ELECTROMEDICAL ELECTRODE ARRANGEMENT

Description

[0001] The invention relates to an electromedical electrode arrangement with at least one implantable cardioversion electrode for delivering electrical impulses and cardioversion impulses to a target tissue, in particular to cardiac muscle tissue.

[0002] DE 10 2017 008 720 A1 discloses a bipolar electrode device consisting of a stimulation pole with an insulated stranded wire, which is routed proximally to the external pacemaker and thus represents the electrical supply line; distal to the stimulation pole is a fixation element and the cardiac needle or loop required for implantation. The electrode device also consists of a cardioversion pole with an insulated stranded wire, wherein the cardioversion pole consists of a bare, wave-shaped stranded wire, has a distal and a proximal end, and the insulated stranded wire is routed proximally to the external pacemaker and thus represents the electrical supply line. Distally, the stranded wire is continued in an insulated manner, with the insulated strands being routed parallel and the insulated stranded wire being routed past the cardioversion pole.The electrode arrangement is characterized in that the cardioversion pole is fixed proximally and distally by thermally bonding the insulated strands.

[0003] EP 0 280 564 A2 discloses a pair of defibrillation patch electrodes for placement on the heart to deliver defibrillation shocks, comprising: a first patch electrode shaped to fit over the right ventricle of the heart, a second patch electrode shaped to fit over the left ventricle of the heart, spaced from the first patch electrode such that a gap is formed between the opposing edges of the two patch electrodes, each of the patch electrodes having means for delivering the defibrillation shocks to the respective electrodes, and each of the patch electrodes being sized and shaped to encompass a substantial portion of the respective ventricular myocardium within the boundaries of the respective patch electrode in order to establish a substantially uniform potential gradient field across the entire ventricular mass when a defibrillation shock is delivered to the electrodes.

[0004] DE 10 2011 111 649 A1 discloses an embodiment and fixation of an implantable epicardial electrode arrangement which enables measurement, monitoring, stimulation and defibrillation of the human heart in conjunction with a pacemaker or defibrillator which can be connected outside the body and which can be easily removed by pulling at any time after use, wherein the electrode arrangement has the shape of a tennis racket.

[0005] Such electromedical electrode arrays are temporarily implanted in patients, for example, after heart surgery, and used to support cardiac function. The implantable cardioversion electrode makes it possible to deliver cardioversion pulses to the patient's heart if necessary to correct conduction disturbances. Compared to pacing or pacemaker pulses, which are delivered to dictate or support a specific heart rhythm, such cardioversion pulses are stronger. To avoid injury to the target tissue, cardioversion pulses must not be delivered via electrodes intended exclusively for the delivery of pacemaker pulses.

[0006] Due to their strength, cardioversion pulses are often perceived as painful by patients. This is especially true when the cardioversion pulses are delivered via external electrodes. However, cardioversion pulses delivered via implantable cardioversion electrodes can also be perceived as unpleasant, if not painful, by patients. Another challenge when delivering cardioversion pulses via implantable cardioversion electrodes is stimulating the target tissue sufficiently for successful cardioversion. The contact between the cardioversion electrode and the target tissue can have a significant influence on the effectiveness of the cardioversion pulses.

[0007] The object of the invention is to provide an electrode arrangement of the type mentioned at the outset with improved usage properties.

[0008] To achieve this objective, an electromedical electrode arrangement comprising at least one implantable cardioversion electrode for delivering cardioversion pulses to a target tissue, in particular to cardiac muscle tissue, is proposed, which comprises the means and features of the independent claim directed to such an electrode arrangement. To achieve this objective, it is thus proposed, in particular, that the cardioversion electrode of the electromedical electrode arrangement consists of a flexible, flat, electrically conductive sheet-like structure that is flat in the undeformed position of use and is designed for planar contact with a target tissue.

