CA2668438C - Filter for simultaneous pacing and ablation - Google Patents
Filter for simultaneous pacing and ablation Download PDFInfo
- Publication number
- CA2668438C CA2668438C CA2668438A CA2668438A CA2668438C CA 2668438 C CA2668438 C CA 2668438C CA 2668438 A CA2668438 A CA 2668438A CA 2668438 A CA2668438 A CA 2668438A CA 2668438 C CA2668438 C CA 2668438C
- Authority
- CA
- Canada
- Prior art keywords
- pacing
- active
- outputs
- heart
- indifferent
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
- 238000002679 ablation Methods 0.000 title claims description 27
- 239000003990 capacitor Substances 0.000 claims description 7
- 238000000034 method Methods 0.000 description 17
- 230000003902 lesion Effects 0.000 description 11
- 238000007674 radiofrequency ablation Methods 0.000 description 7
- 238000010586 diagram Methods 0.000 description 6
- 208000033988 Device pacing issue Diseases 0.000 description 3
- 230000015572 biosynthetic process Effects 0.000 description 3
- 230000000747 cardiac effect Effects 0.000 description 3
- 238000013153 catheter ablation Methods 0.000 description 3
- 210000005003 heart tissue Anatomy 0.000 description 3
- 238000012544 monitoring process Methods 0.000 description 3
- 230000001225 therapeutic effect Effects 0.000 description 3
- 210000001519 tissue Anatomy 0.000 description 3
- 230000006793 arrhythmia Effects 0.000 description 2
- 206010003119 arrhythmia Diseases 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 238000002847 impedance measurement Methods 0.000 description 2
- 238000002955 isolation Methods 0.000 description 2
- 238000002560 therapeutic procedure Methods 0.000 description 2
- 230000002792 vascular Effects 0.000 description 2
- 206010001497 Agitation Diseases 0.000 description 1
- 102100026827 Protein associated with UVRAG as autophagy enhancer Human genes 0.000 description 1
- 101710102978 Protein associated with UVRAG as autophagy enhancer Proteins 0.000 description 1
- 238000010317 ablation therapy Methods 0.000 description 1
- 238000011298 ablation treatment Methods 0.000 description 1
- 230000002159 abnormal effect Effects 0.000 description 1
- 238000007792 addition Methods 0.000 description 1
- 230000000903 blocking effect Effects 0.000 description 1
- 238000010438 heat treatment Methods 0.000 description 1
- 230000002401 inhibitory effect Effects 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000002107 myocardial effect Effects 0.000 description 1
- 210000004165 myocardium Anatomy 0.000 description 1
- 230000037361 pathway Effects 0.000 description 1
- 230000000149 penetrating effect Effects 0.000 description 1
- 230000035515 penetration Effects 0.000 description 1
- 239000000523 sample Substances 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 238000011282 treatment Methods 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
Abstract
Medical apparatus includes a pacing generator, which has first active and indifferent outputs and is configured to generate electrical pacing pulses between the first active and indifferent outputs for pacing a heart of a subject. A radio frequency (RF) generator has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses. A filter includes a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches including one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy.
Description
FILTER FOR SIMULTANEOUS PACING AND ABLATION
FIELD OF THE INVENTION
The present invention relates generally to invasive cardiac therapies, and specifically to validating and monitoring percutaneous cardiac ablation procedures.
BACKGROUND OF THE INVENTION
Invasive cardiac ablation techniques for the treatment of arrhythmias are well known in the art. For example, U.S. Patents 5,443,489 and 5,480,422 describe systems for ablating cardiac tissue by application of radio-frequency (RF) energy to the tissue through a catheter.
In a cardiac ablation procedure, it is important to apply sufficient energy to create a lesion that will block undesired conduction, while minimizing collateral damage to surrounding tissues. Various methods have been proposed for monitoring ablation procedures for this purpose. For example, U.S. Patent 6,743,225 proposes to measure electrical activity of the cardiac tissue proximate a lesion site during an ablation treatment, and then to compare the measurements in order to determine whether the lesion is clinically efficacious so as to be able to block myocardial propagation. The electrical activity can include electrical signals corresponding to the local electrogram signal, pacing threshold value, and the like.
As another example, U.S. Patent Application Publication 2007/0198007 describes methods and devices for monitoring intracardiac ablation progress in near real time, by evaluating capture of a pacing signal while ablation energy is concurrently directed to a target site. Sufficiency of ablation is indicated by failure of signal capture at a maximum predetermined pacing voltage.
An electrode in a cardiac catheter is simultaneously used to test pacing capture and to deliver ablation energy.
SUMMARY OF THE INVENTION
Notwithstanding the above-mentioned references, safety concerns have led practitioners to avoid applying pacing and RF ablation energy to the heart simultaneously, mainly due to the possibility of leakage of substantial RF power into the pacing circuit.
Embodiments of the present invention that are described hereinbelow overcome this problem by using a novel array of notch filters to keep RF energy from penetrating through the pacing circuit. The array comprises two branches of notch filters with high impedance in the frequency range that is used for ablation: one branch protecting the signal path between the pacing circuit and the catheter tip, and the other protecting the return path. The filters have low impedance at the pacing frequency, thus permitting pacing to proceed simultaneously with ablation.
