Delivery device

FIELD OF THE DISCLOSURE

0001The present disclosure pertains to delivery of implantable medical devices, and, more particularly, to delivery of relatively compact implantable medical devices.

BACKGROUND

0002Conventional implantable cardiac pacemakers typically include one or more medical electrical leads that deliver pacing pulses to cardiac tissue and sense the response thereto. Leads occasionally may have mechanical complications and/or MRI compatibility issues. Consequently, relatively compact implantable cardiac pacing devices have been developed that are able to deliver pacing pulses to cardiac tissues without leads. MICRA^™, commercially available from Medtronic Inc., is one example of a compact implantable cardiac pacing device that is configured for implant in close proximity to a pacing site. Other microstimulators have been designed with short pacing leads referred to as leadlets. Exemplary microstimulators having leadlets or features thereof are shown in <patcit id="pcit0001" dnum="US7949395B2"><text>US Patent No. 7,949,395 B2 to Kuzma</text></patcit>, <patcit id="pcit0002" dnum="US20040147973A1"><text>US Patent Pregrant Publication No. 20040147973 A1 to Hauser</text></patcit>, <patcit id="pcit0003" dnum="US7082336B2"><text>US Patent No. 7,082,336 B2 to Ransbury et al.</text></patcit>, <patcit id="pcit0004" dnum="US673867282B"><text>US Patent No. 6,738,672 82 to Schulman et al.</text></patcit>, <patcit id="pcit0005" dnum="US9446248B2"><text>US Patent No. 9,446,248 B2 to Sheldon et al.</text></patcit>, <patcit id="pcit0006" dnum="US20110270340A1"><text>US Pregrant Publication No. 20110270340 A1 to Pellegrini et al.</text></patcit>, <patcit id="pcit0007" dnum="US20090082828A1"><text>US Pregrant Publication No. 20090082828 A1 to Ostroff</text></patcit>, <patcit id="pcit0008" dnum="US8634912B2"><text>US Patent No. 8,634,912 B2 to Bornzin, et al.</text></patcit>, <patcit id="pcit0009" dnum="US9539423B"><text>US Patent No. 9,539,423</text></patcit>, and <patcit id="pcit0010" dnum="US9446248B2"><text>US Patent No. 9,446,248 B2 to Sheldon et al.</text></patcit> A need exists for improved delivery and fixation means for compact implantable cardiac pacing devices. <patcit id="pcit0011" dnum="US20130110127A"><text>US 2013/0110127</text></patcit> teaches a delivery device with a device mover.