[0009] Such a sheet-like structure can be applied particularly reliably to the target tissue of the heart to be treated. The sheet-like structure can be applied to an outer surface of the heart in the body of the patient to be treated, for example to the outside of an atrium of the heart to be treated. The sheet-like structure can establish comparatively large-area contact with the target tissue to be treated and can be reliably applied to the generally curved surfaces of the target tissue to be treated. In this way, sufficient contact can be established between the cardioversion electrode of the electrode array and the tissue to be treated for gentle and safe cardioversion. On the one hand, this promotes the effectiveness of the cardioversion treatment, and on the other hand, the large-area application allows cardioversion pulses to be delivered over a comparatively large area.As a result, the sheet-like structure can promote cardioversion with lower-intensity cardioversion pulses. Lower-intensity cardioversion pulses are generally perceived as less painful and often cause fewer side effects. In the best case, this can reduce or even completely eliminate pain during cardioversion treatment. Overall, the electrode arrangement according to the invention promotes effective yet gentle cardioversion using an implanted cardioversion electrode. Furthermore, the electrode arrangement according to the invention is characterized by its simplified handling and application on the patient. The electrode arrangement can be easily applied and allows the use of an electromedical pulse generator, namely a pacer and / or cardioverter, at the patient's bedside.

[0010] Due to the fact that the cardioversion electrode of the electrode array consists of a flexible sheet, it is also possible to explant the cardioversion electrode gently, for example, by pulling on a proximal end of the cardioversion array. During explantation, the sheet can stretch and deform, for example, by pulling on the proximal end of the electrode array, in such a way that the explantation reduces its expansion perpendicular to the explantation direction. This facilitates atraumatic explantation of the cardioversion electrode.

[0011] In one embodiment of the electrode arrangement, the sheet has an electrical resistance of less than 150 ohms, preferably less than 70 ohms. This can promote the delivery of sufficiently strong cardioversion pulses and protect the target tissue to be treated from injury.

[0012] The sheet-like structure can have a longitudinal axis, in particular a longitudinal central axis, which runs in a single plane when the sheet-like structure is undeformed. The sheet-like structure is thus flat in its initial undeformed position, but due to its flexibility, it can be deformed in such a way that it can be applied flatly to the target tissue to be treated.

[0013] In one embodiment of the electrode arrangement, the planar structure can consist of a longitudinal structure, for example, an electrical conductor, with alternating bending directions and / or be sinusoidal. The longitudinal structure can be an electrical conductor, for example, a stranded wire. The conductor can be bent, for example, sinusoidally bent, to form the planar structure of the cardioversion electrode. Particularly in the area of ​​the planar structure of the cardioversion electrode, the conductor is preferably not insulated, so that cardioversion pulses can be delivered via the conductor forming the planar structure.

[0014] Because the sheet can be sinusoidal and / or consist of a longitudinal structure, for example, a conductor bent in alternating bending directions, the sheet can be not only flexible but also elastic. The elasticity of the sheet can promote reliable adhesion of the sheet to a target tissue.

[0015] In a preferred embodiment of the electrode arrangement, the sheet-like structure is formed from exactly one electrical conductor. However, it is also possible for the sheet-like structure to be formed from multiple electrical conductors for delivering cardioversion pulses.

[0016] The precisely one or at least one conductor from which the sheet-like structure can be formed can have an electrical resistance of less than 150 ohms, preferably less than 70 ohms. In this way, a sheet-like structure with an electrical resistance of less than 150 ohms, preferably less than 70 ohms, can be formed from the conductor.

[0017] The conductor can have a longitudinal axis, in particular a longitudinal central axis, which, when the sheet is undeformed, runs in a plane, for example in a central plane, of the sheet and / or with a changing bending direction. In this way, a sheet with a shape that can be described as a zigzag shape can be provided from the electrical conductor. In one embodiment of the electrode arrangement, the electrical conductor can be bent to form the sheet with a changing bending direction. The changing bending direction of the electrical conductor can impart its flexibility and / or elasticity to the sheet. The conductor can be bent sinusoidally to form a sinusoidal sheet.

[0018] The electrical conductor may have a diameter D of, for example, 0.1-0.5 mm. In one embodiment, the conductor may have a diameter D of 0.1-0.3 mm, for example, a diameter D of 0.2 mm.

[0019] The electrical conductor may comprise at least two adjacent and / or interconnected conductor sections that together span an angle α between 10° and 170°. The conductor may comprise at least two adjacent conductor sections that together span an angle α between 30° and 90°, or an angle α between 30° and 60°, or an angle α of 35°.

