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WO2002022206A1 - Procede et appareil de stimulation ventriculaire gauche mettant en oeuvre une approche endocavitaire du ventricule droit - Google Patents

Procede et appareil de stimulation ventriculaire gauche mettant en oeuvre une approche endocavitaire du ventricule droit Download PDF

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Publication number
WO2002022206A1
WO2002022206A1 PCT/US2001/028413 US0128413W WO0222206A1 WO 2002022206 A1 WO2002022206 A1 WO 2002022206A1 US 0128413 W US0128413 W US 0128413W WO 0222206 A1 WO0222206 A1 WO 0222206A1
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WO
WIPO (PCT)
Prior art keywords
tip
pacing
septum
lead
electrode
Prior art date
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Ceased
Application number
PCT/US2001/028413
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English (en)
Inventor
Hongpyo H. Lee
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Individual
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Individual
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Publication of WO2002022206A1 publication Critical patent/WO2002022206A1/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems
    • A61N1/057—Anchoring means; Means for fixing the head inside the heart
    • A61N1/0573—Anchoring means; Means for fixing the head inside the heart chacterised by means penetrating the heart tissue, e.g. helix needle or hook
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions

Definitions

  • the invention relates to the field of cardiac pacing and in particular to pacing of the left ventricle.
  • CHF Congestive heart failure
  • the heart is characterized by widely spread complex electric conduction networks which ensure rapid and orderly depolarization of heart muscle.
  • This orderly depolarization triggers coordinated cardiac contractions for an efficient cardiac pump function.
  • An extensive cardiac disease process frequently damages this complex conduction system, resulting in slow zigzag, non-orderly myocardial depolarization through muscle conduction, instead of orderly rapid depolarization through the regular conduction network.
  • This electric asynchrony is manifested as a wide left bundle branch block (LBBB) pattern in an electrocardiogram (ECG) and causes an uncoordinated cardiac contraction sequence, which results in more inefficiency on existing poor cardiac pump function.
  • LBBB wide left bundle branch block
  • ECG electrocardiogram
  • the rationale for using a pacemaker in CHF is to resynchronize the cardiac electric depolarization (inter and intraventricular, especially left intraventricular, because of its dominance in the cardiac pump function) by pacing on proper cardiac sites.
  • This electric resynchronization improves cardiac function by achieving better coordination of cardiac contraction sequence.
  • the usual right ventricular pacing alone cannot improve electric asynchrony of left ventricle, but proper left ventricular (single or multiple sites) or biventricular pacing has shown significant electromechanical improvement.
  • left ventricular pacemaker lead has been limited by technical difficulties and relatively high risks, preventing wide spread clinical trial of this cardiac resynchronization therapy.
  • the first technique used was the epicardial approach, but its main limitation is the need for thoracotomy and general anesthesia, which carries a high risk for CHF patient.
  • the current approach is transvenous pacing lead insertion into a tributary of coronary sinus over the left ventricular free wall, but technical difficulties frequently result in improper lead placement.
  • an endocardial approach via an atrial transseptal route was also proposed, but this technique appears too difficult and risky for practical usage.
  • the left ventricle is much more muscular and generates five times more pumping pressure than the right ventricle. Electrophysiological dysfunction in the left ventricle can thus be corresponding more significant to the functioning of the heart than other heart portions. While being the dominant portion of the heart, the left ventricle has been rarely paced, however, because of the anatomical difficulty of accessing or implanting a pacemaker lead in it.
  • the invention is a method of pacing a heart having a left ventricle and a right ventricle which are separated by a septum.
  • the method comprises the steps of disposing a distal end of a pacing lead into the right ventricle in contact with the septum at a selected site using conventional transvenous approaches.
  • a tip is extended from the distal end of the pacing lead to penetrate the septum by a selected distance.
  • the tip extends into the septum toward the left ventricle.
  • the tip has a tip electrode.
  • An electrical signal is applied to the tip and tip electrode to pace the left ventricle.
  • the step of extending a tip from the distal end of the pacing lead screws the tip into the septum, although it is to be expressly understood that any type of penetrating now known or later devised may be employed, such a anchoring, hooking, puncturing, pronging, screwing or pinching.
  • the step of extending a tip from the distal end of the pacing lead extends the tip or at least its tip electrode at least more than half way through the septum toward the left ventricle.
  • the pacing lead has a distal electrode and the step of extending a tip from the distal end of the pacing lead brings the distal electrode on the pacing lead into contact with a right ventricle wall of the septum.
