Patient-safe electromechanical switching using catheters with multiple electrodes for pacing

Abstract

This invention, entitled "Patient-Safe Electromechanical Switching for Pacing Using a Catheter with Multiple Electrodes," discloses a pacing system comprising a signal generator and an electromechanical switch. The signal generator is configured to generate a pacing signal. The electromechanical switch has multiple outputs configured to be coupled to multiple electrodes inserted into a patient's heart, each output configured to deliver the pacing signal to a corresponding electrode. The electromechanical switch is configured to route the pacing signal to only a single selected output at any given time to pace the heart using only that single selected electrode.

Description

Technical Field

[0001] This invention relates generally to electrophysiological mapping, and more specifically to electromechanical switching for cardiac electrophysiological mapping. Background Technology

[0002] With necessary modifications, invasive techniques used for mapping the electrophysiological properties of cardiac tissue can be applied to the commonly proposed electromechanical switching concept. An example of an electromechanical switch is proposed in U.S. Patent 5,977,499, which describes a linear sliding selector switch for selecting multiple channels between several switching positions. Specifically, there is a housing with a hinged door that rotates to a closed position and is held in the closed position by the spring lock. The housing also includes a slider and a printed circuit board. The printed circuit board has multiple rows of contacts. Contactors are mounted to the slider. When the slider moves linearly, an electrical connection is formed and disconnected on the printed circuit board.

[0003] For example, U.S. Patent 6,421,567 describes an implantable electrode arrangement comprising electrode wires having a plurality of conductive surface regions in the distal end region of the electrode wires for outputting electrical signals to and / or receiving signals from the heart. The electrode arrangement can be electrically connected via the electrode wires to an electrocardiographic device, such as a defibrillator or pacemaker, which receives electrical signals and / or outputs pulses. The electrode arrangement may include switching devices, optionally mechanical switching elements, having an arrangement and configuration such that the connection between the respective conductive surface regions and the electrocardiographic device can be permanently switched on or off in the region of the electrode wires. Summary of the Invention

[0004] Embodiments of the present invention provide a pacing system including a signal generator and an electromechanical switch. The signal generator is configured to generate a pacing signal. The electromechanical switch has a plurality of outputs configured to be coupled to a plurality of electrodes inserted into a patient's heart, each output configured to deliver the pacing signal to a corresponding electrode. The electromechanical switch is configured to route the pacing signal to only a single selected output at any given time, so as to use only the single selected electrode to pace the heart.

[0005] In some embodiments, the electromechanical switch includes: (a) a substrate patterned having a plurality of contacts arranged in an array, each contact in the array being coupled to a corresponding output of the plurality of outputs; (b) a movable switch configured to move over the array of contacts and to establish electrical contact with only one contact at any given time; and (c) a motor configured to move the movable switch.

[0006] In some embodiments, the electromechanical switch further includes a screw configured to be rotated by the motor, and the movable switch of the electromechanical switch is coupled to the screw and configured to move along a linear trajectory above the linear array of contacts when the screw is rotated by the motor.

[0007] In some embodiments, the array of contacts is arranged in a circular configuration, and the movable switch of the electromechanical switch is configured to move along a circular trajectory above the array of contacts.

[0008] In one embodiment, the substrate of the electromechanical switch is made of a printed circuit board (PCB). In another embodiment, the motor of the electromechanical switch includes a stepper motor.

[0009] In one embodiment, the system further includes a processor configured to apply a control loop that adaptively controls the motor to fine-tune the position of the movable switch to optimize the electrical contact between the wheel and the contacts. In another embodiment, the processor is configured to control the motor based on an electrocardiogram (ECG) sensed via electrodes associated with the contacts.

[0010] In some embodiments, the movable switch includes a wheel configured to roll over the array of contacts. In one embodiment, the wheel is made of metal. In another embodiment, the wheel is made of a conductive polymer. In yet another embodiment, the wheel is made of a polymer and has conductive strips disposed thereon.

