Abstract: The invention provides an apparatus having a tubular member for receiving an endocardial lead implanted within a patient's body. Disposed generally at a distal end of the tubular member is at least one blade or cutting surface. An adjustment mechanism moves the blade between retracted and extended positions to engage the cutting surface with the endocardial lead to cut the lead. Once severed, the cut portion of the lead remains within an inner channel of the tubular member and the apparatus and cut portion of the lead are removed from within the patient. Various embodiments include the blade pivotally connected to the distal end of the tubular member and activated by a wire adjustment mechanism. Others include a metallic wire for slicing through the lead. Still others include a pneumatically actuated adjustment mechanism that inflates to move the blade and engage the cutting surface with the lead.

Abstract: The invention provides an apparatus having a tubular member for receiving an endocardial lead implanted within a patient's body. Disposed generally at a distal end of the tubular member is at least one blade or cutting surface. An adjustment mechanism moves the blade between retracted and extended positions to engage the cutting surface with the endocardial lead to cut the lead. Once severed, the cut portion of the lead remains within an inner channel of the tubular member and the apparatus and cut portion of the lead are removed from within the patient. Various embodiments include the blade pivotally connected to the distal end of the tubular member and activated by a wire adjustment mechanism. Others include a metallic wire for slicing through the lead. Still others include a pneumatically actuated adjustment mechanism that inflates to move the blade and engage the cutting surface with the lead.

Abstract: Snaring systems and methods involve engaging objects such as pacemaker pacing leads within a patient. Physicians can use snaring systems having loops, tags, and roller mechanisms to remove a pacing leads from a patient. For example, snaring systems can be inserted through a jugular access site, engaged with a pacemaker pacing lead, and withdrawn through the jugular access site so as to remove a portion of the pacing lead. Lead extraction techniques can be employed to further dislodge the pacing lead from the patient.

Abstract: Embodiments of the present invention include a laser catheter that includes a catheter body, a light guide, and a distal tip that extends beyond the exit aperture of the light guide. In some embodiments, an imaging device is disposed on the distal tip such that the imaging device is distal relative to the exit aperture of the light guide. In some embodiments, the imaging device can be gated to record images during and/or slightly beyond periods when the laser catheter is not activated.

Abstract: In some embodiments, without limitation, the invention comprises a catheter having an elongated housing with a channel disposed therein. A laser delivery member is movable and at least partially disposed within the channel. A ramp is disposed within the housing at an angle to its central axis and proximate to its distal end. The ramp is adapted to move the distal end of the laser delivery member outwardly from the central axis of the housing. A guidewire biases the distal end of the laser delivery member generally inwardly toward the central axis of the housing. In some embodiments, without limitation, the offset of the central axis of the tip of the laser delivery member from the central axis of the housing is determined by adjusting the extent to which the laser delivery member travels on the ramp, and disposition of the laser delivery member on the guidewire maintains the offset tip substantially parallel to the central axis of the housing.

Abstract: A method of delivering a payload to a destination vessel branching from a coronary sinus of a patient's heart. The method comprises inserting a catheter assembly into a right atrium of the patient's heart. The catheter assembly comprises an outer catheter and an inner catheter movably disposed within the open lumen of the outer catheter. The inner and outer catheters are operable to be rotated and translated relative to one another such that the distal end of the outer catheter can assume a selectable plurality of shapes appropriate for accessing the coronary sinus. The method further comprises locating and cannulating the patient's coronary sinus by adjusting a relative orientation or longitudinal position of the inner catheter relative to the outer catheter, longitudinally sliding the outer catheter over the distal end of the inner catheter to deep seat the outer catheter within the patient's coronary sinus, and delivering a payload to the destination vessel through the outer catheter or the inner catheter.

Abstract: A catheter assembly employs an outer catheter with a pre-formed distal end and an open lumen. An inner catheter having an open lumen and a pre-formed distal end is movably disposed within the outer catheter. Relative rotation and extension of the inner and outer catheters provides the distal end of the catheter assembly with an adjustable range of two- and three-dimensional shapes. The inner catheter can include sections of varying stiffness, such that extension of the inner catheter within the outer catheter modifies the shape of the outer catheter's pre-formed distal end. The adjustable shaping of the catheter assembly's distal tip provides an improved system for locating and cannulating cardiac venous structures, particularly the coronary sinus via the right atrium.

Abstract: A guiding catheter system employs a compliant shaft with an inflatable balloon affixed to a distal portion of the shaft. The inflatable balloon includes channels that allow some amount of blood to flow past the balloon when inflated in a blood vessel. One or more inflation lumens is in fluid contact with the balloon and allows inflating the balloon from a proximal end of the catheter. A series of perfusion orifices may be included on the shaft proximal to the balloon.

Abstract: A guiding catheter system employs a compliant shaft with an inflatable balloon affixed to a distal portion of the shaft. The inflatable balloon includes channels that allow some amount of blood to flow past the balloon when inflated in a blood vessel. One or more inflation lumens is in fluid contact with the balloon and allows inflating the balloon from a proximal end of the catheter. A series of perfusion orifices may be included on the shaft proximal to the balloon.

Abstract: In some embodiments, without limitation, the invention comprises a catheter having an elongated housing with a channel disposed therein. A laser delivery member is movable and at least partially disposed within the channel. A ramp is disposed within the housing at an angle to its central axis and proximate to its distal end. The ramp is adapted to move the distal end of the laser delivery member outwardly from the central axis of the housing. A guidewire biases the distal end of the laser delivery member generally inwardly toward the central axis of the housing. In some embodiments, without limitation, the offset of the central axis of the tip of the laser delivery member from the central axis of the housing is determined by adjusting the extent to which the laser delivery member travels on the ramp, and disposition of the laser delivery member on the guidewire maintains the offset tip substantially parallel to the central axis of the housing.