  • the step of applying an electrical signal to the tip to pace the left ventricle may also pace the right ventricle.
  • the right ventricle may be paced through a separate distal electrode on the pacing lead independently from pacing of the left ventricle through the tip electrode.
  • the right ventricle is paced through the distal electrode on the pacing lead independently from pacing of the left ventricle through the tip electrode.
  • pacing the right ventricle through a separate distal electrode is synchronized with pacing of the left ventricle.
  • the invention is also defined as an apparatus for pacing a heart having a left ventricle and a right ventricle which are separated by a septum.
  • the apparatus comprises a pacing lead having a distal end adapted to be disposed into the right ventricle in contact with the septum at a selected site.
  • a tip can be extended from the distal end of the pacing lead to penetrate the septum by a selected distance.
  • the tip extends into the septum toward the left ventricle.
  • the tip has a tip electrode so that an electrical signal applied to the tip paces the left ventricle.
  • the tip is a screw tip which is characterized by a distal portion which is conductive, which is exposed to provide the tip electrode, and which is embedded into or at least partially through the septum.
  • the mechanism for advancing or retracting the tip may take anyone of a wide variety of conventional forms associated with screw or embedding cardiac tips with the modification according to the invention of being extendable to a sufficient distance into or through the septum wall to
  • the pacing lead further comprises a distal electrode.
  • the distal electrode of the pacing lead is electrically insulated from the tip.
  • a pacemaker is coupled to the tip and to the distal electrode for selectively applying separate electrical signals to both the tip and to the distal electrode. The pacemaker applies the separate electrical signals to both the tip and to the distal electrode in predetermined synchronization with each other.
  • the pacing lead is either a unipolar or bipolar pacing lead.
  • FIG. 1 is a side cross-sectional view of a human heart in which a lead has been implanted according to the invention to pace the left ventricle.
  • Fig. 2 is an enlarged side cross-sectional view of the distal end of a pacing lead disposed against the right ventricle wall of the septum according to the invention in which a screw tip is fully retracted, but the distal end of the pacing lead is placed against the right ventricle wall of the septum.
  • Fig. 3 is the side cross-sectional view of Fig. 2 in which the screw tip is advanced into the septum toward the left ventricle wall.
  • a pacing lead of the invention is characterized by a longer screw-in tip than is conventional and is provided with an electrically active distal electrode, which is insulated from the proximal part of the screw tip of the pacemaker lead.
  • This electrically active distal screw-in tip is extended from the right ventricular septal endocardium into the left side of the interventricular septum and is used for left ventricular pacing with optional properly synchronized right ventricular pacing. This is done by usual transvenous technique.
  • the method for tip extension into the septum may be any currently known or modified means such as in the illustrated embodiment.
  • the lead in shown as being comprised of a lead through which a stylet is disposed.
  • a stylet is engaged to a follower nut with external threading, which engages internal threading provided in the interior surface of the lead. Rotation of the stylet rotates the follower nut to advance or retract the nut within threading.
  • the lineal extent of internal threading which is provided is sufficient to allow advancement of the tip at least more than halfway through the entire width the septum.
  • the electrically active distal electrode of the tip is comprised of the exposed portion of the metallic tip while the remaining portion of the tip is covered with the electrical insulator.
  • An electrical pin is coupled at its proximal end to a pacemaker, which is typically subcutaneously implanted in the upper chest.
  • Pacemaker leads with active screw-in tips have been used for over a decade with great ease and success to secure or anchor a pacemaker lead tip into stable contact with the endocardium.
  • Current screw-in tips are typically about 2mm in length. According to the invention the length of the screw-in tip is altered to allow extension of the tip into the septum toward the left ventricle by a distance to allow electrical stimulation to the left ventricle.
  • the septum may in some cases be approximately 2 cm thick, thus requiring a screw-in tip approximately 1 cm longer or longer.
  • One of the commonly used screw-in tips presently used for pacing is described and shown by Bisping, "Implantable Electrode," U.S.
  • Patent 4,233,992 (1980), and Bisping "Implantable Lead Assembly with Extendable Screw-in Electrode,” U.S. Patent 4,886,074 (1989), which are incorporated herein by reference. See also Dutcher, “Body-lmplantable Lead with Protected, Extendable Tissue Securing Means,” U.S. Patent 4,217,913 (1980), and Bradshaw, et.al, "Active Fixation Mechanism for Lead Assembly of an Implantable Cardiac Stimulator," U.S. Patent 4,858,623 (1989), which are incorporated herein by reference.
