Abstract
An implantable medical device for implantation into a patient comprises a body, an anchoring device for anchoring the body to tissue at a location of interest, the anchoring device being arranged on the body, and an electrode device for at least one of emitting an electrical stimulation signal and sensing an electrical sense signal. The electrode device comprises at least one electrode and a helically extending coil body, wherein the electrode device is movable with respect to the body between a retracted position, in which the electrode device at least partially is received within the body, and an engagement position, in which the electrode device is moved to protrude from the body to engage with tissue.
Claims
1. An implantable medical device for implantation into a patient, comprising: a body, an anchoring device for anchoring the body to tissue at a location of interest, the anchoring device being arranged on the body, and an electrode device for at least one of emitting an electrical stimulation signal and sensing an electrical sense signal, wherein the electrode device comprises at least one electrode and a helically extending coil body wherein the electrode device is movable with respect to the body between a retracted position, in which the electrode device at least partially is received within the body, and an engagement position, in which the electrode device is moved to protrude from the body to engage with tissue.
2. The implantable medical device according to claim 1, wherein the body forms a distal end to be placed on tissue upon implantation of the implantable medical device, wherein the anchoring device is arranged on and extends from the distal end and wherein the electrode device is movable with respect to the distal end.
3. The implantable medical device according to claim 1, wherein the electrode device is rotatable with respect to the body to screw said helically extending coil body into tissue.
4. The implantable medical device according to claim 1, wherein the body is formed by a lead which is connectable to a generator of the implantable medical device.
5. The implantable medical device according to claim 4, wherein the lead comprises a connector which the lead is connectable to said generator, wherein the connector comprises a gauge device for indicating the position of the electrode device with respect to the body.
6. The implantable medical device according to claim 1, wherein the body is formed by a housing of a leadless pacemaker device.
7. The implantable medical device according to claim 1, wherein the anchoring device is formed by a helically extending coil.
8. The implantable medical device according to claim 7, wherein the electrode device is arranged concentrically within the anchoring device.
9. The implantable medical device according to claim 7, wherein the anchoring device formed by the helically extending coil comprises a first sense of rotation, and the helically extending coil body of the electrode device comprises a second sense of rotation opposite to the first sense of rotation.
10. The implantable medical device according to claim 1, wherein the anchoring device is formed by at least one flexibly bendable tine.
11. The implantable medical device according to claim 1, wherein the at least one electrode is placed at a tip of the helically extending coil body.
12. The implantable medical device according to claim 1, wherein the electrode device comprises a pin to which the helically extending coil body connected and about which the helically extending coil body extends.
13. The implantable medical device according to claim 1, wherein the electrode device is connected to an inner conductor received within the body, wherein the electrode device is movable with respect to the body together with the inner conductor.
