DE102010010478A1 - Device for ablating the mouth of a pulmonary vein - Google Patents

Abstract

A device (1) for ablating or coagulating the mouth (2) or the outlet of a pulmonary vein (3) in the left atrium of a human heart (5) has a device (6) for destroying the tissue at this outlet or the mouth (2) the pulmonary vein (3) and a guide wire (8) for the guided feeding of this device (6) also with the aid of a catheter (7). So that the device (6) can be used with sufficient force and accuracy at the mouth (2), preferably with the aid of a pressure balloon (10), the guide wire (8) is magnetically fixed in the position of use, with a counterpart (11 ) is also provided with at least one magnet (12), for example in the esophagus (13) or on the outside of the pulmonary vein (3) (2).

Description

The invention relates to a device for ablating or coagulating the mouth or the exit of a pulmonary vein in the left atrium of a human heart to eliminate atrial fibrillation or to eliminate the tendency to atrial fibrillation, with a device for destroying the tissue at the exit of the pulmonary vein and at least one in Use position up to or in the pulmonary vein reaching guidewire for guided feeding the device for destroying the tissue to the output of the pulmonary vein.

Such a device is in DE 10 2008 045 038.3 described. In this prior art device is not excluded that the means for destroying the tissue does not completely touch the output of the respective pulmonary vein in the use position, even if this device is pressed by the surgeon as good as possible. The ability to press this device with sufficient accuracy and force is limited by the anatomical conditions and, moreover, the course of the mouth or the exit of the pulmonary vein is often irregular. Thus, there is a risk that not the entire circumferential area of the mouth or the exit of the pulmonary vein is treated, so after the treatment can still occur again atrial fibrillation.

There is therefore the object to provide a device of the type mentioned, with which the supply and in particular the contacting of the device for destroying the tissue at the outlet or the mouth of the pulmonary vein is better possible.

To solve this problem, it is provided that the guide wire is magnetically fixed in the position of use in the region of the mouth of the pulmonary vein.

Due to the magnetic fixation of the guide wire, this attachment requires no tissue injury. Nevertheless, it is achieved that the guide wire is held at its end, so that the supply of the device for destroying the tissue performed with sufficient force, so this device can be pressed against the site to be treated, as it due to the anatomical conditions for a thorough Treatment is required. It can therefore be carried out a stronger pressing movement and feeding, because it can be continued to the end and even to contact with the tissue, which is not so safe with an unattached, so at the end of free guide wire, because of the then possible evasive movements is possible. The magnetic fixation according to the invention thus makes it possible to fix the guide wire such that the device can fulfill its purpose with greater certainty, but without the guidewire having to be fastened with the tissue injuring means or even undesirably injuring the tissue by evasive movements.

A particularly advantageous embodiment of the invention can provide that at least one magnet is provided for fixing and holding on the guide wire or on a counterpart thereto, and on the counterpart or on the guide wire a ferromagnetic part for cooperation with the magnet (s). It is therefore sufficient to place a counterpart in such a way that the end of the guide wire can be fixed magnetically according to the invention, wherein the magnet or magnets may be provided on the guide wire and / or on the counterpart, depending on the anatomical conditions and the specific embodiment of the device to destroy the tissue can be made dependent.

A particularly good magnetic fixation is obtained if at least one magnet is provided both on the guide wire and on the counterpart, and if the magnets are arranged in the position of use so oriented toward one another that they attract each other.

The magnet provided for the magnetic fixing may be an electromagnet or, preferably, a permanent magnet.

The magnetic force of the magnet formed as an electromagnet can be largely or completely reduced for the release of the magnetic connection by reducing or by switching off the electric current of the electromagnet, which is advantageous for the release of the compound, but is bought with electrical leads to the electromagnet. It is favorable if the counterpart provided for the magnetic support fits into the esophagus of the patient and carries one or more magnets and / or ferromagnetic parts on the side facing the left atrium of the heart in the position of use inside the esophagus.

It is already known to use the esophagus close to the heart, and especially near the left atrium of the human heart, when treatments are to be performed on the heart. This possibility makes use of the invention in a particularly expedient embodiment, in which the counterpart for the magnetic fixation, be it an object consisting of ferromagnetic material or even at least one magnet in the esophagus can be placed to cooperate with the counterpart or preferably the magnet to the guide wire accordingly.

A permanent magnet has the advantage of allowing a high magnetic holding force without requiring electrical leads.

