CN212730714U

CN212730714U - Pigtail type quadrupole temporary cardiac pacing electrode lead

Info

Publication number: CN212730714U
Application number: CN202020499490.5U
Authority: CN
Inventors: 吴万里
Original assignee: First Affiliated Hospital of Guangxi Medical University
Current assignee: First Affiliated Hospital of Guangxi Medical University
Priority date: 2020-04-08
Filing date: 2020-04-08
Publication date: 2021-03-19
Anticipated expiration: 2030-04-08

Abstract

The utility model discloses a pigtail type quadrupole temporary cardiac pacing electrode lead, which comprises a lead main body, wherein four mutually insulated guide wires are wrapped in the lead main body; the lead main body mainly comprises a circular section, a straight section and an extension section which are connected in sequence; the round section is formed by curling the head of the lead main body into a round shape, the free end of the round section is the head end of the lead main body, and the free end of the extension section is the tail end of the lead main body; the circular section and the extension section are positioned on the same side of the straight section, one end of the straight section is tangent to the circular section, and the other end of the straight section forms an obtuse angle with the extension section; four electrodes are distributed on the circular section, the four electrodes are respectively connected with four guide wires in the lead main body, and the tail ends of the four guide wires extend out of the free end of the extension section and are respectively connected with four pin type joints. The utility model discloses simple and practical, convenient and fast, reliable and stable and low cost, during the use, send into the right ventricle room with pigtail type quadrupole interim cardiac pacing electrode wire along the venous access, make 1-4 electrodes paste safely, steadily and lean on in the endocardium, do benefit to cardiac pacing.

Description

Pigtail type quadrupole temporary cardiac pacing electrode lead

Technical Field

The utility model belongs to cardiac pacing electrode wire especially relates to a pigtail type quadrupole temporary cardiac pacing electrode wire.

Background

Temporary Cardiac Pacing (TCP) is an emergency and effective measure for treating severe bradycardia, and is also an emergency treatment means for cardiopulmonary resuscitation, and in recent years, the protective application of TCP is increasing in the perioperative period, and TCP has become one of the indispensable medical technologies for hospital rescue. However, the conventional temporary cardiac pacing technology has a relatively outstanding problem, and is usually designed to be bipolar with a smooth cylindrical metal electrode connected to the negative electrode of the pulse generator and a ring electrode connected to the positive electrode of the pulse generator at a distance of 1cm from the head end. A floating electrode lead (bipolar temporary cardiac pacing electrode lead with a balloon) is used beside a bed, and a balloon is arranged between a head electrode and a ring electrode. The floating electrode can fill the head end air sac after being inflated by 1.3ml, and the diameter (about 1cm) of the air sac is larger than the diameter of the vein branch, so that the electrode is not easy to enter the branch vein, can reach the right heart along the blood flow, and can be operated beside a bed without being guided by X rays. They have in common the characteristic that the head is straight and stiff.

When the traditional temporary cardiac pacing electrode lead is used, the cylindrical metal electrode at the head end is inserted into the trabecular myocardium or is attached to the inner membrane of the right ventricle. The advantages are that: is not easy to adhere to the endocardium, can be taken out at any time, and does not damage the intracardiac structure when taken out. Conventional bipolar temporary cardiac pacing electrode electrical leads (including floating electrode leads) suffer from the following disadvantages: 1. the head end is straight and hard, and is inserted into the small cardiac muscle beam, so that the puncturing of cardiac muscle and the filling of pericardium are easy; 2. the head end is smooth and easy to dislocate; 3. when the head end is attached to the endocardium, the head end electrode is easy to slide into a heart cavity due to the heart beating, poor contact is realized, and pacing is unstable; 4. if external chest compression is needed, the heart is easy to puncture; 5. the patient needs to lie in bed and the brake is strict; 6. if the dislocation is repeated, the pacing failure can be life threatening, and the repeated adjustment of the electrodes is susceptible to infection, resulting in infective endocarditis.