BRIEF DESCRIPTION OF THE DRAWINGS

0003The following drawings are illustrative of particular aspects of the present invention and therefore do not limit the scope of the invention. Some drawings do not depict all features as claimed in combination but highlight specific aspects. The drawings are not to scale (unless so stated) and are intended for use in conjunction with the explanations in the following detailed description. Embodiments will hereinafter be described in conjunction with the appended drawings wherein like numerals denote like elements, and: <ul id="ul0001" list-style="none"><li><figref idref="f0001"><b>FIG. 1</b></figref> is a schematic diagram showing an exemplary compact dual chamber intra-cardiac pacing device implanted in a heart.</li><li><figref idref="f0002"><b>FIG. 2A</b></figref> is a schematic diagram of a delivery device advanced into a right ventricle for deployment of a ventricular portion of a compact dual chamber intra-cardiac pacing device.</li><li><figref idref="f0003"><b>FIG. 2B</b></figref> is a schematic diagram of a delivery device positioned in a right atrium for deployment of the atrial portion of the device.</li><li><figref idref="f0004"><b>FIG. 2C</b></figref> is an enlarged perspective view of a leadlet mover that is configured to push, move and/or torque a leadlet into tissue.</li><li><figref idref="f0005"><b>FIG. 3A</b></figref> is a schematic diagram related to an acute retrieval in which a snare is attached to a collar of the pacing device.</li><li><figref idref="f0006"><b>FIG. 3B</b></figref> is a schematic diagram related to another acute retrieval method for removing the pacing device.</li><li><figref idref="f0007"><b>FIG. 3C</b></figref> depicts a pacing device with a first leadlet example according to <figref idref="f0005">FIG. 3A</figref>, referred to as T-shaped leadlet, is fixated in the heart.</li><li><figref idref="f0008"><b>FIG. 4A</b></figref> is a longitudinal cut-away section plan view of a compact dual chamber implantable medical device residing in a lumen of a delivery device.</li><li><figref idref="f0009"><b>FIG. 4B</b></figref> is a plan view of a portion of the delivery device depicted in <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b></li><li><figref idref="f0010"><b>FIG. 5</b></figref> is a perspective view of a distal end of the T-shaped leadlet.</li><li><figref idref="f0011"><b>FIG. 6</b></figref> is a perspective view of a T-shaped leadlet coupled to a pacing device.</li><li><figref idref="f0012"><b>FIG. 7</b></figref> is a perspective view of a T-shaped leadlet and leadlet guide being moved into a leadlet mover.</li><li><figref idref="f0013"><b>FIG. 8A</b></figref> is a perspective view of a distal end of the leadlet mover.</li><li><figref idref="f0013"><b>FIG. 8B</b></figref> is a cross-sectional view of the leadlet mover distal end shown in <figref idref="f0013"><b>FIG. 8A</b></figref> that shows the slots formed by the forks extending from a base of the leadlet mover.</li><li><figref idref="f0013"><b>FIG. 8C</b></figref> is a side view of the leadlet mover prongs shown in <figref idref="f0013"><b>FIG. 8A</b></figref><b>.</b></li><li><figref idref="f0014"><b>FIG. 9A</b></figref> a perspective view of a delivery device for a dual chamber intra-cardiac pacing device in which tethers for controlling delivery of the device exit a Tuohy-Borst valve.</li><li><figref idref="f0015"><b>FIG. 9B</b></figref> is a perspective view of a delivery device for a dual chamber intra-cardiac pacing device in which tethers for controlling delivery of the device exits a handle.</li><li><figref idref="f0016"><b>FIG. 10</b></figref> is a flow diagram for securing a pacing device leadlet to atrial tissue.</li><li><figref idref="f0017"><b>FIG. 11</b></figref> is a schematic view of a leadlet that has been counter-rotated and can be advanced to a fixation point onto cardiac tissue.</li><li><figref idref="f0018"><b>FIG. 12</b></figref> is a schematic view depicting the leadlet and device mover after the leadlet has been fixated and before retracting the leadlet and device movers.</li><li><figref idref="f0019"><b>FIG. 13</b></figref> is a schematic view that depicts a pacing device with a second leadlet example (i.e. hooped leadlet) that has a ring loop to couple with a tether for repositioning the leadlet.</li><li><figref idref="f0020"><b>FIG. 14</b></figref> is an enlarged schematic view of the second leadlet example shown in <figref idref="f0019"><b>FIG. 13</b></figref> in which a ring is used in combination with a tether to pull the leadlet into the lumen of the delivery device.</li><li><figref idref="f0021"><b>FIG. 15</b></figref> is a cross-sectional distal end view of the second leadlet example shown in <figref idref="f0020"><b>FIG. 14</b></figref> in which a ring is used in combination with a tether to pull the leadlet into the lumen of the delivery device.</li><li><figref idref="f0022"><b>FIG. 16A</b></figref> depicts a schematic view of the second leadlet example depicted in <figref idref="f0021">FIG. 15</figref> in which a tether is inserted through the leadlet ring to form a hoop.</li><li><figref idref="f0022"><b>FIG. 16B</b></figref> depicts an enlarged cross-sectional longitudinal view of the second leadlet example shown in <figref idref="f0022"><b>FIG. 16A</b></figref><b>.</b></li><li><figref idref="f0023"><b>FIG. 17A</b></figref> depicts a schematic view of the second leadlet example , shown in <figref idref="f0022">FIG. 16</figref>, in which the leadlet is being re-loaded into the delivery device in order to reposition the leadlet from one tissue site to another tissue site to determine optimal tissue location.</li><li><figref idref="f0023"><b>FIG. 17B</b></figref> depicts a schematic view of the second leadlet example , shown in <figref idref="f0023"><b>FIG. 17A</b></figref><b>,</b> in which the helix is exposed but the remaining portion of the leadlet is substantially loaded into the device mover</li><li><figref idref="f0023"><b>FIG. 17C</b></figref> depicts a schematic view of the second leadlet example , shown in <figref idref="f0023"><b>FIG. 17B</b></figref><b>,</b> in which the leadlet is completely loaded into the lumen of the delivery device.</li><li><figref idref="f0023"><b>FIG. 17D</b></figref> depicts a schematic view of the second leadlet example , shown in <figref idref="f0023"><b>FIG. 17C</b></figref><b>,</b> in which the leadlet has been moved to another tissue location and the leadlet mover has been used to reposition the leadlet out of the distal end of the delivery device.</li><li><figref idref="f0023"><b>FIG. 17E</b></figref> depicts a schematic view of the second leadlet example in which the leadlet has exited the distal end of the delivery device and is ready to be counter-rotated around the leadlet mover in order to create sufficient stress in the leadlet body to attach the helix to tissue during rotation of the leadlet.</li><li><figref idref="f0024"><b>FIG. 18A</b></figref> depicts a schematic view of a leadlet helix that is substantially hidden within the lumen of the distal end of the delivery device.</li><li><figref idref="f0024"><b>FIG. 18B</b></figref> depicts a schematic view of the leadlet helix is starting to exit the distal end of the delivery device.</li><li><figref idref="f0024"><b>FIG. 18C</b></figref> depicts a schematic view of the leadlet helix extending further outside of the distal end of the delivery device.</li><li><figref idref="f0024"><b>FIG. 18D</b></figref> depicts a schematic view of the leadlet as having transferred torque using the leadlet mover.</li><li><figref idref="f0025"><b>FIG. 19</b></figref> depicts a schematic view of the second leadlet example of <figref idref="f0019"><b>FIGS. 13-</b></figref><b>17.</b></li><li><figref idref="f0026"><b>FIG. 20</b></figref> depicts a schematic view of the second leadlet example of <figref idref="f0025"><b>FIG. 19</b></figref> in which the leadlet is folded onto itself in a U-shape while disposed in a lumen of the leadlet mover.</li><li><figref idref="f0027"><b>FIG. 21</b></figref> depicts a schematic view of the second leadlet example of <figref idref="f0026"><b>FIG. 20</b></figref> in which the leadlet is moved in a more proximal position in the lumen of the leadlet mover and one side of the leadlet is locatable in the slot of the leadlet mover.</li><li><figref idref="f0028"><b>FIG. 22</b></figref> depicts a schematic view of the second leadlet example of <figref idref="f0027"><b>FIG. 21</b></figref> in which the leadlet is folded onto itself inside a lumen of the leadlet mover.</li><li><figref idref="f0029"><b>FIG. 23</b></figref> depicts a schematic view of the second leadlet example in which the leadlet is folded onto itself inside a lumen of the leadlet mover.</li><li><figref idref="f0029"><b>FIG. 24</b></figref> depicts a schematic view of the second leadlet example shown in <figref idref="f0029"><b>FIG. 23</b></figref> after the leadlet exited the leadlet mover.</li><li><figref idref="f0030"><b>FIG. 25A</b></figref> depicts a schematic view of the second leadlet example in which the helical tip extends outside a sheath.</li><li><figref idref="f0030"><b>FIG. 25B</b></figref> depicts a schematic view of the leadlet body, shown in <figref idref="f0030"><b>FIG. 25A</b></figref><b>,</b> dropping outside of the groove or slot of a leadlet mover.</li><li><figref idref="f0030"><b>FIG. 25C</b></figref> depicts a schematic view of the leadlet body, shown in <figref idref="f0030"><b>FIG. 25B</b></figref><b>,</b> in which the leadlet body is counter-rotated around the leadlet mover.</li><li><figref idref="f0030"><b>FIG. 25D</b></figref> depicts a schematic view of the leadlet attaching tissue, shown in <figref idref="f0030">FIG. 25B</figref>, by rotating the helical tip.</li><li><figref idref="f0030"><b>FIG. 25E</b></figref> depicts a schematic view of the helical tip attached to the auger shown in <figref idref="f0030"><b>FIG. 25D</b></figref><b>.</b></li><li><figref idref="f0030"><b>FIG. 25F</b></figref> depicts a schematic view of the leadlet mover and delivery device being retracted while the leadlet remains fixated in position.</li><li><figref idref="f0030"><b>FIG. 25G</b></figref> depicts a schematic view of the leadlet mover and delivery device positioned in a more proximal position relative to <figref idref="f0030"><b>FIG. 25F</b></figref> while the leadlet remains fixated in position.</li><li><figref idref="f0030"><b>FIG. 25H</b></figref> depicts a schematic view of the leadlet mover and delivery device positioned in still a more proximal position relative to <figref idref="f0030"><b>FIG. 25G</b></figref> while the leadlet remains fixated in position.</li><li><figref idref="f0031"><b>FIG. 26A</b></figref> is a schematic view of a delivery device for placing a pacing device having active tines.</li><li><figref idref="f0031"><b>FIG. 26B</b></figref> is a schematic view of another active delivery device system.</li><li><figref idref="f0031"><b>FIG. 26C</b></figref> is a schematic view of another version of a delivery device.</li><li><figref idref="f0031"><b>FIG. 26D</b></figref> is a schematic view of a leadlet that loops back onto itself and pulled within the cup of a delivery device system.</li><li><figref idref="f0031"><b>FIG. 26E</b></figref> is a schematic view of yet another delivery device example.</li></ul>

SUMMARY

0004The invention provides system including a delivery device and a leadlet pacing device, as defined by independent claims 1 and 4. Embodiments, examples and aspects not falling under the scope of the claims do not form part of the invention. One or more examples are directed to using a delivery device and method for deploying a compact dual chamber intra-cardiac pacing device within the heart. The compact dual chamber intra-cardiac pacing device comprises a leadlet pacing device (LPD) and a leadlet. The intra-cardiac pacing device is loaded into the lumen at the distal end of the delivery device. Loading the intra-cardiac pacing device into the delivery device requires the leadlet to extend proximally from the LPD while the leadlet fixation means (i.e. helix) extends distally toward the LPD. The delivery device is then positioned in close proximity to ventricular tissue (e.g. right ventricle (RV). The user engages a LPD mover that contacts the proximal end or rear of the LPD and causes the LPD to move in the distal direction out of the delivery device. During or after the LPD exits the distal end of the delivery device, the tines of the LPD deploy and attach to ventricular tissue. After the LPD is secured to tissue through the tines, the delivery device may be moved to allow the leadlet to be in close proximity to atrial tissue. The leadlet is then advanced out of the distal end of the delivery device using a leadlet mover. The leadlet mover looks like a tuning fork with two prongs extending from a base. The two prongs are configured to engage and counter-rotate the leadlet free end (i.e. near the helical tip).