  • the Bisping lead and screw-in tip or any other conventional lead and screw-in tip now known or later devised can be modified according to the invention to be used left ventricle pacing.
  • the exact form of the lead while important, is nonetheless ancillary to the main thrust of the invention which is directed to left ventricle pacing through septum by access through the right ventricle as shown in Fig. 1.
  • Heart 11 has a lead 10 disposed into right atrium 13 in a conventional manner and extending into right ventricle 24 to septum 16.
  • Tip 14 is extended from distal tip 20 of lead 10 and penetrates or extends into septum 16 by a distance sufficient to stimulate a selected pathway in left ventricle 17. Tip 14 will be implanted at a location which is determined by the physician to be for best left ventricular pacing.
  • Fig. 2 is a diagrammatic side view of the invention showing a lead 10 which is characterized by a longer screw-in tip 12 with an electrically active small distal electrode 14, insulated from the proximal part of screw 12 of pacemaker lead 10.
  • lead 10 in shown as being comprised of a lead 11 through which a stylet 13 is disposed.
  • a stylet 13 is engaged to a follower nut 15 with external threading, which engages internal threading 17 provided in the interior surface of lead 11. Rotation of stylet 13 rotates follower nut 15 to advance or retract nut 15 within threading 17.
  • the lineal extent of internal threading 17 provided is sufficient to allow advancement of tip 12 at least more than halfway through the entire width septum 16.
  • electrically active distal electrode 14 of tip 12 is comprised of the exposed portion of metallic tip 12 on the remaining portion of tip 12 is covered with the electrical insulator.
  • tip electrode 14 and tip 12 may be realized, such as a conductive tip 14 coupled to a nonconductive tip 12, which tip 14 is electrically connected to means such as a conductive strip or core embedded within nonconductive tip 12, which is coupled at its proximal end to a pacemaker 32, which is typically subcutaneously implanted in the upper chest.
  • Fig. 3 is side cross sectional diagrammatic view of lead 10 of Fig. 2 in which tip 12 has been advanced by rotating follower nut 15. In the illustrated view of Fig.
  • tip 12 has been advanced so that electrically active electrode tip 14 is positioned in the left side of septum 16.
  • lead 10 is positioned with its distal electrode 20 adjacent right ventricular wall 22.
  • Advancement of tip 12 into septum 16 insures that distal electrode 20 remains in intimate contact with adjacent right ventricular wall 22.
  • the mechanism for advancing or retracting tip 12 is meant to include any mechanism for advancing or retracting tip 12 from or into the distal end 28 of lead 10 now known or later devised.
  • the degree of screw can be varied from almost straight to markedly pitched.
  • a screw mechanism need not be used, but a straight needle which has a fixed or extendable distal anchor can also be used.
  • tip 12 is made of an appropriate material so that it moves easily with the contractions of septum 16 without fatigue or embrittlement.
  • Tip 12 is adapted to being and is screwed into the interventricular septum 16 and is advanced to or toward the left ventricle side 18 of septum 16.
  • Left ventricle pacing can be performed either as unipolar or bipolar pacing as is conventionally practiced. See for example, Helland, etal., "Bipolar Active Fixation Lead for Sensing and Pacing of the Heart," U.S. Patent 5,545,201 (1996), incorporated herein by reference.
  • Pacemaker lead pole 20 is in contact with the endocardium of right ventricle and can be used for right ventricle pacing as unipolar or bipolar electrode.
  • Split bipolar pacing between the left ventricle and right ventricle septum walls 26 and 22 respectively can also be performed.
  • Lead 10 may include additional electrodes as are well known in the art such as proximal ring electrode 30 which may be used for sensing or bipolar operation.
  • the length of screw-tip 12, including its electrically active portion 14, which extends into septum 16 depends on the thickness of interventricular septum 16, which is normally about 1cm, but this is highly variable.
  • Lead 10 can be easily positioned perpendicularly against septum 16 in right ventricle cavity 24, using a variety of techniques including fluoroscopy, a preformed sheath and steerable guide- stylet so that screw-tip 12 can be screwed into the left ventricle side 26 of septum 16.
  • This septal pacing will mimic the normal septal depolarization from left septum 26 to right septum 22 and may substantially improve the coordination of left ventricular contraction by itself. If needed, simultaneous or nonsimultaneous pacing of another left ventricular site, such as the left lateral basal wall, in addition to the described left septal pacing may further augment the electromechanical improvement.
  • left ventricle pacing can be realized by a penetrating electrode 14 disposed into septum 16 from the right ventricle, which electrode 14 is located at or near left ventricle wall 18, conventional methods of approach, which are well known and well tested, as well as being within the skill of the ordinary pacemaker surgeon, can be successfully used to implant lead 10.
  • Multiple chamber pacings can be done easily and any of the means now known to the art or later devised can be employed. See for example, Struble, etal., “Multiple Channel, Sequential Cardiac Pacing System, "U.S. Patent 6,081 ,748 (2000) which is incorporated herein by reference.

