Transcoronary sinus pacing system, LV summit pacing, early mitral closure pacing, and methods therefor

• US 9,265,938 B2
• Filed: 01/14/2014
• Issued: 02/23/2016
• Est. Priority Date: 10/03/2006
• Status: Active Grant

• Current Assignee: Vincent Gaudiani
• Original Assignee: Vincent A. Gaudiani
• Inventors: Gaudiani, Vincent A.
• Primary Examiner(s): Stigell, Theodore
• Assistant Examiner(s): Patel, Natasha
• Application Number:
  US14/155,284
• Publication Number:
  US 20140257101A1
• Time in Patent Office: 770 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 6/481 involving the use of contrast agents
• CPC Class Codes: A61B 6/485 involving fluorescence X-ray imaging
• CPC Class Codes: A61B 8/5292 using additional data, e.g. patient information, image labeling, acquisition parameters
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61M 2025/0037 characterized by lumina being arranged side-by-side
• CPC Class Codes: A61M 25/0021 characterised by the form of the tubing A61M25/0054 takes precedence
• CPC Class Codes: A61M 25/0082 Catheter tip comprising a tool
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

A transcoronary sinus pacing system comprising a sheath having a lumen, a pacing catheter having a pacing needle, wherein the catheter can be advanced within the lumen and placed in the LV summit, and a right ventricular pacing device. A LV summit pacing device. An early mitral valve closure pacing device configured to operate with a right ventricular apex pacing device. A method for implanting a pacing device at a target coronary sinus tissue location, wherein the target can be the posterior LV summit. A method for achieving early closure of a mitral valve. A method for using visualization devices such as fluoroscopy or ultrasound and/or catheter features such as a radiopaque marker to locate a target location for LV pacing and to avoid piercing an artery or the pericardium when anchoring the LV pacing electrode.

Claims

1. A method for activating a left ventricular summit, comprising the steps of:

a. introducing a sheath;

b. steering the sheath to a left ventricular summit;

c. lodging a distal end of the sheath beyond the left ventricular summit;

d. advancing a perforating device through a lumen of the sheath to the left ventricular summit;

e. perforating the left ventricular summit with the perforating device;

f. electrically coupling a cardiac stimulation device to cardiac tissue at the left ventricular summit;

g. removing the sheath; and

h. electrically activating the left ventricular summit using the cardiac stimulation device to achieve early closure of a mitral valve during systole.

2. The method of claim 1, further comprising the steps of:

i. advancing a right ventricular pacing catheter to a target location within a right ventricle; and

j. positioning an electrode at the target location within the right ventricle.

3. The method of claim 1, further comprising the steps of obtaining an angiogram;

obtaining a live fluoroscopic image;

correlating the angiogram with live fluoroscopic image; and

analyzing the correlated images to identify anatomical structures.

4. The method of claim 1, further comprising the steps of:

obtaining an angiogram;

obtaining a live intravascular ultrasound;

correlating an angiogram with live intravascular ultrasound; and

analyzing the correlated images to identify anatomical structures.

5. The method of claim 1, wherein the cardiac stimulation device is electrically coupled to the cardiac tissue at the left ventricular summit via the perforating device.

6. The method of claim 1, wherein the cardiac stimulation device is an internal cardioverter and defibrillator (ICD).

7. The method of claim 1, comprising the step of using the cross-sectional shape of the sheath to facilitate steering and perforating.

8. The method of claim 6, wherein the perforating device is a part of the cardiac stimulation device.

9. A method for achieving early closure of a mitral valve, comprising the steps of:

a. introducing a sheath;

b. steering the sheath to a target location within a coronary sinus;

c. advancing a left ventricular perforating device through a lumen of the sheath to the target location within the coronary sinus;

d. perforating the coronary sinus with the left ventricular perforating device;

e. electrically coupling a cardiac stimulation device to cardiac tissue at the target location within the coronary sinus;

f. removing the sheath;

g. delivering electrical energy to cardiac tissue at a right ventricle; and

h. delivering electrical energy to the cardiac tissue at the target location within the coronary sinus by activating the cardiac stimulation device to achieve early closure of the mitral valve during systole.

10. The method of claim 9, comprising the step of correlating an angiogram with live fluoroscopy.

11. The method of claim 9, comprising the step of correlating an angiogram with live intravascular ultrasound.

12. The method of claim 9, wherein the target location within the coronary sinus is a left ventricular pacing summit.

13. The method of claim 9, comprising the step of using the cross-sectional shape of the sheath to facilitate the steering and perforating.