forming anastomotic sites |
US6694192B2 (en) | 2000-07-06 | 2004-02-17 | Impulse Dynamics N.V. | Uterus muscle controller |
US8086314B1 (en) | 2000-09-27 | 2011-12-27 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US7158832B2 (en) | 2000-09-27 | 2007-01-02 | Cvrx, Inc. | Electrode designs and methods of use for cardiovascular reflex control devices |
US7499742B2 (en) | 2001-09-26 | 2009-03-03 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US7616997B2 (en) | 2000-09-27 | 2009-11-10 | Kieval Robert S | Devices and methods for cardiovascular reflex control via coupled electrodes |
US6985774B2 (en) | 2000-09-27 | 2006-01-10 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US6522926B1 (en) | 2000-09-27 | 2003-02-18 | Cvrx, Inc. | Devices and methods for cardiovascular reflex control |
US7840271B2 (en) | 2000-09-27 | 2010-11-23 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US6850801B2 (en) | 2001-09-26 | 2005-02-01 | Cvrx, Inc. | Mapping methods for cardiovascular reflex control devices |
US7623926B2 (en) | 2000-09-27 | 2009-11-24 | Cvrx, Inc. | Stimulus regimens for cardiovascular reflex control |
US6749600B1 (en) | 2000-11-15 | 2004-06-15 | Impulse Dynamics N.V. | Braided splittable catheter sheath |
US6609025B2 (en) | 2001-01-02 | 2003-08-19 | Cyberonics, Inc. | Treatment of obesity by bilateral sub-diaphragmatic nerve stimulation |
US6564096B2 (en) | 2001-02-28 | 2003-05-13 | Robert A. Mest | Method and system for treatment of tachycardia and fibrillation |
US6684105B2 (en) | 2001-08-31 | 2004-01-27 | Biocontrol Medical, Ltd. | Treatment of disorders by unidirectional nerve stimulation |
US6748271B2 (en) | 2001-07-27 | 2004-06-08 | Cardiac Pacemakers, Inc. | Method and system for treatment of neurocardiogenic syncope |
US8934968B2 (en) | 2001-08-03 | 2015-01-13 | Cardiac Pacemakers, Inc. | Neurostimulation and coronary artery disease treatment |
US6845776B2 (en) | 2001-08-27 | 2005-01-25 | Richard S. Stack | Satiation devices and methods |
US7097665B2 (en) | 2003-01-16 | 2006-08-29 | Synecor, Llc | Positioning tools and methods for implanting medical devices |
US6675809B2 (en) | 2001-08-27 | 2004-01-13 | Richard S. Stack | Satiation devices and methods |
US8565896B2 (en) | 2010-11-22 | 2013-10-22 | Bio Control Medical (B.C.M.) Ltd. | Electrode cuff with recesses |
US7974693B2 (en) | 2001-08-31 | 2011-07-05 | Bio Control Medical (B.C.M.) Ltd. | Techniques for applying, configuring, and coordinating nerve fiber stimulation |
US20080119898A1 (en) | 2005-09-22 | 2008-05-22 | Biocontrol Medical Ltd. | Nitric oxide synthase-affecting parasympathetic stimulation |
US20140046407A1 (en) | 2001-08-31 | 2014-02-13 | Bio Control Medical (B.C.M.) Ltd. | Nerve stimulation techniques |
US7885709B2 (en) | 2001-08-31 | 2011-02-08 | Bio Control Medical (B.C.M.) Ltd. | Nerve stimulation for treating disorders |
US7778711B2 (en) | 2001-08-31 | 2010-08-17 | Bio Control Medical (B.C.M.) Ltd. | Reduction of heart rate variability by parasympathetic stimulation |
US7904176B2 (en) | 2006-09-07 | 2011-03-08 | Bio Control Medical (B.C.M.) Ltd. | Techniques for reducing pain associated with nerve stimulation |
US7778703B2 (en) | 2001-08-31 | 2010-08-17 | Bio Control Medical (B.C.M.) Ltd. | Selective nerve fiber stimulation for treating heart conditions |
US8615294B2 (en) | 2008-08-13 | 2013-12-24 | Bio Control Medical (B.C.M.) Ltd. | Electrode devices for nerve stimulation and cardiac sensing |
US8571653B2 (en) | 2001-08-31 | 2013-10-29 | Bio Control Medical (B.C.M.) Ltd. | Nerve stimulation techniques |
US7308303B2 (en) | 2001-11-01 | 2007-12-11 | Advanced Bionics Corporation | Thrombolysis and chronic anticoagulation therapy |
US6669693B2 (en) | 2001-11-13 | 2003-12-30 | Mayo Foundation For Medical Education And Research | Tissue ablation device and methods of using |
US6746465B2 (en) | 2001-12-14 | 2004-06-08 | The Regents Of The University Of California | Catheter based balloon for therapy modification and positioning of tissue |
US6741878B2 (en) | 2001-12-14 | 2004-05-25 | Biosense Webster, Inc. | Basket catheter with improved expansion mechanism |
US8233991B2 (en) | 2002-02-04 | 2012-07-31 | Boston Scientific Neuromodulation Corporation | Method for programming implantable device |
US7146984B2 (en) | 2002-04-08 | 2006-12-12 | Synecor, Llc | Method and apparatus for modifying the exit orifice of a satiation pouch |
US20070135875A1 (en) | 2002-04-08 | 2007-06-14 | Ardian, Inc. | Methods and apparatus for thermally-induced renal neuromodulation |
US7162303B2 (en) | 2002-04-08 | 2007-01-09 | Ardian, Inc. | Renal nerve stimulation method and apparatus for treatment of patients |
US7386346B2 (en) | 2002-04-22 | 2008-06-10 | Medtronic, Inc. | Controlled and modulated high power racing combined with intracardiac pressure monitoring feedback system utilizing the chronicle implantable hemodynamic monitoring (IHM) and calculated EPAD |
