Abstract: Devices, and methods of use thereof, are disclosed for preventing tumor seeding when withdrawing the device along an entry-exit path. Some embodiments of the present invention comprise a method of withdrawing a probe through a tissue via a path that traverses at least some bone tissue, the method including withdrawing the probe through the path, and at least partially concurrently delivering energy in a bipolar manner from the probe to heat a layer of tissue surrounding the probe to a temperature sufficient for thermal coagulation necrosis of cells. The device may be withdrawn incrementally.

Abstract: A nasogastric device and method is provided, including a first flexible tube configured to be threaded through the nose of a patient, down the esophagus and into the stomach for enteral feeding, a second flexible tube disposed adjacent to the first tube having a distal end, the distal end of said second tube configured to terminate inside the esophagus for delivery of liquids to the esophagus or for sampling of the local environment, an inflatable balloon configured around said first and second flexible tubes, a third flexible tube configured to inflate said inflatable balloon; and a fourth flexible tube communicating with an exterior portion of said inflatable balloon, the fourth tube configured to transport suspensions or solutions of materials; and an elastomeric sleeve which is used to control delivery of therapeutic suspensions of solutions of materials to the exterior of the device to the adjacent esophageal tissue.

Abstract: Apparatuses and methods for treating a heart failure patient by ablating a nerve of the thoracic splanchnic sympathetic nervous system to increase venous capacitance and reduce pulmonary blood pressure. A method comprising: inserting a catheter into a vein adjacent the nerve, applying stimulation energy and observing hemodynamic effects, applying ablation energy and observing hemodynamic effects, applying simulation energy after the ablation and observing hemodynamic effects and monitoring for presence of the lung in the ablation zone. An alternative method comprising: inserting a catheter into a vein adjacent the nerve, detecting that lung tissue is a safe distance from an ablation zone, and delivering ablation energy to the target nerve when lung tissue is a safe distance from the ablation zone.

Abstract: A deflection system for deflecting a body lumen that includes a deflection mechanism, wherein the deflection mechanism includes: a beam having a proximal end and a distal end, wherein the beam includes a neutral position and a deflected position, a pull wire coupled to the distal end of the beam, wherein the beam is configured to be placed in the deflected position when a tension force is applied to the pull wire, and wherein at least a portion of the pull wire is configured to move to a displacement distance away from the beam when the tension force is applied to the pull wire, and one or more constraint members operatively coupled to the beam, wherein each one of the one or more constraint members is configured to limit the displacement distance of the pull wire from the beam when the tension force is applied to the pull wire.

Abstract: Devices, and methods of use thereof, are disclosed for preventing tumor seeding when withdrawing the device along an entry-exit path. Some embodiments of the present invention comprise a method of withdrawing a probe through a tissue via a path that traverses at least some bone tissue, the method including withdrawing the probe through the path, and at least partially concurrently delivering energy in a bipolar manner from the probe to heat a layer of tissue surrounding the probe to a temperature sufficient for thermal coagulation necrosis of cells. The device may be withdrawn incrementally.

Abstract: A method and apparatus are disclosed for determining if a previously carried out heart ablation has been effective in isolating tissue. The method involves inserting an esophageal device, e.g. a catheter, into the esophagus so that an electrode is adjacent the heart, pacing the electrode with an electrical pacing signal, and determining if the heart adopts the pacing signal. Adoption of the pacing signal is indicative of the tissue not being electrically isolated by the ablation, and so may signal that a re-ablation procedure is necessary. Non adoption of the pacing signal is indicative of the tissue being electrically isolated by the ablation. Also disclosed is a processing unit for comparing a measured heart signal with a predetermined pacing signal to determine heart adoption of the pacing signal. The device and processing unit may be used to measure natural heart signals in the esophagus to assist in correct catheter positioning.