For holding or mounting of the magnet (s) and / or the ferromagnetic part in the position of use within the esophagus, the counterpart may comprise a spreader or, preferably, an inflatable balloon, whereby the holder of the magnet or of the ferromagnetic part in the position of use on that wall or placeable or pressable on the wall portion of the esophagus adjacent to the left atrium of the heart.

For the holder of a magnet or a ferromagnetic part in the esophagus so a proven technique using, for example, a balloon can be used, so that the entire device can be easily assembled and used.

The spreader or the balloon may have a supply line and an inner cavity for a coolant. Thus, in the region of the counterpart, the heat which occurs during coagulation or ablation in the left atrium can be prevented from being removed from the esophagus and / or removed. As a result, the counterpart for the magnetic fixation of the guide wire receives an additional function or vice versa, an optionally already known device for cooling within the esophagus for holding one or more magnets or ferromagnetic parts serve.

The holder for the counterpart can be movable in the esophagus and thereby the magnet or the ferromagnetic part of the guide wire can be positioned or the magnet or ferromagnetic part can be adjustable or displaceable on the counterpart. Since the magnet on the guide wire - or a ferromagnetic part provided there - magnetically interacts with the magnet or the ferromagnetic part of the counterpart, so these magnetic forces can also be used to position the end of the guide wire, so that this end of the guide wire as low as possible can be brought in relation to the site to be treated, then to bring the device for destroying the tissue well guided in their position of use.

An expedient embodiment of the invention may provide that the guide wire extends in the distal end region of a device for supplying the catheter through a lateral opening or a lateral channel of this catheter and extends on the outside of the device for destruction of the tissue to the inner wall of the left atrium and there with the counterpart is magnetically fixed. The guidewire thus sets above all the catheter and the device initially located in the interior and allows the supply of both the catheter and the initially located in this device until it extended in the use position of the catheter and / or in its position of use can be expanded.

The magnet may be located at the end of the guidewire and the counterpart may be located immediately outside the left atrium or in the esophagus. This results in the shortest possible distance, which is bridged by the magnetic force, that results in a sufficiently large holding force. In use position, the device for destroying the tissue due to the fixed guidewire can be supplied according to exactly and above all with high force, because the end of the guidewire, which approaches the device more and more does not avoid but retains its position. Accordingly strong and accurate, the device can be pressed and made effective.

In addition to the arrangement of the counterpart in the esophagus, it is also possible that the counterpart on the outside of the heart and thereby of the left atrium and / or the pulmonary vein can be applied and designed as transthoracally feedable counterpart, which at its the pulmonary vein embracing in the position of use and / or contacting area carrying the magnet and / or ferromagnetic parts.

It is known to apply a transthoracic part to the outside of a heart to be treated, that is, an embodiment of the invention makes use of this surgical technique to connect the magnet or ferromagnetic parts to the ferromagnetic parts or magnets on the guide wire to bring a favorable position in the correspondingly good holding forces can be generated by magnetic means.

Thus, there is also a possibility of magnetic fixation of the guide wire when the esophagus is not usable or should not be used.

The transthoracally deliverable counterpart can, in addition to its magnetic holding function, have an ablation device for ablating the outside of the pulmonary vein. It may be appropriate in the required treatment as well To coagulate or ablate the outside of certain areas of the pulmonary vein, so that the counterpart, which can be supplied transthoracically for this purpose, can have a double function by making this ablation possible and at the same time serving as a counterpart to the magnetic fixation.

Magnets and ferromagnetic parts may be attached in different forms to the parts carrying them. it is possible that the magnet (s) is fastened to the guide wire and / or to the counterpart and / or the ferromagnetic part (s) by gluing, welding, sewing, crimping and / or fusing.

Especially when combining one or more of the features and measures described above, a device is provided with a delivery catheter and a guide wire for ablating or coagulating the mouth or the exit of a pulmonary vein, in which the guide wire can be fixed magnetically in the position of use in the region of the mouth of the pulmonary vein so that it can not dodge to the extent that it does a free-ending guide wire when feeding the device for destroying the tissue at the outlet of the pulmonary vein, so that the supply of the device is accurate even in the end and can be done with correspondingly high pressure forces without missing the place to be treated.