0005Counter-rotation causes the leadlet to wind around the leadlet mover thereby creating stress in the leadlet body. Once the helical tip contacts the atrial tissue, the leadlet is allowed to unwind and/or is rotated by the leadlet mover. Unwinding the leadlet causes the helical tip to attach to the atrial tissue while releasing stress in the leadlet body. The compact dual chamber intra-cardiac pacing device is electrically tested to determine whether the tissue sites adequately respond to the delivered pacing pulses. Once electrical testing is completed, the compact dual chamber intra-cardiac pacing device is considered fully deployed and the delivery device is removed from the heart.

0006One or more embodiments involve a lumenless T-shaped leadlet that is coupled to an atrial electrode. The T-shaped leadlet is configured to be pulled by a tether into a slotted tubular portion of the leadlet mover/torquer. The leadlet mover includes an open channel configured to receive the leadlet. The T-shaped leadlet folds back onto itself in a U-shape so that the leadlet does not interfere with LPD fixation of tines to tissue when the tines extend out of the delivery system device cup. The leadlet body makes a U-shape by folding back onto itself in the middle of the fork-shaped leadlet mover. The leadlet body folds back onto itself by a series of steps. For example, the leadlet mover/torquer is retracted into the device mover. The tether is pulled by the user, which in turn, pulls the leadlet into the device mover (i.e. coil) and folds the leadlet. The user continues pulling the tether so that the "T"-shaped end, located where the leadlet conductor turns 90 degrees, falls into a slot on the distal leadlet mover. The user continues pulling on the tether until the "T" in the lead conductor is seated at the proximal end of the slot.

0007One or more other embodiments involve a hooped leadlet. The hooped leadlet includes a ring that surrounds the leadlet body at the distal end. A space exists between the inner surface of the ring and the outer surface of the leadlet body to allow a tether to pass therethrough. The tether is used in conjunction with the delivery device to control movement of the leadlet from a first position to a second position.

0008One or more examples are directed to a compact implantable medical device having leadlet fixation component (e.g. helix, tines etc.) and/or LPD fixation component (e.g. helix, tines etc.) that can be electrically active or not electrically active.

DETAILED DESCRIPTION

0009The following detailed description is exemplary in nature and is not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the following description provides practical examples, and those skilled in the art will recognize that some of the examples may have suitable alternatives. In the following, exemplary dimensions modified with "about" can be interpreted as being ± 10% a designated value.

0010<figref idref="f0001 f0002 f0003 f0004"><b>FIGS. 1-2</b></figref> illustrate compact dual chamber intra-cardiac pacing device 8 that is configured to perform dual chamber intra-cardiac pacing. Compact dual chamber intra-cardiac pacing device <b>8</b> comprises a first implanted portion <b>88</b> in a right ventricle (RV) of a heart, in proximity to an apex, and a second implanted portion <b>86</b> in a right atrium (RA) of the heart, within or around atrial appendage <b>38.</b> First implanted portion <b>88 can</b> be leadlet pacing device (LPD) <b>10</b> that employs tines <b>12</b> to attach to ventricular tissue while second implanted portion <b>86</b> comprises leadlet 20that attaches to atrial tissue through helical tip <b>21.</b> Leadlet <b>20</b> connects first portion <b>88</b> to second portion <b>86.</b> LPD <b>10</b> can generate different or the same pacing pulses to first and second portions <b>86, 88.</b>

0011<figref idref="f0002"><b>FIG. 2A</b></figref> is a plan view of a relatively compact dual chamber intra-cardiac pacing device <b>8</b> implanted in a heart of a patient. The LPD <b>10,</b> commercially available as MICRA^™, a leadless pacing device manufactured by Medtronic, INC. located in Minneapolis, MN, that can be employed for the present disclosure. LPD <b>10,</b> hermetically sealed in housing <b>14,</b> is configured to deliver pacing pulses through electrodes 16/18 and/or leadlet <b>20.</b> An exemplary LPD <b>10</b> and tines <b>12,</b> may be seen and described in greater detail with respect to U.S. Patent Pregrant Publication No. <patcit id="pcit0012" dnum="US20120172690A1"><text>US-2012-0172690-A1</text></patcit>, and Patent Application Serial No. <patcit id="pcit0013" dnum="US62281312B"><text>62/281,312 filed January 21, 2016</text></patcit>. LPD <b>10</b> is configured to pace cardiac tissue using different pacing modes such as DDD mode or VDD mode. DDD is part of the three-position NBG Pacemaker Code. The pacemaker device DDD code indicates that the implantable medical device provides dual chamber pacing, dual chamber sensing, and both triggered and inhibited modes of response (atrial triggered and ventricular inhibited). The DDD mode can be implemented by using the anode ring <b>180</b> and helical electrode <b>21</b> shown in <figref idref="f0017"><b>FIG. 11</b></figref><b>.</b> VDD mode indicates ventricular chamber pacing, dual chamber sensing, and both triggered and inhibited modes of response (atrial triggered and ventricular inhibited).

0012LPD <b>10</b> is preferably formed from a biocompatible and biostable metal such as titanium, which contains a pulse generator (e.g., a power source and an electronic controller - not shown), a plurality of fixation tines <b>12,</b> collar <b>168,</b> and electrodes <b>16, 18,</b> for example, being coupled to the pulse generator by a conductor of an hermetic feedthrough assembly (not shown) that is constructed according to methods known to those skilled in the art of implantable medical devices. Delivery tool interface <b>88</b> and/or collar <b>168</b> are configured to be coupled by the delivery tool during retrieval. Housing <b>14</b> may be overlaid with an insulative layer, for example, medical grade polyurethane, parylene, or silicone. Electrode <b>18,</b> shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>,</b> may be formed by removing a portion of the insulative layer to expose the metallic surface of housing <b>14.</b> According to the illustrated embodiment, electrode <b>16,</b> shown in <figref idref="f0001 f0002 f0003 f0004"><b>FIGS. 1-2</b></figref><b>,</b><figref idref="f0008"><b>FIG. 4A</b></figref> and <figref idref="f0011"><b>FIG. 6</b></figref><b>,</b> and electrode <b>18</b> can be configured to perform bipolar pacing and/or sensing. Bipolar pacing involves optimal low thresholds to ensure long-term pace energy conduction and increased pacing device <b>10</b> longevity. Bipolar sensing electrodes can be tip-to-ring (i.e. helix <b>21</b> and ring <b>180</b> shown in <figref idref="f0017 f0018"><b>FIGS. 11-12</b></figref>) that is selected to optimize detection of both R-waves and arrhythmias as well as rejection of t-waves.

0013A first example leadlet <b>20,</b> referred to as the T-shaped leadlet, is shown in <figref idref="f0004"><b>FIGS. 2C</b></figref> and <figref idref="f0008 f0009"><b>FIGS. 4</b></figref><b>-7.</b> Leadlet <b>20</b> comprises a body <b>23,</b> eyelet tether <b>52,</b> junction <b>158,</b> the helix <b>21,</b> a T-shaped distal end <b>76,</b> and a leadlet guide <b>170,</b> each of which is described below.