There is therefore provided, in accordance with an embodiment of the present invention, medical apparatus, including:
a pacing generator, which has first active and indifferent outputs and is configured to generate
FIELD OF THE INVENTION
The present invention relates generally to invasive cardiac therapies, and specifically to validating and monitoring percutaneous cardiac ablation procedures.
BACKGROUND OF THE INVENTION
Invasive cardiac ablation techniques for the treatment of arrhythmias are well known in the art. For example, U.S. Patents 5,443,489 and 5,480,422 describe systems for ablating cardiac tissue by application of radio-frequency (RF) energy to the tissue through a catheter.
In a cardiac ablation procedure, it is important to apply sufficient energy to create a lesion that will block undesired conduction, while minimizing collateral damage to surrounding tissues. Various methods have been proposed for monitoring ablation procedures for this purpose. For example, U.S. Patent 6,743,225 proposes to measure electrical activity of the cardiac tissue proximate a lesion site during an ablation treatment, and then to compare the measurements in order to determine whether the lesion is clinically efficacious so as to be able to block myocardial propagation. The electrical activity can include electrical signals corresponding to the local electrogram signal, pacing threshold value, and the like.
As another example, U.S. Patent Application Publication 2007/0198007 describes methods and devices for monitoring intracardiac ablation progress in near real time, by evaluating capture of a pacing signal while ablation energy is concurrently directed to a target site. Sufficiency of ablation is indicated by failure of signal capture at a maximum predetermined pacing voltage.
An electrode in a cardiac catheter is simultaneously used to test pacing capture and to deliver ablation energy.
SUMMARY OF THE INVENTION
Notwithstanding the above-mentioned references, safety concerns have led practitioners to avoid applying pacing and RF ablation energy to the heart simultaneously, mainly due to the possibility of leakage of substantial RF power into the pacing circuit.
Embodiments of the present invention that are described hereinbelow overcome this problem by using a novel array of notch filters to keep RF energy from penetrating through the pacing circuit. The array comprises two branches of notch filters with high impedance in the frequency range that is used for ablation: one branch protecting the signal path between the pacing circuit and the catheter tip, and the other protecting the return path. The filters have low impedance at the pacing frequency, thus permitting pacing to proceed simultaneously with ablation.
There is therefore provided, in accordance with an embodiment of the present invention, medical apparatus, including:
a pacing generator, which has first active and indifferent outputs and is configured to generate
2 electrical pacing pulses between the first active and indifferent outputs for pacing a heart of a subject;
a radio frequency (RF) generator, which has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses; and a filter including a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches including one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy.
In some embodiments, the apparatus includes a catheter, which includes a distal tip that is configured to be inserted into a chamber of the heart and an electrode at the distal tip, wherein the first and second active outputs are coupled together to deliver the pacing pulses and the RF electrical energy to the heart via the electrode. Additionally or alternatively, the apparatus includes a monitor, which is configured to detect capture of the pacing pulses by the heart during application of the RF electrical energy.
In some embodiments, each of the first and second branches includes a plurality of notch filters having respective notch frequencies in the vicinity of the frequency of the RF electrical energy. In a disclosed embodiment, each of the notch filters includes an inductor and a capacitor arranged in parallel.
a radio frequency (RF) generator, which has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses; and a filter including a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches including one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy.
In some embodiments, the apparatus includes a catheter, which includes a distal tip that is configured to be inserted into a chamber of the heart and an electrode at the distal tip, wherein the first and second active outputs are coupled together to deliver the pacing pulses and the RF electrical energy to the heart via the electrode. Additionally or alternatively, the apparatus includes a monitor, which is configured to detect capture of the pacing pulses by the heart during application of the RF electrical energy.
In some embodiments, each of the first and second branches includes a plurality of notch filters having respective notch frequencies in the vicinity of the frequency of the RF electrical energy. In a disclosed embodiment, each of the notch filters includes an inductor and a capacitor arranged in parallel.
3 Additionally or alternatively, the filter includes a third branch, which is connected between the first and second branches and the first active and indifferent outputs and which includes a further one or more notch filters that have a low impedance in the vicinity of the frequency of the RF electrical energy. The further one or more notch filters may include a plurality of notch filters including an inductor and a capacitor arranged in series and having respective notch frequencies in the vicinity of the frequency of the RF electrical energy.
Further additionally or alternatively, the filter includes a common mode choke connected between the third branch and the first active and indifferent outputs.
There is also provided, in accordance with an embodiment of the present invention, a method for treating a heart of a subject, the method including:
operating a pacing generator, which has first active and indifferent outputs, to generate electrical pacing pulses between the first active and indifferent outputs so as to pace the heart;
actuating a radio frequency (RF) generator, which has second active and indifferent outputs, to generate RF
electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart simultaneously with the pacing pulses;
inhibiting penetration of the RF electrical energy into the pacing generator by connecting a first branch of a filter between the first and second active outputs and a second branch of the filter between the first and second indifferent outputs, each of the first and second branches including one or more notch filters having a
Further additionally or alternatively, the filter includes a common mode choke connected between the third branch and the first active and indifferent outputs.
