PACING CATHETER FOR ACCESS TO MULTIPLE VESSELS

• US 20090318991A1
• Filed: 06/15/2009
• Published: 12/24/2009
• Est. Priority Date: 06/19/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Heidner, Matthew C., Eidenschink, Tracee, Tomaschko, Daniel K., Olson, Richard J.
• Granted Patent: US 8,457,738 B2
• Time in Patent Office: Days
• US Class Current: 607/10
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/3625 External stimulators
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

Cardioprotective pacing is applied to prevent and/or reduce cardiac injury associated with myocardial infarction (MI) and revascularization procedure. Pacing pulses are generated from a pacemaker and delivered through a plurality of pacing leads introduced into a patient'"'"'s body through a percutaneous transluminal vascular intervention (PTVI) catheter have a plurality of exit ports. In one embodiment, the exit ports are arranged for the pacing leads to enter multiple specified blood vessels.

Claims

1. A percutaneous transluminal vascular intervention (PTVI) device assembly for use during revascularization of a blood vessel, the PTVI device assembly comprising:

a plurality of pacing leads each including a pacing lead distal end portion and one or more pacing electrodes incorporated onto the pacing lead distal end portion;

a catheter including one or more entry ports and a plurality of exit ports and configured to allow the pacing lead distal end portion of each pacing lead of the plurality of pacing leads to enter an entry port of the one or more entry ports and exit from an exit port of the plurality of exit ports; and

a pacemaker configured to be connected to the pacing lead distal end portions of the plurality of pacing leads, the pacemaker including;

a pacing output circuit configured to deliver pacing pulses through the one or more pacing electrodes; and

a control circuit coupled to the pacing output circuit and configured to execute a cardioprotective pacing protocol specifying one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods, the pacing periods each having a pacing duration during which a plurality of the pacing pulses is timed to be delivered according to a stress augmentation pacing mode to augment myocardial mechanical stress to a level effecting cardioprotection against myocardial injury, the non-pacing periods each having a non-pacing duration during which none of the pacing pulses is timed to be delivered.

2. The PTVI device assembly of claim 1, wherein the catheter comprises:

a catheter proximal end portion;

a catheter distal end portion configured to be placed in the blood vessel; and

an elongate catheter shaft coupled between the catheter proximal end portion and the catheter distal end portion,

wherein the one or more entry ports are at the catheter proximal end portion, and at least one exit port of the plurality of exit ports is at the catheter distal end portion.

3. The PTVI device assembly of claim 2, wherein the pacing leads each comprise:

a pacing lead proximal end portion;

a pacing lead distal end portion including one or more pacing electrodes; and

an elongate pacing lead shaft coupled between the pacing lead proximal end portion and the pacing lead distal end portion.

4. The PTVI device assembly of claim 3, wherein the catheter distal end portion comprises a distal tip including an exit port of the plurality of exit ports.

5. The PTVI device assembly of claim 3, wherein the catheter shaft comprises an exit port of the plurality of exit ports.

6. The PTVI device assembly of claim 3, wherein the catheter comprises a plurality of guiding channels each including a lumen extending within a portion of the catheter shaft and including a proximal opening at an entry port of the one or more entry ports and a distal opening at an exit port of the plurality of exit ports, the guiding channels each configured to allow the pacing lead distal end portion of the each pacing lead of the plurality of pacing leads to pass through.

7. The PTVI device assembly of claim 6, wherein the exit ports are arranged to allow the distal end portions of the pacing leads to enter the blood vessel and one or more blood vessels branching from the blood vessel.

8. The PTVI device assembly of claim 3, comprising a pacemaker configured to be coupled to the plurality of pacing leads, the pacemaker comprising:

a pacing output circuit configured to deliver pacing pulses through the plurality of pacing leads; and

a control circuit coupled to the pacing output circuit and configured to execute a cardioprotective pacing protocol specifying one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods, the pacing periods each having a pacing duration during which a plurality of the pacing pulses is delivered, the non-pacing periods each having a non-pacing duration during which none of the pacing pulses is delivered.