Abstract: Devices, and methods of use thereof, are disclosed for preventing tumor seeding when withdrawing the device along an entry-exit path. Some embodiments of the present invention comprise a method of withdrawing a probe through a tissue via a path that traverses at least some bone tissue, the method including withdrawing the probe through the path, and at least partially concurrently delivering energy in a bipolar manner from the probe to heat a layer of tissue surrounding the probe to a temperature sufficient for thermal coagulation necrosis of cells. The device may be withdrawn incrementally.

Abstract: An apparatus for mechanically manipulating hollow organs within the body of a subject, or an organ manipulation apparatus, includes a manipulation section. The manipulation section may include a substantially two-dimensional element, which may have a width that exceeds a distance across a portion of the interior of a hollow organ within which the manipulation section is to be positioned. The manipulation section is configured to manipulate at least a portion of a hollow organ from within, which may modify at least one of a shape, orientation, or location of at least part of the hollow organ. Methods for manipulating hollow organs are also disclosed, as are operating techniques, such as left atrial ablation, in which the shapes, orientations, and/or locations of hollow organs are manipulated to move the hollow organs away from the site of the medical procedure, reducing the potential for damage to the hollow organs.

Abstract: This disclosure provides an extravascular ICD system and method for defibrillating a heart of a patient. The extravascular ICD system includes multiple extravascular electrical stimulation leads or lead segments located in close proximity to one another and having respective defibrillation electrodes. The ICD system utilizes the multiple defibrillation electrodes to form an extravascular electrode vector that may result a reduction in the shock impedance and/or a reduction in the DFT compared to extravascular ICD systems that include only a single extravascular defibrillation electrode. An ICD of the system may, for example, deliver a defibrillation shock using an electrode vector in which a first polarity of the electrode vector is formed by electrically coupling first and second defibrillation electrodes of first and second leads, respectively, to the therapy circuitry and a second polarity of the electrode vector is formed by electrically coupling a housing of the ICD to the therapy circuitry.

Abstract: The invention relates to a multi-pole esophageal electrode catheter that can be used for monitoring, pacing, and cardioversion of atrial fibrillation of the heart, the catheter having a flexible shaft (15) having a proximal end and a distal end and a multipolar electrode (3), characterized in that the distal end of the catheter is formed as a side arranged inflatable balloon (4) so that the multi-pole electrode (3) is aligned in the direction of the heart wall is constantly by means of the balloon.

Abstract: An apparatus for monitoring EMG signals of a patient's laryngeal muscles includes an endotracheal tube having an exterior surface. Conductive ink electrodes are formed on the exterior surface of the endotracheal tube. The conductive ink electrodes are configured to receive the EMG signals from the laryngeal muscles when the endotracheal tube is placed in a trachea of the patient. At least one conductor is coupled to the conductive ink electrodes and is configured to carry the EMG signals received by the conductive ink electrodes to a processing apparatus.

Abstract: A method of implanting electrically conductive leads in the gastrointestinal musculature for stimulation of target tissues involves an endoscopic approach through the esophagus. An endoscope is inserted into the esophagus of a patient. The mucosal surface of the anterior esophagus is punctured in the region encompassing the lower esophageal sphincter (LES). A tunnel is created through the submucosa and exits at the muscularis propria, adventitia, or serosal side of the stomach. The lead is navigated further to the anterior abdominal wall. A first end of the lead remains within the gastrointestinal musculature while a second end of the lead is positioned just outside the anterior abdominal wall. The first end of the lead comprises at least one electrode. An implantable pulse generator (IPG) is implanted and operably connected to the second end of the lead to provide electrical stimulation to target tissues.

Abstract: In a patient suffering from neural impairment, stimulation is provided to sensory surfaces of the face and/or neck, or more generally to areas of the body that stimulate the trigeminal nerve, while performing an activity intended to stimulate a brain function to be rehabilitated. The simulation may then be continued after the performance of the activity has ceased. It has been found that the patient's performance of the activity is then improved after stimulation has ceased. Moreover, it tends to improve to a greater extent, and/or for a longer time, when the post-activity stimulation is applied, as compared to when postactivity stimulation is not applied.