There is also provided, in accordance with an embodiment of the present invention, a method for treating a heart of a subject, the method including:
operating a pacing generator, which has first active and indifferent outputs, to generate electrical pacing pulses between the first active and indifferent outputs so as to pace the heart;
actuating a radio frequency (RF) generator, which has second active and indifferent outputs, to generate RF
electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart simultaneously with the pacing pulses;
inhibiting penetration of the RF electrical energy into the pacing generator by connecting a first branch of a filter between the first and second active outputs and a second branch of the filter between the first and second indifferent outputs, each of the first and second branches including one or more notch filters having a
4 high impedance in a vicinity of the frequency of the RF
electrical energy; and simultaneously applying the pacing pulses and the RF
electrical energy to the heart.
There is also provided, in accordance with an embodiment of the present invention, a medical apparatus, comprising:
a pacing generator, which has first active and indifferent outputs and is configured to generate electrical pacing pulses between the first active and indifferent outputs for pacing a heart of a subject;
a radio frequency (RF) generator, which has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses; and a filter comprising a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches comprising one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy, and wherein the filter further comprises a third branch, which is connected between the first and second branches and the first active and indifferent outputs and which comprises a further one or more notch filters that have a low impedance in the vicinity of the frequency of the RF
electrical energy.
The medical apparatus further comprises a mixer for combining the first active and indifferent outputs with the second active and indifferent outputs and forming a combined RF and pacing waveform for delivering
electrical energy; and simultaneously applying the pacing pulses and the RF
electrical energy to the heart.
There is also provided, in accordance with an embodiment of the present invention, a medical apparatus, comprising:
a pacing generator, which has first active and indifferent outputs and is configured to generate electrical pacing pulses between the first active and indifferent outputs for pacing a heart of a subject;
a radio frequency (RF) generator, which has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses; and a filter comprising a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches comprising one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy, and wherein the filter further comprises a third branch, which is connected between the first and second branches and the first active and indifferent outputs and which comprises a further one or more notch filters that have a low impedance in the vicinity of the frequency of the RF
electrical energy.
The medical apparatus further comprises a mixer for combining the first active and indifferent outputs with the second active and indifferent outputs and forming a combined RF and pacing waveform for delivering
5 contraindicated simultaneous ablation and pacing in the heart of a subject.
The present invention will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings in which:
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a schematic, pictorial illustration showing a system for percutaneous ablation therapy in the heart of a subject, in accordance with an embodiment of the present invention;
Fig. 2 is a block diagram that schematically shows circuitry for delivering RF ablation and pacing signals to a catheter electrode, in accordance with an embodiment of the present invention;
Fig. 3 is a block diagram that schematically shows a filter circuit for use in simultaneous RF ablation and pacing of the heart, in accordance with an embodiment of the present invention; and Fig. 4 is a schematic circuit diagram showing details of a filter circuit for use in simultaneous RF
ablation and pacing of the heart, in accordance with an embodiment of the present invention.
DETAILED DESCRIPTION OF EMBODIMENTS
Fig. 1 is a schematic, pictorial illustration of a system 10 for performing ablative procedures on a heart 12 of a living subject, in accordance with a disclosed embodiment of the invention. The system comprises a 5a probe, typically a catheter 14, which is percutaneously inserted by an operator 16, who is typically a physician, through the patient's vascular system into a chamber or vascular structure of the heart. Operator 16 brings a distal tip 18 of the catheter into contact with the heart wall at a target site that is to be ablated. RF
electrical current is then conducted through wires in the catheter to one or more electrodes at distal tip 18, which apply the RF energy to the myocardium. The energy is absorbed in the tissue, heating it to a point (typically about 50 C) at which it permanently loses its electrical excitability. When successful, this procedure creates non-conducting lesions in the cardiac tissue, which can disrupt abnormal electrical pathways that cause arrhythmias.
Catheter 14 typically comprises a handle 20, having suitable controls to enable operator 16 to steer, position and orient distal tip 18 of the catheter as desired during the ablation. To aid operator 16 in positioning the catheter, the distal portion of the catheter may contains position sensors (not shown) that provide signals to a positioning processor located in a console 24. Catheter 14, may be adapted, mutatis mutandis, from ablation catheters that are known in the art, such as the catheters described in U.S. Patent No. 6,669,692. ECG
electrodes (not shown) on the patient's body surface conduct electrical signals via a cable 26 to an ECG monitor 28 (which may also be integrated into console 24). A user interface 34 provides feedback to the operator and permits the operator to adjust system functions as appropriate.
The present invention will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings in which:
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a schematic, pictorial illustration showing a system for percutaneous ablation therapy in the heart of a subject, in accordance with an embodiment of the present invention;
Fig. 2 is a block diagram that schematically shows circuitry for delivering RF ablation and pacing signals to a catheter electrode, in accordance with an embodiment of the present invention;
Fig. 3 is a block diagram that schematically shows a filter circuit for use in simultaneous RF ablation and pacing of the heart, in accordance with an embodiment of the present invention; and Fig. 4 is a schematic circuit diagram showing details of a filter circuit for use in simultaneous RF
ablation and pacing of the heart, in accordance with an embodiment of the present invention.
