JP4103506B2 - Probe electrode - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a stimulation probe electrode for a left ventricle that can be inserted into and inserted into a coronary sinus.
[0002]
[Prior art]
In general, in postoperative management after cardiac surgery (open surgery), blood and exudate in the pericardium are drained out of the body and electrodes are attached to the heart to prevent cardiac arrhythmia and fibrillation. So-called pacing is performed in which the heart is stimulated using an external cardiac pacemaker disposed outside the body. In this case, as an attachment method for attaching an electrode to the heart, there are generally a method for attaching an electrode to the epicardium and a method for inserting and fixing the electrode to the endocardium. When using the latter method, it is easy to implant an endocardial probe that passes through the right peripheral venous system into the right ventricle, whereas it is important to insert and fix the probe in the left ventricular sinus chamber. Is associated with a serious surgical risk, specifically, the risk of air bubbles being transported to blood vessels in the brain located downstream of the left ventricle. For this reason, it has been attempted to access the coronary sinus system via the right atrium and insert the probe into the coronary sinus system with an electrode disposed on the opposite side of the left ventricle.
[0003]
Conventionally, a catheter having appropriate rigidity is inserted into the superior vena cava and sent to the coronary sinus ostium, or sent to the inside of the coronary sinus, and the probe in the catheter is further inserted from that position into the venous branch. The function when the electrode is set at that position is inspected.
[0004]
[Problems to be solved by the invention]
In order to insert the probe into the endocardium through the coronary sinus and electrically access the left atrium, the probe requires that it can be easily inserted into the coronary sinus and that the intima of the coronary sinus is not damaged. Is done. In particular, when inserting and inserting a probe into and from multiple vein branches in the coronary sinus to find the optimal vein branch that can stimulate the heart with low electricity, the probe enters the coronary sinus. Since there are a plurality of main vein branches that can be used, it is necessary to insert / insert a probe into each of these vein branches. It is necessary to be able to perform this insertion / extraction operation smoothly and not to damage the vascular intima, and in order to search for the optimum position, it is necessary to make sufficient electrical contact with the endocardium of the venous branch. It must be detectable.
[0005]
In other words, the probe needs to satisfy both the ability to insert and insert without damaging the intima and the ability to detect in electrical contact with the intima.
[0006]
And when using it only as a probe, or when using it as temporary pacing, it is necessary to pull out a probe, and it is necessary to pull out smoothly without damaging an inner membrane in that case.
[0007]
However, most current electrodes are designed to attach to the inner surface of the heart chamber rather than the inner surface of the blood vessel. For example, leads are known that use electrodes that terminate in a spiral projection designed to screw into myocardial tissue. However, since this spiral is attached to the end of the electrode, it is difficult to attach the electrode to the blood vessel wall running parallel to the lead wire. In another example, some electrodes include barbed tines that protrude radially from the electrodes. These tines are often used to retain electrodes in blood vessels, but they often block a significant portion of the blood flow through the blood vessels. In such a case, blood flow through the blood vessel is limited.
[0008]
A lead wire having a sealed end is also known. There are also certain difficulties associated with this lead being placed in the coronary sinus or one of its branches. In addition to possible venous occlusion, current leads are implanted by simultaneous manipulation of the lead and a stylet disposed within the lead. The diameter of such leads is beginning to approach the diameter of the coronary sinus or its branches. That is, it is difficult to place such a lead wire in an appropriate position by operating a stylet disposed therein. The implantation procedure becomes even more difficult if there are emboli or other obstructions in the coronary sinus or its branches.
[0009]
The present invention is directed to overcoming, or at least reducing the effects of, one or more of the above-mentioned difficulties. Thus, an object of the present invention is to provide a probe electrode having a suitable shape for electrical connection to the left atrium through the coronary sinus.
