Transvenous intracardiac pacing catheter
The embodiments described herein relate to a self-positioning, quick-deployment low profile transvenous electrode system for sequentially pacing both the atrium and ventricle of the heart in the “dual chamber” mode, and methods for deploying the same.
1. An electrode system connectable to a pacemaker for sequentially pacing both the atrium and ventricle of a human heart comprising:
a plurality of insulated electrical leads comprising a first set of three ventricle leads and a second set of four atrium leads,
an outer catheter sheath disposed over said plurality of leads, the outer catheter sheath being retractable from the ventricle leads to deploy the ventricle leads in the ventricle, each of the ventricle leads having a resiliency and shape to be deployed in contact with the ventricle wall when the sheath is retracted therefrom, the outer catheter sheath also being retractable from the atrium leads to deploy the atrium leads in the atrium, each of the atrium leads having the resiliency and shape to be deployed in contact with the atrium wall when the sheath is retracted,
wherein the ventricle leads are not attachable to the ventricle wall, but are adapted to contact the ventricle wall, and the atrium leads are not attachable to the atrium wall, but are adapted to contact the atrium wall.
2. The electrode system of claim 1 , comprising a first inner sheath disposed over the ventricle leads and a second inner sheath disposed over the atrium leads, the first and second inner sheaths being inside the outer catheter sheath, the outer catheter sheath and first inner sheath being retractable from the ventricle leads to deploy the ventricle leads in the ventricle, each of the ventricle leads having a resiliency and shape to be deployed in contact with the ventricle wall, the outer catheter sheath and second inner sheath being retractable from the atrium leads to deploy the atrium leads in the atrium, each of the atrium leads having the resiliency and shape to be deployed in contact with the atrium wall, wherein the electrode system is withdrawable from the heart so that the atrium leads are returnable to the second inner sheath and the ventricle leads are returnable to the first inner sheath at a location above the SVC-RA junction.
3. A method for quickly deploying a cardiac pacing device to a heart in a patient, comprising:
(i) Providing the system in claim 1 ;
(ii) Accessing a jugular vein in the patient and advancing the catheter sheath under ultrasound or other non-fluoroscopic imaging modality to a right ventricle of the heart of the patient;
(iii) Withdrawing the outer catheter sheath to a first position to deploy the first set of three ventricle leads;
(iv) Withdrawing the outer catheter sheath to a second position to deploy the second set of four atrium leads;
(v) Performing a diagnostic test using the first set of three ventricle leads and the second set of four atrium leads to identify patient cardiac patterns and to validate the operation of the system;
(vi) Performing a cardiac pacing routine appropriate as a treatment for the patient cardiac pattern using the system.
4. The method of claim 3 , wherein performing steps (i)-(iv) are performed in a time period no longer than 30-60 minutes.
5. The electrode system of claim 1 wherein each of said leads has a proximal portion made from wire with radio opaque insulation and a distal portion made from shape memory material.
6. The electrode system of claim 5 wherein each of said leads has a radio opaque tip.
7. The electrode system of claim 6 , wherein when deployed in the ventricle, one of said ventricle leads is central axial lead and two ventricle leads are shape-set at 90 degrees to the central axial lead and are offset 180 degrees from each other in a plane perpendicular to the central axial lead.
8. The electrode system of claim 7 wherein, when connected to a pacemaker, the central axial lead and a second ventricle lead has a signal of a first polarity, and the third ventricle lead has a signal of an opposite polarity.
9. The electrode system of claim 7 wherein, when the atrium leads are deployed in the atrium, the atrium leads are shape-set at 90 degrees to the central axial lead and offset 90 degrees from each other in a plane perpendicular to the central axial lead.
10. The electrode system of claim 9 wherein, when connected to a pacemaker, two of the atrium leads have a signal of a first polarity and two of the atrium leads have a signal of an opposite polarity.
