1. A myocardial lead attachment system for securing a distal end of a lead within a myocardium of a patient’s heart, the system comprising:
an anchor;
a tether coupled to the anchor; and
a delivery instrument for receiving and advancing the anchor through a tract in the heart from a proximal entrance site to a distal exit site in such a manner that the tether extends proximally from the anchor through the tract, said delivery instrument comprising:
a needle having a distal tip and a nest positioned proximal to the distal tip and sized to receive the anchor, and
an ejection mechanism for ejecting the anchor from the nest.
2. The lead attachment system of claim 1 wherein the ejection mechanism further comprises an actuator for ejecting the anchor from the nest.
3. The lead attachment system of claim 1 wherein a distal portion of the needle is formed with a radial curvature.
4. The lead attachment system of claim 2 wherein the ejection mechanism further comprises an elongated member slidable from a retracted position to an extended position in response to actuation of the actuator to engage the anchor mechanism.
5. The lead attachment system of claim 4 further comprising:
a mechanical stop for limiting extension of the elongated member; and
a resilient member biasing the actuator to retract the elongated member.
6. The lead attachment system of claim 1 wherein the delivery instrument further comprises:
a distal electrically active area on the needle; and
a conductive member for connecting the electrically active area to an external electrical device.
7. The lead attachment system of claim 1 wherein the nest further includes a slot for receiving the tether.
8. The lead attachment system of claim 1 wherein the nest includes a ramp adapted to assist in ejection of the anchor.
9. The lead attachment system of claim 1 further comprising a lead body having a proximal end, a distal end, and at least a first electrode near the distal end, said lead body adapted to advance over the tether through the tract.
10. The lead attachment system of claim 9 wherein the lead body is a unipolar lead.
11. The lead attachment system of claim 10 wherein the lead body includes a second electrode spaced apart the first electrode apart by about at least 2 cm.
12. The lead attachment system of claim 9 wherein the lead body is a pseudo-unipolar lead.
13. The lead attachment system of claim 9 wherein the lead body is a bipolar lead.
14. A myocardial lead attachment system for securing a distal end of a lead within a myocardium of a patient’s heart, the system comprising:
an anchor having a longitudinal bore extending therethrough;
a tether coupled to the anchor; and
a delivery instrument for receiving and advancing the anchor through a tract in the heart from a proximal entrance site to a distal exit site in such a manner that the tether extends proximally from the anchor through the tract, said delivery instrument comprising:
a needle having a proximal end, a distal end formed with a nest for receiving the anchor and a central lumen extending therethrough;
a stylet slidably received in the needle lumen and the anchor bore, and
an ejector plug formed on the stylet for engaging the anchor.
15. The lead attachment system of claim 14 wherein the nest is an open sleeve at the distal end of the needle.
16. The lead attachment system of claim 15 wherein the nest has an internal stop for transmitting an axial force to the anchor.
17. The lead attachment system of claim 15 wherein the anchor has a proximal region sized to be received in the nest and a distal region sized to be retained outside of the nest.
18. The lead attachment system of claim 15 wherein the anchor has a tapered distal face shaped to dissect the tissue of the myocardium.
19. The lead attachment system of claim 14 wherein the stylet has a pointed distal end shaped to dissect the tissue of the myocardium.
20. A method for using a delivery instrument to implant a myocardial lead into the heart, said lead having at least a first electrode, the method comprising:
mating a myocardial anchor coupled to a tether to a distal end of the delivery instrument;
advancing the distal end of the delivery instrument through a tract in the heart;
deploying the anchor into the heart;
withdrawing the delivery instrument through the tract in such a manner that the tether extends through the tract;
threading a myocardial lead onto the tether; and
advancing the lead over the tether into the heart.
21. The method of claim 20 further comprising:
advancing the anchor through the epicardium, into the myocardium, and back through the epicardium; and
deploying the anchor mechanism on the epicardial surface.
22. The method of claim 20 further comprising:
advancing the anchor through the epicardium, into the myocardium and through the endocardium; and
deploying the anchor on the endocardial surface.
23. The method of claim 20 further comprising:
advancing the anchor through the epicardium and into the myocardium; and
deploying the anchor into the myocardium.
24. The method of claim 20 further comprising:
advancing the anchor into the pericardium and out of the pericardium without traversing the epicardium; and
deploying the anchor on the pericardial surface.
25. The method of claim 20 further comprising advancing the lead body until the first electrode is in contact with the heart.
26. The method of claim 20 further comprising advancing the lead body until the first electrode is in contact with the myocardium.
27. The method of claim 26 wherein the lead body includes a second electrode proximal to the first electrode and further comprising advancing the lead body until the second electrode is at least partially in contact with the heart.
28. The method of claim 27 further comprising advancing the lead body until the second electrode straddles the epicardium.
29. The method of claim 27 further comprising advancing the lead body until the second electrode is in contact with the myocardium.
30. The method of claim 20 further comprising:
forming a working channel and a visual channel to the heart with an endoscopic probe; and
advancing the anchor and delivery instrument to the heart through the working channel.
The claims below are in addition to those above.
All refrences to claim(s) which appear below refer to the numbering after this setence.
1. A pulley adjusting system comprising:
a housing having a pulling eye and an opening on a surface of the housing, and
an insert having an opening on a surface thereof, the insert and the housing being slidably connected,
wherein the insert is operatively connected to a belt.
2. A pulley adjusting system comprising:
a housing having an opening on a surface thereof, and
an insert having a pulling eye and an opening on a surface of the insert, the insert and the housing being slidably connected,
wherein the insert is operatively connected to a belt.