DETAILED DESCRIPTION OF EMBODIMENTS
Fig. 1 is a schematic, pictorial illustration of a system 10 for performing ablative procedures on a heart 12 of a living subject, in accordance with a disclosed embodiment of the invention. The system comprises a 5a probe, typically a catheter 14, which is percutaneously inserted by an operator 16, who is typically a physician, through the patient's vascular system into a chamber or vascular structure of the heart. Operator 16 brings a distal tip 18 of the catheter into contact with the heart wall at a target site that is to be ablated. RF
electrical current is then conducted through wires in the catheter to one or more electrodes at distal tip 18, which apply the RF energy to the myocardium. The energy is absorbed in the tissue, heating it to a point (typically about 50 C) at which it permanently loses its electrical excitability. When successful, this procedure creates non-conducting lesions in the cardiac tissue, which can disrupt abnormal electrical pathways that cause arrhythmias.
Catheter 14 typically comprises a handle 20, having suitable controls to enable operator 16 to steer, position and orient distal tip 18 of the catheter as desired during the ablation. To aid operator 16 in positioning the catheter, the distal portion of the catheter may contains position sensors (not shown) that provide signals to a positioning processor located in a console 24. Catheter 14, may be adapted, mutatis mutandis, from ablation catheters that are known in the art, such as the catheters described in U.S. Patent No. 6,669,692. ECG
electrodes (not shown) on the patient's body surface conduct electrical signals via a cable 26 to an ECG monitor 28 (which may also be integrated into console 24). A user interface 34 provides feedback to the operator and permits the operator to adjust system functions as appropriate.
6 Embodiments of the present invention combine simultaneous ablation and pacing so that an ablation lesion can be assessed in real time, without interrupting the ablation procedure. Console 24 includes a RF power source 36 that generates an ablation power signal, which is conveyed to catheter 14 via a cable 32. The RF power may be generated at any suitable frequency, but around 500 kHz is typical. A ground cable 33 provides a return path (typically via a back pad or other skin-surface electrode). Alternatively, the RF power may be delivered in a bipolar mode, whereby catheter 14 provides the return path, as well.
Console 24 also comprises a low-frequency pacing generator 38 that produces a cardiac pacing signal.
Pacing generator 38 typically comprises circuitry for varying its output voltage under control of the operator 16, for example, from 3 to 6 volts, while maintaining a constant current output. Alternatively, pacing generator 38 may maintain a constant voltage, while varying its current output or may permit both the voltage and the current to be adjusted. RF power source 36 and pacing generator 38 are both coupled to catheter 14 via cable 32 and to the return path provided by cable 33.
Fig. 2 is a block diagram that schematically shows distal tip 18 of catheter 14 and associated circuitry in console 24, in accordance with an embodiment of the present invention. The output of pacing generator 38, including both the active and return connections, is connected to a filter 40, which is shown in detail in the
Console 24 also comprises a low-frequency pacing generator 38 that produces a cardiac pacing signal.
Pacing generator 38 typically comprises circuitry for varying its output voltage under control of the operator 16, for example, from 3 to 6 volts, while maintaining a constant current output. Alternatively, pacing generator 38 may maintain a constant voltage, while varying its current output or may permit both the voltage and the current to be adjusted. RF power source 36 and pacing generator 38 are both coupled to catheter 14 via cable 32 and to the return path provided by cable 33.
Fig. 2 is a block diagram that schematically shows distal tip 18 of catheter 14 and associated circuitry in console 24, in accordance with an embodiment of the present invention. The output of pacing generator 38, including both the active and return connections, is connected to a filter 40, which is shown in detail in the
7 figures that follow. The purpose of this filter is to prevent leakage of RF energy from RF power source 36 into the pacing circuits, as well as blocking direct current return from the pacing generator to the catheter during ablation. (These features of the filter are very important for patient safety and address concerns that have contraindicated the use of simultaneous ablation and pacing in the past.) The output of RF power source 36 is mixed with the pacing signal following filter 40 in a mixer 42, which may comprise any suitable type of high-frequency electrical junction that is known in the art.
The combined RF and pacing waveform is conducted by cable 32 through catheter 14 and is applied Co a common electrode 44 at distal tip 18 of the catheter. The combined waveform simultaneously paces the patient's heart and delivers ablation energy to the target.
An "indifferent" electrode 46 is connected to cable 33 as the return path for both the RF and pacing currents. Electrode 46 may typically comprise a back pad or other skin-surface electrode, as noted above.
Alternatively, the RF power source and pacing generator may have separate indifferent electrodes and return paths (not shown).
Although electrode 44 is shown in Fig. 2 as a single unit, catheter 14 may alternatively comprise any number of electrodes in any form. For example, the catheter may comprise two or more ring electrodes, a plurality or array of point electrodes, or any combination of these types of electrodes for performing the therapeutic functions described herein. Although it is advantageous for pacing generator 38 and RF power source 36 to be
The combined RF and pacing waveform is conducted by cable 32 through catheter 14 and is applied Co a common electrode 44 at distal tip 18 of the catheter. The combined waveform simultaneously paces the patient's heart and delivers ablation energy to the target.
An "indifferent" electrode 46 is connected to cable 33 as the return path for both the RF and pacing currents. Electrode 46 may typically comprise a back pad or other skin-surface electrode, as noted above.
Alternatively, the RF power source and pacing generator may have separate indifferent electrodes and return paths (not shown).