14. The implantable medical device according to claim 13, wherein the inner conductor forms said at least one electrode.
15. The implantable medical device according to claim 1, wherein the body comprises a housing element in which the electrode device is received, wherein one of the housing element and the electrode device comprises a threading and the other of the housing element and the electrode device comprises a counter element engaging with the threading such that a rotational movement of the electrode device relative to the housing element about a longitudinal axis causes a linear displacement of the electrode device relative to the housing element along the longitudinal axis.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0050] An idea of the present invention shall subsequently be described in more detail with reference to the embodiments shown in the figures. Herein:
[0051] FIG. 1 shows a schematic view of the human heart, including the Sinoatrial node, the Atrioventricular node, the HIS bundle and the left bundle branch and right bundle branch extending from the HIS bundle;
[0052] FIG. 2 shows a schematic drawing of the heart with a lead implanted therein;
[0053] FIG. 3 shows a schematic drawing of the heart with a leadless stimulation device implanted therein;
[0054] FIG. 4 shows a view of an embodiment of an implantable medical device having a body and an anchoring device as well as an electrode device arranged thereon;
[0055] FIG. 5 shows an enlarged view of a distal end of the implantable medical device with the anchoring device and the electrode device;
[0056] FIG. 6A shows the implantable medical device, with the electrode device in a retracted position;
[0057] FIG. 6B shows the implantable medical device, with the electrode device in an engagement position;
[0058] FIG. 7 shows a view of another embodiment of an implantable medical device;
[0059] FIG. 8 shows a view of an embodiment of an implantable medical device with an electrode device formed by an inner conductor;
[0060] FIG. 9 shows a view of another embodiment of an implantable medical device;
[0061] FIG. 10 shows another embodiment of an electrode device;
[0062] FIG. 11A shows the implantable medical device of FIG. 8, in a retracted position of the electrode device;
[0063] FIG. 11B shows the implantable medical device of FIG. 8, in an engagement position of the electrode device;
[0064] FIG. 12 shows a view of an embodiment of a connector for connecting a lead to a generator;
[0065] FIG. 13 shows another embodiment of a connector;
[0066] FIG. 14 shows a view of an embodiment of an implantable medical device, with an electrode device movable along a perpendicular direction with respect to a longitudinal direction of extension of a lead of the implantable medical device;
[0067] FIG. 15 shows a schematic, sectional view of the implantable medical device of FIG. 14;
[0068] FIG. 16A shows another embodiment of an implantable medical device, with an electrode device in a retracted position; and
[0069] FIG. 16B shows the embodiment of FIG. 16A, in an engagement position of the electrode device.
DETAILED DESCRIPTION
[0070] Subsequently, embodiments of the present invention shall be described in detail with reference to the drawings. In the drawings, like reference numerals designate like structural elements.
[0071] It is to be noted that the embodiments are not limiting for the present invention, but merely represent illustrative examples.
[0072] FIG. 1 shows, in a schematic drawing, the human heart comprising the right atrium RA, the right ventricle RV, the left atrium LA and the left ventricle LV, the so-called sinoatrial node SAN being located in the wall of the right atrium RA, the sinoatrial node SAN being formed by a group of cells having the ability to spontaneously produce an electrical impulse that travels through the heart's electrical conduction system, thus causing the heart to contract in order to pump blood through the heart. The atrioventricular node AVN serves to coordinate electrical conduction in between the atria and the ventricles and is located at the lower back section of the intra-atrial septum near the opening of the coronary sinus. From the atrioventricular node AVN the so-called HIS bundle H is extending, the HIS bundle H being comprised of heart muscle cells specialized for electrical conduction and forming part of the electrical conduction system for transmitting electrical impulses from the atrioventricular node AVN via the so-called right bundle branch RBB around the right ventricle RV and via the left bundle branch LBB around the left ventricle LV.
[0073] In the embodiment of FIG. 1, an implantable medical device 1 in the shape of a stimulation device, such as a CRT device, is implanted in a patient, the implantable medical device 1 comprising a generator 12 connected to leads 10, 11 extending from the generator 12 through the superior vena V into the patient's heart. By means of the leads 10, 11, electrical signals for providing a pacing action in the heart shall be injected into intra-cardiac tissue potentially at different locations within the heart, and sense signals may be received. In addition, possibly a defibrillation therapy may be performed by an electrode arrangement arranged on one or both of the leads 10, 11.
[0074] In an embodiment shown in FIG. 2, a lead 10 is implanted into the heart such that it extends into the right ventricle RV of the heart and, at a distal end 101 of a lead body 100, is arranged on intra-cardiac tissue at the septum M in between the right ventricle RV and the left ventricle LV of the heart. At the distal end 101 herein anchoring devices 13 in the shape, e.g., of tines are arranged, the anchoring devices 13 serving to anchor the lead 10 with its body 100 to tissue in particular in the region of the septum M within the heart.
[0075] An implantable medical device 1 as concerned herein may generally be a cardiac stimulation device such as a cardiac pacemaker device. A stimulation device of this kind may comprise a generator 12, as shown in FIG. 1, which may be subcutaneously implanted into a patient at a location remote from the heart, one or multiple leads 10, 11 extending from the generator 12 into the heart for emitting stimulation signals in the heart or for obtaining sense signals at one or multiple locations from the heart.
