Abstract:
Electric potential mapping and electrode attachment device comprises: a main cylinder; a center piece having a center piece passage for receiving a catheter with its electrode running from a center piece inlet to a center piece outlet; a cylinder cap for closing main cylinder; a second cylinder which fits inside of and is allowed to rotate relative to main cylinder; and at least two electromechanical connections used to connect the device to at least two connectors on an electrode lead, where the device facilitates rotation and movement of each connector relative to the other while retaining continuous electrical connection with heart tissue or other body cavity tissue. The device offers continuous recording of electrical potentials of a body cavity during full rotation of collars, connectors, or connections on a laparoscopic device during HIS bundle mapping, pacemaker electrode anchoring, post anchoring, pacemaker programming, and afterwards.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to a novel electric potential mapping and electrode attachment device used to locate and map the HIS bundle electrical impulse section of the heart or any other cavity within the body and produce a high-quality electrocardiogram of the HIS bundle or other cavity with continuous electrical readings through cavity mapping, electrode attachment, final implantation into the patient, and programming of the pacemaker device. 
     2. Description of Related Art 
     The contractions of the atria and ventricles of a heart are synchronized for efficient pumping of blood through the body. An electrical impulse created by the sinus node is conducted to the ventricles by a specialized conduction system, referred to as the His bundle and His Purkinje system. The bundle of His, also known as the AV bundle or atrioventricular bundle, is a collection of heart muscle cells specialized for electrical conduction that transmits electrical impulses from the AV node (located between the atria and the ventricles) to the point of apex of the fascicular branches. The fascicular branches then lead to the Purkinje fibers which innervate the ventricles, causing the cardiac muscle of the ventricles to contract at a paced interval. The His bundle is responsible for rapid sequential multi-site activation of the ventricle which results in efficient simultaneous contraction of both heart ventricles. 
     At times, an external device, such as an artificial pacemaker, is connected to the heart for activation of the myocardium. The impulse is carried through a set of electric wires (leads) to the electrode placed on or in the heart. The most common position of these electrodes is the right ventricular apex. The electrical stimulus causes the heart muscle to contract. This can be seen in U.S. Pat. No. 5,902,324 “Bi-Atrial and Bi-Ventricular Sequential Cardiac Pacing Systems” Thompson et al. issued May 11, 1999, (Thompson). 
     It has been determined that stimulation and pacing are more efficient if the His bundle system is stimulated instead of the heart muscle. This has been described in “Permanent, Direct His-Bundle Pacing—A Novel Approach to Cardiac Pacing in Patients With Normal His-Purkinje Activation”, Pramod Deshmukh, MD, David A. Casavant, MS, Mary Romanyshyn, CRNP, Kathleen Anderson, BSN, Oct. 1, 1999, cardiology Div., Robert Packard Hospital, Sayre, Pa. and Medtronic, inc. Minneapolis, Minn., © 2000 American Heart institute, (Deshmukh). This paper indicated that the right ventricular (RV) apical pacing caused abnormal contraction of the ventricles had disadvantageous effects on cardiac efficiency. RV pacing has also been associated with changes that cause the left ventricular function to deteriorate, “Long-Term His-Bundle Pacing and Cardiac Function” by Melvin M. Scheinman, MD, Leslie A. Saxon, MD, Dept. of Medicine, Univ. of California, San Francisco, © 2000 American Heart Association, Inc., (Scheinman). Scheinman supports and reiterates the findings of Deshmukh. 
     The process of mapping the HIS bundle and attaching the electrode to a precise location in the HIS bundle is currently an extremely difficult surgical procedure because the HIS bundle is very small and is located inside of a small heart chamber in blind corner location that is very difficult to get to laproscopically. This can be seen in U.S. Pat. No. 6,937,897 B2 “Electrode for HIS Bundle Stimulation”, Min et al. issued Aug. 30, 2005, The location and attachment process can become more difficult since the heart is beating and the location of the HIS bundle changes throughout the beating cycle. The heart ‘torques’ when it beats so it translates and rotates as it expands and contracts. In addition, the current means of accessing the HIS bundle is by passing a catheter through the superior vena cava into the atrium and placing it against the atrium wall, so all positioning must be done remotely by manipulating a catheter from outside of the patient. 