[0011] In some embodiments, the electromechanical switch includes: (a) a substrate having a plurality of reed switches arranged in an array, wherein each reed switch in the array is coupled to a corresponding output of the plurality of outputs; (b) a movable switch including a magnet configured to move over the array of reed switches and cause only one reed switch to establish electrical contact at any given time; and (c) a motor configured to move the movable switch.

[0012] In some implementations, the pacing system further includes a processor configured to instruct the pacemaker to generate the pacing signal according to a pre-specified pacing protocol and to instruct the electromechanical switch to route the pacing signal.

[0013] In some embodiments, the pacing signal is unipolar. In other embodiments, the pacing signal is bipolar, and the pacing system includes an additional electromechanical switch to form a dual electromechanical switch together with the electromechanical switch. The dual electromechanical switch is configured to route the bipolar pacing signal to only a selected pair of the outputs at any given time in order to bipolarly pace the heart using only the selected pair of electrodes.

[0014] In one embodiment, the dual electromechanical switch includes: (a) a substrate patterned having a plurality of contacts arranged in a first array and a plurality of contacts arranged in a second array, each contact in the first array being coupled to a corresponding output of the plurality of outputs, and wherein each contact in the second array is coupled to a corresponding output of the plurality of outputs; (b) a first movable switch configured to move over the first array of contacts and establish electrical contact with only one contact of the first array at any given time; (c) a second movable switch configured to move over the second array of contacts and establish electrical contact with only one contact of the second array at any given time; and (d) one or more motors configured to move the first movable switch and the second movable switch independently of each other.

[0015] In one embodiment, the first array and the second array of contacts of the dual electromechanical switch are spatially independent. In another embodiment, the first array and the second array of contacts are concentric circular arrays. In one embodiment, the first array and the second array of contacts vertically overlap each other.

[0016] In some embodiments, the dual electromechanical switch includes: (a) a substrate patterned having a plurality of reed switches arranged in a first array and a plurality of reed switches arranged in a second array, wherein each reed switch in the first array is coupled to a corresponding output of the plurality of outputs, and wherein each reed switch in the second array is coupled to a corresponding output of the plurality of outputs; (b) a first movable switch including a magnet configured to move over the first array of reed switches and cause only one reed switch in the first array to establish electrical contact at any given time; (c) a second movable switch including a magnet configured to move over the second array of reed switches and cause only one reed switch in the second array to establish electrical contact individually at any given time; and (d) one or more motors configured to move the first movable switch and the second movable switch independently of each other.

[0017] According to one embodiment of the invention, a method for pacing the heart is further provided, the method comprising generating a pacing signal. An electromechanical switch having a plurality of outputs coupled to a plurality of electrodes inserted into the heart is used, each output configured to deliver the pacing signal to a corresponding electrode, the electromechanical switch being configured to route the pacing signal to only a single selected output of the outputs at any given time, so as to use only the single selected electrode of the electrodes to pace the heart.

[0018] According to one embodiment of the invention, a manufacturing method is also provided, the method comprising patterning a substrate having a plurality of contacts arranged in an array. The invention provides a movable switch configured to move over the array and establish electrical contact with only one contact at any given time. The invention also provides one or more motors configured to move the movable switch.

[0019] According to one embodiment of the invention, a manufacturing method is further provided, the method comprising patterning a substrate having a plurality of contacts arranged in a first array and a plurality of contacts arranged in a second array. The invention provides a first movable switch configured to move above the first array and establish electrical contact with only one contact of the first array at any given time. The invention provides a second movable switch configured to move above the second array and establish electrical contact with only one contact of the second array at any given time. One or more motors are coupled, the one or more motors being configured to move the first movable switch and the second movable switch independently of each other.

