Super-selective electrical stimulation of the left ventricle via a miniaturized magnetized stimulation wire: proof of concept study.

Cardiac resynchronization therapy provides a treatment option for patients with congestive heart failure. Electrodes are usually advanced via the cardiac venous system (CVS). Placement is often hampered by small vessel diameter or tortuosity. The aim of this study was to develop and test a magnetized stimulation wire (MSW) capable of being navigated into small and tortuous CVS branches. Therefore, a conventional guide wire with a permanent magnet and a single stimulation electrode at its tip was coated with iridium oxide at the distal end and insulated except for the very tip (coating thickness: 500 nm, active uncoated area: 10 mm(2)). The MSW was designed to allow for a remote magnetic steering using a magnetic navigation system (MN) (Stereotaxis™). After in vitro testing of the electrical properties, the MSW was tested in an animal model (n=6 sheep): the MSW was placed in a CVS side branch and navigation characteristics of the MSW were determined. The effective (unipolar) pacing threshold was 4.9±2.4 V (at 2 ms pulse width). The rheobase was 1.89±0.44 V and the chronaxie time was 0.75±0.7 ms. The MSW could be navigated into small CVS branches with reasonable MN properties. This could allow stimulation at CVS sites currently not accessible for conventional stimulation catheters or electrodes.

Sputtered iridium oxide for stimulation electrode coatings.

This work deals with the reactive RF-powered sputter deposition of iridium oxide for use as the active stimulation layer in functional medical implants. The oxygen gettered by the growing films is determined by an approach based on generic curves. Films deposited at different stages of oxygen integration show strong differences in electrochemical behaviour, caused by different morphologies. The dependence of electrochemical activity on morphology is further illustrated by RF sputtering onto heated substrates, as well as DC sputtering onto cold substrates.

Iridium sputtered at varying pressures and target-substrate-distances evaluated for use as stimulation electrode material.

Iridium was sputtered as the top layer of stimulation electrodes. The coatings were varied in their morphology by adjusting the total deposition pressure and the working distance (WD) of target and substrate. It is shown that the resulting different kinds of morphologies have a strong influence on stimulation characteristics. The combination of high working gas pressure and small WD as well as the combination of medium working gas pressure and larger WD yield the best characteristics on macro-sized test electrodes.