MOTION-BASED OPTIMIZATION FOR PLACEMENT OF CARDIAC STIMULATION ELECTRODES

• US 20090157136A1
• Filed: 02/25/2009
• Published: 06/18/2009
• Est. Priority Date: 02/16/2007
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Coyle, Michael J., Rosenberg, Stuart, Yang, Michael, Ryu, Kyungmoo, Park, Euljoon
• Granted Patent: US 8,155,756 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• 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 2001/0585 Coronary sinus electrodes

Abstract

An exemplary method includes use of a multielectrode device that can help position a cardiac stimulation lead to an optimal site in the heart based at least in part on cardiac motion information acquired via the multielectrode device and one or more pairs of current delivery electrodes that establish potential fields (e.g., for use as a coordinate system). An exemplary multielectrode device may be a multielectrode catheter or a multifilar, electrode-bearing guidewire. Various other exemplary methods, devices, systems, etc., are also disclosed.

Claims

1. A multifilar, electrode-bearing guidewire comprising:

a plurality of filars wherein each filar comprises a connector end, a distal end and a length defined by a distance between the connector end and the distal end, wherein each of the plurality of filars comprises a different length and wherein each of the plurality of filars comprises a distal electrode;

a connector portion formed by the connector ends of the plurality of filars; and

a multielectrode portion formed by the distal electrodes of the plurality of filars wherein the multielectrode portion comprises along its length a successively fewer number of filars according to the different lengths of filars.

2. The multifilar, electrode-bearing guidewire of claim 1 wherein the filars comprise spiral filars.

3. The multifilar, electrode-bearing guidewire of claim 1 wherein each of the distal electrodes comprises a distal end electrode located at the distal end of a respective filar.

4. The multifilar, electrode-bearing guidewire of claim 1 wherein the plurality of filars comprises at least three filars.

5. The multifilar, electrode-bearing guidewire of claim 1 wherein the multielectrode portion comprises varying flexibility along its length as a function of the successively fewer number of filars along its length.

6. The multifilar, electrode-bearing guidewire of claim 1 wherein the multielectrode portion comprises a decreasing diameter along its length as a function of the successively fewer number of filars along its length.

7. The multifilar, electrode-bearing guidewire of claim 1 wherein each of the filars comprises an electrically insulating coating.

8. The multifilar, electrode-bearing guidewire of claim 1 further comprising an electrically insulating body that carries the plurality of filars.

9. The multifilar, electrode-bearing guidewire of claim 1 wherein each of the plurality of filars comprises a plurality of electrodes.

10. A method comprising:

positioning a pair of current-delivery electrodes in contact with a patient'"'"'s body;

advancing a multielectrode-bearing delivery device into the coronary sinus of the patient'"'"'s heart and at least partially into a vein of the left ventricle;

delivering current using the pair of current-delivery electrodes to generate a potential field;

measuring potentials associated with the potential field using at least one electrode of the multielectrode-bearing delivery device;

mapping motion of the multielectrode-bearing delivery device based on the measured potentials;

advancing an electrode-bearing lead along the multielectrode-bearing delivery device;

delivering current using the pair of current-delivery electrodes to generate a potential field;

measuring potentials associated with the potential field using at least one electrode of the electrode-bearing lead;

mapping motion of the electrode-bearing lead based on the measured potentials;

determining the position of the electrode-bearing lead by comparing the mapped motion of the multielectrode-bearing delivery device and the mapped motion of the electrode-bearing lead; and

after determining the position of the electrode-bearing lead, retracting the multielectrode-bearing delivery device while maintaining the position of the electrode-bearing lead.

11. The method of claim 10 wherein the position comprises an optimal position for the electrode-bearing lead.

12. The method of claim 10 wherein the mapping motion of the multielectrode-bearing delivery device comprises mapping motion of an electrode of the multielectrode-bearing delivery device, wherein the mapping motion of the electrode-bearing lead comprises mapping motion of an electrode of the electrode-bearing lead and wherein the determining the position of the electrode-bearing lead comprises comparing the mapped motion of the electrode of the delivery device and the electrode of the lead.

13. The method of claim 10 wherein the determining the position of the electrode-bearing lead occurs without X-ray radiography.

14. The method of claim 10 wherein the position comprises a position determined by mapped motion of the multielectrode-bearing delivery device.

15. The method of claim 10 further comprising delivering stimulation energy using the electrode-bearing lead and mapping motion responsive to the stimulation energy.

16. The method of claim 10 further comprising comparing one or more potentials measured using the multielectrode-bearing delivery device to one or more potentials measured using the electrode-bearing lead.

17. The method of claim 10 further comprising positioning an additional pair of current-delivery electrodes in contact with a patient'"'"'s body wherein the pair of current-delivery electrodes and the additional pair of current-delivery electrodes define a two-dimensional coordinate system;

delivering current using the additional pair of current-delivery electrodes to generate an additional potential field;

measuring additional potentials associated with the additional potential field;

mapping motions of at least one electrode of the multielectrode-bearing delivery device and of at least one electrode of the electrode-bearing lead; and

positioning the electrode-bearing lead by comparing the mapped motions in two dimensions.

18. The method of claim 10 wherein the multielectrode-bearing delivery device is a multifilar, electrode-bearing guidewire that comprises, along its length, a successively fewer number of filars and wherein the multifilar, electrode-bearing guidewire comprises a varying flexibility along its length as a function of the successively fewer number of filars.

19. The method of claim 10 wherein the multielectrode-bearing delivery device is a multielectrode catheter.

20. A system for positioning a multielectrode-bearing delivery device in a vein of the heart, the system comprising:

a multielectrode-bearing delivery device;

an electrode-bearing lead positionable via the multielectrode-bearing delivery device;

at least one pair of current-delivery electrodes to establish a coordinate system in a patient'"'"'s body; and

control logic to call for delivery of current to a pair of the current-delivery electrodes to generate a potential field, to call for measuring potentials associated with the potential field using at least one electrode of the multielectrode-bearing delivery device, to call for mapping motion of the at least one electrode of the multielectrode-bearing delivery device, to call for measuring potentials associated with the potential field using at least one electrode of the electrode-bearing lead, to call for mapping motion of the at least one electrode of the electrode-bearing lead, and to call for comparing mapped motion of at least one electrode of the multielectrode-bearing delivery device and at least one electrode of the electrode-bearing lead, and to output an indicator based at least in part on a comparison of mapped motion.

21. The system of claim 20 wherein the indicator comprises an indicator selected from the group consisting of audible indicators, visual indicators and tactile indicators.

22. The method of claim 20 wherein the multielectrode-bearing delivery device is a multifilar, electrode-bearing guidewire that comprises, along its length, a successively fewer number of filars and wherein the multifilar, electrode-bearing guidewire comprises a varying flexibility along its length as a function of the successively fewer number of filars.

23. The method of claim 20 wherein the multielectrode-bearing delivery device is a multielectrode catheter.

24. The system of claim 20 wherein the mapping motion comprises mapping displacement versus time for a cardiac cycle.

25. The system of claim 20 wherein the comparing mapped motion comprises comparing displacement versus time for an electrode of the multielectrode-bearing delivery device and displacement versus time for an electrode of the electrode-bearing lead.

26. The system of claim 20 wherein the comparing comprises implementing a least squares algorithm.