Methods, devices and systems for cardiac rhythm management using an electrode arrangement
Various embodiments of the present invention are directed to systems, methods and devices for cardiac applications. One such device is directed to a catheter, and uses thereof, for capturing myocardium of a heart by delivering pacing signals to a location in the heart. The location is near a His Bundle of the heart. The catheter has a proximal end for interfacing with an electrical pacing signal source and a distal end. The distal end includes a fixation mechanism that attaches the catheter to heart tissue. First and second electrodes are also located at the distal end. Each electrode is individually addressable for providing pacing signals to the heart tissue and also arranged to physically contact the heart tissue when the fixation mechanism is attached to the heart tissue.
1. A method for delivering electrostimulation pulses to a heart using a catheter, the method comprising:
within a right ventricle of the heart, placing a first electrode facing outward from the distal end of the catheter in physical contact with a septal wall at or near a His Bundle of the heart by attaching the catheter to heart tissue; and
generating at least partially concurrent opposite polarity electrostimulation pulses for delivery at respective electrodes, including at least the first electrode and a second electrode, the electrostimulation pulses sufficient to capture the myocardium of the heart.
2. The method of claim 1 , wherein attaching the catheter to heart tissue comprises affixing the catheter to the septal wall using a tine.
3. The method of claim 2 , wherein attaching the catheter to heart tissue comprises affixing the catheter to the septal wall using a tine which extends from the distal end of the catheter.
4. The method of claim 1 , including extending one or more of the first and second electrodes outward in a longitudinal direction from the distal end of the catheter.
5. The method of claim 4 , wherein one of the first or second electrodes comprises a conductive tine configured to extend from the distal end of the catheter, and wherein attaching the catheter to heart tissue comprises affixing the catheter to the septal wall using the conductive tine.
6. The method of claim 5 , wherein the conductive tine includes a helical shape.
7. The method of claim 5 , wherein the conductive tine includes a coating comprising a material configured to modify the surface of the conductive tine to increase one or more of a porosity or a surface area.
8. The catheter of claim 1 , wherein the first and second electrodes are arranged facing laterally outward from the catheter.
9. The method of claim 1 , wherein the catheter includes a third electrode located between a distal and a proximal end of the catheter.
10. The method of claim 1 , wherein the catheter includes an anti-inflammatory delivery device located near the distal end, and wherein the method comprises administering an anti-inflammatory agent from the delivery device.
11. The method of claim 1 , wherein at least one of the electrodes includes a nanostructure.
12. The method of claim 1 , wherein at least one of the electrodes includes a scored surface.
13. The method of claim 1 , comprising sensing electrical activity of the heart using at least one electrode.
14. The method of claim 1 , wherein the method comprises determining a location for attachment to heart tissue to provide increased heart function in response to the electrostimulation pulses including:
delivering the electrostimulation pulses to a candidate location;
in response, detecting one or more of QRS width narrowing, an electrogram fractionation improvement, an earlier activation of a late activation site, or an improved mechanical function of the heart; and
attaching the catheter to the heart tissue at the candidate location.
15. The method of claim 1 , comprising monitoring a function of the heart and in response, adjusting one or more parameters of the electrostimulation pulses.
16. The method of claim 15 , wherein adjusting the electrostimulation pulses comprises shifting an overlap duration of the concurrent electrostimulation pulses.