WO2007117359A2 - Sonde-electrode de stimulation de l'oreillette gauche pour sinus coronaire - Google Patents

Sonde-electrode de stimulation de l'oreillette gauche pour sinus coronaire Download PDF

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Publication number
WO2007117359A2
WO2007117359A2 PCT/US2007/004390 US2007004390W WO2007117359A2 WO 2007117359 A2 WO2007117359 A2 WO 2007117359A2 US 2007004390 W US2007004390 W US 2007004390W WO 2007117359 A2 WO2007117359 A2 WO 2007117359A2
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WIPO (PCT)
Prior art keywords
lead
coronary sinus
pacing
loop structure
fixation element
Prior art date
Application number
PCT/US2007/004390
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English (en)
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WO2007117359A3 (fr
Inventor
Seth J. Worley
Original Assignee
Worley Seth J
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Priority claimed from US11/358,644 external-priority patent/US20060276869A1/en
Application filed by Worley Seth J filed Critical Worley Seth J
Publication of WO2007117359A2 publication Critical patent/WO2007117359A2/fr
Publication of WO2007117359A3 publication Critical patent/WO2007117359A3/fr

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Classifications

    • 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
    • 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
    • A61N2001/0585—Coronary sinus electrodes

Definitions

  • the present invention relates generally to pacing leads. More particularly, the present invention relates to pacing leads for stable pacing of the left atrium through the coronary sinus.
  • Pacing to the left atrium is important for successful bi-atrial pacing.
  • the pacing to the left atrium is usually accomplished by placing a pacing lead into the coronary sinus, which is a venous structure accessible through the right atrium of the heart and serves to drain the coronary veins.
  • the coronary sinus is a curved, generally tubular structure typically having a lesser radius of curvature (the inner side of the curved tube) and a greater radius of curvature (the outer side of the curved tube).
  • the coronary sinus is generally wider at its ostium and tapers inwardly away from the ostium towards the distal portions of the coronary sinus.
  • the ostium of the coronary sinus is located at the juncture of the right atrium and the right ventricle.
  • a pacing lead can be positioned so that an electrode contacts the wall of the coronary sinus closest to the left atrium. Because the coronary sinus is in electrical contact with the left atrium, by pacing the coronary sinus at this position, one can also pace the left atrium.
  • the pacing lead generally is advanced to the ostium of the coronary sinus through the right atrium portion of the right heart.
  • electrodes on the pacing lead should be in constant electrical conductive contact with the wall of the coronary sinus, preferably the left atrial side of the coronary sinus. Conductivity is preferably sufficient so as to enable a pacing voltage of 3 volts or less.
  • leads have been used in which a body of the lead is pre-formed to have a sinusoidal or helical configuration enabling the lead to expand into contact with the walls of the coronary sinus and retain the lead. Examples of such pre-formed coronary sinus leads are disclosed in U.S. Patent Nos. 5,423,865 to Bowald et al. and 5,476,498 to Ayers.
  • Pacing leads 20 generally include a proximal lead portion 21 with a first curved portion 22, a second curved portion 24, a tip electrode 26, and additional electrodes 28 longitudinally disposed relative to proximal lead portion 21.
  • a sheath and straightening stylet or guidewire is used to insert the lead 20 tip first into a coronary sinus. Once the sheath and lead 20 are within the coronary sinus, the sheath is removed and the lead 20 resiliently flexes toward its pre-formed shape.
  • the pre-formed "J" in the lead 20 can cause the tip 26 to be pressed up against the wall of the coronary sinus as depicted in Figs. Ic and Id, but only if the width of the pre-formed pacing lead 20 is greater than that of the coronary sinus.
  • the tip and other electodes may not be in an optimal geometric relationship with the wall of the coronary sinus, since the lead cannot fully assume its preformed shape.
  • the biasing force exerted by the lead has both a laterally directed component, annotated as Fi in the figures, and a longitudinally directed component, annotated as F 2 in the figures.
