the invention will hereinafter be described in relation to embodiments relating to a so called cardiac lv - lead , i . e . a lead adapted to monitor and control the function of the left ventricle of a heart and more precisely to an lv - lead that is adapted to be inserted and positioned in the coronary veins outside the left ventricle . this is illustrated in fig1 , in which is shown a heart 1 which is partially cut through the right atrium 2 and ventricle 3 , wherein a distal part of a medical implantable lead 4 is shown inserted through a vein into the right atrium and from there into a coronary vein 5 surrounding the left ventricle . the coronary veins are gradually tapering so in order to be able to position the lead at a desired position it is important that the lead has a sufficient small cross sectional dimension , at least in a distal portion . for this reason a medical implantable lead according to this invention is formed with a tapered distal portion although it comprises an electric conductor in form of a coil of at least one close - coiled wire . one advantage with an electric conductor formed in this way is that it can be made mri - compatible by providing the one or more conductor wires with an electrically insulating layer such that the coil will act as an inductance coil . a distal portion of a first embodiment of a medical implantable lead is disclosed in a perspective view in fig2 and in a longitudinal section in fig3 . the medical implantable lead according to this embodiment is a bipolar lead having two electrodes , more precisely a first electrode 6 i in form of a tip electrode at a distal end of the lead and a second , annular electrode 6 ii on a distance from the distal end . the lead also comprises an outer flexible tubing 7 , an inner flexible tubing 8 , which both can be made of for example silicone , and a conductor arrangement comprising a coil 9 i , which is wound of two coradially positioned electrically conducting wires 10 i , 10 ii being electrically separated from each other by means of a not shown electrically insulating layer around each wire . one of the wires 10 ii of the coil is electrically connected directly to the second electrode 6 ii , whereas the other wire 10 i of the coil continues as an end conductor in form of a non - coiled conductor 11 i of a wire from the region of the second electrode 6 ii , where the coil 9 i is terminated at a termination point 14 , to the first electrode 6 i and is electrically connected to that electrode . both of the wires of the coil are moreover electrically connected to a respective contact surface of a not shown connector in a proximal end of the lead , which connector can be connected to e . g . a pacemaker or an icd . the reason why the coil is terminated is to allow , in a simple and uncomplicated way , tapering of the distal portion of the lead . the tapering in this embodiment starts at the region of the second electrode 6 ii , where the lead in an exemplary embodiment can have a diameter of e . g . about 2 mm , and tapers continuously to the distal end where the lead can have a diameter of e . g . about 1 . 3 mm . as is illustrated in fig2 and 3 , the most distal portion of the lead is curved in an initial stage . the reason for this is that the lead , when positioned at a desired location in a vein , as illustrated in fig1 , should squeeze against the inner walls of the vein and accordingly help to maintain the lead &# 39 ; s position in the vein in the implanted stage . this lead is provided with one single curvature but it is to be understood that the curvature also can have other shapes , e . g . be formed in an s - shape . during implantation of the lead , this curvature can be straightened by insertion of a so called stylet or guide wire 12 into the inner bore of the inner tubing 8 , as is illustrated in fig4 . fig5 thru 7 illustrate different embodiments of a quadpolar lv - lead , i . e . an lv - lead comprising four electrodes . in a first embodiment according to fig5 , the lead is provided with one single coil 9 i comprising four coradially disposed conducting wires 10 i - 10 iv , each having an electrically insulating layer in order to insulate them electrically from each other as well as render the coil mri - compatible . one wire 10 iv of the coil is terminated at and electrically connected to a fourth electrode 6 iv . from there , three wires continue to a third electrode 6 iii , where one further wire 10 iii is terminated and electrically connected to the third electrode . from the third electrode only two wires of the coil continue to the second electrode 6 ii , where the coil is terminated at the termination point 14 . one of the wires 10 ii of the coil is electrically connected to the second electrode , whereas the other wire 10 i continues as an end conductor in form of a non - coiled electric conductor 11 i within the space between the outer and inner tubings to the most distal , first electrode 6 i . the tapering of the distal portion of the lead is started from the second electrode 6 ii and the termination point 14 . as an alternative ( not shown ) to the embodiment of fig5 , the coil could be