U.S. patent number 3,825,015 [Application Number 05/315,252] was granted by the patent office on 1974-07-23 for single catheter for atrial and ventricular stimulation.
This patent grant is currently assigned to American Optical Corporation. Invention is credited to Barough V. Berkovits.
United States Patent |
3,825,015 |
Berkovits |
July 23, 1974 |
SINGLE CATHETER FOR ATRIAL AND VENTRICULAR STIMULATION
Abstract
A single catheter for atrial and ventricular stimulation. A
single catheter is disclosed that provides separate electrical
stimulation to the atrium and separate electrical stimulation to
the ventricle on mutually insulated conductors. All conductors are
encapsulated in the single catheter and electrical interference
between the atrial and ventricular conductors is eliminated through
the use of electro-static shielding. The catheter provides two or
more mutually insulated electrical conductors for stimulating the
atrium. The best electrical contact made between the atrial
conductors and the atrium may be measured and selected for use.
Inventors: |
Berkovits; Barough V. (Newton
Highlands, MA) |
Assignee: |
American Optical Corporation
(Southbridge, MA)
|
Family
ID: |
23223565 |
Appl.
No.: |
05/315,252 |
Filed: |
December 14, 1972 |
Current U.S.
Class: |
607/123;
128/901 |
Current CPC
Class: |
A61N
1/056 (20130101); Y10S 128/901 (20130101) |
Current International
Class: |
A61N
1/05 (20060101); A61n 001/34 () |
Field of
Search: |
;128/404,418,419D,419P,419R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Wall; Joel Nealon; William C.
Claims
What is claimed is:
1. A single catheter for use with a heart stimulator which
generates electrical inpulses for the purpose of separately
stimulating the atrium and ventricle of said heart, said catheter
comprising first means for conducting atrial stimulation from said
sstimulator to said atrium, said first means including a plurality
of at least three insulated electrical conductors disposed internal
to said single catheter and terminating at different locations
along said catheter from which at least two said conductors are
chosen to conduct said atrial stimulation, second means for
conducting ventricular stimulation from said stimulator to said
ventricle, and means for preventing electro-magnetic interference
between said first and second stimulation application means.
2. A single catheter as recited in claim 1 and wherein said first
means further includes a plurality of at least three regularly
spaced conductive rings exposed to the surface of said catheter,
each of said rings being conductively connected respectively to one
of said plurality of at least three insulated electrical
conductors.
3. A single catheter as recited in claim 2 and wherein said second
means includes a plurality of at least two insulated electrical
conductors disposed internal to said catheter and a plurality of at
least two conductive rings exposed to the surface of said catheter
where each of said plurality of at least two conductive rings is
conductively connected respectively to one of said plurality of at
least two insulated electrical conductors.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates in general to electro-medical equipment and
in particular relates to heart stimulation devices. More
particularly, it relates to the conduction of electrical
stimulation from a heart stimulating device to the atrial and
ventricular chambers of the heart.
Description of Prior Art
In the electro-medical field, therapeutic heat stimulating devices
are well known. Some of these devices are heart pacers which
provide stimulation to the heart in order to cause the heart to
beat. Some pacers provide stimulation only to a ventricle but
another type of pacer provides sequential stimulation to both
artrium and to ventricle to cause the heart to beat in a more
efficient manner. This latter type of pacer is disclosed in U.S.
Pat. No. 3,595,242 entitled "Atrial and Ventricular Demand Pacer"
which has issued in the name of the inventor of the instant
invention. Background material disclosed in this patent is
incorporated herein by reference.
A problem associated with this type of improved heart pacing is
that electrical contact made between the artium wall and the
electrode may be difficult to maintain. This is due to the nature
of the atrial chamber's shape and motion. A solution to this
problem is presented in a co-pending application Ser. No. 101,836
filed on Dec. 28, 1970 and which has since matured into U.S. Pat.
No. 3,729,008 and entitled Electrode for Atrial Pacing with Curved
End for Atrial Wall Engagement, wherein a hook-type electrode for
gripping the atrium wall is disclosed. This type of electrode
solves the atrial wall-electrode contact problem. However, use of
this "hook" catheter for atrial stimulation necessitates a separate
catheter for stimulation of the ventricle. Thus, two catheters are
used which require additional surgical procedures. The instant
invention solves both the electrical contact problem and the dual
catheter problem. The present invention provides a single catheter
which contains electrodes that separately stimulate both the atrium
and the ventricle and simultaneously provide good contact the the
atrium through electrode selection.
SUMMARY OF THE INVENTION
A single catheter contains a plurality of mutually insulated
electrical conductors which are electrically connected within the
catheter to conductive rings. The rings extend through the surface
of the catheter and are exposed to the heart chamber walls. They
are spaced from each other to provide proper stimulation to atrium
and ventricle. The catheter is designed to be inserted into the
ventricle by way of the atrium and a blood vessel leading to the
atrium. Two exposed rings nearest one end of the catheter are
separated by approximately 6 centimeters from the next ring. These
first two rings are used for stimulation of the ventricle. The 6
centimeter distance provides a separation so that the other exposed
rings lie only within the atrium. There are at least three rings
which lie within the atrium, but there may be as many rings as is
conceivably practical. The distance between the two ventricular
rings is selected for optimum performance as are the distances
among the atrial rings.
Some of the atrial rings will make better contact with the atrium
than others. These contacts are determined by testing different
pairs of conductors after insertion of the catheter into the heart
but prior to permanent connection to the heart stimulator. Thus,
two of the atrial rings or terminals are selected for providing the
stimulation, but more than two may be selected if it is felt that
parallel paths of conductors in a particular case will provide a
more reliable and efficient electrical contact.
