WO1994000187A1 - Systeme implantable de conduction pour le c×ur - Google Patents

Systeme implantable de conduction pour le c×ur Download PDF

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Publication number
WO1994000187A1
WO1994000187A1 PCT/US1993/004696 US9304696W WO9400187A1 WO 1994000187 A1 WO1994000187 A1 WO 1994000187A1 US 9304696 W US9304696 W US 9304696W WO 9400187 A1 WO9400187 A1 WO 9400187A1
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WIPO (PCT)
Prior art keywords
target tissue
recited
conducting system
elongated
energy
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
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PCT/US1993/004696
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English (en)
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WO1994000187A9 (fr
Inventor
Eitan Sobel
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Individual
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Individual
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Publication date
Application filed by Individual filed Critical Individual
Priority to AU43802/93A priority Critical patent/AU4380293A/en
Publication of WO1994000187A1 publication Critical patent/WO1994000187A1/fr
Publication of WO1994000187A9 publication Critical patent/WO1994000187A9/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M37/00—Other apparatus for introducing media into the body; Percutany, i.e. introducing medicines into the body by diffusion through the skin
    • A61M37/0069—Devices for implanting pellets, e.g. markers or solid medicaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/056—Transvascular endocardial electrode systems

Definitions

  • Living excitable cells are characterized by membrane electrical activity, which is basically a movement of different ions across the membrane, and the creation of an action potential, which can propagate along a cell, and induce an action potential in an adjacent cell. Without this intrinsic property of excitability, cell behaves like a long cable, in which there is a decay of the electrical voltage along the cell at a length constant called lambda, at which the voltage is 1/e (about a third) of its initial value. Lambda value depends on the type and size of the cell, and may varies considerably.
  • Point electrodes are implanted today for various artificial stimulation purposes. So far, two types of electrodes are known: point electrodes and area electrodes. Localized stimulation can be done either by point electrodes or by area electrodes, and consists of direct stimulation of a portion of a target tissue, while other portions of the target tissue get their stimuli by the "domino effect", in which the excitation of the cells that were directly stimulated by the electrodes is transmitted to neighboring cells, which get their stimuli from a "second hand” source, and their excitation is transmitted to other cells down the line. In contrast, generalized stimulation is almost always done with large area electrodes, which deliver high levels of energy sufficient enough to create global or near global excitation. Direct cell excitation requires a stimulation voltage above a threshold level. The stimulation voltage is directly related to the energy delivered, and inversely related to the surface area of the electrode.
  • Point electrodes are usually build as a screw-in electrode.
  • a point electrode is described by U.S. patent 4,876,109 by Mayer et al. (1989), in which the electrode penetrate the tissue surface, and is in a direct contact with the cardiac muscle cells.
  • Large area electrodes, that are placed on the skin, are used today by external defibrillators.
  • the more advanced implantable defibrillators use area electrodes that are placed around the heart in the pericardial space as described by U.S. patent 4,030,509 by Helman et al. (1977).
  • Another U.S patent 5,033,477 by Chin et al. (1991) describes a new method of implanting area electrodes with minimal amount of surgery.
  • the surgeon inserts electrodes via guide wires.
  • the electrodes coil in the pericardial space in the form of a spring, and create a crimpble button, which is in a direct contact with the heart wall.
  • the electrodes described by Chin et. al. are essentially another type of area electrodes, and therefore, suffer from all the disadvantages of area electrodes as mentioned below.
  • Other newer types of area electrodes are found in newer generation of defibrillators, which have one of the electrodes placed in the target tissue cavity - the heart chambers as described by U.S. patent 5,014,696 by Mehra (1991) .
  • This electrode is a type of an area electrode, as the energy is transmitted via the blood tissue in the cavity to the target tissue - the heart wall, and the surface area of the endocardium is in fact the surface area of this electrode.
  • Suprathreshold stimuli require overcoming the resistance of the tissue around the point electrode. This concentration of energy in a very small area is responsible for macrophages and neutrophils degranulation with secondary fibrosis, tissue damage, and therefore, more resistance around the electrodes.