[0020] Two adjacent conductor sections of the conductor can be connected to each other by a bending radius of, for example, 0.3 mm to 2 mm.

[0021] In the non-tensioned state, the sheet-like structure can have a length L1 measurable in the direction of its longitudinal axis of between 10 and 50 mm, in particular between 25 and 40 mm, respectively. In the non-tensioned state, the sheet-like structure can have a length L2 measurable transversely to its longitudinal axis of between 5 and 30 mm, respectively, and / or be formed from at least one conductor whose length is between 40 and 140 mm.

[0022] The sheet-like structure may comprise a stripped stranded wire as at least one electrical conductor for delivering cardioversion pulses.

[0023] The sheet material, particularly the electrical conductor, can be made of stainless steel, platinum, a platinum alloy, gold, a gold alloy, magnesium, a magnesium alloy, molybdenum, or even a molybdenum alloy. The use of stainless steel is particularly preferred because this material has been tested on patients for decades, has been found to be safe for humans, and, due to its resilience, flexibility, and elasticity, is particularly suitable for the application of the sheet material described above.

[0024] According to the invention, the electrode arrangement has two fixing means between which the sheet-like structure is arranged. The fixing means of the electrode arrangement are designed to fasten and / or stretch the sheet-like structure to a target tissue, in particular to the outside of the heart. With the aid of the two fixing means of the electrode arrangement, the sheet-like structure can be brought into contact with the outside of a target tissue to be treated as a cardioversion electrode and held there. In particular, if the sheet-like structure is not only flexible but also elastic, the sheet-like structure can be stretched in its use position against a target tissue to be treated with the aid of the two fixing means. Due to the elasticity, the sheet-like structure can then automatically apply itself to the target tissue against the retaining force of the two fixing means and remain applied, thus ensuring reliable contact with the target tissue to be stimulated.The two fixation agents thus promote the reliable application of the flat structure of the electrode array, which serves as a cardioversion electrode, to a beating heart. The flat application of the flat structure under tension can prevent the detachment of the flat structure or even just parts of it. This promotes reliable and gentle cardioversion treatment using the electrode array.

[0025] In one embodiment of the electrode arrangement, the sheet-like structure is spaced from at least one of the two fixation means or from both fixation means by a distance of between 10 and 70 mm. As previously mentioned, the sheet-like structure can be clamped to a target tissue and / or adapted to the atrium size of a heart to be treated, in particular by means of the aforementioned fixation means. When clamped, the sheet-like structure can cover an area, for example, between 30 mm² and 1600 mm². The area covered by the sheet-like structure can be calculated from the product of the longitudinal extent and the transverse extent of the clamped sheet-like structure.

[0026] A distal fixation means of the electrode arrangement for securing and / or clamping the sheet-like structure can be arranged distally of the sheet-like structure. For example, the sheet-like structure can be arranged at a distal end of the electrode arrangement or between a distal end of the electrode arrangement and the sheet-like structure.

[0027] In principle, it is possible to position the fixation device in the target tissue using suture material to secure the fixation device in the target tissue and thus anchor the electrode array. However, this can be comparatively complex, as the suture material must first be connected to the fixation device.

[0028] To avoid this effort, the electrode array can have at least one positioning means, for example a cardiac needle, at its distal end for positioning a fixation means, in particular the aforementioned fixation means, in the target tissue. With the help of the positioning means, the fixation means can be positioned there for anchoring the target tissue. After successful positioning, the positioning means can be detached and removed.

[0029] The electrode arrangement may comprise a connecting lead via which the sheet-like structure can be connected to a stimulation generator. For this purpose, the electrode arrangement may comprise a connecting means arranged or formed at the proximal end of the connecting lead. The connecting lead may be connected to the sheet-like structure at a point located along a longitudinal axis, in particular along a longitudinal central axis of the sheet-like structure.

[0030] The connecting lead can be used as a traction device, allowing the sheet-like structure acting as a cardioversion electrode to be explanted from its implanted position by pulling. If the connecting lead is connected to the sheet-like structure at a point that lies on a longitudinal center axis of the sheet-like structure, the sheet-like structure can be deformed by the pulling force during explantation in such a way that a preferably uniform cross-sectional reduction of the sheet-like structure is achieved, oriented perpendicular to the direction of pull. This can facilitate atraumatic explantation of the sheet-like structure.