terminated at the fourth electrode . then one wire of the coil is electrically connected to the fourth electrode , whereas the other wires continue from the termination as end conductors to the first , second and third electrodes , respectively . the tapering could then start at the fourth electrode . fig6 illustrates an embodiment comprising one single coil 9 i containing four conducting wires . however , here two of the conducting wires are transferred to a respective non - coiled conductor 11 i and 11 ii already at a position proximal to the fourth electrode 6 iv and are electrically connected to the first and second electrodes 6 i and 6 ii , respectively . the remaining conducting wires 10 iii and 10 iv are continued in a coiled state and connected directly to the third and fourth electrodes 6 iii and 6 iv , respectively . the tapering of a lead according to this embodiment could begin already at the third electrode 6 iii without having to taper the coil , since it is terminated at a termination point 14 at that electrode . fig7 illustrates an embodiment having one inner and one outer coil 9 i and 9 ii , respectively , each comprising two electrically insulated wires . the wire 10 iv of the outer coil 9 ii is connected to the fourth electrode 6 iv , while the wire 10 iii is continued and connected to the third electrode 6 iii where accordingly the outer coil 9 ii is terminated at a termination point 14 i of the outer coil . the wire 10 ii of the inner coil 9 i is connected to the second electrode 6 ii where also the inner coil is terminated at a termination point 14 and the wire 10 i is transferred to a non - coiled conductor 11 i , which is connected to the first electrode 6 i . the tapering of the lead according to this embodiment could begin already at the third electrode 6 iii without having to taper any coil , since the outer coil 9 ii is terminated at that point . as an alternative ( not shown ) to the embodiment of fig7 , the outer coil could be terminated already at the fourth electrode such that the wire is transferred or connected to an end conductor in form of a non - coiled electric conductor or an eccentrically positioned small diameter coil , which is connected to the third electrode , while the inner coil is terminated at the second electrode and the wires of that coil are connected to the second and first electrodes in the same way as in the embodiment according to fig7 . in this way it is possible to start the tapering of the lead already at the fourth electrode 6 iv . as a further alternative ( not shown ) to the embodiment of fig7 , the inner and outer coils could be terminated at the fourth electrode . then one wire of one of the coils is electrically connected to the fourth electrode , whereas the other wire of that coil and the wires of the other coil continue as end conductors to the third , second and first electrodes , respectively . the tapering could then start at the fourth electrode . fig8 illustrates , in an enlarged longitudinal section through a distal portion of a lead , an alternative embodiment of the end conductor . here the end conductor is not in form of a non - coiled conductor , as in the previously illustrated embodiments . instead , the end conductor is formed as a small diameter coil 13 , which is eccentrically positioned in relation to the centre line of the lead . more precisely , the small diameter coil is positioned in the region between the inner and the outer tubing . by the expression “ small diameter ” is meant a coil having a diameter , which is considerably smaller , preferably more than 50 % smaller , more preferred more than 75 % smaller and most preferred more than 90 % smaller , than any of the other coils 9 i , 9 ii of the lead . one advantage with an end conductor formed as a small diameter coil is that it can be made as an inductance coil if the wire of the coil is insulated which renders it mri - compatible . as is evident from the different embodiments described above and illustrated in the drawings , the invention can be varied and modified in many different ways within the scope of the claims , such as for example the number of electrodes , the number of coils , the number of non - coiled conductors , the positions for terminating the one or more coils , the positions for beginning the tapering , etcetera .
the invention relates to a medical implantable lead for monitoring and / or controlling an organ inside a human or animal body . the lead comprises a conducting arrangement having a first conducting coil of at least one electrically conducting wire for connecting a first electrode electrically to a connector to receive and / or transmit electric signals from and to the tissue , respectively . the lead is tapered in a distal portion and has a smaller cross sectional dimension at the distal portion than at the rest of the lead . the first conducting coil is terminated at a termination point on a distance from the distal end . the conducting arrangement has a first end conductor in the form of a non - coiled electric conductor or an eccentrically positioned small diameter coil which connects the first electrode electrically with the coil .