[0020] The invention will be more fully understood through the following detailed description of embodiments thereof, taken in conjunction with the accompanying drawings, wherein: Attached Figure Description

[0021] Figure 1 This is a schematic diagram of an electrophysiological (EP) mapping system including concentric electromechanical switches according to an embodiment of the present invention;

[0022] Figures 2A to 2C These are bilinear electromechanical switches according to embodiments of the present invention. Figure 1 A schematic top-view illustration of the layout of concentric circular electromechanical switches and side-by-side circular electromechanical switches;

[0023] Figure 3 According to an embodiment of the present invention Figures 2A to 2C A schematic side view of a pulley-operated electromechanical switch; and

[0024] Figure 4 According to an embodiment of the present invention Figures 2A to 2C A schematic diagram illustrating the layout of a reed switch in an electromechanical switch. Detailed Implementation

[0025] Overview

[0026] When using catheters to deliver signals to the heart, such as during cardiac pacing procedures in electrophysiological (EP) mapping protocols, avoiding improper delivery is medically crucial. Therefore, delivery systems for catheters with multiple electrodes (such as those on diagnostic EP catheters) must avoid using semiconductor electrical devices in the signal delivery path because semiconductors may not have sufficient electrical isolation between adjacent channels and semiconductors in specific channels may experience electrical breakdown.

[0027] The embodiments of the present invention described below provide patient-safe pacing systems and pacing methods for use with catheters having multiple electrodes.

[0028] In some embodiments, a pacing system is provided that uses a skin patch as a return electrode in a monopolar pacing layout. The pacing system includes: (a) a signal generator configured to generate a pacing signal; and (b) an electromechanical switch having a plurality of outputs coupled to a plurality of electrodes inserted into a patient's heart, each output configured to deliver a pacing signal to a corresponding electrode, wherein the electromechanical switch is configured to route the pacing signal to only a single selected output at any given time to pace the heart using only that single selected electrode. The electromechanical switch disclosed in this invention prevents any possibility of inter-electrode leakage. Even if the system malfunctions (e.g., a motor failure), there is no possibility of inter-channel leakage or delivery of current to the wrong channel.

[0029] In one embodiment, the electromechanical switch includes: (i) a substrate patterned having a plurality of contacts arranged in an array, each contact in the array being coupled to a corresponding output of the plurality of outputs; (ii) a movable switch configured to move over the array of contacts and to make electrical contact with only one contact at any given time; and (iii) a motor configured to move the movable switch.

[0030] In the context of the disclosed invention, a movable switch can be moved either by rolling a wheel over a contact or by sliding a contact element. Both the wheel and the sliding contact element are conductive. In some embodiments, the wheel is made of metal; in other embodiments, the wheel is made of a polymer including a conductive element. The conductive element can make the body of the wheel conductive or a pattern of conductive material disposed on the surface of the polymer wheel. Examples of polymers that can be used include various types of rubber.

[0031] In some implementations, non-contact mobile electromechanical switching is achieved by using an array of reed switches (i.e., an array of electrical switches operated by an applied magnetic field), as described below. Reed switches are described in U.S. Patent 2,264,746 (granted December 2, 1941).

[0032] In some implementations, the pacing system is configured to pace with a bipolar signal and includes an additional electromechanical switch that moves independently of the first switch. The resulting dual electromechanical switch is configured to route the bipolar pacing signal to only a first single selected output and a second single selected output at any given time, so as to bipolarly pace the heart using only a single selected first electrode and a single selected second electrode. Typically, the dual electromechanical switch is implemented on the same substrate as, for example, a bilinear, concentric, or side-by-side circular layout, as described below.

[0033] In some embodiments, the dual electromechanical switch includes: (a) a substrate patterned having a plurality of contacts arranged in a first array and a plurality of contacts arranged in a second array, wherein each contact in the first array is coupled to a corresponding output of a plurality of outputs, and wherein each contact in the second array is coupled to a corresponding output of a plurality of outputs; (b) a first movable switch configured to move over the first array of contacts and establish electrical contact with only one contact of the first array at any given time; (c) a second movable switch configured to move over the second array of contacts and establish electrical contact with only one contact of the second array at any given time; and (d) one or more motors configured to move the first and second movable switches independently of each other. The two arrays are spatially independent, for example, laterally and / or vertically.

[0034] In some embodiments, the electromechanical switch disclosed in this invention can switch pacing signals from a signal generator among, for example, more than one hundred receiving electrodes on a catheter. The delivery system (such as a cardiac EP mapping system using the electromechanical relay disclosed in this invention) can be in an "off" or "on" state, and if the electromechanical switch malfunctions, it will not cause problems with incorrect delivery of unipolar or bipolar signals, as described below.

