Implantable medical lead with shield
This disclosure describes implantable medical leads and medical device systems utilizing the leads. In some examples, an implantable medical lead comprises a first defibrillation electrode and a second defibrillation electrode, the first and second defibrillation electrodes configured to deliver anti-tachyarrhythmia shocks, and a pace electrode disposed between the first defibrillation electrode and the second defibrillation electrode, the pace electrode configured to deliver a pacing pulse that generates an electric field proximate to the pace electrode. The implantable medical lead further comprises a shield disposed between the first defibrillation electrode and the second defibrillation electrode and over a portion of an outer surface of the pace electrode, wherein the shield is configured to impede the electric field in a direction from the pace electrode away from a heart.
1. An implantable medical lead comprising:
a first defibrillation electrode and a second defibrillation electrode, the first and second defibrillation electrodes configured to deliver anti-tachyarrhythmia shocks;
a pace electrode disposed between the first defibrillation electrode and the second defibrillation electrode, the pace electrode configured to deliver a pacing pulse that generates an electric field proximate to the pace electrode; and
a shield,
wherein the shield is disposed over a portion of an outer surface of the pace electrode,
wherein the shield extends laterally away from the pace electrode in a deployed configuration,
wherein the shield is configured to impede the electric field in a direction from the pace electrode away from a heart in the deployed configuration,
wherein the shield is disposed between the first defibrillation electrode and the second defibrillation electrode, and
wherein the shield extends:
over only a portion of the first defibrillation electrode, wherein the portion of the first defibrillation electrode comprises an end of the first defibrillation electrode most proximal to the pace electrode, and
over only a portion of the second defibrillation electrode, wherein the portion of the second defibrillation electrode comprises an end of the second defibrillation electrode most proximal to the pace electrode.
2. The implantable medical lead of claim 1 , wherein a length of the shield is greater than a length of the pace electrode.
3. The implantable medical lead of claim 1 , wherein a width of the shield is greater than a width of the pace electrode in the deployed configuration.
4. The implantable medical lead of claim 1 , wherein the shield is electrically insulative.
5. The implantable medical lead of claim 1 , wherein the shield is configured to be folded or wrapped around the pace electrode for delivery via a lumen of an implant tool, and configured to elastically unfold or unwrap to the deployed configuration when released from the lumen.
6. The implantable medical lead of claim 1 ,
wherein a distal portion of the implantable medical lead defines an undulating configuration including a first peak extending in a first direction, a second peak extending in the first direction, and a third peak, between the first peak and the second peak, extending in a second direction opposite the first direction, and
wherein at least a portion of the first defibrillation electrode is disposed on the first peak, at least a portion of the second defibrillation electrode is disposed on the second peak, and at least a portion of the pace electrode is disposed on the third peak.
7. The implantable medical lead of claim 1 , wherein the shield comprises at least one support structure configured to facilitate transitioning the shield to the deployed configuration.
8. The implantable medical lead of claim 7 , wherein the support structure comprises Nitinol.
9. The implantable medical lead of claim 1 , further comprising a lead body portion comprising a recess, wherein the pace electrode is recessed within the recess of the lead body portion.
10. The implantable medical lead of claim 1 , wherein the pace electrode comprises a first pace electrode and the shield comprises a first shield and the deployed configuration of the first shield comprises a first deployed configuration, the implantable medical lead comprising:
a second pace electrode; and
a second shield disposed over a portion of an outer surface of the second pace electrode, and extending laterally away from the second pace electrode in a second deployed configuration, wherein the second shield is configured to impede the electric field in a direction from the second pace electrode away from the heart in the second deployed configuration.
11. The implantable medical lead of claim 1 , further comprising a plurality of shields distributed along a length of a distal portion of the implantable medical lead.
12. The implantable medical lead of claim 1 , wherein the shield is configured to impede the electric field in a direction from the portion of the surface of the pace electrode to the shield.
13. The implantable medical lead of claim 1 , wherein the portion of the surface of the pace electrode is an inferior portion, and the shield is configured to impede the electric field in an inferior direction from the pace electrode.
14. The implantable medical lead of claim 1 , further comprising a balloon configured to actuate transitioning the shield to the deployed configuration.
15. An implantable medical system comprising:
an implantable medical device comprising:
a housing; and
therapy delivery circuitry within the housing and configured to generate anti-tachyarrhythmia shocks and a pacing pulse; and
an implantable medical lead configured to be coupled to the medical device comprising:
a first defibrillation electrode and a second defibrillation electrode, the first and second defibrillation electrodes configured to deliver the anti-tachyarrhythmia shocks;
a pace electrode disposed between the first defibrillation electrode and the second defibrillation electrode, the pace electrode configured to deliver the pacing pulse, wherein the pacing pulse generates an electric field proximate to the pace electrode; and
a shield,
wherein the shield is disposed over a portion of an outer surface of the pace electrode,
wherein the shield extends laterally away from the pace electrode in a deployed configuration,
wherein the shield is configured to impede the electric field in a direction from the pace electrode away from a heart in the deployed configuration,
wherein the shield is disposed between the first defibrillation electrode and the second defibrillation electrode, and
wherein the shield extends:
over only a portion of the first defibrillation electrode, wherein the portion of the first defibrillation electrode comprises an end of the first defibrillation electrode most proximal to the pace electrode, and
over only a portion of the second defibrillation electrode, wherein the portion of the second defibrillation electrode comprises an end of the second defibrillation electrode most proximal to the pace electrode;
and
an ICD configured to generate the pacing pulse.
16. The implantable medical system of claim 15 , further comprising a balloon configured to actuate transitioning the shield to the deployed configuration.
17. A method of implanting an implantable medical lead, the method comprising:
positioning a distal portion of an implantable medical lead at a location within a patient, wherein the implantable medical lead comprises:
a first defibrillation electrode and a second defibrillation electrode, the first and second defibrillation electrodes configured to deliver anti-tachyarrhythmia shocks;
a pace electrode disposed between the first defibrillation electrode and the second defibrillation electrode, the pace electrode configured to deliver a pacing pulse that generates an electric field proximate to the pace electrode; and
a shield,
wherein the shield is disposed over a portion of an outer surface of the pace electrode,
wherein the shield extends laterally away from the pace electrode in a deployed configuration,
wherein the shield is disposed between the first defibrillation electrode and the second defibrillation electrode,
wherein the shield extends:
over only a portion of the first defibrillation electrode, wherein the portion of the first defibrillation electrode comprises an end of the first defibrillation electrode most proximal to the pace electrode, and
over only a portion of the second defibrillation electrode, wherein the portion of the second defibrillation electrode comprises an end of the second defibrillation electrode most proximal to the pace electrode, and
wherein the shield is configured to impede the electric field in a direction from the pace electrode away from a heart in the deployed configuration; and
rotationally orienting the distal portion of implantable medical lead such that the shield is opposite the heart relative to the pace electrode.
18. The method of claim 17 , further comprising removing the implantable medical lead from a lumen of an implant tool to release the shield from a wrapped or folded configuration to the deployed configuration.
19. The method of claim 17 , further comprising actuating a transition of the shield to the deployed configuration with a balloon.