Abstract: A reservoir of a system for deploying an implantable lead to an extravascular location delivers a flow of fluid through a lumen of one or both of a tunneling tool and an introducer of the system. In some cases, the tunneling tool includes a pressure sensor assembly for monitoring a change in a pressure of the flow through the lumen thereof. Alternately, or in addition, a flow-controlled passageway, through which the flow of fluid from the reservoir is delivered to the lumen of the introducer, includes a compliant chamber to hold a reserve of the fluid. Fluid from the reserve may be drawn into the lumen of the introducer as the tunneling tool is withdrawn therefrom. Alternately, the introducer may include a chamber located between two seals, wherein fluid that fills the chamber is drawn distally into the lumen of the introducer, as the tunneling tool is withdrawn therefrom.

Abstract: An example catheter includes a handle assembly having a control member, an elongate body, a pull wire, and at least one radiopaque marker. The elongate body defines a lumen configured to receive a medical electrical lead including at least one electrode array. The elongate body includes a proximal portion coupled to the handle assembly and a distal portion that includes an articulating segment and a preformed curve segment. The at least one radiopaque marker is positioned on the distal portion. The pull wire extends from the control member and is anchored to the elongate body distal to the articulating segment such that actuation of the control member controllably bends the articulating segment in a first curve in a first geometric plane. The preformed curve segment defines a second curve in a second geometric plane different from the first geometric plane.

Abstract: In some examples, a system includes a catheter comprising an elongated shaft defining a lumen, and a tether assembly. The tether assembly may include an elongate body, a tether head assembly attached to a distal end of the elongate body, where the tether head assembly includes an attachment mechanism configured to releasably attach to an attachment member of a medical device, and a positioning element fixedly positioned over the elongate body and configured to align the attachment mechanism with the attachment member when the tether head assembly is extended distally out of the lumen. The positioning element may include a distal end, a proximal end, and a length between the distal end and proximal end that is less than a length of the elongate body. The tether head assembly, elongate body, and positioning element may be movable within the lumen of the elongated shaft.

Abstract: A pacemaker has a housing and a therapy delivery circuit enclosed by the housing for generating pacing pulses for delivery to a patient's heart. An electrically insulative distal member is coupled directly to the housing and at least one non-tissue piercing cathode electrode is coupled directly to the insulative distal member. A tissue piercing electrode extends away from the housing.

Abstract: An example device includes an elongated housing, a first and second electrode, and signal generation circuitry. The housing can be implanted within a single first chamber of the heart. The first electrode extends distally from the distal end of the elongated housing. A distal end of the first electrode can penetrate into wall tissue of a second chamber of the heart. The second electrode, extending from the distal end of the elongated housing, is configured to flexibly maintain contact with the wall tissue of the first chamber without penetration of the wall tissue of the first chamber by the second electrode. Signal generation circuitry can be within the elongated housing and coupled to the first and second electrode. The signal generation circuitry can deliver cardiac pacing to the second chamber via the first electrode and the first chamber via the second electrode.

Abstract: A method includes cutting a septal wall between a right atrium and left atrium of a heart of a patient to form a multi-cuspid valvular shunt, and ablating septal wall tissue of at least a portion of the multi-cuspid valvular shunt to cause the ablated portion of the multi-cuspid valvular shunt to be biostable.

Abstract: An implantable medical device (IMD) comprises a plurality of deep tines configured to be advanced into a septum of a heart of a patient in different directions that are not parallel to a longitudinal axis of the implantable medical device, wherein each deep tine of the plurality of deep tines is configured to deliver cardiac pacing to cardiac tissue distal to a chamber of the heart in which the IMD is implanted, and one or more shallow electrodes engageable with the septum, wherein the one or more shallow electrodes are configured to deliver cardiac pacing to the chamber of the heart in which the IMD is implanted.

Abstract: An example device includes an elongated housing, a first and second electrode, and signal generation circuitry. The housing can be implanted within a single first chamber of the heart. The first electrode extends distally from the distal end of the elongated housing. A distal end of the first electrode can penetrate into wall tissue of a second chamber of the heart. The second electrode, extending from the distal end of the elongated housing, is configured to flexibly maintain contact with the wall tissue of the first chamber without penetration of the wall tissue of the first chamber by the second electrode. Signal generation circuitry can be within the elongated housing and coupled to the first and second electrode. The signal generation circuitry can deliver cardiac pacing to the second chamber via the first electrode and the first chamber via the second electrode.

Abstract: A reservoir of a system for deploying an implantable lead to an extravascular location delivers a flow of fluid through a lumen of one or both of a tunneling tool and an introducer of the system. In some cases, the tunneling tool includes a pressure sensor assembly for monitoring a change in a pressure of the flow through the lumen thereof Alternately, or in addition, a flow-controlled passageway, through which the flow of fluid from the reservoir is delivered to the lumen of the introducer, includes a compliant chamber to hold a reserve of the fluid. Fluid from the reserve may be drawn into the lumen of the introducer as the tunneling tool is withdrawn therefrom. Alternately, the introducer may include a chamber located between two seals, wherein fluid that fills the chamber is drawn distally into the lumen of the introducer, as the tunneling tool is withdrawn therefrom.

