A blog about what is new (and old) in the world of active implantable medical devices

Changes in EU Rules for Medical Device Approvals

Posted on by Posted in AIMD Business

IPG with CE Mark

There has been some discussion in Europe over the last year to tighten the rules for medical device approvals. This discussion arose due to some scandals with breast implants in recent years.  One of the things being considered was a regulatory approval process similar to the PMA process in the US. The European Parliament has just voted this down, which is great news for our industry.

They did agree on some stricter requirements for Notified Bodies, specifically the following:

  • Notified Bodies must maintain in-house staff members rather than subcontractors to assess medical devices for CE Marking
  • A new group of Notified Bodies should be formed to evaluate higher-risk devices (such as implants)
  • More access to medical device clinical data for patients and healthcare providers
  • New requirements for reprocessing single-use devices
  • Separate legislation addressing IVD safety

These new rules will need to be approved by the EU members states so this is by no means final, but they are expected to have an impact on future AIMD development and approval.

St. Jude Q3 2013 AIMD Results: CRM Down 1%, Neuromodulation 3% Up

Posted on by Posted in AIMD Business, St. Jude Medical

logo_StJudeMedical

From today’s press release:

Cardiac Rhythm Management (CRM)

Total CRM sales, which include implantable cardioverter defibrillator (ICD) and pacemaker products, were $682 million for the third quarter of 2013, a 1 percent decrease compared to the third quarter of 2012. After adjusting for the impact of foreign currency, total CRM sales were flat.

Of that total, ICD product sales were $418 million in the third quarter, a 1 percent increase compared to the third quarter of 2012. ICD revenue increased 2 percent after adjusting for the impact of foreign currency.

Second quarter pacemaker sales were $264 million, a 5 percent decrease compared to the third quarter of 2012. On a currency neutral basis, pacemaker revenue declined 3 percent.

Neuromodulation

St. Jude Medical sales of neuromodulation products were $104 million in the third quarter of 2013, up approximately 3 percent from the prior year on a reported and currency neutral basis.

 

Neuros Medical Receives IDE Approval to Conduct Pivotal Study

Posted on by Posted in Nerve Blocking, Neuros Medical, Pain

Neuros Medical Altius www.implantable-device.com David Prutchi PhDNeuros Medical received an Investigational Device Exemption to conduct a pivotal clinical trial to evaluate the Altius™ System High Frequency Nerve Block technology for the management of intractable limb pain of amputees.   The prospective, randomized, controlled pivotal clinical trial will consist of 130 patients at 15 institutions in the U.S. to evaluate the safety and efficacy of Neuros Medical’s Altius System.

 

St. Jude Acquires Nanostim, Announces CE Mark of World’s First Leadless Pacemaker

Posted on by Posted in AIMD Business, Bradycardia, Cardiac Pacing, Nanostim, St. Jude Medical

cbhayden@me.com

St. Jude Medical today announced the completion of its acquisition of Nanostim, Inc., a privately-owned developer of miniaturized, leadless pacemakers. The acquisition adds the world’s first and only leadless pacemaker to the St. Jude Medical product portfolio.

httpv://youtu.be/P6PLiyzatOo

According to the press release:

Unlike conventional pacemakers that require a more invasive surgery, the Nanostim™ leadless pacemaker is designed to be implanted directly into the heart via a minimally invasive procedure. The device is delivered using a steerable catheter through the femoral vein, eliminating the need to surgically create a pocket for the pacemaker and insulated wires (called leads) that have historically been recognized as the most vulnerable component of pacing systems. The Nanostim leadless pacemaker recently received CE Mark approval and will be available soon in select European markets. It also recently received U.S. Food and Drug Administration (FDA) conditional approval for its Investigational Device Exemption (IDE) application and pivotal clinical trial protocol to begin evaluating Nanostim leadless technology in the U.S.