US7195594B2 (en) | 2002-05-14 | 2007-03-27 | Pacesetter, Inc. | Method for minimally invasive calibration of implanted pressure transducers |
US20140214135A1 (en) | 2002-05-23 | 2014-07-31 | Bio Control Medical (B.C.M.) Ltd. | Dissolvable electrode device |
US7885711B2 (en) | 2003-06-13 | 2011-02-08 | Bio Control Medical (B.C.M.) Ltd. | Vagal stimulation for anti-embolic therapy |
US8204591B2 (en) | 2002-05-23 | 2012-06-19 | Bio Control Medical (B.C.M.) Ltd. | Techniques for prevention of atrial fibrillation |
US20120303080A1 (en) | 2003-06-13 | 2012-11-29 | Bio Control Medical (B.C.M.) Ltd. | Parasympathetic nerve stimulation |
US7321793B2 (en) | 2003-06-13 | 2008-01-22 | Biocontrol Medical Ltd. | Vagal stimulation for atrial fibrillation therapy |
US8036745B2 (en) | 2004-06-10 | 2011-10-11 | Bio Control Medical (B.C.M.) Ltd. | Parasympathetic pacing therapy during and following a medical procedure, clinical trauma or pathology |
US7277761B2 (en) | 2002-06-12 | 2007-10-02 | Pacesetter, Inc. | Vagal stimulation for improving cardiac function in heart failure or CHF patients |
US7904151B2 (en) | 2002-07-24 | 2011-03-08 | Bio Control Medical (B.C.M.) Ltd. | Parasympathetic stimulation for treating ventricular arrhythmia |
US6944490B1 (en) | 2002-09-25 | 2005-09-13 | Advanced Cardiovascular Systems, Inc. | Apparatus and method for positioning and delivering a therapeutic tool to the inside of a heart |
US7027851B2 (en) | 2002-10-30 | 2006-04-11 | Biosense Webster, Inc. | Multi-tip steerable catheter |
US7277757B2 (en) | 2002-10-31 | 2007-10-02 | Medtronic, Inc. | Respiratory nerve stimulation |
US20040098090A1 (en) | 2002-11-14 | 2004-05-20 | Williams Michael S. | Polymeric endoprosthesis and method of manufacture |
US7141061B2 (en) | 2002-11-14 | 2006-11-28 | Synecor, Llc | Photocurable endoprosthesis system |
US7285287B2 (en) | 2002-11-14 | 2007-10-23 | Synecor, Llc | Carbon dioxide-assisted methods of providing biocompatible intraluminal prostheses |
US20050187615A1 (en) | 2004-02-23 | 2005-08-25 | Williams Michael S. | Polymeric endoprostheses with enhanced strength and flexibility and methods of manufacture |
CA2506655A1 (en) | 2002-11-15 | 2004-06-03 | Synecor, Llc | Polymeric endoprosthesis and method of manufacture |
US7704276B2 (en) | 2002-11-15 | 2010-04-27 | Synecor, Llc | Endoprostheses and methods of manufacture |
US7163554B2 (en) | 2002-11-15 | 2007-01-16 | Synecor, Llc | Endoprostheses and methods of manufacture |
US7555351B2 (en) * | 2002-12-19 | 2009-06-30 | Cardiac Pacemakers, Inc. | Pulmonary artery lead for atrial therapy and atrial pacing and sensing |
US7857748B2 (en) | 2003-01-15 | 2010-12-28 | Syne Cor, Llc | Photocurable endoprosthesis methods of manufacture |
US7387629B2 (en) * | 2003-01-21 | 2008-06-17 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Catheter design that facilitates positioning at tissue to be diagnosed or treated |
US6885889B2 (en) | 2003-02-28 | 2005-04-26 | Medtronic, Inc. | Method and apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration |
JP2006519663A (en) | 2003-03-10 | 2006-08-31 | インパルス ダイナミックス エヌヴイ | Apparatus and method for delivering electrical signals for regulating gene expression in heart tissue |
US6932930B2 (en) | 2003-03-10 | 2005-08-23 | Synecor, Llc | Intraluminal prostheses having polymeric material with selectively modified crystallinity and methods of making same |
US7276062B2 (en) | 2003-03-12 | 2007-10-02 | Biosence Webster, Inc. | Deflectable catheter with hinge |
US7658709B2 (en) | 2003-04-09 | 2010-02-09 | Medtronic, Inc. | Shape memory alloy actuators |
US6832478B2 (en) | 2003-04-09 | 2004-12-21 | Medtronic, Inc. | Shape memory alloy actuators |
US8060197B2 (en) | 2003-05-23 | 2011-11-15 | Bio Control Medical (B.C.M.) Ltd. | Parasympathetic stimulation for termination of non-sinus atrial tachycardia |
US20080046016A1 (en) | 2003-05-23 | 2008-02-21 | Biocontrol Medical Ltd. | Intravascular parasympatheticstimulation for atrial cardioversion |
US7082336B2 (en) | 2003-06-04 | 2006-07-25 | Synecor, Llc | Implantable intravascular device for defibrillation and/or pacing |
US7617007B2 (en) | 2003-06-04 | 2009-11-10 | Synecor Llc | Method and apparatus for retaining medical implants within body vessels |
CA2527909A1 (en) | 2003-06-04 | 2005-01-06 | Synecor Llc | Intravascular electrophysiological system and methods |
US8239045B2 (en) | 2003-06-04 | 2012-08-07 | Synecor Llc | Device and method for retaining a medical device within a vessel |
EP1648558A4 (en) | 2003-06-13 | 2015-05-27 | Biocontrol Medical B C M Ltd | Applications of vagal stimulation |
US7092759B2 (en) | 2003-07-30 | 2006-08-15 | Medtronic, Inc. | Method of optimizing cardiac resynchronization therapy using sensor signals of septal wall motion |