  • Area electrodes can not deliver direct stimuli in an accurate manner to specific areas.
  • a target tissue This term relates to the goals of the implantable conducting system. It is the tissue that will have an important and pivotal role in its operation.
  • the implantable conducting system was designed to stimulate the target tissue, or to sense an impulse, and to be able to transmit it.
  • the implantable conducting system was intended to have substantial treatment and diagnostic advantages for the target tissue.
  • U.S. patent 5,014,696 by Mehra (1991) describes an intracardiac electrode, of which the target tissue is the heart wall.
  • a non-tar ⁇ et tissue This term relates to the goals of the implantable conducting system.
  • This tissue may be a bystander, and may even serve as a mediator, but this tissue is not the tissue that the implantable conducting system was designed for. Although, it may be used in the operation, it is not a crucial element, and has no intended advantage from it.
  • U.S. patent 5,014,696 by Mehra (1991) describes an intracardiac electrode, of which the non-target tissue is the blood, which serves as a mediator.
  • a path along a tissue can mean adjacent, beside, adjoining, on, atop, or Jburied within a target tissue.
  • Conductive medium It is a material able to transmit energy impulses from and to a target tissue.
  • Disruption of continuity A gap in the continuity of the target tissue created by a scar, fibrotic tissue, area with ischemia, or the like.
  • Tro ⁇ ism Hypertrophy. Atrophy Tropism is the growth of a tissue in response to stimulation. Hypertrophy is an exaggerate growth response. Atrophy is a no growth response, and even a decrease in tissue mass.
  • Artificial conducting system represents a new concept of thoughts, that can not be easily accomplished with the current available electrodes. It is composed of conductive medium, in the form of an elongated path along a target tissue.
  • the stimulation along a "line” or a "path” across a distance in a target tissue is new, and offers tremendous advantages. Moreover, the stimulation can be done in a certain direction along the path.
  • the system offers a spectrum of direct contact and a spectrum of energies, that can be delivered by the system. Proximity to the target tissue is an important aspect of the system, and it is preferred, that the conductive medium is embodied by the target tissue cells.
  • this system can be implanted in specific locations, which were chosen for a direct stimulation.
  • the techniques and materials for implanting the artificial conducting system are numerous.
  • One way to implant these electrodes is by using Bucalo's injectable substrate (U.S. patent 4,279,256), comprising of a plurality of electrically conductive bodied, or similarly, by using conductive tinctures, liquids or colloids.
  • This medium can be injected similar to a "tattoo".
  • Some other possible methods of creating conducting paths can use elongated bodies, cone shaped bodies, staples, nails, needles, wires and the like.
  • the conducting system can potentiate the capabilities of impulses generator devices, and enable the development of different new devices. These new devices offer reduced energy expenditure, with less tissues damage. Reduced energy delivery will cause less foreign body reaction, less resistance, while the effectiveness of the stimulation will be augmented.
  • the most striking advantage is the ability of the artificial conducting system to deliver subthreshold stimuli along a path or a distance, leading to unexpected results.
  • Subthreshold stimuli do not cause cells excitation, and therefore, do not initiate propagation of an action potential in the "domini effect".
  • Subthreshold stimuli are used today for increasing conductivity and for terminating various ventricular and supraventricular arrhythmias.
  • U.S. patent 5,083,564 by Scherlag describes increased conductivity in the AV block, by delivering subthreshold stimuli to the AV node. Scherlag uses a state of the art screw-in lead electrode catheter, that is placed in a specific locations, such as near the His bundle. This way, increased conductivity in the His bundle or the AV junction is achieved .
  • a better method of increasing conductivity can be achieved by using artificial conducting paths.
  • the subthreshold stimuli can be transmitted along a path to a longer distances, achieving better accuracy and better results.
  • Subthreshold stimuli are used today for terminating various arrhythmias.
  • a high failure rate is reported with the current available electrodes, especially in ventricular tachycardia, when the reentrant sequence may encircle large segments of the heart wall.
  • a better method of delivering subthreshold stimuli across the length of the critical areas is utilizing artificial conducting paths. Utilizing subthreshold stimuli in a reliable fashion can prevent the delivering of some unnecessary defibrillations to the heart.
  • Subthreshold stimuli can be applied before the deterioration of an unstable rhythm to a malignant arrhythmia, resulting in a major improvement in the quality of life of the patients.
