Methods and apparatus for intravascularly-induced neuromodulation
Methods and apparatus are provided for intravascularly-induced neuromodulation using a pulsed electric field, e.g., to effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, changes in cytokine upregulation, etc., in target neural fibers. In some embodiments, the intravascular PEF system comprises a catheter having a pair of bipolar electrodes for delivering the PEF, with a first electrode positioned on a first side of an impedance-altering element and a second electrode positioned on an opposing side of the impedance-altering element. A length of the electrodes, as well as a separation distance between the first and second electrodes, may be specified such that, with the impedance-altering element deployed in a manner that locally increases impedance within a patient's vessel, e.g., with the impedance-altering element deployed into contact with the vessel wall at a treatment site within the patient's vasculature, a magnitude of applied voltage delivered across the bipolar electrodes necessary to achieve desired neuromodulation is reduced relative to an intravascular PEF system having similarly spaced electrodes but no (or an undeployed) impedance-altering element. In a preferred embodiment, the impedance-altering element comprises an inflatable balloon configured to locally increase impedance within a patient's vasculature. The methods and apparatus of the present invention may be used to modulate a neural fiber that contributes to renal function.
1. An apparatus for intravascularly-induced neuromodulation of a human patient, the apparatus comprising:
a pulsed electric field generator adapted to be placed external to the patient;
an intravascular catheter configured for transluminal delivery to a renal blood vessel of the patient, the catheter comprising a shaft, a balloon carrying monitoring electrodes, and a pair of bipolar electrodes positioned on the shaft on opposite ends of and external to the balloon,
wherein the bipolar electrodes are electrically coupled to the pulsed electric field generator,
wherein the monitoring electrodes are electrically coupled to a monitoring component of the pulsed electric field generator, and wherein the monitoring component is configured to monitor neural signaling across renal neural fibers, and
wherein the catheter is further configured to improve renal function in the patient by directing a pulsed electric field from the pulsed electric field generator across the bipolar electrodes to block neural signaling across target renal neural fibers along the renal blood vessel.
2. The apparatus of claim 1 wherein the balloon is configured to temporarily occlude blood flow within the patient's renal blood vessel.
3. The apparatus of claim 1 wherein the catheter is further configured to space the bipolar electrodes away from tissue of the vessel to provide electrode centering within the renal blood vessel when the balloon is deployed and during the directing of the pulsed electric field.
4. The apparatus of claim 1 wherein the catheter is further configured to direct the pulsed electric field to induce irreversible electroporation in the target renal neural fibers.
5. The apparatus of claim 1 wherein the catheter is further configured to direct the pulsed electric field to deliver thermal radio frequency (RF) energy to the target neural fibers.
6. The apparatus of claim 1 wherein the catheter is further configured to direct the pulsed electric field to at least partially ablate the target neural fibers.