Electrode assembly

The invention relates to an intravascular electrode assembly comprising a first and second, for placement in blood vessels such as veins or Arteries adapted electrode line each having a pacing and / or sensing electrode in the region of a distal end of the respective Electrode line.

For the purposes of the present invention is between intracardiac Electrode leads on the one hand and intravascular electrode lines in the sense distinction that intracardiac electrode lines to are formed such that their sensing or stimulating electrodes after the Implantation are placed in the atrium or ventricle of a heart, while intravascular electrode lines as understood here narrower sense Such electrode lines whose electrodes after Implantation in an artery such as a vein or an artery . are Due to the limited space, in such blood vessels prevails, the corresponding intravascular implantation sites difficult to control, as intracardiac implantation sites. also vary the intravascular implantation sites from patient to patient greater extent than is the case for intracardial implantation sites.

In connection with the stimulation of a heart, the stimulation left heart therefore presents a problem, because a placement intracardiac electrodes in the left heart is highly complicated. Therefore are to stimulate the left atrium or ventricle instead intravascular electrodes used, for example, in Coronary vessels are introduced. This results in the preceding paragraph described problem.

DE 2,605,590 describes an electrode assembly according to the preamble of independent claim 1. A system for fixing the electric Derlei obligations to each other according to their placement is not described above.

This problem is inventively achieved by an intravascular electrode assembly the second electrode line are provided, wherein the longitudinal guides such manipulable are designed such that they allow, in a first state, a longitudinal displacement between the two electrode lines, while the long guides connect a longitudinal displacement between the two electrode lines in a second state.

This solution is based on the idea of ​​the left atrium and the left ventricle of a heart each have their own intravascular provide electrode catheters, each with respect to the different implantation sites are optimized. Preference is given in this connection, an electrode assembly, in which the first Electrode line with the longitudinal guides as atrial electrode catheter is formed, while the second electrode line of the guide first ventricular electrode line is used and as a ventricular Electrode catheter is formed. To implant this Electrode lines is first ventricular electrode line introduced. This is just in the traditional manner possible because the ventricular Electrode line having no guides. Then the atrial Electrode line with their guides so the ventricular pushed electrode lead, the ventricular electrode line extends within the longitudinal guides. The atrial electrode line with their guides can be fed then, passing through the ventricular electrode line is performed.

To have precise guidance of the first electrode lead to allow the longitudinal guides have eyelets, which via the second to push electrode line and accordingly with respect to their Inner diameter to the outer diameter of the second Electrode lead adapted and this substantially correspond.

The diameter of the two electrode lines is preferably less than 2mm, so that they as intravascular electrode lines can be used.

To a two electrode lines comprehensive electrode assembly of to allow the aforementioned kind, is primarily only one of the two Electrode line within the meaning of the invention over the prior modify technology, while the second electrode line prior art can meet. Accordingly, there is the Inventive solution of the aforementioned problem already in a single, inventively designed electrode line with the outside attached to the electrode line longitudinal guides which preferably eyelets include.

The longitudinal guides preferably comprise nitinol, a nickel titanium alloy.

The longitudinal guides have in the longitudinal direction of the electrode line two Ends, of which preferably at least one of the ends of a has oblique, each starting from the electrode line to the other end is inclined. Particularly preferred is a variant in which the both ends of the longitudinal guides are chamfered accordingly. A Such a bevel facilitating the insertion of the electrode lead or the Electrode assembly.

In a preferred embodiment, the slope of the Longitudinal guides of an open lattice structure or a wire mesh educated. This grid structure or the wire mesh is particularly after designed type of stent.

Also preferred is an electrode line, wherein the longitudinal guides are subsequently applied to a case of the electrode line. The Alternative to this is in the longitudinal guides of the envelope material themselves are formed so that the longitudinal guides and the envelope of Electrode line are formed together in one piece. In the preferred variant containing Hulle of Elektrodenieitung and Longitudinal guides different material, for example, is the case of formed electrode lead of a silicone based material, while the Longitudinal guides substantially from nitinolhaltigem material, ie a Metal, are formed.

In a preferred embodiment, the longitudinal guides friction-on tongues of the recording between an second electrode line provided cavity of the longitudinal guides arranged and the casing of the first electrode line and such are configured such that a sheath of the second electrode line by means of of the tongues has a distance from the shell of the first electrode line. With these distance-producing tongues, the immediate friction the cases of the two electrode leads largely to each other be avoided, so that the two electrode lines possible smoothly relatively blank longitudinally move each other. With tongue in this context, any type abstandsvermittelnder part of Longitudinal guides meant especially metal-containing components of Longitudinal guide, both within the longitudinal guides between the Electrode leads are arranged.

