Selectively connecting the tip electrode during therapy for MRI shielding

Abstract

A medical device includes a pulse generator and an electrode configured to contact tissue in a body vessel. The medical device includes a lead that includes a lead connector. The lead connector connects a pulse generator with an electrode via a conductive path. An electrode switch is electrically connected between the lead conductor and the electrode. The electrode switch includes an open state preventing the conductive path between the lead and the electrode. The electrode switch includes a closed state establishing the conductive path between the lead and the electrode when a voltage is applied across the electrode switch that exceeds a threshold voltage. The electrode switch in the open state electrically shields the electrode from electromagnetic radiation and induced voltages during magnetic resonance imaging.

Description

TECHNICAL FIELD

Embodiments of the present invention relate to medical devices and the simultaneous delivery of diagnostic and therapeutic treatments. More specifically, embodiments of the present invention generally relate to implantable medical devices and minimizing the delivery of RF induced voltages to surrounding body tissue in an MRI environment.

BACKGROUND

Magnetic resonance imaging (MRI) is a non-invasive imaging method that utilizes nuclear magnetic resonance techniques to render images within a patient's body. Typically, MRI systems employ the use of a static magnetic coil having a magnetic field strength of between about 0.2 to 3 Teslas. During the procedure, the body tissue is briefly exposed to RF pulses of electromagnetic energy in a plane perpendicular to the magnetic field. The resultant electromagnetic energy from these pulses can be used to image the body tissue by measuring the relaxation properties of the excited atomic nuclei in the tissue.

During imaging, the electromagnetic radiation produced by the MRI system may be picked up by implantable device leads used in implantable medical devices such as pacemakers or cardiac defibrillators. This energy may be transferred through the lead to the electrode in contact with the tissue, which may lead to elevated temperatures at the point of contact. The degree of tissue heating is typically related to factors such as the length of the lead, the properties of the tissue near the lead, the conductivity or impedance of the lead, the shape of the lead, and the surface area of the lead electrodes. Exposure to a magnetic field may also induce an undesired voltage in the lead.

SUMMARY

Embodiments of the present invention generally relate to implantable medical devices and minimizing the delivery of RF induced voltages to surrounding body tissue in an MRI environment. An illustrative medical device includes a pulse generator configured to emit therapy pulses and a lead including an electrode configured to contact tissue in a body vessel. The lead includes a lead conductor electrically coupling the pulse generator with the electrode via a conductive path. The medical device further includes an electrode switch electrically connected between the lead conductor and the electrode. The electrode switch includes an open state preventing formation of the conductive path between the lead and the electrode. The electrode switch further includes a closed state allowing formation of the conductive path between the lead and the electrode upon reception of a voltage applied across the electrode switch which exceeds a threshold voltage. The electrode switch in the open state electrically shields the electrode from at least electromagnetic radiation within the body during an magnetic resonance imaging procedure, thereby preventing the inducement of a voltage on the electrode.

While some embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic drawing of a cardiac rhythm management system including a pulse generator coupled to a lead deployed in a patient's heart.

FIG. 2 illustrates a pulse generator and a lead with an electrode switch.

FIG. 3 graphically illustrates the state of the switch as “on” when the voltage applied across the switch is higher than the threshold voltage, and as “off” when the voltage applied across the switch is lower than or equal to the threshold voltage.

FIG. 4 graphically illustrates the state of the switch as “on” when the voltage applied across the switch is higher than Vth1 or lower than −Vth2, and as “off” when the voltage applied across the switch is between −Vth2 and Vth1.

FIG. 5 illustrates the open or closed state of the switch versus time.

FIG. 6 illustrates a pulse generator and a lead with a switch between the lead conductor and the electrode.

FIG. 7 illustrates a characteristic voltage-current curve for the switch illustrated in FIGS. 6 and 8.

FIG. 8 illustrates a pulse generator and a lead with a switch between the lead conductor and the electrode along with an optional control line for varying the threshold voltage of the device or giving a direct command to turn the switch on or off.

FIG. 9 illustrates an example method for monitoring a voltage across a switch and adjusting a voltage threshold.

FIG. 10 is a cross-sectional view of an illustrative lead.

FIG. 11 is another cross-sectional view of the lead.