[0035] In one embodiment, the movable switches of the dual electromechanical switches are each constrained to move along a linear trajectory by means of a lead screw coupled to a processor-controlled motor (such as a stepper motor) that rotates. In another embodiment, the movable switches of the electromechanical switches are each constrained to move along a circular trajectory by means of rotation by a stepper motor, as described below. Depending on the type of motion (linear or circular), an array of electrode contacts is formed on the line or circle.

[0036] In some implementations, a contact array is formed on a substrate such as a printed circuit board (PCB), and a stepper motor rotates until the moving contact of the movable switch aligns with a selected contact. The dimensions of the moving contact and the array contacts are chosen such that, regardless of the position of the movable switch, only one contact in each array can be connected at any given time.

[0037] In some implementations, electrodes from two or more catheters can be connected to a single bielectromechanical switch, for example, to perform pacing with a unipolar signal using one catheter and to sense the resulting EP signal using another catheter.

[0038] The disclosed pacing system may include a processor configured to instruct a pacemaker to generate pacing signals according to a pre-specified pacing protocol and to instruct electromechanical switches to route the pacing signals.

[0039] Therefore, the electromechanical switching technology disclosed in this invention provides a safe and flexible solution for patients to achieve unipolar or bipolar pacing using a catheter including multiple electrodes.

[0040] System Description

[0041] Figure 1 This is a schematic diagram of an electrophysiological (EP) mapping system 21 including a concentric electromechanical switch 40 according to an embodiment of the present invention. The electromechanical switch 40 is... Figure 2B As described in the figure, physician 27 uses EP mapping catheter 29 to pace the heart 23 of patient 25. As shown in illustration 35, catheter 29 includes multiple arms 20 at its distal end, which may be mechanically flexible, and multiple electrodes 22 are coupled to each of the multiple arms.

[0042] During the pacing procedure, electrode 22 is injected into the tissue of heart 23 and signals are acquired from that tissue. Processor 28 receives the acquired signals via electrical interface 43 and uses the information contained in these signals to construct an EP mapping 31 of at least a portion of the wall tissue of the patient 25's heart 23. During and / or after this procedure, processor 28 may display the EP mapping 31 on display 26.

[0043] In some implementations, system 21, via processor 28, instructs circular electromechanical switch 40 to route (i.e., switch) the bipolar signal generated by pacemaker signal generator 39 to variably pace the heart 23. The bipolar signal is output to multiple electrodes 22 via multiple output terminals 38 (of electromechanical switch 40) to which electrodes 22 are connected. Electromechanical switch 40 switches the output signal between multiple different pairs of electrodes 22. System 21 can use some or all of the electrodes 22 to measure the resulting electrical activity of the heart 23.

[0044] In some implementations, to pace the heart 23 in a bipolar manner via sequential selection of multiple electrode pairs 22, the processor 28 may apply a predefined automatic stimulation routing scheme. Using this protocol, the processor 28 commands the concentric electromechanical switch 40 to route (i.e., switch) between different electrode pairs 22 according to a predetermined sequence. An example of a procedure that can benefit from automatic stimulation routing is pulmonary vein isolation verification.

[0045] During pacing, the corresponding position of tracking electrode 22 is monitored. For example, a Carto3 manufactured by Biosense-Webster (Irvine, California, USA) can be used. ® The system performs tracking. Such systems measure the impedance between the electrode 22 and multiple external conductive patches 24 attached to the body of the patient 25; for example, three external conductive patches 24 may be attached to the patient's chest, and three additional external electrodes may be attached to the patient's back. For ease of illustration, only one chest electrode is shown. The pacing system disclosed in this invention can use the conductive patches 24 as return electrodes in a unipolar pacing configuration.

[0046] Figure 1 The example diagrams shown are chosen solely for conceptual clarity. Other types of inductive geometry, such as those used in Lasso, can also be employed. ® The inductive geometry type in Catheter (manufactured by Biosense Webster).