  • Artificial conducting paths are also useful for delivering suprathreshold stimuli. Combining these electrodes to special "field pacers" devices will enable one to "pace" elongated fields in different target tissues. Although it requires more energy per impulse than the known point electrodes, conducting paths have many advantages and unexpected results, and can not be compared to point electrodes. For example, in atrial fibrillation, artificial conducting system can terminate the fibrillation, and ensure atrial contraction, while a regular pacer with a state of the art point electrode does not have a significant effect on the diseased atrium. Another way of achieving the same goal with less energy expenditure, may be using a regular pacer with a point electrode coinciding with conducting system stimulated at subthreshold level of energy.
  • the new artificial conducting system can operate at defibrillators• levels of energy, and result in a "localized defibrillator", which delivers energies directly to electrically unstable areas of the heart. Delivering more energy via a larger system can cause global or near global excitation, and result in a "global / near global defibrillator”.
  • EPS constant electrophysiologic studies
  • Artificial conducting track may be able to influence conduction without an energy source. It is known that the energy created by cardiac muscle fibers can be*pll49Xs ⁇ sfedtransmitted via electric wires. Therefore, it may be possible to transfer a high percentage of the cells own energy via special artificial conducting paths designed to have only minimal resistance and excellent conductivity. This technology can accomplish all the expectations of this invention without using an artificial energy source.
  • Artificial conducting system has an effect on cardiac function by means of stimulating dysfunctioning areas of the heart, and restoring contraction.
  • the above mentioned "field pacer" device is an example for restoring atrial contraction, and improving of cardiac function. The same is true for any dysfunctioning area of the heart.
  • Creating artificial conducting system along the left ventricle or any other chamber, with or without special devices can increase conduction along the implantable conducting paths. Ensuring simultaneous contraction of a chamber can significantly increase ejection fraction, and increase output. This effect is in a contrast to the poorly synchronized contraction of the diseased heart with poor left ventricular ejection fraction and decreased cardiac output.
  • implanting the system may also break close loops of stimuli, and may prevent unnecessary hypertrophy of cardiac muscle in certain hypertrophic cardiomyopathies.
  • the known effect of increased va ⁇ cularization in the vicinity of pacers' point electrodes can be used with the current invention for treating and preventing ischemia.
  • the artificial conducting system may have additional theoretical advantages and functions, such as:
  • Artificial conducting track may be able to function without an energy source.
  • Artificial conducting system may have a long term effect on the anatomy, the organization and the tropism of target tissue.
  • Artificial conducting system may be used to induce vascularization and increase in blood flow to the stimulated areas.
  • Artificial conducting system can be connected directly to devices via "wires", however, other indirect connection like induction of an impulse from a distance, which is a well known phenomena in electricity, may be utilized.
  • Compensating function by preventing atrophy of unaffected areas, improving organization of fibers, and creating compensatory tropism of the contracting fibers.
  • Fi ure 1 describes an implantation of an artificial conducting medium via a catheter 27, using a special needle 28 to inject or to tattoo a conducting medium 29, in the form of a plurality of conductive particles into the heart wall 30, where it forms a conductive path 31.
  • the conductive medium can be suspended in a suitable substance means 32, which can be conducting colloid, drugs, that prevent foreign body reaction, or the like.
  • Figure 2 describes an implantation of cone shape particles 33 into the heart wall 34 via a catheter 35.
  • the conductive medium can be suspended in a suitable substance means 36.
  • Figure 3 describes an implantation of special staples 37 via a catheter 38, creating another form of an artificial conducting path in the heart wall 39.
  • Figure 4 describes an implantation of an artificial conducting path via a catheter 40, firing special wires or pins 41 into the heart wall 42.
  • Figure 5 describes an implantation of an artificial conducting path via a catheter 43, injecting special nails 44 into the heart wall
  • Figure 6 describes a special catheter 46 for the implantation an elongated wire 47 in the heart wall 48, which serve as an artificial conducting path.
  • Figure 7 shows an elongated wire 49, which is attached to a target tissue 50.
  • Figure 8 demonstrates multiple elongated wires 51, which are placed on the heart walls 52 forming a "basket” type electrode.
  • Figure 9 describes an unipolar electrode 53 connected via a wire 54 to a device 55.