For this reason, some alternative techniques have emerged, such as:

1. TCP is performed using a permanent cardiac pacing electrode lead.

The permanent cardiac pacing electrode lead is soft and has good compliance, and needs to be implanted by adopting a cephalic vein, an axillary vein or a subclavian vein path under the guidance of X-ray fluoroscopy, and the head end of the permanent cardiac pacing electrode lead is divided into an active fixing mode and a passive fixing mode. The active mode adopts the mode that the head end is screwed into the cardiac muscle for fixation, and the passive mode adopts the mode that the wing-shaped head end is inserted into the cardiac muscle trabecula for fixation.

Theoretically, the permanent cardiac pacing electrode lead can overcome the defects of easy dislocation, easy perforation, strict activity restriction after operation, need of CCU ward monitoring and the like of the traditional temporary cardiac pacing electrode lead. However, it also has some drawbacks in itself: the material cost of the permanent cardiac pacing electrode lead is high, a permanent cardiac pacing pulse generator with a corresponding model needs to be connected, and the special physician needs to perform fine operation under the guidance of X rays. The new permanent cardiac pacing pulse generator is expensive, and the abandoned permanent cardiac pacing pulse generator with electric quantity is not easy to obtain at any time, and is repeatedly used in human body to involve a series of legal problems of ethics, disinfection, quality and the like, so that the hidden danger of medical dispute exists. In addition, once the implantation time is long, the spiral or wing-shaped head end of the permanent cardiac pacing electrode lead can be adhered to the endocardium, the extraction is troublesome, the catheter chamber needs to be returned again for complex operation, special instruments and skilled specialists are needed for completion, and the risk is high. Thus, it is not desirable to routinely use permanent cardiac pacing electrode leads for an otherwise low cost, simple, quick temporary cardiac pacing technique.

2. External non-invasive temporary cardiac pacing technology.

The technology does not need to puncture blood vessels, does not need perspective guiding equipment, only needs to clean the skin, and only needs to attach a plate electrode to the chest outer cardiac apex part and the cardiac fundus part respectively and connect a multifunctional defibrillator (having the functions of electrocardiographic monitoring, external non-invasive pacing, cardioversion, defibrillation and the like). The disadvantages are that: the multifunctional defibrillator is large in size and inconvenient to carry and transport; the discharge amount is large, which can stimulate skin and muscle and is difficult to use for the patient with conscious mind.

3. Transesophageal temporary cardiac pacing techniques.

The technique does not need to puncture blood vessels, does not need a perspective guiding device, and can place a 4-pole electrode lead through the esophagus to realize temporary pacing of the heart. However, it is prone to gastrointestinal reactions and requires a patient to be immobilized in a recumbent position. The discharge amount of the artificial cardiac muscle is larger than that of the endocardium for pacing, and the patient can experience discomfort such as pain, burning and the like. In addition, it affects the patient's eating and is not suitable for long-term use.

In summary, there are many problems to be solved in both conventional temporary cardiac pacing and related alternative techniques, which limit their widespread use in clinical work.

Disclosure of Invention

The to-be-solved technical problem of the utility model is to provide a simple and practical, convenient and fast, reliable and stable and low cost's interim cardiac pacing electrode wire of pigtail type quadrupole.

In order to solve the technical problem, the utility model discloses a following technical scheme:

a pigtail type quadrupole temporary cardiac pacing electrode lead comprises a lead main body, wherein four mutually insulated guide wires are wrapped in the lead main body; the lead main body mainly comprises a circular section, a straight section and an extension section which are connected in sequence; the round section is formed by curling the head of the lead main body into a round shape, the free end of the round section is the head end of the lead main body, and the free end of the extension section is the tail end of the lead main body; the circular section and the extension section are positioned on the same side of the straight section, one end of the straight section is tangent to the circular section, and the other end of the straight section forms an obtuse angle with the extension section; four electrodes are distributed on the circular section, the four electrodes are respectively connected with four guide wires in the lead main body, and the tail ends of the four guide wires extend out of the free end of the extension section and are respectively connected with four pin type joints.

The other end of the round section is connected with one end of the straight section, and the other end of the straight section is connected with one end of the extending section and forms an angle of 135 degrees.