0014The leadlet body <b>23</b> is shown to extend the length of leadlet <b>20</b> in <figref idref="f0011"><b>FIG. 6</b></figref> and then breaks away from short bar <b>72</b> (i.e. about 90 degrees away from the length of the leadlet <b>20</b>). The body <b>23</b> can comprise a single electrical conductor <b>19</b> (<figref idref="f0004"><b>FIG. 2C</b></figref> also referred to as a cable), without a lumen, that connects with helix <b>21</b> for delivery of electrical stimulation. Medtronic model SELECTSURE^™ 3830 manual (2013), shows and describes an exemplary lead body <b>23</b> that can be employed for leadlet <b>20.</b> Two or more conductors with or without lumens can also be used to form a leadlet of the present disclosure. An elongated conductor <b>19</b> of leadlet <b>20,</b> which extends through another hermetic feedthrough assembly (not shown), and within an insulative tubular member of leadlet <b>20 (</b><figref idref="f0011"><b>FIG. 6</b></figref><b>),</b> electrically couples the aforementioned pulse generator (contained within housing <b>14</b>) to the helix <b>21.</b> The conductor may be formed by one or more electrically conductive wires, for example, MP35N alloy known to those skilled in the art, in a coiled or cabled configuration, and insulative tubular member may be any suitable medical grade polymer, for example, polyurethane, silicone rubber, or a blend thereof. According to an exemplary embodiment, flexible leadlet body <b>20,</b> extends a pre-specified length (e.g. 10 cm to 20cm, or 15cm to 20cm) from a proximal end of housing <b>14</b> to the other end. The leadlet body is less than 2.33mm (7 French (Fr)) but typically in the range of 1mm to 1.33mm (3 to 4 FR) in size. In one or more embodiments, 0.67 to 1mm (2 to 3 FR) size leadlet body is employed.

0015Eyelet tether <b>52,</b> coupled to tether <b>50,</b> are pre-loaded onto leadlet <b>20,</b> as shown in <figref idref="f0005 f0006 f0007"><b>FIGS. 3A-3C</b></figref><figref idref="f0011 f0012"><b>FIGS. 6-7</b></figref><b>,</b><figref idref="f0014 f0015"><b>FIGS. 9A-9B</b></figref> and <figref idref="f0018"><b>FIG. 12</b></figref><b>.</b> Eyelet tether <b>52,</b> coupled to tether <b>50</b> allow the leadlet <b>20</b> to be moved from one tissue site to another tissue site. Once the leadlet <b>20</b> has been implanted, the physician can cut one of the legs of tether <b>50</b> and pulls it out to remove.

0016Junction <b>158,</b> shown in <figref idref="f0010"><b>FIG. 5</b></figref><b>,</b> ensures that the helix <b>21</b> is securely and stably attached to the conductor. Junction <b>158</b> is located between the helix <b>21</b> and conductor of the leadlet <b>20.</b> Junction <b>158</b> includes a lumen (not shown) for receiving the leadlet <b>20</b> to attach to helix <b>21,</b> which can serve as an electrode for sensing and/or pacing.

0017Leadlet <b>20</b> comprises a T-shaped distal end <b>76</b> as shown in <figref idref="f0010"><b>FIG. 5</b></figref> that allows the user to spin or turn leadlet through the leadlet mover <b>60</b> configured as a slotted tube and described in greater detail below relative to <figref idref="f0013"><b>FIG. 8</b></figref><b>.</b> T-shaped distal end <b>76</b> comprises short bar <b>72</b> and an elongated portion <b>75.</b> The short bar <b>72 (</b><figref idref="f0010"><b>FIG. 5</b></figref><b>)</b> includes the tether <b>52</b> to allow the tether <b>52</b> to be anchored in or near the junction <b>158</b> and generally minimize forces on the lead body 23 at the tether attachment point. It is used during moving of leadlet <b>20</b> into, for example, a lumen of the leadlet mover <b>60</b> to position the leadlet <b>20</b> near cardiac tissue.

0018As shown in <figref idref="f0010"><b>FIGS. 5</b></figref> and <figref idref="f0012"><b>7</b></figref><b>,</b> leadlet guide <b>170</b> is used as a "bumper" to position and/or prevent damage from occurring to the leadlet <b>20</b> as leadlet <b>20</b> is moved into a distal end <b>61</b> of the leadlet mover <b>60.</b> By moving leadlet <b>20</b> into the leadlet mover <b>60 (</b><figref idref="f0013"><b>FIG. 8</b></figref><b>),</b> leadlet <b>20</b> can be moved from one tissue site that may not be electrically responsive to delivered electrical paces to another tissue site that achieves improved responsiveness to attach the leadlet <b>20.</b> Leadlet <b>20</b> is removed from one tissue location by unscrewing helix <b>21</b> from the tissue by leadlet <b>20,</b> disposed in one of the slots <b>66</b> of the leadlet mover <b>60.</b> By leadlet being located in one of the slots <b>66,</b> the leadlet mover 60 can be positioned to torque leadlet <b>20</b> in order to rotate (e.g. screw-in or unscrew) the helix <b>21</b> from tissue by using an exemplary tether/snare configuration <b>(</b><figref idref="f0005 f0006 f0007"><b>FIGS. 3A-3C</b></figref><b>).</b> The tether/snare configuration can be used to tightly grab the leadlet body <b>23</b> to control (rotate/extend) and fixate the leadlet. Leadlet retrieval generally involves reversing the steps relative to <figref idref="f0017 f0018"><b>FIGS. 11-12</b></figref><b>.</b> Leadlet guide <b>170</b> is gum-dropped shaped in which one end <b>174</b> has a larger diameter (e.g. 1.65 mm (0.65 in), 0.051 in or other suitable dimensions) compared to a smaller diameter (e.g. 1.25 mm) on the other end <b>176</b> as shown in <figref idref="f0012"><b>FIG. 7</b></figref><b>.</b> The rounded, smaller diameter end <b>176</b> passes or enters between the inner surfaces of the forks <b>64</b> of leadlet mover <b>60</b> before the larger diameter end <b>174</b> passes between the inner surfaces of the forks <b>64.</b> By pulling the smaller diameter end <b>176</b> passes or enters between the inner surfaces of the forks <b>64</b> of leadlet mover <b>60</b> before the larger diameter end <b>174,</b> the leadlet guide <b>170</b> positions the leadlet <b>20</b> into the leadlet mover <b>60</b> thereby reducing the chances of the leadlet <b>20</b> being damaged. The diameter between the inner surface of the forks <b>64</b> is about 1.83 mm. By having the smaller diameter end <b>176</b> enter the forks <b>64</b> of leadlet mover <b>60,</b> leadlet guide <b>170</b> gradually centers and guides the leadlet <b>20</b> into the leadlet mover <b>60.</b> Optionally, tether knot <b>166</b> provides support and tightness to tether <b>52.</b>

0019Leadlet mover <b>60,</b> shaped like a tuning fork or slotted tube, comprises forks <b>64</b> or prongs, base <b>67,</b> and coil <b>62.</b> Forks <b>64</b> or prongs of the leadlet mover <b>60,</b> located at the distal end <b>61</b> of the leadlet mover <b>60,</b> extend from base <b>67</b> and coil <b>62,</b> as shown in <figref idref="f0004"><b>FIG. 2C</b></figref> and <figref idref="f0012"><b>FIGS. 7</b></figref><b>-8.</b> Leadlet mover <b>60</b> is preferably formed from a single piece but can be formed from multiple pieces of material (e.g. stainless steel). Leadlet mover <b>60</b> comprises and elongated tubular element formed by forks <b>64,</b> coil <b>62</b> and substantially straight wire <b>65.</b> First and second slots <b>66,</b> formed by first and second prongs associated with the leadlet mover <b>60,</b> are diametrically opposed from each other. Forks <b>64</b> are welded or crimped onto a coil <b>62.</b> The coil <b>62</b> has a length (e.g. 20-22cm) that forms into a straight or substantially straight wire <b>65</b> and exits through proximal port <b>94b.</b> The distal end of leadlet mover is hollow (e.g. 4 inches from the distal end) and is solid from the coil to proximal end of leadlet mover <b>60.</b>

0020The leadlet <b>20</b> is guided into the tapered <b>172</b> (optional) of prongs <b>64</b> when the user pulls on a tether to reload the leadlet <b>20</b> into leadlet mover <b>60.</b> Once the leadlet <b>20</b> snaps into position by contacting proximal end <b>71</b> of slot <b>66</b> located near proximal end <b>69</b> of the prong pocket shown in <figref idref="f0013"><b>FIG. 8</b></figref><b>,</b> the leadlet <b>20</b> is considered loaded into the leadlet mover <b>60</b> and can be moved to another tissue site.