  • FIG 10 describes bipolar electrodes 56 and 57, which most significantly stimulate the area in between the electrodes. These electrodes (56, 57) are connected via wires 58 and 59 to a device
  • Figure 11 describes a linear electrode 61, which presents a voltage gradient along its path, and is connected by a wire 62 to a device 63.
  • Figure 12 describes multiple conducting paths type electrode 64 connected by a wire 65 to a device 66.
  • Figure 13 shows a zone 67, with attached multiple conducting paths
  • conducting paths 68 join together and create conducting path 69 attached to area 70.
  • Figure 14 is similar to figure 13, however, an area 71 contains an area-type electrode 72, which is connected to conducting path 73 attached to area 74.
  • Figure 15 shows an electrode 75 connected by a wire 76 to a device
  • a spectrum of direct stimulations are represented by areas 78 to
  • area 78 can represent subthreshold level of stimulation
  • area 79 can represent "field pacing" level of stimulation
  • area 78 can represent subthreshold level of stimulation
  • area 79 can represent "field pacing" level of stimulation
  • 80 to 82 can represent different defibrillation levels of stimulation.
  • Figure 16 presents a possible finding during electrophysiologic studies (EPS) , in which a region of slow conductivity or a scar 83 facilitate the development of a reentrant circuit 84.
  • EPS electrophysiologic studies
  • the implantation of the conducting path can be done in area 85 across the scar 83.
  • Figure 17 shows an ectopic focus 86 found during electrophysiologic studies (EPS) , which is responsible for the development of arrhythmogenic impulses 87.
  • EPS electrophysiologic studies
  • the implantation of the conducting paths can be done across the abnormal area 88.
  • Figure 18a and figure 18b are an upper view and a lateral view of a target tissue respectively.
  • a portion of the target tissue 89 is separated by a scar 90 or an ischemic area 90 from an adjacent portion of the target tissue 91.
  • a conducting path 92 is bridging between the two portions of the same target tissue.
  • Figure 19 shows two target tissues.
  • a nerve 93 and a muscle 94 are separated by a small gap 95.
  • a conducting path 96 is bridging between the two target tissues.
  • Figure 20 represents a stimulation method to increase conductivity along the AV node 97, the His Bundle 98, and the Purkinje fibers 99.
  • a device 100 and a wire 101 shown in the figure may be similar to the device suggested by scherlag (U.S. patent 5,083,564) , but an electrode 102 is new, and consists of artificial conducting path 102.
  • Figure 21 represents an heart with a diseased atrium 103.
  • a pacer like device 104 is connected via a wire 105 to artificial conducting systems 106 and 107, which deliver "field pacing" levels of energy.
  • device 104 can be subthreshold stimulator, which can increase conductivity in the atrium by delivering subthreshold levels of energy via the conducting paths 106, 107, while a device 108, a wire 109 and a point electrode 110 can be used as a regular pacer.
  • Figure 22 represents an arrhythmogenic heart with a region of slow conductivity 111 or a scar 111.
  • Creating artificial conducting system 112, and connecting these paths to a device 113 will enable the delivering of various levels of energy. Lower levels of energies can prevent and treat the arrhythmias at earlier stages. At low levels of energy the device 113 becomes a "subthreshold stimulator", and at higher levels of energy it becomes a "field pacer" and a "localized or a global/near global defibrillator".
  • Figure 23 represents an heart with a region of slow conductivity or a scar 114. Creating an artificial conducting system 115 may prevent arrhythmias by itself, without an energy source device.
  • Figure 24 represent a possible short term effect of the artificial conducting system on heart function. The contraction of a chamber in drawing 116 to 120 is ineffective, since it shifts blood from one side of the chamber to the other.
  • Figure 25 is in contrast to figure 24.
  • the contraction in drawing 121 to 125 is simultaneous, and therefore effective, with better ejection fraction and cardiac output.
  • Figure 26 represent a possible usage of the invention in a muscular structure.
  • the artificial conducting system 126 is implanted in the urinary bladder 127, and connected via a wire 128 to a device 129. Triggering a switch 130, which can be beneath the skin, will operate the system, and can create a contraction in the urinary bladder 127.
  • the invention is a new elongated type of electrode implanted along a target tissue.
  • this type of electrode has unprecedented advantages in the treatment of the heart and other organs diseases.
  • the scope of this invention should be determined by the claims and their legal equivalents, rather than by the examples given.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Radiology & Medical Imaging (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Dermatology (AREA)
  • Medical Informatics (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Electrotherapy Devices (AREA)