     Note that this invention is very suitable for application and mapping of other body cavities. The HIS bundle is very small and is located in a very hard to reach area. Because of the high degree of control required to effectively map this cavity, the device may be easily used to map practically any other body cavity in humans or animals. 
     Pacemaker electrodes are attached to heart tissue by screw means. A screw is a helix or a corkscrew-shaped appendage attached to the distal end of the electrode, with its longitudinal axis normal to the distal outer surface of the electrode, where the helix is used to literally screw into heart tissue or otherwise attach or seat the distal outer surface of the electrode onto heart tissue at a precise point. Electrodes typically use a fixed screw or a rotational screw design. With fixed screw electrodes, the helix is fixed onto the distal outer surface of the electrode. Thus, the whole electrode must be rotated to rotate the helix and attach the electrode to the heart. With rotational screw electrodes, the helix may be rotated in isolation, without also rotating of the electrode. With rotational screw, the helix is fixed to a holder, where the holder may be rotated, causing the helix to rotate and extent distally from the distal outer surface of the electrode, thereby extending the screw from such and attaching to heart tissue. The distal surface of the electrode has a hole or aperture from which the helix extends and retracts. 
     Mapping is the process of positioning the electrode, recording an electrical potential reading, repositioning the electrode, recording another electrical signal, and repeating until an accurate enough map or sufficient amount of electrical readings is taken by the surgeon to render an electrical topography of the heart chamber or otherwise enough information to determine the exact best position on the His bundle to attach the electrode in order to stimulate the simultaneous contraction of both ventricles to achieve maximum pumping efficiency. The electrical potential reading used in the mapping process is the electric potential difference between the electrode collar and the electrode helix, as set forth in Deshmukh. The electrode collar is located on the distal outer surface of the electrode. The electrode collar is typically the outer ring on the distal outer surface of the electrode. In the case of rotational screw electrodes, typically, the helix extends from the center of the ring of electrode collar. 
     With prior art methods and devices, after the surgeon determines the precise optimum attachment point, he must disconnect one or both electrical signals/readings in order to begin and complete the rotating of the electrode or helix. At this point, the electrode may move slightly off-center, in any direction, from its precise location. A fraction of a millimeter shift could substantially change electrical readings. 
     Such mislocations are typically discovered after attachment, when the surgeon re-connects electrical signals to see that the electrical readings have changed. At this point, the surgeon must: disconnect electrical signals, retract the electrode or helix, reconnect electrical signals, remap, relocated electrode, disconnect electrical signals, reattach electrode to heart, reconnect electrical signals, and recheck electrical signals, perhaps only to repeat this procedure over and over again. This could theoretically lead to an endless cycle or infinite loop of mislocations. 
     To solve this problem, this invention provides continuous electrical signal monitoring of the heart as the electrode is moved within the heart and rotated for attachment means into heart tissue. Thus, if the electrode were to move off-center from the precise location determined by electrical signal readings, then the surgeon would immediately know, discontinue attachment, unscrew the electrode or helix, and make adjustments or otherwise relocate to offset the effect, and begin attachment again. Electrical signals are also continuously monitored after attachment. The surgeon can be certain of accurate and precise electrode placement. The method of attachment disclosed here allows more exact control and placement of the electrode because of the superior amount of measurement data produced by electric potential mapping and electrode attachment device. 
     Additionally, electric potential mapping and electrode attachment device can provide a complete and uninterrupted electrocardiogram of the HIS bundle. The surgeon has continuous electric potential readings right up to final disconnection of the attachment device and attachment of the pacemaker control module for final insertion into the patient. This data is necessary as set forth in Deshmukh to program the pacemaker “to pace” the heart most efficiently. Electric potential mapping and electrode attachment device is first to provide such a cardiogram of the HIS bundle during rotation and attachment as well as before and after. This data better ensures that the pacemaker will be programmed to run in the most efficient fashion because the cardiogram used for input in the programming is more exact, without disconnection of electrical contacts, ending of one cardiogram, only to start a new one after electrode attachment. With the prior art, it would be possible to use a cardiogram generated from a different location, where the electrode move off-center slightly during attachment. This would yield improper programming of the pacemaker, so it would not pace the heart in the most efficient fashion. 