The four electrodes are respectively an electrode A, an electrode B, an electrode C and an electrode D, and the four pin type joints are respectively an A joint, a B joint, a C joint and a D joint.

The lengths of the circular section and the straight section are both 4 cm; the electrode A, the electrode B, the electrode C and the electrode D are respectively positioned on the lead main body 2cm, 3cm, 4cm and 5cm away from the head end of the lead main body.

The lead body is made of elastic plastic.

The guide wire is a stainless steel guide wire.

The electrode is an annular stainless steel electrode, and the electrode is wrapped on the surface of the lead main body in a turtleback shape.

Aiming at the problems of the current temporary cardiac pacing technology and the electrode lead used by the technology, the inventor designs and manufactures a pigtail type quadrupole temporary cardiac pacing electrode lead which comprises a lead main body, wherein four mutually insulated guide wires are wrapped in the lead main body; the lead main body mainly comprises a circular section, a straight section and an extension section which are connected in sequence; the round section is formed by curling the head of the lead main body into a round shape, the free end of the round section is the head end of the lead main body, and the free end of the extension section is the tail end of the lead main body; the circular section and the extension section are positioned on the same side of the straight section, one end of the straight section is tangent to the circular section, and the other end of the straight section forms an obtuse angle with the extension section; four electrodes are distributed on the circular section, the four electrodes are respectively connected with four guide wires in the lead main body, and the tail ends of the four guide wires extend out of the free end of the extension section and are respectively connected with four pin type joints. The circular section is not easy to enter branches by mistake, does not damage blood vessels, is convenient to push and take out, can be carried out under/without X-ray fluoroscopy, and does not worry about puncturing the heart; the straight section and the extension section form an obtuse angle, so that the direction of the lead is convenient to control and adjust, and the lead is convenient to push to enter the right ventricle through the right atrium and the tricuspid orifice; four electrodes are distributed on the circular section, so that the circular section can be more tightly and effectively electrically connected with the endocardium; the four electrodes are matched with the four connectors, so that various pacing modes can be combined, and the pacing safety can be ensured. The utility model discloses simple and practical, convenient and fast, reliable and stable and low cost, during the use, send into the right ventricle room with pigtail type quadrupole interim cardiac pacing electrode wire along the venous access, make 1-4 electrodes paste safely, steadily and lean on in the endocardium, do benefit to cardiac pacing.

Drawings

Fig. 1 is a schematic structural diagram of the pigtail type quadrupole temporary cardiac pacing electrode lead of the present invention.

Fig. 2 is a schematic diagram of a conventional temporary cardiac pacing electrode lead implanted in the apical portion of the right ventricle.

Fig. 3 is a schematic view of the pigtail-shaped quadrupole temporary cardiac pacing electrode lead implanted in the apex of the right ventricle.

In the figure: 1 circular segment, 2 flat segments, 3 extension segments, 4 electrodes A, 5 electrodes B, 6 electrodes B, 7 electrodes D, 8A joints, 9B joints, 10C joints and 11D joints.

Detailed Description

A, basic structure

As shown in fig. 1, the pigtail-type quadrupole temporary cardiac pacing electrode lead of the present invention comprises a lead main body, wherein four insulated guide wires are wrapped inside the lead main body; the main body of the lead mainly comprises a circular section, a straight section and an extension section which are connected in sequence. The round section is formed by curling the head of the lead main body into a round shape, the free end of the round section is the head end of the lead main body, and the free end of the extension section is the tail end of the lead main body; the circular section and the extension section are positioned on the same side of the straight section, one end of the straight section is tangent to the circular section, and the other end of the straight section forms an obtuse angle with the extension section; four electrodes are distributed on the circular section, the four electrodes are respectively connected with four guide wires in the lead main body, and the tail ends of the four guide wires extend out of the free end of the extension section and are respectively connected with four pin type joints.

Second, design and manufacture

1. The main body of the lead is made of plastic with a hard texture and a high elasticity, and the 2cm (without a metal electrode section) of the head end of the lead is made of plastic with a soft texture and a high elasticity.