Abstract

Procédés, dispositifs et applications d'un système implantable de conduction. Dans le c÷ur, le système artificiel de conduction peut transmettre des stimulus ayant différentes intensités et étant engendrés par un dispositif, ou assurer la conduction des impulsions autonomes du c÷ur. Le système de conduction est adapté au traitement et à la prophylaxie des anomalies de conduction et de l'arythmie, à l'amélioration du fonctionnement cardiaque, et à la stimulation du tropisme et de la vascularisation du tissu cardiaque. De même, on peut implanter les systèmes artificiels de conduction dans divers tissus musculaires et nerveux pour restituer ou corriger le fonctionnement tissulaire.
PCT/US1993/004696 1992-06-22 1993-05-17 Systeme implantable de conduction pour le c×ur Ceased WO1994000187A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU43802/93A AU4380293A (en) 1992-06-22 1993-05-17 An implantable conducting system for the heart

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US90200792A 1992-06-22 1992-06-22
US07/902,007 1992-06-22
US08/055,762 1993-05-03

Publications (2)

Publication Number Publication Date
WO1994000187A1 true WO1994000187A1 (fr) 1994-01-06
WO1994000187A9 WO1994000187A9 (fr) 1994-03-03

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Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2790967A1 (fr) * 1999-03-17 2000-09-22 Medtronic Inc Systeme de stimulation cardiaque
WO2014113813A1 (fr) * 2013-01-21 2014-07-24 Cala Health, Inc. Dispositifs et procédés pour contrôler les tremblements
US9802041B2 (en) 2014-06-02 2017-10-31 Cala Health, Inc. Systems for peripheral nerve stimulation to treat tremor
US10765856B2 (en) 2015-06-10 2020-09-08 Cala Health, Inc. Systems and methods for peripheral nerve stimulation to treat tremor with detachable therapy and monitoring units
US10814130B2 (en) 2016-07-08 2020-10-27 Cala Health, Inc. Dry electrodes for transcutaneous nerve stimulation
US11331480B2 (en) 2017-04-03 2022-05-17 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation for treating diseases related to overactive bladder
US11344722B2 (en) 2016-01-21 2022-05-31 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation for treating diseases related to overactive bladder
US11596785B2 (en) 2015-09-23 2023-03-07 Cala Health, Inc. Systems and methods for peripheral nerve stimulation in the finger or hand to treat hand tremors
US11857778B2 (en) 2018-01-17 2024-01-02 Cala Health, Inc. Systems and methods for treating inflammatory bowel disease through peripheral nerve stimulation
US11890468B1 (en) 2019-10-03 2024-02-06 Cala Health, Inc. Neurostimulation systems with event pattern detection and classification
US12233265B2 (en) 2016-08-25 2025-02-25 Cala Health, Inc. Systems and methods for treating cardiac dysfunction through peripheral nerve stimulation
US12251560B1 (en) 2019-08-13 2025-03-18 Cala Health, Inc. Connection quality determination for wearable neurostimulation systems
US12453853B2 (en) 2013-01-21 2025-10-28 Cala Health, Inc. Multi-modal stimulation for treating tremor
US12575780B2 (en) 2015-07-31 2026-03-17 Cala Health, Inc. Systems, devices, and method for the treatment of osteoarthritis