Exemplary embodiments of the invention are described in greater detail below with reference to the drawing, in which, in a partially schematic representation:

1 a longitudinal section through a human heart to be treated, in which a catheter is placed over the right to left atrium, through which a device for destroying the tissue at the exit of a pulmonary vein can be supplied, wherein the device is in the position of use and a magnetically fixed guide wire is arranged on the inside of the wall of the left atrium, while in the observer from the underlying esophagus a counterpart with a ferromagnetic part or at least one other magnet is arranged,

2 a longitudinal section through the wall of the left atrium, at which a pulmonary vein opens, wherein the means for destroying the tissue at the outlet of the pulmonary vein is arranged in the use position and two ways are shown simultaneously, the guidewire for supplying this device to interact with the delivery catheter, wherein a magnet for the magnetic fixation according to the invention is provided at the end of this guide wire,

3 a counterpart intended to cooperate with the magnet of the guidewire, which is designed as a balloon and, in the position of use, can be inserted into the esophagus adjacent to the left atrium of the heart and has a plurality of magnets and also electrodes with temperature sensors,

4 one opposite 3 modified embodiment of the counterpart with a displaceable on it magnet with temperature sensor,

5 a modified embodiment of the device according to the invention, wherein on the outside of a pulmonary vein of a human heart as a counterpart to the holder of magnets or ferromagnetic parts a transthoracally be supplied part is provided, which surrounds the respective pulmonary vein in the position of use on the outside with a curvature located at its distal end, as well as

6 a side view of the in 5 in the position of use shown transthoracally deliverable counterpart.

One in total with 1 designated, especially in 2 The device shown serves to ablate or coagulate the mouth 2 or the exit of a pulmonary vein 3 in the left atrium 4 ( 1 ) of a human heart 5 to eliminate atrial fibrillation or to eliminate the tendency to atrial fibrillation.

Accordingly belongs to the device 1 one in total with 6 designated means for destroying the tissue at the mouth 2 or the exit of the respective pulmonary vein 3 according to 1 in the left atrium 4 comes into use and with the help of a catheter 7 and one in use position to or into the pulmonary vein 3 reaching guidewire 8th led to the estuary 2 or the exit of the pulmonary vein 3 what can be brought in 2 is shown. You can see in 2 also at one to the device 6 belonging Andrückballon 10 an electrode band 9 for coagulation or ablation.

In essence, the device works 1 or the device 6 as it is in DE 10 2008 045 038 is described.

Thus the device 6 and in particular the pressure balloon 10 with the electrode band 9 with sufficient force to the mouth 2 can be pressed to avoid parts of the mouth 2 are not treated, is provided in both embodiments that the guide wire 8th in use position in the area of the mouth 2 the pulmonary vein 3 in a manner to be described is magnetically fixed. By such a fixation of the free end of the guide wire 8th this can be done while feeding the device 6 and especially the pressure balloon 10 do not yield and dodge, so that a correspondingly greater pressure force can be expended. So it is the one hand, the leadership of the institution 6 and her pressure balloon 10 improved and more accurately carried out and on the other hand can with greater force a pressure of the device 6 on the estuary 2 take place without damaging evasive movements take place and thus parts of the mouth 2 leave unencumbered.

The magnetic fixation of the guide wire 8th It looks like that on the guidewire 8th in the embodiments at the free end of the guidewire 8th , or on a counterpart to be described 11 at least one magnet 12 and on the counterpart or guidewire, a ferromagnetic member for coaction with the magnet or magnets 12 is provided. It is provided in the embodiments that both at the free end of the guide wire 8th as well as on the differently designed in the various embodiments counterpart 11 in each case at least one magnet 12 is provided and these magnets 12 are arranged oriented towards each other so that they tighten in the use position and thereby the fixation and fixing of the guide wire 8th cause. In the embodiments, the magnet is 12 a permanent magnet.

In the embodiment according to the 1 to 4 it is provided that the counterpart provided for the magnetic mount 11 one in the esophagus 13 the patient is fitting part and according to 4 one or according to 3 several magnets 12 carries, with this counterpart 11 with the magnet or magnets 12 in position of use in a left atrium 4 of the heart 5 facing and adjacent side within the esophagus 13 is arranged.

This is for holding or storing one or more magnets 12 within the esophagus 13 serving counterpart 11 is in the embodiment according to the 1 to 4 with a spreader or an inflatable balloon 14 provided with which the holder of the magnet or magnets 12 on the wall or on the wall area of the esophagus 13 Placeable and pressable, in the position of use the left atrium 4 of the heart 5 is adjacent, as you can see clearly in 1 and 2 recognizes.

