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WO2016024710A1 - Procédé, appareil et cathéter pour placer une extrémité de dérivation de stimulateur cardiaque, passée à travers un sinus coronaire, dans une cloison inter-ventriculaire cacuminale ou intermédiaire - Google Patents

Procédé, appareil et cathéter pour placer une extrémité de dérivation de stimulateur cardiaque, passée à travers un sinus coronaire, dans une cloison inter-ventriculaire cacuminale ou intermédiaire Download PDF

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Publication number
WO2016024710A1
WO2016024710A1 PCT/KR2015/006045 KR2015006045W WO2016024710A1 WO 2016024710 A1 WO2016024710 A1 WO 2016024710A1 KR 2015006045 W KR2015006045 W KR 2015006045W WO 2016024710 A1 WO2016024710 A1 WO 2016024710A1
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WIPO (PCT)
Prior art keywords
catheter
wire
pacemaker
lead
ventricular septum
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Ceased
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PCT/KR2015/006045
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English (en)
Korean (ko)
Inventor
김준홍
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University Industry Cooperation Foundation of Pusan National University
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University Industry Cooperation Foundation of Pusan National University
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode

Definitions

  • the present invention relates to a method, apparatus, and catheter for positioning a lead end of a pacemaker that has passed through a coronary sinus in an intermediate or attached ventricular septum, and more particularly in cardiac pacemaker treatment used in patients with cardiac arrhythmias.
  • the present invention relates to a method, an apparatus, and a catheter for positioning a lead end of a pacemaker that has passed through a coronary sinus in an intermediate or attached ventricular septum.
  • Cardiac pacemakers Since the introduction of artificial pacemakers for the first time in 1958 by Furman and Rovinson et al., Cardiac pacemakers have been used as the main treatment for patients with bradycardia. Recently, the pacemaker has been used as a major treatment for arrhythmia diseases such as complete atrioventricular block, high atrioventricular block, and symptomatic dysfunction syndrome. Cardiac pacemaker treatment is a treatment method in which the electrical stimulation of the heart does not flow normally and artificially creates the electrical stimulation by an artificial pacemaker.
  • FIG. 1 is a diagram of a conduction system of the heart
  • A is a flow chart of the conduction system
  • B shows the waveform of the electrocardiogram
  • C illustrates the relationship between the conduction process and the waveform.
  • the conduction system of the heart through the bundle branch at the ventricular heat through the Atrioventricular (AV) node from the Sinoatial (SA) node in the atrium through the conduciton pathways It is transmitted throughout the ventricles.
  • the transmission of stimuli in the ventricles is via the His-Purkinje system.
  • QRS-complex In ECG, QRS-complex (QRS wave) is caused by the depolarization process of ventricular muscle, and the first down wave following P wave is called Q wave, the first up wave is R wave, and the down wave following R is called S wave. Attach.
  • the width of the QRS means the time when electricity is conducted from the heat to the entire ventricle.In the normal state, the width of the QRS wave is within about 0.12 seconds (about 90ms or less), and in the case of more than 0.12 seconds (120ms), each block, etc. Suggests ventricular conduction disorder.
  • the pacemaker is composed of a generator and a lead.
  • the main body supplies power, and a computer is included in it to grasp the electrical state of the heart coming through the induction wire, and to provide electricity or to rest when necessary.
  • the guide line transfers electricity generated from the body to the heart.
  • RV apex right ventricle pacing
  • RVAP right ventricular attachment
  • RV apex the electrical stimulation in the right ventricular attachment
  • RV apex the electrical stimulation in the right ventricular attachment
  • the stimulus is transmitted through myocardial cells in the ventricles, which slows the time for all electrical stimulation to spread throughout the ventricles.
  • the width of the QRS on the ECG becomes wider, which is called a wide QRS. That is, the QRS through the RVAP is about 160ms, which is considerably later than about 90ms in the normal case.
  • Wide QRS has a side effect that causes ventricular dessynchonization in which ventricular movement is not unified, leading to loss of ventricular function.
  • efforts are being made to obtain narrower QRS by applying electrical stimulation near the conduction system located in the ventricular septum.
  • a representative method is to apply an electrical stimulus around the conduction system by placing the lead end of the pacemaker in the right ventricular basal septum. This is called “right ventricular septal pacing, RVSP.”