     BRIEF SUMMARY OF THE INVENTION 
     Electric potential mapping and electrode attachment device comprises: a main cylinder; a center piece having a center piece passage for receiving a catheter with its electrode running from a center piece net to a center piece outlet; a cylinder cap for closing main cylinder; a second cylinder which fits inside of and is allowed to rotate relative to main cylinder; and at least two electromechanical connections used to connect the device to at least two connectors on an electrode lead, where the device facilitates rotation and movement of each connector relative to the other while retaining continuous electrical connection with heart tissue or other body cavity tissue. 
     A laparoscopic device is attached to electric potential mapping and electrode attachment device. Electric potential mapping and electrode attachment device is used to better implant, locate, attach, and program the laparoscopic device and otherwise most efficiently implement the device into the patient. A laparoscopic device is a device that is inserted into a small incision, usually 0.5-⅕ cm, in the abdomen, and is used for minimally invasive surgery. A pacemaker electrode with attached wire lead is such a laparoscopic device. Any laparoscopic device may be mated with the invention. Invention is used to better locate, implant, attach and or program the laparoscopic device. 
     Electric potential mapping and electrode attachment device is capable of continuously recording electrical potentials of a heart cavity or other body cavity during full rotation of collars, connectors, or connections on the laparoscopic device. 
     Electric potential mapping and electrode attachment device is capable continuously recording electrical signals during HIS bundle mapping, pacemaker electrode anchoring, post anchoring, pacemaker programming, and afterwards. 
     Electric potential mapping and electrode attachment device is capable of continuously recording electrical potentials of any body cavity during manipulation and full rotation of the attached laparoscopic device. 
     Electric potential mapping and electrode attachment device is capable of receiving and holding a pacemaker lead inside of a catheter having an electrode at its distal end or other laparoscopic device. 
     Electric potential mapping and electrode attachment device can be used by the surgeon to precisely manipulate or position the electrode or other laparoscopic device in a heart chamber or other body cavity. 
     Electric potential mapping and electrode attachment device can be used by the surgeon to precisely manipulate or position any laparoscopic device in any body cavity. 
     It is an aspect of the invention to provide a positioning device to position and secure a cardiac pacemaker electrode to the HIS bundle section of a heart, which is located inside a small chamber of another chamber, while continuously recording relevant electrical potentials of the cavities. 
     It is an aspect of the invention to provide a means for securing the electrode and lead from a cardiac pacemaker in a precise location on the HIS bundle inside a heart chamber, at the exact location that yields maximum efficiency regarding timing and pacing of heart valves, while continuously recording relevant electrical potentials of the heart. 
     It is an aspect of the invention to provide a means for retaining continuous electrical signal connections with the electrode from mapping, electrode attachment, to pacemaker control unit programming, without interruption of the electrical signals. 
     It is an aspect of the invention to provide the ability for a surgeon to screw-in, rotate, or otherwise attach a cardiac pacemaker electrode to patient tissue with the same hand used to manipulate or position the electrode in a heart chamber while retaining continuous electrical signal connections and monitoring during such one handed rotation and manipulation, leaving the other hand free to position another medical device, operate a computer, or other interface. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a schematic illustration of a cross section of a human heart showing a catheter stimulating the heart. 
         FIG. 2  is a side elevation view of a typical pacemaker electrode with corkscrew helix. 
         FIG. 3  is an end elevation view of the distal end of a typical pacemaker electrode with corkscrew helix. 
         FIG. 4  is a top perspective view of electric potential mapping and electrode attachment device with both electrode and stylet inserted or attached. 
         FIG. 5  is a side elevation view of electric potential mapping and electrode attachment device with both electrode and stylet inserted or attached. 