[0047] Processor 28 uses software stored in memory to operate system 21. For example, the software may be downloaded to processor 28 electronically via a network, or alternatively or otherwise, the software may be provided and / or stored on a non-transitory tangible medium such as magnetic storage, optical storage, or electronic storage. Specifically, processor 28 runs dedicated algorithms that enable processor 28 to perform the functions described above.

[0048] Patient-safe mechanical switching using catheters with multiple electrodes for pacing

[0049] Figures 2A to 2C The bilinear electromechanical switch 50 according to the embodiment of the present invention, Figure 1 A schematic top view of the arrangement of concentric circular electromechanical switches 40 and side-by-side circular electromechanical switches 60. The electromechanical dual switches disclosed in this invention are configured to route bipolar pacing signals.

[0050] like Figure 2A As shown, the dual-linear electromechanical switch 50 includes two linear contact arrays 50a and 50b aligned parallel to each other. The first linear array 50a includes contacts 52, and the second linear array 50b includes contacts 54. Electrodes are disposed on a substrate made of a printed circuit board (PCB) 51.

[0051] Movable switches 56 and 58 are each constrained to move along a linear trajectory between contacts 52 and 54 by being respectively coupled to lead screws 57 and 59. Each of screws 57 and 59 is rotated independently by stepper motors 55a and 55b, respectively. The first movable switch 56 includes a movable contact 56a, and the second movable switch 58 includes a movable contact 58a, wherein movable contacts 56a and 58a move independently on contact arrays 50a and 50b, respectively. Only a single contact at each of arrays 50a and 50b can be connected to the movable contact at any given time, which ensures electrical isolation between adjacent channels of the system 21 for the pacemaker heart 23.

[0052] Movable contacts 56a and 58a are connected to a pacemaker signal source (connection and source not shown) included in system 21. Bipolar signals are output to multiple electrodes 22 via multiple output terminals 38a (of electromechanical switch 50) to which electrodes 22 are connected. Figure 1 (See image). Electromechanical switch 50 outputs pacing signals to the selected electrodes in catheter 29 via leads 56b and 58b of switch 50, respectively.

[0053] like Figure 2B As shown, the concentric circular electromechanical switch 40 includes a first outer circular array 40a of contacts 42 and a second inner circular array 40b of contacts 44 disposed on a substrate made of a printed circuit board (PCB) 41. The two circular arrays are concentrically aligned.

[0054] Movable switches 46 and 48 are each constrained to move along a circular trajectory between electronic contacts by being respectively connected to circular guide rails 47 and 49. Each of movable switches 46 and 48 is connected to a stepper motor ( Figure 2C An exemplary coupling mechanism and stepper motor are shown, which rotates each movable switch above its corresponding circular guide rail. A first movable switch 46 includes a movable contact 46a, and a second movable switch 48 includes a movable contact 48a, which are movable separately and independently on contact arrays 40a and 40b. Only a single contact at each array can be connected to the movable contact at any given time to ensure electrical isolation between adjacent channels of the system 21 for the pacemaker heart 23.

[0055] Movable contacts 46a and 48a are connected to a pacemaker signal source (connection and source not shown) included in system 21. Bipolar signals are output to multiple electrodes 22 via multiple output terminals 38 (of electromechanical switch 40) to which electrodes 22 are connected. Figure 1 (See image). The electromechanical switch 40 outputs pacing signals to the selected electrodes in the catheter 29 via leads 46b and 48b of the switch 40, respectively.

[0056] like Figure 2C As shown, the side-by-side circular electromechanical switch 60 includes a first circular array 60a of contacts 62, which is arranged side-by-side with a second circular array 60b of contacts 64. Both arrays are disposed on a substrate made of a printed circuit board (PCB) 61.

[0057] The movable switches 66a and 66b are respectively constrained to move along circular trajectories between contacts 62 and 64 by being connected to guide rails 67a and 67b respectively, wherein guide rails 67a and 67b are similar to Figure 2B Guide rail 47. Each of the movable switches 66a and 66b is connected to stepper motors 65a and 65b respectively via corresponding shafts 63a and 63b through a coupling mechanism including corresponding disks 69a and 69b, wherein each shaft rotates each disk so that each movable switch rotates on its corresponding circular guide rail.