  • the longitudinally directed component of the biasing force tends to urge the lead longitudinally backward in the coronary sinus toward the ostium, thereby reducing lead stability.
  • the lead When the coronary sinus is wider than the pacing lead 20, the lead may assume a loop shape longitudinally disposed relative to proximal lead portion 21 as depicted in Figs. Ib, Ie and If.
  • the longitudinally directed component of the biasing force F 2 is generally relatively less due to the contact of the lead with the coronary sinus wall laterally opposite the tip 26, but the resilience of the lead may provide little or no laterally directed biasing force Fi for good electrical conductivity, and in some cases the tip electrode can lose contact with the wall of the coronary sinus altogether. This can lead to higher voltage requirements, greater instability and higher pacing and sensing thresholds.
  • pacing leads 30 that can be used to pace the left atrium through the coronary sinus, such as the Medtronic Attain® Bipolar OTW Lead Model No. 4194 and leads as disclosed in U.S. Patent No. 5,683,445 to Swoyer, both of which are incorporated herein by reference.
  • the pacing lead 30 generally includes a first curved portion 32, a second curved portion 34, and a tip electrode 36. As depicted in Fig. 2, the angle 31 at the first curve 32 is greater than ninety degrees. Again, a sheath and stylet are used to insert the lead 30 tip first into a coronary sinus.
  • the sheath and lead 30 are within the coronary sinus, the sheath and stylet are removed and the lead 30 takes its pre-formed shape, enabling the tip electrode 36 to contact the walls of the coronary sinus if the diameter of the coronary sinus is less than the width of the pre-formed shape of the lead.
  • using these leads to pace the coronary sinus presents the same problems inherent with the leads according to Morris et al. as described above.
  • the present inventor has recognized that prior art leads and fixation methods provide a success rate of 60% or less when used to pace the left atrium via the coronary sinus. Hence, there is still a need for a lead and fixation method assuring stable pacing of the left atrium through the coronary sinus. Because the general problems discussed above have not been addressed by conventional pacing leads, there is a current need for pacing leads addressing the problems and deficiencies inherent with conventional designs.
  • the pacing lead of the various embodiments of the present invention substantially addresses the aforementioned problems of conventional designs by providing lead shapes and methods of pacing lead deployment that assure that the electrodes of the lead are firmly in electrical conductive contact with the wall of the coronary sinus so as to enable pacing voltages of 3 volts or less.
  • the improved pacing is accomplished because as the lead is advanced into the coronary sinus, a resilient fixation element preformed in a prolapsed position so as to be laterally adjacent the lead body, is laterally compressed by the walls of the coronary sinus as it is advanced into the coronary sinus.
  • the resilience of the fixation element biases the lead body and portions of the fixation element against the wall of the coronary sinus, thereby improving electrical conductivity between the coronary sinus wall and electrodes disposed on the lead body or on the biased portions of the fixation element.
  • the prolapsed fixation element insures that the tip electrode is fixed relative to the coronary sinus closest to the left atrium, thus resulting in lower pacing voltages and thresholds and higher pacing stability.
  • the lead has a pacing portion and a resilient fixation element extending distally from the pacing portion.
  • the pacing portion includes a proximal electrode and a distal electrode.
  • the fixation element is preformed so as to be doubled-back or prolapsed along the pacing portion, forming a loop structure.
  • the width dimension of the preformed loop structure is predetermined so as to be larger than the diameter of the coronary sinus.
  • the electrodes of the pacing portion are biased against the wall of the coronary sinus (lesser curvature) where the left atrium is in proximity to the coronary sinus because the pacing lead proximal to the fixation element conforms naturally to the lesser curvature of the coronary sinus.
  • a pacing lead for implantation in a coronary sinus having an opening and a wall defining an interior and presenting a diameter dimension
  • an elongated lead body having a pacing portion with at least one electrode and a resilient fixation element.
  • the fixation element extends from the pacing portion and defines a loop structure laterally adjacent the pacing portion.
