Methods for lead placement on a surface of the heart

Abstract

The methods and apparatus for lead placement on a surface of the heart are employed using an elongated body having proximal and distal end portions. The body defines a lead receiving passageway extending between a proximal inlet and a distal outlet for receiving a lead therethrough for contact with the heart surface. The elongated body is adapted for insertion between a pericardium and an epicardial surface. At least a portion of the body may have a non-circular cross-sectional shape adapted to retain the body orientation between the pericardium and the epicardial surface.

1 . A method for placing a lead on an epicardial surface of the heart with a lead placement apparatus, the lead placement apparatus including an elongated body having a lead receiving passageway extending therethrough, the method comprising: 
 advancing a distal end of the lead placement apparatus to the epicardial surface in a minimally invasive manner;    steering the distal end of the lead placement apparatus in a plane parallel to the epicardial surface to an attachment site;    applying a vacuum force to a contact surface at the distal end of the lead placement apparatus to temporarily secure the contact surface to the epicardial surface at the attachment site;    advancing a lead through the lead receiving passageway to the attachment site; and    securing a distal end of the lead to the epicardial surface.    
     
     
         2 . The method of  claim 1  further comprising viewing the epicardial surface adjacent a distal end of the lead receiving passageway.  
     
     
         3 . The method of  claim 2  wherein viewing the epicardial surface further comprises advancing a viewing device through a viewing lumen in the lead placement apparatus.  
     
     
         4 . The method of  claim 1  further comprising electrically mapping the epicardial surface.  
     
     
         5 . The method of  claim 1  further comprising temporarily pacing the heart.  
     
     
         6 . The method of  claim 5  further comprising using the lead placement apparatus to temporarily pace the heart.  
     
     
         7 . The method of  claim 5  further comprising using the lead to temporarily pace the heart.  
     
     
         8 . The method of  claim 1  further comprising accessing the heart from a sub-xyphoid access opening.  
     
     
         9 . The method of  claim 1  wherein steering the distal end of the lead placement apparatus comprises steering the distal end of the lead placement apparatus between the epicardial surface and a pericardial surface of the heart to the attachment site.  
     
     
         10 . The method of  claim 1  wherein steering the distal end of the lead placement apparatus comprises curving a portion of the lead placement apparatus relative to a longitudinal axis of the lead placement apparatus.  
     
     
         11 . A method for placing a lead on a heart surface with a lead placement apparatus, the lead placement apparatus including an elongated body having a lead receiving passageway extending therethrough, the method comprising: 
 advancing a distal end of the lead placement apparatus to the heart surface in a minimally invasive manner;    temporarily and non-invasively holding a contact surface at the distal end of the lead placement apparatus to the heart surface at an attachment site using a suction force;    advancing a lead through the lead receiving passageway to the attachment site; and    securing a distal end of the lead to the heart surface.    
     
     
         12 . The method of  claim 11  wherein temporarily and non-invasively holding the distal end of the lead placement apparatus to the heart surface comprises suctioning the contact surface to the heart surface proximal to the attachment site.  
     
     
         13 . The method of  claim 11  wherein temporarily and non-invasively holding the distal end of the lead placement apparatus to the heart surface comprises holding the distal end of the lead placement apparatus to the epicardial surface proximal to the attachment site.  
     
     
         14 . The method of  claim 11  further comprising delivering a fluid to the attachment site through the lead placement apparatus.  
     
     
         15 . A method for placing a lead on an epicardial surface of the heart with a lead placement apparatus, the lead placement apparatus including an elongated body having a lead receiving passageway extending therethrough, the method comprising: 
 advancing a distal end of the lead placement apparatus to the epicardial surface in a minimally invasive manner;    suctioning a contact surface at the distal end of the lead placement apparatus to the epicardial surface at an attachment site;    advancing a lead through the lead receiving passageway to the attachment site;    directing a distal end of the lead towards the attachment site an angle to the epicardial surface at the attachment site;    pacing the heart with a pacing signal to determine whether the selected location is suitable for lead placement; and    securing the lead to the epicardial surface.    
     
     
         16 . The method of  claim 15  wherein pacing the heart with a pacing signal comprises electrically mapping the epicardial surface.  
     
     
         17 . The method of  claim 15  wherein pacing the heart comprises using the lead to temporarily pace the heart.  
     
     
         18 . The method of  claim 15  wherein pacing the heart comprises using the lead placement apparatus to temporarily pace the heart.  
     
     
         19 . The method of  claim 15  wherein engaging the lead comprises engaging a plurality of leads with the epicardial surface.  
     
     
         20 . The method of  claim 15  further comprising viewing the epicardial surface adjacent a distal end of the lead receiving passageway.