While the invention is amenable to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and are described in detail below. The intention, however, is not to limit the invention to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the scope of the present disclosure.

DETAILED DESCRIPTION

FIG. 1 is a schematic drawing of a cardiac rhythm management system 10 including a pulse generator 12 coupled to a lead 14 deployed in a patient's heart 16. According to some embodiments, the pulse generator 12 is typically implanted subcutaneously at an implantation location in the patient's chest or abdomen. As shown, the heart 16 includes, a superior vena cava 17, a right atrium 18 and a right ventricle 20, a left atrium 22 and a left ventricle 24, a coronary sinus ostium 26, a coronary sinus 28, and various cardiac branch vessels including a great cardiac vein 30 and an exemplary branch vessel 32.

As shown in FIG. 1, the lead 14 may include an elongated body 34 having a proximal region 36 and a distal region 38. The distal region 38 has a distal end 40 including an electrode 42, according to embodiments of the present invention. The lead 14 includes a lead conductor which electrically connects the pulse generator 12 to the electrode 42. To facilitate left ventricular pacing epicardially via an epicardial approach, lead 14 may be deployed in coronary veins 32 through the coronary sinus 28. In embodiments, the lead 14 can be implanted in other locations of the body such as the right ventricle, right atrium, or any other desired location in the body. Although FIG. 1 depicts the lead 14 as part of a cardiac rhythm management system 10 with an electrode 42, the lead 14 may alternatively include one or more sensors and/or one or more electrodes 42, and may couple the one or more sensors with a monitor in addition to, or in lieu of, the pulse generator 12. Additionally, although only one lead is illustrated in FIG. 1, the cardiac management system 10 may include any desired number of leads.

FIG. 2 illustrates a pulse generator 12 and a lead 14 with an electrode switch 44, according to some embodiments. In the embodiment of FIG. 2, the switch 44 is normally open, but is configured to close during the delivery of therapeutic pacing. In its normally open state, the switch 44 either creates an electrical discontinuity between the lead conductor and the electrode 42, or provides a relatively high resistance between the lead conductor and the electrode 42 and thus, between the lead conductor and the surrounding tissue. Accordingly, in its normally open state the switch 44 substantially shields the electrode 42 and surrounding tissue from receiving induced current pulses and/or electromagnetic radiation generated by an MRI system. Thus, in this configuration, the electrode 42 and surrounding tissue is isolated from the electromagnetic (e.g., RF) energy picked up by the lead 14 during magnetic resonance imaging. In embodiments, a relatively high resistance is a resistance high enough to substantially shield an electrode and surrounding tissue from receiving induced current pulses and/or electromagnetic radiation generated by an MRI system.

According to some embodiments, the switch 44 is configured to permit electrical continuity between the lead conductor and the electrode 42 when a voltage exceeding a threshold voltage is applied across the switch 44. Alternatively, in those embodiments in which the switch 44 increases the resistance between the lead conductor and the electrode 42 when open, the switch 44 can be configured to reduce its resistance when a voltage exceeding a threshold voltage is applied across the switch 44. In embodiments, this threshold voltage is selected as a result of the design of the switch 44 circuitry. Accordingly, the threshold voltage required to trigger the switch 44 may differ depending on the type and configuration of the switch 44. As an example, the threshold voltage of the switch 44 does not exceed a supply voltage such as 12V. As another example, the threshold voltage of a switch is fixed between 12V to 30V. As another example, the threshold voltage is variable.

In embodiments, the pulse generator 12 is configured to emit therapy pulses. Examples of therapy pulses include, but are not limited to, cardiac pacing pulses for heart failure and bradycardia; anti-tachy pacing and shock therapy for tachycardia; and pacing pulses for neurostimulation and pain mitigation. According to some embodiments, the pulse generator 12 is configured to provide a pacing pulse with a voltage amplitude higher than the threshold voltage of the switch 44, such that the switch 44 establishes a conductive path by completing the circuit between the lead conductor and the electrode 42 for the duration of the pacing pulse. In embodiments, the switch 44 includes a normally open switch 43 and a controller 45 that monitors the voltage applied across the normally open switch 43. In embodiments, when the voltage applied across the normally open switch 43 is greater than the threshold voltage, the controller 45 causes the switch 43 to close, creating a conductive path between the lead 14 and the electrode 42.

