Implantable electrical leads and associated delivery systems

Abstract

Disclosed is a delivery system for a component, for example, a splitting lead. A splitting lead can have a proximal portion to engage a controller and a distal portion to split apart into sub-portions that travel in multiple directions during implantation into a patient. The delivery system can include a handle and a component advancer to advance and removably engage a portion of the component. The component advancer can be coupled to the handle and advance the component into the patient by applying a force to the portion in response to actuation of the handle by the operator. Also, the delivery system can include an insertion tip with first and second ramps to facilitate advancement of first and second sub-portions into the patient in first and second directions. The leads may have various electrode configurations including, for example, wrapped or embedded electrodes, helical or elliptical coils, thin metallic plates, etc.

What is claimed is: 
     
         1 . An electrical lead for implantation in a patient, the lead comprising:
 a distal portion comprising one or more electrodes that are configured to generate therapeutic energy for biological tissue of the patient; and   a proximal portion coupled to the distal portion and configured to engage a controller, the controller configured to cause the one or more electrodes to generate the therapeutic energy,   wherein at least a portion of the distal portion of the lead comprises two parallel planar surfaces that include the one or more electrodes.   
     
     
         2 . The electrical lead of  claim 1 , wherein the two parallel planar surfaces comprise a rectangular prism and the one or more electrodes comprise defibrillation electrodes or cardiac pacing electrodes. 
     
     
         3 . The electrical lead of  claim 1 , wherein one or more electrodes comprise thin metallic plates. 
     
     
         4 . The electrical lead of  claim 3 , wherein the thin metallic plates are rectangular. 
     
     
         5 . The electrical lead of  claim 3 , wherein the thin metallic plates are elliptical. 
     
     
         6 . The electrical lead of  claim 3 , wherein the thin metallic plates are on both of the two parallel planar surfaces. 
     
     
         7 . The electrical lead of  claim 1 , wherein one or more electrodes comprise coil(s) wrapped around the portion of the distal portion of the lead comprising two parallel planar surfaces. 
     
     
         8 . The electrical lead of  claim 7 , further comprising an electrically insulating mask over a portion of the coil(s) on one of the parallel planar surfaces. 
     
     
         9 . The electrical lead of  claim 1 , wherein at least one electrode is partially embedded in the portion of the distal portion of the lead comprising two planar parallel surfaces, and the partially embedded electrode has an embedded portion and an exposed portion. 
     
     
         10 . The electrical lead of  claim 9 , wherein the exposed portion is on both of the two planar parallel surfaces. 
     
     
         11 . The electrical lead of  claim 9 , wherein the exposed portion is on only one of the two planar parallel surfaces. 
     
     
         12 . The electrical lead of  claim 9 , wherein the exposed portion comprises at least 50% of a perimeter of the partially embedded electrode. 
     
     
         13 . The electrical lead of  claim 9 , wherein the partially embedded electrode is a circular helical coil. 
     
     
         14 . The electrical lead of  claim 9 , wherein the partially embedded electrode is an elliptical helical coil. 
     
     
         15 . The electrical lead of  claim 9 , wherein the partially embedded electrode is a solid electrode having a circular, elliptical, or rectangular cross section. 
     
     
         16 . The electrical lead of  claim 15 , wherein the partially embedded electrode includes an additional structural feature to increase surface area beyond that provided by its cross-section. 
     
     
         17 . The electrical lead of  claim 15 , wherein the partially embedded electrode includes an additional structural feature to increase current density beyond that provided by its cross-section. 
     
     
         18 . The electrical lead of  claim 15 , wherein the partially embedded electrode comprises a feature to increase current density at particular location(s). 
     
     
         19 . The electrical lead of  claim 1  in a system further comprising:
 a non-transitory, machine-readable medium storing instructions which, when executed by at least one programmable processor, cause the at least one programmable processor to perform operations comprising:
 receiving sensor data; 
 determining, based at least on the sensor data, an initial set of electrodes on the electrical lead including more than two defibrillation electrodes, from which to deliver a defibrillation pulse; 
 delivering the defibrillation pulse with the initial set of electrodes; 
 receiving post-delivery sensor data; 
 determining, based at least on the post-delivery sensor data whether the defibrillation pulse successfully defibrillated the patient; and 
 if necessary, determining an updated set of electrodes from which to deliver a subsequent defibrillation pulse. 
 
 
     
     
         20 . The electrical lead of  claim 1 , wherein the one or more electrodes comprise both defibrillation electrodes and cardiac pacing electrodes. 
     
     
         21 . The electrical lead of  claim 1 , wherein the distal portion is configured for extravascular implantation and wherein the one or more electrodes comprise both defibrillation electrodes and cardiac pacing electrodes. 
     
     
         22 . A method comprising:
 placing a lead comprising both defibrillation and cardiac pacing electrodes at an extravascular location within a patient.   
     
     
         23 . The method of  claim 22  wherein the extravascular location is in a mediastinum of the patient. 
     
     
         24 . The method of  claim 23  wherein the extravascular location is in a region of a cardiac notch. 
     
     
         25 . The method of  claim 23  wherein the extravascular location is on or near the inner surface of an intercostal muscle. 
     
     
         26 . The method of  claim 22  wherein the placing further comprises inserting the lead through an intercostal space associated with the cardiac notch of a patient.