CN102090924B - Preformed bending ablation catheter - Google Patents

Abstract

The entitled preformed bending ablation catheter of the present invention.The invention provides a kind of medical treatment device, described device includes inserting pipe, and described insertion pipe has longitudinal axis, and has the far-end be suitable to by body passage insertion patient's body lumen.Electrode is positioned on the described far-end of described insertion pipe, and is configured to contact described endoceliac tissue.Component with resilience is contained in the described far-end of described insertion pipe, and is configured to when unfettered, makes described far-end curve curved shape away from described longitudinal axis, make when stressed described in be distally-oriented to described longitudinal axis and stretch.

Description

Preformed bending ablation catheter

Technical field

Present invention relates generally to the method and apparatus for invasive treatment, specifically, relate to conduit.

Background technology

The treating irregular heart pulse means known to being are melted in cardiac muscular tissue.Such as, in radio frequency (RF) melts, insert the catheter into Heart at target location and contact tissue.Then RF energy is applied by supravasal electrode, in order to form infringement, its mesh Be destroy tissue in proarrhythmia current path.

Recently, the periphery of pulmonary vein mouth melts the treatment as atrial arrhythmia, especially auricular fibrillation Means are accepted.Such as, be incorporated by reference United States Patent (USP) 6,064,902 herein describe for ablation blood vessel (as Pulmonary vein) conduit of tissue on inwall.The tip portion of conduit can from the first substantially straight configuration (the most proximally and distally Part substantially conllinear) (the most proximally and distally part is almost parallel, the spacing between it to turn to the second configuration of J-shaped Substantially the same with the internal diameter of blood vessel).The distal portions of conduit rotates around the longitudinal axis of conduit so that supravasal near-end Circumferential displacement is carried out along the inwall of pulmonary vein with distal ablation electrode.So, can use electrode catheter in pulmonary vein Some circumferentially spaced sites of ablation on wall, method is in each one or two site of circumferential position ablation.

Summary of the invention

The intrusion apparatus embodiments providing more safely and efficiently contact inner tissue described below and Method.

Therefore, according to The embodiment provides a kind of medical treatment device including inserting pipe, wherein inserting pipe and having Longitudinal axis also has the far-end being adapted to pass through in body passage insertion patient's body lumen.Electrode is positioned at the far-end inserting pipe, and quilt It is configured to contact endoceliac tissue.Insert in the far-end of pipe and comprise the structure with resilience can with shape-memory material Part, when this component is unfettered, makes far-end curve curved shape away from longitudinal axis, when stressed, it can be made towards longitudinal direction Axis stretches.

In disclosed embodiment of this invention, device includes that at least one is positioned at the position sensor inserting pipe far-end. This at least one position sensor is configured to measure the angle of bend inserting pipe far-end.In this case, this at least one Position sensor generally includes two position sensors being positioned at the different longitudinal position inserting pipe far-end.

Generally, when applying inward radial force, component with resilience is configured to stretch towards longitudinal axis.There is resilience The component of power can be configured as bending when radial force exceedes predetermined threshold value.

According to embodiments of the invention, additionally provide the armarium including crust, wherein crust have longitudinal axis and Distal openings, and be adapted to pass through in body passage insertion patient's body lumen.Conduit is configured to pass through crust and inserts body cavity, and has Far-end with resilience, far-end is shaped as when unfettered, curves curved shape away from longitudinal axis, when stressed, far End stretches towards longitudinal axis.

In disclosed embodiment of this invention, when the far-end of conduit is through crust, crust applies inward radial force, The far-end making conduit stretches, and after entering body cavity through the distal openings of crust, the far-end of conduit is curved shape.Conduit is usual It is configured to Intradermal outside enclose and rotate about the axis.

In certain embodiments, conduit includes the electrode of far-end, and it is configured to contact endoceliac tissue.Equipment can To include radio frequency (RF) generator, during connection, it supplies RF energy, thus ablation tissue by conduit to electrode.

