Pacemaker

Abstract

A method for pacing a chamber of a patient's heart includes providing a pulse generator including at least one lead configured to deliver electrical impulses to at least one activation site located in the myocardium of the heart. The pulse generator is implanted in the patient through a sub-xiphoid approach or a mini-thoracotomy using a robotic mechanism. The at least one lead is connected to the activation sites using the robotic mechanism.

What is claimed is: 
     
         1 . A method for pacing a chamber of a patient's heart, the method comprising providing a pulse generator comprising at least one lead configured to deliver electrical impulses to at least one activation site located in the myocardium of the heart; implanting the pulse generator in the patient through a sub-xiphoid approach or a mini-thoracotomy using a robotic mechanism; and connecting the at least one lead to the activation sites using the robotic mechanism. 
     
     
         2 . The method of  claim 1 , wherein implanting the pulse generator comprises positioning the pulse generator underneath the skin of the patient's torso and tunneling the leads from the pulse generator to an epicardial surface of the heart. 
     
     
         3 . The method of  claim 1 , wherein the at least one lead comprises first, second, third, and fourth leads, and wherein first lead attaches to an activation site located in the right atrium, the second lead attaches to an activation site located in the right ventricle, the third lead attaches to a posterior activation site in the left ventricle, and the fourth lead attaches to an anteriolateral activation site in the left ventricle. 
     
     
         4 . The method of  claim 1 , wherein the activation sites are sites determined to improve or optimize resynchronization of ventricular contraction. 
     
     
         5 . The method of  claim 1 , wherein the at least one lead comprises first, second, third, and fourth leads, the method further comprising delivering the electrical impulses through the first, second, third, and fourth leads to the activation sites within the cardiac tissue; and sensing electrical activity in the heart using each of the first, second, third, and fourth leads. 
     
     
         6 . The method of  claim 1 , further comprising selecting the activation sites to be located in areas of the heart that have been determined to include the most electrically contractile cardiac tissue. 
     
     
         7 . The method of  claim 1 , wherein connecting the at least one lead to the at least one activation site comprises using an imaging system to generate at least one image of the patient's heart; and selecting the at least one activation site from the generated image. 
     
     
         8 . The method of  claim 7 , further comprising using the imaging system to map at least a portion of the patient's heart; determining the most viable areas for lead placement on the patient's heart; and determining coordinates of the activation sites from the map. 
     
     
         9 . The method of  claim 8 , wherein determining the most viable areas for lead placement comprises determining portions of the at least one image that depicts an area of the myocardium having a contractile activity greater than a predetermined threshold amount. 
     
     
         10 . The method of  claim 8 , wherein determining the most viable areas for lead placement comprises placing one or more electrodes against selected locations of the heart; measuring an impedance at the selected locations; recording the impedance measurements associated with the locations; and selecting the locations having the most desirable impedance measurements as viable locations for lead placement. 
     
     
         11 . The method of  claim 8 , further comprising retrieving the determined coordinates of the activation sites; receiving motion signals encoding the movement of a user's hand; and controlling movement of the of the robotic mechanism based on the motion signals so that the robotic mechanism replicates the movement of the user's hand. 
     
     
         12 . The method of  claim 7 , wherein the imaging system comprises one of a Doppler echocardiogram imaging system, a computed tomography imaging system, a magnetic resonance imaging system, a fluoroscopy imaging system, an ultrasound imaging system, and a positron emission tomography imaging system. 
     
     
         13 . The method of  claim 1 , wherein the mini-thoracotomy comprises directing the robotic mechanism through an operative channel that passes between the sixth and seventh ribs. 
     
     
         14 . The method of  claim 1 , wherein the sub-xiphoid approach comprises directing the robotic mechanism through an operative channel that passes through an incision directly below the sternum and through the diaphragm. 
     
     
         15 . The method of  claim 1 , wherein the robotic mechanism comprises a surgical rover, comprising: (a) a front section adapted to carry at least one surgical implement, the front section including at least one front suction cup; (b) a rear section including at least rear one suction cup; (c) interconnecting members spanning the front and rear sections; (d) means for moving the front and rear sections relative to each other along the interconnecting members, so as to change the distance between the front and rear sections; and (e) means for selectively independently applying suction to the front and rear suction cups. 
     
     
         16 . The method of  claim 15 , wherein the interconnecting members comprise a pair of spaced-apart cables. 
     
     
         17 . The method of  claim 15 , wherein the means for moving at least one of the front and rear sections along the interconnecting members comprises an actuator carried by the rear piece adapted to reel the cables in and out. 
     
     
         18 . The method of  claim 15 , wherein the means for moving at least one of the front and rear sections along the interconnecting members comprises: an actuator carried by the rear section adapted to reel the cables in; and a spring adapted to move the rear section along the cables in the opposite direction away from the front section. 
     
     
         19 . The method of  claim 15 , wherein the means for moving the front and rear sections relative to each other are operable to move opposing sides of the rover by different amounts, so as to affect a change in direction of travel.