CA2475919A1 - Lasso for pulmonary vein mapping and ablation - Google Patents
Lasso for pulmonary vein mapping and ablation Download PDFInfo
- Publication number
- CA2475919A1 CA2475919A1 CA002475919A CA2475919A CA2475919A1 CA 2475919 A1 CA2475919 A1 CA 2475919A1 CA 002475919 A CA002475919 A CA 002475919A CA 2475919 A CA2475919 A CA 2475919A CA 2475919 A1 CA2475919 A1 CA 2475919A1
- Authority
- CA
- Canada
- Prior art keywords
- curved section
- distal end
- generating
- pulmonary vein
- section
- 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.)
- Granted
Links
Classifications
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
- A61B5/053—Measuring electrical impedance or conductance of a portion of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
-
- 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
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00375—Ostium, e.g. ostium of pulmonary vein or artery
-
- 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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00839—Bioelectrical parameters, e.g. ECG, EEG
-
- 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
- A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
Abstract
A method is provided for electrical mapping of a pulmonary vein of a heart, including introducing into the heart a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section. At a location on the curved section, a first position signal is generated having fewer than six dimensions of position and orientation information. At a vicinity of the distal end of the base section, a second position signal is generated having six dimensions of position and orientation information. The method also includes measuring, at one or more locations on the curved section, an electrical property of the pulmonary vein.
Description
.L
LASSO FOR PULMONARY' ~~EIN MAPPING AND ABLATION
FIELD OF THE INVENTION
The present invention relates generally to intrabody mapping systems, and specifically to methods and devices for electrophysiologicaI mapping of intracardiac s sites to facilitate therapeutic procedures.
BACKGROUND OF THE INVENTION
Cardiac arrhythmia, such as atrial fibrillation, occurs when regions of cardiac tissue abnormally conduct electric signals to adjacent tissue, thereby disrupting the normal cardiac cycle and causing asynchronous rhythm. The primary sources of undesired signals are located in the tissue region along the pulmonary veins of the left atrium and in the superior pulmonary veins. After unwanted signals are generated in the pulmonary veins or conducted through the pulmonary veins from other sources, they are conducted into the left atrium where they can initiate or continue arrhythmia.
Procedures for treating arrhythmia include surgically disrupting the origin of the signals causing the arrhythmia, as well as disrupting the conducting pathway for such signals. More recently, it has been found that by mapping the electrical properties of the endocardium and the heart volume, and selectively ablating cardiac tissue by application of energy, it is sometimes possible to cease or modify the propagation of unwanted electrical signals from one portion of the heart to another.
LASSO FOR PULMONARY' ~~EIN MAPPING AND ABLATION
FIELD OF THE INVENTION
The present invention relates generally to intrabody mapping systems, and specifically to methods and devices for electrophysiologicaI mapping of intracardiac s sites to facilitate therapeutic procedures.
BACKGROUND OF THE INVENTION
Cardiac arrhythmia, such as atrial fibrillation, occurs when regions of cardiac tissue abnormally conduct electric signals to adjacent tissue, thereby disrupting the normal cardiac cycle and causing asynchronous rhythm. The primary sources of undesired signals are located in the tissue region along the pulmonary veins of the left atrium and in the superior pulmonary veins. After unwanted signals are generated in the pulmonary veins or conducted through the pulmonary veins from other sources, they are conducted into the left atrium where they can initiate or continue arrhythmia.
Procedures for treating arrhythmia include surgically disrupting the origin of the signals causing the arrhythmia, as well as disrupting the conducting pathway for such signals. More recently, it has been found that by mapping the electrical properties of the endocardium and the heart volume, and selectively ablating cardiac tissue by application of energy, it is sometimes possible to cease or modify the propagation of unwanted electrical signals from one portion of the heart to another.
2 0 The ablation process destroys the unwanted electrical pathways by formation of non-conducting lesions.
In this two-step procedure - mapping followed by ablation - electrical activity at points in the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors into the heart, and acquiring data at a multiplicity of points. These data are then utilized to select the target areas at which ablation is to be performed.
A number of approaches nave been described far acquiring cardiac electrical data using single- and mufti-electrode catheters. US Patents 5,487,391 to Panescu, 5,84$,972 to Triedman et al., 4,649,924 to Taccardi, 5,311,866 to Kagan et al., 5,297,549 to Beatty et al., S,38S,146 and 5,450,846 to Goldreyer, S,S49,109 to G
Samson et al., 5,711,298 to Littmarm et aL, and 5,662,108 to Budd et al., all of which are incorporated herein by reference, are typical examples of methods proposed for mapping electrical characteristics of the heart utilizing catheter-mounted electrodes.
US Patents 5,807,395 MuIier et al. and 6,190,382 to Ormsby et al., which are incorporated herein by reference, describe systems for ablating body tissue using radio frequency. US Patents 6,090,084 and 6,251,109 to Hassett et al., 6,117,101 to Diederich et al., 5,938,660 to Swartz et al., 6,245,064 and 6,024,740 to Lesh et al., 5,971,983, 6,012,457 and 6,164,283 to Lesh, 6,004,269 to Crowley et al., and 6,064,902 to Haissaguerre et al., all of which are incorporated herein by reference, to describe apparatus for tissue ablation to treat atriaI arrhythmia, primarily tissue located within the pulmonary veins or on the ostia of the pulmonary veins. US
Patents 5,582.609 and 6,142,994 to Swanson et al., 6,152,920 to Thompson et al., 6,120,496 to Whayne et al., and 6,267,760 to Swanson, all of which are incorporated herein by reference, describe techniques for positioning therapeutic elements within 2 5 the body, and ablating and forming incisions in soft tissue.
US Patent 6,104,944 to Martinelli, which is incorporated herein by reference, describes a method for navigating a catheter that includes locatable electrode elements distributed along the catheter. The locatable electrode elements include at least two navigated electrode elements and one or more virtually navigable electrode 2 0 elements located relative to the navigated electrode elements. Location data are provided for the navigated electrode elements, and location data for the virtually navigable electrode elements are determined as a function of the location data for the navigated electrode elements.
