1. Field of the Invention
At least one embodiment of the invention refers to a leadless heart stimulation and/or monitoring device such as a leadless pacemaker. The device comprises a sealed housing, one or more electrodes configured to electrically contact heart tissue when in use and electric components arranged within the housing. The electric components are at least in part operationally connected to the at least one electrode. Further, the electric components comprise a power supply for providing power supply to at least some of the other electric components.
2. Description of the Related Art
In recent years, earnest efforts have been undertaken to develop key components for realizing leadless pacemaker designs. Such engagements have centered on weaning the delivery of pacing waveforms from explicit, wired linkages to distally-stationed pulse generation units.
The strategy, in recognition of the notable fraction of implant complications stemming from lead-associated factors, has crafted a unique set of development criteria for affiliated pacemaker designs. Most proposed configurations have explored myocardial interfacing through intravenous implantation. After injection via a catheter the device resides within targeted heart chamber. The sizing constraints presented by such placements, coupled with the challenges linked to device extraction and replacement, have fostered demand for both higher energy density primary cell chemistries and rechargeable in-implant power sources.
It is an object of at least one embodiment of the invention to provide such a cardiac device that meets the demand described in the previous section at least in part.
According to a first aspect of the invention, this object is achieved by a leadless heart stimulation and/or monitoring device having a sealed housing, one or more electrodes configured to electrically contact heart tissue when in use and electric components arranged within the housing. The electric components are at least in part operationally connected to the at least one electrode. The electric components include a power supply for providing power to the electric components. The power supply includes a rechargeable battery. The power supply further comprises a coil that is configured to receive electric power via a tuned magnetic field.
According to a second aspect of the invention, this object is achieved by an leadless heart stimulation and/or monitoring system comprising a device having a sealed housing, one or more electrodes configured to electrically contact heart tissue when in use and electric components arranged within the housing. The electric components are at least in part operationally connected to the at least one electrode. The electric components include a power supply for providing power to the electric components. The power supply includes a rechargeable battery and further comprises an implant-based coil that is configured to receive electric power via a tuned magnetic field.
The system further comprises a catheter having a distal end and a catheter-based coil arranged at or near the distal end. The catheter is dimensioned to be introduced into a heart chamber and the catheter-based coil is tuned to the implant-based coil.
Thus, means are provided for renewing on-board system power in leadless pacemakers. By means of an infrequent (once every few years; preferred about five years) venous access procedure, a specially-designed catheter can interact with the implant which is anchored to the myocardium and reside within the patient's heart in ways that maximize electromagnetic coupling dynamics and provide optimal recharging responses.
At least one embodiment of the invention includes the recognition that a key complication for rechargeable support arises from the complexities associated with delivering effective wireless coupling from electromagnetic sources outside of the body to devices stationed within it. In even the most efficient telemetry interfacing systems, inductive charging efficiencies notably decay as a function of the receiving unit's implant depth. In general the voltage across an inductive link falls of as the cube of the distance separating the coils, which means that the power transferred falls off to the sixth power of the distance. The coil size associated with the shallow pockets of traditional pacemakers already overwhelms the available volumes presented by packaging constraints endemic to pacer configurations and thus has little opportunity for effective scaling. With this context in effect, the invention provides a solution for circumventing the efficiency losses associated with inductive charging from sources outside the body by describing a technique where venous catheter-based interfacing serves to maximize the recharging response.
According to a preferred embodiment, the at least one electrode is configured to anchor the device in heart tissue and serves a fixation element. It is therefore preferred if the at least one electrode is a helical screw-in electrode.
Preferably, the electric components comprise a battery recharging circuit that is electrically connected to both, the implant-based coil and the rechargeable battery of the power supply.
The housing of the device preferably has a diameter of less than 8 mm and even more preferred, less than 6.3 mm (19 Fr).
The device preferably comprises a second fixation element that is arranged at a proximal end and configured to be latched by a capturing element of a catheter. In this context, it is preferred that the recharging catheter comprises a capturing element mating the second fixation element. In a second embodiment a snare catheter is used to grab the device fixation element. The recharging catheter is then guided to the device by advancing over the snare catheter.
Additionally or alternatively, the recharging catheter preferably is dimensioned so that a distal catheter end (the catheter tip) can slip over the housing of the device. In this embodiment, the catheter has an open distal end with an inner diameter that is slightly larger than the outer diameter of the housing of the device.