Finally, a short circuit or electrical contact of the sensing or stimulating electrodes of an electrode lead to the electrodes to prevent the second electrode line, it is provided in particular, the electrodes of the first electrode line on those isolate side of the periphery of the first electrode line electrically, the facing due to the longitudinal guides of the second electrode line.

The invention is now the basis of exemplary embodiments with the aid Figures are explained in detail. The figures show:<dl tsize="7"><dt>figure 1</dt><dd>a side view of an electrode assembly with two Electrode lines;</dd><dt>figure 2</dt><dd>the registered in 1 section AA enlarged representation;</dd><dt>figure 3</dt><dd>a portion of a first electrode line with a Longitudinal guide in the form of a Nitinolhülse;</dd><dt>figure 4</dt><dd>a side view of a portion of a first Electrode line with a longitudinal guide, the bevels comprising;</dd><dt>figure 5</dt><dd>a portion of an electrode line with a variant a longitudinal guide, the distance mediating tongues comprising;</dd><dt>figure 6</dt><dd>the distal end of a first electrode line with partially insulated pacing or sensing electrodes; and</dd><dt>figure 7</dt><dd>an alternative embodiment similar to FIG. 1</dd></dl>

1 shows an electrode assembly 10 having an atrial Electrode catheter 12 and a second ventricular electrode catheter 14. The two electrodes 12 and catheter 14 are, due to their Diameter and flexibility of an intravascular assembly Suitable formed. That is, the two intravascular Electrode catheter 12 and 14 are thin and flexible enough to be in a Blood vessel such as a vein or artery to be placed.

Both electrodes 12 and catheter 14 have a sheath, of which the Case 16 of the atrial electrode catheter 12 with longitudinal guides 18 in Form is equipped of eyelets for receiving longitudinally movable the ventricular electrode catheter formed 14th A suitable Material for the cases of the electrode catheter and for Longitudinal guides 18, for example, silicon, which is in the range of Longitudinal guides 18, for example by a stiffening wire or Like can be reinforced.

Both electrode catheter 12 and 14 have at your respective distal End pacing and / or sensing electrodes. The pacing and Sensing electrodes 20 and 22 of the ventricular catheter electrodes 14 are in the usual way as a tip electrode 20 and a ring electrode 22 is formed. Corresponding electrodes selectively enable the unipolar or bipolar pacing or sensing. Alternatively, both Electrode catheter even with an electrode in the form of a peak his or ring electrode equipped.

Also, the atrial electrode catheter 12 comprises a tip electrode 24 and a ring electrode 26, these two electrodes, on its ventricular electrode line 14 side facing electrically insulated are, so it does not cause a short circuit between the electrodes 20 and 22 of the ventricular catheter 14 and the corresponding electrodes Electrodes 24 and 26 of the atrial electrode catheter 12 comes when it the distal ends of the two electrodes at the catheter longitudinal displacement the atrial electrode catheter with respect to the ventricular Electrode catheter 12 at the same height.

In the case of implantation is first ventricular electrode line inserted into blood vessels of a patient such that the distal end of the Electrode wire 14 with its electrodes 20 and 22 the desired Destination, including the coronary sinus occupies. Subsequently, the eyelets 18 the atrial electrode lead 12 at the proximal end of the ventricular Electrode lead 14 is pushed to the electrode line 14, so that the atrial electrode line through its eyelets 18 of the already implanted ventricular electrode line is out 14th Also has the distal end the atrial electrode line 12 the intended destination in reached the atrium of the heart, the atrial electrode line 12 is by means their eyelets 18 with respect to the ventricular electrode lead 14 by Jamming fixed. Corresponding eyelets 18 that such jamming allow, are shown in FIG. 7

Figure 2 shows a section through the electrode assembly of Figure 1 in the Area of ​​the longitudinal guides 18. As shown in Figure 2 is to be taken, is the Longitudinal guide 18, a constituent of the shell 16 of the atrial electrode line 12. Within this envelope 16 of the atrial electrode line 12 is a stiffening helical coil 30 arranged in metal.

The ventricular electrode line 14 is similar to the atrial Electron line 12, only that it has no longitudinal guides 18th Also ventricular electrode line 14 has a casing 32 made, for example, Silicone and disposed therein reinforcing metal coil 34. Of the Outer diameter of sleeve 32 is slightly less than the Inner diameter of the longitudinal guide 18 to a mobility of the atrial electrode line 12 with respect to the ventricular electrode line 14 permit.

