Nerve stimulation systems via endovascular leads

1. An implantable stimulation system including:

a. a pulse generator,

b. an implantable lead ( 200 ) extending:

(1) between:

(a) a proximal end ( 301 ) connected to the pulse generator, and

(b) a distal end:

i. including an expandable member ( 202 ):

 A. formed of elastic electrically insulating material, and

 B. bearing a stimulation electrode ( 201 . 1 , 201 . 2 ) electrically connected to the pulse generator,

ii. wherein the expandable member ( 202 ) is configured to expand from:

 A. a compact state wherein the expandable member ( 202 ) is closely adjacent the lead ( 200 ), and

 B. an expanded state wherein the expandable member ( 202 ) laterally extends from the lead ( 200 );

(2) within a vessel ( 103 . 1 ) having a vessel wall, and

(3) through the vessel wall with the expandable member ( 202 ) in the expanded state outside the vessel.

2. The implantable stimulation system of claim 1 wherein the lead further includes a lead electrode ( 201 . 3 ) thereon spaced from the expandable member ( 202 ) and situated within the vessel.

3. The implantable stimulation system of claim 1 wherein the expandable member ( 202 ) in the expanded state includes a distally facing front area whereupon the electrode ( 201 . 1 , 201 . 2 ) is situated.

4. The implantable stimulation system of claim 1 wherein the lead ( 200 ) includes a lead electrode ( 201 . 3 ) thereon, with the lead electrode ( 201 . 3 ) being spaced from the distal end of the lead ( 200 ) by more than 0.5 cm.

5. The implantable stimulation system of claim 1 wherein the pulse generator:

a. includes an electrically conductive case ( 20 ), and

b. is configured to perform electrical impedance plethysmography via the electrode and the case ( 20 ).

6. The implantable stimulation system of claim 1 wherein the pulse generator includes a kinematic sensor ( 54 ) configured to generate a tilt signal indicative of inclination.

7. The implantable stimulation system of claim 1 wherein the pulse generator:

a. includes a kinematic sensor ( 54 ), and

b. is configured to generate a respiration effort signal (REFFS) from an output of the kinematic sensor ( 54 ).

8. The implantable stimulation system of claim 1 wherein the pulse generator:

a. includes an electrically conductive case ( 20 ), and

b. is configured to obtain a far-field electrogram via:

(1) at least one of:

(a) the electrode ( 201 . 1 , 201 . 2 ), or

(b) a lead electrode ( 201 . 3 ) spaced from the electrode ( 201 . 1 , 201 . 2 ) on the lead ( 200 ), and

(2) the case ( 20 ).

9. The implantable stimulation system of claim 8 wherein the pulse generator is configured to record vascular pressure waveforms depending on the tilt signal and the far field electrogram.

10. An implantable stimulation system including:

a. a pulse generator,

b. an implantable lead ( 200 ) extending between:

(1) a proximal end ( 301 ) connected to the pulse generator, and

(2) a distal end:

(a) including an expandable member ( 202 ):

i. formed of elastic electrically insulating material, and

ii. bearing a stimulation electrode ( 201 . 1 , 201 . 2 ) electrically connected to the pulse generator,

(b) wherein the expandable member ( 202 ) is configured to expand from:

i. a compact state wherein the expandable member ( 202 ) is closely adjacent the lead ( 200 ), and

ii. an expanded state wherein the expandable member ( 202 ) laterally extends from the lead ( 200 ),

wherein the pulse generator is configured to deliver stimulation pulses for at least one of:

I. vagus nerve stimulation (VNS), and

II. phrenic nerve stimulation (PhrNS),

via the electrode ( 201 . 1 , 201 . 2 ).

11. The implantable stimulation system of claim 10 wherein the pulse generator is configured to:

a. generate a respiration effort signal (REFFS), and

b. deliver VNS and/or PhrNS depending on the REFFS.

12. The implantable stimulation system of claim 1 :

a. further including a cardiac lead ( 900 ),

b. wherein the pulse generator ( 902 ) is further configured to:

(1) sense cardiac activity, and

(2) deliver cardiac stimulation pulses via the cardiac lead ( 900 ).

13. The implantable stimulation system of claim 1 wherein the pulse generator is configured to deliver stimulation pulses for at least one of:

a. vagus nerve stimulation (VNS), and

b. phrenic nerve stimulation (PhrNS),

via the electrode ( 201 . 1 , 201 . 2 ).

14. The implantable stimulation system of claim 13 wherein the pulse generator is configured to:

a. generate a respiration effort signal (REFFS), and

b. deliver VNS and/or PhrNS depending on the REFFS.

15. The implantable stimulation system of claim 1 :

a. further including a cardiac lead ( 900 ),

b. wherein the pulse generator ( 902 ) is further configured to:

(1) sense cardiac activity, and

(2) deliver cardiac stimulation pulses via the cardiac lead ( 900 ).

16. The implantable stimulation system of claim 15 wherein the pulse generator ( 902 ) is configured to:

a. detect at least one of:

(1) atrial fibrillation (AF), and

(2) PR interval,

via the cardiac lead ( 900 ), and

b. deliver nerve stimulation pulses via the electrode ( 201 . 1 , 201 . 2 ) in synchrony with cardiac activity.

17. An implantable stimulation system including:

a. a pulse generator,

b. an implantable lead ( 200 ) extending between:

(1) a proximal end ( 301 ) connected to the pulse generator, and

(2) a distal end:

(a) including an expandable member ( 202 ):

i. formed of elastic electrically insulating material, and

ii. bearing a stimulation electrode ( 201 . 1 , 201 . 2 ) electrically connected to the pulse generator,

(b) wherein the expandable member ( 202 ) is configured to expand from:

i. a compact state wherein the expandable member ( 202 ) is closely adjacent the lead ( 200 ), and

ii. an expanded state wherein the expandable member ( 202 ) laterally extends from the lead ( 200 ),

c. a cardiac lead ( 900 ),

wherein the pulse generator ( 902 ) is configured to:

a. detect at least one of:

(1) atrial fibrillation (AF), and

(2) PR interval,

via the cardiac lead ( 900 ), and

b. deliver:

(1) cardiac stimulation pulses via the cardiac lead ( 900 ), and

(2) nerve stimulation pulses via the electrode ( 201 . 1 , 201 . 2 ) in synchrony with cardiac activity.

18. The implantable stimulation system of claim 17 wherein the pulse generator is configured to deliver stimulation pulses for at least one of:

a. vagus nerve stimulation (VNS), and

b. phrenic nerve stimulation (PhrNS),

via the electrode ( 201 . 1 , 201 . 2 ).

19. The implantable stimulation system of claim 18 wherein the pulse generator is configured to:

a. generate a respiration effort signal (REFFS), and

b. deliver VNS and/or PhrNS depending on the REFFS.