2. The head end part of the lead is curled into an elastic round section, and the blunt round and elastic head end with a pig tail configuration ensures that the lead is not easy to insert into branches and puncture blood vessels, the heart and the internal structures thereof when being sent into the right ventricle through the great vein, the right atrium and the tricuspid valve, thereby avoiding the damage of the great vein, the right atrium, the tricuspid valve leaflet, the chordae tendineae and the right ventricle.

3. The front straight section 4cm of the connecting circular section forms an angle (a angle) of 135 degrees with the long axis (extending section) of the whole lead.

4. The tail part of the lead is provided with four pin type electrode joints which are respectively an A joint, a B joint, a C joint and a D joint.

5. 4 annular stainless steel electrodes, namely an electrode A, an electrode B, an electrode C and an electrode D are distributed on the front section of the lead, so that 1-4 electrodes can be stably attached, point contact is changed into linear contact, and the lead is reliable and stable.

6. The ring-shaped stainless steel electrode is wrapped on the surface of the lead in a turtle-back shape, the two sides of the ring-shaped stainless steel electrode are in smooth transition with the lead, the middle part of the ring-shaped stainless steel electrode is slightly bulged, and the ring-shaped stainless steel electrode is easy to contact with the endocardium.

7. The lengths of the circular section and the straight section are both 4 cm; electrode A, electrode B, electrode C, electrode D are located respectively on the wire main part of distance wire main part head end 2cm, 3cm, 4cm, 5cm, specifically do: the first electrode at the upper end of the circle segment is called electrode A, the second electrode at the front end of the circle segment is called electrode B, the third electrode at the lower end of the circle segment is called electrode C, the fourth electrode is located on the straight segment at the distance of C1cm, and the distance between the adjacent electrodes is 1 cm.

8. The 4 electrodes are respectively connected with the corresponding pin-type joint at the tail part through stainless steel guide wires with higher bending strength, and the four guide wires are mutually insulated in the lead.

Third, using method

1. Puncture femoral vein (or axillary vein, subclavian vein and internal jugular vein), and place the vascular sheath.

2. The lead is sent into a pigtail type quadrupolar temporary cardiac pacing electrode lead through a vascular sheath, enters a larger vein such as femoral vein, axillary vein, subclavian vein, internal jugular vein and superior and inferior vena cava, and the head end of the lead is naturally curled into a circle. The big and blunt head end is not easy to enter the branch by mistake and is not easy to damage the blood vessel.

3. Pushing the lead to the right atrium. The direction is adjusted by the bending of the front section of the lead, and the lead enters the right ventricle through the tricuspid orifice.

4. The round section of the lead end is sent to the apex of the heart and embedded into the included angle formed by the ventricular septum and the free wall of the right ventricle, and certain tension is applied forwards, so that the round section electrode of the lead end is tightly attached to the endocardium.

Because the pressure of the left ventricle is far higher than that of the right ventricle, the thickness of the free wall of the left ventricle and the ventricular septum is also larger than that of the free wall of the right ventricle, and the ventricular septum protrudes towards the right ventricle, the included angle formed by the ventricular septum and the free wall of the right ventricle is smaller, the formed apical cavity of the right ventricle is smaller, the circular section at the head end of the lead is not easy to shift after being embedded, and 1-4 electrodes are in good contact with the endocardium.

5. The needle type connector at the tail part is connected with the electrocardiogram monitoring device to obtain an intracavitary electrocardiogram, and the contact condition of each electrode and the endocardium can be judged by observing the intracavitary electrocardiogram.

6. Two electrodes are selected to be connected with the positive electrode and the negative electrode of the pulse generator, and pacing parameters are tested and set for pacing therapy or pacing monitoring. The four electrodes can be combined into a plurality of pacing modes, which is beneficial to ensuring the pacing safety.

7. The extraction lead has no difference with the extraction of the traditional temporary cardiac pacing electrode lead, can be safely extracted at any time and any place, and does not need X-ray fluoroscopy.