0021After the ventricular portion <b>88</b> of the compact device <b>8</b> is deployed out through a distal opening <b>36</b> of a delivery device <b>26</b> (also referred to as a delivery tool), the atrial portion <b>86</b> is deployed. <figref idref="f0001"><b>FIG. 1</b></figref><b>,</b><figref idref="f0002"><b>FIG. 2A</b></figref> and <figref idref="f0003"><b>FIG. 2B</b></figref> show atrial portion <b>86</b> of compact dual chamber intra-cardiac pacing device <b>8</b> implanted in RA, according to one or more embodiments. A portion of the right atrial wall, for example, in appendage <b>38 (</b><figref idref="f0001"><b>FIG. 1</b></figref><b>),</b> has a laminate structure that includes an inner layer of pectinate muscle (PM) and an outer layer of visceral pericardium (VP), which forms the epicardial surface. Atrial portion <b>86</b> is secured at the implant site by fixation means <b>21</b> (e.g. helix, tines etc.) penetrating through the layer of PM without perforating through the VP and causing pericardial effusion. According to one or more embodiments, the leadlet <b>20</b> unfolds when the leadlet mover/torquer <b>60</b> is extended beyond the device mover <b>39</b> formed by intermediate member <b>32</b> and coiled distal end <b>43</b> shown in <figref idref="f0008"><b>FIG. 4A</b></figref> and <figref idref="f0013"><b>FIG. 8</b></figref><b>.</b>

0022Skilled artisans understand that device mover <b>39</b> can be preferably configured such that outer member <b>34</b> retracts thereby causing LPD <b>10</b> to exit delivery device <b>26.</b> Suitable construction detail for such an exemplary delivery device <b>26</b> is described in commonly assigned <patcit id="pcit0014" dnum="US9526522B"><text>U.S. Patent No. 9,526,522 issued December 27, 2016</text></patcit>. Another exemplary device mover <b>39</b> can be configured such that outer member <b>34</b> can be configured to push at the proximal end <b>45</b> of LPD <b>10</b> described in <patcit id="pcit0015" dnum="US9414857B2"><text>U.S. Patent No. 9,414,857 B2 issued August 16, 2016</text></patcit>. Either way for delivering the LPD <b>10</b> can be employed by the present disclosure.

0023The helical tip <b>21</b> is configured to have a certain pitch that penetrates the PM without perforating the VP. Preferably, helix <b>21</b> comprises a right handed pitch, shown in <figref idref="f0020"><b>FIG. 14</b></figref><b>.</b> Other exemplary helix <b>21</b> that may be used is disclosed in <patcit id="pcit0016" dnum="US8755909B2"><text>US Patent No. 8,755,909 B2 issued Jan. 17, 2014</text></patcit>, and assigned to the assignee of the present invention.

0024Referring to <figref idref="f0007 f0008 f0009 f0010 f0011 f0012"><b>FIGS. 3-7</b></figref><b>,</b><figref idref="f0014 f0015"><b>FIG. 9</b></figref> and <figref idref="f0017"><b>FIG. 11</b></figref><b>,</b> delivery device <b>26</b> is shown and described in greater detail relative to the steps of implanting the atrial portion <b>86</b> of device <b>8,</b> which is after the user has deployed ventricular portion <b>88</b> of the device <b>8</b> in the RV. Delivery device <b>26</b> comprises proximal end <b>31,</b> distal end <b>30</b> with a lumen <b>47</b> therethrough, as shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b> Delivery device <b>26</b> functionally includes a device mover <b>39</b> (shown in <figref idref="f0008"><b>FIG. 4A</b></figref>), a leadlet mover <b>60/65</b> and handle <b>58</b> shown in <figref idref="f0014 f0015"><b>FIGS. 9A-9B</b></figref><b>.</b>

0025Device mover <b>39</b> comprises intermediate member <b>32</b> and a coiled distal end <b>43.</b> Conceptually, the outer member <b>34,</b> intermediate member <b>32,</b> and leadlet mover <b>60/65</b> are similar to three stacked tubes, as is shown in <figref idref="f0008 f0009"><b>FIG. 4</b></figref><b>,</b><figref idref="f0013"><b>FIG. 8</b></figref> and <figref idref="f0017"><b>FIGS. 11</b></figref><b>-12.</b> As previously stated, device mover <b>39</b> can be configured so that retracting outer member <b>34</b> causes LPD <b>10</b> to exit out of the distal end <b>30</b> of the delivery device <b>26</b> in response to the user engaging button <b>85</b> as is shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b> Button <b>84</b> causes deflection and curve in <figref idref="f0014 f0015"><b>FIG. 9</b></figref><b>.</b>

0026Outer member <b>34</b> defines an outer shaft or tube of the delivery device <b>26</b> and holds intermediate member <b>32.</b> Outer member <b>34</b> is an outer tube extending from the proximal end at handle <b>58</b> to the distal tip and forms a lumen (not shown) in which intermediate member <b>32</b> resides.

0027Intermediate member <b>32</b> of device mover <b>39</b> is configured to hold leadlet mover <b>60</b> in position. Intermediate member <b>32</b> comprises a coiled distal end <b>43</b> shown in <figref idref="f0008"><b>FIG. 4A</b></figref> and a shaft <b>32.</b> Intermediate member <b>32</b> extends from the handle <b>58</b> to the coiled distal end <b>43</b> and forms a lumen <b>47</b> to support LPD <b>10</b> and contain leadlet <b>20</b> during delivery of LPD <b>10</b> and leadlet <b>20</b> to ventricular and atrial tissues.

0028Intermediate member <b>32</b> can also include a pull wire assembly (not shown) integrated therein. The pull wire assembly may be coupled to a control member similar <b>84</b> and/or <b>85</b> of handle <b>58</b> that causes intermediate member <b>32</b> to bend along distal portions thereof. A length of outer member <b>34,</b> between handle <b>58</b> and distal opening <b>36,</b> when outer member <b>34</b> is in the position shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>,</b> may be about 110 cm, for example, to reach into the right ventricle (RV) from the femoral access site.

0029Prior to loading compact device <b>8</b> into delivery device <b>26,</b> atrial portion <b>86</b> is reoriented relative to ventricular portion <b>88</b> by bending and/or folding leadlet <b>20</b> as shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b> To load device <b>8</b> into delivery device <b>26,</b> the user may employ a tether <b>50</b> of delivery device <b>26 (</b><figref idref="f0009"><b>FIG. 4B</b></figref><b>)</b> engaged to tether <b>52</b> at a zone <b>124 (</b><figref idref="f0012"><b>FIG. 7</b></figref><b>)</b> that coincides with folding first and second segments <b>4-1</b> and <b>4-2</b> shown relative to <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b> According to the illustrated embodiment, opposing lengths of tether <b>50</b> extend within lumen <b>46</b> of intermediate member <b>32</b> so that tether <b>50</b> loops around leadlet <b>20</b> for engagement therewith, and proximal ends <b>50</b> of the tether lengths protrude from a proximal port opening <b>94b (</b><figref idref="f0014"><b>FIG. 9A</b></figref><b>)</b> of delivery tool <b>26,</b> where an user may grasp them. The user may pull proximal ends of tether <b>50,</b> to draw folded segment <b>4-2</b> of leadlet <b>20</b> in through a distal opening of lumen <b>28,</b> followed by atrial portion <b>86,</b> and then followed by ventricular portion <b>88.</b> Ventricular portion <b>88</b> is loaded last into device <b>26</b> so that ventricular portion <b>88</b> can be first delivered to ventricular tissue followed by delivery of the atrial portion <b>86.</b>

