Transvascular neural stimulation device

Abstract

This document discusses, among other things, apparatus, systems, and methods for transvascularly stimulation of a nerve or nerve trunk. In an example, an apparatus is configured to transvascularly stimulate a nerve trunk through a blood vessel. The apparatus includes an expandable electrode that is chronically implantable in a blood vessel proximate a nerve trunk. The expandable electrode is configured to abut a predetermined surface area of the vessel wall along a predetermined length of the vessel. An electrical lead is coupled to the expandable electrode. An implantable pulse generator is coupled to the lead and configured to deliver an electrical stimulation signal to the electrode through the lead. In an example method, an electrical signal is delivered from an implanted medical device to an electrode chronically implanted in a blood vessel proximate a nerve trunk to transvascularly deliver neural stimulation from the electrode to the nerve trunk.

1 . An implantable apparatus for transvasculary stimulating a vagus nerve trunk in a cervical region from an internal jugular vein (IJV) to provide a heart failure therapy, the apparatus comprising:
 an expandable electrode chronically implantable in the IJV, the expandable electrode configured to abut an intravascular surface of the IJV in the cervical region proximate the vagus nerve trunk;   an implantable pulse generator configured to use the electrode to transvascularly stimulate the vagus nerve trunk from the IJV;   a controller to operate on programmed instructions for delivering the heart failure therapy using the pulse generator and the electrode, wherein the heart failure therapy includes transvascularly stimulating the vagus nerve in the cervical region.   
   
   
       2 . The apparatus of  claim 1 , wherein the expandable electrode is configured to abut a wall of the IJV along a predetermined length of the IJV, wherein the predetermined length is about 1 centimeter. 
   
   
       3 . The apparatus of  claim 1 , wherein the expandable electrode has an expanded diameter between about 0.5 cm to 1.5 cm. 
   
   
       4 . The apparatus of  claim 1 , wherein the expandable electrode is configured to abut a predetermined surface of a wall of the IJV, wherein the predetermined surface area is about 0.25 to 0.5 cm 2 . 
   
   
       5 . The apparatus of  claim 1 , wherein the expandable electrode includes a mesh, at least part of the mesh being conductive. 
   
   
       6 . The apparatus of  claim 1 , wherein the expandable electrode includes a drug-eluting component that is configured to be implanted inside the IJV, wherein the drug-eluting component is adapted to elute a drug to prevent occlusion. 
   
   
       7 . The apparatus of  claim 1 , wherein the expandable electrode includes a drug-eluting component that is configured to be implanted inside the IJV, wherein the drug-eluting component is adapted to elute a drug to reduce inflammation. 
   
   
       8 . The apparatus of  claim 1 , wherein the expandable electrode included platinum or platinum-iridium. 
   
   
       9 . The apparatus of  claim 1 , further comprising a right ventricle lead and a left ventricle lead, wherein the apparatus is configured to capture myocardial tissue using the right ventricle lead and the left ventricle lead, and the apparatus is adapted to deliver cardiac resynchronization therapy using the left and right ventricle leads. 
   
   
       10 . The apparatus of  claim 1 , further comprising at least one of a right ventricle lead or a left ventricle lead, wherein the apparatus is configured to pace the right or left ventricle using the right ventricle lead or the left ventricle lead. 
   
   
       11 . The apparatus of  claim 1 , wherein the expandable electrode has a surface area to touch a wall of the IJV, and all of the surface area is conductive. 
   
   
       12 . The apparatus of  claim 1 , wherein the expandable electrode has a surface area to touch a wall of the IJV, and some of the surface area is non-conductive. 
   
   
       13 . The apparatus of  claim 1 , wherein the instructions are further operable on the controller to transvascularly stimulate the vagus nerve trunk to deliver antiarrhythmia therapy following myocardial infarction. 
   
   
       14 . A system for transvasculary stimulating a vagus nerve trunk in a cervical region from an internal jugular vein (IJV) in a cervical region to provide a heart failure therapy, the system comprising:
 an expandable electrode implantable in the IJV within the cervical region proximate the vagus nerve trunk;   a lead assembly coupled to the expandable electrode, the lead assembly including an electrical lead adapted to be intravascularly fed into the IJV; and   an implantable device coupled to the lead assembly, the implantable device including a controller circuit to communicate with a neural stimulator, wherein the implantable device is programmed with instructions used by the controller to implement the heart failure therapy, wherein the programmed heart failure therapy includes instructions used by the controller to control the neural stimulator to transvascularly stimulate the vagus nerve in the cervical region using the lead and the electrode.   
   
   
       15 . The system of  claim 14 , wherein the instructions are further operable on the controller to transvascularly stimulate the vagus nerve trunk to deliver antiarrhythmia therapy following myocardial infarction. 
   
   
       16 . The system of  claim 14 , wherein:
 the expandable electrode is configured to abut a predetermined surface area of the internal jugular vein along about 1 centimeter of the IJV, the expandable electrode having an expanded diameter dimensioned and configured to fix the electrode in place in the blood vessel by frictional forces; and   the expandable electrode includes a mesh, at least part of the mesh being conductive.   
   
   
       17 . The system of  claim 14 , wherein the expandable electrode includes a drug-eluting coating that prevents inflammation of stimulated tissue. 
   
   
       18 . The system of  claim 14 , wherein the expandable electrode has a surface area to touch a wall of the IJV, and all of the surface area is conductive. 
   
   
       19 . The system of  claim 12 , wherein the expandable electrode has a surface area to touch a wall of the IJV, and some of the surface area is non-conductive. 
   
   
       20 . A method, comprising:
 implanting an electrode in an internal jugular vein (UV) within a cervical region and proximate to a vagus nerve trunk, wherein the electrode is configured to be chronically implanted in the IJV;   implanting an implantable neural stimulator; and   implementing a programmed heart failure therapy using the electrode and the neural stimulator, wherein the heart failure therapy transvascularly stimulates the vagus nerve trunk in the cervical region from the IJV.   
   
   
       21 . The method of  claim 20 , wherein implanting the electrode includes intravascularly feeding a lead with the electrode into the IJV. 
   
   
       22 . The method of  claim 20 , wherein implanting the electrode includes intravascularly feeding the electrode into the IJV and expanding the electrode after the electrode is fed into a desired position in the IJV. 
   
   
       23 . The method of  claim 20 , further comprising implementing a programmed antiarrhythmia therapy using the electrode and the neural stimulator, wherein antiarrhythmia therapy transvascularly stimulates the vagus nerve in the cervical region from the IJV.