[0031] In one embodiment of the electrode arrangement, it is provided that it has at least one lateral electrode for delivering pacing pulses, which can also be referred to as pacemaker pulses.

[0032] For example, in conjunction with the cardioversion electrode, the lateral electrode can also deliver pacing pulses to the heart being treated. This allows the electrode arrangement to perform a dual function, delivering not only cardioversion pulses but also pacing pulses to the heart.

[0033] The at least one lateral electrode of the electrode array can be assigned at least one fixation means for attaching the lateral electrode to or in a target tissue. This makes it possible to reliably anchor the lateral electrode in the target tissue for the duration of the electrode array's use to support a patient's cardiac function.

[0034] In a particularly advantageous embodiment of the electrode arrangement, it is provided that the fixing means assigned to the lateral electrode is one of at least two fixing means for fastening and / or clamping the sheet-like structure.

[0035] In this way, the fixation device assigned to the lateral electrode serves a dual function. On the one hand, the fixation device is used to anchor the lateral electrode in the target tissue; on the other hand, it also serves to reliably hold the sheet-like structure serving as a cardioversion electrode in its intended use position. With this embodiment of the electrode arrangement, a separate fixation device serving solely to fix the lateral electrode is thus unnecessary.

[0036] To ensure reliable fixation of the lateral electrode and the cardioversion electrode, namely the sheet, this embodiment of the electrode arrangement provides only a minimum of fixation means. This minimizes lesions in the target tissue caused by the fixation means.

[0037] The at least one lateral electrode and the at least one cardioversion electrode can be arranged at a freely selectable angle relative to each other. In a preferred embodiment of the electrode arrangement, the lateral electrode and the cardioversion electrode together form an angle between 1° and 170°. In one embodiment of the electrode arrangement, the aforementioned connecting lead, the lateral electrode, and the cardioversion electrode can together form a Y-shape in the implanted position of use.

[0038] The electrode arrangement, in particular the at least one cardioversion electrode and / or the at least one lateral electrode, can be explantable by pulling on a proximal end of the electrode arrangement, in particular on a proximal end of the previously mentioned connecting line.

[0039] The conductor of which the sheet-like structure may be made may be an electrical conductor of the connecting cable. The sheet-like structure may thus consist of an electrical conductor, in particular a stranded wire, of the connecting cable.

[0040] Exemplary embodiments of the invention are described in more detail below with reference to the drawings. The invention is not limited to the exemplary embodiments shown. Further exemplary embodiments of the invention result from a combination of the features of the claims and / or from a combination of the features of the exemplary embodiments shown in the figures. They show: Figure 1: a side view of a first embodiment of an electrode arrangement with an implantable cardioversion electrode, which consists of a flexible, in the undeformed initial position flat, electrically conductive sheet structure, which is designed for planar contact with a target tissue, Figure 2: a variant of the in Figure 1 shown electrode arrangement, with a lateral electrode in addition to the cardioversion electrode, via which pacing pulses can be delivered to a target tissue, as well as Figure 3: an enlarged detailed view of the surface structure of the Figures 1 and 2 electrode arrangements shown.

[0041] All figures show at least parts of electromedical electrode assemblies, designated as a whole by 1. Each electrode assembly 1 shown is configured to deliver electrical impulses to a target tissue, namely, cardiac muscle tissue. Each electrode assembly 1 shown has an implantable cardioversion electrode 2 for delivering cardioversion impulses.

[0042] The cardioversion electrodes 2 each consist of a flexible, flat, electrically conductive sheet 3, which is designed for flat contact with a target tissue. The sheet 3 is elastic and has an electrical resistance of less than 150 ohms, preferably less than 70 ohms.

[0043] The sheet-like structure 3 has a longitudinal axis 4, namely a longitudinal central axis, which runs in a single plane when the sheet-like structure 3 is undeformed. The sheet-like structure 3 is formed from a longitudinal structure, namely an electrical conductor 5 with alternating bending directions and is therefore zigzag-shaped. In the exemplary embodiments of sheet-like structures 3 shown in the figures, these consist of exactly one electrical conductor 5, which is configured to deliver cardioversion pulses.