In disclosed embodiment of this invention, conduit includes the position sensor in far-end, and equipment includes position Sensing system, it is configured to and position sensor communication, in order to determine far-end position in vivo.Position sensing is permissible It is configured to supply the instruction of the angle of bend of distal end of catheter.

According to embodiments of the invention, still further provides a kind of Therapeutic Method, it includes being had by body passage The crust of longitudinal axis and distal openings inserts in the body cavity of patient.Inserting the catheter in crust, wherein conduit has resilience The far-end of power, far-end is shaped as when unfettered, curves curved shape away from longitudinal axis, when stressed, is distally-oriented to Longitudinal axis stretches.Conduit is advanced by crust so that the far-end of conduit enters body cavity through the distal openings of crust, and in curved Curved shape.At body transluminal operation conduit so that the endoceliac tissue of distal contact, when distal contact tissue, Intradermal moves outside Dynamic conduit, makes far-end advance along tissue with required path.

In certain embodiments, move conduit to include around axis rotary guide pipe.In one embodiment, body cavity includes blood Pipe, rotary guide pipe makes far-end around the inner periphery circumferentially path traveling of blood vessel.Such as, insert crust can include crust warp Passed the left atrium of the vascular system entrance patient's heart of patient by skin, and propulsion bulb can include the far-end of conduit It is arranged in pulmonary vein, in order in pulmonary vein mouth, circumferentially advance in path.

In disclosed embodiment of this invention, the method includes the instruction providing distal end of catheter angle of bend, Yi Jitong Cross and this instruction is responded the pressure controlling far-end to tissue.

By the detailed description of the embodiment below in conjunction with accompanying drawing, the present invention be will be more fully understood.

Accompanying drawing explanation

Fig. 1 be the system for cardiac tissue ablation according to the embodiment of the present invention schematically illustrate figure；

Fig. 2 is the schematic sectional view according to the heart being inserted with conduit in the left atrium shown in the embodiment of the present invention；And

Fig. 3 is the schematic side elevation of the conduit in pulmonary vein mouth according to the embodiment of the present invention.

Detailed description of the invention

Invention described below embodiment provides for simple, the peace along endoceliac selected path ablation tissue Complete and reliable apparatus and method.Some in these embodiments are particularly suited for melting the circumference road in tubular structure (such as blood vessel) Footpath.However, it is also possible to the principle of the present invention to be applied to linear path and the application in addition to melting.

In disclosed embodiment of this invention, medical treatment device (such as conduit) include by body passage insert body cavity (as Ventricle) in insertion pipe.Insert Guan Qi far-end to have and the electrode of endoceliac contact tissue.The far-end inserting pipe comprises Preformed component with resilience, as shape memory supports so that when conduit is not retrained by radial force, far-end is away from insertion The longitudinal axis of pipe curves curved shape.In other words, distal end of catheter is bending without constraint shapes, is not using any kind During the active steering mechanism of class, conduit presents this shape.

When the far-end of conductive pipe applies the power in suitable direction, such as inward radial force so that be distally-oriented to longitudinal axis Line stretches.Therefore the instruction of the power of angle of bend offer catheter tip urging tissue.The far-end of conduit can be made structure foot Enough weaknesses, in order to bending when to the pressure organized more than certain threshold value, thus for likely piercing through the excessive pressure of tissue The safety providing extra is weighed.

Can be with this preformed bending conduit along the circular path ablation tissue in pulmonary vein.To this end, usual warp By fossa ovalis, crust being inserted left atrium, the position of fossa ovalis is coaxial with the pulmonary vein carrying out melting.By conduit through outward Skin (it is with radial constraint conduit so that it is be kept upright when through crust), until the far-end of conduit stretches out from crust and enters Vein.The curved shape of the far-end stretched out from crust makes the inwall of the electrode contact vein at distal end of catheter.The conduit selected is curved The angle of Qu Duan and length should make when the longitudinal axis of crust with conduit insertion pipe aligns with the axis of vein, and far-end is oppressed The inwall of vein.

