Method and apparatus for providing intrapericardial access and inserting intrapericardial electrodes

DETAILED DESCRIPTION The method of the present invention provides access to the interior of the pericardium through an incision in the inferior border of the pericardium and a tunnel dissected between the pericardium and the diaphragm.
In the method, one jaw of a clamp-like placement device is extended interiorly of the pericardium through the incision and the other jaw is extended exteriorly of the pericardium through the tunnel.
The jaws include tubular guide elements with aligned open distal ends curved toward one another.
Once placed relative to the pericardium, the jaw elements are moved to clamp the tissue of the pericardium therebetween.
A guide wire is then extended through the tubular elements and the pericardial tissue therebetween.
Once the wire is so placed, the clamp-like device is removed, leaving the wire in place to facilitate access to the interior of the pericardium.
In the method of placing an electrode within the pericardium, a guide cannula is extended over the wire and into the pericardium.
A primary electrode is then passed through the cannula and into the interior of the pericardium.
A secondary electrode may be inserted through the incision in the inferior border of the pericardium.
The apparatus of the invention comprises the clamp-like placement device, including first and second elongate jaw elements, each of which has an open-ended tubular guide extending over the length thereof and terminating in an open distal end extending laterally of the element.
It further comprises means for securing the jaw elements together in a condition wherein the open distal ends of the tubular guides are in aligned closely disposed relationship to one another.
In the preferred embodiment, the apparatus further comprises means for holding the jaw elements in clamping engagement with opposite sides of pericardial tissue and a secondary open-ended tubular guide secured to and extending along at least one of the jaw elements.
A principal object of the invention is to provide a method and apparatus for accessing the interior of the pericardium with a minimum of surgery and risk of physical trauma to the heart