Although electrode 44 is shown in Fig. 2 as a single unit, catheter 14 may alternatively comprise any number of electrodes in any form. For example, the catheter may comprise two or more ring electrodes, a plurality or array of point electrodes, or any combination of these types of electrodes for performing the therapeutic functions described herein. Although it is advantageous for pacing generator 38 and RF power source 36 to be
8 connected to the same electrode 44 via mixer 42, as shown in the figures, catheter 14 may alternatively comprise separate pacing and RF electrodes (typically in close proximity to one another), which are driven separately by the pacing generator and RF power source. Even in this latter configuration, the isolation provided by filter 40 is important when ablation and pacing go on simultaneously.
During the ablation procedure, ECG monitor 28 (Fig. 1) indicates whether the heart has actually captured the pacing signal, i.e., whether the heartbeat synchronizes with the pacing signal applied through electrode 44. As long as the pacing signal is captured, lesion formation is considered to be incomplete. The pacing amplitude may be increased gradually during the ablation procedure, as the pacing threshold increases due to lesion formation. When the pacing signal can no longer be captured even at high amplitude, lesion formation is considered to be complete, and the procedure at the current ablation site is terminated. In general, the pacing threshold increases with the size of the lesion, and this technique may thus be used to control the size of the lesion that is created by ablation.
Additional lesions may then be ablated at other locations, depending on the therapeutic plan.
This sort of pacing-based ablation technique is described in greater detail in the above-mentioned U.S.
Patent Application Publication 2007/0198007, which also describes variations and additions to the technique that may be combined with the embodiments of the present invention that are described herein.
During the ablation procedure, ECG monitor 28 (Fig. 1) indicates whether the heart has actually captured the pacing signal, i.e., whether the heartbeat synchronizes with the pacing signal applied through electrode 44. As long as the pacing signal is captured, lesion formation is considered to be incomplete. The pacing amplitude may be increased gradually during the ablation procedure, as the pacing threshold increases due to lesion formation. When the pacing signal can no longer be captured even at high amplitude, lesion formation is considered to be complete, and the procedure at the current ablation site is terminated. In general, the pacing threshold increases with the size of the lesion, and this technique may thus be used to control the size of the lesion that is created by ablation.
Additional lesions may then be ablated at other locations, depending on the therapeutic plan.
This sort of pacing-based ablation technique is described in greater detail in the above-mentioned U.S.
Patent Application Publication 2007/0198007, which also describes variations and additions to the technique that may be combined with the embodiments of the present invention that are described herein.
9 Reference is now made to Figs. 3 and 4, which schematically show details of filter 40, in accordance with an embodiment of the present invention. Fig. 3 is a block diagram that shows the overall architecture of the filter, while Fig. 4 is a circuit diagram showing details of a particular implementation of this architecture.
Filter 40 has the following features:
= Two branches 54 and 56 of parallel notch filter blocks GO. Each block is a passive unit comprising an inductor and capacitor connected in parallel. These blocks have high impedance in the frequency range close to the specified resonant frequency of RF ablation. In the example shown in the figures, the component values of the inductors and capacitors are chosen so as to create multiple, overlapping notches, spaced 25 kHz apart over a range of +50 kHz around the 500 kHz center frequency.
= A branch 52 of serial notch filter blocks 58. Each block is a passive unit with a serially-connected inductor and capacitor. These blocks have low impedance in the frequency range close to the specified resonant frequency and thus shunt to ground any RF
energy that penetrated through branches 54 and 56.
Here, too, blocks 58 create multiple, overlapping notches, spaced 25 kHz apart over a range of +50 kHz around the 500 kHz center frequency.
= A common mode choke 50 attenuates any small common-mode noise that would otherwise pass to the pacer side of filter 40.
Of the two branches of parallel blocks 60, branch 54 connects via mixer 42 to electrode 44 at the tip of catheter 14, while branch 56 connects to indifferent electrode 46. Thus, these blocks separate not only the energetic catheter tip electrode from pacing generator 38, but also the return path. On the other hand, for the low-frequency pacing pulses from the pacing generator, parallel blocks 60 and common mode choke 50 have low impedance, so pacing is enabled. Combining the parallel and serial blocks as shown in the figures creates strong energy attenuation (and isolation) in the frequency range of 500 kHz.
Alternatively, the notch filters may be designed for other frequency ranges, and larger or smaller numbers of the filter blocks may be used, depending on the ablation parameters and the required degree of attenuation.
RF power source 36 typically includes an impedance measurement circuit (not shown), which checks the impedance of the RF circuit through the patient's body to ensure that there is good electrical contact before the high-power RF ablation current is actuated. Because branches 54 and 56 connect to both the active and indifferent electrodes, filter 40 will not affect the impedance measurement.
Although the embodiment described above relates specifically to combination of pacing with RF ablation therapy, the principles of the present invention may likewise be applied in any sort of diagnostic or therapeutic environment in which RF energy is applied to the body simultaneously with pacing of the heart. It will thus be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
Filter 40 has the following features:
= Two branches 54 and 56 of parallel notch filter blocks GO. Each block is a passive unit comprising an inductor and capacitor connected in parallel. These blocks have high impedance in the frequency range close to the specified resonant frequency of RF ablation. In the example shown in the figures, the component values of the inductors and capacitors are chosen so as to create multiple, overlapping notches, spaced 25 kHz apart over a range of +50 kHz around the 500 kHz center frequency.
= A branch 52 of serial notch filter blocks 58. Each block is a passive unit with a serially-connected inductor and capacitor. These blocks have low impedance in the frequency range close to the specified resonant frequency and thus shunt to ground any RF
energy that penetrated through branches 54 and 56.