  • RVSP right ventricular septal pacing
  • the most frequently used site for RVSP is the ventricular septal region of the right ventricular outflow tract (RVOT).
  • RVSP theoretically compensates for the shortcomings of RVAP, but to actually perform the procedure, it is not easy to position the pacemaker lead precisely in the ventricular septum around the RVOT, or the lead is missing or repositioned. The procedure itself is difficult to use because of its limitations. Another consideration is that the RVSP places the end of the lead in the ventricular septum but is fixed to the outer wall rather than the inside of the ventricular septum, which stimulates the inner wall of the left ventricle or in the middle of the ventricular septum. It is known to be less effective than the method.
  • CTR Cardiac Resynchronization Therapy
  • the CRT treatment is known to be a very effective and promising treatment when there is a problem such as left bundle branch block (LBBB) in a heart failure patient.
  • LBBB left bundle branch block
  • the CRT treatment has the disadvantage of using two leads to stimulate the ventricle to obtain a narrower QRS.
  • the present inventor proposed a method for placing a pacemaker lead inside the ventricular septum (Korean application number: 10-2014-092789). This method involves placing the pacemaker lead in the ventricular septum of the basal part of the ventricular septum, but in some studies, the pacemaker lead is placed in the ventricular septum of the apical part of the ventricle. It is posted that positioning is more advantageous.
  • the present invention has been made to solve the above problems, and an object of the present invention is to direct electrical stimulation to an intermediate or attached ventricular septum in which a cardiac conduction system is located to deliver electrical stimulation more effectively in the treatment of a pacemaker.
  • a method, apparatus, and catheter are provided for placing a lead tip of a pacemaker that has passed through a coronary sinus in a mid- or attached ventricular septum at the same time as it provides safety.
  • Devices for locating the lead ends of the pacemakers that have passed through the venous sinus include: a surgical wire connected to the relative vein (SVC), coronary sinus (CS), AIV, ventricular septum, right ventricle, right atrium, and relative vein or inferior vena cava; A capture catheter inserted through a relative vein or inferior vena cava to capture the surgical wire located in the right ventricle; And a pacemaker lead inserted along the surgical wire and having an end inserted into the apical interventricular septum tissue.
  • a through-hole through which the treatment wire passes, and the frontal vein and AIV (anterior interventricular vein) located in the ventricular septum are easily blocked to prevent coronary sinuses. It further comprises a balloon tipped guiding catheter formed with a balloon (bloon) that can be inflated by blowing air.
  • a method of positioning the lead end of a cardiac pacemaker through the coronary sinus in an intermediate or attached ventricular septum where the cardiac conduction system is located to deliver an effective electrical stimulation is provided. Inserting through vein, coronary sinus (CS) and anterior interventricular vein (AIV); ii) placing the procedure wire through the intermediate or attached apical interventricular septum to the right ventricle of the heart; iii) inserting the capture catheter inserted into the relative vein or inferior vena cava into the right ventricle via the right atrium; iv) capturing the procedure wire with the capture means of the capture catheter and then pulling the procedure wire captured with the capture catheter toward the relative vein or inferior vena cava; And v) inserting the lead of the pacemaker along the surgical wire while holding both ends of the surgical wire to position the tip of the lead within the attached ventricular septum.
  • CS coronary sinus
  • AIV anterior interventricular vein
  • the present invention of the present invention is a method for positioning the lead end of a cardiac pacemaker passing through the coronary sinus in the mid to apical interventricular septum, the apparatus is coronary sinus (CS) and AIV A method of locating and stimulating the pacemaker lead into the medial or attached ventricular septum via an anterior interventricular vein, (1) overcoming the disadvantages of wider QRS pacing due to conventional RVAP, and (2) patients requiring conventional CRTs.
  • the present invention has the advantage of expecting a treatment effect with only one lead without using two leads.
  • a high-risk and non-physiological procedure for artificially opening the left ventricle and the low-pressure right ventricle, which are responsible for high pressure arterial blood as in the conventional methods US 2010/0298841 A1, US 2013/0231728 A1, etc.
  • the procedure can be accompanied by placing the pacemaker lead into the ventricular septal tissue through a relatively simple procedure within the flow of the vein using the most naturally formed route along the path of the septal vein. The advantage is that the risks present can be minimized.