[0076] If the implantable medical device 1 is a stimulation device using leads, a lead 10 forms a generally longitudinal, tubular body 100 extending along a longitudinal axis L, as shown in FIG. 2, which reaches into the heart and is anchored at a location of interest, for example, on the septum M of the heart in the region of the right ventricle RV.
[0077] In another embodiment, the implantable medical device 1 may be a leadless pacemaker device, which does not comprise leads, but has the shape of a capsule and may be directly implanted into the heart, for example into the right ventricle RV of the heart.
[0078] Referring now to FIG. 3, in one embodiment an implantable medical device 1 in the shape of a leadless pacemaker device 15 comprises a body 150 in the shape of a housing which extends longitudinally along a longitudinal axis L and encapsulates components of the leadless pacemaker device 15, such as a processing device, a data memory, a battery, pulse generation circuitry and the like to allow for a stimulation operation immediately within the heart.
[0079] In the embodiment of FIG. 3, the body 150 in the shape of the housing of the leadless pacemaker device 15 forms a distal end 151 which is placed on intra-cardiac tissue in the region of the septum M of the heart. Anchoring devices 13 in the shape, e.g., of tines are arranged on the body 150 in the region of the distal end 151 and extend from the distal end 151 generally along the longitudinal axis L.
[0080] Referring now to FIGS. 4 to 6A, and 6B, in one embodiment an implantable medical device 1 comprises a lead 10 having a body 100 which, at a distal end 101, is to be placed on tissue, for example, on the septum M of the heart.
[0081] In the shown embodiment, an anchoring device 13 in the shape of a helically wound coil is arranged on the distal end 101, the anchoring device 13 being configured to anchor the body 100 at its distal end 101 to the tissue in the region of the septum M. The anchoring device 13 herein is fixedly arranged on the distal end 101 and serves the function of a screw which may be screwed into tissue by rotating the body 100 as a whole in a sense of rotation R1, as this is indicated in FIG. 5.
[0082] In addition, an electrode device 14 having a helically extending coil body 142 is arranged on the body 100 to extend from the body 100 at the distal end 101. The electrode device 14 is axially movable along a longitudinal axis L, along which the body 100 generally extends, with respect to the body 100.
[0083] As this is shown in FIGS. 6A and 6B, the electrode device 14 with its helically extending coil body 142 is connected to an inner conductor 103 received within an outer conductor 104 of the body 100. The outer conductor 104 is fixedly connected to a housing element 105, which may, for example, form the distal end 101 of the body 100. The inner conductor 103 is movable, i.e. rotatable and axially slidable, within the outer conductor 104.
[0084] Both the inner conductor 103 and the outer conductor 104 may be embedded in an electrically insulating tubing material, which in FIGS. 6A and 6B is not shown for the sake of easy illustration.
[0085] The electrode device 14 with its helically extending coil body 142 is rotatable by rotating the inner conductor 103. Inside of the housing element 105 herein a counter element 106, e.g., in the shape of a stud protruding radially inwards is formed, the counter element 106 engaging with the helically extending coil body 142 such that a rotation of the helically extending coil body 142 causes an interaction with the counter element 106 and hence an axial displacement of the electrode device 14 and the inner conductor 103 along the longitudinal axis L with respect to the housing element 105 and the body 100 connected thereto.
[0086] The electrode device 14 comprises an electrode 140 formed by a pointed tip of the helically extending coil body 142. The helically extending coil body 142 may, for example, be formed from an electrically conductive core which is coated by an electrically insulating coating material, wherein the helically extending coil body 142, for example, does not comprise a coating in the region of the tip, such that the electrode 140 is formed at the tip by exposing the electrically conductive inner core of the helically extending coil body 142.