0030The T-shaped leadlet <b>20</b> folds back onto itself in a U-shape configuration partially shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b> The U-shape configuration of the leadlet <b>20</b> does not interfere with LPD <b>10</b> fixation of tines <b>12</b> to tissue when the tines <b>12</b> extend out of the delivery system device cup <b>44</b> or tubular sidewall that holds LPD <b>10</b> in position. Device cup <b>44</b> defines a distal portion of outer member lumen <b>28.</b><figref idref="f0026"><b>FIG. 20</b></figref> shows the U-shape configuration more clearly with respect to the hooped leadlet <b>300</b> example but skilled artisans should be able to appreciate that the same or similar U-shape configuration will apply to the T-shaped leadlet example Referring back to <figref idref="f0008"><b>FIG. 4A</b></figref><b>,</b> the leadlet body <b>23</b> makes a U-shape configuration by folding a first segment <b>4-1</b> back onto itself of second segment <b>4-2</b> in the middle of the fork <b>64</b> shaped leadlet mover <b>60.</b> The leadlet body <b>23</b> folds back onto itself by a series of steps. For example, the leadlet mover and/or torquer <b>60</b> is retracted into the device mover <b>39</b> shown in <figref idref="f0008"><b>FIG. 4A</b></figref><b>.</b> The tether <b>50</b> is pulled by the user, which in turn, pulls the leadlet <b>20</b> into the device mover (i.e. coil) and folds the leadlet <b>20.</b> The user continues pulling the tether <b>50</b> so that the "T"-shaped distal end <b>76,</b> located where the lead conductor turns 90 degrees shown in <figref idref="f0010"><b>FIG. 5</b></figref><b>,</b> falls into a slot <b>66 (</b><figref idref="f0013"><b>FIGS. 8A-8B</b></figref><b>)</b> on the distal end <b>61</b> of the leadlet mover <b>60.</b> The user continues pulling until the "T" in the lead conductor is seated at the proximal end <b>69</b> of the slot <b>66</b> shown in <figref idref="f0013"><b>FIG. 8A</b></figref><b>.</b>

0031Referring to <figref idref="f0004"><b>FIG. 2C</b></figref> and <figref idref="f0012"><b>FIGS. 7</b></figref><b>-8,</b> a leadlet mover <b>60/65</b> is preferably formed from a single piece but can be formed from multiple pieces of material (e.g. stainless steel). Leadlet mover <b>60</b> comprises tubular-like element formed by forks <b>64,</b> coil <b>65</b> and substantially straight wire <b>65.</b> Forks <b>64</b> are shaped like a tuning fork <b>63</b> with first and second prongs <b>64</b> extending from a base <b>67.</b> First and second slots <b>66,</b> formed by first and second forks <b>64</b> or prongs associated with the leadlet mover <b>60,</b> are diametrically opposed <b>(</b><figref idref="f0013"><b>FIG. 8B</b></figref><b>)</b> from each other. Forks <b>64</b> are welded or crimped onto a coil <b>62</b> shown in <figref idref="f0013"><b>FIG. 8A</b></figref><b>.</b> The coil <b>62</b> has a length (e.g. 20-22cm) that forms into a straight or substantially straight wire <b>65</b> and exits through proximal port <b>94b.</b>

0032A loop can be formed from tether <b>50,</b> as is shown in <figref idref="f0012"><b>FIG. 7</b></figref> in order to attach to eyelet <b>52</b> to pull leadlet <b>20.</b> The tether <b>50,</b> shown in <figref idref="f0008 f0009"><b>FIG. 4</b></figref><b>,</b> extends through a lumen or opening between the forks <b>64</b> out of the coil <b>62.</b> The tether then travels all the way through the device mover <b>39</b> and exits from port <b>94b,</b> as shown in <figref idref="f0014"><b>FIG. 9A</b></figref><b>.</b> In an alternate embodiment, the tether <b>50</b> exits delivery tool <b>26</b> through port <b>94a</b> as shown in <figref idref="f0015"><b>FIG. 9B</b></figref><b>.</b> Here, the tether takes a path through a side port <b>68</b> in the device mover and runs alongside the inside of the deflectable outer shaft before exiting the delivery tool.

0033The eyelet tether <b>52</b> is located along the distal end <b>76</b> of the leadlet, which runs along a portion of the T-shape distal end <b>76 (</b><figref idref="f0010 f0011"><b>FIGS. 5-6</b></figref><b>).</b>

0034<figref idref="f0016"><b>FIG. 10</b></figref> is a flow diagram of method <b>200</b> related to attaching a leadlet to atrial appendage tissue as shown and described relative to <figref idref="f0017 f0018"><b>FIGS. 11-12</b></figref><b>.</b> Exemplary leadlets that can be employed herein include leadlet <b>20</b> and leadlet <b>300</b> described below; however, it should be appreciated that other leadlet designs may also be able to be used.

0035Before implementing method <b>200,</b> as previously discussed, LPD <b>10</b> is attached to cardiac tissue such as the left and/or the right ventricular tissue. For example, one or more LPD <b>10</b> can be placed in the left ventricle, the right ventricle or both ventricles. As previously stated, ventricular portion <b>88</b> is typically deployed by advancing the delivery device <b>26</b> through a venous system of the patient, for example, from a femoral venous access site and up through an inferior vena cava (IVC) of the patient into RA and across the tricuspid valve into right ventricle RV, until a distal end <b>30</b> of delivery device <b>26</b> abuts the target implant site. With distal end <b>30</b> abutting the implant site, the user applies a push force through delivery device <b>26</b> while retracting outer member <b>34</b> to release fixation tines <b>12</b> of ventricular portion <b>88</b> out through distal opening <b>36 (</b><figref idref="f0008"><b>FIG. 4A</b></figref><b>)</b> for engagement with tissue at the implant site. The user checks the electrical response to delivered paces to the ventricular tissue. If the response is determined to effectively capture tissue, the user proceeds to position deliver device <b>26</b> such that the distal opening <b>36</b> of outer member <b>34</b> shown in <figref idref="f0006"><b>FIG. 3B</b></figref> is directed into an atrium.

0036At block <b>202,</b> the leadlet helix <b>21</b> is deployed. In particular, the leadlet helix <b>21</b> is moved distally until it extends out of the leadlet mover <b>60</b> from delivery device <b>26.</b> At block <b>204,</b> a part of the leadlet body <b>23</b> is positioned into one side of the groove or slot <b>66.</b> The helix <b>21</b> is centered within the forks <b>64</b> so that leadlet <b>20</b> is locked into position in leadlet mover <b>60</b> shown in <figref idref="f0013"><b>FIG. 8A</b></figref><b>.</b> The user may be able to feel or hear leadlet <b>20</b> contact proximal end <b>71</b> of leadlet mover <b>60.</b> Once leadlet <b>20</b> is substantially or actually locked into position, leadlet <b>20</b> can be torqued by the leadlet mover <b>60.</b> Leadlet <b>20</b> is torqued by counter-rotating leadlet <b>20</b> around the leadlet mover <b>60</b> as shown in <figref idref="f0017"><b>FIG. 11</b></figref><b>.</b> Counter-rotation of leadlet <b>20</b> occurs by moving, in a counter clockwise motion, the free end near helix <b>21</b> of the leadlet <b>20.</b> Counter-rotation of leadlet <b>20</b> causes the leadlet <b>20</b> to wrap or twist around the leadlet mover <b>60</b> so that the leadlet <b>20</b> and the leadlet mover <b>60</b> look like a red-striped barber pole or candy cane. The leadlet <b>20</b> is rotated a number of times around the leadlet mover <b>60.</b> For example, the leadlet <b>60</b> can be counter-rotated up to three or four times. The leadlet and leadlet mover are then deemed to be in a counter-rotated state. Counter-rotated means the leadlet is rotated in a counter clockwise direction.

