Intraseptal multi-electrode cardiac pacemaker and methods of use thereof
An intraseptal multi-electrode cardiac pacemaker has a plurality of first individual electrodes implanted at an interventricular septum at varying depths and/or lateral distances from the distal end of a flexible conduit and configured to provide a cardiac pacing therapy by stimulating left bundle branch conduction fibers. A plurality of second individual electrodes may also be implanted in the septum at suitable depths to stimulate conduction fibers of the right bundle branch. After implantation, first and second individual electrodes are interrogated to select a subset of electrodes suitable to deliver the pacing therapy according to a predetermined criterion such as capturing the left ventricle or capturing the right ventricle via normal conduction system of the heart at the lowest voltage level via corresponding bundle branches. A combination of the pacemaker with a cardioverter/defibrillator is provided by positioning a defibrillator coil near the distal end of the flexible conduit of the pacemaker.
1. A method of providing intraseptal cardiac pacing comprising the steps of:
a. providing a flexible conduit housing a plurality of first individual electrical wires extending therethrough and terminating with a corresponding plurality of first individual electrodes extending from a distal end of said flexible conduit,
b. advancing said flexible conduit through a right atrium and into a right ventricle to position said distal end thereof at an interventricular septum,
c. deploying said plurality of first individual electrodes at a predetermined first distance into said interventricular septum, said predetermined first distance is selected to cause said plurality of first individual electrodes to operably reach left bundle branch conduction fibers inside said interventricular septum,
d. interrogating said plurality of first individual electrodes to determine a subset thereof meeting a first predetermined acceptance criterion, and
e. initiating said intraseptal cardiac pacing using at least some of said first individual electrodes of said subset of first individual electrodes meeting said predetermined acceptance criterion, wherein said at least some first individual electrodes are connected to a cardiac pacemaker.
2. The method as in claim 1 , wherein said first predetermined acceptance criterion in step (d) is capture of conduction system fibers located within said interventricular septum.
3. The method as in claim 2 , wherein in step (e) said subset of first individual electrodes is further stratified based on a lowest voltage threshold necessary for achieving said capture of conduction system fibers located within said interventricular septum.
4. The method as in claim 1 further comprising a step (f) of leaving remaining first individual electrodes in a passive state implanted in said interventricular septum.
5. The method as in claim 1 , wherein said step (f) further including a step of re-evaluating at least some of said first individual electrodes for meeting said first predetermined acceptance criterion and changing said subset of selected first individual electrodes when a malfunction of the previously selected first electrodes is detected.
6. The method as in claim 1 , wherein in step (c) said plurality of first individual electrodes are deployed into said interventricular septum to operably reach said left bundle conduction fibers distally of a bifurcation of His Bundle conduction fibers into said left bundle branch conduction fibers and a right bundle branch conduction fibers.
7. The method as in claim 6 , wherein in step (a) said flexible conduit further housing a plurality of second individual electrical wires extending therethrough and terminating with a corresponding plurality of second individual electrodes extending from a distal end of said flexible conduit, said step (c) further comprising deploying said plurality of second individual electrodes at a predetermined second distance into said interventricular septum, said predetermined second distance is selected to cause said plurality of second individual electrodes to operably reach said right bundle branch conduction fibers inside said interventricular septum.
8. The method as in claim 7 , wherein step (d) further comprising interrogating said plurality of second individual electrodes to determine a subset thereof meeting a second predetermined acceptance criterion.
9. The method as in claim 6 , wherein in step (a) said flexible conduit further comprises a defibrillator coil at said distal end thereof, said method further comprising a step of activating said defibrillator coil to apply a suitable shock upon meeting a predetermined shock criterion.