JP2007504910A (en) | 2003-09-12 | 2007-03-08 | ミノウ・メディカル・エルエルシイ | Selectable biased reshaping and / or excision of atherosclerotic material |
US8206456B2 (en) | 2003-10-10 | 2012-06-26 | Barosense, Inc. | Restrictive and/or obstructive implant system for inducing weight loss |
US20050247320A1 (en) | 2003-10-10 | 2005-11-10 | Stack Richard S | Devices and methods for retaining a gastro-esophageal implant |
US7480532B2 (en) | 2003-10-22 | 2009-01-20 | Cvrx, Inc. | Baroreflex activation for pain control, sedation and sleep |
US20050119752A1 (en) | 2003-11-19 | 2005-06-02 | Synecor Llc | Artificial intervertebral disc |
US7377939B2 (en) | 2003-11-19 | 2008-05-27 | Synecor, Llc | Highly convertible endolumenal prostheses and methods of manufacture |
WO2005058415A2 (en) | 2003-12-12 | 2005-06-30 | Synecor, Llc | Implantable medical device having pre-implant exoskeleton |
US7486991B2 (en) | 2003-12-24 | 2009-02-03 | Cardiac Pacemakers, Inc. | Baroreflex modulation to gradually decrease blood pressure |
US20050149132A1 (en) | 2003-12-24 | 2005-07-07 | Imad Libbus | Automatic baroreflex modulation based on cardiac activity |
US8126559B2 (en) | 2004-11-30 | 2012-02-28 | Cardiac Pacemakers, Inc. | Neural stimulation with avoidance of inappropriate stimulation |
US20080015659A1 (en) | 2003-12-24 | 2008-01-17 | Yi Zhang | Neurostimulation systems and methods for cardiac conditions |
US7509166B2 (en) | 2003-12-24 | 2009-03-24 | Cardiac Pacemakers, Inc. | Automatic baroreflex modulation responsive to adverse event |
US7460906B2 (en) | 2003-12-24 | 2008-12-02 | Cardiac Pacemakers, Inc. | Baroreflex stimulation to treat acute myocardial infarction |
US8126560B2 (en) | 2003-12-24 | 2012-02-28 | Cardiac Pacemakers, Inc. | Stimulation lead for stimulating the baroreceptors in the pulmonary artery |
US7643875B2 (en) | 2003-12-24 | 2010-01-05 | Cardiac Pacemakers, Inc. | Baroreflex stimulation system to reduce hypertension |
US7869881B2 (en) | 2003-12-24 | 2011-01-11 | Cardiac Pacemakers, Inc. | Baroreflex stimulator with integrated pressure sensor |
US20050142315A1 (en) | 2003-12-24 | 2005-06-30 | Desimone Joseph M. | Liquid perfluoropolymers and medical applications incorporating same |
US7873413B2 (en) | 2006-07-24 | 2011-01-18 | Cardiac Pacemakers, Inc. | Closed loop neural stimulation synchronized to cardiac cycles |
US8024050B2 (en) | 2003-12-24 | 2011-09-20 | Cardiac Pacemakers, Inc. | Lead for stimulating the baroreceptors in the pulmonary artery |
US20050273146A1 (en) | 2003-12-24 | 2005-12-08 | Synecor, Llc | Liquid perfluoropolymers and medical applications incorporating same |
US7706884B2 (en) | 2003-12-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Baroreflex stimulation synchronized to circadian rhythm |
US20050271794A1 (en) | 2003-12-24 | 2005-12-08 | Synecor, Llc | Liquid perfluoropolymers and medical and cosmetic applications incorporating same |
US7295881B2 (en) | 2003-12-29 | 2007-11-13 | Biocontrol Medical Ltd. | Nerve-branch-specific action-potential activation, inhibition, and monitoring |
US7572228B2 (en) | 2004-01-13 | 2009-08-11 | Remon Medical Technologies Ltd | Devices for fixing a sensor in a lumen |
US7547286B2 (en) | 2004-02-16 | 2009-06-16 | Choate John I M | Method to reduce inflammation and tactile finger sensation deficit due to carpal tunnel syndrome or arthritis |
US20050187556A1 (en) | 2004-02-25 | 2005-08-25 | Synecor, Llc | Universal percutaneous spinal access system |
US8352031B2 (en) | 2004-03-10 | 2013-01-08 | Impulse Dynamics Nv | Protein activity modification |
US8548583B2 (en) | 2004-03-10 | 2013-10-01 | Impulse Dynamics Nv | Protein activity modification |
EP1750799A2 (en) | 2004-05-04 | 2007-02-14 | The Cleveland Clinic Foundation | Methods of treating medical conditions by neuromodulation of the sympathetic nervous system |
US7231260B2 (en) | 2004-05-06 | 2007-06-12 | Boston Scientific Scimed, Inc. | Intravascular self-anchoring electrode body with arcuate springs, spring loops, or arms |
US7260431B2 (en) | 2004-05-20 | 2007-08-21 | Cardiac Pacemakers, Inc. | Combined remodeling control therapy and anti-remodeling therapy by implantable cardiac device |
US8116881B2 (en) | 2004-06-10 | 2012-02-14 | Bio Control Medical (B.C.M.) Ltd | Electrode assembly for nerve control |
WO2006012050A2 (en) | 2004-06-30 | 2006-02-02 | Cvrx, Inc. | Connection structures for extra-vascular electrode lead body |
US7532938B2 (en) | 2004-09-10 | 2009-05-12 | The Cleveland Clinic Foundation | Intraluminal electrode assembly |
CA2577175A1 (en) | 2004-09-30 | 2006-04-13 | Synecor, Llc | Artificial intervertebral disc nucleus |
US20060074453A1 (en) | 2004-10-04 | 2006-04-06 | Cvrx, Inc. | Baroreflex activation and cardiac resychronization for heart failure treatment |