In such embodiment, recharging is achieved by placing a catheter-based coil over the external housing of the device. The recharging source coil, which resides within the distal end of the catheter forms a solenoid at the catheter's bore. This embodiment provides the shortest charging times as it results in the source and receiver coils aligning co-axially. In this embodiment the catheter can either exist as a lose fitting architecture that can easily slip over both the implanted device and any tissue that has encapsulated it or it could provide a tighter fit in contexts where the in-growth is either managed appropriately or the distal end of the recharging catheter presents a means for cutting through unmanaged in-growth.
Alternatively, the recharging catheter presents a smaller diameter than the device's housing and thus does not fit around the full girth of the implant housing, but instead contains a mechanism for latching onto the end of the implant such that the primary and secondary coils align coaxially (though offset along that common axis). With this configuration, the recharging catheter contains either an inner tool (e.g. a mechanical capturing element) for mechanically grabbing and holding the implant, or a magnetic tool for “recapturing” the implant. As with the first embodiment, the catheter-based coil can be employed as an electromagnet for capturing the device magnetically. In an alternative embodiment, a snare catheter is used to grab the device fixation element. The recharging catheter is then guided to the device by advancing over the snare catheter.
In an embodiment wherein the recharging catheter does not comprise a capturing element, the catheter does not need to attach to or surround the device, but may instead be stationed in near proximity (for example, within the same heart chamber). With such an approach, charging is less efficient than the two previously discussed methods because the coils are not co-axial. It still however presents a case that is orders of magnitude more efficient than re-charging from the body surface due to the power transfer decay as a sixth power of the distance between inductively coupled links.
Alternatives to the claimed solution are
At least one embodiment of the invention includes the recognition that, because power falls off to the sixth power of distance. The efficiency of inductively powered systems where the implant coil diameter is ˜5 mm and the distance separating the receiver and source coils is ˜8 cm (or more) is typically well under 0.1%. To make matters worse, this percentage is reported for perfectly aligned coils, whereas in practice the implanted device coil may present steep angles to the nearest external surface of the body. This misalignment of the coils compounds the inefficiencies.
In the case where sources outside the body are leveraged to instate inductive charging, the affiliated efficiency penalties are anticipated to require substantial “overdriving” of the electromagnetic source and a dramatic increase in the time required to renew charging to appropriate levels. Overdriving of the transmit coil is fundamentally limited by the Specific Absorption Rate, which in the US is 1.6 W/Kg. One cannot transmit beyond this limit without risk of damaging tissue through heating. Such demands could mean that dependent patients would face a need to recharge their pacemakers relatively frequently (potentially once or more per month) using Holter-like devices that would be worn for extended periods. Considering the need for an increased output from the driver unit, the recharging session might even demand that the patient remain tethered to a wall outlet or, worse yet, spend frequent 24-hour spans (or longer) in clinical care facilities.
Sidestepping rechargeable power sources in light of their noted complications motivates a need for primary cell support. Unfortunately, even the highest density battery chemistries present complications for packing appropriate capacities into packages sized to support 5 year pacing life spans for in-chamber implant devices. To add further challenge, device in-growth and the constant motion of the heart present challenges for “recapturing” the implant at the end of the primary cell's battery life. Such confounding factors create serious hurdles for device extraction/replacement, whether it will be a full change-out or a battery replacement alone.
Last, device feature set reduction, while certainly an available factor for managing power consumption, can unwittingly undermine value proposition for leadless pacemaker designs. Though it is easier to support less functionality for longer spans of time, such an approach makes the devices less useful as therapy delivery vehicles. In addition, there are limited gains by limiting device functionality. In one embodiment over 50% of the battery capacity goes directly into pacing the heart, so de-featuring a device is squeezing gains only from a minority of the energy usage because the pacing output cannot be omitted.
The claimed solution to enhanced recharging support centers on the use of dedicated periodically-scheduled sessions for administering catheter-based power renewal. During the sessions, which are anticipated occurring at most once every 5 years, the patient steps into a clinical setting and receive venous-reliant delivery of a battery recharge response. The procedure involves the insertion of a catheter into the vasculature and the subsequent routing of its distal end to the implant site of the pacer. The terminus of the catheter (that is the catheter tip) presents a charging coil to the in-body device (that is the heart stimulation and/or monitoring device). Due to the electromagnetic coupling efficiencies achieved via the close proximity of the recharging source and the receiving coil on the pacemaker, a rapid recharge process ensues wherein the patient achieves complete power source renewal in a matter of, at most, a few hours.