Pre-shaped catheters have been developed to assist with positioning within the 2 5 body. These catheters may be shaped to specifically access a particular site within the heart. For US Patents 5,779,669 and 5,93I,81I to Haissaguerre et al., which are incorporated herein by reference, describe a steerable catheter, particularly for use in the heart, which comprises a pre-shaped loop with a flexible middle section that bends in response to forces applied by a steering device. The steerable catheter is
In this two-step procedure - mapping followed by ablation - electrical activity at points in the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors into the heart, and acquiring data at a multiplicity of points. These data are then utilized to select the target areas at which ablation is to be performed.
A number of approaches nave been described far acquiring cardiac electrical data using single- and mufti-electrode catheters. US Patents 5,487,391 to Panescu, 5,84$,972 to Triedman et al., 4,649,924 to Taccardi, 5,311,866 to Kagan et al., 5,297,549 to Beatty et al., S,38S,146 and 5,450,846 to Goldreyer, S,S49,109 to G
Samson et al., 5,711,298 to Littmarm et aL, and 5,662,108 to Budd et al., all of which are incorporated herein by reference, are typical examples of methods proposed for mapping electrical characteristics of the heart utilizing catheter-mounted electrodes.
US Patents 5,807,395 MuIier et al. and 6,190,382 to Ormsby et al., which are incorporated herein by reference, describe systems for ablating body tissue using radio frequency. US Patents 6,090,084 and 6,251,109 to Hassett et al., 6,117,101 to Diederich et al., 5,938,660 to Swartz et al., 6,245,064 and 6,024,740 to Lesh et al., 5,971,983, 6,012,457 and 6,164,283 to Lesh, 6,004,269 to Crowley et al., and 6,064,902 to Haissaguerre et al., all of which are incorporated herein by reference, to describe apparatus for tissue ablation to treat atriaI arrhythmia, primarily tissue located within the pulmonary veins or on the ostia of the pulmonary veins. US
Patents 5,582.609 and 6,142,994 to Swanson et al., 6,152,920 to Thompson et al., 6,120,496 to Whayne et al., and 6,267,760 to Swanson, all of which are incorporated herein by reference, describe techniques for positioning therapeutic elements within 2 5 the body, and ablating and forming incisions in soft tissue.
US Patent 6,104,944 to Martinelli, which is incorporated herein by reference, describes a method for navigating a catheter that includes locatable electrode elements distributed along the catheter. The locatable electrode elements include at least two navigated electrode elements and one or more virtually navigable electrode 2 0 elements located relative to the navigated electrode elements. Location data are provided for the navigated electrode elements, and location data for the virtually navigable electrode elements are determined as a function of the location data for the navigated electrode elements.
Pre-shaped catheters have been developed to assist with positioning within the 2 5 body. These catheters may be shaped to specifically access a particular site within the heart. For US Patents 5,779,669 and 5,93I,81I to Haissaguerre et al., which are incorporated herein by reference, describe a steerable catheter, particularly for use in the heart, which comprises a pre-shaped loop with a flexible middle section that bends in response to forces applied by a steering device. The steerable catheter is
3 0 advanced into the patient until a complexly curved section of the catheter is seated relative to an anatomical feature within the patient. The complexly curved section generally corresponds in shape to the anatomical feature against which the catheter is .
to be seated. Once seated. a pulling force is applied to a wire to cause a flexible intermediate section of the catheter to flex and thereby entrain a distal end of the catheter into contact with a desired site within the patient. Embodiments of this catheter contain electrodes and temperature sensors, such that the catheter can be used for recording, mapping, stimulation or ablation. Based on the apparatus described in the '669 and '8I 1 patents, Biosense Webster developed the LASSO Circular Mapping Catheter, a catheter capable of circumferentially mapping pulmonary veins.
US Patent 6,063,022 to Ben-Haim, which is assigned to the assignee of the present patent application and is incorporated herein by reference, describes an invasive probe including two position sensors in a fixed, known relation to the distal end of the probe. The position sensors generate signals responsive to their respective position coordinates and at least one contact sensor along a radial surface of the probe for generating a signal representing its contact with body tissue to be ablated by electrodes on the probe.
US Patent 6,272,371 to Ben-Haim, which is assigned to the assignee of the present patent application and is incorporated herein by reference, describes an invasive probe including a flexible portion that assumes a predetermined curve form when a force is applied thereto. Two position sensors, fixed to the distal portion of the probe in known positions, are used to determine position and orientation 2 0 coordinates of at least one of the sensors, and to determine the locations of a plurality of points along the length of the distal portion of the probe.
PCT Patent Publication WO 96/05768 and corresponding US Patent Application Publication 2002/0065455 to Ben-Haim et al., which are assigned to the assignee of the present patent application and which are incorporated herein by 2 5 reference, describe a system that generates six-dimensional position and orientation information regarding the tip of a catheter. This system uses a plurality of sensor coils adjacent to a locatable site in the catheter, for example near its distal end, and a plurality of radiator coils fixed in an external reference frame. These coils generate signals in response to magnetic fields generated by the radiator coils, which signals 3 0 allow for the computation of six position and orientation dimensions, so that the position and orientation of the catheter are known without the need for imaging the catheter.
c The following patents. which are incorporated herein by reference, may be of interest:
US Patent 6,348,062. entitled, "Vasculax device having one or more articulation regions and methods of use"
US Patent 6,332,880, entitled, °'Loop structures for supporting multiple electrode elements"
US Patent 6,332,881, entitled, "Surgical ablation tool"
US Patent 6,308,093, entitled, "Method and apparatus far guiding ablative therapy of abnormal biological electrical excitation"
1 o US Patent 6,290,699, entitled, "Ablation tool for forming lesions in body tissue"
US Patent 6,264,654, entitled, "Ablation catheter"
US Patent 6,235,025, entitled, "Process and device fox the treatment of atrial arrhythmia"
US Patent 6,217,528, entitled, "Loop structure having improved tissue contact capability"
US Patent 6,068,629, entitled, "System and methods far tissue mapping and ablation"
US Patent 5,931,835, entitled, "Radio frequency energy delivery system for 2 o multipolar electrode catheters"
US Patent 5,916,213. entitled, "Systems and methods for tissue mapping and ablation"
US Patent 5,239,999. entitled, "Helical endocardial catheter probe"
US Patent 4,940,064, entitled, "Catheter for mapping and ablation and method therefore"
to be seated. Once seated. a pulling force is applied to a wire to cause a flexible intermediate section of the catheter to flex and thereby entrain a distal end of the catheter into contact with a desired site within the patient. Embodiments of this catheter contain electrodes and temperature sensors, such that the catheter can be used for recording, mapping, stimulation or ablation. Based on the apparatus described in the '669 and '8I 1 patents, Biosense Webster developed the LASSO Circular Mapping Catheter, a catheter capable of circumferentially mapping pulmonary veins.