[0087] With its electrode 140, hence, the electrode device 14 may come into engagement with tissue in order to electrically couple to tissue for emitting electrical stimulation signals into and/or receiving electrical sense signals from tissue.
[0088] The electrode device 14, as apparent from FIGS. 6A and 6B, may be moved in between different positions with respect to the housing element 105 of the body 100. In a retracted position, shown in FIG. 6A, the electrode device 14 fully or at least with substantial portions is received within the housing element 105, such that the electrode device 14 does not or only with a portion extends from the housing element 105. By rotating the inner conductor 103 the electrode device 14 may be moved out of the housing element 105, as this is shown in FIG. 6B, in order to bring the electrode device 14 into engagement with tissue at a location of interest.
[0089] Herein, the electrode device 14 may be continuously moved such that the electrode device 14 may be brought into different positions to engage with a particular tissue region at a particular depth. This may be used, as indicated in FIG. 4, in particular to provide for a pacing at the left bundle branch LBB. In particular, by screwing the electrode device 14 into tissue the electrode 140 may be brought into a position in which it is located in the vicinity of the left bundle branch LBB, such that the electrode 140 of the electrode device 14 may couple with the left bundle branch LBB and hence may capture the left bundle branch LBB to inject signals into the left bundle branch LBB and/or receive sense signals from the left bundle branch LBB.
[0090] As the electrode device 14 may assume different positions with respect to the body 100 and hence may be variably moved to a particular depth, the electrode 140 may be placed at different depths within tissue and hence may provide for an excitation and/or sensing at a particular location depending on the position of the electrode device 14. In particular, during implantation a capturing of the electrode 140 to tissue, in particular to the left bundle branch LBB, may be monitored, such that the electrode device 14 may be brought into a position in which an optimum coupling to the left bundle branch LBB may be established, such that an effective stimulation and/or sensing at the left bundle branch LBB may be achieved.
[0091] As it is illustrated in FIG. 5, in one embodiment the electrode device 14 with its helically extending coil body 142 comprises a sense of rotation R2 which is opposite to the sense of rotation R1 of the anchoring device 13. This allows to screw the anchoring device 13 into tissue in the sense of rotation R1, while the electrode device 14 is in its retracted position according to FIG. 6A. Once the body 100 with its distal end 101 is coupled to tissue by means of the anchoring device 13, the electrode device 14 may be screwed into tissue in the sense of rotation R2, which causes a load on the anchoring device 13 in the sense of rotation R1 such that the anchoring by means of the anchoring device 13 is tightened rather than loosened when screwing the electrode device 14 into tissue for bringing the electrode 140 into a position in which an effective coupling to tissue is established.
[0092] In the embodiment of FIGS. 4 to 6A, and 6B, the electrode device 14 is formed by a helically extending element which is fixedly connected to the inner conductor 103, which itself is formed by a helically extending, coil-shaped electrical conductor.
[0093] In the embodiments of FIGS. 7 to 11A, and 11B, the electrode device 14 is formed by the inner conductor 103 itself. The electrode device 14 herein comprises a pin 141 formed by an inner core of the inner conductor 103, which may, for example, be formed by a wire or a rope, for example from a nickel cobalt alloy, such as MP35N. A helically extending coil body 142 is arranged on the pin 141. The helically extending coil body 142 may, for example, be formed by a separate element which is glued or welded to the pin 141. Alternatively, the helically extending coil body 142 may be integrally formed with the pin 141, for example by a stamping, rolling or milling technique.
[0094] FIGS. 8 to 10 show different modifications of the implantable medical device 1.
[0095] In the embodiment of FIG. 8, the inner conductor 103 comprises an inner core, for example made from a conductive wire, which forms the pin 141. An electrical insulation 103A is placed on the inner core and surrounds the inner core, wherein the pin 141 is not covered by the electrical insulation 103A. In the region of the pin 141 an electrically insulating, thin coating may be placed, wherein a tip of the pin 141 is left free such that an electrode 140 is formed at the tip of the pin 141 and exposed towards the outside.
