Adjustable lead systems for cardiac septal wall implantation
An implantable lead system may include an adjustable lead assembly. The lead assembly may include a fixation member and an implantable lead slidably coupled to and rotatable relative to the fixation member. The implantable lead system may include a telescoping delivery system. The delivery system may include an outer catheter and an inner catheter slidably coupled to and rotatable relative to the outer catheter. The lead assembly may be implanted in a cardiac septal wall through the delivery assembly.
1 . An implantable medical device comprising:
an elongate fixation member couplable to a septal wall of a patient's heart;
an elongate lead body comprising a distal end portion configured to be at least partially inserted into the septal wall, the lead body being slidably coupled to and rotatable relative to the elongate fixation member;
a plurality of electrodes comprising:
a first electrode coupled to the distal end portion of the lead body implantable in the septal wall of a patient's heart to pace a first region of the patient's heart; and
a second electrode coupled to the lead body proximal to the first electrode to pace a second region of the patient's heart;
a securing member to couple a proximal end portion of the fixation member and a proximal end portion of the lead body;
a therapy delivery circuit operably coupled to the plurality of electrodes to deliver cardiac therapy to the patient's heart;
a sensing circuit operably coupled to the plurality of electrodes to sense electrical activity of the patient's heart; and
a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit, the controller configured to deliver cardiac therapy to the patient's heart using one or both of the first region and the second region.
2 . The device of claim 1 , wherein the distal end portion of the lead body comprises a tapered or helix structure comprising the first electrode.
3 . The device of claim 1 , wherein when the lead body is implanted, one or both of the first electrode and the second electrode are implanted in the septal wall.
4 . The device of claim 1 , wherein the plurality of electrodes comprises at least four electrodes.
5 . The device of claim 1 , wherein the first region comprises the left ventricular myocardium of the patient's heart and the second region comprises the right atrial myocardium of the patient's heart.
6 . The device of claim 5 , wherein the first region comprises the basal region, septal region, or basal-septal region of the left ventricular myocardium and the second region comprises the triangle of Koch region in the right atrium of the patient's heart.
7 . The device of claim 1 , wherein the first region comprises the left bundle branch of the patient's heart and the second region comprises the right bundle branch of the patient's heart.
8 . The device of claim 1 , wherein the fixation member defines a lumen and the lead body is slidably received in the lumen.
9 . The device of claim 1 , wherein the fixation member comprises a fixation element including a helix structure to screw in or out of the septal wall in response to rotation of the fixation member.
10 . The device of claim 1 , wherein the fixation member is electrically conductive.
11 . The device of claim 1 , wherein the fixation member comprises an elongate braided structure.
12 . The device of claim 1 , wherein the plurality of electrodes are coupled to one or more electrically insulated coil conductors.
13 . The device of claim 12 , wherein the one or more electrically insulated coil conductors define an inner lumen to receive a guide wire.
14 . The device of claim 13 , wherein the first electrode defines at least part of the inner lumen.
15 . The device of claim 13 , further comprising a sealing element coupled to the first electrode of the implantable lead to form a fluid seal between the guide wire and an inner surface of the first electrode.
16 . The device of claim 1 , wherein the implantable medical device comprises one or more of the following: a transvenous implantable pacemaker, a cardiac resynchronization therapy (CRT) device, a transvenous CRT pacemaker (CRT-P), a transvenous CRT defibrillator (CRT-D), an implantable transvenous cardioverter defibrillator (ICD), a subcutaneous ICD (S-ICD), and a subcutaneous medical device.
17 . The device of claim 1 , wherein at least one of the first electrode, and the second electrode comprises a segmented electrode including two or more segments angularly spaced from one another.