Cardiac electrode attachment procedure

Abstract

Surgical procedure and surgical instruments include an electrode structure for insertion through tissue superiorly of a subxiphoid incision to a position posterior of an aspect of the sternum and anterior of the pericardium. The electrode structure may be expanded, for example, including an inflatable member to position a number of electrodes of the electrode structure in contact with the pericardium. Alternatively, an electrode structure on an insertion cannula may be retained in contact with the pericardium by the cannula positioned within the dissected tissue. Electrical conductors from the contacting electrodes are routed through the tract of dissected tissue toward the subxiphoid incision for attachment to a generator that is implanted in a subcutaneous pocket near the subxiphoid incision.

1 . A surgical procedure for contacting electrodes supported on an electrode structure to the heart of a patient, the procedure comprising the steps for: 
 forming a subxiphoid incision on the patient;    dissecting tissue along a tract superiorly from the subxiphoid incision to a posterior aspect of the patient's sternum near the patient's heart for advancing the electrode structure through the subxiphoid incision and along the tract of dissected tissue to the posterior aspect of the patient's sternum; and    positioning the electrode structure within the region posterior to the posterior aspect of the patient's sternum and anterior to the patient's heart to form contact therewith of a number of the electrodes of the electrode structure.    
   
   
       2 . The surgical procedure according to  claim 1  including: 
 expanding the electrode structure within said region to form the contact with the pericardium outside the patient's heart by each of the number of electrodes.    
   
   
       3 . The surgical procedure according to  claim 1  in which the electrode structure includes an inflatable member and conductors extending from each of the number of electrodes, and further comprises the steps for: 
 inflating the member to contact the number of electrodes with the patient's heart; and    routing the conductors along the tract of dissected tissue toward the subxiphoid incision.    
   
   
       4 . The surgical procedure according to  claim 1  including a generator for supplying signals to the number of electrodes, and further comprising the steps for: 
 connecting a conductor for each of the number of electrodes to receive signals from the generator; and    implanting the generator subcutaneously in the patient near the subxiphoid incision.    
   
   
       5 . The surgical procedure according to  claim 3  performed using an insertion instrument and further comprising the steps for: 
 confining the inflatable member within the insertion instrument in one configuration thereof;    inserting the insertion instrument in the one configuration through the subxiphoid incision and along the tract of dissected tissue to the posterior aspect of the patient's sternum;    re-configuring the insertion instrument in another configuration to expose the inflatable member; and    disengaging the insertion instrument from the inflated member for removal of the insertion instrument through the subxiphoid incision.    
   
   
       6 . The surgical procedure according to  claim 1  including radiologically visualizing placement of the electrode structure advanced to the posterior aspect of the patient's sternum through the subxiphoid incision and along the tract of dissected tissue.  
   
   
       7 . The surgical procedure according to  claim 5  in which the insertion instrument is generally U-shaped with one portion for insertion through the subxiphoid incision, and with another portion in substantial alignment with the one portion and spaced therefrom, and further comprising the steps for: 
 inserting the one portion through the subxiphoid incision to position the electrode structure at the posterior aspect of the patient's sternum with said another portion extending outside the patient's body superiorly from the subxiphoid incision substantially coextensively with the one portion inside the patient's body.    
   
   
       8 . The surgical procedure according to  claim 7  further comprising the step for: 
 determining positioning indicia for said another portion of the insertion instrument on the outside of the patient's body superiorly of the subxiphoid incision for selectively positioning the one portion of the insertion instrument within the patient's body with reference to the positioning indicia.    
   
   
       9 . The surgical procedure according to  claim 1  performed with an electrode structure disposed near the distal end of an elongated flexible body, the procedure including the steps for: 
 selectively stiffening the elongated body for positioning the electrode structure; and    removing stiffening of the elongated body following positioning of the electrodes in contact with the patient's heart.    
   
   
       10 . The surgical procedure according to  claim 9  in which the elongated body slidably carries a substantially rigid obturator; and 
 removing stiffening includes removing the obturator carried by the elongated body.