         FIG. 6  has three side elevation views of electric potential mapping and electrode attachment device with both electrode and stylet just before and after insertion or attachment of each. 
         FIG. 7  is a cross sectional view of electric potential mapping and electrode attachment device with electrode just before attachment and a bottom plan view of electric potential mapping and electrode attachment device with electrode just before attachment. 
         FIG. 8  is a cross sectional view of electric potential mapping and electrode attachment device with attached electrode and a bottom plan view of electric potential mapping and electrode attachment device with attached electrode. 
         FIG. 9  is a cross sectional view of electric potential mapping and electrode attachment device with attached electrode and stylet and a bottom plan view of electric potential mapping and electrode attachment device with attached electrode and stylet. 
         FIG. 10  is an exploded view of electric potential mapping and electrode attachment device. 
         FIG. 11  is a blow-up of a cross sectional view of electric potential mapping and electrode attachment device with attached electrode and stylet. 
         FIG. 12  is a blow-up of a cross sectional view of the distal end of cardiac pacemaker electrode mapping and attachment. 
         FIG. 13  is a blow-up of a cross sectional view of the distal end of electric potential mapping and electrode attachment device with attached electrode. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       FIG. 1  is a schematic illustration of a cross section of a human heart showing a catheter stimulating the heart. Here the right and left atria  3 ,  5  and right and left ventricles  9 ,  11  are shown. An upper section atrial HIS bundle  71  of a His Perkinje nerve fiber bundle  70  (HIS bundle) is present in the wall of right atrium  3  which passes down a septum  13  to a right ventricle  9  and a left ventricle  11 . In normal operation, electrical stimulation of the atrial HIS bundle  71  causes the atria  3 ,  5  to simultaneously contract passing blood through the tricuspid valve  17  and into the right ventricle  9 . The signal moves slowly downward into the right HIS bundle branch  73  and the left HIS bundle branch  75  causing right and left: ventricles  9 ,  11 , respectively, to begin to contract as the atria  3 ,  5  have just about completed their contraction. The delayed contraction of ventricles  9 ,  11  allows maximal ejection fraction of the heart and optimum pumping efficiency. When the timing is thrown off, by disease or other disorder, the efficiency drops considerably. This may be due to a non-conductive section of the HIS bundle. Thus, it is very important to correct contractions regarding improper timing. Usually, a cardiac pacemaker system is used to correct said contractions. 
     Cardiac pacemaker systems (pacemakers) typically comprise: a power/control unit (not depicted); at least one electrode  121 ; a wire lead  103 ; an electromechanical connector  131 ; and a stylet  141 . Electrode  121  is permanently attached to one end of wire lead  103  and an electromechanical connector  131  is permanently attached to the other end of wire lead  103 . Electrode  121  typically comprises an electrode collar  127  and a helix  122 . 
     Electrode collar  127  is located on the distal surface of electrode  121 . See  FIG. 3 . Electrode collar  127  is typically the outer ring on the distal surface of the electrode  121 . Electrode collar  127  functions to make an electrical connection to heart tissue. Helix  122  is a corkscrew shaped screw capable of being inserted into heart tissue by screw means. Helix  122  typically has more rounded bends rather than sharp cornered bends as depicted in  FIG. 3 . Helix  122  has a tip  123  that may be used to puncture heart tissue in order to retrieve a proper electrical reading or to start the screw attachment means. Helix  122  also functions to make an electrical connection to heart tissue. 
     Wire lead  103  includes a catheter, cannula, or tube  105  running longitudinally along the full length of wire lead  103 , where one end of cannula  105  leads to electrode  21  and the other end to the electromechanical connector  131 , where cannula  105  extends through electromechanical connector. Cannula  105  is sized to accept a specific stylet  141  where they are typically designed in pairs, where stylet  141  is a rigid or semi-rigid wire used to guide, move, and position electrode  121  inside a body cavity. 
     Stylet  141  comprises and guide wire  143  and a wrench  145 .  143  and  145  are rigidly connected so that each rotates along with the other. The whole structure of  141  is also known as a guide-wire. In order to use stylet  141 , guide wire  143  must be completely inserted into cannula  105  and seated onto the proximal end of electrode  121 . Guide wire  143  may be pre-formed in various shapes such as straight or J-shaped in order to allow easier positioning and attaching of electrode  121 . 
