Coronary sinus lead for pacing the left atrium

Abstract

A pacing lead for implantation in a coronary sinus having an opening and a wall defining an interior and presenting a diameter dimension. The pacing lead includes an elongated lead body, a resilient fixation element, and at least one electrode on either the lead body or the fixation element. The fixation element extends from the pacing portion and defines a loop structure laterally adjacent the pacing portion. The loop structure presents a predetermined width dimension greater than the diameter dimension of the coronary sinus, wherein when the loop structure is inserted into the opening of the coronary sinus, the loop structure is laterally compressed by the wall of the coronary sinus and the electrode is biased against the wall of the coronary sinus.

1 . A pacing lead for implantation in a coronary sinus having an opening and a wall defining an interior and presenting a diameter dimension, the pacing lead comprising an elongated lead body with a resilient fixation element extending therefrom and defining a loop structure laterally adjacent the lead body, the pacing lead further including at least one electrode on either the lead body or the fixation element, the loop structure presenting a predetermined width dimension greater than the diameter dimension of the coronary sinus, wherein when the loop structure is inserted into the opening of the coronary sinus, the loop structure is laterally compressed by the wall of the coronary sinus and the at least one electrode is biased against the wall of the coronary sinus.  
   
   
       2 . The lead of  claim 1 , wherein the lead includes a pair of electrodes.  
   
   
       3 . The lead of  claim 2 , wherein the pair of electrodes is disposed on the lead body.  
   
   
       4 . The lead of  claim 1 , wherein the loop structure includes a generally arcuate proximal portion and a generally arcuate distal portion.  
   
   
       5 . The lead of  claim 4 , wherein the generally arcuate proximal portion subtends an angle of at least about 120 degrees.  
   
   
       6 . The lead of  claim 5 , wherein the generally arcuate proximal portion subtends an angle of about 180 degrees.  
   
   
       7 . The lead of  claim 4 , wherein the generally arcuate distal portion subtends an angle of at least about 40 degrees.  
   
   
       8 . The lead of  claim 7 , wherein the generally arcuate distal portion subtends an angle of about 90 degrees.  
   
   
       9 . The lead of  claim 4 , wherein the loop structure includes a generally straight portion between the generally arcuate proximal portion and the generally arcuate distal portion.  
   
   
       10 . The lead of  claim 1 , wherein the loop structure includes a generally straight proximal portion defining an angle with the pacing portion of less than 90 degrees.  
   
   
       11 . The lead of  claim 10 , wherein the loop structure includes a generally straight distal portion defining an angle with the generally straight proximal portion of between about 90 and about 150 degrees.  
   
   
       12 . The lead of  claim 11 , wherein the loop structure includes a generally straight portion between the generally straight proximal portion and the generally straight distal portion.  
   
   
       13 . The lead of  claim 1 , wherein the lead defines a central lumen.  
   
   
       14 . The lead of  claim 13 , wherein the central lumen extends through the lead body and the resilient fixation element.  
   
   
       15 . The lead of  claim 13 , wherein the lead defines an aperture extending from the central lumen to an exterior surface of the lead.  
   
   
       16 . The lead of  claim 1 , further comprising a catheter and a guidewire operably coupled to the catheter for guiding the lead towards the opening of the coronary sinus.  
   
   
       17 . The lead of  claim 16 , wherein the lead defines an aperture extending from the central lumen to an exterior surface of the lead, the guidewire extending through the central lumen and aperture of the lead.  
   
   
       18 . The lead of  claim 1 , wherein the lead comprises a lead width, the lead width being between 4 and 6 French.  
   
   
       19 . The lead of  claim 1 , wherein the predetermined width dimension is between about 10% and about 200% of the diameter dimension of the coronary sinus.  
   
   
       20 . The lead of  claim 1 , wherein the predetermined width dimension is between about 25% and about 75% of the diameter dimension of the coronary sinus.  
   