  • the catheter and surgical wire for capturing the right ventricle from the right atrium, avoiding tissues (leaflet, subvavular structure, modulator band, etc.) of the heart compared to the method proposed by the present inventor first Since it can pass through, there is an advantage that can prevent damage to the tissue in the heart as described above.
  • FIG. 1 is a diagram of a conduction system of the heart
  • A is a flow chart of the conduction system
  • B shows the waveform of the electrocardiogram
  • C illustrates the relationship between the conduction process and the waveform.
  • FIG. 2 shows a pacemaker treatment presently being performed.
  • FIG. 3 is a flow chart of a method for positioning the lead end of a pacemaker that has passed through a coronary sinus in an attached ventricular septum, in accordance with a preferred embodiment of the present invention.
  • FIGS. 4 and 5 are schematic diagrams of the anatomical structure of the heart and coronary veins, in accordance with a preferred embodiment of the present invention.
  • Figure 6 is a photograph showing the Pressuized septal venogram when the coronary sinus is blocked using a balloon catheter, according to a preferred embodiment of the present invention.
  • FIG. 7 is a cross-sectional schematic diagram of a dual type perforated catheter according to a preferred embodiment of the present invention, where (A) the length of the first and second tubes is the same, (B) is the length of the first and second tubes Shows a different case.
  • FIGS. 8 and 9 are a partial cutaway view showing the process of puncturing the ventricular septum using a dual-type puncture catheter, according to a preferred embodiment of the present invention
  • Figure 8 is a direction of the support wire is the RVIT direction
  • 9 illustrates a case in which the advancing direction of the support wire is in the RV epicardial vein direction.
  • FIG. 10 is a photograph showing a path through which a surgical wire passes, according to a preferred embodiment of the present invention.
  • FIG. 11 illustrates an example of a capture catheter, in accordance with a preferred embodiment of the present invention.
  • FIG. 12 is a schematic diagram showing an unfolded state of the capturing means (mesh) of the capture catheter in the heart according to a preferred embodiment of the present invention.
  • Methods, devices, and catheters for positioning the lead tip of a pacemaker within the mid to apical interventricular septum of the present invention are directed to coronary and anterior interventricular vein to deliver electrical stimulation more effectively in the treatment of pacemakers.
  • the end of the pacemaker lead is located in the ventricular septum, but it is fixed to the outer wall instead of the inside of the ventricular septum to stimulate the stimulus, which is theoretically a conduction system located inside the ventricular septum.
  • the electrical stimulation delivery scheme for is less effective when delivering electrical stimulation in the intra-septal.
  • the present inventors have developed a method and apparatus for positioning the lead end of a pacemaker in an intermediate or attached ventricular septum using a surgical wire that passes through a relative vein, coronary sinus, ventricular septum, or inferior vena cava (or relative vein).
  • the method of positioning the lead end of the pacemaker of the present invention in the ventricular septum comprises the steps of: i) inserting the surgical wire through the relative vein, coronary venous sinus (CS) and an anterior interventricular vein (AIV); ii) placing the procedure wire through the mid to apical interventricular septum into the right ventricle of the heart; iii) inserting a capture catheter inserted into a relative vein or inferior vena cava into the right ventricle via the right atrium, and capturing the procedure wire with the capture means of the capture catheter; iv) pulling the procedure wire captured with the capture catheter toward the relative vein or inferior vena cava; And v) holding the ends of the procedure wire, inserting the leads of the pacemaker along the procedure wire to position the ends of the leads in the intermediate or attached ventricular septum.
  • CS coronary venous sinus
  • AIV anterior interventricular vein
  • the procedure wire is introduced through the relative vein and the coronary venous sinus, and placed in the right ventricle through the intermediate or attached ventricular septum, and then guided back to the relative vein or the inferior vena cava; And inserting a lead of the pacemaker along the surgical wire to position the end of the lead in the intermediate or attached ventricular septum.
  • FIG. 3 is a flow chart of a method by which the lead end of a pacemaker may be located within the ventricular septum, in accordance with a preferred embodiment of the present invention. The method of the present invention will be described with reference to FIG. 3.
  • a surgical wire through a relative vein, coronary venous sinus (CS) and an anterior interventricular vein (AIV) (S10).
  • CS coronary venous sinus
  • AIV anterior interventricular vein
  • the "intervention wire” is inserted through the relative vein, coronary sinus and AIV, passes through the medial or attached ventricular septum, then is led to the inferior vena cava (or relative vein), where both sides are fixed by the operator.