     Typically, electromechanical connector  131  is an “IS-1 pacemaker connector”. IS-1 pacemaker connector comprises two electromechanical connectors:  133  and  135 . Electromechanical connector  133  is electrically connected to electrode collar  127  and electromechanical connector  135  is electrically connected to helix  122 . Electromechanical connectors  133  and  135  are each mechanically connected to different structure on electrode  121  and each may be rotated relative to the other, thereby rotating different structure on electrode  121 , relative to the other. With rotational screw electrodes, either stylet  141  or electromechanical connector  133  or both must be rotated in order to extend helix  122  from the center of electrode collar  127 . Alternately, with fixed screw electrodes, either stylet  141  or electromechanical connector  133  or both must be rotated in order to start helix  122  to screw into heart tissue. There are many specifically designed electrodes  121  on the market; however, practically all include an IS-1 pacemaker connector at their proximal end, where each design has its own specifically designed stylet  141  or set of such that may be used for a specific purposes such as attaching fixed screw or rotational screw electrodes of other function. 
     This invention is first to provide continuously viable electrical connections between connectors  133  and  135  with concurrent ability to rotate such independently from each other, thereby yielding the ability to produce a high-quality electrocardiogram of the HIS bundle electric potential with continuous viable electric potential readings during the complete process of mapping, rotating of electrode or helix or both, screw attachment to heart tissue, and afterwards. 
     Pacemakers typically function by inserting stimulation electrode  121  into the superior vena cava, through the tricuspid valve  17  and rest it on the ventricle muscle, as described in Thompson. Wire lead  103  and electrode  121  must pass through catheter  101  for body insertion. This is not optimal because wire lead passes through the tricuspid valve and thus may interfere with the valve or cause an irritation. Pacemakers are intended to remain in place permanently, thus lead  103  may have long-term effects or otherwise cause damage to the valve and inefficiency of its operation. Also, the electrical stimulation of the right ventricle  9  also has long-term adverse effects on the muscle. To avoid these issues and to have better pacing, the pacing electrode should be placed and anchored into the HIS bundle  71  (or alternately anchored to septum wall  13 ) so that the pacing electrode is electrically connected to HIS bundle  71 . 
     The His bundle tissue appears to lie in a small fossa at the apex of the membranous septum, where mapping is required in order to find HIS bundle  70 . Mapping is the process of positioning the electrode  121 , recording an electrical potential reading, repositioning the electrode  121 , recording another electrical signal, and repeating until an accurate enough map or sufficient amount of electrical readings is taken by the surgeon to render an electrical topography of the heart chamber or otherwise enough information to determine the exact position on the His bundle to attach the electrode in order to stimulate the simultaneous contraction of both ventricles in order to achieve maximum efficiency. The electrical potential reading used in the mapping process is the electric potential difference between electrode collar  127  and helix tip  123 . The electric potential has maximum amplitude when the electrode  121  is closest to the HIS bundle center, with the tip of the helix  123  located exactly on center of the His bundle. 
     As noted in Deshmukh, successful mapping requires a high-quality electrocardiogram of the HIS bundle electric potential that must be recorded and monitored by electrode  121 . Electric potential mapping and electrode attachment device may be used to easily map the heart chamber in order to determine the optimal precise position for electrode  121 . Electrode  121  is moved by manipulating the electric potential mapping and electrode attachment device  200  where  200  is also used as a continuous interface between the recording system (not shown) and the electrode  121  as the movement occurs. 
     Electric potential mapping and electrode attachment device comprises a main cylinder  210  and a secondary cylinder  250 , wherein said cylinders are concentric and mounted on a common longitudinal center axis with said secondary cylinder  250  fitting completely inside of said main cylinder  210 . Common longitudinal axis is void or hollow in order to receive the stylet  141 , which must extend there through, where proper function requires that stylet  141  be threaded down the center of electric potential mapping and electrode attachment device as depicted. Typically, electrode lead  103  is attached first and then stylet  141  is threaded through electric potential mapping and electrode attachment device and electrode lead  103 . 
