Coronary sinus cannula with left ventricle lead and pressure tent
Techniques for biventricular pacing include a rigid shaped stylet approximating curves of a coronary sinus and branch vein. Some techniques include a parasternal coronary sinus cannula comprising an outer sheath and an obturator. The obturator is removeably disposed inside the outer sheath from a device end of the hollow shaft. The obturator includes a flexible stem that fits snugly inside the hollow shaft, a malleable core disposed inside the flexible stem, a tapered tip that extends beyond a cardiac end of the shaft when the obturator is disposed inside the outer sheath, and a sensor for determining properties of the subject in a vicinity of the tapered tip. An optional pressure-seal, such as a tent, connected to suction maintains negative intrepleural pressure for insertion under local anesthesia.
1. A lead for a pacing electrode comprising:
a hollow tube of flexible material open at a proximal end;
a first electrode at a distal end of the hollow tube;
a first electrical conductor that electrically connects the first electrode to the proximal end and that is positioned within the flexible material; and
a shaped stylet of rigid material inside the hollow tube at the distal end and removable through the open proximal end,
wherein the shaped stylet is curved in a first plane to match a curve of a left ventricle portion of coronary sinus and curved in a different second plane to match a curve of a branch vein of the coronary sinus.
2. A lead as recited in claim 1 , further comprising:
a second electrode at the distal end of the hollow tube and spaced apart from the first electrode; and
a second electrical conductor that electrically connects the second electrode to the proximal end and that is positioned within the flexible material apart from the first electrical conductor.
3. A lead as recited in claim 1 , wherein the proximal end is configured to be releasably connected physically and electrically to a pacing signal generator.
4. A lead as recited in claim 1 , wherein the distal end is configured to hook into a wall of the branch vein when the shaped stylet is retracted through the open proximal end.
5. A lead as recited in claim 1 , wherein the hollow tube and first electrode have a diameter less than an inner diameter of a coronary sinus cardioplegia cannula catheter.
6. A lead as recited in claim 1 , wherein the hollow tube and first electrode and the second electrode have a diameter less than an inner diameter of a cardioplegia cannula catheter.
7. A lead as recited in claim 1 , further comprising at the distal end a probe for a guidance system for at least one of an X-ray fluoroscope guidance system, an echocardiography guidance system, an electrical guidance system, a thermography guidance system, or a radio frequency identification (RFID) guidance system.
8. A kit for a lead for a pacing electrode comprising:
a hollow tube of flexible material open at a proximal end;
a first electrode at a distal end of the hollow tube;
a first electrical conductor that electrically connects the first electrode to the proximal end; and
a shaped stylet of rigid material for insertion and removal through the hollow proximal end to position in the hollow tube at the distal end,
wherein the shaped stylet is curved in a first plane to match a curve of a left ventricle portion of coronary sinus and curved in a different second plane to match a curve of a branch vein of the coronary sinus.
9. A method for placing a left ventricle pacing electrode, comprising:
inserting a coronary sinus cannula catheter through an orifice from a right atrium to a coronary sinus;
feeding a distal end of a left ventricle lead that includes a shaped stylet in a hollow tube through the coronary sinus cannula catheter into the coronary sinus and a branch vein of the coronary sinus;
removing the coronary sinus cannula catheter; and
retracting the shaped stylus,
wherein the left ventricle lead comprises:
the hollow tube made of flexible material and open at a proximal end,
a first electrode at a distal end of the hollow tube;
a first electrical conductor that electrically connects the first electrode to the proximal end and that is positioned within the flexible material; and
the shaped stylet of rigid material inside the hollow tube at the cardiac distal end and removable through the open proximal end, wherein the shaped stylet is curved in a first plane to match a curve of a left ventricle portion of the coronary sinus and curved in a different second plane to match a curve of the branch vein of the coronary sinus.
10. A method as recited in claim 9 , wherein inserting the coronary sinus cannula catheter further comprises first performing a parasternal medial sternotomy to gain access to the chest cavity and then inserting the coronary sinus cannula catheter into the right atrium.
11. A method as recited in claim 9 , wherein inserting the coronary sinus cannula catheter comprises inserting a cardioplegia cannula catheter during open heart surgery.
12. A method as recited in claim 9 , further comprising physically and electrically connecting the proximal end of the lead to a biventricular pacing (BiVP) signal source after removing the coronary sinus cannula catheter.
13. A method as recited in claim 12 , further comprising performing biventricular pacing.
14. A method as recited in claim 13 , further comprising retracting the LV lead after performing temporary biventricular pacing.