  • the loop structure presents a predetermined width dimension greater than the diameter dimension of the coronary sinus, wherein when the loop structure is advanced into the opening of the coronary sinus, the loop structure is laterally compressed by the wall of the coronary sinus and the at least one electrode is biased against the wall of the coronary sinus.
  • a pacing lead having a lead body with a resilient fixation element extending from a distal end thereof.
  • the resilient fixation element is preformed in a prolapsed configuration so as to form a loop laterally adjacent the lead body.
  • the prolapsed form of the fixation element is deployed with the lead positioned outside of the ostium of the coronary sinus.
  • the fixation element is then advanced into the coronary sinus so that the loop structure of the fixation element is laterally compressed by the wall of the coronary sinus, thereby biasing electrodes on the lead body or fixation element against the wall of the coronary sinus.
  • a feature and advantage of an embodiment of the invention is that the left atrium can be paced by directing the tip electrode towards the left atrium side of the coronary sinus.
  • a feature and advantage of an embodiment of the invention is that assuring constant contact between the lead electrodes and the walls of the coronary sinus can increase the stability of the fixation and pacing.
  • a feature and advantage of an embodiment of the invention is that the design of the pacing lead enables use on various sized coronary sinuses without sacrificing stability or pacing/sensing thresholds.
  • a feature and advantage of an embodiment of the invention is a method of pacing lead deployment assuring constant contact between the lead electrodes and the walls of the coronary sinus.
  • a feature and advantage of an embodiment of the invention is that the left atrium can be paced by biasing one or more lead electrode against the wall of the coronary sinus using a resilient fixation element of the lead.
  • a feature and advantage of an embodiment of the invention is that the resilient fixation element of the lead may or may not contain electrodes for sensing and pacing the left atrium via the coronary sinus.
  • Fig. Ia is a fragmentary elevational view of a prior art coronary sinus pacing lead
  • Fig. Ib-If are fragmentary cross-sectional views of a coronary sinus depicting prior art coronary sinus pacing leads being inserted into the coronary sinus;
  • Fig. 2 is a fragmentary elevational view of a prior art left- ventricle pacing lead
  • Fig. 3 is a fragmentary elevational view of a coronary sinus pacing lead according to an embodiment of the present invention
  • Fig. 4 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention prior to being inserted into the coronary sinus;
  • Fig. 5 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention being inserted into the coronary sinus
  • Fig. 6 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention inserted into the coronary sinus
  • Fig. 7 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention inserted into the coronary sinus;
  • Fig. 8 is a fragmentary elevation view of a coronary sinus pacing lead according to an embodiment of the present invention.
  • Fig. 9 is a fragmentary elevation view of a coronary sinus pacing lead according to an embodiment of the present invention.
  • Fig. 10 is a fragmentary elevation view of a coronary sinus pacing lead according to an embodiment of the present invention
  • Fig. 11 is a fragmentary elevation view of a coronary sinus pacing lead according to an embodiment of the present invention.
  • Fig. 12 is a fragmentary cross-sectional view of the coronary sinus lead of Fig. 8, taken along a longitudinal axis of the lead;
  • Fig. 13 is a fragmentary cross-sectional view of the coronary sinus lead of Fig. 9, taken along a longitudinal axis of the lead;
  • Fig. 14 is a fragmentary cross-sectional view of the coronary sinus lead of Fig. 10, taken along a longitudinal axis of the lead;
  • Fig. 15 is a fragmentary elevation view of the coronary sinus pacing lead according to an embodiment of the present invention
  • Fig. 16 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention in a straightened orientation in a sheath prior to being inserted into the coronary sinus;
  • Fig. 16a is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention in an alternative prolapsed orientation in a sheath prior to being inserted into the coronary sinus;
  • Fig. 17 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention being inserted into the coronary sinus;
  • Fig. 18 is a fragmentary cross-sectional view of a coronary sinus depicting a coronary sinus pacing lead according to an embodiment of the present invention inserted into the coronary sinus.