[0058] A first movable switch 66a, including a movable contact 660a, and a second movable switch 66b, including a movable contact 660b, are movable on contact arrays 60a and 60b, respectively. Only a single contact at each array can be connected to the movable contact at any given time to ensure electrical isolation between adjacent channels of the system 21 for the pacing heart 23.

[0059] Movable contacts 660a and 660b are connected to a pacemaker signal source (electrical connections and signal source not shown) included in system 21. Bipolar signals are output to multiple electrodes 22 via multiple output terminals 38c (of electromechanical switch 60) to which electrodes 22 are connected. Figure 1 (See image). Electromechanical switch 60 outputs a pacing signal to the selected electrode in catheter 29 via leads 68a and 68b of switch 60.

[0060] Figures 2A to 2C The top-view illustrations shown are given by way of example and have been simplified for clarity of concept. For example, the motion mechanism is drawn with minimal detail.

[0061] Figure 3 According to an embodiment of the present invention Figures 2A to 2C A schematic side view of a rotary switch with a pulley. As shown, the rotary switch 458 includes movable contacts 458a that roll above an array of contacts 454 using a conductive wheel 1458. The rotary switch 458 is driven by a motor (such as a motor via...) Figure 2A The screw 457 moves as the stepper motors 55a and 55b rotate.

[0062] In some embodiments, wheel 1458 is made of metal. In other embodiments, wheel 1458 is made of a conductive polymer such as conductive rubber. Using rubber can extend the life of the mechanical switch by preventing erosion of the solder pads, such as due to metal-to-metal friction and metal-to-metal scratching. Using rubber can also improve the mechanical contact between wheel 1458 and each contact in contact 454, for example, by adapting to changes in the morphology of the contacts.

[0063] In some implementations, the polymer wheel is provided with conductive strips 460 to establish individual electrical contact with each contact in the contacts 454 as the wheel 1458 rolls. For this purpose, the conductive strips 460 (e.g., gold strips) cover a portion of the wheel's circumference. The wheel itself acts as a mechanical absorber and eliminates high friction with the PCB pads, and accommodates vertical misalignment between the movable switch 458 and the PCB for better mechanical contact. Figure 3 The 460th section of the Nakajo line is drawn as a circular sector, but it can also have other suitable patterns.

[0064] In some implementations, to establish a strong electrical contact between wheel 1458 and contact 454, processor 28 applies a control loop that adaptively controls the motor to fine-tune the position of movable switch 458 (e.g., by moving the wheel forward or backward). Processor 28 is configured to control the motor based on an electrocardiogram (ECG) sensed via electrodes associated with the contacts. For example, when the system senses an acceptable quality ECG via the corresponding electrodes according to pre-specified criteria (e.g., a sufficiently large signal), processor 28 determines that a good electrical contact has been achieved for switching between wheel 1458 and contact 454. Because the contact area is small (e.g., tangent of a circle), using ECG to control contact quality can help in situations where dust particles on the contacts degrade the electrical contacts, for example.

[0065] Figure 4 According to an embodiment of the present invention Figures 2A to 2C A schematic diagram of the reed switch layout of an electromechanical switch. As shown, there is a gap between the array of movable switch 550 and reed switches 552, i.e., no mechanical contact. Instead, wherever movable switch 550 is located above reed switches 552, a magnet 555 (such as a stationary magnet) inside movable switch 550 causes the normally open reed switch 552 to close and transmit a pacing signal. Movable switch 550 is activated by a motor (such as via...) Figure 2A The screw 557 moves as the stepper motors 55a and 55b rotate.

[0066] As illustrated, a reed switch typically has two "bars" in its normally open mode, and these "bars" can be connected to a magnet. Using a reed switch can extend the life of the disclosed pacemaker switch by eliminating problems with mechanical devices, such as damage to PCB pads due to friction with the movable switch.