The construction of the catheter utilizes an electrostatic shield
around the ventricular electrodes therby electromagnetically
separating atrial stimulation from ventricular stimulation. In a
particular embodiment, the shield may be utilized as one of the
conductors for ventricular stimulation.
It is an advantage of this invention to provide atrial and
ventricular stimulation of the kind that may be utilized by a
demand atrial and ventricular heart pacer where there is no need
for separate atrial and ventricular catheters thereby reducing
surgical problems involved.
It is thus an object of this invention to provide improved heart
stimulation equipment.
It is yet another object of this invention to provide improved
atrial and ventricular demand heart pacing.
It is still another object of this invention to provide atrial and
ventricular stimulation utilizing a single catheter allowing a
single insertion into the heart and a simplified surgical
procedure.
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:
FIG. 1 is a schematic representation of an illustrative embodiment
of the present invention; and
FIG. 2 is a more detailed schematic representation of part of the
illustrative embodiment depicted in FIG. 1.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to FIG. 1, enclosure 10 is intended to schematically
represent the ventricle of a heart and enclosure 12 is intended to
schematically represent the atrium of the heart. Single catheter 30
is depicted as being inserted into ventricle 10 via atrium 12.
Conductive rings 14 and 15 make electrical contact with the inside
of the ventricle chamber, and conductive rings 16, 17, 18 and 19
are conductively connected to the inside wall of the atrium
chamber. Typical distances between rings 16, 17, 18 and 19 may be
on the order of 1 centimeter respectively as may be the distance
between rings 14 and 15. The distance between rings 15 and 16 is on
the order of 6 centimeters. However, all these ring locations can
be varied with respect to each other; the distances therebetween
are not necessarily critical. However, the constraint of rings 14
and 15 lying in the ventricle and rings 16-19 lying in the atrium
must be satisfied.
Terminal 24 is conductively connected to ring 14, terminal 25 is
conductively connected to ring 15, terminal 26 is conductively
connected to ring 16, terminal 27 is conductively connected to ring
17, terminal 28 is conductively connected to ring 18, and terminal
29 is conductively connected to ring 19. The respective numbers
with the subscript I is intended to represent the respective
insulated conductors. For example, insulated conductor 24I is
associated with terminal 24.
Catheter portion 30 is illustrated as being broken away from
catheter portion 31. However, these portions are part of the same
catheter and are illustrated as such for the purpose of indicating
relative distance. For example, the distance between catheter
portion 30 and catheter portion 31 may be on the order of several
feet.
Referring to FIG. 2, one observes the insulated conductors depicted
in FIG. 1. Insulated conductor N is intended to mean that the
number of insulated conductors contained within a catheter are to
be limited only by physical space available and there is no special
total number of catheters that can be used. Electro-static shield
40 is depicted as encompassing insulated conductors 24I and 25I
which provide ventricular stimulation. Electro-static shield 40
effectively prevents interference from the stimulation provided on
the ventricular conductors from being picked up by the atrial
conductors and vice versa. In an alternative embodiment, one of the
ventricular conductors can be comprised of shield 40 itself.
Typically, but not necessarily, shield 40 is braided.
In a particular embodiment, the conductive rings 14-19 may be made
from a platinum compound and the respective conductors contained
within catheter 30 are welded to the inner portion of the
conductive rings. The catheter itself may be constructed of a
typical high grade durameter rubber which is normally used in
surgical implantations. The conductors themselves in a particular
embodiment may be ordinary conductive copper wire, but can also be
constructed from coiled wire as well.
In operation, catheter 30 is inserted through a blood vessel and
into atrium 12. It is then further urged into ventricle 10 so that
catheter 30 comes to rest in the manner schematically depicted.
Conductive rings 14 and 15 make electrical contact with ventricle
10, and conductive rings 16-19 make electrical contact with atrium
12. Although the catheter is depicted as linear, in reality it is a
flexible tube and certain of the conductive rings will become
located within the atrium 12 to provide better electrical contact
than other of those rings. The best contacts are determinable from
external measurements made on terminals 26-29 and at least two of
the atrial rings are selected. More than two can be selected by
utilizing two rings in parallel if this seems to be advisable.
Otherwise, the unselected electrodes need not be used.
The optimum electrode combination for best atrial-ventricular
stimulation is thus selectable after insertion of the catheter into
the heart. Since the size of the heart tends to vary from person to
person, it is desirable to select from the above-described
electrode stimulation to provide best electrical contact. The
availability of these different contact combinations permits the
adapting of this electrode to the size of the particular heart in
which it is implanted and provides optimum contact. It is thus seen
that the need for separate catheters, one for insertion into the
ventricle, and another for insertion into the atrium, are
eliminated by use of this single catheter for atrial and
ventricular stimulation.
The invention may be embodied in other specific forms without
departing from the spirit or the essential characteristics thereof.
It should be understood that the number of conductive rings
utilized is limited only by physical size. It should be understood
further that the distances between the atrial rings, the
ventricular rings, and between the two groups, can be selected for
optimum performance. 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. It should be further
understood that no limitations are placed upon utilization of the
invention with an implantable or external heart stimulating device.
When utilized with an implantable device, after the conductive
measurements are made, the selected conductors are utilized, the
others are ignored by sealing them within the catheter. Of course,
in the external configuration the unused conductors are merely
ignored without any sealing necessary. Thus, all changes which come
within the meaning and range of equivalency of the claims are
therefore intended to be embraced therein.
* * * * *