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FDA Panel Majority Votes Against Effectiveness of CardioMEMS CHAMPION HF Monitoring Device

Posted on by Posted in CardioMEMS, Heart Failure (CHF), St. Jude Medical, Telemetry

CardioMEMS miniature implantable sensor for heart failure and aneurism management

Although the FDA advisory panel found CardioMEMS’ CHAMPION HF Pressure Measurement System to be safe, on October 9, 2013, the majority of panel members decided that the implantable sensor monitor to help guide treatment in patients with congestive heart failure is not effective.

According to Forbes, one panel member said it was difficult to connect the dots between use of the monitor and decreased hospitalization and lack of data on use in women.

This is not the first time that CardioMEMS attempts to receive PMA approval.  In 2011 FDA rejected the Champion implantable monitoring system for heart failure for premarket approval, in part due to questions about the validity of presented data. Last year, CardioMEMS received an FDA Warning Letter.

MicroTransponder Raises Funds for Clinical Trials of Serenity VNS IPG for Treating Tinnitus

Posted on by Posted in Micro Transponder, Tinnitus, Vagus Nerve Stimulation

MicroTransponder Serenity IPG for treatment of Tinnitus David Prutchi PhD www.implantable-device.com

MicroTransponder, Inc. of Dallas, TX has raised $3.4 million to carry out clinical trials of its Vivistim System to help restore functionality in the upper limbs of stroke patients, and its Serenity System designed to “rewire” the auditory cortex of tinnitus patients. The company intends to secure a CE mark for both systems next year, and then raise more funds to support a clinical trial for a pre-market approval in the U.S.

According to the company’s website, the Serenity System™ pairs Vagus Nerve Stimulation (VNS) with listening to tones. VNS is approved by the FDA and has been used to treat over 60,000 patients for epilepsy and depression, but has not yet been evaluated for safety or efficacy to treat tinnitus.  The device is fully implantable and can easily be used at home. During the therapy, an individual sits in a comfortable chair and wear headphones. They listen to tones while receiving small bursts of neurostimulation, which activate the vagus nerve.  UT Dallas says that “preclinical tests demonstrated that this approach “rewires” damaged brain circuitry associated with tinnitus, potentially yielding long-term reversal of symptoms. The initial human trial in Belgium provided encouraging results.”

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Increase in Temperature from AIMDs Dissipating Endogenous Heat

Posted on by Posted in Impulse Dynamics, MetaCure, My Portfolio, Rechargeable Batteries, Wireless Power Transmission

Analysis of Temperature Increase at the Device/Tissue Interface for Implantable Medical Devices Dissipating Endogenous HeatActive Implantable Medical Devices generate heat as a result of resistive losses in their circuitry, exothermic reaction in their batteries, eddy-current heating due to inductive recharge, friction between mechanical components, etc.  The European Standard which regulates AIMDs limits the heating of the outer surface of an AIMD to 2ºC above normal body temperature.  Despite the rapid growth in the use of AIMDs, the relationship between AIMD endogenous heat generation and tissue temperature has not been quantified.   In the attached paper we aimed at determining the limit of endogenous heat that can be dissipated in-vivo by the surface area of an AIMD to remain compliant with the 2ºC temperature increase limit.  In our study, four Sinclair mini-pigs underwent implantation of AIMD simulants instrumented to dissipate heat and measure temperature internally, as well as the device/tissue interface temperature.

We found that for a device with the surface area and geometry that we used, approximately 1W can be dissipated before reaching the 2ºC temperature increase limit. 

Click here for a preprint of this paper

 

ElectroCore’s Noninvasive Vagus Nerve Stimulation – An Interesting Challenge to Implantable VNS Systems

Posted on by Posted in Asthma, COPD, Migraine, Vagus Nerve Stimulation

ElectroCore noninvasive VNS www.implantable-device.com David Prutchi PhD

Surgically accessing the Vagus Nerve is not trivial, and implanting a VNS system involving cuff electrodes is risky and recovery is lengthy.  Enter ElectroCore Medical of Bernards Township, New Jersey – it is developing non-invasive VNS therapies that treat or prevent symptoms of serious headache conditions, including migraines and cluster headaches, and bronchoconstriction including asthma and chronic obstructive pulmonary disorder (COPD).