  • the pacemaker lead is inserted through the coronary sinus and inserted into the intermediate or attached ventricular septum.
  • the intervention wire serves as a guide for the pacemaker lead and is also referred to as a "pacemaker lead guide wire.”
  • the procedure wire is routed through the appropriate ventricular basal vein (septal vein) and the anterior interventricular vein (AIV) to the intermediate or attached ventricular septum.
  • AIV anterior interventricular vein
  • Balloon catheter is a catheter with a balloon (balloon) formed on the tip (top), inserted through the relative vein, coronary sinus, and then inflated by blowing air from the outside to prevent coronary sinus.
  • Balloon catheter is a catheter with a balloon (balloon) formed on the tip (top), inserted through the relative vein, coronary sinus, and then inflated by blowing air from the outside to prevent coronary sinus.
  • the flow of blood in the coronary sinus is blocked, so that the pressure of the coronary sinus increases, and the coronary sinus expands.
  • the septal vein and ventricular septal veins located in the ventricular septum are pounded out.
  • FIGS. 4 and 5 are schematic diagrams of the anatomical structure of the heart and coronary veins in accordance with a preferred embodiment of the present invention.
  • the relative vein is connected to the coronary sinus (CS), and the coronary vein (CS) is connected to the anterior interventricular vein (AIV) through a great cardiac vein (GCV). Therefore, the surgical wire in the present invention is inserted into the relative vein, coronary vein, GCV (great cardiac vein), AIV (anterior interventricular vein).
  • the surgical wire inserted into the AIV is pierced to the right ventricle with a mid to apical interventricular septum.
  • the circle represents the position of the end of the surgical wire, that is, the position of the ventricular septum in which the surgical wire is bent.
  • Figure 6 is a photograph showing the Pressuized septal venogram when the coronary sinus is blocked using a balloon catheter, according to a preferred embodiment of the present invention.
  • Intervention wire is inserted into the septal vane and AIV through the aperture of the balloon catheter, and then passes through the mid to apical interventricular septum by external force.
  • next step is ii) placing the procedure wire in the right ventricle by passing the procedure wire through an intermediate or attached ventricular septum (S20).
  • the balloon catheter is pulled out and removed, and the tip of the procedure wire is located in the intermediate or attached right ventricle.
  • the ventricular septal puncture catheter is a dual puncture catheter consisting of two tubes each having two wires inserted therein.
  • FIG. 7 shows a dual puncture catheter with two lumens.
  • FIG. 7 is a cross-sectional schematic diagram of a dual type perforated catheter according to a preferred embodiment of the present invention, where (A) the length of the first and second tubes is the same, (B) is the length of the first and second tubes 8 and 9 illustrate a partial cardiac incision showing a process of puncturing the ventricular septum using a dual puncture catheter, and FIG. 8 illustrates a case in which the support wire is in the RVIT direction. Shows the case where the advancing direction of the support wire is the RV epicardial vein direction.
  • a dual puncture catheter having two lumens includes a first tube into which a support wire is inserted and a second tube into which a surgical wire is inserted.
  • the first tube 11 and the second tube 12 of the perforated catheter are in close contact with each other and fixedly coupled to each other.
  • the two tubes may be formed in close contact or may be divided into two spaces by a membrane in one tube. .
  • tube 12 may be the same, or may differ.
  • Fig. 7A shows the case where the lengths of the first pipe and the second pipe are the same, and (B) shows the case where the lengths of the first pipe and the second pipe are different.
  • tube is formed shorter and the length of a 1st pipe
  • the support wire 21 inserted into the first tube 11 serves to support when the surgical wire 22 inserted into the second tube 12 punctures the mid to apical interventricular septum. That is, the support wire 21 serves as a support for preventing the surgical wire 22 from being pushed back when the surgical wire 22 punctures the intermediate or attached ventricular septum. As described above, the surgical wire 22 penetrates into the ventricular septum and is connected to a relative vein or inferior vena cava, which serves to guide or support the lead of the pacemaker later.
  • the support wire serves as a support, and the surgical wire serves to penetrate the intermediate or attached ventricular septum, so that the support wire is often softer than the surgical wire.
  • a puncture catheter is formed with a radiopaque marker 14.