[0096] A helically extending coil body 142 extends about the pin 141, wherein the helically extending coil body 142 may be integrally formed with the pin 141, or may be glued or welded to the pin 141 as a separate element.
[0097] As visible from FIG. 8, the helically extending coil body 142 comprises a diameter (measured transverse to the longitudinal axis L) which is equal to or smaller than the diameter of the electrical insulation 103A of the inner conductor 103 proximally of the helically extending coil body 142. In this way the electrode device 14 may be screwed into tissue, wherein the electrical insulation 103A forms a channel within the tissue having the diameter of the electrical insulation 103A. This may facilitate an explantation (if necessary) in that for explantation the helically extending coil body 142 may be unscrewed, and once the tissue channel formed by the electrical insulation 103A is reached the helically extending coil body 142 may be slid out of the channel by pulling on the body 100.
[0098] In the embodiment of FIG. 8, the anchoring device 13 is formed by hook elements placed on the distal end 101 of the body 100.
[0099] A further electrode 102 in the shape of a ring electrode may be placed on the body 100.
[0100] In the embodiment of FIG. 9, the electrode device 14 and the inner conductor 103 are identical in shape and function to the electrode device 14 and the inner conductor 103 of the embodiment of FIG. 8. In contrast to the embodiment of FIG. 8, the anchoring device 13 in the embodiment of FIG. 9 is formed by a helically extending screw element, which is fixedly arranged on the body.
[0101] The helically extending screw element 13 may have a sense of rotation which may be equal to or opposite to a sense of rotation of the helically extending coil body 142 of the electrode device 14.
[0102] Whereas in the embodiments of FIGS. 8 and 9 the helically extending coil body 142 is arranged on the pin 141 formed by the inner conductor 103 to extend substantially along the length of the pin 141, in the embodiment of FIG. 10 the helically extending coil body 142 protrudes beyond the tip of the pin 141 along the longitudinal axis L. An electrode 140 herein is formed by the helically extending coil body 142. The pin 141 may entirely be covered by an electrically insulating coating, such that the pin 141, for example, does not electrically couple to tissue.
[0103] As visible from FIGS. 11A and 11B, the electrode device 14 may be placed in tissue at different depths, such that the electrode 140 may be brought into a position at a particular depth in which an efficient coupling to a particular tissue region may be established.
[0104] In the embodiments of FIGS. 7 to 11A, and 11B, the inner core of the conductor 103 may be formed by wire filaments, for example, made from a nickel cobalt alloy. The wire filaments form the pin 141 and may be welded together to form the distal tip of the pin 141. In regions of the pin 141 other than the electrode region 140 an electrically insulating coating, such as a parylene coating, may be placed to electrically insulate the pin 141 in regions not covered by the electrical insulation 103A.
[0105] By forming the electrode device 14 integrally with the inner conductor 103, an easy, robust arrangement can be provided. In particular, a risk of breaking at a transition from the electrode device 14 to the inner conductor 103 is substantially reduced, in that the electrode device 14 is integrally formed with the inner conductor 103. The inner conductor 103 is movable together with the electrode device 14, such that the inner conductor 103 may be moved into tissue together with the electrode device 14, allowing to place the electrode device 14 at different depths within tissue.
[0106] A further electrode 102 placed on the body 100 may form a counter electrode for the electrode 140 of the electrode device 14. In addition or alternatively, the further electrode 102 may form a shock electrode, for example for providing a defibrillation function. The further electrode 102 may have the shape e.g. of a ring electrode or a coil electrode.
[0107] The implantable medical device 1 may be formed, e.g., by a stimulation device having a lead, as shown in FIGS. 1 and 2. Alternatively, the implantable medical device 1 may have the shape of a leadless pacemaker, as shown in FIG. 3.