Abstract: An apparatus for monitoring EMG signals of a patient's laryngeal muscles includes an endotracheal tube having an exterior surface and a first location configured to be positioned at the patient's vocal folds. A first electrode is formed on the exterior surface of the endotracheal tube substantially below the first location. A second electrode is formed on the exterior surface of the endotracheal tube substantially above the first location. The first and second electrodes are configured to receive the EMG signals from the laryngeal muscles when the endotracheal tube is placed in a trachea of the patient.

Abstract: A leadless intra-cardiac medical device includes a housing that is configured to be implanted entirely within a single local chamber of the heart. A first electrode is provided on the housing at a first position such that when the housing is implanted in the local chamber, the first electrode engages the local wall tissue at a local activation site within the conduction network of the local chamber. An intra-cardiac extension is coupled to the housing and configured to extend from the local chamber into an adjacent chamber of the heart. A stabilization arm of the intra-cardiac extension engages the adjacent chamber. A second electrode on the intra-cardiac extension engages distal wall tissue at a distal activation site within the conduction network of the adjacent chamber.

Abstract: An endotracheal tube usable for intraopertive monitoring of the laryngeal nerve. The endotracheal tube includes at least one electrical contact that is movable along and about an exterior sidewall of the endotracheal tube and connected to the exterior sidewall by a connector when the electrode is placed in a position to optimize the conductivity between the nerve being monitored and the electrical contact. The electrical contact may be connected using a locking tube, tape, adhesive, etc.

Abstract: In a method and device for positioning a linear array of electrodes mounted on a distal end section of an elongated flexible member in a patient's respiratory airways at the level of the patient's diaphragm, a length of the elongated flexible member pre-determined to position the linear array of electrodes at the level of the patient's diaphragm is inserted through the patient's respiratory airways. Signals representative of an electrical activity of the patient's diaphragm (EAdi) are detected through the electrodes of the linear array, a presence or absence of ECG signal components is detected in the EAdi signals, and the position of the linear array of electrodes in the patient's respiratory airways is detected in response to the presence or absence of the ECG signal components in the EAdi signals.

Abstract: A system and method for determining on a continuous, real-time basis the proximity of the esophagus to an endocardial catheter during mapping, ablation or other endocardial catheter-based procedures, comprising an esophagus probe catheter and an endocardial catheter adapted for proximal signal transmission between each other. A signal processing unit is included to process and compare a characteristic of the proximity signal that is changes or attenuates with distance between the two catheters, such as impedance, amplitude and/or phase. Audio and/or optical outputs are provided to alert an operator when the distance between the catheters changes or is below a baseline measurement to avoid damage to the esophagus by the endocardial catheter. The system and method may include adaptations of the catheters with location sensor, and a mapping/navigational system for nonfluoroscopic location determination of the catheters.

Abstract: The present application is directed to a feeding tube in particular for total parental nutrition and/or medicine dosing. The feeding tube functionality is combined with internal monitoring of vital functions, such as ECG, PH, etc. The position of the electrodes is essential for measuring the optimal signal. In the present application the optimal position is determined by measuring the inversion point of the ECG signal. During insertion of the catheter or modified feeding tube the ECG signal is continuously monitored. Via an acoustic signal the strength of the signal is notable. This enables the nursing staff a simple control of the insertion process.

Abstract: A system for determining the proximity of the esophagus to the ablation electrode of an ablation catheter during an ablation procedure is disclosed. The system comprises an ablation catheter having at least one ablation electrode, an esophageal probe catheter having at least one electrode, and a signal processing unit. Both the ablation electrode and the esophageal probe catheter are electrically connected to the signal processing unit. The signal processing unit receives electrical signals from the ablation electrode on the ablation catheter and the electrode on the esophageal probe catheter and compares the signals to determine the proximity of the esophagus to the ablation electrode.