US8175705B2 (en) | 2004-10-12 | 2012-05-08 | Cardiac Pacemakers, Inc. | System and method for sustained baroreflex stimulation |
US8244355B2 (en) | 2004-10-29 | 2012-08-14 | Medtronic, Inc. | Method and apparatus to provide diagnostic index and therapy regulated by subject's autonomic nervous system |
US7468062B2 (en) | 2004-11-24 | 2008-12-23 | Ablation Frontiers, Inc. | Atrial ablation catheter adapted for treatment of septal wall arrhythmogenic foci and method of use |
US7891085B1 (en) | 2005-01-11 | 2011-02-22 | Boston Scientific Neuromodulation Corporation | Electrode array assembly and method of making same |
US7672724B2 (en) | 2005-01-18 | 2010-03-02 | Cardiac Pacemakers, Inc. | Method and apparatus for optimizing electrical stimulation parameters using heart rate variability |
US8609082B2 (en) | 2005-01-25 | 2013-12-17 | Bio Control Medical Ltd. | Administering bone marrow progenitor cells or myoblasts followed by application of an electrical current for cardiac repair, increasing blood supply or enhancing angiogenesis |
US20060178586A1 (en) | 2005-02-07 | 2006-08-10 | Dobak John D Iii | Devices and methods for accelerometer-based characterization of cardiac function and identification of LV target pacing zones |
US8224444B2 (en) | 2005-02-18 | 2012-07-17 | Bio Control Medical (B.C.M.) Ltd. | Intermittent electrical stimulation |
US7769446B2 (en) | 2005-03-11 | 2010-08-03 | Cardiac Pacemakers, Inc. | Neural stimulation system for cardiac fat pads |
US7363082B2 (en) | 2005-03-24 | 2008-04-22 | Synecor Llc | Flexible hermetic enclosure for implantable medical devices |
US7542800B2 (en) | 2005-04-05 | 2009-06-02 | Cardiac Pacemakers, Inc. | Method and apparatus for synchronizing neural stimulation to cardiac cycles |
US7499748B2 (en) | 2005-04-11 | 2009-03-03 | Cardiac Pacemakers, Inc. | Transvascular neural stimulation device |
US7881782B2 (en) | 2005-04-20 | 2011-02-01 | Cardiac Pacemakers, Inc. | Neural stimulation system to prevent simultaneous energy discharges |
US7904158B2 (en) | 2005-04-28 | 2011-03-08 | Medtronic, Inc. | Measurement of coronary sinus parameters to optimize left ventricular performance |
US7561923B2 (en) | 2005-05-09 | 2009-07-14 | Cardiac Pacemakers, Inc. | Method and apparatus for controlling autonomic balance using neural stimulation |
US7765000B2 (en) * | 2005-05-10 | 2010-07-27 | Cardiac Pacemakers, Inc. | Neural stimulation system with pulmonary artery lead |
US7734348B2 (en) | 2005-05-10 | 2010-06-08 | Cardiac Pacemakers, Inc. | System with left/right pulmonary artery electrodes |
US7617003B2 (en) | 2005-05-16 | 2009-11-10 | Cardiac Pacemakers, Inc. | System for selective activation of a nerve trunk using a transvascular reshaping lead |
EP1937357B1 (en) | 2005-09-06 | 2023-11-01 | Impulse Dynamics N.V. | Apparatus for delivering electrical signals to a heart |
US8731659B2 (en) | 2005-09-20 | 2014-05-20 | Cardiac Pacemakers, Inc. | Multi-site lead/system using a multi-pole connection and methods therefor |
US7616990B2 (en) | 2005-10-24 | 2009-11-10 | Cardiac Pacemakers, Inc. | Implantable and rechargeable neural stimulator |
WO2007052341A1 (en) | 2005-11-01 | 2007-05-10 | Japan Electel Inc. | Balloon catheter system |
US7630760B2 (en) | 2005-11-21 | 2009-12-08 | Cardiac Pacemakers, Inc. | Neural stimulation therapy system for atherosclerotic plaques |
EP1971285B1 (en) | 2005-12-30 | 2012-01-18 | C.R.Bard, Inc. | Apparatus for ablation of cardiac tissue |
AU2007212587B2 (en) | 2006-02-03 | 2012-07-12 | Synecor, Llc | Intravascular device for neuromodulation |
WO2007091244A1 (en) | 2006-02-07 | 2007-08-16 | Impulse Dynamics Nv | Assessing cardiac activity |
US8457763B2 (en) | 2006-04-27 | 2013-06-04 | Medtronic, Inc. | Implantable medical electrical stimulation lead fixation method and apparatus |
US8005543B2 (en) | 2006-05-08 | 2011-08-23 | Cardiac Pacemakers, Inc. | Heart failure management system |
US7801604B2 (en) | 2006-08-29 | 2010-09-21 | Cardiac Pacemakers, Inc. | Controlled titration of neurostimulation therapy |
US8620422B2 (en) | 2006-09-28 | 2013-12-31 | Cvrx, Inc. | Electrode array structures and methods of use for cardiovascular reflex control |
US9643004B2 (en) | 2006-10-31 | 2017-05-09 | Medtronic, Inc. | Implantable medical elongated member with adhesive elements |
US7805194B1 (en) | 2006-11-03 | 2010-09-28 | Pacesetter, Inc. | Matrix optimization method of individually adapting therapy in an implantable cardiac therapy device |
US8311633B2 (en) | 2006-12-04 | 2012-11-13 | Synecor Llc | Intravascular implantable device having superior anchoring arrangement |
US8337518B2 (en) | 2006-12-20 | 2012-12-25 | Onset Medical Corporation | Expandable trans-septal sheath |
US8005545B2 (en) | 2007-01-24 | 2011-08-23 | Bio Control Medical (B.C.M.) Ltd. | Parasympathetic stimulation for prevention and treatment of atrial fibrillation |
