Cardiac pacing

Abstract

A cardiac pacing system that includes an implantable pulse generator and electrical leads that include a lead body portion having a distal end and a proximal end, a connector configured to electrically connect the proximal end of the lead body to the pulse generator, and at least one electrode disposed at the distal end of the lead body for delivering electrical stimulation to a patient's heart, wherein the distal end of the lead body is configured to terminate within the mediastinum of the thoracic cavity of the patient, proximate to the heart.

What is claimed is: 
     
         1 . A system comprising:
 a bifurcated lead comprising a plurality of cores wherein the plurality of cores are configured to be advanced in different directions, the bifurcated lead configured to electrically couple with a pulse generator and transmit therapeutic electric pulses generated by the pulse generator.   
     
     
         2 . The bifurcated lead of  claim 2 , wherein the plurality of cores can be biased to bend in a predetermined manner upon reaching a cavity within a patient. 
     
     
         3 . The bifurcated lead of  claim 2 , the plurality of cores comprising shape memory material that causes the plurality of cores to bend responsive to a condition. 
     
     
         4 . The bifurcated lead of  claim 3 , wherein the shape memory material is nitinol. 
     
     
         5 . The bifurcated lead of  claim 3 , wherein the condition is the plurality of cores being at a particular temperature. 
     
     
         6 . The bifurcated lead of  claim 3 , wherein the condition is the plurality of cores being at a particular pressure. 
     
     
         7 . The bifurcated lead of  claim 3 , wherein the condition is the plurality of cores receiving electrical stimulation. 
     
     
         8 . The bifurcated lead of  claim 1 , wherein the plurality of cores are configured to be steerable to cause independent advancement of the plurality of cores in the different directions. 
     
     
         9 . The bifurcated lead of  claim 8 , wherein the plurality of cores are configured to be steerable by a physician. 
     
     
         10 . The bifurcated lead of  claim 8 , wherein the plurality of cores are configured to be steerable by an automated system. 
     
     
         11 . A system comprising:
 a multi-pole lead comprising a plurality of end-leads each having a respective pole, the poles configured to deliver therapeutic energy and/or sense a state of a patient, the multi-pole lead configured to electrically couple with a pulse generator and transmit the therapeutic electric pulses generated by the pulse generator; and   a controller configured to selectively activate any combination of the poles to deliver the therapeutic energy and/or sense the state of a patient.   
     
     
         12 . The system of  claim 11 , further comprising a yoke configured to maintain a hermetically sealed housing for internal electrical cables of the multi-pole lead and to split the internal cables into the plurality of end-leads. 
     
     
         13 . The system of  claim 11 , the controller configured to:
 determine whether a current combination of poles is ineffective at treating with the therapeutic energy;   switch vectors for the delivery of therapy energy by utilizing a different combination of poles; and   deliver the therapeutic energy with the different combination of poles.   
     
     
         14 . The system of  claim 11 , the controller configured to:
 monitor sensing characteristics of the patient as determined from sensing signals received from a current combination of poles;   determine whether the current combination of poles is ineffective at providing adequate sensing signals for sensing the state of the patient;   switch vectors for the sensing by utilizing a different combination of poles; and   sense the state of the patient based on receiving sensing signals with the different combination of poles.   
     
     
         15 . The system of  claim 11 , wherein an end lead of the multi-pole lead includes a flange configured to anchor the distal end within the patient.