Devices and methods for steering electrical stimulation in cardiac rhythm management
First Claim
1. An apparatus comprising:
- a catheter arrangement configured for use in capturing myocardium of a heart of a patient, the catheter arrangement comprising;
a fixation mechanism configured to attach the catheter arrangement to heart tissue at a target region that is at or near the His bundle of the heart on a portion of the right ventricular septum that is distal to an apex of the right ventricle of the heart;
at least two individually-addressable electrodes configured to provide electrostimulation signals to the heart tissue; and
an elongated structure configured to direct and to support the fixation mechanism and the individually-addressable electrodes at the target region that is at or near the His bundle of the heart on a portion of the right ventricular septum that is distal to an apex of the right ventricle of the heart; and
a pulse generation circuit electrically coupled to the at least two individually-addressable electrodes and configured to generate electrostimulation signals for delivery to different portions within the target region using the at least two individually-addressable electrodes;
wherein the pulse generation circuit is configured to change the electrostimulation signal from being delivered in a first mode to being delivered in a second mode when the fixation mechanism has been attached to the heart tissue at the target region.
1 Assignment
0 Petitions
Accused Products
Abstract
Tools and methods are particularly suited for certain cardiac conditions involving use of a catheter for pacing of the right and left ventricles from a lead in the right ventricle, e.g., to facilitate mechanically and/or electrically synchronous contractions for resynchronization. Certain aspects involve pacing and/or mapping by delivering pulses to a cardiac site useful for improving heart function as measured, e.g., by QRS width, fractionation, late LV activation timing, mechanical synchronicity of free wall and septal wall, effective throughput/pressure, or a combination thereof. In one embodiment, a catheter arrangement includes a fixation mechanism to attach the catheter arrangement to heart tissue, individually-addressable electrodes for providing pacing signals to the heart tissue, and an elongated structure that supports the fixation mechanism and the electrodes. The elongated structure is used to direct an end thereof to the target region in the right ventricle, and deliver an electrical pacing signal to different portions within the target region of the heart when the fixation mechanism is operative to attach to heart tissue and also when the fixation mechanism is not attaching the catheter arrangement to heart tissue.
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Citations
20 Claims
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1. An apparatus comprising:
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a catheter arrangement configured for use in capturing myocardium of a heart of a patient, the catheter arrangement comprising; a fixation mechanism configured to attach the catheter arrangement to heart tissue at a target region that is at or near the His bundle of the heart on a portion of the right ventricular septum that is distal to an apex of the right ventricle of the heart; at least two individually-addressable electrodes configured to provide electrostimulation signals to the heart tissue; and an elongated structure configured to direct and to support the fixation mechanism and the individually-addressable electrodes at the target region that is at or near the His bundle of the heart on a portion of the right ventricular septum that is distal to an apex of the right ventricle of the heart; and a pulse generation circuit electrically coupled to the at least two individually-addressable electrodes and configured to generate electrostimulation signals for delivery to different portions within the target region using the at least two individually-addressable electrodes; wherein the pulse generation circuit is configured to change the electrostimulation signal from being delivered in a first mode to being delivered in a second mode when the fixation mechanism has been attached to the heart tissue at the target region. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method comprising:
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placing at least a first electrode at a location at or near a His bundle of a heart on a portion of a right ventricular septum that is distal to an apex of the right ventricle of the heart; providing an electrostimulation using the first electrode to stimulate the right ventricle and a left ventricle of the heart for synchronous contraction of the right and left ventricles using at least the first electrode; determining that a pacing threshold voltage has increased; and responsive to determining that the pacing voltage threshold has increased, adjusting an electrostimulation pulse duration; wherein the placement of the first electrode is defined by improving, relative to intrinsic activity, a QRS width of the patient. - View Dependent Claims (14, 15)
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16. A method comprising:
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placing at least a first electrode at a location at or near a His bundle of a heart on a portion of a right ventricular septum that is distal to an apex of the right ventricle of the heart; providing an electrostimulation using the first electrode to stimulate the right ventricle and a left ventricle of the heart for synchronous contraction of the right and left ventricles using at least the first electrode; identifying a pacing threshold voltage change; and in response to the identifying the pacing threshold voltage change, adjusting a duration of an electrostimulation pulse; wherein the placement of the at least a first electrode is defined by one of improving, relative to intrinsic activity, a QRS width of the patient, a fractionation of the patient, and a timing of electrical stimulation of a late activation site of the left ventricle relative to the QRS. - View Dependent Claims (17, 18, 19, 20)
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Specification