The longitudinal guide 18 is formed so that the covers 16 and 32 of the atrial or ventricular electrode line 12 and 14, a distance a from each other, as indicated by the dashed line 36 in Figure 2 is indicated.

Figure 3 shows a short section of an atrial electrode line 12 ' an alternative longitudinal guide 18 'as the metal sleeve on the outside of the Electrode line 12 'is placed. The design of the metal sleeve 18 with Constrictions 40 is selected such that a in the metal sleeve 18 ' introduced ventricular electrode line at a lateral distance to atrial electrode line 12 'takes up. generated by crimping Constrictions 42 on the metal sleeve 18 'ensure a secure grip on the atrial electrode lines 12 '.

Figure 4 again shows a short section of atrial Electrode line 12 "with it attached longitudinal guide 18 '. The Longitudinal guide 18 'is designed like the longitudinal guide 18' of Figure 3 and has like these stop-making constrictions 42 "in which are produced for example by crimping. In addition, the Longitudinal guide 18 'but also two bevels 44, which in the manner of a Stents are designed web-like and are designed to prevent the Longitudinal guides 18 "during insertion of the atrial electrode line 12 'in Fabric hook.

Figure 5 again shows a short section of atrial Electrode line 12 '' with it, arranged longitudinal guide 18 '. Also, the longitudinal guide 18 '' is preferably made of metal such as formed Nitinol and has for holding and for guiding along a ventricular electrode line two brackets 50 on. In addition, the Longitudinal guide 18 '' 'two tongues 52 which at the atrial electrode line 12 'are formed around and extending circumferentially of atrial Electrode line 12 '' overlap. The tongues 52 have on the one hand Function of the longitudinal guide 18 " 'grip on the atrial electrode lead 12' '' giving by creating positive a corresponding clamping effect. Furthermore, the thickness of the tongues 52 ensures that a in the Longitudinal guide 18 '' 'located ventricular electrode line a distance from the atrial electrode lead 12 '' 'has. Therefore, in the Longitudinal guide 18 'such constrictions as the constrictions 40 of Longitudinal guide 18 'omitted from FIG. 3

Figure 6 shows the distal end of an atrial electrode line 12 '. With a longitudinal guide 18 '', as it is already described in FIG. 5 from Figure 6 shows that the tip electrode 24 'and the ring electrode 26 '' 'on that peripheral side of the atrial electrode catheter 12' '' are isolated, which when implanted a ventricular electrode line faces and is guided past these. This circumferentially 18 '' 'is determined by the alignment of the longitudinal guide. The Alignment of the longitudinal guide 18 '' 'with respect to the atrial electrode line 12 '' 'with their partly insulated electrodes 24' and 26 '' 'is thus so to Select that the bracket 50, the longitudinal guide 18 'in that Circumferential direction have, in which the electrodes 24 'and 26' '' of the atrial Electrode lead 12 '' 'are insulated.

According to the depicted in Figure 7 variant is compared to that of Figure 1 Variant shown additionally a cable 60 provided within the ventricular electrode line extends and at its distal end exits. This cable is connected to the distal end of atrial connected to the electrode line, so that it is possible, the distal end of atrial electrode line using the cable pull in the direction of the distal End of the ventricular electrode line to pull. The cable proceeds to this purpose within the ventricular electrode lead up to their proximal end, to be operated from there.

In a not shown variant of an atrial electrode line with a longitudinal guide or eyelet, the eyelet with respect to the longitudinal axis the atrial electrode line as tilted by means of a cable so be it to jam the eyelet with an eyelet in the located ventricular electrode line is, so that both Electrode wires are fixed relative to each other.

Alternatively, the eyelet on the atrial electrode line can also be deformable otherwise to jamming with a to allow electrode line in the eyelet.

It is also possible, the atrial electrode line in the region of the eyelet for example, S-shaped, or otherwise bent to preform such that the Longitudinal axes of the atrial electrode lead and the ventricular Electrode lead in the eye tend not parallel to extend to each other so that there is tension between the eyelet and takes her located second electrode line. During the Introducing the first atrial electrode line is then their repealed preforming eg by means of a corresponding stylet, so that atrial and ventricular electrode line slightly relative to each other are displaced longitudinally. Then - when the atrial electrode line has assumed the position provided - the stylet is removed, the atrial electrode line tilted because of their preforming the eyelet the ventricular electrode line and the two line electrodes are fixed relative to one another.