US Patent 6,063,022 to Ben-Haim, which is assigned to the assignee of the present patent application and is incorporated herein by reference, describes an invasive probe including two position sensors in a fixed, known relation to the distal end of the probe. The position sensors generate signals responsive to their respective position coordinates and at least one contact sensor along a radial surface of the probe for generating a signal representing its contact with body tissue to be ablated by electrodes on the probe.
US Patent 6,272,371 to Ben-Haim, which is assigned to the assignee of the present patent application and is incorporated herein by reference, describes an invasive probe including a flexible portion that assumes a predetermined curve form when a force is applied thereto. Two position sensors, fixed to the distal portion of the probe in known positions, are used to determine position and orientation 2 0 coordinates of at least one of the sensors, and to determine the locations of a plurality of points along the length of the distal portion of the probe.
PCT Patent Publication WO 96/05768 and corresponding US Patent Application Publication 2002/0065455 to Ben-Haim et al., which are assigned to the assignee of the present patent application and which are incorporated herein by 2 5 reference, describe a system that generates six-dimensional position and orientation information regarding the tip of a catheter. This system uses a plurality of sensor coils adjacent to a locatable site in the catheter, for example near its distal end, and a plurality of radiator coils fixed in an external reference frame. These coils generate signals in response to magnetic fields generated by the radiator coils, which signals 3 0 allow for the computation of six position and orientation dimensions, so that the position and orientation of the catheter are known without the need for imaging the catheter.
c The following patents. which are incorporated herein by reference, may be of interest:
US Patent 6,348,062. entitled, "Vasculax device having one or more articulation regions and methods of use"
US Patent 6,332,880, entitled, °'Loop structures for supporting multiple electrode elements"
US Patent 6,332,881, entitled, "Surgical ablation tool"
US Patent 6,308,093, entitled, "Method and apparatus far guiding ablative therapy of abnormal biological electrical excitation"
1 o US Patent 6,290,699, entitled, "Ablation tool for forming lesions in body tissue"
US Patent 6,264,654, entitled, "Ablation catheter"
US Patent 6,235,025, entitled, "Process and device fox the treatment of atrial arrhythmia"
US Patent 6,217,528, entitled, "Loop structure having improved tissue contact capability"
US Patent 6,068,629, entitled, "System and methods far tissue mapping and ablation"
US Patent 5,931,835, entitled, "Radio frequency energy delivery system for 2 o multipolar electrode catheters"
US Patent 5,916,213. entitled, "Systems and methods for tissue mapping and ablation"
US Patent 5,239,999. entitled, "Helical endocardial catheter probe"
US Patent 4,940,064, entitled, "Catheter for mapping and ablation and method therefore"
4 G
SU'~2R'lARY OF THE Il~'~'ENTlOI~' It is an object of some aspects of the present invention to provide apparatus and methods to increase the accuracy with which electrophysiological properties of the heart are mapped.
It is also an object of some aspects of the present invention to provide apparatus and methods for positioning operative elements, such as ablation electrodes, within a pulmonary vein (PV).
It is a further object of some aspects of the present invention to provide improved apparatus and methods for real-time, accurate, simultaneous ~deterrnination 1 o of the location of a plurality of electrophysiological sensing elements mounted on an intracardiac catheter.
It is yet a further object of some aspects of the present invention to provide apparatus and methods far reducing the time required for mapping electrophysiologicaI properties of the heart.
It is still a further object of some aspects of the present invention to provide apparatus and methods for intracardiac mapping which can readily be integrated into existing mapping support systems and methods, in order to increase the accuracy of these systems and methods.
In preferred embodiments of the present invention, apparatus for 2 o circumferentially mapping a pulmonary vein (PV) comprises .a catheter that includes a curved section of a known fixed length, preferably shaped to generally conform to the shape of the interior surface of the PV. The curved section comprises one or more sensing electrodes, and its proximal end is joined at a fixed or generally known angle to a base section of the catheter, or at an angle whose range is limited.
Preferably, at least one single-coil five-dimensional position sensors is fixed to the curved section of the catheter. Most preferably, two single-coil five-dimensional position sensors are fixed to the curved section, one at the distal end and one approximately at the center of the curve. A mufti-coil six-dimensional position sensor is preferably fixed to the distal end of the base section, proximate to the joint with the curved section. The 3 o catheter is inserted into the heart, and the curved section is positioned in essentially continuous contact with the wall of the PV, while the base section remains within the
SU'~2R'lARY OF THE Il~'~'ENTlOI~' It is an object of some aspects of the present invention to provide apparatus and methods to increase the accuracy with which electrophysiological properties of the heart are mapped.
It is also an object of some aspects of the present invention to provide apparatus and methods for positioning operative elements, such as ablation electrodes, within a pulmonary vein (PV).
It is a further object of some aspects of the present invention to provide improved apparatus and methods for real-time, accurate, simultaneous ~deterrnination 1 o of the location of a plurality of electrophysiological sensing elements mounted on an intracardiac catheter.
It is yet a further object of some aspects of the present invention to provide apparatus and methods far reducing the time required for mapping electrophysiologicaI properties of the heart.
It is still a further object of some aspects of the present invention to provide apparatus and methods for intracardiac mapping which can readily be integrated into existing mapping support systems and methods, in order to increase the accuracy of these systems and methods.