[0108] If the implantable medical device 1 is formed by a device having a lead 10, the lead 10 at its proximal end may have a connector 16 as shown in FIG. 12, the connector 16 having contact elements 161, 162 arranged on a connector body 160 for electrically connecting the lead 10 to a generator 12 by plugging the connector 16 into a corresponding plug receptacle of the generator 12. The connector 16 may have a standardized shape and may form a DF4 or DF2 connector.
[0109] Herein, as indicated in FIG. 12, the connector 16 may comprise a gauge device 163 having a window 164 in which a marker element 165 is movable to indicate a relative position of the electrode device 14 with respect to the body 100 of the lead 10. The marker element 165 may be mechanically coupled to the inner conductor 103 received within the body 100, such that a relative position of the marker element 165 in the window 164 indicates the position of the electrode device 14 with respect to the body 100 and in particular a depth of an electrode 140 provided by the electrode device 14.
[0110] In the embodiment of FIG. 12, the inner conductor 103 may, for example, be rotated by rotating the contact element 161, as illustrated in FIG. 12. The contact element 161 herein may be elastically coupled to the inner conductor 103, such that a rotation of the contact element 161 causes a rotation of the inner conductor 103, wherein an axial displacement of the inner conductor 103 with respect to the contact element 161 is compensated by the elasticity of the connection of the inner conductor 103 to the contact element 161.
[0111] In another embodiment of a connector 16 shown in FIG. 13, the connector 16 comprises a turning wheel 166 which is connected to the inner conductor 103 received in the body 100, such that by rotation of the turning wheel 166 the inner conductor 103 may be rotated and the electrode device 14 connected to the inner conductor 103 may be moved within the body 100. A scale herein may be provided at a transition in between the turning wheel 166 and the connector body 160 of the connector 16, such that the relative position of the turning wheel 166 indicates the position of the electrode device 14 with respect to the body 100.
[0112] In the embodiment of FIG. 13, the body 100 with its outer conductor 104 may be elastically coupled to the connector body 160 and the contact element 162, to which the outer conductor 104 is electrically contacted. If the turning wheel 166 is rotated, the body 100 may be axially moved with respect to the connector body 160, wherein the body 100, for example, is supported on the connector body 160 by means of a spring element, which, for example, also provides for an electrical connection of the outer conductor 104 of the body 100 with the contact element 162.
[0113] In an embodiment shown in FIGS. 14 and 15, the body 100 forms a housing element 105 which comprises a channel 105A having a curved shape through which the electrode device 14 extends, as visible from FIG. 15. The electrode device 14, formed, for example, from an elastically deformable wire or formed integrally with the inner conductor 103, may be elastically bent such that, by moving the inner conductor 103, the electrode device 14 may be moved out of the housing element 105.
[0114] In the embodiment of FIGS. 14 and 15, the channel 105A forms a 90° angle, such that an axis L′ along which the electrode device 14 is moved out of the housing element 105 extends perpendicularly to the longitudinal axis L along which the body 100 generally extends. The engagement direction of the electrode device 14 hence differs from the longitudinal direction of extension of the body 100.
[0115] The electrode device 14 may comprise a helically extending coil body 142 and forms a tip electrode 140, allowing to screw the electrode device 14 into tissue in order to electrically couple the electrode 140 to tissue.
[0116] In the embodiment of FIGS. 14 and 15, the body 100, in the region of the housing element 105 forming the distal end of the body 100, comprises a drive cylinder 107 in which a threading 107A is formed. The inner conductor 103 herein comprises a counter element 108 engaging with the threading 107A, such that a rotation of the inner conductor 103 causes an axial displacement of the electrode device 14 with respect to the housing element 105.
[0117] In the embodiment of FIGS. 14 and 15 the helically extending coil body 142 may also be dispensable, the electrode device 14 hence being formed solely by the pin 141 which may be inserted into tissue by advancing the electrode device 14 by rotating the inner conductor 103.