[0067] In some implementations, magnet 555 is an electromagnet that remains closed when moved over a reed switch not intended for contact. Therefore, the electromagnet is only activated when positioned over the target reed switch to close the circuit at the intended path. Further options are possible to avoid activating the wrong reed switch: for example, magnet 555 could remain horizontally flipped while moving over the array and only flip vertically over the target reed switch. Other methods are also possible, such as using logic components to disconnect the reed switch.

[0068] Figure 4 The diagrams are given by way of example. Other implementations using reed switches are also possible, for example, switching the reed switch by using an electromagnet instead of a fixed magnet.

[0069] Although the implementation schemes described herein primarily relate to medical applications, the methods and systems described herein can also be used in other applications, such as electrical switches, control circuits, and communication switches.

[0070] Therefore, it should be understood that the embodiments described above are cited by way of example, and the invention is not limited to what is specifically shown and described above. Rather, the scope of the invention includes combinations and sub-combinations of the various features described above, as well as variations and modifications thereof, which will occur to those skilled in the art upon reading the above description and which are not disclosed in the prior art. Documents incorporated herein by reference are considered an integral part of this application, except that if any terminology defined in such incorporated documents conflicts with the definitions expressly or implicitly given in this specification, only the definitions in this specification shall be considered.

Claims

1. A pacing system, the pacing system comprising: A signal generator configured to generate a pacing signal; as well as An electromechanical switch having multiple outputs configured to be coupled to multiple electrodes inserted into a patient's heart, each output configured to deliver a pacing signal to a corresponding electrode, wherein the electromechanical switch is configured to route the pacing signal to only a single selected output at any given time to pace the heart using only the single selected electrode, wherein the electromechanical switch includes: A substrate, the substrate being patterned to have a plurality of contacts arranged in an array, wherein each contact in the array is connected to a corresponding output of the plurality of outputs; A movable switch, configured to move above the array of contacts and establish electrical contact with only one contact at any given time; and A motor configured to move the movable switch.

2. The pacing system of claim 1, wherein the electromechanical switch further comprises a screw configured to be rotated by the motor, wherein the movable switch of the electromechanical switch is coupled to the screw and configured to move in a linear trajectory above the linear array of contacts when the screw is rotated by the motor.

3. The pacing system of claim 1, wherein the array of contacts is arranged in a circular configuration, and wherein the movable switch of the electromechanical switch is configured to move along a circular trajectory above the array of contacts.

4. The pacing system of claim 1, wherein the substrate of the electromechanical switch is made of a printed circuit board (PCB).

5. The pacing system of claim 1, wherein the motor of the electromechanical switch comprises a stepper motor.

6. The pacing system of claim 1, wherein the movable switch includes a wheel configured to roll over the array of contacts.

7. The pacing system of claim 6, further comprising a processor configured to apply a control loop that adaptively controls the motor to fine-tune the position of the movable switch, thereby optimizing the electrical contact between the wheel and the contact.

8. The pacing system of claim 7, wherein the processor is configured to control the motor based on an electrocardiogram (ECG) sensed via the electrodes associated with the contacts.

9. The pacing system of claim 6, wherein the wheel is made of metal.

10. The pacing system of claim 6, wherein the wheel is made of a conductive polymer.

11. The pacing system of claim 6, wherein the wheel is made of a polymer and is provided with a conductive strip.

12. The pacing system of claim 1, further comprising a processor configured to instruct the signal generator to generate the pacing signal and instruct the electromechanical switch to route the pacing signal according to a pre-specified pacing protocol.

13. The pacing system of claim 1, wherein the pacing signal is unipolar.

14. The pacing system of claim 1, wherein the pacing signal is bipolar, and wherein the pacing system includes an additional electromechanical switch to form a dual electromechanical switch together with the electromechanical switch, wherein the dual electromechanical switch is configured to route the bipolar pacing signal to only a selected pair of said outputs at any given time so as to bipolarly pace the heart using only the selected pair of said electrodes.