In preferred embodiments of the present invention, apparatus for 2 o circumferentially mapping a pulmonary vein (PV) comprises .a catheter that includes a curved section of a known fixed length, preferably shaped to generally conform to the shape of the interior surface of the PV. The curved section comprises one or more sensing electrodes, and its proximal end is joined at a fixed or generally known angle to a base section of the catheter, or at an angle whose range is limited.
Preferably, at least one single-coil five-dimensional position sensors is fixed to the curved section of the catheter. Most preferably, two single-coil five-dimensional position sensors are fixed to the curved section, one at the distal end and one approximately at the center of the curve. A mufti-coil six-dimensional position sensor is preferably fixed to the distal end of the base section, proximate to the joint with the curved section. The 3 o catheter is inserted into the heart, and the curved section is positioned in essentially continuous contact with the wall of the PV, while the base section remains within the
5 E
Left atrium, typically positioned such that the joint with the curved section is at the ostium of the vein. The information generated by the three position sensors is used to calculate the locations and orientations of the sensing electrodes, which enables mapping of the surface of the PV.
Advantageously, the single-coil position sensors, which are generally substantially smaller than the mufti-coi3 position sensor, are fixed to the curved section, which preferably is relatively small in order to be readily placed in the PV.
The larger rnulti-coil position sensor is fixed to the base section, which can be relatively large because it remains within the atrium. Six-dimensional information from the mufti-coil position sensor, combined with the generally known angle of the joint and predetermined flexing behavior of the curved section, compensates for the more limited information from the single-coil position sensors. The resulting accurate position information for the sensing electrodes enables high-resolution electrophysiological mapping of the PV and accurate location of regions of abnormal electrical behavior.
In some preferred embodiments of the present invention, upon completion of electrophysiological mapping, the mapping catheter is removed from the heart.
Responsive to the measured PV potentials, target tissue is selected fox ablation in order to treat the arrhythmia. The target tissue is ablated using methods and apparatus 2 0 known in the art, such as those described in the references cited hereinabove.
Optionally, the mapping catheter is reinserted into the PV after the completion of ablation, in order to confirm that the ablation has terminated signals causing arrhythmia, such as by achieving bi~-directional block.
Alternatively, in some preferred embodiments of the present invention, the 2 5 sensing electrodes on the mapping catheter are adapted to additionally perform ablation of selected sites, or the mapping catheter further comprises ablation elements, thereby eliminating the need for separate ablation apparatus.
Preferably, the termination of the abnormal electrical activity is confirmed using the sensing electrodes prior to removal ofthe mapping catheter.
Left atrium, typically positioned such that the joint with the curved section is at the ostium of the vein. The information generated by the three position sensors is used to calculate the locations and orientations of the sensing electrodes, which enables mapping of the surface of the PV.
Advantageously, the single-coil position sensors, which are generally substantially smaller than the mufti-coi3 position sensor, are fixed to the curved section, which preferably is relatively small in order to be readily placed in the PV.
The larger rnulti-coil position sensor is fixed to the base section, which can be relatively large because it remains within the atrium. Six-dimensional information from the mufti-coil position sensor, combined with the generally known angle of the joint and predetermined flexing behavior of the curved section, compensates for the more limited information from the single-coil position sensors. The resulting accurate position information for the sensing electrodes enables high-resolution electrophysiological mapping of the PV and accurate location of regions of abnormal electrical behavior.
In some preferred embodiments of the present invention, upon completion of electrophysiological mapping, the mapping catheter is removed from the heart.
Responsive to the measured PV potentials, target tissue is selected fox ablation in order to treat the arrhythmia. The target tissue is ablated using methods and apparatus 2 0 known in the art, such as those described in the references cited hereinabove.
Optionally, the mapping catheter is reinserted into the PV after the completion of ablation, in order to confirm that the ablation has terminated signals causing arrhythmia, such as by achieving bi~-directional block.
Alternatively, in some preferred embodiments of the present invention, the 2 5 sensing electrodes on the mapping catheter are adapted to additionally perform ablation of selected sites, or the mapping catheter further comprises ablation elements, thereby eliminating the need for separate ablation apparatus.
Preferably, the termination of the abnormal electrical activity is confirmed using the sensing electrodes prior to removal ofthe mapping catheter.
6 There is therefore provided, in accordance with an embodiment of the present invention, apparatus for eiectricaI mapping of a pulmonary vein of a heart, including a catheter, which includes:
a curved section including a single-coil position sensor, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
and a base section having a distal end attached to a proximal end of the curved section, the base section including a mufti-coil position sensor within 3 mm of the distal end thereof.
The mufti-coil position sensor is typically positioned within 1 rnm of the distal end of the base section.
For some applications, the curved section includes a material that is flexible, and maintains a substantially fixed length of the curved section. In an embodiment, the curved section has an elasticity that is generally constant over at least a quarter of the curved section.
In an embodiment, the mufti-coil position sensor includes exactly two coils.
Alternatively, the mufti-coil position sensor includes exactly three coils.
For some applications, the catheter includes one or more ablation elements.
Alternatively or additionally, at least one of the electrodes is adapted to perform ablation.
2 0 In an embodiment, the single-coil position sensor is positioned in a vicinity of a distal end of the curved section. Alternatively or additionally, the curved section includes a center single-coil position sensor in a vicinity of a center thereof.
The curved section is typically shaped to generally conform to a shape of an interior surface of the pulmonary vein.
2 5 For some applications. the apparatus includes a processor, adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes, responsive to respective position signals generated by the single-coil and mufti-coil position sensors. Alternatively or additionally, the apparatus includes a processor, adapted to generate an electrophysiological map of the pulmonary vein
a curved section including a single-coil position sensor, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
and a base section having a distal end attached to a proximal end of the curved section, the base section including a mufti-coil position sensor within 3 mm of the distal end thereof.
The mufti-coil position sensor is typically positioned within 1 rnm of the distal end of the base section.