When melting, operator makes the tissue in electrode contact ostium venosum cordis by handling conduit, then rotates crust In catheter shaft, simultaneously apply RF energy to electrode.This rotation makes electrode move around the inner periphery circumferentially path of vein, And along this path ablation tissue.Alternatively, RF energy can be supplied intermittently, in order to melt choosing along path Fixed point.Alternatively or in addition to this rotary form, doctor can move form to use other, in order to Conduit is made to advance along different types of path.

Fig. 1 is schematically illustrating of the system 20 of the tissue of the heart 26 for patient 28 according to embodiments of the present invention Figure.Operator 22 (such as heart disease doctor) inserts conduit 24 by the vascular system of patient 28 so that the far-end of conduit enters suffers from In person's ventricle.Operator 22 propulsion bulb so that its far-end engages with endocardial tissue in required one or more positions, As shown in figure below.With suitable adapter, conduit 24 is connected with control station 30 at its near-end.Control station includes that RF occurs Device 36, it applies RF energy by the electrode at distal end of catheter, in order to melt the tissue of distal contact.Alternatively Or in addition, conduit 24 may be used for other diagnosis and/or treatment functions, such as electrocardiogram or other kinds of ablation therapy.

In the illustrated embodiment, system 20 uses magnetic position sensing to determine distal end of catheter position seat in heart 26 Mark.Drive circuit 34 driving field generator 32 when determining position coordinates, in control station 30 so that it is produce magnetic in patient 28 body ?.Field generator 32 generally includes coil, and it is placed on the external known position below patient's trunk.These coils are comprising Heart 26 produces magnetic field in interior predetermined work volume.One or more magnetic field sensors in conduit 24 far-end are (such as Fig. 3 institute Show) by responding these magnetic field generation signal of telecommunication.Control station processes these signals, in order to determine (the position, position of conduit 24 far-end Put and/or direction) coordinate, it is also possible to determine angle of bend, as mentioned below.Control station 30 can make when driving display 38 With coordinate so that it is the position of display conduit and state.This position sensing and the method processed can use (such as) Biosense The CARTO that Webster Inc. (Diamond Bar, California) manufactures^TMSystem is implemented.

Alternatively or additionally, system 20 can include for handling in patient 28 body and operation is led The automatic mechanism (not shown) of pipe 24.This type of mechanism usually controls lengthwise movement (advance/regain) and the rotation of conduit 24 Turn.In this type of embodiment, control station 30 generates the control for controlling catheter movement according to the signal that position sensing provides System input.

Although fig 1 illustrate that concrete system configuration, but also can use it in alternative embodiment of the present invention His system configuration.For example, it is possible to implement method described below with other kinds of position sensor, such as impedance type or ultrasonic position Put sensor.As used herein, term " position sensor " refer to be arranged on conduit 24 or within element, this element makes Control station 30 receives the signal of indicator elment coordinate.Thus this position sensor can include the receptor in conduit, it is according to biography The energy that sensor receives produces position signalling to controller；Or sensor can include emitter, outside its emitting probe The energy that receptor can sense.Additionally, similarly, when implementing method described below, it is possible not only to use conduit, and permissible Other kinds of probe is used to carry out drawing and measuring application with other organs and region at heart.

Fig. 2 is the schematic sectional view of the heart 26 according to the embodiment of the present invention, it is shown that insert the conduit 24 in heart. When inserting conduit in the illustrated embodiment, first crust 40 is passed through the up caval vein of vascular system by operator via skin 42 right atriums 44 inserting heart.Crust generally enters left atrium 46 via fossa ovalis through atrial septum film 48.As additionally A kind of selection, it is possible to use other access paths.Then conduit 24 is inserted by crust, until the far-end of conduit passes crust The distal openings of end enters left atrium, as shown in the figure.

