U.S. patent number 3,729,008 [Application Number 05/101,836] was granted by the patent office on 1973-04-24 for electrode for atrial pacing with curved end for atrial wall engagement.
This patent grant is currently assigned to American Optical Corporation. Invention is credited to Barough V. Berkovits.
United States Patent |
3,729,008 |
Berkovits |
April 24, 1973 |
ELECTRODE FOR ATRIAL PACING WITH CURVED END FOR ATRIAL WALL
ENGAGEMENT
Abstract
A curvilinear electrode suitable for being curved-over and
supported by a moving atrium wall of a patient's heart. The
electrode includes at least one long, thin, flexible electrical
conductor encapsulated by an electrically insulating flexible
catheter sleeve. The electrode has a sufficient resilience to
maintain the curve in a plane and yet allow the curve to be flexed
linear for insertion through a blood vessel of the patient.
Inventors: |
Berkovits; Barough V. (Newton
Highlands, MA) |
Assignee: |
American Optical Corporation
(Southbridge, MA)
|
Family
ID: |
22286662 |
Appl.
No.: |
05/101,836 |
Filed: |
December 28, 1970 |
Current U.S.
Class: |
607/125; 604/530;
604/21 |
Current CPC
Class: |
A61N
1/057 (20130101); A61N 1/056 (20130101) |
Current International
Class: |
A61N
1/375 (20060101); A61N 1/05 (20060101); A61N
1/372 (20060101); A61n () |
Field of
Search: |
;128/348,349R,35R,404,418,419P,2M |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
Dodinot et al., "Annals of the New York Academy of Sciences" Vol.
167, Art. 2, pp. 1038-1054, October, 1969..
|
Primary Examiner: Kamm; William E.
Claims
What is claimed is:
1. Electrode apparatus of the intravascular type for use with
devices for electrically stimulating the heart of a patient, said
apparatus including at least one long, thin, flexible electrical
conductor, an electrically-insulating flexible catheter enclosing
said conductor, there being an electrically non-conducting material
forming an outer wall of said catheter, said conductor having one
end extending through the exterior surface of said catheter to
permit electrical contact between said heart and said conductor
near one end of said conductor, and catheter curve-holding means
carried by said outer wall adjacent said end and substantially
parallel to and secured along substantially its entire length to
the catheter for normally urging said catheter in a curve near said
end, the configuration of said curve arranged to be curved-over and
supported by a wall of an atrium moving in response to the beating
of said heart and being suitable for causing electrical contact to
be maintained between said conductor and said atrium, and where
said catheter curve-holding means further includes torsion means
for maintaining an axial restoring torque on said catheter at said
end to encourage said curve to be planar.
2. Electrode apparatus as recited in claim 1 and wherein said
catheter curve-holding means further includes flexible means for
permitting said curve to be extended into an approximately linear
shape for insertion of said catheter into and removal of said
catheter from a blood vessel leading to the heart of said
patient.
3. Electrode apparatus as recited in claim 2 and wherein said
catheter curve-holding means further includes contractile means for
causing said approximately linear shape to be formed into said
curve about the top of said wall of said atrium after said
insertion into said heart.
4. Electrode apparatus as recited in claim 1 and wherein said
catheter curve-holding means is made of rubber.
5. Electrode apparatus as recited in claim 1 and wherein said
apparatus includes two conductors.
6. Electrode apparatus as recited in claim 1 and wherein said
catheter curve-holding means includes ridges for increased gripping
of the atrium wall.
7. Electrode apparatus as recited in claim 1 and wherein said
catheter curve-holding means is made of polyvinyl chloride.
8. Electrode apparatus as recited in claim 1 and wherein said
catheter curve-holding means is made of polyethylene.
9. Electrode apparatus as recited in claim 1 and wherein said
catheter curve-holding means is made of polyurethane.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates, generally, to an area of medical
electronics concerned with electrical stimulation of a patient's
heart. More particularly, the present invention relates to improved
means for conducting electrical stimulation from heart stimulating
apparatus to the atrium of the heart.
2. Description of Prior Art
In the medical electronics field, electronic devices have been
developed for providing stimulation to the heart. These electronic
devices are commonly called pacers. An example of a demand pacer is
disclosed in U.S. Pat. No. 3,528,428 issued in the name of the
applicant of the present invention.