For some applications, the curved section includes a material that is flexible, and maintains a substantially fixed length of the curved section. In an embodiment, the curved section has an elasticity that is generally constant over at least a quarter of the curved section.
In an embodiment, the mufti-coil position sensor includes exactly two coils.
Alternatively, the mufti-coil position sensor includes exactly three coils.
For some applications, the catheter includes one or more ablation elements.
Alternatively or additionally, at least one of the electrodes is adapted to perform ablation.
2 0 In an embodiment, the single-coil position sensor is positioned in a vicinity of a distal end of the curved section. Alternatively or additionally, the curved section includes a center single-coil position sensor in a vicinity of a center thereof.
The curved section is typically shaped to generally conform to a shape of an interior surface of the pulmonary vein.
2 5 For some applications. the apparatus includes a processor, adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes, responsive to respective position signals generated by the single-coil and mufti-coil position sensors. Alternatively or additionally, the apparatus includes a processor, adapted to generate an electrophysiological map of the pulmonary vein
7 responsive to respective position signals generated by the single-coil and mufti-coil position sensors. and responsive to the electrical property.
In an embodiment, the mufti-coil position sensor includes two or more non-concentric coils. In this case, the two or more non-concentric coils are typically arranged so as to be mutually orthogonal.
There is further provided, in accordance with an embodiment of the present invention, apparatus for electrical mapping of a pulmonary vein of a heart, including a catheter, which includes:
a curved section including a first position sensor, capable of generating fewer 1 o than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of tire pulmonary v;,in;
anu a base section having a distal end attached to a proximal end of the curved section, the base section including, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
In an embodiment. the first position sensor is capable of generating exactly five dimensions of position and orientation information.
There is yet further provided, in accordance with an embodiment of the present invention, apparatus for electrical mapping of a pulmonary vein of a heart, 2 0 including a catheter, which includes:
a curved section including a first position sensor in a vicinity of the distal end, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
2 5 a base section having a distal end attached to a proximal end of the curved section, the base section including, within 3 mrn of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information; and a processor, adapted to generate an electrophysiological map of the pulmonary 3 0 vein responsive to respective position signals generated by the first and second position sensors, and responsive to the electrical property.
In an embodiment, the mufti-coil position sensor includes two or more non-concentric coils. In this case, the two or more non-concentric coils are typically arranged so as to be mutually orthogonal.
There is further provided, in accordance with an embodiment of the present invention, apparatus for electrical mapping of a pulmonary vein of a heart, including a catheter, which includes:
a curved section including a first position sensor, capable of generating fewer 1 o than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of tire pulmonary v;,in;
anu a base section having a distal end attached to a proximal end of the curved section, the base section including, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
In an embodiment. the first position sensor is capable of generating exactly five dimensions of position and orientation information.
There is yet further provided, in accordance with an embodiment of the present invention, apparatus for electrical mapping of a pulmonary vein of a heart, 2 0 including a catheter, which includes:
a curved section including a first position sensor in a vicinity of the distal end, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
2 5 a base section having a distal end attached to a proximal end of the curved section, the base section including, within 3 mrn of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information; and a processor, adapted to generate an electrophysiological map of the pulmonary 3 0 vein responsive to respective position signals generated by the first and second position sensors, and responsive to the electrical property.
8 G
In an embodiment, the processor is adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes.
responsive to the respective position signals.
There is still further provided, in accordance with an embodiment of the present invention, apparatus for electrical mapping of a chamber of a body of a subject, including a catheter, which includes:
a curved section including a first position sensor, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the chamber; and 1 o a base section having a distal end attached to a proximal end of the curved section, the base section including, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
There is also provided, in accordance with an embodiment of the present invention, a method for electrical mapping of a pulmonary vein of a heart, including:
introducing into the heart a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having 2 0 fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the pulmonary vein.
Typically, the method includes generating an electrophysiological map of the pulmonary vein responsive to the first position signal, the second position signal, and the electrical property. Alternatively or additionally, ablating the tissue includes determining a location of an electrical abnormality in the tissue responsive to the first position signal, the second position signal, and the electr7cal property, and ablating 3 C the tissue substantially at the location.
In an embodiment, the processor is adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes.
responsive to the respective position signals.
There is still further provided, in accordance with an embodiment of the present invention, apparatus for electrical mapping of a chamber of a body of a subject, including a catheter, which includes:
a curved section including a first position sensor, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the chamber; and 1 o a base section having a distal end attached to a proximal end of the curved section, the base section including, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
There is also provided, in accordance with an embodiment of the present invention, a method for electrical mapping of a pulmonary vein of a heart, including:
introducing into the heart a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having 2 0 fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the pulmonary vein.
Typically, the method includes generating an electrophysiological map of the pulmonary vein responsive to the first position signal, the second position signal, and the electrical property. Alternatively or additionally, ablating the tissue includes determining a location of an electrical abnormality in the tissue responsive to the first position signal, the second position signal, and the electr7cal property, and ablating 3 C the tissue substantially at the location.
9 In an embodiment. introducing the catheter into the heart includes positioning the curved section within the pulmonary vein. In this case, positioning the curved section within the pulmonary vein typically includes positioning the base section within a left atrium of the heart. Additionally, positioning the curved section within 5 the pulmonary vein typically includes generally maintaining a point of attachment of the curved and base sections in a vicinity of an ostium of the pulmonary vein while mapping the pulmonary vein.
There is still further provided, in accordance with an embodiment of the present invention, a method for electrical mapping of a chamber of a body of a 1~ subject, including:
introducing into the chamber a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the chamber.