Abstract: Methods and apparatus for treating ailments provide for: inserting a balloon-electrode device into an esophagus of a mammal, the balloon-electrode device including: (i) a nasogastral (NG) having an internal passageway and an external surface, (ii) at least one electrode coupled to the external surface of the NG tube, (iii) a conductor extending through the internal passageway of the NG tube and electrically connecting to the electrode, and (iv) a balloon surrounding the electrode and a portion of the NG tube; inflating the balloon with fluid such that the electrode is substantially centrally located within an interior volume of the balloon; and applying at least one electrical signal to the electrode via the conductor such that an electro-magnetic field emanates from the electrode to at least one of nerves and muscles of the mammal.

Abstract: Apparatus connect electrically conductive wire to a miniature, implantable sensor or stimulator device for detecting electrical signals or stimulating living tissue. The implantable device has an electrically conductive end on its case which is intimately connected to a doorknob electrode for communicating electrical signals between the living tissue and the device by a biocompatible wire. A spring clip removably attaches to the doorknob electrode so that the wire may be easily attached to the doorknob electrode during surgery. An insulating rubber boot, which may be silicone, surrounds the case end, doorknob electrode, and spring clip to isolate the living tissue from the conductive components. The components are biocompatible materials.

Abstract: A ready-to-install electrode system designed for use with an endoscope for performing cardioversion through the esophagus, and an assembly of the system and an endoscope. The system is characterized in that it includes a globally tubular protective cover (3) designed to be fitted on the endoscope (40) to cover at least the distal end of the endoscope, at least one electrode (2a-d) including a conductive electric membrane (21) connected to an electric conduction wire designed to be connected by its free end to a cardioversion apparatus, first and second fixing elements adapted to fix the at least one electrode respectively on the distal end of the endoscope and on the tubular wall (31) of the cover, such that the conductive membrane is directly accessible from outside the cover.

Abstract: A nerve stimulation device has a pulse generator for generating stimulation pulses and an output for the stimulation pulses from the pulse generator, which is connectable to an electrode arrangement adapted for interaction with a living being to stimulate the phrenic nerve. The nerve stimulation device is made more safe and effective by the provision of an input connectable to an esophageal electrode for the reception of measurement signals. The esophageal electrode is adapted to be inserted in the esophagus of the living being for obtaining measurement signals. A signal analyzer filters myo-electrical signals from the diaphragm out of the measurement signals and a regulating unit regulates the pulse generator dependent on the myo-electrical signals.

Abstract: Instruments for thermally-mediated treatment of a patient's lower esophageal sphincter (LES) to induce an injury healing response to thereby populate the extracellular compartment of walls of the LES with collagen matrices to altere the biomechanics of the LES to provide an increased intra-esophageal pressure for preventing acid reflux. A preferred embodiment is a bougie-type device for trans-esophageal introduction that carries conductive electrodes for delivering Rf energy to walls of the LES (i) to induce the injury healing response or (ii) to “model” collagenous tissues of the LES by shrinking collagen fibers therein.

Abstract: An esophageal stethoscope includes a tubular flexible body having an acoustic input region. A carrier member, which is separate from the tubular flexible body, is selectively engageable with the tubular flexible body either proximally or distally of the acoustic input region. The carrier member carries one or more devices for providing esophageal recording, monitoring or stimulation functions. For transesophageal cardiac pacing, electrodes are mounted to the carrier member such that engagement of the carrier member with the tubular flexible body functions to convert the esophageal stethoscope to a pacing stethoscope. To carry out a sensing, recording or monitoring function, such as esophageal oximetry, one or more oximetry probes are mounted to the carrier member such that engagement of the carrier member with the esophageal stethoscope converts the stethoscope for use in an oximetry sensing application.

Abstract: An esophageal stethoscope includes a tubular flexible body having an acoustic input region. A carrier member, which is separate from the tubular flexible body, is selectively engageable with the tubular flexible body either proximally or distally of the acoustic input region. The carrier member carries one or more devices for providing esophageal recording, monitoring or stimulation functions. For transesophageal cardiac pacing, electrodes are mounted to the carrier member such that engagement of the carrier member with the tubular flexible body functions to convert the esophageal stethoscope to a pacing stethoscope. To carry out a sensing, recording or monitoring function, such as esophageal oximetry, one or more oximetry probes are mounted to the carrier member such that engagement of the carrier member with the esophageal stethoscope converts the stethoscope for use in an oximetry sensing application.