One of them of the operator 22 longitudinal axis by the crust 40 in left atrium 46 and conduit 24 and pulmonary vein 50 Axis aligns.Operator can be with position method for sensing mentioned above and the schematic diagram of the heart 26 being obtained ahead of time or image Carry out this alignment operation.Alternatively or additionally, can be in cryptoscope or the help of other visualization devices Under carry out this alignment operation.The far-end of conduit is inserted target pulmonary vein by operator, and makes catheter tip contact with ostium venosum cordis. Then operator makes conduit rotate around its axis Intradermal outside, in order to make it around the inner periphery of vein circumferentially with circumference road Advance in footpath.Meanwhile, operator starts RF generator 36, in order to along this path ablation tissue.Complete in a pulmonary vascular After this operation, operator can move crust and conduit, repeats this operation in other pulmonary vein one or more.

Alternatively or additionally, operator 22 can be advanced by crust 40 and/or be regained conduit 24, To make it advance (with melting) along the heart wall in left atrium 46 or other positions with linear path.

Above operation can be carried out in the case of not using any steering mechanism in conduit 24.Curved due to conduit Shape, it is only necessary to the advance of conduit/regain and rotate.Relative to device known in the art, internal turn mechanism is not had to subtract The size of ductule also reduces cost.As it was noted above, above-mentioned operation can be carried out rather than such as Fig. 1 institute with automatic mechanism Show and manually carried out by operator.

Fig. 3 is the schematic side elevation according to the embodiment of the present invention, it is shown that the conduit 24 in the mouth of pulmonary vein 50 The details of far-end.Conduit 24 includes inserting pipe 62, and it is generally made by biocompatible plastic (such as polyurethane) and comprised conduit Function element.The longitudinal axis inserting pipe (in addition to the far-end of bending) aligns with the longitudinal axis of crust 40.

The component 60 with resilience of the distal internal inserting pipe 62 is pre-formed into curved shape.Component 60 can include (such as) post, rod or the pipe being made up of shape-memory material (such as Nitinol), it is prepared to when it is in free Austria During family name's body state, there is this curved shape.When applying inward radial force to the far-end of bending, it can be made towards longitudinal axis Line stretches.Therefore, the conduit 24 in crust 40 keeps stretching by crust itself.Catheter tip is (or right to the mouth of vein 50 Its hetero-organization) pressure also make the far-end of conduit stretch.Component 60 with resilience can be made structure the weakest, in order to Can bend when to the pressure of catheter tip more than certain predetermined threshold value, thus for likely piercing through heart wall vein Excessive pressure provides extra safety to weigh.

Conduit 24 includes being positioned at the electrode 64 inserting pipe 62 far-end.This electrode is by running through the conductor (not shown) of conduit Being connected with RF generator 36, therefore RF generator can provide RF energy, in order to melts the tissue with electrode contact.In Fig. 3 Circular arrow shown in electrode 64 can be made with circumference road around the inner periphery of the mouth of vein 50 around its axis rotary guide pipe 24 Advance in footpath.Therefore operator 22 can easily and reliably form circle and melts stove.

Conduit 24 includes being positioned at the position sensor 66 and 68 at the different longitudinal position inserting pipe 62 far-end.At Fig. 1 Shown sensor 66 and 68 includes coil with in embodiment described above, and the magnetic field that its sensing is produced by field generator 32 is also To control station 30 output signal.Control station finds position and the direction coordinate of coil by processing these signals.Sensor 66 He The angle of bend of the direction difference instruction distal end of catheter of 68 (or in other words, curvature).Alternatively, can be used it The position sensor of his type or bend sensor measure angle of bend.Additionally or alternatively, operator 22 can pass through fluoroscopic observation angle of bend.