[0044] The conductor 5 has an electrical resistance of less than 150 ohms, preferably less than 70 ohms. In this way, the conductor 5 can be used to provide a sheet-like structure 3 that has an electrical resistance of less than 150 ohms, preferably less than 70 ohms, which is favorable for cardioversion.

[0045] A longitudinal axis of the conductor 5 is arranged in a plane, in particular in a central plane, of the sheet structure 3 in the undeformed sheet structure 3 and runs through this central plane with alternating bending directions. In particular, the illustration from Figure 3 clarifies that the sheet-like structure 3 is formed from the conductor 5 bent in alternating bending directions. The conductor 5 has a diameter D of 0.1-0.5 mm. The diameter of the conductor 5 can be, for example, 0.1-0.3 mm or even 2 mm. The conductor 5 has adjacent conductor sections 6 that are connected to one another and together span an angle α between 10° and 170°.

[0046] In the Figure 3 In the embodiment shown, the angle α is approximately 35°. The adjacent conductor sections 6 are connected to each other via a bending radius R. The bending radius R can, for example, be between 0.3 mm and 2 mm.

[0047] In the non-tensioned state, the sheet-like structure 3 can, for example, have a length L1 measurable in the direction of its longitudinal axis 4 of between 10 and 50 mm inclusive. In the non-tensioned state, the sheet-like structure has a length L2 measurable transversely to its longitudinal axis 4 of, for example, between 5 and 30 mm inclusive.

[0048] The electrical conductor 5 from which the sheet 3 is made can have a length of, for example, 40-140 mm. Figure 3 also indicates a length L3 that the sheet 3 can have in its stretched, extended state. The length L3 is greater than the length L1 and can be a multiple of the length L1 of the sheet 3 in its non-stretched state, for example, one and a half times, twice, two and a half times, or even three times.

[0049] The sheet 3 has a stripped stranded wire as an electrical conductor 5 for delivering cardioversion pulses. The sheet 3, specifically its electrical conductor 5, is made of stainless steel.

[0050] At the Figure 2 In the second embodiment of the electrode assembly 1 shown, it can be seen that the electrode assembly 1 has two fixing means 7, 8, between which the sheet-like structure 3 is arranged. The fixing means 7, 8 serve to stretch the sheet-like structure 3 to an outer side of the heart and to secure it in the stretched state. The sheet-like structure 3 is spaced from at least one of the two fixing means 7, 8 by a distance of between 10 and 70 mm.

[0051] Also in the Figure 1In the electrode arrangement 1 shown, the sheet-like structure 3 is arranged between two fixing means 7 and 8 of the electrode arrangement 1, which are comparable in terms of their function. These fixing means 7 and 8 also serve to attach and / or clamp the sheet-like structure 3 to a target tissue, for example, on the outside of the heart.

[0052] The sheet 3 can be expanded by the two fixing means 7 and 8 and can be adapted to the atrium size of a heart to be treated by expanding and stretching the sheet 3. When expanded, the sheet 3 can cover an area between 30 mm² and 1600 mm². This area can correspond to the product of the previously mentioned dimensions L2 and L3 of the expanded and stretched sheet 3.

[0053] The distal fixation means 8 of the two fixation means 7 and 8 of the electrode arrangement 1 is arranged distally of the sheet-like structure 3, for example, between a distal end 9 of the electrode arrangement 1 and the sheet-like structure 3. The electrode arrangement 1 has an anchoring means 10 in the form of a cardiac needle at its distal end 9. Using the anchoring means 10, the electrode arrangement 1 can be anchored in the target tissue. The positioning means 10 serves to bring the distal fixation means 8 into its use position in the target tissue. The positioning means 10 can then be detached and removed.

[0054] At its proximal end 11, the electrode arrangement 1 also has a further needle 12 with which the electrode arrangement 1, namely its connecting cable 13, can be pierced through the body wall of a patient and guided outwards.

[0055] The flat structure 3 can be connected to a stimulation device via the connecting cable 13. The connecting cable 13 is connected to the flat structure 3 at a point 14 located on the longitudinal center axis 4 of the flat structure 3. Point 14 can also be referred to as the connection point.