Abstract: The invention provides for an esophageal probe for transesophageal cardiac stimulation. An esophageal probe can be made de novo or can be a modified transesophageal echocardiogram (TEE) probe. The invention further provides for an electrode-containing membrane to so modify a TEE probe for transesophageal cardiac stimulation. Methods are provided by the invention for using esophageal probes of the invention for transesophageal pacing or defibrillation.

Abstract: An electrode useful for generating or receiving electrical signals generally comprises a base and more than one dome-like protuberance on an exterior surface of the base. The electrodes can be utilized in connection with various probe applications. For example, the electrodes can be utilized with an esophageal probe for invasively monitoring cardiac functions, including the ECG or cardiac output of a patient. To further minimize the differences in voltage potential as may be caused by electrolytes present at the point of contact, a gold-plated layer may be provided on the outer surface of the electrodes. An exemplary probe generally comprises a chassis with an electrical cable extending from the proximal end of the chassis and with the cable terminating at an electrical plug configured for connection to a cardiac monitor.

Abstract: An electrode useful for generating electrical signals generally comprises a base and more than one dome-like protuberance on an exterior surface of the annular ring-like base. The electrodes can be utilized in connection with various probe applications. For example, the electrodes can be utilized with a probe adapted for insertion into an anatomical canal, e.g. the esophagus of an animal or a human for ECG or cardiac output measurements. An exemplary probe generally comprises a chassis with an electrical cable extending from the proximal end of the chassis and with the cable terminating at an electrical plug configured for connection to a cardiac monitor. The probe also includes an electrode assembly comprising the dome-like protuberances and configured to generate or receive electrical signals that are indicative of the cardiac functions of the patient. The probe may further include an engagement device attached to the chassis for stabilizing the probe within the esophagus.

Abstract: The invention concerns a device for carrying out a transespohageal echocardiography and a cardioversion and includes a single endoscope (1) provided at its distal end with an ultrasonic sensor (3) and in the proximity of its distal end with at least one electrode (8) for generating electric shocks. The invention is usefull for the treatment of auricular fibrillation.

Abstract: Device and method for effecting ventricular cardiac pacing by inserting electrodes which are supported by a carrier into the stomach of a patient via the patient's esophagus, and pressing the electrodes against the wall of the stomach by the action of a carrier displacing member.

Abstract: A mechanically expandable esophageal medical lead has an elongated flexible body which carries at a distal end thereof one or more electrically conducting members. The conducting members are moveable laterally with respect to the body portion of the medical lead by means of a mechanical structure contained therein. The degree and extent of mechanical movement can be controlled through manipulation of a pull wire axial movement mechanism.

Abstract: A transnasal conduit for transesophageal echocardiography (TEE) probe insertion. A transnasal conduit has a relatively large inner diameter with relatively thin pliable walls. A normally closed or closeable distal end facilitates insertion of the transnasal conduit into the patient during intubation. Pinch clamp means in the form of a thumbscrew or the like may be used to secure a probe temporarily to the transnasal conduit both during and after intubation. A patient flange having ears or lobes may be adjacent the pinch clamp and serve to temporarily secure the transnasal conduit along with any accompanying probe to the patient by means of an elastic strap, string, or the like. The open proximal end of the transnasal conduit may be bell shaped, or flared, to facilitate introduction of the probe. By providing a transnasal conduit that allows atraumatic of a TEE probe, conscious ICU or ambulatory patients may be monitored using TEE thereby enhancing patient diagnosis and monitoring.