US8150521B2 (en) | 2007-03-15 | 2012-04-03 | Cvrx, Inc. | Methods and devices for controlling battery life in an implantable pulse generator |
US8406877B2 (en) | 2007-03-19 | 2013-03-26 | Cardiac Pacemakers, Inc. | Selective nerve stimulation with optionally closed-loop capabilities |
WO2008137766A2 (en) | 2007-05-02 | 2008-11-13 | Wireless Control Network Solutions, Llc | Systems and methods for dynamically configuring node behavior in a sensor network |
WO2008135985A1 (en) | 2007-05-02 | 2008-11-13 | Earlysense Ltd | Monitoring, predicting and treating clinical episodes |
US20090018596A1 (en) | 2007-05-15 | 2009-01-15 | Cvrx, Inc. | Baroreflex activation therapy device with pacing cardiac electrical signal detection capability |
US8901878B2 (en) | 2007-06-05 | 2014-12-02 | Impulse Dynamics Nv | Transcutaneous charging device |
WO2009005625A1 (en) | 2007-07-03 | 2009-01-08 | Synecor, Llc | Satiation devices and methods for controlling obesity |
US20090012546A1 (en) | 2007-07-03 | 2009-01-08 | Synecor, Llc | Devices for treating gastroesophageal reflux disease and hiatal hernia, and methods of treating gastroesophageal reflux disease and hiatal hernia using same |
US8249717B2 (en) | 2007-07-18 | 2012-08-21 | Cardiac Pacemakers, Inc. | Systems and methods for providing neural stimulation transitions |
US7848812B2 (en) | 2007-07-20 | 2010-12-07 | Cvrx, Inc. | Elective service indicator based on pulse count for implantable device |
US7676266B1 (en) | 2007-07-30 | 2010-03-09 | Pacesetter, Inc. | Monitoring ventricular synchrony |
US8060218B2 (en) | 2007-08-02 | 2011-11-15 | Synecor, Llc | Inductive element for intravascular implantable devices |
US8027724B2 (en) | 2007-08-03 | 2011-09-27 | Cardiac Pacemakers, Inc. | Hypertension diagnosis and therapy using pressure sensor |
US8265736B2 (en) | 2007-08-07 | 2012-09-11 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US8204596B2 (en) | 2007-10-31 | 2012-06-19 | Synecor Llc | Isolation connector for an intravascular implantable medical device |
US8155744B2 (en) | 2007-12-13 | 2012-04-10 | The Cleveland Clinic Foundation | Neuromodulatory methods for treating pulmonary disorders |
US8216225B2 (en) * | 2007-12-21 | 2012-07-10 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Irrigated ablation electrode assembly having a polygonal electrode |
US8538535B2 (en) | 2010-08-05 | 2013-09-17 | Rainbow Medical Ltd. | Enhancing perfusion by contraction |
US9005106B2 (en) | 2008-01-31 | 2015-04-14 | Enopace Biomedical Ltd | Intra-aortic electrical counterpulsation |
US8626290B2 (en) | 2008-01-31 | 2014-01-07 | Enopace Biomedical Ltd. | Acute myocardial infarction treatment by electrical stimulation of the thoracic aorta |
US20140114377A1 (en) | 2008-01-31 | 2014-04-24 | Enopace Biomedical Ltd. | Vagus nerve stimulation |
US20150151121A1 (en) | 2008-01-31 | 2015-06-04 | Enopace Biomedical Ltd. | Enhancing perfusion by contraction |
US8626299B2 (en) | 2008-01-31 | 2014-01-07 | Enopace Biomedical Ltd. | Thoracic aorta and vagus nerve stimulation |
US20110004198A1 (en) | 2008-03-05 | 2011-01-06 | Robert Hoch | Pressure Sensing Catheter |
EP2197539A1 (en) | 2008-04-30 | 2010-06-23 | Medtronic, Inc. | Techniques for placing medical leads for electrical stimulation of nerve tissue |
CN102202726A (en) | 2008-05-02 | 2011-09-28 | 梅德特龙尼克有限公司 | Electrode lead system |
US8103360B2 (en) | 2008-05-09 | 2012-01-24 | Foster Arthur J | Medical lead coil conductor with spacer element |
US8239037B2 (en) | 2008-07-06 | 2012-08-07 | Synecor Llc | Intravascular implant anchors having remote communication and/or battery recharging capabilities |
WO2010005482A1 (en) | 2008-07-08 | 2010-01-14 | Cardiac Pacemakers, Inc. | Systems for delivering vagal nerve stimulation |
US9717914B2 (en) | 2008-09-16 | 2017-08-01 | Pacesetter, Inc. | Use of cardiohemic vibration for pacing therapies |
AU2009302272B2 (en) | 2008-10-10 | 2013-02-07 | Cardiac Pacemakers, Inc. | Multi-sensor strategy for heart failure patient management |
US8386053B2 (en) | 2008-10-31 | 2013-02-26 | Medtronic, Inc. | Subclavian ansae stimulation |
EP2421605B1 (en) | 2009-04-23 | 2017-07-12 | Impulse Dynamics NV | Implantable lead connector |
US20110066017A1 (en) | 2009-09-11 | 2011-03-17 | Medtronic, Inc. | Method and apparatus for post-shock evaluation using tissue oxygenation measurements |
US20110082452A1 (en) | 2009-10-02 | 2011-04-07 | Cardiofocus, Inc. | Cardiac ablation system with automatic safety shut-off feature |
JP5503012B2 (en) | 2009-10-30 | 2014-05-28 | カーディアック ペースメイカーズ, インコーポレイテッド | Pacemaker using vagus surge and response |
EP2498706B1 (en) | 2009-11-13 | 2016-04-20 | St. Jude Medical, Inc. | Assembly of staggered ablation elements |
US8249706B2 (en) | 2010-01-26 | 2012-08-21 | Pacesetter, Inc. | Adaptive rate programming control in implantable medical devices using ventricular-arterial coupling surrogates |