[0010]
[Means for Solving the Problems]
In order to achieve the above object, a first aspect of the present invention is a catheter that can be inserted into and inserted into a coronary sinus ostium of a heart, and a heart configured to be placed in the coronary sinus ostium through the catheter. A lead electrode for an intimal electrode, wherein the lead is used when searching for an optimum position for applying electrical stimulation to the heart and is configured to be withdrawn after the search. A first apex formed so as to project in one direction perpendicular to the axis of the lead, and a part receding in the axial direction of the lead from the first apex, perpendicular to the axis A second apex formed so as to protrude in the other direction, and a portion that extends from the second apex in the axial direction of the lead so as to project in one direction orthogonal to the axis 3 Formed with the top of the th Is, the first, endocardial electrode terminals on the second and third top is configurations that are respectively formed, one of the plurality of terminals with the insertion-挿出operations on coronary sinus can be easily Since the terminal can contact the endocardium, detection defects can be greatly reduced.
[0011]
Also, at least two top portions may be formed on the left and right sides, and the electrode terminals may be formed on the respective top portions. By doing so, any one of the plurality of terminals is placed in the endocardium. The possibility of contact is high, and the detection accuracy is improved.
[0012]
Further, the top portion may be formed in four directions, and the electrode terminals may be formed on the respective top portions . In this way , any one of a plurality of terminals may contact the endocardium. Is higher, and the detection accuracy is further improved.
[0013]
According to a second aspect of the invention, the probe electrode according to claim 1, first, second and third top has a flat surface section, since the conductive terminal is formed on the flat surface portion, a plurality of terminals There is a high possibility that any one of the terminals contacts the endocardium, the detection accuracy is further improved, and the endocardium is hardly damaged.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
[0015]
FIG. 1 is a cross-sectional view of a heart 1, in which a plurality of blood vessels in the heart 1 are shown. In the figure, reference numeral 3 indicates the right atrium, reference numeral 4 indicates the left atrium, reference numeral 5 indicates the right ventricle, and reference numeral 6 indicates the left ventricle. The catheter 20 introduced through the superior vena cava 2 passes through the right atrium 3 and is guided to the coronary sinus ostium 8. In some cases, it is guided to the inside of the coronary sinus 7. The endocardial lead 11 is inserted into the catheter 20. The endocardial lead 11 is provided with a wiring in which a flexible conducting wire is covered with a resin, and the tip of the conducting wire protrudes from the resin to form a probe electrode 10 as shown in FIG.
[0016]
The tip portion of the probe electrode 10 includes a zigzag portion 12 formed in a zigzag manner. The zigzag portion 12 is provided with a first apex portion at a position retracted 10 mm from the tip, and second, third and fourth apexes are formed separately on the left and right at a position retracted by a predetermined interval. That is, the first and third apexes are formed so as to be separated from the axis of the endocardial lead 11 in one direction orthogonal to the axis, and the second and fourth apexes are orthogonal to the coaxial line. It is formed to leave in the direction. Each top portion includes an inclined portion and a flat surface portion, and the electrode terminal 13 is provided on the flat surface portion.
[0017]
Since the zigzag portion 12 is formed in this manner and the electrode terminal 13 is provided on the flat surface portion, at the time of inspection, at least one of the electrode terminals 13 provided on the flat surface portion is in contact with the endocardium, and electrical conduction Check accuracy in the state is greatly improved. Further, since the zigzag portion 12 is formed by the inclined portion and the flat surface portion, it can be smoothly operated even when the electrode terminal 13 is inserted into and inserted into the vein branch, and it is effective to damage the intima. Can be prevented.
[0018]
In this embodiment, the top part of the zigzag part 12 is provided in two places on the left and right, and a total of four places are provided. In addition, although the top part was formed so that it might be two places each on the right and left, the top part is formed in one place on each side, that is, the top part is orthogonal to the axis line from the axis of the endocardial lead 11 4 The zigzag portion 12 may be formed three-dimensionally so as to be separated from each other in one direction.
[0019]
3 to 5 are views for explaining a state in which the endocardial lead 11 is inserted into the catheter 20 and the probe electrode 10 is exposed from the distal end of the catheter 20.