In embodiments, the threshold voltage of the switch 44 is selected such that the voltage level of the pacing pulse is sufficient to activate the switch, but the voltage level of energy in the lead induced by an MRI field by itself is not high enough to activate the switch 44. In this manner, the desired pacing pulses are effectively delivered to the electrode 42 and into the surrounding tissue while the undesirable MRI induced current and generated electromagnetic radiation are prevented from flowing through the switch 44 to the electrode 42.

FIG. 3 graphically illustrates the state of the switch 44 as “on” when the voltage applied across the switch 44 is higher than the threshold voltage, and as “off” when the voltage applied across the switch 44 is lower than or equal to the threshold voltage. In some embodiments, and as further illustrated in FIG. 4, the threshold voltage may be a negative or a positive voltage. For example, as illustrated in FIG. 4, the switch 44 is “on” when the voltage applied across the switch is higher than Vth1 or lower than −Vth2, and “off” when the voltage applied across the switch 44 is between −Vth2 and Vth1. In embodiments, Vth1 is equal to Vth2. In other embodiments, Vth1 is greater than or equal to Vth2.

FIG. 5 illustrates the open or closed state of the switch 44 versus time, showing that the switch 44 is “closed” during the interval of the pacing pulse, and is “open” otherwise. At time t₁, the switch 44 is off (e.g., open) since the measured voltage across the switch 44 is zero. At time t₂, a first pacing pulse P1 is applied across the switch 44. Accordingly, the switch 44 is closed at time t₂. At time t₃, the switch 44 is open since the measured voltage across the switch 44 is zero. At time t₄, a second pacing pulse P2 with a negative voltage value is applied across the switch 44. Since the absolute value of the pacing pulse is greater than the absolute value of Vth2, the switch 44 is on. At time t₅, the switch 44 is off since the measured voltage across the switch 44 is zero.

In embodiments, the duration of pacing pulses and signals emitted from the pulse generator 12 are longer than a threshold duration, which means that the frequency of the pacing pulses is not higher than a threshold frequency (e.g., frequency=1/duration). In embodiments, the threshold duration is 60 nanoseconds and the threshold frequency is 8.5 MHz. In embodiments, any switch, controller, or device that receives pacing pulses or signals from the pulse generator 12 is responsive to pacing pulses or signals below a particular frequency. As an example, the switch 44 (FIG. 2) closes upon receiving one or more pacing pulses from the pulse generator 12 that are above the threshold voltage and have a duration longer than the threshold duration.

According to some embodiments, the switch 44 is an electrical switch such as, for example, a diode for alternating current (“DIAC”) switch, which changes its resistance based upon the magnitude of the applied voltage. According to other embodiments, the switch 44 is a mechanical switch, with additional circuitry to monitor the voltage applied across the switch 44 and to accomplish closure of the switch 44 when the voltage applied across the switch exceeds a predetermined voltage level. In some embodiment, the switch 44 may be a DIAC, TRISIL™, or similar device. The switch 44 may include other types of circuit components, including, but not limited to transistors, diodes, field-effect transistors (“FET”), and/or electro-mechanical relays. According to some embodiments the switch 44 may be unipolar or bipolar, depending on the application.

FIG. 6 illustrates a pulse generator 12 and a lead 14 with a DIAC, TRISIL™, or similar device 46 between the lead conductor and the electrode 42. In some embodiments, the device 46 is constructed with discreet components, and exhibits a large resistance (approaching that of an open circuit) until a voltage which is higher than a threshold voltage of the device 46 is applied across the device 46, which then causes the resistance of the device 46 to drop significantly (approaching that of a short circuit to establish a conductive path). In embodiments, a high impedance resistor 47 is connected in parallel with the switch 46. As an example, the impedance of the resistor 47 is high enough to prevent electromagnetic energy picked up by the lead 14 from transferring to the surrounding tissue via the electrode 42. However, the impedance of the resistor 47 is low enough to provide a conductive path between the pulse generator 12 and a common ground to permit sensing of applications and re-charging of capacitors located in the pulse generator 12, which might otherwise be inhibited by including the normally-open switch at the electrode 42.