     There are at least two openings  211  in main cylinder  210 , through which said secondary cylinder  250  may be easily rotated by finger or hand within the main cylinder  210  and independently from main cylinder  210 . Openings  211  are sized to be slightly larger than an average human thumbprint. Openings  211  are oval shaped in best mode. Secondary cylinder  250  has at least two ridges or other raised areas  251  on its exterior surface to provide for increased grip or friction during finger rotation of  250  within  210 . Best mode  250  has eight ridges  251 . 
     Electric potential mapping and electrode attachment device further comprises a proximal end button  271  and a distal end cap  273 . Proximal end button  271  is generally cylindrical with outer diameter slightly smaller than the inner diameter of main cylinder  210 . End button  271  is placed concentrically within cylinder  210  so that button  271  can slide longitudinally within cylinder  210 . Proximal end of cylinder  210  has a reduced diameter end or rounded end, which acts to contain button  271  within cylinder  210 . Sliding action of end button  271  within cylinder  210  is retained on the other end by spring  280 . Distal cap  273  functions to provide a distal member or end of cylinder  210 . Distal cap  273  is rigidly attached to cylinder  210 . 
     Members  210 ,  220 ,  250 ,  260 ,  271 , and  273  have a center passage or void  279  for receiving a catheter with electrode where the void runs from a centerpiece net  275  to a centerpiece outlet  277 . In other words, electric potential mapping and electrode attachment device effective hollow at its longitudinal core with void  279 , which is required so that a laparoscopic device, such as an electrode with lead, can be inserted through electric potential mapping and electrode attachment device for mapping, electrode attachment, or other procedure. 
     When electric potential mapping and electrode attachment device is properly connected to electromechanical connector  131  of the pacemaker, main cylinder  210  is electrically and mechanically connected to electromechanical connector  135  on lead  103 . Electric potential mapping and electrode attachment device further comprises a main cylinder-to-electrode lead electromechanical connection means where there is a rigid connection and electrical connection between main cylinder  210  and lead connector  135 . Said means may be by threaded member, clamping member, collet member, chuck member, magnetic member, electromagnetic member, or similar. Electrical connection of said means may be accessed at an electrical connector  290  on the electric potential mapping and electrode attachment device. Electrical connector  290  provides the ability to connect an electrical connector such as an alligator clip or similar to it while also allowing the ability to move it and slightly rotate wire lead  103 , which would be adjusted in the usual way to manipulate electrode  121 . Electrical connector  290  provides continuous viable electrical connection to helix  122  during rotation of helix or electrode or both. 
     When electric potential mapping and electrode attachment device is properly connected to electromechanical connector  131  of the pacemaker, secondary cylinder  250  is electrically and mechanically connected to electromechanical connector  133  on lead  103 . Electric potential mapping and electrode attachment device further comprises: a secondary cylinder to-electrode lead mechanical connection means and a secondary cylinder to-electrode lead resilient electrical connection, where there is a rigid mechanical connection and electrical connection between main cylinder  210  and lead connector  135 . This electrical connection may be accessed at an electrical connector  230  on the electric potential mapping and electrode attachment device. Electrical connector  230  provides the ability to connect an electrical connector such as an alligator clip or similar to it in order to provide a continuous viable electrical connection to said electrode collar  127 , while also allowing complete rotation of electromechanical connector  133  relative to electromechanical connector  135 , as is required to attach electrode  121  to heart tissue by screw means with some electrode designs, where rotation is accomplished by rotating said secondary cylinder  250 . 
