Abstract: The present invention provides, in certain embodiments, unique products and methods for occluding vascular vessels. Implantable devices useful in some inventive embodiments include at least two expandable occluding members, e.g., self-expandable sponge form devices, with an intermediate segment extending between the members. These devices are preferably compressible for placement in a delivery device lumen for delivery to a vascular vessel site. Upon deployment in the vessel, each of the members expands to occlude the vessel at a separate vessel location with the intermediate segment occupying space in the vessel between the two members. Optionally, the intermediate segment can be constructed to provide a hollow or other interior region for receiving one or more materials, for example, to receive an injectable fill material after one or both of the expandable members have been deployed.

Abstract: A method and apparatus for accessing the pericardial space which provides for stable short term or long term placement of a delivery catheter or cannula having its distal most end located in the pericardial space. The catheter or cannula may be introduced into the pericardial space either transvenously through the wall of a heart chamber or transthoracically by penetrating the chest wall and the pericardium. Some embodiments are provided with a mechanism for stabilizing the distal end of the catheter or cannula, which mechanism may employ an extensible elastic, generally tubular member located at the distal end of the catheter or cannula. The device may be provided with a mechanism for extending the tubular member longitudinally, causing its diameter to diminish substantially.

Abstract: The present invention provides, in certain embodiments, unique products and methods for occluding vascular vessels. Implantable devices useful in some inventive embodiments include at least two expandable occluding members, e.g., self-expandable sponge form devices, with an intermediate segment extending between the members. These devices are preferably compressible for placement in a delivery device lumen for delivery to a vascular vessel site. Upon deployment in the vessel, each of the members expands to occlude the vessel at a separate vessel location with the intermediate segment occupying space in the vessel between the two members. Optionally, the intermediate segment can be constructed to provide a hollow or other interior region for receiving one or more materials, for example, to receive an injectable fill material after one or both of the expandable members have been deployed.

Abstract: Methods and systems for transvenously accessing the pericardial space via the vascular system and atrial wall, particularly through the superior vena cava and right atrial wall, to deliver treatment in the pericardial space are disclosed. A steerable instrument is advanced transvenously into the right atrium of the heart, and a distal segment is deflected into the right atrial appendage. A fixation catheter is advanced employing the steerable instrument to affix a distal fixation mechanism to the atrial wall. A distal segment of an elongated medical device, e.g., a therapeutic catheter or an electrical medical lead, is advanced through the fixation catheter lumen, through the atrial wall, and into the pericardial space. The steerable guide catheter is removed, and the elongated medical device is coupled to an implantable medical device subcutaneously implanted in the thoracic region. The fixation catheter may be left in place.

Abstract: Methods and systems for transvenously accessing the pericardial space via the vascular system and atrial wall, particularly through the superior vena cava and right atrial wall, to deliver treatment in the pericardial space are disclosed. A steerable instrument is advanced transvenously into the right atrium of the heart, and a distal segment is deflected into the right atrial appendage. A fixation catheter is advanced employing the steerable instrument to affix a distal fixation mechanism to the atrial wall. A distal segment of an elongated medical device, e.g., a therapeutic catheter or an electrical medical lead, is advanced through the fixation catheter lumen, through the atrial wall, and into the pericardial space. The steerable guide catheter is removed, and the elongated medical device is coupled to an implantable medical device subcutaneously implanted in the thoracic region. The fixation catheter may be left in place.

Abstract: Methods and systems for transvenously accessing the pericardial space via the vascular system and atrial wall, particularly through the superior vena cava and right atrial wall, to deliver treatment in the pericardial space are disclosed. A steerable instrument is advanced transvenously into the right atrium of the heart, and a distal segment is deflected into the right atrial appendage. A fixation catheter is advanced employing the steerable instrument to affix a distal fixation mechanism to the atrial wall. A distal segment of an elongated medical device, e.g., a therapeutic catheter or an electrical medical lead, is advanced through the fixation catheter lumen, through the atrial wall, and into the pericardial space. The steerable guide catheter is removed, and the elongated medical device is coupled to an implantable medical device subcutaneously implanted in the thoracic region. The fixation catheter may be left in place.

Abstract: A method and apparatus for removing a medical device entrapped in a bodily passageway resulting from a spasmodic constriction of bodily tissue surrounding the device involves delivering to the site of the constriction an amount of an antispasmodic agent sufficient to relax the surrounding bodily tissue. The method may also be used for relaxing the tissue of a vessel wall to inhibit constriction of the vessel wall upon the introduction of a medical device into the vessel.