9. A system delivering cardioprotective pacing to a first blood vessel and a second blood vessel during a revascularization procedure, the system comprising:

a first pacing lead including a first distal end portion and a first pacing electrode incorporated onto the first distal end portion;

a second pacing lead including a second distal end portion and a second pacing electrode incorporated onto the second distal end portion; and

a catheter configured to accommodate a portion of the first pacing lead and a portion of the second pacing lead and allow the first distal end portion to exit from the catheter and enter the first blood vessel and the second distal end portion to exit from the catheter and enter the second blood vessel.

10. The system of claim 9, wherein the catheter comprises a first exit port and a second exit port and is configured to allow the first distal end portion to exit from the catheter through the first exit port and the second distal end portion to exit from the catheter through the second exit port.

11. The system of claim 10, wherein the catheter comprises:

a catheter proximal end portion including one or more entry ports;

a catheter distal end portion including at least the first exit port and configured to be placed in the first blood vessel; and

an elongate catheter shaft coupled between the catheter proximal end portion and the catheter distal end portion.

12. The system of claim 11, wherein the catheter shaft comprises at least the second exit port.

13. The system of claim 11, wherein the catheter comprises:

a first guiding channel extending between the catheter proximal end portion and the first exit port and configured to accommodate the portion of the first pacing lead; and

a second guiding channel extending between the catheter proximal end portion and the second exit port and configured to accommodate the portion of the second pacing lead.

14. The system of claim 13, wherein the control circuit is programmed to execute the cardioprotective pacing protocol specifying one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods each having a duration between approximately 10 seconds and 20 minutes.

15. A method for delivering cardioprotective pacing to blood vessels during a revascularization procedure, the method comprising:

providing a percutaneous transluminal vascular intervention (PTVI) device assembly including a catheter and a plurality of pacing leads, the catheter including one or more entry ports and a plurality of exit ports, the pacing leads each including a pacing lead distal end portion introduced into one of the blood vessels by entering an entry port of the one or more entry ports and exiting from an exit port of the plurality of exit ports, the pacing lead distal end portion including one or more pacing electrodes;

delivering pacing pulses through the plurality of pacing leads; and

controlling the delivery of the pacing pulses by executing a cardioprotective pacing protocol specifying one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods, the pacing periods each having a pacing duration during which a plurality of the pacing pulses is timed to be delivered according to a stress augmentation pacing mode to augment myocardial mechanical stress to a level effecting cardioprotection against myocardial injury, the non-pacing periods each having a non-pacing duration during which none of the pacing pulses is timed to be delivered.

16. The method of claim 15, wherein delivering the pacing pulses comprises executing the cardioprotective pacing protocol specifying one or more cardiac protection pacing sequences each including alternating pacing and non-pacing periods each programmed to a duration between approximately 10 seconds and 20 minutes.

17. The method of claim 15, wherein providing the PTVI device assembly comprises introducing the pacing leads into the blood vessels through a plurality of guiding channels each extending in the catheter and coupled between an entry port of the one or more entry ports and an exit port of the plurality of exit ports.

18. The method of claim 15, wherein providing the PTVI device assembly comprises provide a PTVI device assembly including a catheter and a first pacing lead and a second pacing lead, the first pacing lead including a first pacing electrode, the second pacing lead including a second pacing electrode.

19. The method of claim 18, wherein delivering the pacing pulses comprises delivering the pacing pulses through the first pacing electrode placed in a first blood vessel and the second pacing electrode placed in a second blood vessel.

20. The method of claim 19, wherein delivering the pacing pulses comprises delivering the pacing pulses through the first pacing electrode placed in a left anterior descending coronary artery and the second pacing electrode placed in a right coronary artery.

21. The method of claim 19, wherein delivering the pacing pulses to first and second blood vessels comprises delivering the pacing pulses using the first pacing electrode as an anode and the second pacing electrode as the cathode.