Relative to the angle of bend of far-end time unfettered, the reduction (far-end stretches) of angle of bend is by being in contact with it The instruction of the radial force that tissue is applied on conduit 24 far-end: the radial pressure that tissue is applied by operator is the biggest, angle of bend The least.Control station 30 can have angle of bend instruction on display screen 38, such as the diagram of distal end of catheter.Then operator 22 can To control the radial pressure that conduit tissue in heart 26 applies, so that in the range of angle of bend is maintained at suitably.Logical The degree of stretching often needing distal end of catheter is less, to guarantee electrode 64 contact tissue securely；But avoid excessive stretching journey Degree, to prevent owing to pressure is excessive and pierce through tissue.Alternatively or additionally, can automatically be monitored and controlled The angle of bend of conduit.

Although above example is specifically related to the treatment of pulmonary vein inside and around, but conduit 24 and the design of system 20 Feature may generally be also used to other veins and tremulous pulse and the treatment of other kind body cavitys (tubulose and other shapes) inside.Cause This, it will be appreciated that above-described embodiment is to be illustrated by way of example, and the present invention is not by the most particularly illustrated and described The limitation of content.Further, the scope of the present invention includes the combination of above-mentioned various feature and sub-portfolio and those skilled in the art Can undocumented variations and modification in thinkable and prior art when reading description above.

Claims (13)

1. a medical treatment device, including:

Inserting pipe, described insertion pipe has longitudinal axis, and has the far-end be suitable to by body passage insertion patient's body lumen；

Electrode, described electrode is positioned on the far-end of described insertion pipe, and is configured to contact described endoceliac tissue；And

Component with resilience, described component with resilience is contained in the described far-end of described insertion pipe, and is configured to When unfettered, make described far-end curve curved shape away from described longitudinal axis, when stand from described tissue to described far It is distally-oriented to described longitudinal axis described in making during the pressure held stretch,

Wherein said component with resilience is configured as bending when described pressure exceedes predetermined threshold value.

Device the most according to claim 1, wherein said component with resilience comprises shape-memory material.

Device the most according to claim 1, also includes at least one position being positioned at the described far-end of described insertion pipe Sensor.

Device the most according to claim 3, at least one position sensor wherein said is configured to measure described insertion The angle of bend of the described far-end of pipe.

Device the most according to claim 4, at least one position sensor wherein said includes being positioned at described insertion pipe Two position sensors at different longitudinal position in described far-end.

Device the most according to claim 1, wherein said component with resilience is configured to by inside radial direction Stretch towards described longitudinal axis during power.

7. an armarium, including:

Crust, described crust is had longitudinal axis and distal openings, and is suitable to be inserted in patient's body lumen by body passage；And

Conduit, described conduit is configured to pass through described crust and inserts described body cavity, and has far-end with resilience, described far End is shaped as when unfettered, and described far-end curves curved shape away from described longitudinal axis, and when standing from described body When the tissue of intracavity is to the pressure of described far-end, described in be distally-oriented to described longitudinal axis and stretch,

Wherein said far-end with resilience is configured as bending when described pressure exceedes predetermined threshold value.

Equipment the most according to claim 7, wherein said crust applies inward radial force so that described conduit described Far-end stretches when it is through described crust, and wherein passes the described far-end of described crust when the described far-end of described conduit After opening enters described body cavity, the described far-end of described conduit presents described curved shape.

Equipment the most according to claim 8, wherein said conduit is configured to revolve around described axis at described outer Intradermal Turn.

Equipment the most according to claim 7, wherein said conduit includes the electrode being positioned at described far-end, described electrode It is configured to contact described tissue.

11. equipment according to claim 10, also include that radio frequency (RF) generator, described RF generator are coupled into by institute State conduit and provide RF energy to described electrode, in order to melt described tissue.

12. equipment according to claim 7, wherein said conduit includes the position sensor being positioned at described far-end, and And wherein said equipment includes position sensing, described position sensing to be configured to described position sensor communicating, To determine described far-end position in described health.

13. equipment according to claim 12, wherein said position sensing is configured to supply the institute of described conduit State the instruction of the angle of bend of far-end.