Not Applicable.
1. Field of the Invention
The present invention relates to the structure and manufacturing process for fracture resistant, implantable electrical lead bodies for use in conjunction with implantable electronic medical devices, such as cardiac pacemakers and defibrillators, that monitor and/or stimulate a tissue of an animal for therapeutic purposes.
2. Description of the Related Art
Numerous medical conditions, such as cardiac and neurological dysfunctions, are treated by implanted electronic devices which provide monitoring and/or electrical stimulation to the affected tissues of an animal. These devices are of various types and constructions, and typically attach to the animal tissue via implanted leads. These leads may be partially or entirely intra-vascular.
Failures in the bodies of such leads may result in compromise of some or all of the functional intent of the implanted electronic device. Lead body failure modes include partial or complete insulation break, insulation perforation, partial or complete conductor coil fracture, EMI pickup by the lead body, and lead body maturation or dislodgement. For Implanted Cardiac Defibrillators (ICDs), lead body failures may manifest as over sensing, under sensing, loss of capture or non-capture, loss of output, Pacemaker Mediated Tachycardia (PMT). See Chakri Yarlagadda, MD, FACC, FASNC, FSCAI, Director of Non-Invasive Cardiology, St Joseph Health Center; Invasive Cardiologist, Ohio Heart Institute: “Pacemaker Malfunction”, Feb. 18, 2009, eMedicine from WebMD, (http://emedicine.medscape.com/article/156583-overview).
The above described lead body failures often result from mechanical stresses introduced by surgical sutures, post-surgery flexure, or lead body conductor coil mechanical resonances. The coiled helixes of the lead body conductors form a natural spring with very little damping, and can easily resonate in response to mechanical inputs from body motion. Left unchecked, such resonance will eventually result in mechanical abrasion and weakening of the surrounding lead body insulation, as well as lead body conductor coil breakage due to local metal fatigue. The above lead body failures can also be promoted by pinching of the lead body structure from suturing or pinching between skeletal structures, such as the upper ribs and clavicle. A closely wound conductor helix can be kinked by such, thus predisposing the electrical conductor to fracture.
With the definition of a Lead Defect being that which requires surgery to correct a fracture or sensing flaw, recent studies have shown that approximately 15% of ICD patients experience a lead defect within five years of implantation, that 40% of ICD patients experience a lead defect within eight years of implantation, and that the annual failure rate levels off at 20%/year beyond ten years. See Thomas Kleemann, MD: Herzzentrum Ludwigshafen, Germany, “Increasing Rates of ICD Lead Failure Noted During Long Term Follow-Up”, Heartwise, Apr. 30, 2007, (http://www.theheart.org/article/787831.do), repeated in Medscape May 4, 2007.
Lead body fractures in conjunction with ICDs may result in misinterpretation of conductor fracture induced noise as fibrillation, leading to subsequent inappropriate shocks to the patient. These shocks are often repetitive due to the structural problem in the lead body and can be traumatic to the patient. Most importantly, shocks due to lead body fractures are no longer synchronized to the patient's intrinsic heart beat in the normal fashion, and have therefore been known to induce ventricular fibrillation. In such cases, because the lead body is damaged, adequate energy for defibrillation may not be delivered and result in death to the patient. Lead body fractures in the case of pacemakers can cause over sensing and/or failure to capture which can result in the patient fainting.
Potential complications during lead-change surgery include vascular injury, venous thrombosis, cardiac tapenade, hemothorax, pneumothorax, perforation of heart, avulsion of right ventricle, bleeding, and infection. See Chakri Yarlagadda, supra.
Considering: a) the potential for inappropriate shocks to the patient; b) the severity of potential lead-replacement surgical complications; c) the existence of a few million ICD and pacemaker patients worldwide with hundreds of thousands of new implants being added yearly, and d) the potential for lead failure rates noted above, there is therefore a need for implanted medical leads to attain improved robustness and resistance to fracture from mechanical stresses. An alternative method for design and manufacturing of a lead body with improved performance is therefore needed.