2 o The present invention will be more fully understood from the following detailed description of the preferred embodiments thereof, taken together with the drawing. in which:
li BRIEF DESCRIPTION OF THE DRAWING
Fig. 1 is a schematic, pictorial illustration of a mapping system, for mapping of electrical activity in a pulmonary vein, in accordance with a preferred embodiment of the present invention;
Fig. 2 is a simplified pictorial representation of a cardiac diagnostic and therapeutic system, in accordance with a preferred embodiment of the present invention; and Fig. 3 is a schematic, sectional illustration of a portion of a left atrium of the heart, showing the distal portion of the catheter of Fig. 2 partially inserted into a pulmonary vein, in accordance with a preferred embodiment of the present invention.
l~
DETAILED DESCRIPTION' 4F PREFERRED EMI3rJDIMEN'TS
Fig. I is a schematic, pictorial illustration of a mapping system 18, for mapping of electrical activity in a pulmonary vein of a heart 44 of a subject 46, in accordance with a preferred embodiment of the present invention. System 18 comprises a catheter 20, which is inserted by a user 42 through a vein or artery of the subject into a pulmonary vein of the heart. Preferably, system 18 further comprises a console 43.
Fig. 2 is a schematic, pictorial illustration showing a distal portion of catheter 20, for facilitating accurate electrophysiological mapping of a pulmonary vein (PV) in order to enable therapeutic ablation. Catheter 20 comprises a curved section joined at a generally known or range-restricted angle alpha to a base section 24, at a joint 36. Joint 36 may define the point where two initially-separate members (sections 22 and 24) are joined, or, alternatively, the joint may define the point on catheter 20 where a single member is bent, so as to form base section 24 and curved 1 ~ section 22. Curved section 22 is of a known fixed length, and comprises material that preferably is twistable but not stretchable when subjected to typical forces.
Preferably, curved section 22 is sufficiently resilient so as to assume a predetermined, curved form, when no force is applied thereto, and to be deflected from the predetermined curved form when a force is applied thereto. Preferably, curved section 22 has an elasticity that is generally constant over at least a portion of its length, for example, because of internal reinforcement of the curved section with a resilient longitudinal member, as is known in the art. One or more sensing electrodes 26, adapted for sensing electrical characteristics of PV tissue, are fixed to curved section 22.
2 5 Preferably, at least one single-coil position sensor 30 is fixed to curved section 22. Most preferably, a first single-coil position sensor 30 is fixed to the distal end of curved section 22 (distal with respect to base section 24), and a second single-coil position sensor 30 is fixed to the approximate center of curved section 22.
Optionally, one or more additional single-coil position sensors 30 are fixed to curved 3 0 section 22. Additionally, a multi-coil position sensor 32 is preferably fixed near the distal end of base section 24, in the vicinity of joint 36. Mufti-coil position sensor 32 is preferably able to generate six position and orientation dimensions, using 1_ techniques described in the above-cited PCT Patent Publication to Ben-Haim et al., or other techniques known in the art. lvlulti-coil position sensor 32 preferably comprises two or three coils, which are generally sufficient for generating six dimensions of position information. Single-coil position sensor 30 is preferably able to generate five position and orientation dimensions. A preferred electromagnetic mapping sensor is manufactured by Biosense Webster (Israel) Ltd.. (That Hacarmel, Israel) and marketed under the trade designation NOGATM. Alternatively, single-coil and multi coil positions sensors 30 and 32 comprise field sensors other than coils, such as Hall effect devices or other antennae, in which case position sensors 30 are preferably smaller than position sensor 32.
Position sensors 30 and 32 are fixed to catheter 20 by any suitable method, for example, using polyurethane glue or the like. The position sensors are electrically connected to an electromagnetic sensor cable (not shown), which extends through the catheter body and into a control handle of the catheter. The electromagnetic sensor cable preferably comprises multiple wires encased within a plastic covered sheath.
Within the catheter body, the sensor cable may be enclosed within a protective sheath along with lead wires of sensing electrodes 26, if desired. Preferably, in the control handle, the wires of the sensor cable are connected to a circuit board (not shown), which amplifies the signals received from the position sensors and transmits 2 o them to a computer housed in console 43 (Fig. 1 ), in a form understandable to the computer. Alternatively, amplifying circuitry is included at the distal end of catheter 20, so as to reduce the effect of noise.
Reference is again made to Fig. 1. In a prefer-ed embodiment of the present invention, to use position sensors 30 and 32, the subject is placed in a magnetic field 2 S generated, for example, by situating under the subject a pad containing field generator coils 48 for generating a magnetic field. A reference electromagnetic sensor (not shown) is preferably fixed relative to the subject. e.g., taped to the subject°s back, and catheter 20 containing the position sensors is advanced into the subject's heart and into one of the pulmonary veins. The coils in the position sensors generate weak 3 0 electrical signals indicative of their position in the magnetic field.
Signals generated by both the fixed reference sensor and position sensors in the heart are amplified and transmitted to console 43, which analyzes the signals so as to facilitate the ,G
determination and visual display of the precise location of position sensors 30 and 32 relative to the reference sensor.
Each of position sensors 30 preferably comprises one coil, and position sensor 32 preferably comprises three non-concentric, typically mutually-orthogonal coils, such as those described in the above-cited PCT Patent Publication WO 96/05768.
The coils sense magnetic fields generated by field generator coils 48, which are driven by driver circuits 45 (Fig. 1 ). Alternatively, the sensors may generate fields, which are detected by coils 48. System 18 thus achieves continuous generation of five dimensions of position and orientation information with respect to each of position sensors 30, and six dimensions with respect to position sensor 32.
As noted above, catheter 20 is coupled to console 43, 'which enables the user to observe and regulate the functions of the catheter. Console 34 includes a processor, preferably a computer with appropriate signal processing circuits.
The processor is coupled to drive a monitor 47. The signal processing circuits typically receive, amplify, fiber and digitize signals from catheter 20, including signals generated by position sensors 30 and 32 and sensing electrodes 26. The digitized signals are received and used by the console to compute the position and orientation of the catheter and to analyze the electrical signals from the electrodes. The information derived from this analysis is used to generate an electrophysiological map 49 of a pulmonary vein (PV) of the subject, typically in order to facilitate therapeutic ablation.
'Typically, system 18 includes other elements, which are not shown in the figures for the sake of simplicity. For example, system 18 may include an ECG
monitor, coupled to receive signals from one or more body surface electrodes, so as io provide an ECG synchronization signal to console 43. As mentioned above, the system typically also includes a reference position sensor, either on an externally-applied reference patch attached to the exterior of the subject's body, or on an internally-placed catheter, which is inserted into heart 44 and maintained in a fixed position relative to the heart. By comparing the position of catheter 20 to that of the 3 0 reference catheter, the coordinates of catheter 20 are accurately determined relative to the heart, irrespective of heart motion. Alternatively, any other suitable method may be used to compensate for heart motion.