[0056] The conductor 5 can be an electrical conductor, in particular a stranded wire, of the connecting cable 13. The sheet-like structure 3 can thus consist of an electrical conductor, in particular a stranded wire, of the connecting cable 13. The previously mentioned point 14 then defines the transition between the connecting cable 13 and the sheet-like structure 3.

[0057] At its proximal end 11, each of the electrode assemblies 1 shown has a connector 16 with which the respective connecting lead 13 can be connected to a stimulation generator. The connector 16 can, for example, be a connector plug.

[0058] The Figure 2 The electrode arrangement 1 shown comprises, in addition to the cardioversion electrode 2, an implantable lateral electrode 15. The lateral electrode 15 serves to deliver pacing pulses to the target tissue. Pacing pulses can be delivered in conjunction with the cardioversion electrode 2.

[0059] The lateral electrode 15 of the Figure 2 In the electrode arrangement 1 shown, the fixation means 7 is assigned to one of the two fixation means 7 and 8. The fixation means 7 is thus also used to secure the lateral electrode 15 in a target tissue. The fixation means 7 assigned to the lateral electrode 15 is thus one of the two fixation means 7 and 8 that serves to secure and / or tension the sheet-like structure 3. This fixation means 7 can be introduced into the target tissue with the aid of an anchoring means 10 arranged distal to the lateral electrode 15. This positioning means 10 is also designed as a cardiac needle.

[0060] Figure 2 indicates that the lateral electrode 15 and the at least one cardioversion electrode 2, namely the sheet-like structure 3, can be arranged at a freely selectable angle relative to one another, for example, at an angle between 1° and 170°. The arrangement of the lateral electrode 15 and the cardioversion electrode 2 in an angular range of 1° to 170°, and preferably at an angle to one another that is less than 90°, can promote the gentle and preferably atraumatic explanation of the electrode arrangement. The lateral electrode 15, the cardioversion electrode 2, and the connecting lead 13 then form a Y-shape.

[0061] The electrode assembly 1, namely the cardioversion electrode 2 and the lateral electrode 15, can be explanted by pulling on the proximal end 11 of the electrode assembly 1, namely by pulling on the proximal end 11 of the connecting lead 13 of the electrode assembly 1. The Figure 1The electrode arrangement 1 shown can be explanted in the same way by pulling on the connecting line 13.

[0062] The invention relates to improvements in the technical field of electromedical electrode assemblies. As an improvement, an electromedical electrode assembly 1 is proposed, which comprises at least one implantable cardioversion electrode 2, which consists of a flexible, flat, electrically conductive sheet 3, which is flat in the undeformed position of use and is designed for planar contact with a target tissue. List of reference symbols

[0063] 1 Electromedical electrode array 2 Cardioversion electrode 3 Sheet 4 Longitudinal axis of 3 5 Longitudinal structure, electrical conductor 6 Adjacent conductor sections 7 Fixation device 8 Distal fixation device 9 Distal end of 1 10 Positioning device, cardiac needle 11 Proximal end 12 Needle at 11 13 Connecting lead 14 Point 15 Lateral electrode 16 Connecting device

Claims

1. Electromedical electrode assembly (1) having at least one implantable cardioversion electrode (2) for delivering cardioversion pulses to a target tissue, in particular to heart muscle tissue, characterized in that the cardioversion electrode (2) consists of a flexible, electrically conductive sheet-like structure (3) which is planar in the undeformed initial position and which is designed and intended for flat application to a target tissue, wherein the electrode assembly (1) has two fixing means (7, 8), between which the sheet-like structure (3) is arranged and which are designed for fastening and / or clamping the sheet-like structure (3) to a target tissue, for example to an outside of the heart.

2. Electrode assembly (1) according to the preceding claim, wherein the sheet-like structure (3) is elastic.

3. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3) has a longitudinal axis (4), in particular a longitudinal center axis, which extends in a plane when the sheet-like structure (3) is not deformed.

4. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3) consists of a longitudinal structure (5), in particular of an electrical conductor, with an alternating bending direction and / or is sinusoidal.

5. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3) is formed from at least one, in particular exactly one, electrical conductor (5) for the delivery of cardioversion pulses.

6. Electrode assembly (1) according to the preceding claim, wherein the at least one electrical conductor (5) has an electrical resistance which is less than 150 ohms, preferably less than 70 ohms.

7. Electrode assembly (1) according to one of the two preceding claims, wherein a longitudinal axis of the at least one conductor (5) extends in a plane of the non-deformed sheet-like structure (3) and / or with an alternating bending direction.

8. Electrode assembly (1) according to one of claims 5 to 7, wherein the at least one conductor (5) has a diameter D of 0.1 to 0.5 mm, in particular 0.1 to 0.3 mm, in particular 0.2 mm.

9. Electrode assembly (1) according to one of claims 5 to 8, wherein the conductor (5) has at least two mutually adjoining and / or interconnected conductor sections (6) which together span an angle α between 10° and 170° and / or are interconnected via a bending radius R, in particular via a bending radius of 0.3 to 2 mm.

10. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3), in the non-clamped state, has a linear extension L1, measurable in the direction of its longitudinal axis (4), of between 10 to 50 mm, in particular between 25 to 40 mm, in each case inclusive.

11. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3), in the non-clamped state, has an extension L2, measurable transversely to its longitudinal axis (4), of between 5 and 30 mm, inclusive, and / or is formed from at least one electrical conductor (5), the length of which is 40 to 140 mm.

12. Electrode assembly (1) according to one of the preceding claims 5 to 11, wherein the at least one electrical conductor (5) is a bared strand for delivering cardioversion pulses.

13. Electrode assembly (1) according to one of the claims 5 to 12, wherein the sheet-like structure (3), in particular its electrical conductor (5), consists of stainless steel, of platinum, of a platinum alloy, of gold, of a gold alloy, of magnesium, of a magnesium alloy, of molybdenum or of a molybdenum alloy.

14. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3) is at a distance of between 10 and 70 mm, inclusive, from at least one of the two fixing means (7, 8).

15. Electrode assembly (1) according to one of the preceding claims, wherein the sheet-like structure (3) can be clamped, in particular by the fixing means (7, 8), and / or adapted to the atrial size of a heart to be treated.

16. Electrode assembly (1) according to one of the preceding claims, wherein a distal fixing means (8) of the electrode assembly (1) for fastening and / or clamping the sheet-like structure (3) is distal of the sheet-like structure (3), in particular at a distal end (9) of the electrode assembly (1) or between a distal end (9) of the electrode assembly (1) and the sheet-like structure (3).

17. Electrode assembly (1) according to one of the preceding claims, wherein the electrode assembly (1) has at its distal end (9) at least one positioning means (10), in particular a heart needle, for positioning a fixing means (8) of the electrode assembly (1) in the target tissue.

18. Electrode assembly (1) according to one of the preceding claims, wherein the electrode assembly (1) has a connecting lead (13) by means of which the sheet-like structure (3) can be connected to a stimulation generator , in particular wherein the connecting lead (13) is connected to the sheet-like structure (3) at a point (14) which lies on a longitudinal center axis (4) of the sheet-like structure (3).

19. Electrode assembly (1) according to one of the preceding claims, wherein the electrode assembly (1) comprises at least one implantable lateral electrode (15) for delivering pacing pulses.

20. Electrode assembly (1) according to the preceding claim, wherein at least one lateral electrode (15) is associated with at least one fixing means (7, 8) for securing the lateral electrode (15) in a target tissue.

21. Electrode assembly (1) according to the preceding claim, wherein the fixing means (7, 8) associated with the lateral electrode (15) is one of at least two fixing means (7, 8) for fastening and / or clamping the sheet-like structure (2).

22. Electrode assembly (1) according to one of the preceding claims, wherein the at least one lateral electrode (15) and the at least one cardioversion electrode (2) can be arranged at a freely selectable angle relative to one another, in particular at an angle between 1° and 170°.

23. Electrode assembly (1) according to claim 19, wherein the electrode assembly (1), in particular the at least one cardioversion electrode (2) and / or the at least one lateral electrode (15), can be explanted by pulling on a proximal end (11) of the electrode assembly (1).