  • the radiopaque marker 14 detects the position of the puncture catheter (the position of the end of the surgical wire) through the imaging device, and helps the surgical wire 22 to puncture the ventricular septum. That is, a radiopaque marker 14 is formed to impart ease of intermediate or attached ventricular septal perforation.
  • the end of the second tube that is, the outlet portion of the second tube of the perforated catheter is formed with a slightly inclined guide portion 13. This is to allow the procedure wire 22 to exit the second tube 12 and puncture the intermediate or attached ventricular septum.
  • the puncture process will be described.
  • the support wire 21 is inserted into the first tube 11 of the puncture catheter.
  • the support wire may be entered first and the perforated catheter may be entered, or the support wire may be inserted into the perforated catheter while being inserted.
  • the support wire 21 moves in various paths according to the characteristics of the wire and the shape of the septal vein, such as the right ventricular inflow tract (RVIT) direction (septal vein) according to the direction in which the coronary sinus is connected. do.
  • RVIT right ventricular inflow tract
  • the procedure wire may easily exit to the desired right ventricular outlet, such as RVIT, without the aid of another instrument (another wire or other catheter), but in most cases it does not lead to the desired outlet. In other words, the ideal wire exit varies from patient to patient. If it is difficult to penetrate the middle or attached ventricular septum with only the procedure wire, the use of a support wire makes the procedure very easy. A dual lumen catheter is very useful for this purpose. .
  • the perforated catheter After inserting the support wire 21, the perforated catheter is sent to the appropriate location of the intermediate or attached ventricular septum, and the surgical wire 22 is inserted into the second tube 12 of the perforated catheter.
  • the position at which the procedure wire exits that is, the position of the end of the second tube, can be confirmed by the radiopaque marker 14 through the imaging device, and is a "ventricular septal penetration start point".
  • the support wire 21 is inserted in the right ventricular inflow tract (RVIT) direction (septal vein) or in the right ventricular epicardial vein (RV epicardial vein) direction is performed by the operator. It is relatively easy to know the location of the and wires together. Therefore, the operator grasps the position of the support wire and pushes the procedure wire as shown in FIG. 8 or 9 to puncture the ventricular septum.
  • RVIT right ventricular inflow tract
  • RV epicardial vein right ventricular epicardial vein
  • the surgical wire passing through the ventricular septum is directed to the right ventricle.
  • the end of the surgical wire is formed to have a pointed shape or a rigid property, so that the perforation of the ventricular septum is more easily performed. This leads the procedure wire to the right ventricle, which then removes the puncture catheter and support wire.
  • an interventional wire is placed in the intermediate or attached right ventricle through a mid to apical interventricular septum.
  • FIG. 10 is a photograph showing a path through which a surgical wire passes, according to a preferred embodiment of the present invention.
  • the red line shown in FIG. 10 represents a path through which the procedure wire passes.
  • the procedure wire passes through the relative vein, coronary sinus, GCV (great cadiac vein), AIV (anterior interventricular vein), and then penetrates the mid or apical interventricular septum to the middle or attached right ventricle. It is located at.
  • the cardiac tissue located in the right ventricle when the capture catheter is inserted into the right ventricle from the relative vein or inferior vena cava into the right ventricle (three thousand valves) Damage to leaflets, subvavular structures, modulator bands, and the like. That is, upon insertion of the capture catheter, the capture catheter can be directed towards the procedure wire located in the middle or attached right ventricle without damaging the tissue in the right ventricle of the heart.
  • a capture catheter is a catheter for capturing a surgical wire located in the middle or attached right ventricle, and can be called a" wire induction device “in the sense that guides the surgical wire to a relative vein or an inferior vena cava. have.
  • FIG. 11 is a diagram illustrating an example of a capture catheter, according to a preferred embodiment of the present invention.
  • the capture catheter is a means (capture means) for capturing a procedure wire, and preferably a mesh is formed.
  • Mesh is a concept that includes not only a narrow grid structure but also a straight basket type. In other words, as shown in Fig. 11, the basket type will be referred to as one type of mesh, and as shown in Fig. 12, the lattice structure will also be referred to as one type of mesh.
  • the mesh is narrowed from the relative or inferior vena cava until it enters the right ventricle through the right atrium, then unfolds in the right ventricle, inserts an intervention wire into the mesh net, and then narrows the mesh again.
  • the procedure wire will be captured.