7. 4 i C
Fig. 3 is a schematic, sectional illustration of a portion of a left atrium 50 of heart 44, showing the distal portion of catheter 20 partially inserted into a pulmonary vein 52, in accordance with a preferred embodiment of the present invention.
During a procedure, catheter 20 is advanced into Left atrium 50, and ioint 36 is placed at or near an ostium 52 of PV 52 so that curved section 22 is within the PV and in substantially continuous contact with the tissue of the wall of the PV. The computer housed in console 43 determines the five-dimensional dispositions of single-coil position sensors 30, and the six-dimensional disposition of mufti-coil position sensor 32. Using these determined positions, the generally known measurement of angle alpha, the Length of curved section 22, and the generally known flexing behavior of curved section 22, control unit 40 preferably calculates the six-dimensional position and angle coordinates of sensing electrodes 26. Alternatively, other calculation techniques, as will be evident to one skilled in the art having read this application, are used.
Typically, the positions of sensing electrodes 26 and the electrical data measured by sensing electrodes 26 are used in combination to determine the location of electrical abnormalities in PV tissue, and to select target tissue to which ablation can be usefully and accurately applied in order to create non-conducting lesions so as to interrupt the inappropriate conduction pathways, and/or to terminate the electrical 2 0 abnormalities. In a preferred embodiment of the present invention, catheter 20 is removed upon the completion of electrophysiological mapping, and the target tissue is ablated using methods and apparatus known in the art, such as those described in one or more of the references cited hereinabove. Alternatively, a catheter similar to catheter 20, but comprising ablation elements instead of sensing electrodes, is used to perform this ablation. Qptionally, catheter 20 is reinserted into the PV after the completion of ablation, in order to confnn that the ablation has blocked or terminated the signals causing arrhythmia.
Alternatively or additionally, sensing electrodes 26 are adapted to additionally perform ablation, or catheter 20 further comprises ablation elements 28 fixed thereto.
3 0 thereby generally eliminating the need for insertion of dedicated ablation apparatus.
Ablation elements 28 are preferably electrodes that perform ablation using radiofrequency energy. Alternatively, ablation elements 28 perform ablation by applying other local treatments, such as by applying ultrasound or laser energy, or by applying a cryogenic treatment. Preferably, each element adapted to perform ablation (whether a sensing electrode 26 or an ablation element 28) has an associated temperature sensor incorporated therein or separate therefrom, for sensing temperature at the surface where ablation is being performed. Control unit 40 preferably uses the sensed temperatures to regulate the supplied energy, and thereby generally maintain the ablation temperature at a desired level. Preferably, the blocking or termination of the abnormal electrical activity is confirmed using sensing electrodes 26 prior to removal of catheter 20.
In a preferred embodiment, ablation elements 2$ and sensing electrodes 26 are preferably attached to catheter 20 and operative, muratis mutandis, in accordance with one of the arrangements described in European Patent Application EP 1 125 549 and corresponding US Patent Application 09/506,766 to Ben-Haim et al., which are assigned to the assignee of the present application and which are incorporated herein by reference. Alternatively or additionally, the electrodes may comprise ring electrodes, or substantially any other suitable type of surface electrodes, as are known in the art.
In a preferred embodiment of the present invention, apparatus for accurately mapping electrophysiological characteristics of the heart comprises a Biosense 2 o Webster LASSO Circular Mapping Catheter. Typically, in this embodiment, 10 sensing electrodes are located on the curved and flexible distal section of the catheter, one single-coil five-dimensional location sensor is located on the distal end of the distal section, and one single-coil five-dimensional location sensor is located at the proximal end or near the center of the distal section. The three-coil six-dimensional 2 5 location sensor is placed on the base section proximate to the point of connection with the complexly curved proximal section.
Advantageously, position sensors 30, which are generally substantially smaller than position sensor 32, are fixed to curved section 22, which preferably is relatively small in order to be readily placed in the PV. Larger position sensor 32 is 3 0 fixed to base section 24, which can be relatively large because it remains within the atrium. Six-dimensional information from position sensor 32, combined with the generally known angle of joint 36 and predetermined flexing behavior of curved 1 %
section 22; compensates for the more limited information from position sensors 30.
The resulting accurate position information for sensing electrodes 26 enables high-resolution electrophysioIogical mapping of the PV and accurate location of regions of abnormal electrical behavior.
It is to be understood that whereas preferred embodiments of the present invention are generally described hereinabove with respect to accurately mapping the electrical characteristics of pulmonary veins, the scope of the present invention includes applying analogous techniques to other areas of the body wherein accurate mapping of particular characteristics can be useful in enabling therapeutic techniques.
It will be appreciated by persons skilled in the ari 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 that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
There is still further provided, in accordance with an embodiment of the present invention, a method for electrical mapping of a chamber of a body of a 1~ subject, including:
introducing into the chamber a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the chamber.
2 o The present invention will be more fully understood from the following detailed description of the preferred embodiments thereof, taken together with the drawing. in which:
li BRIEF DESCRIPTION OF THE DRAWING
Fig. 1 is a schematic, pictorial illustration of a mapping system, for mapping of electrical activity in a pulmonary vein, in accordance with a preferred embodiment of the present invention;
Fig. 2 is a simplified pictorial representation of a cardiac diagnostic and therapeutic system, in accordance with a preferred embodiment of the present invention; and Fig. 3 is a schematic, sectional illustration of a portion of a left atrium of the heart, showing the distal portion of the catheter of Fig. 2 partially inserted into a pulmonary vein, in accordance with a preferred embodiment of the present invention.
l~
DETAILED DESCRIPTION' 4F PREFERRED EMI3rJDIMEN'TS
Fig. I is a schematic, pictorial illustration of a mapping system 18, for mapping of electrical activity in a pulmonary vein of a heart 44 of a subject 46, in accordance with a preferred embodiment of the present invention. System 18 comprises a catheter 20, which is inserted by a user 42 through a vein or artery of the subject into a pulmonary vein of the heart. Preferably, system 18 further comprises a console 43.
