Cardiac mapping instrument with shapeable electrode

Abstract

An instrument including an elongated shaft and a non-conductive handle is disclosed. The shaft defines a proximal section and a distal section. The distal section forms an electrically conductive tip. Further, the shaft is adapted to be transitionable from a straight state to a first bent state. The shaft is capable of independently maintaining the distinct shapes associated with the straight state and the first bent state. The handle is rigidly coupled to the proximal section of the shaft. The instrument is useful for epicardial pacing and/or mapping of the heart for temporary pacing on a beating heart, for optimizing the placement of ventricular leads for the treatment of patients with congestive heart failure and ventricular dysynchrony and/or for use in surgical ablation procedures.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS [0001] This application is a continuation-in-part of U.S. Ser. No. 10 / 056,807 filed Jan. 25, 2002, the disclosure of which is incorporated herein by reference.FIELD OF THE INVENTION [0002] This invention relates to methods and systems for epicardial pacing and mapping of the heart for temporary pacing on a beating heart, for optimizing the placement of ventricular leads for the treatment of patients with congestive heart failure and ventricular dysynchrony or for use in surgical ablation procedures. More particularly, it relates to a mapping instrument designed to be indifferent to rotational orientation and including a bendable shaft capable of independently maintaining a desired shape. BACKGROUND OF THE INVENTION [0003] The heart includes a number of pathways that are responsible for the propagation of signals necessary to produce continuous, synchronized contractions. Each contraction cycle begins in the right atrium where a sinoatrial node...

AI Technical Summary

Benefits of technology

[0026] Yet another aspect of the present invention relates to a method of performing a left sided epicardial lead placement procedure. The method comprises providing an instrument including an elongated shaft and a handle, the shaft defining a proximal section rigidly coupled to the handle, a distal section forming an electrically conductive tip; positioning the tip through a patient's chest to contact a first area of epicardial tissue of the patient's left ventricle; applying stimulation energy to the patient's right ventricle; recording the time at which a depolarization wave is sensed over the left ventricle following stimulation of the right ventricle; repositioning the tip to contact a second area of epicardial tissue of the patient's left ventricle; reapplying stimulation energy to the patient's right ventricle; recording the time at which the depolarization wave is sensed over the left ventricle following restimulation of the right ventricle; placing an epicardial lead in contact with the area of tissue that had the longest time interval at which the depolarization wave was sensed over the left ventricle following stimulation of the right ventricle. Once the optimal lead location site has been determined, it can visually marked by using adjacent anatomical landmarks. The mapping instrument is removed and an epicardial pacing lead implanted at that site.

Problems solved by technology

Disturbances in the heart's electrical system may lead to various rhythmic problems that can cause the heart to beat irregularly, too fast or too slow.

Patients experiencing atrial fibrillation may suffer from fatigue, activity intolerance, dizziness and even strokes.

While drugs may be the treatment of choice for some patients, drugs typically only mask the symptoms and do not cure the underlying cause.

While relatively non-invasive, catheter-based treatments present certain obstacles to achieving precisely located, complete ablation lesion patterns due to the highly flexible nature of the catheter itself, the confines of the surgical site, etc.

Ablation of PV tissue may cause the PV to shrink or constrict due to the relatively small thickness of tissue formed within a PV.

Because PV's have a relatively small diameter, a stenosis may result due to the ablation procedure.

These structures may be undesirably damaged when ablating within a PV.

Unfortunately, however, the actual lesion pattern formation technique and / or bodily structure may vary from what is expected, so that the curve is less than optimal.

As a result, the electrosurgical instrument design may actually impede convenient use by a surgeon.

While certain advancements have improved overall performance, the accepted practice of imparting a permanent curve or other shape variation into the instrument itself may impede optimal usage during a particular procedure.

Venous anatomy may not allow a transvenous lead to be placed in an optimal location.

These include inability to cannulate the coronary sinus or the desired coronary vein, inability of the lead to properly lodge in the vein or lack of any vein in the preferred location.

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