11. A self-positioning, quick-deployment low profile transvenous electrode system for pacing of a heart with a pacemaker, comprising:
a plurality of insulated electrical wires bundled together to form a distal set of three (3) ventricle leads disposed within a first inner sheath, and a proximal set of four (4) atrium leads disposed within a second inner sheath, the first inner sheath and the second inner sheath disposed within an outer steerable catheter sheath,
said outer steerable catheter sheath being movable from said first inner sheath and said second inner sheath once inserted into the heart for deploying the first inner sheath to the ventricle and the second inner sheath to the atrium, said outer steerable catheter sheath being entirely removed from the atrium and ventricle when the transvenous electrode system is engaged,
said first inner sheath being movable to expose the distal set of three (3) ventricle leads to the ventricle, and said second inner sheath being movable to expose the four (4) atrium leads to the atrium, the first inner sheath and the second inner sheath each made from a polymer, wherein the polymer is doped with a radiopaque material to form a radiopaque polymer sheath or is labelled with at least one radiopaque marker element,
each of the ventricular and atrial leads have a proximal body portion, a distal end portion, and a tip portion,
the proximal body portion made from a radiopaque polymer-covered copper wire,
the distal end portion made from shape memory material, the shape memory material selected from stainless steel, spring steel, cobalt-chromium alloy, nickel-titanium alloy, and mixtures thereof, the tip portion made from shape memory material and a radiopaque material, the radiopaque material selected from a barium-containing compound, a bismuth-containing compound, a steel compound, a tungsten-containing compound, and mixtures thereof,
two of the three ventricle leads are shape-set at a 90 degree angle in an expanded configuration, and the two ventricle leads are offset 180 degrees from each other, one of the three ventricle leads is a central axial lead,
each of the four atrium leads are shape-set at a 90 degree angle in an expanded configuration, and each of the four atrium leads are separated 90 degrees from each other,
the steerable catheter sheath is comprised of a distal portion and a proximal portion, and has a distance marker every 10 cm along its entire length,
the distal portion of the steerable catheter sheath is 5 cm in length and has a 0.010″ pitch coil and a biocompatible polymer cover,
the proximal portion of the steerable catheter sheath is 30 cm in length, has a 0.020″ pitch coil, a biocompatible polymer cover, at a proximal end of the proximal portion has a hub element, a Touhy-Borst access connector with a side port, an actuator dial that allows the steerable catheter sheath to be shaped and controlled, a deployment stop, and a cable junction housing,
atrium lead terminals and ventricle lead terminals extend from the cable junction housing to the pacemaker, wherein the pacemaker comprises computer program instructions readable by a processor to provides functions selected from the group consisting of: a diagnostic function, a sensor operation, a stimulation signal, a program for an individual lead for sensing, a program to reduce over-sensing of the ventricular leads by T-waves or other noise or attenuating or interfering signals, a program to reduce over-sensing of the atrium leads by the R-wave, a program to minimize cross-talk, and a program to adjust sensing and stimulation on a lead-by-lead basis;
the atrium leads shape-set to sense and stimulate an SA node area and an AV node area of the heart, the ventricle leads shape set to sense and stimulate a Bundle of His area, an Apex-Purkinje fiber area, and a Free-wall Purkinje area,
each of said ventricular leads connected to a ventricular sensor or stimulator in said pacemaker and each of said atrium leads connected to an atrium sensor or stimulator in said pacemaker.
12. The system of claim 11 , wherein the pacemaker includes two sequential pulse generators that can provide sensing and stimuli for a ventricle and an atrium for sequentially pacing both the atrium and ventricle of a heart in the “dual chamber” mode.
13. The system of claim 12 , wherein the computer program instructions executable by a processor provides one or more functions selected from: decreasing sensitivity of certain leads and increasing sensitivity of other leads during a depolarization cycle (PQRST) allows the invention to increase SNR in the sensing function, decreasing or increasing stimulatory signals to one or more leads allows the invention to more accurately provide stimulation to the AV node, the SA node, the ventricular apex, or other cardiac tissue to provide a level of granularity to the stimulation function, programming leads so that sensing leads are not required to share the function of a shocking/stimulation leads, and bypassing damaged or degraded leads to allow continued functioning without requiring the entire device to be removed from a patient, this increasing the longevity of implanted devices using the inventive technology.
14. The system of claim 11 , wherein the pacemaker includes computer program instructions executable by a processor for performing digital signal processing for the ventricle leads and the atrium leads, wherein the digital signal processing is selected from the group consisting of: multiple input, multiple output (MIMO), single input multiple output (SIMO), single input single output (SISO), and multiple input single output (MISO).
15. An electrode system connectable to a pacemaker for sequentially pacing both the atrium and ventricle of a human heart comprising:
a plurality of insulated electrical leads comprising a first set of ventricle leads and a second set of atrium leads,
an outer catheter sheath disposed over said plurality of leads, the outer catheter sheath being retractable from the ventricle leads to deploy the ventricle leads in the ventricle, each of the ventricle leads having a resiliency and shape to be deployed in contact with the ventricle wall when the outer sheath is retracted therefrom,
the outer catheter sheath also being retractable from the atrium leads to deploy the atrium leads in the atrium, each of the atrium leads having the resiliency and shape to be deployed in contact with the atrium wall when the sheath is retracted,
wherein the ventricle leads are not attachable to the ventricle wall, but are adapted to contact the ventricle wall, and the atrium leads are not attachable to the atrium wall, but are adapted to contact the atrium wall,
the electrode system further comprising a first inner sheath disposed over the ventricle leads and a second inner sheath disposed over the atrium leads, the first and second inner sheaths being inside the outer catheter sheath, the outer catheter sheath and first inner sheath being retractable from the ventricle leads to deploy the ventricle leads in the ventricle, the outer catheter sheath and second inner sheath being retractable from the atrium leads to deploy the atrium leads in the atrium.