Its gammaCore® therapy is applied using a hand-held, non-invasive neurostimulator device, and is used to treat primary headaches in adults, including migraine, cluster headache, and medication overuse headache. According to ElectroCore, “gammaCore relies on the activation of afferent A-fibers in the vagus nerve which is not implicated in negative cardiac or respiratory effects.”  Results from studies of the therapy as both an acute and preventative against these headache types have been promising, and are ongoing around the world.

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Interesting 2012 Presentation by Setpoint Medical on Neuromodulation for Treating Chronic Inflammatory Diseases

Posted on by Posted in Inflammation, Neural Stimulation, SetPoint Medical, Vagus Nerve Stimulation

Setpoint Medical www.implantable-device.com David Prutchi PhD

I found online the PowerPoint presentation for: R Zitnik, Y Levine, M Faltys, T Arnold, “Harnessing the Inflammatory Reflex: Using Neuromodulation as a Novel Approach to Treat Chronic Inflammatory Diseases”, North American Neuromodulation Society Meeting 2012.

The presentation shows some preliminary animal results, presents an artist’s conception of the implantable system, and concludes as follows:

“- Inflammatory diseases are a $30B market with significant unmet need

– Using neuromodulation to drive the inflammatory reflex has a sound biological foundation: Use in clinic is supported by strong preclinical evidence

– This is the first demonstration that an implantable neuromodulation device improves clinical manifestations of RA:

  • Significant and clinically meaningful improvement in signs and symptoms
  • Response rates were comparable to those with current biologic agents
  • Further larger controlled studies in RA and other chronic inflammatory diseases are warranted.
  • Our microregulator offers significant advantages over current vagal nerve stimulation devices

SetPoint intends to offer a novel therapy that will significantly increases patient QOL, while bending per-patient cost curves down by more than 60%”

 

 

 

Cyberonics Reports 12.4% Increase in VNS Sales for Fiscal Q1 2014

Posted on by Posted in AIMD Business, Cyberonics, Epilepsy, Vagus Nerve Stimulation

Cyberonics VNS IPGs www.implantable-device.com David Prutchi PhDNet product sales increased 12.4% to $67.4 million in the first fiscal quarter ended July 26 for Cyberonics, Inc. of Houston, TX. Including license revenue, sales were up 14.2% overall, with Europe in particular contributing a strong performance. Diluted earnings per share were adjusted by $0.17 cents due to a litigation settlement.

According to the Aug. 22, 2013 press release, “operating results for the first quarter of fiscal 2014 compared to the first quarter of fiscal 2013, and other achievements, include:

  • Net product sales of $67.4 million, an increase of 12.4%;
  • Net sales of $68.9 million (including $1.5 million of license revenue), an increase of 14.2%;
  • Worldwide unit sales of 3,354, an increase of 9.8%;
  • Record U.S. net product sales of $56.4 million, an increase of 10.8%;
  • Strong International unit sales of 899, an increase of 20.8%;
  • Adjusted non-GAAP income from operations increased by 21.9% to $21.0 million and adjusted non-GAAP income per diluted share increased by 27.9% to $0.48;¹
  • Share repurchases of $13 million; and
  • Significant progress in three clinical studies, E-36, E-37, and ANTHEM.”

 

Autonomic Technologies’ Sphenopalatine Ganglion Stimulator Treats Cluster Headaches

Posted on by Posted in Autonomic Technologies, Cluster Headaches, Migraine, Sphenopalatine Ganglion Stimulation

ATI SPG Neurostimulator for Cluster Headache and Migraine www.implantable-device.com David Prutchi PhD

Autonomic Technologies, Inc. (ATI) is a medical device company located in the San Francisco Bay Area focused on the development of neurostimulators for the treatment of severe headache. The company’s initial product, the ATI Neurostimulation System, is approved in Europe for the treatment of cluster headache and is currently being investigated in a multi-center, randomized study for the treatment of high frequency, high disability migraine.