The optimal method for realizing the approach presented herein centers on the development of a catheter-based coil structure stationed in the terminus of the recharging catheter and an affiliate small-frame implant-based receiver coil in the body of the device. The catheter-based source coil, after being fed through the vasculature, enables delivering close proximity inductive recharging capabilities by mitigating a vast majority of the absorption response endemic to recharging strategies that leverage coupling at a distance and deep-body electromagnetic penetration dynamics. Specifically, an electrophysiologist inserts the catheter, potentially from a femoral implantation site (though others might be considered), and steer it into position such that it either latches onto the back end of the pacer or, worst case, is simply parked close to the device. Alternatively, a snare catheter is used to capture the back end of the device, and then the recharging catheter is advanced over the snare catheter to the back end of the device. After appropriately positioning the charging catheter, the patient is then connected to charging equipment in the catheter laboratory and subjected to a recharging procedure or they are ushered to an out of lab monitoring station where longer duration recharging ensues. In either case the terminus of the charging catheter located external to the body operates as the injection port for driving power into the delivery coil. After a full recharge session, the electrophysiologist removes the catheter and the patient thus has renewed pacemaker support for another number of years.
The above and other aspects, features and advantages of embodiments of the invention will be more apparent from the following more particular description thereof, presented in conjunction with the following drawings, wherein:
a and b: illustrate the operation of the embodiment of
a and b: disclose an alternative embodiment;
a and b: illustrate a further alternative embodiment;
In
The heart stimulation and/or monitoring device has a sealed housing 20 that included a power supply comprising a rechargeable battery 22. Battery 22 may be composed of one or more battery cells. Housing 20 further includes electric components 24 that are operatively connected to batteries 22.
At a distal end of the heart stimulation and/or monitoring device 10, a helical screw 26 is arranged that can be screwed into heart tissue in order to fix the heart stimulation and/or monitoring device to myocardium 16 (heart tissue). Screw 26 thus serves as a first fixation element. Screw 26 may in some embodiments made from electrically conductive material so as to establish an electric contact to the myocardium after implantation and serve as sensing and/or stimulation electrode.
Batteries 22 are rechargeable. For recharging batteries 22, the device's power supply comprises an implant-based coil 28 that is dimensioned and arranged so as to receive electric power via an alternating magnetic or electro-magnetic field. Implant-based coil 28 is connected to batteries 22 via a battery charging circuit that is part of the electric components 24.
The distal end of catheter 12 is provided with a catheter-based coil 30 that can generate and emit an alternating magnetic or electromagnetic field. Implant-based coil 28 and catheter-based coil 30 are tuned so as to allow an efficient transfer of energy from coil 30 to coil 28.
Catheter-based coil 30 is electrically connected to an external energy source (not shown) at least when in use. Electric leads (not shown) providing such electric connection are integrated in catheter 12 and supply power to catheter-based coil 30.
a and 3b illustrate the operation of the embodiment from
According to this embodiment, recharging is achieved by placing the catheter-based coil 30 over the external housing 20 of the device 10. The catheter-based recharging source coil 30, which resides within the distal end of the catheter 12 forms a solenoid at the catheter's bore. In another embodiment the coil is embedded in the sidewall of the catheter. This embodiment provides the shortest charging times as it results in the source and receiver coils 30 and 28 aligning co-axially. In this embodiment the catheter 12 can either exist as a lose fitting architecture that can easily slip over both the implanted device 10 and any tissue 32 that has encapsulated it or it could provide a tighter fit in contexts where the in-growth is either managed appropriately or the distal end of the recharging catheter presents a means for cutting through unmanaged in-growth. In the case that in-growth is appropriately managed and a tighter diameter catheter tip is used, the catheter-based charging coil 30 could potentially be used to “recapture” the exposed portion of the implant via electromagnetic attraction.