Here, too, blocks 58 create multiple, overlapping notches, spaced 25 kHz apart over a range of +50 kHz around the 500 kHz center frequency.
= A common mode choke 50 attenuates any small common-mode noise that would otherwise pass to the pacer side of filter 40.
Of the two branches of parallel blocks 60, branch 54 connects via mixer 42 to electrode 44 at the tip of catheter 14, while branch 56 connects to indifferent electrode 46. Thus, these blocks separate not only the energetic catheter tip electrode from pacing generator 38, but also the return path. On the other hand, for the low-frequency pacing pulses from the pacing generator, parallel blocks 60 and common mode choke 50 have low impedance, so pacing is enabled. Combining the parallel and serial blocks as shown in the figures creates strong energy attenuation (and isolation) in the frequency range of 500 kHz.
Alternatively, the notch filters may be designed for other frequency ranges, and larger or smaller numbers of the filter blocks may be used, depending on the ablation parameters and the required degree of attenuation.
RF power source 36 typically includes an impedance measurement circuit (not shown), which checks the impedance of the RF circuit through the patient's body to ensure that there is good electrical contact before the high-power RF ablation current is actuated. Because branches 54 and 56 connect to both the active and indifferent electrodes, filter 40 will not affect the impedance measurement.
Although the embodiment described above relates specifically to combination of pacing with RF ablation therapy, the principles of the present invention may likewise be applied in any sort of diagnostic or therapeutic environment in which RF energy is applied to the body simultaneously with pacing of the heart. It will thus be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
Claims (7)
1. Medical apparatus, comprising:
a pacing generator, which has first active and indifferent outputs and is configured to generate electrical pacing pulses between the first active and indifferent outputs for pacing a heart of a subject;
a radio frequency (RF) generator, which has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses;
a filter comprising a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches comprising one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy, and wherein the filter further comprises a third branch, which is connected between the first and second branches and the first active and indifferent outputs and which comprises a further one or more notch filters that have a low impedance in the vicinity of the frequency of the RF
electrical energy; and a mixer for combining the first active and indifferent outputs with the second active and indifferent outputs and forming a combined RF and pacing waveform for delivering contraindicated simultaneous ablation and pacing in the heart of a subject.
a pacing generator, which has first active and indifferent outputs and is configured to generate electrical pacing pulses between the first active and indifferent outputs for pacing a heart of a subject;
a radio frequency (RF) generator, which has second active and indifferent outputs and is configured to generate RF electrical energy of a predetermined frequency between the second active and indifferent outputs for application to the heart of the subject simultaneously with the pacing pulses;
a filter comprising a first branch connected between the first and second active outputs and a second branch connected between the first and second indifferent outputs, each of the first and second branches comprising one or more notch filters having a high impedance in a vicinity of the frequency of the RF electrical energy, and wherein the filter further comprises a third branch, which is connected between the first and second branches and the first active and indifferent outputs and which comprises a further one or more notch filters that have a low impedance in the vicinity of the frequency of the RF
electrical energy; and a mixer for combining the first active and indifferent outputs with the second active and indifferent outputs and forming a combined RF and pacing waveform for delivering contraindicated simultaneous ablation and pacing in the heart of a subject.
2. The apparatus according to claim 1, further comprising a catheter, which comprises a distal tip that is configured to be inserted into a chamber of the heart and an electrode at the distal tip, wherein the first and second active outputs are coupled together to deliver the pacing pulses and the RF electrical energy to the heart via the electrode.
3. The apparatus according to claim 1 or 2, further comprising a monitor, which is configured to detect capture of the pacing pulses by the heart during application of the RF electrical energy.
4. The apparatus according to any one of claims 1-3, wherein each of the first and second branches comprises a plurality of notch filters having respective notch frequencies in the vicinity of the frequency of the RF
electrical energy.
electrical energy.
5. The apparatus according to claim 4, wherein each of the notch filters comprises an inductor and a capacitor arranged in parallel.
6. The apparatus according to any one of claims 1-5, wherein the further one or more notch filters comprise a plurality of notch filters comprising an inductor and a capacitor arranged in series and having respective notch frequencies in the vicinity of the frequency of the RF
electrical energy.
electrical energy.