[0118] In an embodiment shown in FIGS. 16A and 16B an electrode device 14 is formed by a pin 141 forming an electrode 140. The electrode device 14 is operatively coupled to a drive cylinder 107, which is rotatable within a bearing element 109 fixedly arranged within the housing element 105. The pin 141 of the electrode device 14 comprises a counter element 108 in the shape of a stud, which engages with a threading 107A formed inside the drive cylinder 107. A rotation of the drive cylinder 107 within the bearing element 109 hence causes the electrode device 14 to be axially advanced with respect to the housing element 105, as it is visible from the different positions of the electrode device 14 with respect to the housing element 15 in FIGS. 16A and 16 B.
[0119] In the embodiment of FIGS. 16A, 16B, the anchoring device 13 is formed by tines arranged on the housing element 105.
[0120] A rotation of the drive cylinder 107 may, for example, be achieved by a mandrel, which may be brought into operative connection with the drive cylinder 107, for example through a body 100 of a lead 10 or, in case of a leadless pacemaker, by engaging the mandrel with the leadless pacemaker during implantation.
[0121] The idea of the present invention is not limited to the embodiments described above.
[0122] The implantable medical device may have the shape of a stimulation device comprising leads, or may have the shape of a leadless pacemaker device.
[0123] The electrode device may be formed in different ways and is not limited to the embodiments described above. The electrode device may be integrally formed with an inner conductor. The electrode device, alternatively, may be formed by an element connected to an inner conductor.
[0124] The electrode device may be rotated by an inner conductor. Alternatively, the electrode device may be rotated by a mandrel or the like which may be operatively connected to the electrode device.
[0125] The electrode device may comprise one or multiple electrodes. If multiple electrodes are placed on the electrode device, the electrodes may be electrically independent of each other, such that one or multiple electrodes of the electrode device may be used separately or in combination to provide for an electrical stimulation and/or electrical sensing at a location of interest.
[0126] The anchoring device may be formed in different ways and is not limited to the embodiments described above. Generally, the anchoring device may be formed by hooks, tines or one or multiple screw elements. Elements of the anchoring device may be rigid, or may be elastically deformable.
[0127] It will be apparent to those skilled in the art that numerous modifications and variations of the described examples and embodiments are possible in light of the above teachings of the disclosure. The disclosed examples and embodiments are presented for purposes of illustration only. Other alternate embodiments may include some or all of the features disclosed herein. Therefore, it is the intent to cover all such modifications and alternate embodiments as may come within the true scope of this invention, which is to be given the full breadth thereof. Additionally, the disclosure of a range of values is a disclosure of every numerical value within that range, including the end points.
LIST OF REFERENCE NUMERALS
[0128] 1 Implantable medical device
[0129] 10 Lead
[0130] 100 Lead body
[0131] 101 Distal end
[0132] 102 Electrode
[0133] 103 Inner conductor
[0134] 103A Electrical insulation
[0135] 104 Outer conductor
[0136] 105 Housing element
[0137] 105A Channel
[0138] 106 Counter element
[0139] 107 Drive cylinder
[0140] 107A Threading
[0141] 108 Counter element
[0142] 109 Bearing element
[0143] 11 Lead
[0144] 12 Generator
[0145] 13 Anchoring device
[0146] 14 Electrode device
[0147] 140 Electrode
[0148] 141 Pin
[0149] 142 Coil body
[0150] 15 Leadless device
[0151] 150 Body (housing)
[0152] 151 Distal end
[0153] 16 Connector
[0154] 160 Connector body
[0155] 161, 162 Contact element
[0156] 163 Gauge device
[0157] 164 Window
[0158] 165 Marker element
[0159] 166 Turning wheel
[0160] AVN Atrioventricular node
[0161] H HIS bundle
[0162] L, L′ Longitudinal axis
[0163] LA Left atrium
[0164] LBB Left bundle branch
[0165] LV Left ventricle
[0166] M Intra-cardiac tissue (myocardium)
[0167] R1, R2 Sense of rotation
[0168] RA Right atrium
[0169] RBB Right bundle branch
[0170] RV Right ventricle
[0171] SAN Sinoatrial node
[0172] V Superior vena