   
       21 . A method of inserting a pacing lead having a preformed shape into a coronary sinus to pace a left atrium, the coronary sinus having an opening and a wall defining an interior and presenting a diameter dimension, the method comprising: 
 providing a pacing lead comprising an elongated lead body having a pacing portion with at least one electrode and a resilient fixation element, the fixation element extending from the pacing portion and defining a preformed loop structure laterally adjacent the pacing portion, the loop structure presenting a predetermined width dimension greater than the diameter dimension of the coronary sinus;    advancing the loop structure into the interior of the coronary sinus, such that the loop structure is operably laterally compressed by the coronary sinus wall thereby biasing the pacing portion and at least one electrode against the wall of the coronary sinus proximate the left atrium.    
   
   
       22 . The method of  claim 21 , further comprising: 
 providing a pair of electrodes disposed on the pacing portion of the lead;    advancing the loop structure into the interior of the coronary sinus, such that both electrodes are biased against the wall of the coronary sinus.    
   
   
       23 . The method of  claim 21 , further comprising: 
 providing a guide catheter having a guide wire operably coupled thereto for guiding the pacing lead towards the coronary sinus opening;    anchoring the guide wire into at least a portion of the coronary sinus;    inserting the pacing lead into the guide catheter with the fixation element held in a straightened position;    advancing the guide catheter and pacing lead to a position proximate the opening of the coronary sinus; and    advancing the pacing lead out of the sheath towards the opening of the coronary sinus such that the fixation element defines the preformed loop structure prior to advancing the loop structure into the interior of the coronary sinus.    
   
   
       24 . A pacing lead configured for implantation in a coronary sinus having an opening and a wall defining an interior, the pacing lead comprising an elongated lead body with at least one electrode and presenting a lead body axis, the pacing lead further including a resilient fixation element extending from the lead body and having a tip presenting a tip axis, the resilient fixation element defining a loop structure laterally adjacent the pacing portion, the loop structure presenting a predetermined width dimension greater than the diameter dimension of the coronary sinus, wherein when the loop structure is inserted into the opening of the coronary sinus, the loop structure is laterally compressed by the wall of the coronary sinus and the at least one electrode is biased against the wall of the coronary sinus.  
   
   
       25 . The lead of  claim 24 , wherein the lead includes a pair of electrodes.  
   
   
       26 . The lead of  claim 25 , wherein the pair of electrodes is disposed on the lead body.  
   
   
       27 . The lead of  claim 24 , wherein the lead defines a central lumen.  
   
   
       28 . The lead of  claim 27 , wherein the central lumen extends through the lead body and the resilient fixation element.  
   
   
       29 . The lead of  claim 27 , wherein the lead defines an aperture extending from the central lumen to an exterior surface of the lead.  
   
   
       30 . The lead of  claim 24 , further comprising a catheter and a guidewire operably coupled to the catheter for guiding the lead towards the opening of the coronary sinus.  
   
   
       31 . The lead of  claim 30 , wherein the lead defines an aperture extending from the central lumen to an exterior surface of the lead, the guidewire extending through the central lumen and aperture of the lead.  
   
   
       32 . The lead of  claim 24 , wherein the predetermined width dimension is between about 10% and about 200% of the diameter dimension of the coronary sinus.  
   
   
       33 . The lead of  claim 24 , wherein the predetermined width dimension is between about 25% and about 75% of the diameter dimension of the coronary sinus.  
   
   
       34 . A method of inserting a pacing lead having a preformed shape into a coronary sinus, the coronary sinus having an opening and a wall defining an interior and presenting a diameter dimension, the method comprising: 
 providing a pacing lead comprising an elongated lead body and a resilient fixation element with at least one electrode on either the lead body or the fixation element, the fixation element extending from the lead body and defining a preformed loop structure laterally adjacent the lead body, the loop structure presenting a predetermined width dimension greater than the diameter dimension of the coronary sinus;    deploying the loop structure outside the opening of the coronary sinus; and    advancing the loop structure into the interior of the coronary sinus, such that the loop structure is operably laterally compressed by the coronary sinus wall thereby biasing the at least one electrode against the wall of the coronary sinus.