Methods for electrical neuromodulation of the heart

Abstract

The present disclosure provides for a method for treating a patient in which a catheter having an electrode array is moved through the pulmonary trunk of the patient towards a branch point that helps to define the beginning of a left pulmonary artery and a right pulmonary artery of the heart. The electrode array is positioned in the right pulmonary artery where the electrodes contact a posterior surface, a superior surface and/or an inferior surface of the right pulmonary artery. The one or more electrodes can be positioned to contact the posterior surface, the superior surface and/or the inferior surface of the right pulmonary artery at a position superior to the branch point. The electrode array can also be positioned in the right pulmonary artery no more than three times the diameter of the pulmonary trunk to the right of the branch point.

1 . (canceled) 
     
     
         2 . A method of modulating an autonomic cardiopulmonary nerve to treat acute heart failure, the method comprising:
 positioning a distal portion of a catheter comprising an electrode array in a subject, the electrode array comprising a plurality of electrodes in a row and column pattern, the catheter comprising a plurality of conductive members insulated from each other, each conductive member of the plurality of conductive members coupled to one electrode of the plurality of electrodes and extending out of the subject for coupling to a stimulation system, the subject comprising:
 a pulmonary trunk; 
 a right lateral plane passing along a right luminal surface of the pulmonary trunk; 
 a left lateral plane parallel to the right lateral plane, the left lateral plane passing along a left luminal surface of the pulmonary trunk; 
 a branch point between the right lateral plane and the left lateral plane, the pulmonary trunk having a diameter taken across a plane perpendicular to the left lateral plane and the right lateral plane; 
 a right pulmonary artery; and 
 a left pulmonary artery, the branch point at least partially defining a beginning of the left pulmonary artery and the right pulmonary artery; 
   positioning the electrode array in the right pulmonary artery to the right of the left lateral plane;   contacting the electrode array on a superior surface of the right pulmonary artery; and   providing electrical current to a combination of electrodes of the plurality of electrodes of the electrode array to modulate the autonomic cardiopulmonary nerve to increase heart contractility to treat the acute heart failure.   
     
     
         3 . The method of  claim 2 , wherein contacting the electrode array comprises contacting the electrode array superior to the branch point. 
     
     
         4 . The method of  claim 2 , wherein positioning the electrode array comprises positioning the electrode array to the right of the branch point by no more than three times a diameter of the pulmonary trunk. 
     
     
         5 . The method of  claim 2 , wherein the right pulmonary artery comprises a second branch point that divides the right pulmonary artery into at least two additional arteries, and wherein positioning the electrode array comprises positioning the electrode array between the branch point and the second branch point. 
     
     
         6 . The method of  claim 2 , wherein positioning the electrode array comprises:
 floating a pulmonary catheter to the right pulmonary artery;   inserting a guidewire through the pulmonary catheter to the right pulmonary artery; and   tracking the catheter over the guidewire.   
     
     
         7 . The method of  claim 2 , wherein the autonomic cardiopulmonary nerve comprises at least one of the right dorsal medial cardiopulmonary nerve, the right dorsal lateral cardiopulmonary nerve, the left ventral cardiopulmonary nerve, the left dorsal medial cardiopulmonary nerve, the left dorsal lateral cardiopulmonary nerve, or the left stellate cardiopulmonary nerve. 
     
     
         8 . The method of  claim 2 ,
 wherein contacting the electrode array comprises contacting the electrode array superior to the branch point,   wherein positioning the electrode array comprises positioning the electrode array to the right of the branch point by no more than three times a diameter of the pulmonary trunk,   wherein the right pulmonary artery comprises a second branch point that divides the right pulmonary artery into at least two additional arteries, wherein positioning the electrode array comprises positioning the electrode array between the branch point and the second branch point, and   wherein positioning the electrode array comprises:
 floating a pulmonary catheter to the right pulmonary artery; 
 inserting a guidewire through the pulmonary catheter to the right pulmonary artery; and 
 tracking the catheter over the guidewire. 
   