  • a pacing lead 40 generally includes a proximal lead portion 42 presenting a lead axis 42a terminating in the fixation element 43 of the pacing lead at a first or proximal curve 44 having a first angle 46, a second or distal curve 50 having a second angle 52, and a tip 57 with a tip electrode 56 and presenting a longitudinal lead tip axis 57a.
  • Lead 40 is preformed in a prolapsed configuration, with fixation element 43 doubled back so as to be laterally adjacent proximal lead portion 42 forming a loop structure 57a.
  • a first section 48 is generally defined between the first and second curves 44, 50 and a second section 54 is generally defined between the second curve 50 and the tip electrode 56.
  • the pacing lead 40 may also include additional curves and sections disposed between the first and second curves.
  • the pacing lead 40 can also include additional curves and sections disposed between the tip of the pacing lead and the second curve.
  • Fixation element 43 can also be configured in a continuous curve with a variety of radius arcs.
  • Pacing leads are generally known in the art and are disclosed in U.S. Patent Nos. 6,321,123 to Morris et al. and 5,683,445 to Swoyer, both of which are incorporated herein by reference in their entirety.
  • the pacing lead 40 can also include one or more electrodes 58 disposed at any desired point on the proximal lead portion 42 or fixation element 43.
  • the pacing lead 40 can further include a stylet 60 slidably disposed in the lead to initially straighten the preformed shape and which then may be withdrawn to the start of the fixation element to enable the preformed shape to develop and to selectively maintain the stiffness of the pacing lead 40 as the lead 40 is advanced into and positioned within the coronary sinus.
  • the shape of tip electrode 56 may be modified as desired, for example by maximizing contact surface area, to enable better contact with the wall of the coronary sinus and resultantly better performance.
  • the respective lengths of the first and second sections 48, 54 and the first and second angles 46, 52 between the first and second sections 48, 54 of the pacing lead 40 can be selected so that the tip electrode 56 will be in constant contact with the left atrial wall of the coronary sinus, i.e., to maximize contact between the tip electrode 46 and the left atrial wall of the coronary sinus.
  • the overall length L and width W of the first and second sections 48, 54 can also be selected so that the tip electrode 56 will be in constant contact with the left atrial wall of the coronary sinus.
  • the dimensions of the pacing lead according to exemplary embodiments of the present invention can be seen in Table I.
  • the width of the pacing lead is preferably from about 10% to 200% greater than the diameter of the coronary sinus, more preferably from about 25% to about 75% greater than the diameter of the coronary sinus, and most preferably about 50% greater than the diameter of the coronary sinus for stability and good electrical contact.
  • Table I Pacing lead dimensions according ; to various exemplary embodiments.
  • Second angle* (degrees) 105-165 120 ⁇ 30 120 ⁇ 30 *Pre-formed angle prior to insertion into the coronary sinus.
  • implanting the pacing lead 40 into the coronary sinus can be accomplished by first inserting a stylet 60 into the pacing lead 40 and then advancing the pacing lead 40 with stylet 60 towards the ostium of the coronary sinus.
  • Introducers for accessing the coronary sinus of the heart can be seen in U.S. Patent Application Publication Nos. 2003/0208141 Al, 2004/0019359Al, and 2003/0208220A1, each to Worley et al., which are incorporated herein by reference.
  • the implantation can be done using a guide wire supported guiding catheter 62 having a sheath 64 and guide support wire 66.
  • a guide wire supported guiding catheter 62 is disclosed, for example, in U.S. Patent No.
  • pacing lead 40 may be inserted tip first using a sheath and stylet.
  • one end of the guide wire 66 is first inserted deep into the coronary sinus.
  • the other end of the guide wire 66 is operably coupled to the sheath 64 of the guiding catheter 62.
  • the guide wire 66 can then maintain the positioning of the sheath 64 proximate the ostium of the coronary sinus.
  • the stylet 60 of the pacing lead 40 is withdrawn out of the pacing lead 40 to a position proximate the first or proximal bend 44 of the pacing lead 40.