15. The pacing system of claim 14, wherein the dual electromechanical switch comprises: A substrate, the substrate being patterned to have a plurality of contacts arranged in a first array and a plurality of contacts arranged in a second array, wherein each contact in the first array is connected to a corresponding output terminal of the plurality of output terminals, and wherein each contact in the second array is connected to a corresponding output terminal of the plurality of output terminals. A first movable switch, the first movable switch being configured to move above the first array of contacts and to make electrical contact with only one contact of the first array at any given time; A second movable switch is configured to move above the second array of contacts and establish electrical contact with only one contact of the second array at any given time; as well as One or more motors, the one or more motors being configured to move the first movable switch and the second movable switch independently of each other.

16. The pacing system of claim 15, wherein the first array of contacts and the second array of contacts of the dual electromechanical switch are spatially independent.

17. The pacing system of claim 15, wherein the first array of contacts and the second array of contacts are concentric circle arrays.

18. The pacing system of claim 15, wherein the first array of contacts and the second array of contacts vertically overlap each other.

19. A method for manufacturing a pacing system according to claim 1, the method comprising: A patterned substrate having multiple contacts arranged in an array; A movable switch is provided, the movable switch being configured to move above the array and establish electrical contact with only one contact at any given time; as well as One or more motors are provided, the one or more motors being configured to move the movable switch.

20. A method for manufacturing a pacing system according to claim 15, the method comprising: A substrate patterned with a plurality of contacts arranged in a first array and a plurality of contacts arranged in a second array; A first movable switch is provided, the first movable switch being configured to move above the first array and establish electrical contact with only one contact of the first array at any given time; A second movable switch is provided, the second movable switch being configured to move above the second array and establish electrical contact with only one contact of the second array at any given time; as well as Connect one or more motors, the one or more motors being configured to move the first movable switch and the second movable switch independently of each other.

21. A pacing system, the pacing system comprising: A signal generator configured to generate a pacing signal; as well as An electromechanical switch having multiple outputs configured to be coupled to multiple electrodes inserted into a patient's heart, each output configured to deliver a pacing signal to a corresponding electrode, wherein the electromechanical switch is configured to route the pacing signal to only a single selected output at any given time to pace the heart using only the single selected electrode, wherein the electromechanical switch includes: A substrate having a plurality of reed switches arranged in an array, wherein each reed switch in the array is connected to a corresponding output terminal of the plurality of output terminals; A movable switch, the movable switch including a magnet configured to move above the array of reed switches and such that at any given time only one reed switch establishes electrical contact; and A motor configured to move the movable switch.

22. The pacing system of claim 21, further comprising a processor configured to instruct the signal generator to generate the pacing signal and instruct the electromechanical switch to route the pacing signal according to a pre-specified pacing protocol.

23. The pacing system of claim 21, wherein the pacing signal is unipolar.

24. The pacing system of claim 21, wherein the pacing signal is bipolar, and wherein the pacing system includes an additional electromechanical switch to form a dual electromechanical switch together with the electromechanical switch, wherein the dual electromechanical switch is configured to route the bipolar pacing signal to only a selected pair of said outputs at any given time so as to bipolarly pace the heart using only the selected pair of said electrodes.

25. The pacing system of claim 24, wherein the dual electromechanical switch comprises: A substrate, the substrate being patterned to have a plurality of reed switches arranged in a first array and a plurality of reed switches arranged in a second array, wherein each reed switch in the first array is connected to a corresponding output terminal of the plurality of output terminals, and wherein each reed switch in the second array is connected to a corresponding output terminal of the plurality of output terminals. A first movable switch, the first movable switch including a magnet configured to move above a first array of reed switches and cause only one reed switch in the first array to establish electrical contact at any given time; A second movable switch, the second movable switch including a magnet configured to move above a second array of reed switches and individually cause only one reed switch in the second array to establish electrical contact at any given time; as well as One or more motors, the one or more motors being configured to move the first movable switch and the second movable switch independently of each other.

26. A method for manufacturing a pacing system according to claim 21, the method comprising: A patterned substrate having multiple reed switches arranged in an array; A movable switch including a magnet is provided, the movable switch being configured to move over the array and such that at any given time only one reed switch establishes electrical contact; as well as One or more motors are provided, the one or more motors being configured to move the movable switch.

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