7. The apparatus according to any one of claims 1-6, wherein the filter further comprises a common mode choke connected between the third branch and the first active and indifferent outputs.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/133,716 US8357149B2 (en) | 2008-06-05 | 2008-06-05 | Filter for simultaneous pacing and ablation |
US12/133716 | 2008-06-05 |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2668438A1 CA2668438A1 (en) | 2009-12-05 |
CA2668438C true CA2668438C (en) | 2017-11-21 |
Family
ID=41059625
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA2668438A Expired - Fee Related CA2668438C (en) | 2008-06-05 | 2009-06-05 | Filter for simultaneous pacing and ablation |
Country Status (7)
Country | Link |
---|---|
US (1) | US8357149B2 (en) |
EP (1) | EP2130507B1 (en) |
JP (1) | JP5389536B2 (en) |
CN (1) | CN101601890B (en) |
AU (1) | AU2009202197B2 (en) |
CA (1) | CA2668438C (en) |
IL (1) | IL199172A (en) |
Families Citing this family (94)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11229472B2 (en) | 2001-06-12 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with multiple magnetic position sensors |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US8663220B2 (en) | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US8641708B2 (en) * | 2009-12-29 | 2014-02-04 | Biosense Webster (Israel), Ltd. | Measuring weak signals over ablation lines |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
CN102198013A (en) * | 2010-03-25 | 2011-09-28 | 北京迈迪顶峰医疗科技有限公司 | Ablation, mapping and pacing system, control device and RF ablation executing device |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US9387031B2 (en) | 2011-07-29 | 2016-07-12 | Medtronic Ablation Frontiers Llc | Mesh-overlayed ablation and mapping device |
ES2727868T3 (en) | 2011-09-22 | 2019-10-21 | Univ George Washington | Systems for visualizing ablated tissue |
JP5926806B2 (en) | 2011-09-22 | 2016-05-25 | ザ・ジョージ・ワシントン・ユニバーシティThe George Washingtonuniversity | System and method for visualizing ablated tissue |
EP2811932B1 (en) | 2012-02-10 | 2019-06-26 | Ethicon LLC | Robotically controlled surgical instrument |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US8827993B2 (en) | 2012-06-13 | 2014-09-09 | Biosense Webster (Israel) Ltd. | Gated sampling of electrocardiogram signals during ablation waveform zero-crossing |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9393037B2 (en) | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9113911B2 (en) | 2012-09-06 | 2015-08-25 | Medtronic Ablation Frontiers Llc | Ablation device and method for electroporating tissue cells |
US9091603B2 (en) * | 2012-09-26 | 2015-07-28 | Biosense Webster (Israel) Ltd. | Temperature simulator for thermocouple-based RF ablation system |
BR112015007010B1 (en) | 2012-09-28 | 2022-05-31 | Ethicon Endo-Surgery, Inc | end actuator |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US9351657B2 (en) | 2013-07-19 | 2016-05-31 | Biosense Webster (Israel) Ltd. | Cardiac activity visualization with frequency discrimination |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US20150141847A1 (en) | 2013-11-20 | 2015-05-21 | The George Washington University | Systems and methods for hyperspectral analysis of cardiac tissue |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
KR102612185B1 (en) | 2014-11-03 | 2023-12-08 | 460메디컬, 인크. | Systems and methods for assessment of contact quality |
JP2017537681A (en) | 2014-11-03 | 2017-12-21 | ザ・ジョージ・ワシントン・ユニバーシティThe George Washingtonuniversity | Damage evaluation system and method |
EP3220844B1 (en) | 2014-11-19 | 2020-11-11 | EPiX Therapeutics, Inc. | Systems for high-resolution mapping of tissue |
SG11201703943VA (en) | 2014-11-19 | 2017-06-29 | Advanced Cardiac Therapeutics Inc | Ablation devices, systems and methods of using a high-resolution electrode assembly |
JP6673598B2 (en) * | 2014-11-19 | 2020-03-25 | エピックス セラピューティクス,インコーポレイテッド | High resolution mapping of tissue with pacing |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
JP2018501874A (en) * | 2014-12-31 | 2018-01-25 | セント・ジュード・メディカル,カーディオロジー・ディヴィジョン,インコーポレイテッド | Filter circuit for electrophysiology system |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US9636164B2 (en) | 2015-03-25 | 2017-05-02 | Advanced Cardiac Therapeutics, Inc. | Contact sensing systems and methods |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US11141213B2 (en) | 2015-06-30 | 2021-10-12 | Cilag Gmbh International | Surgical instrument with user adaptable techniques |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US10779904B2 (en) | 2015-07-19 | 2020-09-22 | 460Medical, Inc. | Systems and methods for lesion formation and assessment |
US11033322B2 (en) | 2015-09-30 | 2021-06-15 | Ethicon Llc | Circuit topologies for combined generator |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US11051840B2 (en) | 2016-01-15 | 2021-07-06 | Ethicon Llc | Modular battery powered handheld surgical instrument with reusable asymmetric handle housing |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
CA3017269A1 (en) | 2016-03-15 | 2017-09-21 | Epix Therapeutics, Inc. | Improved devices, systems and methods for irrigated ablation |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
CN110809448B (en) | 2017-04-27 | 2022-11-25 | Epix疗法公司 | Determining properties of contact between catheter tip and tissue |
US11510576B2 (en) * | 2017-04-27 | 2022-11-29 | Medtronic Cryocath Lp | Treatment device having multifunctional sensing elements and method of use |
WO2019217317A1 (en) * | 2018-05-07 | 2019-11-14 | Farapulse, Inc. | Systems, apparatuses, and methods for filtering high voltage noise induced by pulsed electric field ablation |
