Lead assembly providing sensing or stimulation of spaced-apart myocardial contact areas

• US 20090088827A1
• Filed: 10/02/2007
• Published: 04/02/2009
• Est. Priority Date: 10/02/2007
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Tockman, Bruce, Liu, Lili
• Application Number:
  US11/906,794
• Publication Number:
  US 20090088827A1
• Time in Patent Office: Days
• US Class Current: 607/123
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0568 with drug delivery
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

Lead assemblies and methods for sensing or stimulating a first myocardial contact area and a second myocardial contact area when implanted are discussed. A lead assembly includes a lead body having at least one preformed biased portion at an intermediate portion thereof and an unbiased portion disposed between the biased portion and the distal end thereof. A first electrode is located at the preformed biased portion and is arranged to provide sensing or stimulation to the first myocardial contact area. A second electrode is located on the lead body distal to, and spaced apart from, the first electrode and is arranged to provide sensing or stimulation to a distinct second myocardial contact area spaced apart from the first myocardial contact area. In an example, the lead assembly includes a second preformed biased portion at the distal end of the lead body. In another example, the lead assembly includes additional electrodes.

Claims

1. A lead assembly comprising:

a lead body extending from a proximal end to a distal end and having an intermediate portion therebetween, the lead body having at least one preformed biased portion at the intermediate portion and an unbiased portion disposed between the biased portion and the distal end;

a connector at the proximal end of the lead body; and

a first electrode and a second electrode, the first electrode located at the preformed biased portion and arranged to provide sensing or stimulation of a first myocardial contact area when implanted, the second electrode located on the lead body distal to, and spaced apart from, the second electrode and arranged to provide sensing or stimulation of a distinct second myocardial contact area spaced apart from the first myocardial contact area when implanted.

2. The lead assembly of claim 1, wherein the first and second electrodes are spaced apart from each other by an amount that is sufficient to avoid phrenic nerve stimulation at one of the first or second electrodes when implanted, when phrenic nerve, diaphragmatic or thoracic muscle stimulation is observed at the other of the first or second electrodes under otherwise similar pacing conditions.

3. The lead assembly of claim 1, comprising a second preformed biased portion at the distal end of the lead body, the second preformed biased portion including a preformed radius of curvature constructed and arranged to urge at least one electrode thereon toward a myocardial wall when implanted.

4. The lead assembly of claim 1, comprising at least a third electrode located on the lead body near the second electrode, the second and third electrodes forming a distal bipolar electrode pair to sense or stimulate the second myocardial contact area.

5. The lead assembly of claim 1, comprising at least a fourth electrode located on the at least one biased portion, the first and fourth electrodes forming an intermediate bipolar electrode pair to sense or stimulate the first myocardial contact area.

6. The lead assembly of claim 1, comprising a drug eluting region located adjacent one or both of the first and second electrodes, the drug eluting region constructed and arranged to provide a drug to the first or second myocardial contact areas.

7. The lead assembly of claim 1, comprising at least a third and a fourth electrode located on the at least one biased portion.

8. The lead assembly of claim 7, comprising at least a fifth electrode located on the lead body near the second electrode.

9. The lead assembly of claim 1, wherein the at least one preformed biased portion includes a preformed three-dimensional bias constructed and arranged to urge at least one electrode thereon toward a myocardial wall.

10. The lead assembly of claim 1, wherein the at least one preformed biased portion includes a preformed two-dimensional bias constructed and arranged to urge at least one electrode thereon toward a myocardial wall.

11. The lead assembly of claim 1, wherein the second electrode is spaced at least between 1 cm and 3 cm from the first electrode.

12. The lead assembly of claim 1, wherein the second electrode is spaced at least between 3 cm and 6 cm from the first electrode.

13. The lead assembly of claim 1, wherein a cross-sectional size of the lead body is between about 4 Fr and 6 Fr.

14. A method comprising:

accessing a lead body having at least one preformed biased portion at an intermediate portion thereof and an unbiased portion disposed distal to the preformed biased portion, including accessing a first electrode that is located at the preformed biased portion against a first myocardial contact area adjacent a first portion of a coronary vessel and accessing a second electrode that is located on the lead body distal to, and spaced apart from, the first electrode against a wall of a second myocardial contact area adjacent a second portion of the vessel, the first and second myocardial contact areas providing distinct myocardial sensing or stimulation contact areas; and

using at least one of the first and second electrodes for sensing or electrostimulation.

15. The method of claim 14, comprising selectively communicating at least one electrical pacing signal with one of the first or second myocardial contact areas.

16. The method of claim 15, comprising avoiding phrenic nerve stimulation at one of the first or second electrodes when phrenic nerve, diaphragmatic or thoracic muscle stimulation is observed at the other of the first or second electrodes under otherwise similar pacing conditions.

17. The method of claim 15, comprising avoiding a high stimulation threshold at one of the first or second electrodes when a high stimulation threshold is observed at the other of the first or second electrodes under otherwise similar pacing conditions.

18. The method of claim 15, comprising sequentially pacing the first myocardial contact area and the second myocardial contact area.

19. The method of claim 14, comprising accessing a third electrode that is urged against the wall of the second myocardial contact area.

20. The method of claim 19, wherein accessing the second and third electrodes comprises accessing second and third electrodes that are urged against the wall of the second myocardial contact area by allowing a distally positioned preformed radius of curvature to assume its preformed shape.

21. The method of claim 19, wherein accessing the second and third electrodes comprises accessing the second and third electrodes that are urged against the wall of the second myocardial contact area by wedging the second and third electrodes into the second portion of the vessel.

22. The method of claim 14, comprising accessing a fourth electrode that is urged against the wall of the first myocardial contact area.

23. The method of claim 14, comprising inserting the lead body into the coronary vessel includes inserting a stylet into a lead body lumen;

and guiding the stylet through a vessel intersecting the first and second myocardial contact areas.

24. The method of claim 14, wherein accessing the first electrode that is urged against the wall of the first myocardial contact area and accessing the second electrode that is urged against the wall of the second myocardial contact area includes accessing the same vessel branch with the first electrode and the second electrode.

25. The method of claim 14, wherein accessing the first electrode that is urged against the wall of the first myocardial contact area and accessing the second electrode that is urged against the wall of the second myocardial contact area includes accessing a first vessel branch with the first electrode and accessing a second vessel branch with the second electrode,

the second vessel branch oriented at an acute angle to the first vessel branch.