Leads for pacing and/or sensing the heart from within the coronary veins

Abstract

A lead for monitoring or stimulating cardiac activity is provided. The lead is adapted for implantation on or about the heart within the coronary vasculature and for connection to a signal generator. The lead body has one or more electrodes associated therewith. The lead is constructed and arranged so that when it is implanted, the electrodes are housed in the coronary vasculature and urged into intimate contact a vessel wall.

1 . A lead comprising: 
 a lead body adapted to carry signals to and from a heart, the lead body having a proximal portion and a distal portion;    a connector located at a proximal end of the lead, the lead adapted for connection to a signal generator for monitoring or stimulating cardiac activity, the lead constructed and arranged for implantation within a coronary vein, a portion of the distal portion of the lead body having a preformed radius of curvature substantially the same as or slightly smaller than a coronary sinus and geometrically shaped to hug a wall of the coronary sinus upon implantation therein; and    at least one electrode coupled with the lead body.    
   
   
       2 . The lead as recited in  claim 1 , wherein the lead is constructed and arranged for implantation within the coronary sinus.  
   
   
       3 . The lead as recited in  claim 1 , where the at least one electrode includes a first electrode associated with the distal portion of the lead body, the first electrode including a first electrode contact area, and a second electrode associated with the distal portion of the lead body, the second electrode including a second electrode contact area, the first and second electrodes upon implantation in a body being housed in the coronary sinus, the distal portion of the lead constructed and arranged to urge the first and second electrodes toward a wall of the coronary sinus.  
   
   
       4 . The lead as recited in  claim 3 , wherein the first electrode and the second electrode are spaced in close proximity to one another, the first electrode and the second electrode spaced about 1-5 mm apart.  
   
   
       5 . The lead as recited in  claim 1 , wherein the at least one electrode is constructed and arranged to provide pacing and sensing only of a left atrium while in an implanted site in the coronary sinus.  
   
   
       6 . The lead as recited in  claim 1 , wherein the at least one electrode is constructed and arranged to provide pacing and sensing of a left ventricle while in an implanted site in the coronary sinus.  
   
   
       7 . The lead as recited in  claim 6 , further comprising at least one atrial pacing electrode.  
   
   
       8 . The lead as recited in  claim 1 , wherein the distal portion of the lead body further includes a helical portion having the at least one electrode thereon, the helical portion constructed and arranged to urge the at least one electrode toward a myocardial wall.  
   
   
       9 . The lead as recited in  claim 3 , wherein the distal portion of the lead body further comprises at least one arched tine located opposite the first electrode, and at least one arched tine located opposite the second electrode, the tines constructed and arranged to urge the electrode contact area of the first and second electrodes toward a myocardial wall of the coronary sinus.  
   
   
       10 . The lead as recited in  claim 1 , wherein the distal portion of the lead body further comprises a double bias configuration constructed and arranged to urge the at least one electrode toward a myocardial wall of the coronary sinus.  
   
   
       11 . The lead as recited in  claim 2 , wherein the first electrode and/or the second electrode is partially masked and further comprises an electrical contact portion constructed and arranged to contact a myocardial wall of the coronary sinus upon implantation therein.  
   
   
       12 . The lead as recited in  claim 1 , wherein the lead body further comprises an external steroid collar disposed in close proximity to one electrode.  
   
   
       13 . The lead as recited in  claim 1 , wherein at least a portion of the lead body comprises a shape memory material.  
   
   
       14 . The lead as recited in  claim 1 , wherein the distal portion of the lead body has a tapered outer diameter.  
   
   
       15 . A lead comprising: 
 a lead body adapted to carry signals to and from a heart, the lead body having a proximal portion and a distal portion, and an intermediate portion therebetween;    a connector located at a proximal end of the lead;    the distal portion of the lead body constructed to be implanted within a coronary vein;    at least one electrode coupled with the lead body;    the distal portion of the lead body having a tapered outer diameter, and the outer diameter includes a first diameter at the intermediate portion and a second diameter at the distal portion, and the first diameter is greater than the second diameter; and    a portion of the distal portion of the lead body having a preformed radius of curvature substantially the same as or slightly smaller than a coronary sinus and geometrically shaped to hug a wall of the coronary sinus upon implantation therein.    
   
   
       16 . The lead as recited in  claim 15 , wherein the distal portion of the lead body further includes a helical portion having the at least one electrode thereon, the helical portion constructed and arranged to urge the at least one electrode toward a myocardial wall.  
   
   
       17 . The lead as recited in  claim 15 , wherein a plurality of electrodes are disposed on the helical portion, and the plurality of electrodes are spaced about 120 degrees apart along the helical portion.  
   
   
       18 . The lead as recited in  claim 15 , further comprising apical electrodes, mid ventricular electrodes, and ventricular electrodes coupled with the lead body.  
   
   
       19 . The lead as recited in  claim 15 , wherein the distal portion of the lead body further includes at least one arched tine located opposite the at least one electrode.  
   
   
       20 . The lead as recited in  claim 19 , wherein the at least one arched tine comprises a pliable, thin arched tine which extends from a first end to a second end, and the first end and the second end are coupled with the lead body.  
   
   
       21 . A method comprising: 
 providing a coronary sinus lead comprising: 
 a lead body adapted to carry signals to and from a heart, the lead body having a proximal portion and a distal portion;  
 a connector located at a proximal end of the lead, the lead adapted for connection to a signal generator for monitoring or stimulating cardiac activity, the lead constructed and arranged for implantation within a coronary sinus, the distal portion of the lead body having the same radius of curvature as or smaller radius of curvature than the coronary sinus and geometrically shaped to hug a wall of the coronary sinus upon implantation therein;  
 a first electrode associated with the distal portion of the lead body, the first electrode including a first electrode contact area;  
 a second electrode associated with the distal portion of the lead body, the second electrode including a second electrode contact area, the distal portion of the lead constructed and arranged to urge the first and second electrodes toward a wall of the coronary sinus;  
   inserting the coronary vein lead into the coronary sinus, disposing the first and second electrodes in the coronary sinus;    advancing the distal portion of the lead through the coronary sinus; and    sensing and pacing of the heart via the coronary vein lead in its implanted site in a coronary vein.    
   
   
       22 . The method as recited in  claim 21 , further comprising placing a guide catheter into the coronary sinus, threading a guide wire into the coronary sinus, pushing the coronary sinus lead over the guide wire and into the coronary sinus; and providing left sided sensing and pacing of the heart via the coronary sinus lead in its implanted site in the coronary sinus.  
   
   
       23 . The method as recited in  claim 21 , wherein providing a coronary sinus lead further includes providing a helical portion having at least one electrode thereon.