     
     
         9 . A method of modulating an autonomic cardiopulmonary nerve, the method comprising:
 positioning a distal portion of a catheter comprising an electrode array comprising a plurality of electrodes in a subject, the catheter comprising a plurality of conductive members, each conductive member of the plurality of conductive members coupled to one electrode of the plurality of electrodes and extending out of the subject for coupling to a stimulation system, the subject comprising:
 a pulmonary trunk; 
 a left lateral plane passing along a left luminal surface of the pulmonary trunk; and 
 a right pulmonary artery; 
   positioning the electrode array in the right pulmonary artery to the right of the left lateral plane;   contacting the electrode array on a superior surface of the right pulmonary artery; and   providing electrical current to a combination of electrodes of the plurality of electrodes of the electrode array to modulate the autonomic cardiopulmonary nerve to increase heart contractility to treat the acute heart failure.   
     
     
         10 . The method of  claim 9 , comprising contacting the electrode array on another surface of the right pulmonary artery. 
     
     
         11 . The method of  claim 9 , further comprising contacting the electrode array on the superior surface of the right pulmonary artery and an anterior surface of the right pulmonary artery. 
     
     
         12 . The method of  claim 9 , wherein positioning the electrode array comprises:
 floating a pulmonary catheter to the right pulmonary artery;   inserting a guidewire through the pulmonary catheter to the right pulmonary artery; and   tracking the catheter over the guidewire.   
     
     
         13 . The method of  claim 9 , wherein the autonomic cardiopulmonary nerve comprises at least one of the right dorsal medial cardiopulmonary nerve, the right dorsal lateral cardiopulmonary nerve, the left ventral cardiopulmonary nerve, the left dorsal medial cardiopulmonary nerve, the left dorsal lateral cardiopulmonary nerve, or the left stellate cardiopulmonary nerve. 
     
     
         14 . The method of  claim 9 ,
 comprising contacting the electrode array on another surface of the right pulmonary artery; and   further comprising contacting the electrode array on the superior surface of the right pulmonary artery and an anterior surface of the right pulmonary artery,   wherein positioning the electrode array comprises:
 floating a pulmonary catheter to the right pulmonary artery; 
 inserting a guidewire through the pulmonary catheter to the right pulmonary artery; and 
 tracking the catheter over the guidewire. 
   
     
     
         15 . A method of modulating an autonomic cardiopulmonary nerve, the method comprising:
 contacting an electrode array comprising a plurality of electrodes on a superior surface of a right pulmonary artery, the catheter comprising a plurality of conductive members, each conductive member of the plurality of conductive members coupled to one electrode of the plurality of electrodes and extending out of the subject for coupling to a stimulation system; and   providing electrical current to a combination of electrodes of the plurality of electrodes of the electrode array to modulate the autonomic cardiopulmonary nerve to increase heart contractility to treat the acute heart failure.   
     
     
         16 . The method of  claim 15 , comprising contacting the electrode array on a second surface of the right pulmonary artery. 
     
     
         17 . The method of  claim 15 , wherein contacting the electrode array comprises contacting the electrode array superior to a branch point between the right pulmonary artery and a left pulmonary artery. 
     
     
         18 . The method of  claim 15 , wherein the electrodes of the plurality of electrodes are in a row and column pattern. 
     
     
         19 . The method of  claim 15 , wherein positioning the electrode array comprises:
 floating a pulmonary catheter to the right pulmonary artery;   inserting a guidewire through the pulmonary catheter to the right pulmonary artery; and   tracking the catheter over the guidewire.   
     
     
         20 . The method of  claim 15 , wherein the autonomic cardiopulmonary nerve comprises at least one of the right dorsal medial cardiopulmonary nerve, the right dorsal lateral cardiopulmonary nerve, the left ventral cardiopulmonary nerve, the left dorsal medial cardiopulmonary nerve, the left dorsal lateral cardiopulmonary nerve, or the left stellate cardiopulmonary nerve. 
     
     
         21 . The method of  claim 15 ,
 comprising contacting the electrode array on a second surface of the right pulmonary artery,   wherein contacting the electrode array comprises contacting the electrode array superior to a branch point between the right pulmonary artery and a left pulmonary artery, and   wherein positioning the electrode array comprises:
 floating a pulmonary catheter to the right pulmonary artery; 
 inserting a guidewire through the pulmonary catheter to the right pulmonary artery; and 
 tracking the catheter over the guidewire.