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  • Engineering & Computer Science (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Hospice & Palliative Care (AREA)
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Abstract

La sonde de stimulation de cette invention est caractérisée par une pointe filetée plus longue que celle d'une sonde classique et elle comporte une électrode distale électriquement active qui est isolée de la partie proximale de l'extrémité filetée de la sonde du stimulateur cardiaque. La pointe filetée distale électriquement active fait saillie à partir de l'endocarde septal du ventricule droit dans la partie gauche du septum interventriculaire et sert à la stimulation ventriculaire gauche éventuellement associée à une stimulation ventriculaire droite correctement synchronisée. Ceci est effectué par mise en oeuvre d'une technique de stimulation transveineuse. Le procédé permettant une saillie de la pointe dans le septum peut faire appel à un moyen actuellement connu ou à un moyen modifié tel que présenté dans le mode de réalisation illustré. Dans le mode de réalisation illustré, la sonde est traversée par un stylet. Ce stylet s'accouple à un écrou de vis-mère doté d'un filetage externe qui s'accouple à un filetage interne ménagé dans la surface interne de la sonde. La rotation du stylet fait tourner l'écrou de vis-mère de sorte que celui-ci avance ou recule à l'intérieur du filetage. L'extension linéaire du filetage interne est suffisante pour permettre une progression de la pointe sur au moins la moitié de la largeur totale du septum. Dans le mode de réalisation illustré, l'électrode distale électriquement active de la pointe se compose d'une partie exposée de la pointe métallique tandis que la partie restante de ladite pointe est recouverte d'un isolant électrique. Une broche électrique est couplée en son extrémité proximale à un stimulateur cardiaque classique qui est généralement implanté de manière sous-cutanée dans la partie supérieure de la poitrine.
PCT/US2001/028413 2000-09-12 2001-09-11 Procede et appareil de stimulation ventriculaire gauche mettant en oeuvre une approche endocavitaire du ventricule droit Ceased WO2002022206A1 (fr)

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US66031600A 2000-09-12 2000-09-12
US09/660,316 2000-09-12