FIG. 7 illustrates a characteristic voltage-current curve for the device 46 of FIG. 6 according to some embodiments. As illustrated in FIG. 7, the magnitude of the voltage across the device 46 increases at a low current until the threshold voltage (shown as “VBO”) is exceeded. When the threshold voltage is exceeded, the device 46 switches to a conductive state, at which point the resistance breaks down and current flows easily across the device 46 as indicated at 47A in FIG. 7. The device 46 switches back to a non-conductive state when the current flowing through the device 46 falls below a specified level, at which point the high resistance of the device is re-established as indicated at 47B in FIG. 7.

FIG. 8 illustrates a pulse generator 12 and a lead 14 with a switching device 48 between the lead conductor and the electrode 42. An expanded view of the switching device 48 is provided below the arrow. In embodiments, the switching device 48 includes an optional control line 50 for varying the threshold voltage of the switching device 48. According to some embodiments, a controller 52 integrated within the switching device 48 receives a control signal from the pulse generator 12 via the control line 50, and changes the threshold voltage across the switching device 48 based on the control signal. In certain embodiments, the controller 52 selects between two or more circuits having characteristic voltage-current curves similar to that of FIG. 7 but with different threshold voltages. In other embodiments, the pulse generator 12 directly commands the controller 52 via control line 50 to turn the device on or off.

During an MRI scan, the switching device 48 can be used alone to isolate the electrode 42 from the rest of the conductor within the lead 14. Therapy applied voltages which exceed the breakdown voltage of the switching device 48 create a low impedance path for the duration of the pulse. After the pulse is removed, the switching device 48 resumes a high impedance state and opens the electrical connection between the lead conductor and the electrode 42. As depicted in FIG. 8, a separate control line 50 can be used to control the gate of the switching device 48 or change its threshold voltage. According to some embodiments, using a DIAC, TRISIL™, or similar device can be ideal for use in a defibrillator or other device that applies high voltages to an electrode. Typical DIACs with a threshold voltage of 20 to 30 volts may be sufficient for use in a defibrillator, for example. In some embodiments, a special version of a DIAC constructed with discrete components such as silicon-controlled rectifiers (“SCR”)/triodes for alternating current (“TRIAC”) and controlling (gate firing) circuits may be used for therapy voltages lower than 20 to 30 volts.

The controller 52 may be directly controlled through the main lead 14 or through a separate line 50. In embodiments, the controller 52 is any desired microcontroller. The controller 52 may also be programmed dynamically via any external device such as a remote terminal, according to embodiments. As an example, a remote terminal communicates with the pulse generator 12 via any suitable wireless interface. Accordingly, in this example, commands from the remote device are forwarded from the pulse generator 12 to the controller 52 via the control line 50.

FIG. 9 illustrates an example process for monitoring a voltage across at a switch and adjusting a voltage threshold using the switching device 48 of FIG. 8. The process may generally begin at block 60 where the switch controller 52 monitors a voltage (V) across the switching device 48. In embodiments, the voltage (V) is provided by the pulse generator 12. After measuring the voltage (V), the switch controller 52 determines if the measured voltage (V) is greater than the voltage threshold (Vth) 62. If V>Vth, the switch controller 52 determines if the switching device 48 is closed at block 64. If the switch controller 52 determines that the switching device 48 is not closed, the switch controller 52 closes the switching device (block 68). If the switch controller 52 determines that the switching device 48 is closed at block 64, the switch controller 52 proceeds to determine if a command to adjust Vth has been received at block at block 72. If V≦Vth (block 62), the switch controller 52 determines if the switch 48 is open at block 66. If the switching device 48 is not open, the switch controller 52 opens the switching device 48 (block 70). If switching device 48 is open, the switch controller proceeds to determine if a command to adjust Vth has been received at block 72.

If the switch controller 52 determines that a command to adjust Vth has not been received (block 72), the switch controller 52 returns to monitoring the voltage (V) across the switching device 48 (block 60). If the switch controller 52 determines that a command to adjust Vth has been received, the switch controller 52 adjusts Vth 72 based on the command. In some embodiments, the switch controller 52 receives the command from the pulse generator 12 via the control line 50.

