Pacing guidewire
View Patent ↗Guidewires and methods for transmitting electrical stimuli to a heart and for guiding and supporting the delivery of elongate treatment devices within the heart are disclosed. A guidewire can comprise an elongate body, including first and second elongate conductors, and at least first and second electrodes. A distal end portion of the elongate body can include a preformed bias shape, such as a pigtail-shaped region, on which the first and second electrodes can be located. The preformed bias shape can optionally be non-coplanar relative to an intermediate portion of the elongate body. The first and second elongate conductors can be formed of a single structure or two or more electrically connected structures. The conductors can extend from proximal end portions to distal end portions that electrically connect to the first and second electrodes. A corewire can extend the length of the elongate body, can at least partially form the first conductor, and can be at least partially surrounded by the second conductor.
1. A method, comprising:
advancing a distal end portion of a bipolar pacing guidewire into a left ventricle of a patient's heart, including positioning first and second electrodes against or spaced from a left ventricular wall;
transmitting electrical stimuli through the guidewire to the first and second electrodes to induce and maintain cardiac ventricular tachycardia; and
performing a valve treatment procedure on the heart while it is maintained by the electrical stimuli in a state of ventricular tachycardia.
2. The method of claim 1 , wherein advancing the distal end portion of the bipolar pacing guidewire into the left ventricle includes advancing a resiliently deformable, pre-formed curved shape into the left ventricle.
3. The method of claim 2 , wherein the pre-formed curved shape includes a pigtail-shaped region that turns through 540 degrees or more, and wherein the first and second electrodes are spaced apart on the turns.
4. The method of claim 1 , wherein positioning the first and second electrodes includes positioning the first electrode a spaced distance from the ventricular wall and positioning the second electrode against the ventricular wall.
5. The method of claim 4 , wherein the first electrode is an anode and the second electrode is a cathode.
6. The method of claim 1 , wherein positioning the first and second electrodes includes positioning the first electrode against a ventricular wall on a first side of a ventricular apex and positioning the second electrode against a ventricular wall on a second side of the ventricular apex.
7. The method of claim 1 , wherein transmitting electrical stimuli through the guidewire to the first and second electrodes includes transmitting electrical stimuli through a first elongate conductor electrically connected to the first electrode and transmitting electrode stimuli through a second elongate conductor electrically connected to the second electrode.
8. The method of claim 7 , wherein transmitting electrical stimuli through the first elongate conductor includes transmitting electrical stimuli through a corewire and a helical coil.
9. The method of claim 7 , wherein transmitting electrical stimuli through the second elongate conductor includes transmitting electrical stimuli through a hypotube or a braid and a helical coil.
10. The method of claim 1 , wherein transmitting electrical stimuli to the first and second electrodes includes generating a current flow of 4.0 mA or less between the electrodes.
11. The method of claim 10 , wherein transmitting electrical stimuli to the first and second electrodes includes generating a current flow of 3.0 mA or less between the electrodes.
12. The method of claim 1 , wherein inducing and maintaining cardiac ventricular tachycardia includes inducing ventricular rates of 120-220 bpm and lowering the patient's blood pressure.
13. The method of claim 1 , wherein performing the valve treatment procedure includes:
delivering a balloon catheter over the pacing guidewire until a dilatation balloon, at a distal end portion of the balloon catheter, is positioned within a native aortic valve; and
radially expanding the dilatation balloon into contact with a native heart valve annulus.
14. The method of claim 1 , wherein performing the valve treatment procedure includes:
delivering a balloon catheter over the pacing guidewire until a dilatation balloon, at a distal end portion of the balloon catheter, is positioned within a native aortic valve; and
radially expanding the dilatation balloon to urge a prosthetic heart valve into contact with the native aortic valve.
15. The method of claim 14 , further comprising adjusting the electrical stimuli transmitted through the guidewire once the dilatation balloon is deflated.
16. The method of claim 1 , wherein performing the valve treatment procedure includes:
delivering a balloon catheter over the pacing guidewire until a dilatation balloon, at a distal end portion of the balloon catheter, is positioned within a native mitral valve; and
radially expanding the dilatation balloon to urge a prosthetic heart valve into contact with the native mitral valve.
17. The method of claim 1 , further comprising:
sensing an electrophysiological response to the electrical stimuli transmitted through the guidewire; and
adjusting the transmitted electrical stimuli through the guidewire based on the electrophysiological response.
18. The method of claim 17 , wherein sensing the electrophysiological response includes sensing if less than a 1:1 capture of the left ventricle exists.
19. The method of claim 17 , wherein sensing the electrophysiological response includes sensing the patient's systolic blood pressure or pulse pressure.
20. The method of claim 17 , wherein adjusting the transmitted electrical stimuli includes increasing the electrical stimuli transmitted through the guidewire if the patient's systolic blood pressure is less than 70 mmHg or the pulse pressure is less than 20 mmHg.
21. The method of claim 1 , further comprising removably coupling a connector body to a proximal end portion of the bipolar pacing guidewire, including electrically coupling first and second terminals of the connector body to first and second elongate conductors respectively associated with the first and second electrodes.
22. The method of claim 21 , wherein removably coupling the connector body to the proximal end portion of the bipolar pacing guidewire includes preventing shorting between the first and second elongate conductors.