8. When the pacing lead needs to be adjusted, the lead can be pushed and rotated lightly beside a bed after disinfection, the electrocardiogram change in the cavity is observed, the direct condition of the electrode and the endocardium is judged, the direct condition is not needed to be carried out under X-ray fluoroscopy, and the heart puncture is not worried about.

9. When emergency chest cardiac compression is needed, the lead does not need to be withdrawn, and the heart is not worried about puncturing. When the external cardiac compression is stopped, the bedside pacing lead adjustment, the pacing treatment or the pacing monitoring can be immediately carried out without sending to the catheter chamber again for implanting the pacing electrode lead under the X-ray fluoroscopy.

10. In an emergency, the operation can be performed without fluoroscopy at the bedside, like implanting a floating electrode lead (a bipolar temporary cardiac pacing electrode lead with a balloon). Puncturing femoral vein, sending into electrode lead, passing through vascular sheath about 11cm, naturally curling the lead head end into round shape, pushing the electrode lead at uniform speed, if encountering resistance, withdrawing the electrode lead slightly and rotating, changing direction and continuing to push. After the electrode lead is pushed to about 35cm, the joints B and A are respectively connected with the cathode and the anode of the pulse generator, the pacing frequency is set to be larger than the self frequency for 15-20 times/minute, and the electrode lead is pushed while pacing. Observing the electrocardiographic monitoring, wherein a wide QRS pacing graph wave prompt electrode crosses the tricuspid valve, and if the QRS wave of the electrocardiogram II lead is upward, the prompt electrode is positioned in the outflow tract of the right ventricle; withdrawing about 4cm and rotatory, propelling movement electrode wire again after changing the direction, observe the heart electrograph II leads QRS wave downwards, the suggestion electrode is located right ventricle heart point portion, propelling movement electrode about 3 ~ 5cm again, observe the intracavity heart electrograph, after the survey parameter is satisfied and stable, the external portion of fixed electrode wire.

Claims

1. A pigtail type quadrupole temporary cardiac pacing electrode lead comprises a lead main body, wherein four mutually insulated guide wires are wrapped in the lead main body; the method is characterized in that: the lead main body mainly comprises a circular section, a straight section and an extension section which are connected in sequence; the round section is formed by curling the head of the lead main body into a round shape, the free end of the round section is the head end of the lead main body, and the free end of the extension section is the tail end of the lead main body; the circular section and the extension section are positioned on the same side of the straight section, one end of the straight section is tangent to the circular section, and the other end of the straight section forms an obtuse angle with the extension section; four electrodes are distributed on the circular section, the four electrodes are respectively connected with four guide wires in the lead main body, and the tail ends of the four guide wires extend out of the free end of the extension section and are respectively connected with four pin type joints.

2. The pigtail quadrupolar temporary cardiac pacing electrode lead of claim 1, wherein: the other end of the circular section is connected with one end of the straight section, and the other end of the straight section is connected with one end of the extending section and forms an angle of 135 degrees.

3. The pigtail quadrupolar temporary cardiac pacing electrode lead of claim 2, wherein: the four electrodes are respectively an electrode A, an electrode B, an electrode C and an electrode D, and the four pin type joints are respectively an A joint, a B joint, a C joint and a D joint.

4. The pigtail quadrupolar temporary cardiac pacing electrode lead of claim 3, wherein: the lengths of the circular section and the straight section are both 4 cm; the electrode A, the electrode B, the electrode C and the electrode D are respectively positioned on the lead main body 2cm, 3cm, 4cm and 5cm away from the head end of the lead main body.

5. The pigtail quadrupolar temporary cardiac pacing electrode lead of claim 4, wherein: the lead body is made of elastic plastic.

6. The pigtail quadrupolar temporary cardiac pacing electrode lead of claim 5, wherein: the guide wire is a stainless steel guide wire.

7. The pigtail quadrupolar temporary cardiac pacing electrode lead of claim 6, wherein: the electrode is an annular stainless steel electrode, and the electrode is wrapped on the surface of the lead main body in a turtle-back shape.