According to the 1 to 4 has this balloon 14 a supply line 15 and an inner cavity for a coolant, which via this supply line 15 is added and possibly deductible. Thus, in the coagulation of the mouth 2 occurring heat to be kept away from the esophagus or dissipated.

The holder for the counterpart 11 can be in the esophagus 13 movable and thereby the magnet held by her 12 be positionable. This can cause the magnet 12 of the guidewire 8th be placed and held accordingly at a preferred location.

4 shows a possibility that on the counterpart 11 located magnet 12 even relative to this counterpart 11 is adjustable to the desired assignment to the magnet 12 of the guidewire 8th to optimize.

One recognizes especially in 3 , but also in 4 that on the counterpart 11 also temperature sensor 16 are provided, with which the already mentioned supply of a cooling medium can be controlled.

In 2 are two possible embodiments for the arrangement of the guide wire 8th at the same time, one of which may be provided in practice:
On the one hand, you realize that the guidewire 8th with the magnet provided at its free end 12 in the distal end region of the device for delivery 6 serving and belonging to her catheter 7 through a side opening 17 a side channel 18 exit, which side channel 18 until this opening 17 parallel to the catheter 7 runs and at the opening 17 to the exit of the guidewire 8th ends. Thus, the guide wire runs 8th first in this channel 18 on the outside of the catheter and the device 6 to the inner wall of the left atrium 4 where then the magnet 12 this guidewire 8th with the counterpart 11 and whose magnet or magnet can be fixed.

In this way, the guide wire can 8th the catheter 7 and thus the device 6 very close to the mouth 2 lead and the guide wire 8th Due to its magnetic fixation, it can also be used when pressing the pressure balloon 10 and the electrode band 9 absorb occurring reaction forces and thus prevent the electrode belt 9 not with the necessary force and accuracy at the mouth 2 is pressed circumferentially.

The second possibility for the arrangement of the guide wire 8th , in the 2 is shown corresponds to a conventional arrangement in an inner channel of the catheter 7 from which the guidewire 8th at the distal end of the device 6 exit, again at the free end of this guidewire 8th now inside the pulmonary vein 3 the magnet 12 is arranged.

One recognizes especially in 2 good, that in both arrangements of the guidewire 8th at the end of the guidewire 8th arranged magnet and its counterpart 11 for holding one or more magnets 12 get close enough to each other to get a good magnetic holding power, because the counterpart 11 with his magnets 12 immediately adjacent to the esophagus 13 is arranged.

In a modified embodiment according to 5 and 6 is the device 6 with her catheter 7 and the guidewire 8th analogous to in 2 arranged, the counterpart 11 however, on the outside of the heart 5 and also the left atrium 4 arranged and on the outside of the pulmonary vein 3 created in position of use, with this counterpart 11 transthoracally supplied. One recognizes this intended for this embodiment pen-like counterpart 11 especially in 6 and at its distal end, it has a curved area 11a on, on the inside of the magnet or magnets 12 are arranged so that it is with this curved area 11a according to 5 the outside of a pulmonary vein 3 immediately adjacent to the left atrium 4 can apply. This counterpart 11 thus engages in the position of use part of the pulmonary vein 3 and carries in it the pulmonary vein 3 embracing or touching area the magnet (s) 12 that with the magnet 12 on the guide wire 8th interact in such a way that the guidewire 8th magnetically fixed.

It should be noted that this transthoracally deliverable counterpart 11 in addition to its magnetic holding function, an ablation device for ablating on the outside of the pulmonary vein 3 can have.

The magnet (s) 12 can in different ways on the guide wire 8th and / or the respective counterpart 11 be attached, namely, for example, by gluing, welding, sewing, crimping and / or fusing. Correspondingly high forces can be transmitted, as they can be applied by modern permanent magnets with such dimensions, the feeding through blood vessels in the left atrium 4 of the heart 5 allow.