Abstract: A method and apparatus for accessing the pericardial space which provides for stable short term or long term placement of a delivery catheter or cannula having its distal most end located in the pericardial space. The catheter or cannula may be introduced into the pericardial space either transvenously through the wall of a heart chamber or transthoracically by penetrating the chest wall and the pericardium. Some embodiments are provided with a mechanism for stabilizing the distal end of the catheter or cannula, which mechanism may employ an extensible elastic, generally tubular member located at the distal end of the catheter or cannula. The device may be provided with a mechanism for extending the tubular member longitudinally, causing its diameter to diminish substantially.

Abstract: A method and apparatus for accessing the pericardial space which provides for stable short term or long term placement of a delivery catheter or cannula having its distal most end located in the pericardial space. The catheter or cannula may be introduced into the pericardial space either transvenously through the wall of a heart chamber or transthoracically by penetrating the chest wall and the pericardium. Some embodiments are provided with a mechanism for stabilizing the distal end of the catheter or cannula, which mechanism may employ an extensible elastic, generally tubular member located at the distal end of the catheter or cannula. The device may be provided with a mechanism for extending the tubular member longitudinally, causing its diameter to diminish substantially.

Abstract: A method and apparatus for accessing the pericardial space which provides for stable short term or long term placement of a delivery catheter or cannula having its distal most end located in the pericardial space. The catheter or cannula may be introduced into the pericardial space either transvenously through the wall of a heart chamber or transthoracically by penetrating the chest wall and the pericardium. Some embodiments are provided with a mechanism for stabilizing the distal end of the catheter or cannula, which mechanism may employ an extensible elastic, generally tubular member located at the distal end of the catheter or cannula. The device may be provided with a mechanism for extending the tubular member longitudinally, causing its diameter to diminish substantially.

Abstract: A method and apparatus for accessing the pericardial space which provides for stable short term or long term placement of a delivery catheter or cannula having its distal most end located in the pericardial space. The catheter or cannula may be introduced into the pericardial space either transvenously through the wall of a heart chamber or transthoracically by penetrating the chest wall and the pericardium. Some embodiments are provided with a mechanism for stabilizing the distal end of the catheter or cannula, which mechanism may employ an extensible elastic, generally tubular member located at the distal end of the catheter or cannula. The device may be provided with a mechanism for extending the tubular member longitudinally, causing its diameter to diminish substantially.

Abstract: A method of operating a pacemaker and a pacemaker system that cuts short a pacemaker-defined refractory time period whenever capture is not achieved. The pacemaker generates a cardiac stimulation pulse, and in response thereto, initiates an evoked response detection time period and a refractory time period. If an evoked response occurs during the evoked response detection time period, capture is presumed. If an evoked response does not occur during the evoked response detection time period, then capture is not achieved and the refractory time period is terminated, or cut short, thereby lengthening the window during which natural cardiac activity may be sensed. In the event natural cardiac activity is not detected following the termination of the refractory time period, a backup stimulation pulse may be generated.

Abstract: Device for use in removing undesired material, e.g., occlusion or plaque, from a duct or blood vessel within a patient's body. The device comprises a catheter (21) adapted to be disposed within a duct and an element disposed adjacent to the distal end portion of the catheter such as fiber optic (25) emitting laser energy, a heated element (51) or a knife (62) for intersecting and releasing the undesired material. An inflatable bladder (29) is provided for positioning the distal end portion of the catheter adjacent the inner surface of the duct to maintain the element for intersecting and releasing the undesired material adjacent thereto. The device can also include a pair of abutments (22,23) disposed adjacent the distal end.

Abstract: A rotational connector for mounting optical fibers for alignment with a laser source wherein the rotational connector enables rotation of the optical fiber while still retaining alignment with the source of laser energy. The connector includes a ferrule having a cylindrical portion having which is rotatably positioned within the housing of the source of laser energy and is adapted to receive and hold the optical fibers in a bore which runs through the cylindrical portion. The ferrule includes a disc portion which is mounted between thrust bearings which are oppositely disposed on the outer surfaces of the disc portion. The result is that the ferrule is free to rotate and yet cannot be translated with respect to the source of laser energy.

