Extravascular lead designs for optimized pacing and sensing having segmented, partially electrically insulated defibrillation coils

An implantable medical electrical lead, comprising:

• an elongate lead body having a proximal end and a distal portion and comprising an insulated portion;
• an electrical conductor disposed within the elongate lead body;
• a first defibrillation coil segment and a second defibrillation coil segment each positioned along the distal portion, the first defibrillation coil segment and the second defibrillation coil segment being spaced a distance apart from each other and are electrically coupled to the electrical conductor, the insulated portion of the elongate lead body positioned between the first and second defibrillation coil segments within the distance, the first defibrillation coil segment and the second defibrillation coil segment having the same polarity when a voltage is applied to the electrical conductor;
• and
• the first defibrillation coil segment and the second defibrillation coil segment each including:
• at least one coated section being coated with tantalum pentoxide;
• at least one uncoated section not coated with tantalum pentoxide;
• and
• the at least one uncoated section being configured to deliver a defibrillation shock and at least one of deliver a pacing pulse to the heart and sense a cardiac depolarization, the at least one uncoated section being positioned anterior to the right ventricle when the distal portion of the elongate lead body is one of subcutaneously and substernally positioned between a first position proximate the xiphoid process and a second position superior to the xiphoid process.

A method for implanting a medical electrical lead comprising:

• an elongate lead body having a proximal end and a distal portion and comprising an insulated portion;
• a defibrillation electrode positioned along the distal portion of the lead body, the defibrillation electrode including a first defibrillation electrode segment and a second defibrillation electrode segment spaced a distance apart from each other, the second defibrillation electrode segment positioned distal to the first defibrillation electrode segment, the insulated portion of the elongate lead body positioned between the first and second defibrillation electrode segments and within the distance, at least one of the first and second defibrillation electrode segments including at least one coated portion and at least one uncoated portion, the at least one coated portion being coated with an electrically insulating material configured to prevent transmission of a pacing pulse to a patient's heart and configured to allow transmission of a defibrillation shock to the heart, the at least one uncoated portion being configured to transmit a defibrillation shock and at least one of transmit a pacing pulse to the heart and sense a cardiac depolarization;
• an electrical conductor disposed within the elongate lead body, each of the first and second defibrillation electrode segments being electrically coupled to the electrical conductor;
• and
• one or more pace/sense electrodes along the distal portion of the lead body and configured to, at least one of, deliver pacing pulses to and sense electrical activity from the heart, wherein at least one of the pace/sense electrodes is disposed between the first defibrillation electrode segment and the second defibrillation electrode segment, wherein the method comprises:
• creating an incision at a first location proximate a center of a torso of the patient;
• introducing an implant tool into the patient through the incision at the first location;
• advancing a distal end of the implant tool through a substernal space underneath the sternum to create a substernal tunnel;
• and
• introducing the medical electrical lead into the substernal tunnel such that the distal portion of the elongate lead body is positioned between a first position proximate the xiphoid process and a second position superior to the xiphoid process such that at least one of the first or second defibrillation electrode segments is positioned anterior to a right ventricle of the heart.

An implantable medical electrical lead comprising:

• an elongate lead body having a proximal end and a distal portion and comprising an insulated portion;
• a defibrillation electrode positioned along the distal portion of the lead body, the defibrillation electrode including a first defibrillation electrode segment and a second defibrillation electrode segment spaced a distance apart from each other, the second defibrillation electrode segment positioned distal to the first defibrillation electrode segment, the insulated portion of the elongate lead body positioned between the first and second defibrillation electrode segments and within the distance, the distance being less than approximately five centimeters, at least one of the first and second defibrillation electrode segments including at least one coated portion and at least one uncoated portion, the at least one coated portion being coated with an electrically insulating material configured to prevent transmission of a pacing pulse to a patient's heart and configured to allow transmission of a defibrillation shock to the heart, the at least one uncoated portion being configured to transmit a defibrillation shock and at least one of transmit a pacing pulse to the heart and sense a cardiac depolarization;
• an electrical conductor disposed within the elongate lead body, each of the first and second defibrillation electrode segments being electrically coupled to the electrical conductor;
• and
• one or more pace/sense electrodes along the distal portion of the lead body and configured to, at least one of, deliver pacing pulses to and sense electrical activity from the heart, wherein at least one of the pace/sense electrodes is disposed between the first defibrillation electrode segment and the second defibrillation electrode segment.