The device 1 for ablating or coagulating the mouth 2 or the exit of a pulmonary vein 3 in the left atrium of a human heart 5 has a facility 6 to destroy the tissue at this exit or mouth 2 the pulmonary vein 3 and a guidewire 8th for the guided feeding of this device 6 also with the help of a catheter 7 on. Thus the device 6 preferably with the help of a pressure balloon 10 with sufficient force and accuracy at the mouth 2 can be used is the guidewire 8th Magnetically fixed in position of use, with a counterpart for this fixation 11 also with at least one magnet 12 for example in the esophagus 13 or on the outside of the pulmonary vein 3 is provided.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 102008045038 [0002, 0033]

Claims (14)

Contraption ( 1 ) for ablating or coagulating the mouth ( 2 ) or the output of a pulmonary vein ( 3 ) in the left atrium ( 4 ) of a human heart ( 5 ) to remedy atrial fibrillation or to eliminate the tendency to atrial fibrillation, 6 ) for destroying the tissue at the exit of the pulmonary vein and with at least one in the position of use up to or into the pulmonary vein ( 3 ) reaching guidewire ( 8th ) for guided delivery of the device for destroying the tissue to the pulmonary vein outlet ( 3 ), characterized in that the guidewire ( 8th ) in the use position in the area of the mouth ( 2 ) of the pulmonary vein ( 3 ) is magnetically fixed. Device according to claim 1, characterized in that for fixing and holding on the guide wire ( 8th ) or on a counterpart ( 11 ), at least one magnet ( 12 ) and on the counterpart or on the guide wire a ferromagnetic part for cooperation with the / the magnet ( 12 ) is provided. Device according to claim 1 or 2, characterized in that both on the guide wire ( 8th ) as well as on the counterpart ( 11 ) at least one magnet ( 12 ) is provided, and the magnets ( 12 ) are arranged oriented to each other so that they attract each other. Device according to one of claims 1 to 3, characterized in that the magnet provided for the magnetic fixing ( 12 ) is an electromagnet or preferably a permanent magnet. Device according to one of claims 1 to 4, characterized in that the magnetic force of the magnet formed as an electromagnet ( 12 ) for the release of the magnetic connection by reducing or by switching off the electric current of the electromagnet is largely or completely reduced. Device according to one of claims 1 to 5, characterized in that provided for the magnetic holder counterpart ( 11 ) in the esophagus ( 13 ) of the patient and one or more magnets ( 12 ) and / or ferromagnetic parts in the position of use in the left atrium ( 4 ) of the heart ( 5 ) side within the esophagus ( 13 ) wearing. Device according to one of claims 1 to 6, characterized in that for holding or supporting the magnet or magnets ( 12 ) and / or the ferromagnetic part within the esophagus ( 13 ) the counterpart ( 11 ) a spreader or an inflatable balloon ( 14 ), whereby the holder of the magnet or magnets ( 12 ) or the ferromagnetic part on that wall or on the wall area of the esophagus ( 13 ) is placeable or pressable, which in the position of use the left atrium ( 4 ) of the heart ( 5 ) is adjacent. Device according to one of claims 1 to 7, characterized in that the spreader or the balloon ( 14 ) a supply line ( 15 ) and an inner cavity for a coolant. Device according to one of claims 1 to 8, characterized in that the holder for the counterpart ( 11 ) in the esophagus ( 13 ) and thereby the magnet ( 12 ) or the ferromagnetic part of the guide wire ( 8th ) are positionable, or that the magnet ( 12 ) or the ferromagnetic part on the counterpart ( 11 ) is adjustable or displaceable. Device according to one of claims 1 to 9, characterized in that the guide wire ( 8th ) in the distal end region of a device for supplying the device ( 6 ) catheter ( 7 ) through a lateral opening ( 17 ) or a side channel ( 18 ) and on the outside of the device ( 6 ) to destroy the tissue to the inner wall of the left atrium ( 4 ) and there with the counterpart ( 11 ) is magnetically fixable. Device according to claim 10, characterized in that the magnet ( 12 ) at the end of the guidewire ( 8th ) and the counterpart ( 11 ) immediately on the outside of the left atrium ( 4 ) or in the esophagus ( 13 ) is arranged. Device according to one of claims 1 to 11, characterized in that the counterpart ( 11 ) on the outside of the heart ( 5 ) and the left atrium ( 4 ) and / or the pulmonary vein ( 3 ) can be applied and as transthoracally feedable counterpart ( 11 ), which at its the pulmonary vein ( 3 ) in the position of use encompassing and / or touching the magnet or magnets ( 12 ) and / or ferromagnetic parts. Apparatus according to claim 12, characterized in that the transthoracally feedable counterpart ( 11 ) in addition to its magnetic holding function a Ablatiereinrichtung for ablating the outside of the pulmonary vein ( 3 ) having. Device according to one of claims 1 to 13, characterized in that the magnet or magnets ( 12 ) is fastened to the guide wire and / or to the counterpart and / or the ferromagnetic part or parts by gluing, welding, sewing, crimping and / or fusing.

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