The present invention pertains to a geometry and manufacturing process to create an implantable medical lead using a reflow process employing heat shrinkable tubing along the entire length of the lead. That medical lead comprises a polymer sandwich of varying polymer hardnesses surrounding the lead coils. Bottomley in U.S. Published Patent Application No. 2008/0243218 employs PET (poly(ethylene terephthalate) for various purposes including overmold insulation, spiral wrap insulation, lead-end terminations, and as spot heat shrink to aid in manufacturing steps. But Bottomley teaches neither using a sandwich of polymers of different hardnesses which are reflowed into a sandwich around the lead coils, nor the reflow technique of the present invention wherein heat shrinkable tubing is employed along the entire length of the lead and then heated to effect a uniform polymer reflow. Bottomley instead teaches a drawdown reflow process using a heated die. The Kampa, et al. U.S. Pat. No. 7,112,298 describes the use of a polymer to form the diameter of a catheter lumen, and manufacturing the balance of the catheter in layers around this interior coating. Drawdown through heated dies is mentioned as a method of forming outer layers of the catheter. Neither the full-length heat shrinkable tubing process of the present invention, nor implantable lead manufacture, is mentioned. The Snow U.S. Published Patent Application No. 2001/0010247 teaches manufacturing of reinforced thin walled cannula with a relatively large lumen, in which a coated elongate member is wound in a helical manner around a mandrel. Heat shrinkable tubing compresses the elongate prior to heating to aid in the elongate member sealing its own interlocking edges. Other layers may be added on top of the elongate, with heat used to fuse these subsequent layers together. No mention is made of implantable lead manufacture via a sandwich of polymers of different hardnesses which are reflowed into a sandwich around lead coils.
The present invention defines an alternative design and associated manufacturing process which together produce implantable medical lead bodies with improved robustness and resistance to fracture from mechanical stresses, resulting in a decrease in the presently experienced lead failure rates detailed above. They are intended as an alternative to prior design and manufacturing techniques, attempting to overcome recognized limitations of the prior art.
In the present implantable medical lead body a lead body conductor coil or coils is embedded in a sandwich of a polymer (such as for example polytetrafluoroethylene, silicone, or polyurethane) which has degrees of hardness in such a way as to allow for lead body flexure in both the radial and longitudinal directions. That polymer sandwich provides a supporting structure for the lead body conductor coils.
Another aspect of the current invention is attainment of intimate contact between the polymer sandwich material and the lead body conductor coils by means of a reflow process.
A further aspect is providing the ability to vary the lead body flexibility and handling characteristics by selecting different combinations of polymer hardness and thickness.
Yet another aspect of the invention is use of the softest polymer layer directly over the lead body conductor coils to encapsulate them and to provide flexibility as well as mechanical damping.
Another aspect of the current invention is elimination of mechanical resonances in the conductor coils by the polymer sandwich.
Still another aspect is a lead body conductor coil pattern that leaves some space (approximately one-fourth to two times the conductor width) between adjacent turns of the coil conductors (or between adjacent filars of the electrical conductor) to allow movement without coil-to-coil interference.
A further aspect of the current invention is incorporation of a lumen core at the center of the lead body.
Another aspect of the current invention is production of an implantable medical lead body with improved robustness and resistance to fracture from the suture and flexing introduced mechanical stresses commonly experienced by implantable leads.
The lead body configuration and associated manufacturing process encompassed by the current invention together provide improved robustness and resistance to fracture from the suture, flexing, and vibration introduced mechanical stresses commonly experienced by implantable leads.
The current invention spans the areas of geometric configuration design, material selection, manufacturing techniques, and manufacturing steps.
“Filar” means the number of separate conductive strands wound onto the lead body.
“Reflow” means applying sufficient pressure and temperature to a polymeric material to cause it to change configuration.
“Teflon®” is used here in its generic sense and includes PTFE, ETFE, FEP and other non-stick coatings.
The manufacturing process creates the layers of the electrical lead body 100 in a step-by-step fashion from the inside-out as follows.
As best shown in
Then, the first insulating layer 16 is applied to the mandrel 10 as a tube which is slid over the tapered end 10a of mandrel 10 followed at step 56 by sliding a first length of heat shrink tubing (not shown) also over the tapered end 10a, over the not yet reflowed first insulating layer 16. The first length of heat shrink tubing material (not shown) is then exposed at step 58 to heat for a period of time sufficient to cause the first heat shrink material (not shown) to decrease diametrically in size and to reflow the first insulating layer 16. In one embodiment, suitable heat shrink materials include FEP (fluorinated ethylene polypropylene), however, it is noted that other materials possessing similar characteristics would also work, thus the invention is not considered to be so limited. Due to variables such as the pitch of the spiral wound electrical conductor 20 and the thickness of the first, second and third insulating layers 16, 22, 26 it is difficult to characterize the heat treatment necessary to cause the first, second and third insulating layers 16, 22, 26 to reflow. In one embodiment, a vertical reflow system is used (not shown), which is well known to those skilled in the art. A vertical reflow system comprises a cylindrical chamber which is provided with a heat source through which the lead body is sequentially passed. It has been found that the first, second and third insulating layer 16, 22, 26 successfully reflow at a temperature of 450 degrees C., plus or minus 25 degrees C. when passed through a vertical reflow system at a speed of 0.1 to 0.3 centimeters per second. Following reflowing of the first insulating layer 16 the first length of heat shrink tubing (not shown) is removed and discarded at step 60.
