Electrode insertion tools, lead assemblies, kits and methods for placement of cardiac device electrodes
Insertion tools, lead assemblies, kits, and methods for placement of cardiac device electrodes. In some embodiments, an insertion tool having a proximal end and a distal, dissecting end includes a structure configured to receive or engage a structure on a lead assembly. Some embodiments include a lead assembly having an end including a structure configured for engaging the distal end of an associated insertion tool. Some embodiments include kits or systems including both an insertion tool and a lead assembly, each having a structure for engaging the other. In these embodiments, the engaging structures may take several forms including threads, small posts, circular or semi-circular receiving members, and/or a slot. Some embodiments also include methods for placement of cardiac device electrodes with the assistance of an associated insertion tool, wherein the cardiac device electrodes are associated with a lead assembly having an end configured to engage a distal, dissecting portion of an associated insertion tool.
1. A tool for use in subcutaneous insertion of a lead electrode assembly, the tool comprising:
a proximal end having a handle;
a distal end including a dissecting tip shaped for separating subcutaneous tissue to form a channel therethrough, and an engaging structure disposed adjacent to the dissecting tip; and
a shaft extending between the proximal and distal ends;
wherein the engaging structure is configured to directly engage a portion of an associated lead assembly;
further wherein:
the distal end further comprises a dissecting portion proximal to the engaging structure, the dissecting portion shaped to further separate subcutaneous tissue relative to the dissecting tip such that, when the engaging structure is used to secure the lead electrode assembly thereto, and the handle is pulled in a proximal direction, the dissecting portion reduces drag on the lead assembly;
the dissecting tip, engaging structure, and dissecting portion generally form a conical portion with a discontinuity at the engaging structure, the discontinuity extending at least partly about the conical portion; and
wherein the engaging structure includes a transversely extending structure.
2. The tool of claim 1 , wherein the discontinuity extends wholly around the conical portion.
3. The tool of claim 1 , wherein the transversely extending structure forms a ridge and a slot.
4. The tool of claim 1 , further comprising means for locking the tool in an engaged configuration relative to a lead assembly configured to engage the engaging structure of the tool.
5. The tool of claim 1 , further comprising a locking member coupled to a control mechanism disposed relative to the handle, the locking member configured to lock the tool in an engaged position in response to actuation by the control mechanism.
6. The tool of claim 1 , further comprising a locking member coupled to means for controlling the locking member, the means for controlling the locking member accessible at or near the handle, the locking member configured to lock the tool in an engaged configuration relative to a lead assembly when actuated by the means for controlling.
7. The tool of claim 1 , wherein a shoulder is defined between the distal end and the shaft proximally adjacent the distal end, wherein the shoulder is shaped for non-traumatic passage in a proximal direction through subcutaneous tissue.
8. A lead assembly for a cardiac stimulus system, the lead assembly comprising:
a distal end comprising at least a first electrode and a distal tip; and
a proximally extending shaft including an electrical conductor coupled to the first electrode;
wherein the distal end further comprises an engagement structure configured for direct engagement with an associated introducer tool and a receiving portion for receiving the distal end of the associated introducer tool such that, when an associated introducer tool is received in the receiving portion, the distal tip of the lead assembly extends over and around a portion of the associated introducer tool;
wherein the engagement structure includes one or more tabs extending into the receiving portion from an outer sheath near the distal tip.
9. A lead assembly for a cardiac stimulus system, the lead assembly comprising:
a distal end comprising at least a first electrode and a distal tip; and
a proximally extending shaft including an electrical conductor coupled to the first electrode;
wherein the distal end further comprises an engagement structure configured for direct engagement with an associated introducer tool and a receiving portion for receiving the distal end of the associated introducer tool such that, when an associated introducer tool is received in the receiving portion, the distal tip of the lead assembly extends over and around a portion of the associated introducer tool;
wherein the engagement structure includes one or more slots adjacent a disk, the slots sized and configured to receive corresponding tabs on the associated introducer tool.