Abstract: In some embodiments, without limitation, the invention comprises a catheter having an elongated housing with a channel disposed therein. A laser delivery member is movable and at least partially disposed within the channel. A ramp is disposed within the housing at an angle to its central axis and proximate to its distal end. The ramp is adapted to move the distal end of the laser delivery member outwardly from the central axis of the housing. A guidewire biases the distal end of the laser delivery member generally inwardly toward the central axis of the housing. In some embodiments, without limitation, the offset of the central axis of the tip of the laser delivery member from the central axis of the housing is determined by adjusting the extent to which the laser delivery member travels on the ramp, and disposition of the laser delivery member on the guidewire maintains the offset tip substantially parallel to the central axis of the housing.

Abstract: Embodiments of a balloon biasing laser catheter are provided. In some embodiments, the laser catheter may include a distal tip that extends from the distal end of the catheter from a point near the light guide aperture. The distal tip may be disposed at the periphery of the catheter. In some embodiments, a balloon may be disposed between the light guide aperture and the distal tip, such that the a light guide extending from the aperture may be disposed proximate with the distal tip having the balloon in between. A retaining wire may be coupled with the distal tip and slidably coupled with the light guide. The retaining wire may keep the light guide biased relatively parallel with the distal tip and/or the catheter body when the balloon is inflated. The light guide may include a guidewire lumen the extends to the distal end of the distal tip.

Abstract: A lead locking device has a lead engaging member with a mandrel extending along a lumen and attached to the distal end of the lead engaging member such that it extends beyond the proximal end of the lead engaging member. The lead locking device also has a loop handle attached to the proximal end of the mandrel. The lead engaging member has a first configuration which is narrower than a second configuration and is sufficiently long to extend along substantially the entire length of a lead to be removed from a patient's body. At the distal end, a spring coil is disposed around a tapered section of the mandrel to improve tracking of the lead locking device through the inner lumen of a pacing or defibrillator lead.

Abstract: Methods of using a catheter involve providing a sheath comprising a proximal region, a deflection region, a distal-end region including a shapeable region, an anchor region defined between the deflection region and the shapeable region, and a longitudinal axis. The method also involves imparting a pre-established shape to the shapeable region. The method further involves applying axial force in a proximal direction at the anchor region so as to cause the deflection region to deflect relative to the longitudinal axis while the pre-established shape imparted to the shapeable region of the sheath is substantially maintained.

Abstract: An apparatus and method for treating atrial fibrillation with ablation therapy in which a stent is deployed within a pulmonary vein and tissue surrounding the stent is ablated with radiofrequency energy to stop discharges from ectopic foci in the vein from reaching the left atrium. The deployed stent can then be left in place to prevent stenosis of the vein as well as allowing repeat ablation procedures as needed.

Abstract: In some embodiments, without limitation, the invention comprises a catheter having an elongated housing with a channel disposed therein. A laser delivery member is movable and at least partially disposed within the channel. A ramp is disposed within the housing at an angle to its central axis and proximate to its distal end. The ramp is adapted to move the distal end of the laser delivery member outwardly from the central axis of the housing. A guidewire biases the distal end of the laser delivery member generally inwardly toward the central axis of the housing. In some embodiments, without limitation, the offset of the central axis of the tip of the laser delivery member from the central axis of the housing is determined by adjusting the extent to which the laser delivery member travels on the ramp, and disposition of the laser delivery member on the guidewire maintains the offset tip substantially parallel to the central axis of the housing.

Abstract: A lead locking device has a lead engaging member with a mandrel extending along a lumen and attached to the distal end of the lead engaging member such that it extends beyond the proximal end of the lead engaging member. The lead locking device also has a loop handle attached to the proximal end of the mandrel. The lead engaging member has a first configuration which is narrower than a second configuration and is sufficiently long to extend along substantially the entire length of a lead to be removed from a patient's body. At the distal end, a spring coil is disposed around a tapered section of the mandrel to improve tracking of the lead locking device through the inner lumen of a pacing or defibrillator lead.

Abstract: Methods of manipulating a catheterization apparatus involve providing a catheter having a flexible shaft with a preformed curve on a distal end of the flexible shaft, one or more electrodes disposed along the distal end of the flexible shaft, and a shape deflection area defined as a region on the flexible shaft between the preformed curve and a generally straight proximal portion of the flexible shaft. A first steering mechanism is anchored at a distal portion of the preformed curve, and a second steering mechanism is anchored distal to the shape deflection area. The method also involves changing a curvature of the preformed curve in response to a proximally directed force applied to the first steering mechanism, and moving the distal end of the catheter relative to the proximal portion of the flexible shaft in response to a proximally directed force applied to the second steering mechanism.

Abstract: An electrophysiology catheter includes a flexible shaft with one or more electrodes disposed at a distal end having a preformed curve. A first steering apparatus allows altering a curvature of the distal end and a second steering apparatus allows steering of the distal end without significantly altering the curvature of the distal end. The first and second steering apparatuses are used for maneuvering the catheter and providing positive contact between the distal end and the tissue targeted for treatment.

Abstract: A peel-away sheath for a catheter includes at least one weakened area in a non-longitudinal pattern, such as a helical pattern, along the length of the sheath. One embodiment of a catheter sheath includes a tube having at least one pull wire integrally located within its wall. Another embodiment of a catheter sheath includes a tube having at least one integral lumen within its wall. The integral lumen may house a filling material. One embodiment of a catheter may include a first sheath which is positioned within a second sheath, with each of the first and second sheaths having at least one weakened area along its length. A reinforcing guide for a guide catheter includes a tube having a lumen with a diameter at least as large as the guide catheter diameter. The reinforcing guide includes a gap with a width which is less than the guide catheter diameter.