  • the pacing lead 40 can then be advanced out of the sheath 64 to deploy the preformed loop of fixation element 43 while maintaining the stylet 60 at its position proximate the first bend 44 of the lead 40.
  • the stylet 60 is kept at the first bend 44 of the pacing lead 40 while the lead 40 and stylet 60 are advanced into the coronary sinus, proximal bend 44 first.
  • the first angle 46 between the first and second sections 48, 54, in its pre-formed configuration is approximately 120 degrees.
  • the first angle 46 will compress or decrease until the tip electrode 56 comes into contact with the wall of the coronary sinus. Once this happens, the second angle 52 between the first and second sections 48,
  • the walls of the coronary sinus flatten the distal curve 50 as the lead 40 is advanced into the tapering tubular structure of the coronary sinus.
  • the tapering shape of the coronary sinus maximizes the contact between the tip electrode 56 and left atrium side of the coronary sinus.
  • the lead 40 By compressing the proximal and distal curves 44, 50, the lead 40 folds over and the tip electrode 56 is pressed against the left atrial side of the coronary sinus, thus improving the contact between the tip electrode 56 and the wall of the coronary sinus.
  • Contact between the tip electrode 26 and the coronary sinus is maintained as the pacing lead 40 expands to assume its natural, expanded state. The contact results in lower pacing voltages and thresholds and higher pacing stability.
  • the contact also inhibits any movement of the pacing lead 40 due to the heart beating and breathing of the patient once it is in its place within the coronary sinus.
  • the coil or ring electrode 58 also has improved contact with the wall of the coronary sinus, as depicted in Fig. 7.
  • lead 40 generally includes lead body 67 with pacing portion 68 and with fixation element 70 extending distally from lead body 67.
  • Lead body 67 generally includes inner body 72 defining central lumen 74, inner conductor 76 which is electrically coupled with distal electrode 78, inner insulative sheath 80, outer conductor 82 which is electrically coupled with proximal electrode 84, and outer insulative sheath 86.
  • Electrodes 78, 84 may be structured as rings 88 encircling lead 40, may be dorsal protuberances 90, or may be any other suitable structure enabling electrical coupling with the wall of the coronary sinus.
  • Conductors 76, 82 may be coiled wire as commonly used in the art, or may be any other suitable generally flexible conductive structure.
  • Inner body 72 and insulative sheathes 80, 86 may be formed from silicone, polyuretha ⁇ e, or other resilient biocompatible material.
  • fixation element 70 may be integral with inner body 72 of lead body 67.
  • fixation element 70 is preformed with a proximal portion 92 and distal portion 94, which together define a loop structure 96 laterally adjacent lead body 67.
  • Loop structure 96 presents a width dimension, annotated "W" in the figures.
  • proximal portion 92 and distal portion 94 may be generally arcuate in shape or may be generally straight.
  • a straight portion 97 may be interposed between proximal portion 92 and distal curved 94 as depicted in Fig. 11.
  • a short opposite bend 99 may be included between pacing portion 68 and proximal portion 92 to improve electrode contact with the coronary sinus wall when lead 40 is implanted.
  • proximal and distal portions 92, 94 are arcuate as depicted for example in Fig. 12
  • proximal portion 92 desirably subtends an angle ⁇ of at least about 120 degrees and preferably about 180 degrees
  • distal portion 94 subtends an angle of between about 40 and about 90 degrees.
  • proximal and distal portions 92, 94 are generally straight as depicted for example in Fig. 11, proximal portion 92 preferably forms an angle ⁇ with pacing portion 68 of less than 90 degrees.
  • Distal portion 94 preferably forms an angle ⁇ with respect to proximal portion 92 of between about 90 and about 150 degrees.
  • Central lumen 74 may terminate in pacing portion 68 as depicted in Figs. 10 and 14, may extend into fixation element 70, terminating in an aperture 98 leading to the outside surface 100 of the lead as depicted in Figs. 8 and 12, or may extend through to tip 102 as depicted in Figs. 9 and 13. It will be readily appreciated that in the embodiment of Figs. 8 and 12, aperture 98 may be positioned and dimensions so that when fixation element 70 is straightened, aperture 98 is partially or fully closed.