     Secondary cylinder to-electrode lead mechanical connection means may be by threaded member, clamping member, collet member, chuck member, magnetic member, electromagnetic member, or similar. In best mode, secondary cylinder-to-electrode lead mechanical connection means comprises: a collet or chuck  220  and a collet striker  260 . In best mode, secondary cylinder to-electrode lead resilient electrical connection comprises a resilient electrical connector  240 . This structure is used to attach electric potential mapping and electrode attachment device to electromechanical connector  133 . Collet  220  is a chuck collar with at least two fingers  221  on its distal end. Collet  220  forms a collar around the electromechanical connector  133  and exerts a strong clamping force on  133  when it is tightened on such via the collet striker  260 . When collet  220  is at rest, spring  280  forces collet  220  in the proximal direction into a taper section of collet striker  260 . Collet striker  260  is a specifically sized and shaped bushing with distally facing taper on its interior diameter that acts to force collet fingers  221  closed. Clamping force is provided by spring  280 . Spring  280  is compressed between spring retainer ring  283  and proximal end button  271 . Ring  283  is fixed while button  271  slides to compress and release spring  280 . Collet fingers  221  are released when end button  271  is depressed, which forces collet  220  in the distal direction, where the taper on the collet striker widens, allowing collet fingers  221  to open, thereby releasing electromechanical connector  133 . Fingers  221  naturally spring open from its shape. Collet  220  is typically made of metal. Collet  220  may have 2-20 fingers  221 . 
     Collet  220  further comprises a nut area  223  in rigid connection with the collet fingers  221 . Collet is oblong shaped with fingers  221  on one end and nut area  223  on the other end or alternately in the middle of oblong shape. Nut area  223  engages counterpart structure or wrench structure on the secondary cylinder  250 . Nut area  223  fits within inverse matching structure on the interior surface of secondary cylinder  250 , so that cylinder  250  acts as a wrench to rotate said nut area  223  on collet, thereby rotating collet fingers  221 , thereby rotating electromechanical connector  133  on the pacemaker, when the electric potential mapping and electrode attachment device is properly connected to such. Thus, connector  133  may be rotated by rotating secondary cylinder  250  when electric potential mapping and electrode attachment device is properly attached to  133 . 
     Continuous viable electrical connection may be maintained by a resilient electrical connector  240 . Resilient electrical connector  240  is resilient in that it may be compressed and it will naturally spring back into shape from the compression. Resilient electrical connector  240  is also capable of maintaining electrical conductivity during said compression and response. Resilient electrical connector  240  electrically connects collet striker  260  to said electrical connector  230  and is physically placed between such. Resilient electrical connector  240  keeps a preload positive force or pressure on collet striker  260 , directed radially inward towards the center axis of the electric potential mapping and electrode attachment device, thereby allowing  240  to remain in contact with  200  as  200  is repeatedly and completely rotated. Thus,  240  must be compressed before installing between collet  220  and connector  230 . 
     Collet striker  260  maintains electrical connection with collet  220  because collet striker  260  is clamping down on collet  220 . Likewise, collet  220  maintains electrical connection with electromechanical connector  133  because collet  220  is clamping down on connector  133 . 
     In best mode, resilient electrical connector  240  is a ball detent. Ball detent comprises a metal sphere, sliding within a hollow metal cylinder with one open end and one closed end, against the pressure of a spring. When elements are sized appropriately, conductivity between the ball and cylinder is maintained during sliding. The spring pushes the ball against the open end of the cylinder where it is retained within such because the open end of cylinder has a smaller diameter than the ball. When elements are sized appropriately, the ball rides along the surface of the collet, where  240  maintains electrical conductivity with such despite imperfections in outer circumference of collet, alignment of members, wear of members, or other imperfection. The flexible conductive range of this device would depend on the diameter of the ball, where larger diameters yield large flexible conductive ranges. 
     Electrical connector  290  is electrically and mechanically connected to electromechanical connector  135 . In best mode connector  290  has a threaded base  291  so that one end is a threaded member  291 , which can be mated with a taped hole in main cylinder  210 . After the electric potential mapping and electrode attachment device is properly connected to electromechanical connector  135  on the pacemaker, connector  290  may then be connected by simply screwing in down onto  135 . 
     After electrode attachment, a programming module or the control module may be electrically connected to connectors  290  and  230  along with the previously mentioned electrical connectors used for mapping, thereby allowing continuous electrical readings throughout programming and other control process.