Applicant has filed other pacer patent applications including Ser.
No. 810,519 filed on Mar. 26, 1969 and which has matured into U.S.
Pat. No. 3,595,242, and 884,825 filed on Dec. 15, 1969 and which
has matured into U.S. Pat. No. 3,661,158. In these copending
applications, heart stimulating devices are disclosed that
stimulate both an atrium and a ventricle of the heart. These pacers
require two sets of electrodes. The present invention is capable of
use with most pacers and is particularly adapted for use with this
latter type of pacer.
The electrodes normally used with these devices are long, thin,
flexible conductors enclosed by a flexible catheter. At one end of
the catheter, the conductor is exposed in order to make contact
with the heart.
In some electrode apparatus configurations (called bipolar
electrodes), two conductors are included within one catheter,
thereby providing a forward conduction path and return path for
electrical stimulation to the heart. For this type of electrode,
two conductors are exposed and each conductor makes contact with
the heart.
The bipolar electrode apparatus used with ventricular stimulation
has a generally linear and flexible shape. The two conductors are
exposed at one end of the catheter approximately 1 inch from each
other. The electrode apparatus is inserted into a blood vessel and
is pushed into the ventricle. It normally rests in the ventricular
cavity without falling out. The ventricle is formed so that the
electrode will normally be confined to its region without
difficulty.
But, by comparison, the electrode used for stimulating an atrium
has difficulty in maintaining its position within the confines of
the atrial cavity. The atrium has smooth walls allowing easy
slippage of an ordinary linear electrode therefrom.
Thus, a problem with the prior art electrode is that it is not well
suited for use with the atrium. Applicant's solution to this
problem is to provide improved electrode apparatus which can be
inserted in a normal manner into a vessel of the body leading to
the atrium, and to automatically cause a gripping of, and a support
by, the atrium wall. The present invention solves the
electrode-heart contact problem associated with atrial pacing.
SUMMARY OF THE INVENTION
The invention relates generally to electrode apparatus for use with
heart stimulating devices. More particularly, the invention relates
to a curved electrode apparatus and catheter particularly suited
for use in stimulating an atrium of a patient's heart. A particular
resilience is built into the catheter to provide a particular shape
suitable for being supported by the wall of the atrium. The
resilience built into the catheter has a twofold purpose; first it
can create an axial torque to cause a twisting action to tend to
maintain the curve in a plane, and second it has a flexibility for
providing an approximately linear shape for proper insertion into a
blood vessel.
An advantage of this invention is to permit reliable atrial
stimulation. The electrode of the present invention will not slip
out of the atrium, nor will it loosen and make poor electrical
contact with the atrium.
It is thus an object of the present invention to provide an
improved electrode apparatus for use with heart stimulating
devices.
It is a further object of the present invention to provide an
improved electrode for stimulating an atrium of the heart.
Other objects and advantages of the present invention will become
apparent to one having reasonable skill in the art after referring
to the detailed description of the appended drawings wherein:
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 depicts two electrodes, one of which is curvilinear in
accordance with the present invention, both of which are
operatively connected to a heart stimulating device;
FIG. 2 is a sectional view of the catheter 11 of FIG. 1 in a first
illustrative embodiment of the present invention;
FIG. 3 is a sectional view of a second illustrative embodiment of
the present invention;
FIG. 4 is a sectional view of a third illustrative embodiment of
the present invention;
FIG. 5 depicts schematically the axial or twisting torque provided
by the present invention; and,
FIG. 6 is a side view of a curved electrode in accordance with the
present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to FIG. 1, heart stimulating device 10 is connected to
catheter 12 which encloses conductors 13 and 23. These conductors
are insulated from each other. One provides a signal or stimulating
conductive path and the other provides a return conductive path.
This catheter electrode apparatus is an example of prior art. It is
inserted into the ventricle of the heart to provide it with
electrical stimulation.
By comparison, catheter 11 is also operatively connected to pacer
or heart stimulator 10, and similarly has conductors 14 and 24
enclosed therein. But, this catheter is curvilinear or curved near
the end that makes contact with the heart. The cross-section of
catheter 11 at the location designated as 15 is thicker than the
cross-section of the catheter at a point closer to the pacer. This
can be seen more clearly in FIG. 6.