  • the mesh net is expanded or narrowed by external manipulation, and when unfolded, the surgical wire should be able to easily pass through the mesh net, and when it is narrowed, the mesh net should be sized to hold the surgical wire tightly.
  • the procedure wire passes through the mesh net, the mesh net is narrowed again by external operation means. At this time, the surgical wire is captured to the mesh.
  • Whether the procedure wire has passed through the mesh network may be confirmed using an existing imaging apparatus.
  • an existing imaging apparatus Preferably, as shown in Figure 12 by forming a radiopaque marker (radiopaque marker) on the top or bottom of the mesh, it can be easily confirmed through the imaging device.
  • the capture catheter is composed of an outer catheter (outer catheter), the central (central bar), the mesh (mesh).
  • the mesh net is fixed to the central body with the upper part collected and the lower part is fixed to the external catheter in the collected state.
  • the centrosome has a structure inserted into an external catheter.
  • FIG. 12 is a schematic diagram showing an unfolded state of the capturing means (mesh) of the capture catheter in the heart according to the preferred embodiment of the present invention.
  • the surgical wire penetrating the intermediate or attached ventricular septum is placed in the middle or attached right ventricle, and the catheter inserted through the relative vein or inferior vena cava is in the right ventricle. It will unfold.
  • the mesh net can be lowered to the attachment of the right ventricle, making it easier to capture the procedure wire located in the middle or attached right ventricle.
  • the procedure wire is captured by a capture catheter.
  • the surgical wire When the surgical catheter is captured by the capture catheter and the capture catheter is pulled toward the relative vein or inferior vena cava, the surgical wire also exits to the relative or inferior vena cava.
  • the capture catheter is completely pulled out of the body, and the surgical wire is also pulled out of the body.
  • the procedure wire is located at one end outside the upper part of the body and passes through the relative vein, coronary sinus, AIV, intermediate or attached ventricular septum, right ventricle, right atrium, inferior vena cava (or relative vein) and the other end of the body. It will be located outside of.
  • the capture catheter can be inserted through the relative vein or the inferior vena cava, more preferably in the inferior vena cava.
  • the treatment wire serves not only as a guide but also as a support. In this case, it is preferable that one end of the procedure wire is located at the top and the other is located at the bottom, rather than all the ends of the procedure wire are located at the top. It is because it is more preferable as a support role.
  • a through hole is formed inside the lead of the pacemaker so that the procedure wire can be inserted.
  • the upper and lower ends of the surgical wire extend out of the body, passing through the pacemaker lead along the surgical wire through the relative vein, coronary sinus and AIV, while the operator grasps both ends of the surgical wire. And placed in the middle or attached ventricular septum.
  • the operator inserts the pacemaker lead while holding both ends of the procedure wire, thereby securing sufficient support for safely inserting the lead tip of the pacemaker into the ventricular septal tissue.
  • the end of the pacemaker lead has a sharp shape so as to easily penetrate the ventricular septal tissue, and a locking jaw (hook) is formed so that it is not easily separated after being inserted into the ventricular septal tissue.
  • the lead end of the pacemaker in the tissue in the middle or attached ventricular septum, it is possible to deliver a direct and effective electrical stimulation to the conduction system of the heart to obtain a narrow QRS
  • the lead of the pacemaker since the surgical wire serves as a support, the lead of the pacemaker may be stably and easily inserted into the tissue of the intermediate or attached ventricular septum.
  • the present invention relates to a method, apparatus, and catheter for positioning a lead end of a pacemaker that has passed through a coronary sinus in an intermediate or attached ventricular septum, and more particularly in cardiac pacemaker treatment used in patients with cardiac arrhythmias.
  • a method for more effectively delivering electrical stimulation it is available in the field of methods, devices, and catheter to locate the lead end of a pacemaker that has passed through a coronary sinus in an intermediate or attached ventricular septum.