  • lead 40 is packaged with fixation element 70 held straight with a straightening member (not depicted). The straightening member is removed prior to or during insertion of lead 40 to enable fixation element 70 to assume its preformed shape.
  • the lateral biasing force exerted by the resilience of the fixation element is a function of the material properties, the cross-sectional dimension of the fixation element, and the amount of lateral deflection, annotated in the figures as ⁇ Df X of the fixation element.
  • the amount of lateral deflection of the fixation element will vary depending on the diameter of the coronary sinus, and will generally be between about 0.5 centimeters and 12 centimeters, most typically from about 1.5 centimeters to about 6 centimeters. It will be appreciated that the magnitude of lateral biasing force may be predetermined by adjusting the material properties and dimensions of the fixation element using known principles of engineering. Generally, it is desirable if the fixation element provides between about 1 gram to about 30 grams of biasing force and more desirably between about 3 grams to about 10 grams when fixed in the coronary sinus.
  • one end of the guide wire 66 is first inserted deep into the coronary sinus as depicted in Figs. 16 and 16a.
  • the other end of the guide wire 66 is operably coupled to the sheath 64 of the guiding catheter 62.
  • the guide wire 66 can then maintain the positioning of the sheath 64 proximate the ostium of the coronary sinus.
  • Stylet 60 is inserted in central lumen 74 of lead 40 and the lead is advanced into sheath 64 in a straightened orientation as depicted in Fig.16 or alternatively in a prolapsed orientation as depicted in Fig. 16a.
  • lead 40 may be advanced into sheath 64 with guide wire 66 extending through aperture 98 and central lumen 74.
  • central lumen 74 also accommodates stylet 60 to enable lead 40 to be advanced along the guide wire.
  • the stylet 60 of the pacing lead 40 is withdrawn to a position proximate the proximal portion 62 of pacing lead 40.
  • the pacing lead 40 is then deployed out of the sheath 64.
  • the lead 40 and stylet 60 are advanced into the coronary sinus, proximal portion 92 first as depicted in Fig. 17.
  • the loop structure 96 As the pacing lead 40 is inserted into the ostium of the coronary sinus, the loop structure 96, the uncompressed width W of which is greater than the diameter D of the coronary sinus, is compressed laterally in the direction of the arrow by the walls of the coronary sinus.
  • fixation element 70 Once completely in place with fixation element 70 deflected inwardly by an amount ⁇ D fX as depicted in Fig. 18, the deflection of resilient fixation element 70 biases lead body 67 and electrodes 78, 84, against the wall of the coronary sinus.
  • the improved electrode conductive contact resulting from the biasing force applied by fixation element 70 enables lower pacing voltages and thresholds and improves lead stability. The contact also inhibits any movement of the pacing lead 40 due to the heart beating and breathing of the patient once it is in its place within the coronary sinus.
  • a pacing lead according to the invention may take a variety of alternative forms, each including a fixation element prolapsed so as to form a loop structure laterally adjacent a body portion of the lead.
  • the term loop structure includes any lead wherein the lead tip 57a, 102, is doubled back along the lead body and a longitudinal axis extending from the lead tip 57a, 102, parallels or intersects a longitudinal axis of the lead body when the tip and lead body axes are projected onto a common plane parallel to and including the lead body axis.
  • the fixation element forming a loop structure may include a plurality of more or less straight segments angled with respect to each other, or a plurality of curved segments of various radii, a single segment with a more or less continuous curve, or a plurality of straight and curved segments joined together.
  • the fixation element and lead body may be made with any material having suitable engineering and biocompatibility properties.
  • the lead electrodes may take any suitable form including without limitation, coils or rings, and "buttons" or protuberances, and may be positioned on the lead body or the fixation element or any combination thereof. It may be relatively more desirable, however, to locate the electrodes proximal to any relatively sharp angles or bends in the lead so as to avoid fractures in the conductors leading to the electrodes.