Potential disadvantages of the embodiment of
It is noted that in
In order to keep the outer and thus the inner dimensions of the distal end of catheter 12 as small as possible and thus close to the outer diameter of the implantable device, recharging according to the embodiment of
a and 4b illustrate a second embodiment, wherein the recharging catheter 12′ presents a smaller diameter (for example, 10 Fr, that is 3.3 mm) and does not fit around the full girth of the implant housing 20, but instead contains a mechanical capturing element for latching onto a second fixation element 36 at the proximal end of the implantable device 10 such that the primary and secondary coils 30 and 28 align coaxially (though offset along that common axis). With this configuration, the recharging catheter 12 contains either an inner tool for mechanically grabbing and holding the implant, or a magnetic tool for “recapturing” the device. To achieve the latter, catheter-based coil 30 can be employed to serve as an electromagnet for capturing the device magnetically.
Similar to
The type of recharging that is illustrated in
a and 5b illustrate yet another embodiment of this invention that would again leverage a smaller diameter recharging catheter (for example, 10 Fr.). In this configuration, the recharging catheter 12 would not need to attach to or surround the implant 10, but would instead be stationed in near proximity (for example, within the same heart chamber). With such an approach, charging is less efficient than the two previously discussed methods because the coils 28 and 30 are not co-axial. It still however presents a case that is orders of magnitude more efficient than re-charging from the body surface due to the power transfer decay as a 6th power of the distance between inductively coupled links.
Again, in
As can be taken from
In the embodiment shown in
The leadless pacemaker 10 further has a second fixation element 36 on its proximal side to fix the leadless pacemaker 10 on the implantation tool, which is in this embodiment an introduction catheter but could as well be a recharging catheter. The second fixation element 36 connects the leadless pacemaker to the catheter. According to the embodiment of
In an alternative embodiment also shown in
For the embodiment shown in
For example during implantation of a leadless pacemaker the catheter is forwarded up to the cardiac tissue and via the electrodes 48 of the catheter sheath electrical cardiac signals are sensed and displayed on the programmer. The implanting physician can decide whether the position is appropriate for final implantation or not and replace the distal end of the catheter if necessary. Once the final position of for implantation is found the leadless pacemaker located within the catheter sheath is forwarded and fixed, the second fixation element at the distal side of the leadless pacemaker is released and the sheath is removed.
In an alternative embodiment of the second fixation element for fixing the proximal side of the leadless pacemaker an inflatable balloon is located within the catheter sheath near the distal end of the catheter. The leadless pacemaker in this embodiment is formed at its proximal end such that the proximal end of the implant deforms the deflated balloon on introduction into the catheter sheath from the distal end of the sheath but allows the balloon to grip the proximal end of the leadless pacemaker when inflated. In a preferred embodiment the proximal end of the leadless pacemaker, as shown in
The inductive recharging strategy presented in this disclosure offers a realistic avenue for dramatically extending the functional lifespan of leadless pacemakers. As most pacer designs interface with the myocardium via implant sites internal to the heart, robust anchoring methods prove essential. Device dislodgement in such contexts would knowingly lead to pulmonary embolisms (on the right-side of the heart) and/or stroke (on the left). Unfortunately, this need for robust anchoring combined with device in-growth, implant depth, and the constant contractions and blood flow native to the implant environment, present serious challenges for renewed/continual power support. The electromagnet absorption response of the human body enforces weak coupling for inductive charging sources stationed outside of the body. By directly recharging using a close-proximity catheter our approach cuts recharging times to manageable levels, trading off short-term procedure-affiliated discomforts for dramatic gains in device support and longevity. Compared to efforts that rely upon primary cell chemistries, our approach additionally overcomes periodic device replacement needs, avoiding the complications associated with implant recapture and explantation processes. Last, device feature set minimization can be driven to a reduced extent by power source management and more so via device sizing and heart geometry considerations.
Although an exemplary embodiment of the invention has been shown and described, it should be apparent to those of ordinary skill that a number of changes and modifications to the invention may be made without departing from the spirit and scope of the invention. This invention can readily be adapted to a number of different kinds of implantable medical devices by following the present teachings. All such changes, modifications and alterations should therefore be recognized as falling within the scope of at least one embodiment of the invention.
This application claims the benefit of U.S. Provisional Patent Application 61/643,912, filed on 8 May 2012 and U.S. Provisional Patent Application 61/643,911, filed on 8 May 2012 the specifications of which are hereby incorporated herein by reference.
Number | Date | Country | |
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61643912 | May 2012 | US | |
61643911 | May 2012 | US |