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Delivery catheter

a technology for medical electrical leads and catheters, which is applied in the direction of catheters, intravenous devices, etc., can solve the problems of ineffective pacing, inability to deliver electrical signals, and inability to meet the needs of patients,

Inactive Publication Date: 2007-08-30
WILLIAMS TERRELL M +1
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

However, pacing from a right atrial appendage, the typical pacing location in the right atrium, is ineffective if conduction between the right atrium and ventricles is blocked, for example at the AV node of the right atrium.
Ventricular pacing at an apex of the right ventricle is typically employed to bypass such a block, but recent studies have put forth the proposition that problems may arise from pacing at the right ventricular apex because an electrical impulse traveling from the apex moves contrary to the heart's natural conduction pathways.
Existing catheters are not well suited for delivery of an electrical lead to the bundle of His, requiring protracted procedures to reach the desired location.
The length of the procedure results in prolonged periods of time in an operating suit causing increased expense and difficulty for the patient as well as greater radiation exposure to the patient.
In addition, existing catheters, to the extent they are able to deliver a lead to the His bundle, are generally parallel to the heart surface when they reach the location, making it more difficult to deliver and attach a lead to the underlying cardiac tissue.

Method used

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Examples

Experimental program
Comparison scheme
Effect test

case 1

[0059] A femoral EP mapping / ablation catheter was inserted through a femoral vein and positioned to record a His potential and serve as a fluoroscopic reference. His sensing and pacing were achieved in 5 minutes and 30 seconds, during which there were two interruptions. The HG catheter did not appear within the flouro field as expected. Moving the patient revealed that the catheter tip was in the internal jugular vein. The second delay was the result of pausing to find a working channel for the EP amplifier and setting up the required alligator clip cable.

[0060] His sensing and pacing were accomplished, but without taking threshold measurements.

case 2

[0061] The Cath Lab was not available, so the His pacing procedure was done without use of either the EP amplifier or the mapping catheter fluoroscopic reference.

[0062] Final lead His lead placement was achieved in 13 minutes, 33 seconds, including several lead placements. A His potential was first recorded at 3 minutes and 56 seconds.

[0063] The final His pacing threshold was 2.2 v @ 0.5 ms pw. Dr. Yee reported direct His pacing in this patient.

case 3

[0064] Based on the results of Case 2, Dr. Yee decided not to use the mapping catheter, from below, nor the EP amplifier. He used the Medtronic 2090 analyzer only. The first two attempts resulted in atrial capture, and the third His pacing.

[0065] Final His lead placement was achieved in 8 minutes, 59 seconds. Dr. Yee wrote “If it were not for the desire to record and document things several times over, including taking pictures, we probably could have achieved His pacing in <5 min.”

[0066] The final His pacing threshold was 0.7 v @ 0.5 ms pw, direct His pacing was achieved.

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Abstract

A catheter used to deliver a medical electrical lead to a right atrium of a heart in close proximity to a His bundle. The catheter is adapted such that the distal tip confronts the His bundle generally perpendicularly. The catheter includes a proximal portion and a generally hook-shaped distal portion. The distal portion may include curves that direct the distal tip at an angle of over 180 degrees from the direction of the proximal portion.

Description

[0001] This application is a continuation-in-part of U.S. patent application Ser. No. 11 / 273,978 filed on Nov. 15, 2005, entitled DELIVERY CATHETER.BACKGROUND OF THE INVENTION [0002] The present invention is related to the delivery of medical electrical leads and more particularly to catheter delivery of such leads to a site in a right atrium of a heart in close proximity to the His bundle. [0003] Various types of medical electrical leads have been developed for endocardial introduction into different chambers of a patient's heart. These flexible leads, various constructions of which are well known in the art, may be delivered using accessory tools, for example a stylet passing through a lumen of a body of the lead, or a catheter having a lumen through which the lead is passed. [0004] A lead implanted in the right atrium can provide pacing therapy to preserve both atrial-ventricular synchronization and the normal ventricular activation and contraction patterns. However, pacing from ...

Claims

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Application Information

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Patent Type & Authority Applications(United States)
IPC IPC(8): A61M25/00A61M5/00
CPCA61M25/0041
Inventor WILLIAMS, TERRELL M.YEE, RAYMOND
Owner WILLIAMS TERRELL M