US9050453B2 (en) | 2010-03-19 | 2015-06-09 | National Cerebral And Cardiovascular Center | Electrostimulation system, and electrostimulation electrode assembly and biological implantable electrode therefore |
AU2011239668B2 (en) | 2010-04-15 | 2014-04-17 | Cardiac Pacemakers, Inc. | Autonomic modulation using transient response with intermittent neural stimulation |
US9408661B2 (en) | 2010-07-30 | 2016-08-09 | Patrick A. Haverkost | RF electrodes on multiple flexible wires for renal nerve ablation |
DE102011053021B4 (en) | 2010-08-26 | 2013-12-19 | Acandis Gmbh & Co. Kg | Electrode for medical applications, system with an electrode and method of making an electrode |
US8934956B2 (en) | 2010-08-31 | 2015-01-13 | Interventional Autonomics Corporation | Intravascular electrodes and anchoring devices for transvascular stimulation |
US20150150508A1 (en) | 2010-08-31 | 2015-06-04 | Interventional Autonomics Corporation | Intravascular electrodes and anchoring devices for transvascular stimulation |
US20130018444A1 (en) | 2011-07-11 | 2013-01-17 | Glenn Richard A | Intravascular electrodes for transvascular stimulation |
EP2616141B1 (en) | 2010-09-15 | 2016-01-13 | Cardiac Pacemakers, Inc. | Automatic selection of lead configuration for a neural stimulation lead |
AU2011236083A1 (en) | 2010-10-20 | 2012-05-10 | Maria G. Aboytes | Catheter apparatuses having expandable mesh structures for renal neuromodulation and associated systems and methods |
JP5972272B2 (en) | 2010-10-29 | 2016-08-17 | シーブイアールエックス, インコーポレイテッドCvrx, Inc. | Implant tools and improved electrode design for minimally invasive procedures |
SG190177A1 (en) | 2010-11-16 | 2013-06-28 | Tva Medical Inc | Devices and methods for forming a fistula |
US8781582B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
US20120197141A1 (en) | 2011-01-28 | 2012-08-02 | Pacesetter, Inc. | Implantable echo doppler flow sensor for monitoring of hemodynamics |
JP5331836B2 (en) | 2011-02-21 | 2013-10-30 | コヴィディエン リミテッド パートナーシップ | System and method for supplying and deploying an occlusion device in a conduit |
US8983601B2 (en) | 2011-02-25 | 2015-03-17 | The Cleveland Clinic Foundation | Extravascular neuromodulation to treat heart failure |
US20120232563A1 (en) | 2011-03-08 | 2012-09-13 | Medtronic, Inc. | Implant catheters for physiological pacing |
US8734388B2 (en) | 2011-04-01 | 2014-05-27 | Rutgers, The State University Of New Jersey | Catheter for minimally invasive cardiac pacing surgery and method of use |
CA2833610C (en) | 2011-04-22 | 2015-01-27 | Topera, Inc. | Basket style cardiac mapping catheter having a flexible electrode assembly for detection of cardiac rhythm disorders |
EP2701795B1 (en) * | 2011-04-28 | 2020-12-09 | Interventional Autonomics Corporation | Neuromodulation systems for treating acute heart failure syndromes |
WO2013003368A1 (en) | 2011-06-28 | 2013-01-03 | Boston Scientific Neuromodulation Corporation | System and method for using impedance to determine proximity and orientation of segmented electrodes |
JP6095658B2 (en) | 2011-07-11 | 2017-03-15 | インターベンショナル オートノミックス コーポレーション | System and method for neuromodulation therapy |
US9446240B2 (en) | 2011-07-11 | 2016-09-20 | Interventional Autonomics Corporation | System and method for neuromodulation |
US8855783B2 (en) | 2011-09-09 | 2014-10-07 | Enopace Biomedical Ltd. | Detector-based arterial stimulation |
WO2013043592A1 (en) | 2011-09-19 | 2013-03-28 | Boston Scientific Scimed, Inc. | Subintimal re-entry catheter and retrograde recanalization |
US10463259B2 (en) | 2011-10-28 | 2019-11-05 | Three Rivers Cardiovascular Systems Inc. | System and apparatus comprising a multi-sensor catheter for right heart and pulmonary artery catheterization |
US9119600B2 (en) | 2011-11-15 | 2015-09-01 | Boston Scientific Scimed, Inc. | Device and methods for renal nerve modulation monitoring |
US9005100B2 (en) | 2011-12-15 | 2015-04-14 | The Board Of Trustees Of The Leland Stanford Jr. University | Apparatus and methods for treating pulmonary hypertension |
US8825130B2 (en) | 2011-12-30 | 2014-09-02 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Electrode support structure assemblies |
US20140074148A1 (en) | 2012-02-21 | 2014-03-13 | Synecor Llc | Embolic protection system and method for use in an aortic arch |
US11395921B2 (en) | 2012-04-29 | 2022-07-26 | Nuxcel2 Llc | Intravascular electrode arrays for neuromodulation |
US20130289686A1 (en) | 2012-04-29 | 2013-10-31 | Synecor Llc | Intravascular electrode arrays for neuromodulation |
CN104470579B (en) | 2012-06-06 | 2018-06-01 | 洋红医疗有限公司 | Artificial kidney valve |
WO2014007871A1 (en) | 2012-07-05 | 2014-01-09 | Mc10, Inc. | Catheter device including flow sensing |