0037At block <b>206,</b> the leadlet <b>20</b> is moved or advanced to the atrial wall. For example, the device mover <b>39</b> is located between points <b>42a,b</b> while leadlet mover <b>60</b> advances from point <b>42</b> to point <b>60a.</b> The user can place the helix <b>21</b> directly onto atrial tissue. For example, the user can place the helix <b>21</b> onto atrial tissue near or at atrial appendage <b>38</b> such that helix <b>21</b> abuts against pectinate muscle (PM).

0038At block <b>208,</b> the leadlet <b>20</b> is rotated by the leadlet mover <b>60.</b> The rotation of the leadlet <b>20</b> causes the helical tip <b>21</b> to gradually attach to tissue thereby fixating the helical tip <b>21</b> to the atrial wall. Under fluoroscopy, the user can view through the programmer user interface the unwinding of the leadlet <b>20.</b> Unwinding of the leadlet indicates that a rotation has occurred. Once the leadlet <b>20</b> is unwound, the helix <b>21</b> is attached to the wall. The helix <b>21</b> can be further rotated in a clockwise direction by the user rotating control member <b>9.</b>

0039<figref idref="f0018"><b>FIG. 12</b></figref> shows retraction of the leadlet mover <b>60</b> and device mover <b>39</b> to perform a tug test to determine effectiveness of the physical attachment between the helix <b>21</b> and atrial tissue. Electrical testing is also performed to determine the electrical stimulation through the conductor of leadlet <b>20</b> to the helix <b>21</b> captures the tissue. If the electrical stimulation is sufficient, the tether is removed or loosened at block <b>210.</b> The tether is loosened by opening the Tuohy-Borst valve <b>95 (</b><figref idref="f0014 f0015"><b>FIGS. 9A-9B</b></figref><b>)</b> thereby opening port <b>94b.</b> Tuohy-Borst valve <b>95</b> is located near luer lock <b>39</b> and flush line <b>97.</b> At block <b>212,</b> the delivery device <b>26</b> retraces its movement to exit the heart.

0040Method <b>200</b> is different compared to conventional methods that torque leadlets. For example, counter-rotation to wind leadlet <b>20</b> followed by rotating the leadlet <b>20</b> to unwind the leadlet <b>20</b> in order to attach helix <b>21</b> to atrial appendage tissue is the complete opposite of the steps employed by conventional Medtronic, Inc. helical leads. For example, Medtronic, Inc. helical leads typically are wound by rotating of the leadlet body or lead mover member followed by counter-rotation of the leadlet body to relieve any residual torque to attach the lead to tissue.

0041Referring to <figref idref="f0019 f0020 f0021 f0022 f0023 f0024 f0025 f0026 f0027 f0028 f0029 f0030"><b>FIGS. 13-25</b></figref><b>,</b> a second leadlet example <b>300</b> is disclosed that can be used in cooperation with delivery device <b>26</b> to deliver the LPD <b>10</b> to a first tissue site (e.g. ventricular tissue) and then deliver the leadlet <b>300</b> to a second tissue site (e.g. atrial tissue) using method <b>200.</b> The second leadlet <b>300</b> example comprises a leadlet body <b>23,</b> a sleeve head <b>304</b> to connect the leadlet body <b>23 (</b><figref idref="f0020"><b>FIG. 14</b></figref><b>),</b> a core <b>325</b> that connects the conductor <b>19</b> to a fixation component (e.g. helix <b>21</b> etc.), coil <b>322</b> (providing mechanical support) and a ring <b>302</b> around the leadlet body <b>23.</b> The sleeve head <b>304</b> is configured to connect with leadlet body <b>20.</b> Sleeve head <b>304</b> extends a length of about 3 mm and has a diameter of about 1.65 mm that is slightly greater than the lead body <b>20</b> to allow the tip to center in the forks of the leadlet mover <b>60.</b> The bendltaper <b>334</b> of the sleeve head <b>304</b> forces the leadlet body <b>23</b> to enter the forks <b>64</b> of leadlet mover <b>60</b> or cup, formed by forks <b>64,</b> while the user pulls on the tethers to pull ring <b>302</b> into the lumen. While entering the cup in region 20-1 and 20-2 of <figref idref="f0026"><b>FIG. 20</b></figref> of the leadlet mover <b>60,</b> the sleeve head <b>304</b> serves as a "bumper" that may contact the inner diameter <b>340</b> of the cup formed by forks <b>64</b> while positioning the leadlet <b>300</b> therein. Referring to <figref idref="f0027"><b>FIG. 21</b></figref><b>,</b> only the leadlet head <b>350,</b> starting at proximal position 20-3 of head <b>350</b> fits between the inner surfaces of forks <b>64.</b><figref idref="f0026 f0027"><b>FIGS 20-21</b></figref> depict leadlet <b>300</b> disposed in deliver device <b>26.</b>

0042The ring <b>302</b> is configured to provide sufficient space between the lead body <b>20</b> and the inner diameter of ring <b>302</b> to allow a tether <b>306</b> to loop therebetween. The ring <b>302</b> and tether <b>306</b> functions in a similar way as a nose ring in a bull. Just as the nose ring can be used to pull and control the bull, the ring <b>302</b> and tether <b>50</b> control movement of the leadlet <b>300.</b> The tether <b>306</b> is about 180 degrees from sleeve head bend <b>334</b> for orienting the leadlet <b>300</b> to move the leadlet <b>300</b> into the delivery device <b>26.</b> Sleeve head <b>304</b> is connected to leadlet body <b>20.</b> Referring to <figref idref="f0025"><b>FIG. 19</b></figref><b>,</b> at the distal end of leadlet body <b>20</b> includes a flexible section <b>332</b> that allows the leadlet body <b>20</b> to bend. Flexible section <b>332</b> is configured to bend or move after the tether has been attached to the ring <b>302.</b> Ring <b>302</b> can comprise a non-conductive polymer or a conductive metal which can double as an electrode (i.e. sense ring) that is coupled to a conductor in the leadlet body.

0043The leadlet <b>300,</b> positioned near the distal end of the delivery device <b>26,</b> as shown in <figref idref="f0026 f0027 f0028 f0029"><b>FIGS. 20-24</b></figref><b>,</b> is pulled through the distal opening <b>36</b> and into the lumen of delivery device <b>26</b> until the ring <b>302</b> is seated at shelf <b>332</b> of delivery device <b>26.</b> After the user has been able to pull ring <b>302</b> near to shelf <b>332,</b> first portion <b>20-1</b> is folded over second portion <b>20-2</b> of leadlet body 20 in a U-shape configuration shown in <figref idref="f0026"><b>FIG. 20</b></figref><b>.</b>