Abstract: The disclosure relates to a device for use in removing undesired material, e.g., occlusion or plaque, from a duct or blood vessel within a patient's body. The device comprises a catheter adapted to be disposed within a duct and an element disposed adjacent to the distal end portion of the catheter such as a fiber optic emitting laser energy, a heated element or a knife for intersecting and releasing the undesired material. An inflatable bladder is provided for positioning the distal end portion of the catheter adjacent the inner surface of the duct to maintain the element for intersecting and releasing the undesired material adjacent thereto. The device can also include a pair of abutments disposed adjacent the distal end portion of the catheter to form a chamber adjacent the inner surface of the blood vessle afor receiving the undesired material and for preventing the escape of laser energy after it has been applied to the undesired material.

Abstract: The disclosure relates to a device for use in removing undesired material, e.g., an occlusion or plaque, from a duct or blood vessel within a patient's body. The device comprises a catheter adapted to be disposed within a duct and having a distal end portion with a tip and a tapered surface extending from the tip to the side of the catheter. The catheter has a lumen extending through the length thereof. The intersection of the lumen and the tapered surface forming an elongated opening. Pulsed laser energy is applied by an optical fiber extending through the lumen to the elongated openings and thereby the undesired material. An inflatable bladder is provided for positioning the distal end portion of the catheter adjacent the inner surface of the duct to position the elongated opening adjacent the undesired material to be removed. A filament extending through the catheter and connected to the distal end portion can be rotated at the proximal end of the catheter to rotatably position the distal portion thereof.

Abstract: The disclosure relates to a device for use in removing undesired material from a duct within a patient's body. The device comprises a catheter adapted to be disposed within a duct an an element disposed adjacent to the distal end portion of the catheter such as a fiber optic emitting laser energy, a heated element or a knife for intersecting and releasing the undesired material. The undesired material may be an occlusion or an accumulation of plaque within a blood vessel. An inflatable bladder is provided for positioning the distal end portion of the catheter adjacent the inner surface of the duct to maintain the element for intersecting and releasing the undesired material adjacent thereto. The device can also include a pair of abutments disposed adjacent the distal end portion of the catheter to form a chamber adjacent the inner surface of the blood vessel and prevent the escape of laser energy after it has been applied to the undesired material.

Abstract: The disclosure relates to a device for use in removing undesired material from a duct within a patient's body. The device comprises a catheter adapted to be disposed within a duct and an element disposed adjacent to the distal end portion of the catheter such as a fiber optic emitting laser energy, a heated element or a knife for intersecting and releasing the undesired material. The undesired material may be an occlusion or an accumulation of plaque within a blood vessel. An inflatable bladder is provided for positioning the distal end portion of the catheter adjacent the inner surface of the duct to maintain the element for intersecting and releasing the undesired material adjacent thereto. The device can also include a pair of abutments disposed adjacent the distal end portion of the catheter to form a chamber adjacent the inner surface of the blood vessel and prevent the escape of laser energy after it has been applied to the undesired material.

Abstract: The disclosure relates to a device for use in removing undesired material from a duct within a patient's body. The device comprises a catheter adapted to be disposed within a duct and an element disposed adjacent to the distal end portion of the catheter such as a fiber optic emitting laser energy, a heated element or a knife for intersecting and releasing the undesired material. The undesired material may be an occlusion or an accumulation of plaque within a blood vessel. An inflatable bladder is provided for positioning the distal end portion of the catheter adjacent the inner surface of the duct to maintain the element for intersecting and releasing the undesired material adjacent thereto. The device can also include a pair of abutments disposed adjacent the distal end portion of the catheter to form a chamber adjacent the inner surface of the blood vessel and prevent the escape of laser energy after it has been applied to the undesired material.

Abstract: An implantable, microprocessor-based cardiac pacer provides physiologically adaptive pacing in four fundamental modes: ventricular-inhibited; atrial-synchronized ventricular with or without ventricular sensing; and atrial-ventricular (AV) sequential. In the AV sequential mode, the pacer automatically shifts to atrial synchronous ventricular pacing when the atrial rate exceeds the programmed minimum rate. Temporary pacing modes are available for treatment of arrhythmia and either atrial or ventricular overdrive pacing via chest wall stimulation. The pacer continuously monitors tachyarrhythmia and automatically enters and exits a special arrhythmia response mode. Eight parameters can be altered one at a time or reprogrammed to a standard set in a single programming step using pre-existing magnetic programmers. A weak battery is signified by substituting a lower frequency voltage-sensitive backup oscillator and by dropping the atrial beat in the magnet rate.