JP2015531630A (en) | 2012-08-23 | 2015-11-05 | ミニマリー・インヴェイシヴ・サージカル・アクセス・リミテッド | Direct aortic access system for transcatheter aortic valve surgery |
US20140172006A1 (en) | 2012-08-24 | 2014-06-19 | Synecor Llc | System for facilitating transcatheter aortic valve procedures using femoral access |
US9833608B2 (en) | 2012-11-20 | 2017-12-05 | NeuroTronik IP Holding (Jersey) Limited | Positioning methods for intravascular electrode arrays for neuromodulation |
US11202904B2 (en) | 2012-11-20 | 2021-12-21 | Nuxcel Limited | Positioning methods for intravascular electrode arrays for neuromodulation |
US9446243B2 (en) | 2012-12-07 | 2016-09-20 | Boston Scientific Neuromodulation Corporation | Patient posture determination and stimulation program adjustment in an implantable stimulator device using impedance fingerprinting |
US9656089B2 (en) | 2012-12-14 | 2017-05-23 | Boston Scientific Neuromodulation Corporation | Method for automation of therapy-based programming in a tissue stimulator user interface |
WO2014158986A1 (en) | 2013-03-12 | 2014-10-02 | Cardiac Pacemakers, Inc. | Medical device with multiple sensor fusion |
WO2014141284A2 (en) | 2013-03-13 | 2014-09-18 | Magenta Medical Ltd. | Renal pump |
US9494960B2 (en) | 2013-03-14 | 2016-11-15 | Boston Scientific Neuromodulation Corporation | Voltage regulator programmable as a function of load current |
WO2014149895A1 (en) | 2013-03-15 | 2014-09-25 | Boston Scientific Neuromodulation Corporation | Neuromodulation system for providing multiple modulation patterns in a single channel |
US10098694B2 (en) | 2013-04-08 | 2018-10-16 | Apama Medical, Inc. | Tissue ablation and monitoring thereof |
EP3010580A1 (en) | 2013-06-18 | 2016-04-27 | Cardiac Pacemakers, Inc. | System and method for mapping baroreceptors |
WO2015013205A1 (en) | 2013-07-22 | 2015-01-29 | Boston Scientific Scimed, Inc. | Medical devices for renal nerve ablation |
WO2015057521A1 (en) | 2013-10-14 | 2015-04-23 | Boston Scientific Scimed, Inc. | High resolution cardiac mapping electrode array catheter |
WO2015084774A1 (en) | 2013-12-05 | 2015-06-11 | Cardiac Pacemakers, Inc. | Dosed delivery of autonomic modulation therapy |
US9764113B2 (en) | 2013-12-11 | 2017-09-19 | Magenta Medical Ltd | Curved catheter |
US20170189642A1 (en) | 2014-03-09 | 2017-07-06 | NeuroTronik IP Holding (Jersey) Limited | Systems and methods for neuromodulation of sympathetic and parasympathetic cardiac nerves |
US9415224B2 (en) | 2014-04-25 | 2016-08-16 | Cyberonics, Inc. | Neurostimulation and recording of physiological response for the treatment of chronic cardiac dysfunction |
US9597515B2 (en) | 2014-03-28 | 2017-03-21 | Cardiac Pacemakers, Inc. | Systems and methods for facilitating selection of one or more vectors in a medical device |
CA2946791C (en) | 2014-05-22 | 2023-09-19 | CARDIONOMIC, Inc. | Catheter and catheter system for electrical neuromodulation |
WO2015187386A1 (en) | 2014-06-03 | 2015-12-10 | Boston Scientific Scimed, Inc. | Electrode assembly having an atraumatic distal tip |
EP3151773B1 (en) | 2014-06-04 | 2018-04-04 | Boston Scientific Scimed, Inc. | Electrode assembly |
CN109199581A (en) | 2014-08-05 | 2019-01-15 | 上海魅丽纬叶医疗科技有限公司 | Radio frequency ablation catheter and its equipment with network management shape supporting structure |
US20170312525A1 (en) | 2014-08-06 | 2017-11-02 | NeuroTronik IP Holding (Jersey) Limited | Systems and methods for neuromodulation of sympathetic and parasympathetic cardiac nerves |
WO2016040037A1 (en) | 2014-09-08 | 2016-03-17 | CARDIONOMIC, Inc. | Catheter and electrode systems for electrical neuromodulation |
US20160174864A1 (en) | 2014-12-18 | 2016-06-23 | Biosense Webster (Israel) Ltd. | Far Field-Insensitive Intracardiac Catheter Electrodes |
CN109568786A (en) | 2015-01-05 | 2019-04-05 | 卡迪诺米克公司 | Heart, which is adjusted, promotes method and system |
US20180236220A1 (en) | 2015-01-14 | 2018-08-23 | NeuroTronik IP Holding (Jersey) Limited | Inflatable intravascular electrode supports for neuromodulation |
US9737228B2 (en) | 2015-01-30 | 2017-08-22 | Cardiac Pacemakers, Inc. | Physiologic event detection and data storage |
WO2016176333A1 (en) | 2015-04-27 | 2016-11-03 | Reflex Medical, Inc. | Systems and mehtods for sympathetic cardiopulmonary neuromodulation |
EP3302602A1 (en) | 2015-06-04 | 2018-04-11 | Jozef Reinier Cornelis Jansen | Method and computer system for processing a heart sensor output |
US20170065818A1 (en) | 2015-09-08 | 2017-03-09 | Interventional Autonomics Corporation | Neuromodulation Systems and Methods for Treating Acute Heart Failure Syndromes |
US11771491B2 (en) | 2015-12-30 | 2023-10-03 | Schuler Scientific Solutions, Llc | Tissue mapping and treatment |
EP3426338A4 (en) | 2016-03-09 | 2019-10-30 | Cardionomic, Inc. | Cardiac contractility neurostimulation systems and methods |