0044<figref idref="f0030"><b>FIGS. 25A-25H</b></figref> depicts details between leadlet <b>300</b> attaching tissue <figref idref="f0030"><b>FIG. 25A</b></figref> includes leadlet <b>300</b> in which the helical tip <b>21</b> extends from the leadlet mover (also referred to as a sheath). In one or more embodiments shown in <figref idref="f0030"><b>FIGS. 25E-25H</b></figref> the leadlet mover coil (described earlier) is replaced with a polymer tube. In this case, the tubing incorporates a radiopaque additive to help the physician see the tubing location.. <figref idref="f0030"><b>FIG. 25B</b></figref> depicts the leadlet body <b>20</b> dropping outside the groove or slot <b>66</b> (shown <figref idref="f0013"><b>FIGS. 8A-8B</b></figref><b>)</b> of the leadlet mover <b>60.</b><figref idref="f0030"><b>FIG. 25C</b></figref> shows the leadlet body <b>20</b> counter-rotated around the leadlet mover <b>60.</b> The leadlet body <b>20</b> is typically counter-rotated three or four times around the leadlet mover <b>60.</b><figref idref="f0030"><b>FIG. 25D</b></figref> shows leadlet <b>300</b> attaching to auger by rotating the helical tip <b>21.</b><figref idref="f0030"><b>FIG. 25E</b></figref> is shows the helical tip <b>21</b> is attached to tissue. <figref idref="f0030"><b>FIG. 25F</b></figref> depicts the leadlet mover <b>60</b> and delivery device <b>26</b> being retracted while leadlet <b>300</b> remains fixated in position. <figref idref="f0030"><b>FIG. 25G</b></figref> depicts the leadlet mover <b>60</b> and delivery device <b>26</b> positioned in a more proximal position relative to <figref idref="f0030"><b>FIG. 25F</b></figref> while leadlet <b>300</b> remains fixated in position. <figref idref="f0030"><b>FIG. 25H</b></figref> depicts the leadlet mover <b>60</b> and delivery device <b>26</b> positioned in still a more proximal position relative to <figref idref="f0030"><b>FIG. 25G</b></figref> while leadlet <b>300</b> remains fixated in position. Leadlet 300 would be in its relaxed or more natural state if the lead body in <figref idref="f0029"><b>FIG 24</b></figref><b>,</b> or <figref idref="f0030"><b>25F</b></figref> or <b>25G</b> was more straight.

0045<figref idref="f0031"><b>FIGS. 26A-26E</b></figref> depict numerous leadlet delivery device systems that may be used to attach leadlet <b>20</b> to cardiac tissue (e.g. atrial tissue) using method <b>200</b> incorporated herein. Each embodiment in <figref idref="f0031"><b>FIGS. 26A-26E</b></figref> can be configured to operate in the same fashion as outlined in method <b>200</b> except as described below. <figref idref="f0031"><b>FIG. 26A</b></figref> depicts a delivery system <b>400</b> that comprises pacing device <b>10,</b> delivery element <b>404,</b> tether <b>402</b> extending from delivery element <b>404,</b> leadlet <b>20</b> with an active helix <b>21.</b> Delivery element <b>404</b> and tether <b>402</b> are pre-loaded to loop around leadlet <b>20.</b> Once leadlet <b>20</b> is attached to tissue, tether <b>402</b> can be cut and delivery device <b>26</b> removed.

0046Delivery system <b>420,</b> shown in <figref idref="f0031"><b>FIG. 26B</b></figref><b>,</b> includes a pacing device <b>10,</b> delivery element <b>404,</b> tether <b>402</b> extending from delivery element <b>404,</b> and leadlet <b>20</b> with an active helix <b>21.</b> In this embodiment, the leadlet <b>20</b> is twisted around the delivery element <b>404.</b> The leadlet <b>20</b> is then positioned near tissue. The leadlet body then unwinds thereby attaching the helix <b>21</b> to tissue. Tether <b>402</b> is then loosened.

0047<figref idref="f0031"><b>FIG. 26C</b></figref> depicts a delivery system <b>430</b> that comprises pacing device <b>10,</b> delivery element <b>404,</b> tether <b>402</b> extending from delivery element <b>404,</b> leadlet <b>20</b> with an active helix <b>21.</b> Delivery element <b>404</b> and tether <b>402</b> are pre-loaded to loop around leadlet <b>20.</b> Once leadlet <b>20</b> is attached to tissue, tether <b>402</b> can be cut and delivery device <b>26</b> removed.

0048<figref idref="f0031"><b>FIG. 26D</b></figref> depicts a delivery system <b>440</b> that includes a set of tines <b>12</b> at the end of the leadlet <b>20.</b> Outside the end of the leadlet <b>20</b> is a loop configured to connect with a tether. The tether wraps around the loop <b>78.</b> The tether loop connection is used to hold onto the other loop, which is similar to a person holding a handle to a bucket. The tether centers the pacing device <b>10.</b> Once centered, the pacing device <b>10</b> is moved inside the delivery device <b>26.</b> The user pulls on the single tether, located at the proximal end, to load the device <b>10</b> into the delivery device <b>26.</b> The user continues to pull on the single tether until the tines <b>12</b> drop in or enter the device cup <b>44.</b>

0049<figref idref="f0031"><b>FIG. 26E</b></figref> depicts a delivery system <b>450</b> includes a set of passive tines <b>12</b> at the end of the leadlet <b>20.</b> Outside the end of the leadlet <b>20</b> is a loop configured to connect with a tether. The tether wraps around the loop <b>78.</b> The tether loop connection is used to hold onto the loop, which is similar to a person holding a handle to a bucket. The tether centers the pacing device <b>10.</b> Once centered, the pacing device <b>10</b> is moved inside the delivery device <b>26.</b> The user pulls on the single tether, located at the proximal end, to load the device <b>10</b> into the delivery device <b>26.</b> The user continues to pull on the single tether until the tines <b>12</b> drop in or enter the device cup <b>44.</b>

0050Skilled artisans appreciate that except for the tines directly attached to LPD <b>10,</b> passive tines can be used in place of the helix on the leadlets shown on each embodiment in <figref idref="f0031"><b>FIGS. 26A-26E</b></figref><b>.</b> Passive tines generally float in the atria until snagging occurs between the passive tines and the pectinate muscle. Passive tines are not actively puncture the pectinate muscle like the active tines of LPD 10.

0051In the foregoing detailed description, specific exemplary embodiments have been described. However, it may be appreciated that various modifications and changes can be made without departing from the scope of the invention as set forth below. Many different embodiments exist relative to the present disclosure. For example, while <figref idref="f0001">FIGS. 1</figref>, <figref idref="f0018 f0019">12-13</figref> depict the LPD 10 placed in the RV and the leadlet 20 positioned at the atrial appendage, LPD 10 can be placed in or on the LV, RA or LA. Similarly, leadlet 20 can be placed in various locations in the heart such as the LV, RV, or LA. Optionally, leadlet 20 can include a ring electrode to allow tip to ring bipolar pacing and/or sensing.

0052One alternative example relates to the leadlet guide 170. While leadlet guide 170 is shown attached to leadlet 20, leadlet guide 170 can also be configured to be positioned and fixated at the distal end of the delivery device 26. In this embodiment, the used aligns the leadlet into the leadlet guide 170.

0053Another alternative example relates to bipolar sensing electrodes can integrated bipolar (tip-to-coil) for other device 8 configurations.

0054A snare-type tool, such as is known to those skilled in the art, may be employed in lieu of tether 50, such that the term "tether" may broadly refer to such a snare.

0055In one or more embodiments, intermediate member 32, including a coiled distal end 43, shown in <figref idref="f0008">FIG. 4A</figref>, can be configured to engage device ventricular portion 88 by abutting distal end 43.

0056The present disclosure provides a more efficient single delivery device 26 solution to contain, deliver and attach both the leadlet 20 and the LPD 10 to separate tissue sites. The single delivery device 26 is more efficient than conventional delivery devices in at least two ways. First, the single delivery device 26 reduces costs over conventional devices that require two separate delivery devices to deliver a LPD and a leadlet with an electrode to the atria. Second, the single delivery device more quickly and efficiently delivers the LPD and the leadlet than conventional devices.