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Abstract

La présente invention concerne un procédé, un appareil et un cathéter pour placer une extrémité d'une dérivation d'un stimulateur cardiaque, passée à travers un sinus coronaire, à l'intérieur d'une cloison inter-ventriculaire cacuminale ou intermédiaire et, plus précisément, un procédé, un appareil et un cathéter pour placer une extrémité d'une dérivation d'un stimulateur cardiaque, passée à travers un sinus coronaire, à l'intérieur d'une cloison inter-ventriculaire cacuminale ou intermédiaire dans un effort pour transférer plus efficacement un stimulus électrique dans une thérapie par stimulateur cardiaque pour le cœur, qui est utilisée pour un patient ayant une maladie d'arythmie du cœur. Un appareil pour placer une extrémité d'une dérivation d'un stimulateur cardiaque, selon un mode de réalisation donné à titre d'exemple de la présente invention, comprend un fil chirurgical, un cathéter de capture et une dérivation de stimulateur cardiaque. L'invention concerne également un procédé pour placer une extrémité d'une dérivation d'un stimulateur cardiaque, passée à travers un sinus coronaire, à l'intérieur d'une cloison inter-ventriculaire cacuminale ou intermédiaire, qui comprend : une étape pour introduire un fil chirurgical à travers une veine cave supérieure et le sinus coronaire, passer le fil chirurgical à travers la cloison inter-ventriculaire cacuminale ou intermédiaire, puis guider le fil chirurgical vers la veine cave supérieure ou la veine cave inférieure ; et une étape pour placer l'extrémité de la dérivation à l'intérieur de la cloison inter-ventriculaire en introduisant la dérivation du stimulateur cardiaque le long du fil chirurgical.
PCT/KR2015/006045 2014-08-14 2015-06-16 Procédé, appareil et cathéter pour placer une extrémité de dérivation de stimulateur cardiaque, passée à travers un sinus coronaire, dans une cloison inter-ventriculaire cacuminale ou intermédiaire Ceased WO2016024710A1 (fr)

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KR1020140106209A KR20160020887A (ko) 2014-08-14 2014-08-14 중간 또는 첨부의 심실 중격 내에 관상정맥동을 통과한 심박동기의 리드 끝단을 위치시키는 방법, 장치, 및 카테터
KR10-2014-0106209 2014-08-14

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US10433962B2 (en) 2016-05-06 2019-10-08 Transmural Systems Llc Annuloplasty procedures, related devices and methods
EP3653257A1 (fr) * 2018-11-15 2020-05-20 Tau Pnu Medical Co., Ltd. Sonde de stimulateur cardiaque pour stimulation de cerclage
JP2020534981A (ja) * 2017-09-25 2020-12-03 タウ ピーエヌユー メディカル カンパニー， リミテッド 冠状静脈洞を通過したペースメーカーリードの先端をヒス束に位置させる装置
US11007059B2 (en) 2016-05-06 2021-05-18 Transmural Systems Llc Annuloplasty procedures, related devices and methods
US11039923B2 (en) 2016-05-06 2021-06-22 Transmural Systems Llc Annuloplasty procedures, related devices and methods
US11259926B2 (en) 2017-08-26 2022-03-01 Transmural Systems Llc Cardiac annuloplasty and pacing procedures, related devices and methods
US11980545B2 (en) 2016-05-06 2024-05-14 Transmural Systems Llc Annuloplasty procedures, related devices and methods

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KR102053451B1 (ko) * 2017-11-24 2020-01-08 (주) 타우피엔유메디칼 서클라지 심방 제세동장치
KR102067989B1 (ko) 2018-03-26 2020-01-20 (주) 타우피엔유메디칼 심근 전기 신호 감지 캡쳐카테터
KR102167091B1 (ko) 2018-08-21 2020-10-16 (주) 타우피엔유메디칼 스네어 일체형 심근 전기 신호 감지 카테터
US20210393292A1 (en) * 2018-11-23 2021-12-23 Tau-Pnu Medical Co., Ltd. Device for valve regurgitation surgery and cardiac pacemaker lead fixation
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KR102240805B1 (ko) 2019-07-12 2021-04-15 (주) 타우피엔유메디칼 위치고정장치를 구비한 서클라지 시술장치

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US10433962B2 (en) 2016-05-06 2019-10-08 Transmural Systems Llc Annuloplasty procedures, related devices and methods
US11007059B2 (en) 2016-05-06 2021-05-18 Transmural Systems Llc Annuloplasty procedures, related devices and methods
US11039923B2 (en) 2016-05-06 2021-06-22 Transmural Systems Llc Annuloplasty procedures, related devices and methods
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JP2020534981A (ja) * 2017-09-25 2020-12-03 タウ ピーエヌユー メディカル カンパニー， リミテッド 冠状静脈洞を通過したペースメーカーリードの先端をヒス束に位置させる装置
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