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Cited By (25)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003092799A1 (fr) * 2002-04-29 2003-11-13 Medtronic, Inc. Sonde de stimulation a electrode de fixation active partiellement masquee
EP1428550A1 (fr) * 2002-12-13 2004-06-16 P.A. & M. S.p.A. Sonde cardiaque unique pour la stimulation bi-ventriculaire
US6932804B2 (en) 2003-01-21 2005-08-23 The Regents Of The University Of California System and method for forming a non-ablative cardiac conduction block
WO2005107850A1 (fr) * 2004-04-27 2005-11-17 Medtronic, Inc. Electrode de stimulation cardiaque trans-septale
US7317950B2 (en) 2002-11-16 2008-01-08 The Regents Of The University Of California Cardiac stimulation system with delivery of conductive agent
WO2008139396A3 (fr) * 2007-05-11 2009-01-08 Chamalow S A Cathéter monoélectrode utilisé pour l'électrostimulation cardiaque univentriculaire et biventriculaire
US8396549B2 (en) 2001-11-29 2013-03-12 Medtronic, Inc. Papillary muscle stimulation
US8880192B2 (en) 2012-04-02 2014-11-04 Bio Control Medical (B.C.M.) Ltd. Electrode cuffs
WO2018035343A1 (fr) * 2016-08-19 2018-02-22 Cardiac Pacemakers, Inc. Dispositif médical implantable trans-septal
US10448971B2 (en) 2016-12-21 2019-10-22 Medtronic, Inc. Apparatus for forming a passageway in tissue and associated interventional medical systems
US11058880B2 (en) 2018-03-23 2021-07-13 Medtronic, Inc. VFA cardiac therapy for tachycardia
US11213676B2 (en) 2019-04-01 2022-01-04 Medtronic, Inc. Delivery systems for VfA cardiac therapy
US11235161B2 (en) 2018-09-26 2022-02-01 Medtronic, Inc. Capture in ventricle-from-atrium cardiac therapy
US11235159B2 (en) 2018-03-23 2022-02-01 Medtronic, Inc. VFA cardiac resynchronization therapy
US11305127B2 (en) 2019-08-26 2022-04-19 Medtronic Inc. VfA delivery and implant region detection
US11400296B2 (en) 2018-03-23 2022-08-02 Medtronic, Inc. AV synchronous VfA cardiac therapy
US11679265B2 (en) 2019-02-14 2023-06-20 Medtronic, Inc. Lead-in-lead systems and methods for cardiac therapy
US11697025B2 (en) 2019-03-29 2023-07-11 Medtronic, Inc. Cardiac conduction system capture
US11712188B2 (en) 2019-05-07 2023-08-01 Medtronic, Inc. Posterior left bundle branch engagement
US11813466B2 (en) 2020-01-27 2023-11-14 Medtronic, Inc. Atrioventricular nodal stimulation
US11813464B2 (en) 2020-07-31 2023-11-14 Medtronic, Inc. Cardiac conduction system evaluation
US11911168B2 (en) 2020-04-03 2024-02-27 Medtronic, Inc. Cardiac conduction system therapy benefit determination
US11951313B2 (en) 2018-11-17 2024-04-09 Medtronic, Inc. VFA delivery systems and methods
US12296177B2 (en) 2018-12-21 2025-05-13 Medtronic, Inc. Delivery systems and methods for left ventricular pacing
US12465770B2 (en) 2020-07-31 2025-11-11 Medtronic, Inc. Coronary sinus conduction system pacing and delivery

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5728140A (en) * 1996-06-17 1998-03-17 Cardiac Pacemakers, Inc. Method for evoking capture of left ventricle using transeptal pacing lead

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5728140A (en) * 1996-06-17 1998-03-17 Cardiac Pacemakers, Inc. Method for evoking capture of left ventricle using transeptal pacing lead