The ATI Neurostimulation System is a rechargeable, multi-channel, peripheral nerve stimulation system. The System includes:

  • The ATI Neurostimulator: A miniaturized neurostimulator (smaller than an almond) with an integral lead designed to fit ranging facial anatomy.
  • The Remote Controller: A hand-held device with simple therapy controls that provides on-demand patient-controlled SPG therapy. Therapy settings are individualized and can be adjusted quickly by physicians using a programmer laptop.

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Cleveland FES Center’s Networked Neural Prosthesis

Posted on by Posted in Brain-Computer Interface, Cleveland FES Center, Muscular Stimulation, Paralysis, Spinal Cord Injury (SCI)

Cleveland FES - Networked Neural Prosthesis (NNP) system, www.implantable-device.com, David Prutchi, Ph.D.

The Cleveland FES Center was established in 1991 as a consortium between the Cleveland VA Medical Center (CVAMC), the private educational institution of Case Western Reserve University (CWRU), and the public hospital system of MetroHealth Medical Center (MHMC).

As part of this consortium, Dr. Hunter Peckham – biomedical engineering professor at Case Western Reserve University – and his group have developed the Networked Neuroprosthetic System (NNPS), which is based on a network of small implanted modules they call “neuroprosthetic building blocks”.  These modules are distributed throughout the body, and each is dedicated to a specific function.  Modules are linked to a centralized power source via a network cable through which they also communicate with each other.

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SetPoint Medical Secures $27M to Develop VNS Device to Treat Inflammatory Diseases

Posted on by Posted in Boston Scientific, Inflammation, SetPoint Medical, Vagus Nerve Stimulation

SetPoint Medical implantable device for rheumatoid arthritis and Crohn's Disease

SetPoint Medical, headquartered in Valencia, California, is developing neuromodulation therapies for patients with inflammatory autoimmune diseases, such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD), psoriasis, diabetes, heart disease, and multiple sclerosis. SetPoint’s proprietary neuromodulation platform consists of an implantable “microregulator”, wireless charger and iPad prescription pad application.

SetPoint announced today that it has secured $27 million in financing from its current investors along with new investors Covidien Ventures, Action Potential Venture Capital Limited, the new GlaxoSmithKline (GSK) strategic venture capital fund for bioelectronic medicines and technologies, and Boston Scientific. The proceeds of the financing will be used to expand ongoing clinical development of the SetPoint bioelectronics therapy approach in rheumatoid arthritis and Crohn’s disease and advance development of the SetPoint proprietary neuromodulation platform.

Medtronic Implants first Activa® PC+S DBS IPG Capable of Sensing and Recording Brain Activity While Delivering Therapy

Posted on by Posted in Alzheimer's, Brain Stimulation, Medtronic, OCD, Parkinson's Disease

Activa PC+S deep brain stimulator with sensing and recording of brain activity David Prutchi PhD www.implantable-device.com

Medtronic today announced the first implant of the novel Activa® PC+S deep brain stimulation (DBS) system that, for the first time, enables the sensing and recording of select brain activity while simultaneously providing targeted DBS therapy.

According to the press release:

This initiates research on how the brain responds to the therapy and could yield insights that one day significantly change the way people with devastating neurological and psychological disorders, such as Parkinson’s disease, essential tremor, dystonia, and treatment-resistant obsessive-compulsive disorder, are treated.

The Activa® PC+S DBS system delivers proven Medtronic DBS Therapy while at the same time sensing and recording electrical activity in key areas of the brain using sensing technology and an adjustable algorithm, which enable the system to gather brain signals at various moments as selected by a physician. Initially, this new technology will be made available to a select group of physicians worldwide for use in clinical studies. These physicians will use the system to map the brain’s responses to Medtronic DBS Therapy and explore applications for the therapy across a range of neurological and psychological conditions.

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