In embodiments, the command is a voltage “high” or a voltage “low.” Upon receiving the voltage “high” (e.g., 1) or voltage “low” (e.g., 0) from the pulse generator 12, the switch controller 52 switches between a first voltage threshold and a second voltage threshold. In embodiments, when the switching device 48 includes more than two voltage thresholds, the switch controller 52 receives a series of commands from the pulse generator 12. For example, a switching device 48 with four voltage thresholds (e.g., Vth1, Vth2, Vth3, and Vth4) receives two signals from the pulse generator 12 via the control line 50 before switching voltage thresholds. As an example, the four threshold voltages may be distinguished by the following control signals: Vth1=00, Vth2=01, Vth3=10, Vth4=11. Accordingly, when the switch controller 52 receives two voltage “low” signals in series (e.g., 00), the switch controller 52 switches to Vth1. Similarly, when the switch controller 52 receives a voltage “high” and a voltage “low” in series (e.g., 01), the switch controller 52 switches to Vth2. In embodiments, the switching device 48 is not limited to any particular number of voltage thresholds, and the switch controller 52 is configured to handle any signaling pattern transmitted from the pulse generator 12.

FIG. 10 illustrates a cross-sectional view of a lead 80, according to embodiments of the present invention. As shown in FIG. 10, lead 80 includes an outer conductor 82, an insulating layer of material 84 with a breakdown voltage of a certain threshold, and an inner conductor 86. According to some embodiments, a pulse generator 12 is in electrical communication with the outer conductor 82, and the electrode 42 is in electrical communication with the inner conductor 86. In embodiments, the insulating layer of material 84 is a varistor (e.g., variable resistor). Example varistors are disclosed in U.S. patent application Ser. No. 11/498,916 entitled “Transient Voltage Protection Circuit Boards and Manufacturing Methods,” the entire contents of which are incorporated herein by reference. In other embodiments, the insulating layer of material 84 is any other desired material having a breakdown voltage of a certain threshold.

Electromagnetic radiation generated by or current induced by an MRI system is received by the outer conductor 82, but is not transmitted through the insulating layer 84, which acts as a highly resistive barrier until the threshold voltage is exceeded. The pulse generator 12 may then generate a pulse with a voltage value exceeding the threshold voltage of the insulating layer 84, at which point the breakdown voltage of the insulating layer 84 is exceeded and the pacing pulse proceeds through the insulating layer 84, into the inner conductor 86, and to the electrode 42 and surrounding tissue. The lead 80 cross section as depicted in FIG. 10 may be formed along the length of a lead, or may optionally be formed only along the distal section of the lead so as to minimize induced currents on the inner conductor 86 at or near the electrode 42 during an MRI scan. In one alternative embodiment, the pulse generator 12 is in electrical communication with the inner conductor 86, and the electrode 42 is in electrical communication with the outer conductor 82.

FIG. 11 illustrates the lead 80 connected with the pulse generator 12. The electrode 42 is on the distal end of the lead 80. FIG. 11 further illustrates a longitudinal cross-sectional view of a portion of the lead 80 according to some embodiments of the present invention. In some embodiments, the lead 80 includes an outer insulating layer 88 encapsulating the outer conductor 82. As illustrated in FIG. 11, the insulating material 84 is positioned between the outer conductor 82 and the inner conductor 86. In embodiments, the pulse generator 12 connects to the outer conductor 82 on a proximal portion of the lead 80, and the electrode 42 connects to the inner conductor 86 on a distal portion of the lead 80. In other embodiments, the pulse generator 12 connects to the inner conductor 86 on the distal portion of the lead 80, and the electrode 42 connects to the outer conductor 82 on the proximal portion of the lead 80.

Various modifications and additions can be made to the exemplary embodiments discussed without departing from the scope of the present invention. For example, while the embodiments described above refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications, and variations as fall within the scope of the present disclosure, together with all equivalents thereof.