Abstract: An apparatus for aiding in the treatment of cardiac arrest patients which includes a flexible tube having an elongated bladder attached between its opposite ends and a stomach bladder attached to its distal end. Each bladder has a conductive portion which serves as an electrode. Wires are embedded in the sidewall of the tube and connected to each electrode. Passageways formed in the sidewall of the tube and fluid-conveying tubes connected thereto form a fluid path through which a saline solution or a gas passes to fill the bladders. The tube is positioned so that the stomach bladder lies in the fundus of the stomach and the esophageal bladder lies in the posterior to the heart. The stomach bladder is filled and moderate countertraction is applied. Then the esophageal bladder is filled. The esophageal bladder serves as a platform by expanding and hardening the esophagus behind the heart. The heart is then compressed between the sternum and the hardened esophageal bladder, thus enhancing artificial circulation.

Abstract: An esophageal/stomach placement electrode comprises a flexible tubular member designed to be inserted into the esophagus and/or stomach. An electrode is carried by the tube in the region of its distal end. The tube is hinged by its distal end which enables the end of the tube to laterally actuate in the esophagus or the stomach. An actuating mechanism is disposed in the tube in the region of the hinge and is controlled from a point external to the body for causing the distal end of the tube to actuate laterally, and engage the esophagus or stomach with it. The inner portion of the hinge is more bendable than the outer portion. Additionally, the control cables are all within the tubular member.

Abstract: An esophageal probe for transesophageal cardiac stimulation or monitoring. The probe comprises an elongate member adapted to be positioned within the esophagus of a patient and having a distal end and a proximal end. A second elongate member is slidably mounted on the first and engages at least one electrode carrier for selectively displacing an electrode laterally relative to the elongate member for positioning the electrode at the optimal position for cardiac stimulation and monitoring of the patient.

Abstract: A transesophageal defibrillating system includes a large area anterior patch electrode and a large area posterior patch electrode, as in some conventional exterior defibrillating systems. An esophageal probe has a pair of ring electrodes, one of which is carried at or near its distal end. The system is operatively arranged to supply defibrillation pulses between the large anterior patch electrode and either the distal electrode (carried by the probe) or the large posterior electrode, depending on which one of the latter two electrodes is connected or coupled by the clinician or paramedic to the defibrillating pulse source. The system includes a source of pacing pulses which may be supplied to the patient via the anterior patch electrode and at least one of the electrodes carried by the esophageal probe. The distal electrode is believed to be the more effective electrode to use for this purpose.

Abstract: An esophageal stethoscope comprises a tubular flexible body having a proximal end and a closed distal end, an acoustic region defined on the body and spaced from the closed distal end. First and second spaced apart electrodes are mounted on one side of the body and between the distal end and the acoustic input region. The electrodes are spaced from each other and the distance between the mid-point of the electrodes and the acoustic input region is about 5-10 cm. A second pair of electrodes are mounted between the distal end and the first electrode pair and are manually movable laterally into engagement with the esophageal tissue.

Abstract: A method and apparatus for emergency pacing of a surgical patient's heart through an esophageal catheter. Pacing electrodes are connected to the external wall of the catheter having sufficient surface area to reduce the current density to a level which does not burn or injure the patient's esophagus. Pacing pulses are applied to the electrodes by a pacing generator and the pulses are transmitted through the esophagus wall to the patient's heart.

Abstract: An esophageal probe for transesophageal cardiac stimulation or monitoring. The probe comprises an elongate member adapted to be positioned within the esophagus of a patient and having a distal end and a proximal end. A second elongate member is slidably mounted on the first and engages at least one electrode carrier for selectively displacing an electrode laterally relative to the elongate member for positioning the electrode at the optimal position for cardiac stimulation and monitoring of the patient.

Abstract: A single use disposable esophageal electrode structure is formed with a planar sheet body member. The body member carries a plurality of spaced-apart conductive electrode members. A temperature sensor can also be carried on the body member. A layer of adhesive on the body member can be used to affix it to an esophageal probe. A plurality of conducting members is coupled to the body member. Each of the conducting members is in turn coupled to a respective one of the electrodes. A free end of the conducting members carries an electrical connector for connection to other electrical units.