[0020]
FIG. 3 shows a state before the endocardial lead 11 is inserted into the catheter 20. FIG. 4 shows a state in which the endocardial lead 11 is inserted from one lumen of the catheter 20. FIG. 5 shows a state in which the probe electrode 10 provided on the endocardial lead 11 is viewed from the distal end of the catheter 20.
[0021]
The operating state will be described. With the endocardial lead 11 inserted into the catheter 20, the catheter 20 is inserted into the superior vena cava and guided through the right atrium 3 to the coronary sinus ostium 8. Then, the probe electrode 10 of the endocardial lead 11 in the catheter 20 is sent out, and the probe electrode 10 is inserted into the coronary sinus 7. Then, it is further inserted into the first vein branch 9.
[0022]
In some cases, the resin coating of the catheter 20 or the endocardial lead 11 is guided to the inside of the coronary sinus 7 so that the probe electrode 10 is exposed and inserted further into the coronary sinus 7. It may be.
[0023]
When the electrode terminal 13 of the probe electrode 10 contacts the intima of the vein branch 9, the state of the fibrillation prevention function is checked when electricity is applied at this location. A place suitable for setting the probe itself (or a place suitable for setting an electrode for cardiac pacing), that is, a place suitable for stimulating the heart to prevent cardiac arrhythmia and fibrillation. explore. Specifically, if the first vein branch 9a does not provide a good result, the probe electrode is temporarily retracted and sent to the next vein branch 9b, where it is examined. This is repeated for each vein branch 9a, 9b, 9c, 9d... To determine the most effective place. Then, pull the needle electrode 10 probe is inserted and fixed separately new electrode pin.
[0024]
【The invention's effect】
The present invention includes a catheter that can be inserted into and removed from the coronary sinus ostium of the heart, and an endocardial electrode lead configured to be placed in the coronary sinus ostium through the catheter , Since the endocardial electrode terminals are formed on the second and third apexes, the endocardial electrode terminals are easily in contact with the endocardium, and the inspection accuracy is improved.
[0025]
In particular, in the case where the top of the probe electrode is formed on a flat surface portion and the electrode terminal is formed on the flat surface portion, the inspection accuracy is high and damage to the endocardium can be reduced as much as possible.
[Brief description of the drawings]
FIG. 1 shows a cross-sectional view of the heart.
FIG. 2 shows a probe electrode according to an embodiment of the present invention.
FIG. 3 shows an endocardial lead of the present invention and a catheter for inserting the lead.
4 shows a state in which the endocardial lead of FIG. 3 is inserted into a catheter.
5 shows a state in which a probe electrode is pushed out from the distal end of the catheter in FIG.
[Explanation of symbols]
1 heart 2 superior vena cava 3 right atrium 4 left atrium 5 right ventricle 6 left ventricle 7 coronary sinus 8 coronary sinus port 9 vein branch 10 probe electrode 11 endocardial lead 12 zigzag portion 13 electrode terminal 20 catheter

Claims (2)

A catheter that can be inserted into and removed from the coronary sinus ostium of the heart, and an endocardial electrode lead configured to be placed in the coronary sinus ostium through the catheter;
The lead is a probe electrode that is used when searching for an optimal position for applying electrical stimulation to the heart and is configured to be withdrawn after the search,
On the tip side of the lead,
A first top formed to project in one direction perpendicular to the axis of the lead;
A second top portion formed so as to protrude in the other direction orthogonal to the axis line at a portion retracted in the axial direction of the lead from the first top portion;
A third top portion formed so as to protrude in one direction orthogonal to the axial line is formed at a portion retracted from the second top portion in the axial direction of the lead,
A probe electrode characterized in that an endocardial electrode terminal is formed on each of the first, second and third apexes. In the probe electrode according to claim 1, first, second and third top has a flat surface portion, the probe electrode, characterized in that the terminal conductive to the flat surface portion is formed.

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