US11026619B2 (en) | 2016-04-13 | 2021-06-08 | Cardiac Pacemakers, Inc. | Determining cardiac pacing capture effectiveness of an implantable medical device |
US10292844B2 (en) | 2016-05-17 | 2019-05-21 | Medtronic Vascular, Inc. | Method for compressing a stented prosthesis |
JP7142020B2 (en) | 2016-11-22 | 2022-09-26 | シネコー・エルエルシー | A system for introducing a mitral valve therapy device (MVTD) to a mitral valve location |
US20180214697A1 (en) | 2017-01-31 | 2018-08-02 | NeuroTronik IP Holding (Jersey) Limited | Enhancing left ventricular relaxation through neuromodulation |
EP3606425B1 (en) | 2017-04-05 | 2022-06-01 | Medtronic Vascular Inc. | Sizing catheters, methods of sizing anatomies and methods of selecting a prosthesis for implantation |
-
2015
- 2015-08-31 AU AU2015315570A patent/AU2015315570B2/en active Active
- 2015-08-31 EP EP15763160.7A patent/EP3194017A1/en active Pending
- 2015-08-31 WO PCT/US2015/047780 patent/WO2016040038A1/en active Application Filing
-
2017
- 2017-03-01 US US15/446,881 patent/US10722716B2/en active Active
-
2020
- 2020-07-24 US US16/937,932 patent/US20200360694A1/en active Pending
- 2020-08-12 AU AU2020217387A patent/AU2020217387B2/en active Active
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060089694A1 (en) * | 2004-10-21 | 2006-04-27 | Cardiac Pacemakers, Inc. | Delivery system and method for pulmonary artery leads |
US20080071178A1 (en) * | 2006-09-15 | 2008-03-20 | Cardiac Pacemakers, Inc. | Anchor for an implantable sensor |
US20090171411A1 (en) * | 2006-12-06 | 2009-07-02 | The Cleveland Clinic Foundation | Method and System for Treating Acute Heart Failure by Neuromodulation |
US20090228078A1 (en) * | 2007-12-12 | 2009-09-10 | Yunlong Zhang | System for stimulating autonomic targets from pulmonary artery |
US7925352B2 (en) * | 2008-03-27 | 2011-04-12 | Synecor Llc | System and method for transvascularly stimulating contents of the carotid sheath |
US20130072995A1 (en) * | 2011-07-11 | 2013-03-21 | Terrance Ransbury | Catheter system for acute neuromodulation |
Cited By (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11986650B2 (en) | 2006-12-06 | 2024-05-21 | The Cleveland Clinic Foundation | Methods and systems for treating acute heart failure by neuromodulation |
US11229398B2 (en) | 2016-03-09 | 2022-01-25 | CARDIONOMIC, Inc. | Electrode assemblies for neurostimulation treatment |
US11806159B2 (en) | 2016-03-09 | 2023-11-07 | CARDIONOMIC, Inc. | Differential on and off durations for neurostimulation devices and methods |
US11559687B2 (en) | 2017-09-13 | 2023-01-24 | CARDIONOMIC, Inc. | Methods for detecting catheter movement |
US11077298B2 (en) | 2018-08-13 | 2021-08-03 | CARDIONOMIC, Inc. | Partially woven expandable members |
US11648395B2 (en) | 2018-08-13 | 2023-05-16 | CARDIONOMIC, Inc. | Electrode assemblies for neuromodulation |
US11607176B2 (en) | 2019-05-06 | 2023-03-21 | CARDIONOMIC, Inc. | Systems and methods for denoising physiological signals during electrical neuromodulation |
Also Published As
Publication number | Publication date |
---|---|
AU2015315570B2 (en) | 2020-05-14 |
WO2016040038A1 (en) | 2016-03-17 |
AU2020217387A1 (en) | 2020-09-03 |
AU2015315570A1 (en) | 2017-04-06 |
US10722716B2 (en) | 2020-07-28 |
AU2020217387B2 (en) | 2022-10-06 |
EP3194017A1 (en) | 2017-07-26 |
US20170173339A1 (en) | 2017-06-22 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US20200360694A1 (en) | Methods for electrical neuromodulation of the heart | |
US20200197692A1 (en) | Catheter and catheter system for electrical neuromodulation | |
US11986650B2 (en) | Methods and systems for treating acute heart failure by neuromodulation | |
US20210370068A1 (en) | Floatable catheters for neuromodulation | |
JP5309210B2 (en) | Stimulus delivery system for delivering spinal cord stimulation | |
US20200101292A1 (en) | Systems and methods of facilitating therapeutic neuromodulation |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: CARDIONOMIC, INC., MINNESOTA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:WALDHAUSER, STEVEN L.;GOEDEKE, STEVEN D.;SIGNING DATES FROM 20160125 TO 20160126;REEL/FRAME:053303/0875 |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: DOCKETED NEW CASE - READY FOR EXAMINATION |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: PRE-INTERVIEW COMMUNICATION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NON FINAL ACTION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: RESPONSE TO NON-FINAL OFFICE ACTION ENTERED AND FORWARDED TO EXAMINER |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: FINAL REJECTION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NON FINAL ACTION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: RESPONSE TO NON-FINAL OFFICE ACTION ENTERED AND FORWARDED TO EXAMINER |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: FINAL REJECTION MAILED |