JP2020081217A (en) * | 2018-11-21 | 2020-06-04 | 国立大学法人 新潟大学 | Ablation catheter and cardiac therapy system |
US11583332B2 (en) | 2019-12-24 | 2023-02-21 | Biosense Webster (Israel) Ltd. | Combined cardiac pacing and irreversible electroporation (IRE) treatment |
US11744636B2 (en) | 2019-12-30 | 2023-09-05 | Cilag Gmbh International | Electrosurgical systems with integrated and external power sources |
US20210196361A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with monopolar and bipolar energy capabilities |
US11911063B2 (en) | 2019-12-30 | 2024-02-27 | Cilag Gmbh International | Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade |
US11786294B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Control program for modular combination energy device |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing ultrasonic blade |
US11684412B2 (en) | 2019-12-30 | 2023-06-27 | Cilag Gmbh International | Surgical instrument with rotatable and articulatable surgical end effector |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US11950797B2 (en) | 2019-12-30 | 2024-04-09 | Cilag Gmbh International | Deflectable electrode with higher distal bias relative to proximal bias |
US11944366B2 (en) | 2019-12-30 | 2024-04-02 | Cilag Gmbh International | Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11937866B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Method for an electrosurgical procedure |
Family Cites Families (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4945912A (en) * | 1988-11-25 | 1990-08-07 | Sensor Electronics, Inc. | Catheter with radiofrequency heating applicator |
US5391199A (en) * | 1993-07-20 | 1995-02-21 | Biosense, Inc. | Apparatus and method for treating cardiac arrhythmias |
US5954665A (en) * | 1995-06-07 | 1999-09-21 | Biosense, Inc. | Cardiac ablation catheter using correlation measure |
US6113592A (en) * | 1995-06-09 | 2000-09-05 | Engineering & Research Associates, Inc. | Apparatus and method for controlling ablation depth |
JPH09308638A (en) * | 1996-05-23 | 1997-12-02 | Inter Noba Kk | High frequency heart abbration system |
US6027500A (en) * | 1998-05-05 | 2000-02-22 | Buckles; David S. | Cardiac ablation system |
US6758846B2 (en) * | 2000-02-08 | 2004-07-06 | Gyrus Medical Limited | Electrosurgical instrument and an electrosurgery system including such an instrument |
US6511478B1 (en) | 2000-06-30 | 2003-01-28 | Scimed Life Systems, Inc. | Medical probe with reduced number of temperature sensor wires |
US6669692B1 (en) * | 2000-08-21 | 2003-12-30 | Biosense Webster, Inc. | Ablation catheter with cooled linear electrode |
US6743225B2 (en) * | 2001-03-27 | 2004-06-01 | Uab Research Foundation | Electrophysiologic measure of endpoints for ablation lesions created in fibrillating substrates |
US7918850B2 (en) * | 2006-02-17 | 2011-04-05 | Biosense Wabster, Inc. | Lesion assessment by pacing |
-
2008
- 2008-06-05 US US12/133,716 patent/US8357149B2/en active Active
-
2009
- 2009-06-03 AU AU2009202197A patent/AU2009202197B2/en not_active Ceased
- 2009-06-04 JP JP2009134671A patent/JP5389536B2/en active Active
- 2009-06-04 IL IL199172A patent/IL199172A/en active IP Right Grant
- 2009-06-05 CN CN200910147480.3A patent/CN101601890B/en active Active
- 2009-06-05 CA CA2668438A patent/CA2668438C/en not_active Expired - Fee Related
- 2009-06-05 EP EP09251493.4A patent/EP2130507B1/en active Active
Also Published As
Publication number | Publication date |
---|---|
JP2009291612A (en) | 2009-12-17 |
AU2009202197A1 (en) | 2009-12-24 |
CA2668438A1 (en) | 2009-12-05 |
US20090306641A1 (en) | 2009-12-10 |
IL199172A (en) | 2014-11-30 |
EP2130507A1 (en) | 2009-12-09 |
EP2130507B1 (en) | 2015-07-29 |
CN101601890A (en) | 2009-12-16 |
US8357149B2 (en) | 2013-01-22 |
AU2009202197B2 (en) | 2013-11-28 |
CN101601890B (en) | 2015-01-28 |
JP5389536B2 (en) | 2014-01-15 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2668438C (en) | Filter for simultaneous pacing and ablation | |
CN107921258B (en) | Cardiac pulsed field ablation | |
US20210393327A1 (en) | Treatment of cardiac tissue with pulsed electric fields | |
US20200289185A1 (en) | Waveform generator and control for selective cell ablation | |
US20220370125A1 (en) | Electroporation system and method of preconditioning tissue for electroporation therapy | |
US11197716B2 (en) | Monitoring nerve activity | |
US20080275439A1 (en) | Cardiac ablation and electrical interface system and instrument | |
JP2024506935A (en) | Contact quality systems and methods | |
US6468271B1 (en) | Device and method for percutaneous myocardial revascularization | |
US20140100562A1 (en) | Renal nerve modulation devices and methods | |
US20110190755A1 (en) | Patient return electrode detection for ablation system | |
CN104582619A (en) | System for detecting tissue contact during ablation | |
US20030212390A1 (en) | System for operating an ablation generator with dual energy source | |
US20130138097A1 (en) | System and method to detect patient return electrode connection in an rf ablation system | |
JP2024506907A (en) | Pulse sequence for cardiac ablation by irreversible electroporation with low skeletal muscle stimulation | |
JP2023543846A (en) | Pretreatment waveform for irreversible electroporation | |
US20230190364A1 (en) | Systems and methods for monitoring return patch impedances | |
US11617619B2 (en) | System and method for detecting application of grounding pad for ablation devices | |
US20220346857A1 (en) | Tissue ablation using high-frequency unipolar ire | |
US11877783B2 (en) | Cardiac surgical instrument and connector with built-in electrogram (EGM) filtering circuitry |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request |
Effective date: 20140515 |
|
MKLA | Lapsed |
Effective date: 20210607 |