Cited By (32)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8396549B2 (en) 2001-11-29 2013-03-12 Medtronic, Inc. Papillary muscle stimulation
US7177704B2 (en) 2002-04-29 2007-02-13 Medtronic, Inc. Pacing method and apparatus
WO2003092799A1 (fr) * 2002-04-29 2003-11-13 Medtronic, Inc. Sonde de stimulation a electrode de fixation active partiellement masquee
US7317950B2 (en) 2002-11-16 2008-01-08 The Regents Of The University Of California Cardiac stimulation system with delivery of conductive agent
EP1428550A1 (fr) * 2002-12-13 2004-06-16 P.A. & M. S.p.A. Sonde cardiaque unique pour la stimulation bi-ventriculaire
US6932804B2 (en) 2003-01-21 2005-08-23 The Regents Of The University Of California System and method for forming a non-ablative cardiac conduction block
WO2005107850A1 (fr) * 2004-04-27 2005-11-17 Medtronic, Inc. Electrode de stimulation cardiaque trans-septale
WO2008139396A3 (fr) * 2007-05-11 2009-01-08 Chamalow S A Cathéter monoélectrode utilisé pour l'électrostimulation cardiaque univentriculaire et biventriculaire
US8880192B2 (en) 2012-04-02 2014-11-04 Bio Control Medical (B.C.M.) Ltd. Electrode cuffs
WO2018035343A1 (fr) * 2016-08-19 2018-02-22 Cardiac Pacemakers, Inc. Dispositif médical implantable trans-septal
CN109562269A (zh) * 2016-08-19 2019-04-02 心脏起搏器股份公司 经隔膜可植入医疗设备
US10391319B2 (en) 2016-08-19 2019-08-27 Cardiac Pacemakers, Inc. Trans septal implantable medical device
CN109562269B (zh) * 2016-08-19 2023-08-11 心脏起搏器股份公司 经隔膜可植入医疗设备
US10448971B2 (en) 2016-12-21 2019-10-22 Medtronic, Inc. Apparatus for forming a passageway in tissue and associated interventional medical systems
US11617600B2 (en) 2016-12-21 2023-04-04 Medtronic, Inc. Apparatus for forming a passageway in tissue and associated interventional medical systems
US11235159B2 (en) 2018-03-23 2022-02-01 Medtronic, Inc. VFA cardiac resynchronization therapy
US11058880B2 (en) 2018-03-23 2021-07-13 Medtronic, Inc. VFA cardiac therapy for tachycardia
US11400296B2 (en) 2018-03-23 2022-08-02 Medtronic, Inc. AV synchronous VfA cardiac therapy
US11819699B2 (en) 2018-03-23 2023-11-21 Medtronic, Inc. VfA cardiac resynchronization therapy
US12172021B2 (en) 2018-09-26 2024-12-24 Medtronic, Inc. Capture in ventricle-from-atrium cardiac therapy
US11235161B2 (en) 2018-09-26 2022-02-01 Medtronic, Inc. Capture in ventricle-from-atrium cardiac therapy
US11951313B2 (en) 2018-11-17 2024-04-09 Medtronic, Inc. VFA delivery systems and methods
US12296177B2 (en) 2018-12-21 2025-05-13 Medtronic, Inc. Delivery systems and methods for left ventricular pacing
US11679265B2 (en) 2019-02-14 2023-06-20 Medtronic, Inc. Lead-in-lead systems and methods for cardiac therapy
US11697025B2 (en) 2019-03-29 2023-07-11 Medtronic, Inc. Cardiac conduction system capture
US11213676B2 (en) 2019-04-01 2022-01-04 Medtronic, Inc. Delivery systems for VfA cardiac therapy
US11712188B2 (en) 2019-05-07 2023-08-01 Medtronic, Inc. Posterior left bundle branch engagement
US11305127B2 (en) 2019-08-26 2022-04-19 Medtronic Inc. VfA delivery and implant region detection
US11813466B2 (en) 2020-01-27 2023-11-14 Medtronic, Inc. Atrioventricular nodal stimulation
US11911168B2 (en) 2020-04-03 2024-02-27 Medtronic, Inc. Cardiac conduction system therapy benefit determination
US11813464B2 (en) 2020-07-31 2023-11-14 Medtronic, Inc. Cardiac conduction system evaluation
US12465770B2 (en) 2020-07-31 2025-11-11 Medtronic, Inc. Coronary sinus conduction system pacing and delivery

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