The process of gradual heating, with compression applied by the heat-shrinkable-tubing, results in a relatively uniform thickness layer of polymer being deposited on the mandrel, forming first insulating layer 16.
The electrical conductor 20 in one embodiment is MP35N drawn fused tubing sold under the name DFI® but could also be any non-ferromagnetic material having sufficient conductivity to deliver electrical energy through the lead body 100. The MP35N drawn fused tubing is an insulated conductor which could be insulated by such bio-compatible materials such as Teflon®, polyimide, urethanes or other materials. The conductive coil layer 15 may be initially secured in place using a variety of methods (e.g., crimping, swaging, heat shrink, others) (not shown). It is understood that the winding pattern for the conductive coil layer 15 shown herein is for purposes of illustration only and therefore does not limit the scope of the invention. As an example, the winding pattern as illustrated is monofilar, however, the invention is also compatible with multifilar applications. It is also understood that while a single conductive coil layer is shown in the drawings, this is for purposes of illustration only and therefore additional embodiments utilizing multiple conductive coil layers are also compatible with the method of this invention and therefore within its scope.
In one embodiment the second set of blockers 18 comprises a heat shrink material, where at step 64 the heat shrink material is placed over the coil between the second set of blockers 18 and serves to prevent the migration of the subsequent (i.e., second 22 and third 26) insulating layers. In one embodiment, suitable heat shrink materials include PET (polyethylene terephthalate) heat shrink material, however, it is noted that other materials possessing similar characteristics would also work, thus the invention is not considered to be so limited. Placement of the second set of blockers 18 is followed by the application of heat to cause the heat shrink material to shrink in size.
As shown in
All the insulating layers by be made of the same general type of material or different materials, however, in either case the layers have a particular relationship in respect of their degrees of hardness. Specifically, the second insulating layer 22 is softer than the first and third insulating layers 16 and 26. That is, the second insulating layer 22 has a lower degree of hardness that both the first and third insulating layers 16 and 26. The first and third insulating layers 16 and 26 may have the same or different degrees of hardness. The relative hardness and thickness of the insulating layers 16, 22, and 26 may be varied to affect the desired lead body flexibility and handling characteristics, provided that the second insulating layer 22 is softer than the first and third insulating layers 16 and 26. The polymers of layers 16, 22, and 26 provide inherent biocompatibility with the animal into which the electrical lead body 100 will be implanted.
A cushioning, vibration damping sandwich is formed by surrounding the conductive coil layer 15 by polymer layers 16, 22 and 26. This sandwich structure of multiple coaxial insulating layers reduces mechanical resonances within the coiled electrical conductor 20, thereby minimizing such resonances as a potential cause of conductor fatigue which could eventually result in lead body failure. The relative softness of second insulating layer 22 relative to the first and third insulating layers 16 and 26 is essential to achieve this vibration dampening.
With reference to
The new electrical lead body 100 depicted in
The foregoing description was primarily directed to a certain embodiments of the industrial vehicle. Although some attention was given to various alternatives, it is anticipated that one skilled in the art will likely realize additional alternatives that are now apparent from the disclosure of these embodiments. Accordingly, the scope of the coverage should be determined from the following claims and not limited by the above disclosure.
This application is a continuation-in-part of U.S. patent application Ser. No. 13/199,097 filed on Aug. 19, 2011, and claims benefit of U.S. provisional patent application No. 61/401,867 filed on Aug. 20, 2010 and U.S. provisional patent application No. 61/469,167 filed on Mar. 30, 2011, the disclosures in which are incorporated herein by reference as if set forth in their entirety herein.
Number | Date | Country | |
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61401867 | Aug 2010 | US | |
61469167 | Mar 2011 | US |
Number | Date | Country | |
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Parent | 13199097 | Aug 2011 | US |
Child | 13435931 | US |