Claims

1. A medical device comprising: a pulse generator configured to deliver one or more therapy pulses;an electrode configured to contact tissue in a body vessel;a lead comprising proximal and distal ends, the lead selectively connecting the pulse generator with the electrode via a conductive path;an inner conductor and an outer conductor, each of the inner conductor and the outer conductor extending within the lead and the outer conductor extending coaxially around the inner conductor, the inner conductor in electrical communication with the pulse generator, the outer conductor in electrical communication with the electrode;at least one portion of the lead located proximal of the electrode and between the proximal and distal ends, the at least one portion including an insulating material between the outer conductor and the inner conductor, the insulating material configured to: exhibit a non-conductive state in which the insulating material is configured to block current induced in the outer conductor by an MRI system from being transmitted to the inner conductor to minimize current on the inner conductor during an MRI scan, andexhibit a conductive state in which the insulating material is configured to permit the one or more therapy pulses from the pulse generator to be transmitted between the inner conductor and the outer conductor through the insulating material, wherein the insulating material has a breakdown voltage threshold between a first voltage associated with the current induced by the MRI system and a second voltage associated with the stimulation energy;an outer insulating layer extending over and encapsulating the outer conductor; andwherein each of the insulating material, the outer conductor, and the outer insulating layer are concentrically disposed around the inner conductor at a cross section of the at least one portion of the lead that is orthogonal to a longitudinal axis of the lead.

2. The medical device of claim 1, wherein the at least one portion of the lead extends along the length of the lead between the proximal and distal ends, and wherein each of the insulating material, the outer conductor, and the outer insulating layer are concentrically disposed around the inner conductor along the length of the lead.

3. A medical device lead comprising: a first conductor;an electrode distal of the first conductor and electrically coupled to the first conductor;a second conductor that is coaxial with the first conductor along at least a portion of the lead;an insulating layer radially between the first conductor and the second conductor along at least the portion of the lead, the insulating layer proximal of the electrode, the insulating layer having a breakdown voltage threshold between a first voltage associated with a current induced in the second conductor by an MRI system and a second voltage associated with therapeutic stimulation energy such that the insulating layer permits conduction of the therapeutic stimulation energy from the first conductor to the second conductor across the insulating layer and to the electrode but the insulating layer blocks the current induced by the MRI system from being transmitted from the first conductor to the second conductor to minimize current on the second conductor during an MRI scan; andan outer insulating layer extending around the first conductor and the second conductor and defining an exterior of the lead,wherein each of the insulating layer, the first conductor, the second conductor, and the outer insulating layer overlap each other along at least the portion of the lead.

4. The medical device lead of claim 3, further comprising a pulse generator configured to electrically connect to the second conductor and output the stimulation energy to the second conductor.

5. The medical device lead of claim 3, wherein the insulating layer comprises a variable resistor.

6. The medical device lead of claim 3, wherein the second conductor surrounds the first conductor along at least the portion of the lead.

7. The medical device lead of claim 3, wherein the insulating layer extends only along the portion of the lead.

8. The medical device lead of claim 3, wherein the first conductor surrounds the second conductor along at least the portion of the lead.

9. A medical device comprising: a pulse generator configured to deliver therapeutic stimulation energy; anda lead comprising: a first conductor configured to electrically couple to the pulse generator;a second conductor coaxial with the first conductor along a portion of the lead;an electrode that is distal of the portion of the lead, the electrode electrically coupled with the second conductor;an insulating layer between the first conductor and the second conductor, the insulating layer proximal of the electrode and having a breakdown voltage threshold that is between a first voltage associated with a current induced by an MRI system on the first conductor and a second voltage associated with the therapeutic stimulation energy delivered by the pulse generator, the insulating layer configured to permit conduction of the therapeutic stimulation energy from the first conductor to the second conductor through the insulating layer but block conduction of the current induced by the MRI system from being transmitted from the first conductor to the second conductor through the insulating layer to minimize current on the second conductor during an MRI scan; andan outer insulating layer extending around the first conductor and the second conductor and defining an exterior of the lead,wherein each of the insulating layer, the first conductor, the second conductor, and the outer insulating layer overlap each other along at least the portion of the lead.

10. The medical device of claim 9, wherein the insulating layer comprises a variable resistor.

11. The medical device of claim 9, wherein the first conductor surrounds the second conductor along at least the portion of the lead.

12. The medical device of claim 9, wherein the insulating layer extends only along the portion of the lead.

13. The medical device of claim 9, wherein the second conductor surrounds the first conductor along at least the portion the lead.