摘要:
A cardiac pacing lead and a method of its use. The lead has an elongated insulative lead body having a distal section formed into a curved configuration appropriate for use in a coronary sinus/cardiac vein of a patient's heart. An active fixation device is located proximal to the distal, curved section of the lead body, which carries an electrode, located along the distal portion of the lead body, spaced from the active fixation device a distance appropriate to locate the electrode adjacent the left atrium or left ventricle of a human heart when the fixation device is located adjacent the ostium of the coronary sinus. The lead is used by advancing the distal portion of the lead through the coronary ostium of the patient's heart and into the coronary sinus/cardiac vein and therefter employing the active fixation device to affix the lead to the patients heart outside of the coronary sinus/cardiac vein.
摘要:
An implantable medical device (IMD) includes a lead status monitoring system. The lead status monitoring system employs a method including the steps of: collecting data sets from a lead impedance source, a stimulation threshold source, and at least one additional source included in the IMD; and processing the data sets to determine if a lead status event has occurred.
摘要:
A delivery catheter includes a pre-formed and resilient heart-wrapping segment. The segment may have a relaxed span that allows the segment to wrap around a left side of a heart from an anterior epicardial surface to a posterior epicardial surface, when the catheter is advanced along the epicardial surface, having been inserted from a sub-xiphoid access site.
摘要:
A medical electrical lead, which may be useful in coupling an implantable medical device, is comprised of a first and second lead. The first lead has a first electrode coupled adjacent a distal end portion thereof. The distal end portion of the first lead is anchorable in the coronary sinus of a patient. The second lead is coupled with and moveable along the first lead. The second lead has a second electrode located thereon wherein the position of the first and second electrodes may be varied relative to one another by movement of the second lead along the first lead. A rubber tip holds the relative position of each electrode.
摘要:
An implantable medical device (IMD) coupled with leads extending to body tissue providing storage of lead related data, monitoring of lead functional status, and indication of lead integrity to the clinician. A lead status monitor (LSM) processes lead related data in a system self test mode and provides a lead status report that identifies and declares conductor/connector issues, insulation issues, and electrode/tissue interface issues indicative of suspected lead related condition mechanisms for each lead employed in the IMD. The LSM operates employing a set of LSM rules that process measured lead impedance values and loss of capture (LOC) values. In a pacing system, particular LSM rules are defined that process periodically determined, pacing pulse characteristic at LOC and bipolar and unipolar lead impedance values that are measured periodically. The lead impedance values are compared to upper and lower limits or trip points of a normal impedance range. Simultaneously, significant changes in lead impedance are detected, and the unipolar impedance value is compared to the bipolar lead impedance value of each lead. Counts of deviations in lead impedances satisfying each LSM rule are maintained. Certain of the lead related condition mechanisms are declared if a count of lead impedance deviations meets a programmed threshold number of such lead impedance deviations within a further programmed number of sequential impedance measurements. Preferably, the pacing pulse strength or voltage at LOC (characterized as LOC_RHEOBASE herein) is periodically determined and compared to a reference LOC_RHEOBASE.
摘要:
A cardiac pacing lead for use in the coronary sinus and coronary veins. The lead is provided with a lead body configured to exhibit a curved configuration along a distal portion thereof, induced to maintain a portion of the curved configuration solely by means of a portion of a polyurethane lead body formed to display the curved configuration and wherein the lead conductor is freely mounted within the segment. The curved configuration includes first and second arcuate segments together providing a single-plane curvature of approximately 180 degrees, separated by a generally straight segment, the first segment having a greater length and greater arc of curvature than the second segment. The lead body encloses a first conductive coil coupled to an electrode mounted to the distal end of the lead body and a second elongated conductive coil is also located within the lead body and extends to a transition point proximal to the distal end of the first coil conductor, the second coil terminating within the lead body and insulated from the exterior of the lead body. The first conductive coil has a generally straight configuration and the distal portion of the second coil is formed to define a curve.
摘要:
A delivery catheter includes a pre-formed and resilient heart-wrapping segment. The segment may have a relaxed span that allows the segment to wrap around a left side of a heart from an anterior epicardial surface to a posterior epicardial surface, when the catheter is advanced along the epicardial surface, having been inserted from a sub-xiphoid access site.
摘要:
A system for monitoring trends in lead impedance includes collecting data from various sources in an implantable medical device system. Lead impedance, non-physiologic sensed events percentage of time in mode switch, results of capture management operation, sensed events, adversion pace counts, refractory sense counts and similar data are used to determine the status of a lead. A set of weighted sum rules are implemented by a software system to process the data and provide displayable information to health care professionals via a programmer. The lead monitoring system includes a patient alert system for patients to seek help in the event a serious lead condition is identified.
摘要:
An implantable lead for establishing electrical contact between a medical device and body tissue, in which an active fixation mechanism secures the lead in place while allowing a distal electrode on the lead to mechanically "float" with respect to the body tissue. In one embodiment, the active fixation mechanism comprises a curved hook disposed on the lead at a point spaced proximally back from the distal end of the lead. The curved hook defines a helix around at least a portion of the lead's circumference. A hollow introducer needle is slidably disposed on the lead. The hollow needle provided with a longitudinal slit in a distal section of is length, such that the distal section of the needle can be advanced over the distal end of the lead, past the fixation hook, which is received in the longitudinal slit. With the needle slid over the distal end of the lead, the needle is stabbed tangentially into an implant site, bringing the fixation hook proximal to the surface of the body tissue. Then, the needle is twisted (bringing about a twisting of the lead), causing the curved fixation hook to pierce and engage the body tissue, securing the lead in place. Then the needle is withdrawn from the body tissue and removed from the lead. In an alternative embodiment, the lead can be placed by an endocardial approach using a flexible cannula with a longitudinally slotted tip.
摘要:
A myocardial pacing lead includes two sets of at least two tines placed to oppose each other. The lead is pressed against the epicardium and is rotated until a rough porous tip abrades the epicardium and allows the tip and the first row of tines to penetrate the myocardium. Excessive penetration and lead migration is prevented by the second row of tines which is mounted backward and just proximal from the first row of tines. The first row of tines anchor on the inside surface of the epicardium which prevents dislodgment. Dacron pads on the second row of tines assures chronic fixation by adhering to the outer surface of the patient's epicardium.