Abstract: An example catheter includes a handle assembly having a control member, an elongate body, a pull wire, and at least one radiopaque marker. The elongate body defines a lumen configured to receive an medical electrical lead including at least one electrode array. The elongate body includes a proximal portion coupled to the handle assembly and a distal portion that includes an articulating segment and a preformed curve segment. The at least one radiopaque marker is positioned on the distal portion. The pull wire extends from the control member and is anchored to the elongate body distal to the articulating segment such that actuation of the control member controllably bends the articulating segment in a first curve in a first geometric plane. The preformed curve segment defines a second curve in a second geometric plane different from the first geometric plane.

Abstract: An implantable electrical lead suitable for left sided cardiac placement, the implantable medical electrical lead having an external blood contacting surface having an external coating including a monolayer of at least one biological agent that promotes endothelialization covalently attached to a polymeric lead surface.

Abstract: An antimicrobial accessory may include a pressure sensitive adhesive and an antimicrobial mixed in the pressure sensitive adhesive. In some examples, an antimicrobial accessory may include at least one first domain comprising a pressure sensitive adhesive and a first antimicrobial and at least one second domain including a second polymer and a second antimicrobial. The antimicrobial accessory may be configured to be attached to a housing of an implantable medical device (IMD).

Abstract: A medical device lead is presented that includes an electrode assembly having a first electrode located near a distal end of the electrode assembly and a second electrode located near a proximal end of the electrode assembly. The electrode assembly also includes a conductive elongated coupler that is electrically coupled to the first electrode and capacitively coupled to the second electrode. At low frequencies and DC (e.g., during delivery of stimulation therapy), the capacitive coupling between the conductive elongated coupler and the second electrode presents a high impedance allowing little current to be redirected from the first electrode to the second electrode. However, at high frequencies (e.g., during an MRI scan) the capacitive coupling between the conductive elongated coupler and the second electrode presents a low impedance, resulting in a significant amount of induced current being redirected to the second electrode and dissipated into bodily fluid surrounding the second electrode.

Abstract: A therapeutic agent reservoir comprises a reservoir body comprising a polymer and a therapeutic agent mixed within the polymer, and an outer coating enclosing the reservoir body, wherein at least a portion of the outer coating comprises a rate-controlling membrane configured to provide a predetermined release rate of the therapeutic agent through the rate-controlling membrane.

Abstract: A method of placing an electrical lead of an implantable cardiac device inside a heart of a patient. The method includes securing a tool to an atrial appendage of the heart to hold onto the atrial appendage, piercing the atrial appendage, and creating an aperture in the atrial appendage while holding the atrial appendage with the tool. The method also includes moving a distal end of the electrical lead into the heart through the aperture in the atrial appendage and into a ventricle of the heart. Furthermore, the method includes coupling the distal end of the electrical lead to cardiac tissue in the ventricle and delivering an electrical signal to the cardiac tissue in the ventricle of the heart to maintain a predetermined heartbeat of the heart.

Abstract: A therapeutic agent reservoir comprises a reservoir body comprising a polymer and a therapeutic agent mixed within the polymer, and an outer coating enclosing the reservoir body, wherein at least a portion of the outer coating comprises a rate-controlling membrane configured to provide a predetermined release rate of the therapeutic agent through the rate-controlling membrane.

Abstract: An implantable electrical lead suitable for left sided cardiac placement, the implantable medical electrical lead having an external blood contacting surface having an external coating including a monolayer of at least one biological agent that promotes endothelialization covalently attached to a polymeric lead surface.

Abstract: A pharmaceutical implant may include a pharmaceutical and at least one excipient, and may be configured to be implanted in a body of a patient. The at least one excipient may dissolve after implantation of the pharmaceutical implant in the body of the patient and release the pharmaceutical. In some examples, the pharmaceutical implant includes at least two pharmaceuticals. The at least one excipient may be selected to provide a desired release profile of the pharmaceutical. For example, the pharmaceutical implant may be configured to dissolve and release the pharmaceutical over a length of time between about one day and about 30 days. In some examples, the pharmaceutical implant may be implanted in the body of the patient proximate to an implantable medical device.

Abstract: A medical device lead is presented that includes an electrode assembly having a first electrode located near a distal end of the electrode assembly and a second electrode located near a proximal end of the electrode assembly. The electrode assembly also includes a conductive elongated coupler that is electrically coupled to the first electrode and capacitively coupled to the second electrode. At low frequencies and DC (e.g., during delivery of stimulation therapy), the capacitive coupling between the conductive elongated coupler and the second electrode presents a high impedance allowing little current to be redirected from the first electrode to the second electrode. However, at high frequencies (e.g., during an MRI scan) the capacitive coupling between the conductive elongated coupler and the second electrode presents a low impedance, resulting in a significant amount of induced current being redirected to the second electrode and dissipated into bodily fluid surrounding the second electrode.

Abstract: A method of placing an electrical lead of an implantable cardiac device inside a heart of a patient. The method includes securing a tool to an atrial appendage of the heart to hold onto the atrial appendage, piercing the atrial appendage, and creating an aperture in the atrial appendage while holding the atrial appendage with the tool. The method also includes moving a distal end of the electrical lead into the heart through the aperture in the atrial appendage and into a ventricle of the heart. Furthermore, the method includes coupling the distal end of the electrical lead to cardiac tissue in the ventricle and delivering an electrical signal to the cardiac tissue in the ventricle of the heart to maintain a predetermined heartbeat of the heart.