Systems and methods for implanting a medical electrical lead
Devices and implantation methods utilizing subcutaneous placement into a patient are disclosed for the insertion, advancement and positioning of a subcutaneous implantable medical device (SIMD) such as a medical electrical lead. The device for implanting the SIMD is configured having a pre-biased distal curve for creating a pathway to an implant location within a substernal space.
1. A substernal delivery system for delivering a medical lead, comprising:
the medical lead, wherein the medical lead includes one or more electrodes;
a pliable sheath configured to receive the medical lead, the pliable sheath having an inner lumen, wherein the medical lead is configured to be slidingly disposed within the inner lumen;
an elongate tool having a proximal end and a distal end configured to be slidingly disposed within the inner lumen, wherein the elongate tool includes a pre-biased curvature that is oriented to form a bend at a distal portion of the elongate tool, wherein an angle of the pre-biased curvature is between approximately 1 to 20 degrees, wherein the bend is located approximately 1 to 4 inches from the distal end; and
a handle coupled to the proximal end of the elongate tool.
2. The delivery system of claim 1 , wherein the distal portion of the elongate tool includes a radiopaque marker, wherein the radiopaque marker comprises a fluorovisible material.
3. The delivery system of claim 1 , wherein the distal portion of the elongate tool includes a radiopaque marker, wherein the radiopaque marker comprises barium sulfate.
4. The delivery system of claim 1 , wherein the pre-biased curvature is defined such that the distal portion of the elongate tool is oriented in a plane that is dissimilar from a plane defined by a proximal portion of the elongate tool.
5. The delivery system of claim 1 , wherein the elongate tool ranges in length from 6 inches to 24 inches.
6. The delivery system of claim 1 , wherein an inner surface of the sheath is formed having a surface configured to enable gliding of the elongate tool within the sheath.
7. The delivery system of claim 1 , further comprising a mapping electrode coupled to the elongate tool.
8. The delivery system of claim 1 , wherein the angle of the pre-biased curvature is between approximately 5 to 20 degrees.
9. The delivery system of claim 1 , wherein a central axis of a proximal portion of the elongate tool defines a plane that is non-parallel to a plane of the distal portion.
10. The delivery system of claim 1 , wherein a proximal portion of the elongate tool is substantially straight from the handle to the bend of the distal portion.
11. The delivery system of claim 1 , wherein the angle of the pre-biased curvature is between 5 degrees and 20 degrees relative to a plane defined by a central axis of a proximal portion of the elongate tool.
12. The delivery system of claim 1 , wherein the distal end is configured to generate a tactile signal indicating contact of the elongate tool with patient tissue during advancement of the elongate tool in a substernal space.
13. The delivery system of claim 12 , wherein the handle is configured to receive the tactile signal generated by the distal end.
14. The delivery system of claim 1 , wherein the handle further includes a directional indicator configured to provide an indication of the orientation of the pre-biased curvature.
15. The delivery system of claim 14 , wherein the directional indicator comprises a marking fixedly coupled to the handle, the marking being configured to provide a visual indication of a directional orientation of the distal portion.
16. The delivery system of claim 14 , wherein the directional indicator is integrally formed on a portion of the handle in a plane that is parallel to a plane of the pre-biased curvature.
17. The delivery system of claim 1 , wherein the elongate tool includes a fluid dispersion port disposed proximate to the distal end, the fluid dispersion port being in fluid communication with a fluid insertion port disposed at the proximal end.
18. The delivery system of claim 17 , further comprising a fluid lumen extending along a length of the elongate tool from the fluid insertion port to the fluid dispersion port for transmission of fluid.