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Cited By (30)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2790967A1 (fr) * 1999-03-17 2000-09-22 Medtronic Inc Systeme de stimulation cardiaque
US10625074B2 (en) 2013-01-21 2020-04-21 Cala Health, Inc. Devices and methods for controlling tremor
WO2014113813A1 (fr) * 2013-01-21 2014-07-24 Cala Health, Inc. Dispositifs et procédés pour contrôler les tremblements
US9452287B2 (en) 2013-01-21 2016-09-27 Cala Health, Inc. Devices and methods for controlling tremor
US10850090B2 (en) 2013-01-21 2020-12-01 Cala Health, Inc. Devices and methods for controlling tremor
US12161858B2 (en) 2013-01-21 2024-12-10 Cala Health, Inc. Devices and methods for controlling tremor
US12453853B2 (en) 2013-01-21 2025-10-28 Cala Health, Inc. Multi-modal stimulation for treating tremor
US9802041B2 (en) 2014-06-02 2017-10-31 Cala Health, Inc. Systems for peripheral nerve stimulation to treat tremor
US10561839B2 (en) 2014-06-02 2020-02-18 Cala Health, Inc. Systems for peripheral nerve stimulation
US10549093B2 (en) 2014-06-02 2020-02-04 Cala Health, Inc. Method for peripheral nerve stimulation
US10179238B2 (en) 2014-06-02 2019-01-15 Cala Health, Inc. Systems for peripheral nerve stimulation
US10173060B2 (en) 2014-06-02 2019-01-08 Cala Health, Inc. Methods for peripheral nerve stimulation
US10905879B2 (en) 2014-06-02 2021-02-02 Cala Health, Inc. Methods for peripheral nerve stimulation
US10960207B2 (en) 2014-06-02 2021-03-30 Cala Health, Inc. Systems for peripheral nerve stimulation
US12109413B2 (en) 2014-06-02 2024-10-08 Cala Health, Inc. Systems and methods for peripheral nerve stimulation to treat tremor
US12157001B2 (en) 2015-06-10 2024-12-03 Cala Health, Inc. Systems and methods for peripheral nerve stimulation to treat tremor with detachable therapy and monitoring units
US10765856B2 (en) 2015-06-10 2020-09-08 Cala Health, Inc. Systems and methods for peripheral nerve stimulation to treat tremor with detachable therapy and monitoring units
US12575780B2 (en) 2015-07-31 2026-03-17 Cala Health, Inc. Systems, devices, and method for the treatment of osteoarthritis
US12420082B2 (en) 2015-09-23 2025-09-23 Cala Health, Inc. Systems and methods for peripheral nerve stimulation in the finger or hand
US11596785B2 (en) 2015-09-23 2023-03-07 Cala Health, Inc. Systems and methods for peripheral nerve stimulation in the finger or hand to treat hand tremors
US12357824B2 (en) 2016-01-21 2025-07-15 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation
US11918806B2 (en) 2016-01-21 2024-03-05 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation of the leg
US11344722B2 (en) 2016-01-21 2022-05-31 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation for treating diseases related to overactive bladder
US10814130B2 (en) 2016-07-08 2020-10-27 Cala Health, Inc. Dry electrodes for transcutaneous nerve stimulation
US12233265B2 (en) 2016-08-25 2025-02-25 Cala Health, Inc. Systems and methods for treating cardiac dysfunction through peripheral nerve stimulation
US12161865B2 (en) 2017-04-03 2024-12-10 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation
US11331480B2 (en) 2017-04-03 2022-05-17 Cala Health, Inc. Systems, methods and devices for peripheral neuromodulation for treating diseases related to overactive bladder
US11857778B2 (en) 2018-01-17 2024-01-02 Cala Health, Inc. Systems and methods for treating inflammatory bowel disease through peripheral nerve stimulation
US12251560B1 (en) 2019-08-13 2025-03-18 Cala Health, Inc. Connection quality determination for wearable neurostimulation systems
US11890468B1 (en) 2019-10-03 2024-02-06 Cala Health, Inc. Neurostimulation systems with event pattern detection and classification

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