  • the pacing lead can be introduced tip-first in the coronary sinus in the conventional fashion.

Abstract

L'invention a pour objet une sonde de stimulation à implanter dans un sinus coronaire, comprenant une ouverture et une paroi qui définit une partie interne et présente un certain diamètre. La sonde comprend un corps allongé, un élément de fixation résistant et au moins une électrode sur le corps de sonde ou l'élément de fixation. L'élément de fixation se déploie à partir de l'unité de stimulation et définit une structure en boucle adjacente latéralement à l'unité de stimulation. La structure en boucle présente une largeur prédéterminée supérieure au diamètre du sinus coronaire, de sorte que, lorsqu'elle est insérée dans l'ouverture de ce dernier, elle se trouve comprimée latéralement par sa paroi contre laquelle l'électrode se trouve poussée.
PCT/US2007/004390 2006-02-21 2007-02-21 Sonde-electrode de stimulation de l'oreillette gauche pour sinus coronaire WO2007117359A2 (fr)

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US11/358,644 2006-02-21
US11/358,644 US20060276869A1 (en) 2005-06-03 2006-02-21 Coronary sinus lead for pacing the left atrium

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US8956352B2 (en) 2010-10-25 2015-02-17 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses having multi-electrode arrays for renal neuromodulation and associated systems and methods
US9084610B2 (en) 2010-10-21 2015-07-21 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses, systems, and methods for renal neuromodulation
US10166069B2 (en) 2014-01-27 2019-01-01 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters having jacketed neuromodulation elements and related devices, systems, and methods
US10188829B2 (en) 2012-10-22 2019-01-29 Medtronic Ardian Luxembourg S.A.R.L. Catheters with enhanced flexibility and associated devices, systems, and methods
US10548663B2 (en) 2013-05-18 2020-02-04 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters with shafts for enhanced flexibility and control and associated devices, systems, and methods
US10736690B2 (en) 2014-04-24 2020-08-11 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters and associated systems and methods

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US9084610B2 (en) 2010-10-21 2015-07-21 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses, systems, and methods for renal neuromodulation
US9636173B2 (en) 2010-10-21 2017-05-02 Medtronic Ardian Luxembourg S.A.R.L. Methods for renal neuromodulation
US9855097B2 (en) 2010-10-21 2018-01-02 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses, systems, and methods for renal neuromodulation
US10342612B2 (en) 2010-10-21 2019-07-09 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses, systems, and methods for renal neuromodulation
US8956352B2 (en) 2010-10-25 2015-02-17 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses having multi-electrode arrays for renal neuromodulation and associated systems and methods
US8998894B2 (en) 2010-10-25 2015-04-07 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses having multi-electrode arrays for renal neuromodulation and associated systems and methods
US8888773B2 (en) 2012-05-11 2014-11-18 Medtronic Ardian Luxembourg S.A.R.L. Multi-electrode catheter assemblies for renal neuromodulation and associated systems and methods
US11147948B2 (en) 2012-10-22 2021-10-19 Medtronic Ardian Luxembourg S.A.R.L. Catheters with enhanced flexibility and associated devices, systems, and methods
US10188829B2 (en) 2012-10-22 2019-01-29 Medtronic Ardian Luxembourg S.A.R.L. Catheters with enhanced flexibility and associated devices, systems, and methods
US10548663B2 (en) 2013-05-18 2020-02-04 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters with shafts for enhanced flexibility and control and associated devices, systems, and methods
US10166069B2 (en) 2014-01-27 2019-01-01 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters having jacketed neuromodulation elements and related devices, systems, and methods
US11154353B2 (en) 2014-01-27 2021-10-26 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters having jacketed neuromodulation elements and related devices, systems, and methods
US10736690B2 (en) 2014-04-24 2020-08-11 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters and associated systems and methods
US11464563B2 (en) 2014-04-24 2022-10-11 Medtronic Ardian Luxembourg S.A.R.L. Neuromodulation catheters and associated systems and methods

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