In FIG. 6, curved region designated as 30 is thicker in
cross-section than the catheter cross-section at the location
designated as 40. The reason for this difference in cross-section
is due to an additional amount of resilient insulation at region
30.
The catheter can be made from various electrical non-conductive
materials such as polyvinyl chloride, plastics, polyethylene,
polyurethane and other body-compatible elastic materials. In the
present invention, the catheter is made from a high medical grade
durameter (resilient) rubber. The additional amount of rubber at
the location of the curve is added to the ordinary flexible
catheter by such processes as vulcanization or injection molding.
The additional rubber forces the catheter to assume an unnatural
shape but one which possesses minimal potential energy.
In FIG. 6, the catheter is depicted as temporarily linear, and this
is shown by dotted diagram 32. This is the shape and potential
energy state of the catheter when it is inserted into a blood
vessel (not shown) to be pushed up to the atrium (not shown).
Upon entering the atrium, the catheter springs back as depicted by
direction 31 to the curve shape depicted. This curve shape has the
proper dimensions to conform to the atrium and to be suitable for
gripping the moving atrium wall. The atrium has a smooth wall which
allows easy slippage of an ordinary electrode. The curved electrode
shown in FIG. 1 and FIG. 6, will now slip from the atrium, as it is
curved over the atrium wall. While inserted in the heart over the
atrium wall (not shown), the inherent return tension or resilience
causes the catheter to apply tension in step with the moving atrium
as the heart is beating. This maintains good electrical
contact.
The curved electrode fits into the atrium and will not fall out and
slide into the ventricle (not shown) by virtue of its shape. But,
the electrode can be pulled out by application of distal force in a
surgical procedure. When the electrode is removed from the atrium
by the application of distal force, the shape of the curved
catheter is shown by dotted configuration 32.
FIG. 2 is a cross-section of the curved electrode taken at curved
region 15 of catheter 11. Flanges 16 are what cause the electrode
to maintain its curved shape. Flanges 16 lie on the inside of the
curve. (They could be on the outside of the curve and the resulting
resilience effects would be similar.)
FIG. 3 is a second illustrative embodiment of the present invention
taken at curved region 15 of catheter 11. Flange 17 is shown in a
different shape from flanges 16, but has much the same effect as
flanges 16.
FIG. 4 is a third illustrative embodiment of the present invention
taken at curved region 15 of catheter 11 and is a combination of
flanges 16 and 17. In FIG. 4, flange 17 is at the inside of the
curve and flanges 16 are on the outside of the curve. This
configuration combines the resilient advantages of FIGS. 2 and
3.
The purpose of the flanges is two-fold. First, a resilient
restoring force must be created to make the electrode spring back
in direction 31 as depicted in FIG. 6. Second, the flange is
intended to diminish twisting (axial torques which will tend to
displace the curve portion of the electrode out of a plane) and
thus encourages the curve portion to be planar. (If a curved
electrode is allowed to twist excessively while in operational
connection with an atrium, it could fall out of the atrium
cavity.)
In FIG. 5, arrows 18 indicate directions in which the axial torque
resisting force is applied by flanges 16 and 17. In FIG. 6,
application of this torque resisting force will tend to cause the
curve of the electrode to remain in the plane of the paper.
In a preferred embodiment, the curve has a 1-inch radius, and is
generally in the shape of a semi-circle. There is approximately 1.5
to 2 centimeters between exposed conductors of the same catheter.
The exposed conductors can be made of platinum.
The invention may be embodied in other specific forms without
departing from the spirit or essential characteristics thereof.
Other cross-sectional areas of rubber, or other materials suitable
for creating these torques within a body environment can be used.
Also, grooves or ridges can be arranged on the inside curve of the
catheter to even better grip the atrium wall.
The present embodiments are therefore to be considered in all
respects as illustrative and not restrictive, the scope of the
invention being indicated by the appended claims rather than by the
foregoing description, and all changes which come within immediate
range of the claims, are therefore intended to be embraced
therein.
* * * * *