Fig. 2 is a schematic, pictorial illustration showing a distal portion of catheter 20, for facilitating accurate electrophysiological mapping of a pulmonary vein (PV) in order to enable therapeutic ablation. Catheter 20 comprises a curved section joined at a generally known or range-restricted angle alpha to a base section 24, at a joint 36. Joint 36 may define the point where two initially-separate members (sections 22 and 24) are joined, or, alternatively, the joint may define the point on catheter 20 where a single member is bent, so as to form base section 24 and curved 1 ~ section 22. Curved section 22 is of a known fixed length, and comprises material that preferably is twistable but not stretchable when subjected to typical forces.
Preferably, curved section 22 is sufficiently resilient so as to assume a predetermined, curved form, when no force is applied thereto, and to be deflected from the predetermined curved form when a force is applied thereto. Preferably, curved section 22 has an elasticity that is generally constant over at least a portion of its length, for example, because of internal reinforcement of the curved section with a resilient longitudinal member, as is known in the art. One or more sensing electrodes 26, adapted for sensing electrical characteristics of PV tissue, are fixed to curved section 22.
2 5 Preferably, at least one single-coil position sensor 30 is fixed to curved section 22. Most preferably, a first single-coil position sensor 30 is fixed to the distal end of curved section 22 (distal with respect to base section 24), and a second single-coil position sensor 30 is fixed to the approximate center of curved section 22.
Optionally, one or more additional single-coil position sensors 30 are fixed to curved 3 0 section 22. Additionally, a multi-coil position sensor 32 is preferably fixed near the distal end of base section 24, in the vicinity of joint 36. Mufti-coil position sensor 32 is preferably able to generate six position and orientation dimensions, using 1_ techniques described in the above-cited PCT Patent Publication to Ben-Haim et al., or other techniques known in the art. lvlulti-coil position sensor 32 preferably comprises two or three coils, which are generally sufficient for generating six dimensions of position information. Single-coil position sensor 30 is preferably able to generate five position and orientation dimensions. A preferred electromagnetic mapping sensor is manufactured by Biosense Webster (Israel) Ltd.. (That Hacarmel, Israel) and marketed under the trade designation NOGATM. Alternatively, single-coil and multi coil positions sensors 30 and 32 comprise field sensors other than coils, such as Hall effect devices or other antennae, in which case position sensors 30 are preferably smaller than position sensor 32.
Position sensors 30 and 32 are fixed to catheter 20 by any suitable method, for example, using polyurethane glue or the like. The position sensors are electrically connected to an electromagnetic sensor cable (not shown), which extends through the catheter body and into a control handle of the catheter. The electromagnetic sensor cable preferably comprises multiple wires encased within a plastic covered sheath.
Within the catheter body, the sensor cable may be enclosed within a protective sheath along with lead wires of sensing electrodes 26, if desired. Preferably, in the control handle, the wires of the sensor cable are connected to a circuit board (not shown), which amplifies the signals received from the position sensors and transmits 2 o them to a computer housed in console 43 (Fig. 1 ), in a form understandable to the computer. Alternatively, amplifying circuitry is included at the distal end of catheter 20, so as to reduce the effect of noise.
Reference is again made to Fig. 1. In a prefer-ed embodiment of the present invention, to use position sensors 30 and 32, the subject is placed in a magnetic field 2 S generated, for example, by situating under the subject a pad containing field generator coils 48 for generating a magnetic field. A reference electromagnetic sensor (not shown) is preferably fixed relative to the subject. e.g., taped to the subject°s back, and catheter 20 containing the position sensors is advanced into the subject's heart and into one of the pulmonary veins. The coils in the position sensors generate weak 3 0 electrical signals indicative of their position in the magnetic field.
Signals generated by both the fixed reference sensor and position sensors in the heart are amplified and transmitted to console 43, which analyzes the signals so as to facilitate the ,G
determination and visual display of the precise location of position sensors 30 and 32 relative to the reference sensor.
Each of position sensors 30 preferably comprises one coil, and position sensor 32 preferably comprises three non-concentric, typically mutually-orthogonal coils, such as those described in the above-cited PCT Patent Publication WO 96/05768.
The coils sense magnetic fields generated by field generator coils 48, which are driven by driver circuits 45 (Fig. 1 ). Alternatively, the sensors may generate fields, which are detected by coils 48. System 18 thus achieves continuous generation of five dimensions of position and orientation information with respect to each of position sensors 30, and six dimensions with respect to position sensor 32.
As noted above, catheter 20 is coupled to console 43, 'which enables the user to observe and regulate the functions of the catheter. Console 34 includes a processor, preferably a computer with appropriate signal processing circuits.
The processor is coupled to drive a monitor 47. The signal processing circuits typically receive, amplify, fiber and digitize signals from catheter 20, including signals generated by position sensors 30 and 32 and sensing electrodes 26. The digitized signals are received and used by the console to compute the position and orientation of the catheter and to analyze the electrical signals from the electrodes. The information derived from this analysis is used to generate an electrophysiological map 49 of a pulmonary vein (PV) of the subject, typically in order to facilitate therapeutic ablation.
'Typically, system 18 includes other elements, which are not shown in the figures for the sake of simplicity. For example, system 18 may include an ECG
monitor, coupled to receive signals from one or more body surface electrodes, so as io provide an ECG synchronization signal to console 43. As mentioned above, the system typically also includes a reference position sensor, either on an externally-applied reference patch attached to the exterior of the subject's body, or on an internally-placed catheter, which is inserted into heart 44 and maintained in a fixed position relative to the heart. By comparing the position of catheter 20 to that of the 3 0 reference catheter, the coordinates of catheter 20 are accurately determined relative to the heart, irrespective of heart motion. Alternatively, any other suitable method may be used to compensate for heart motion.
7. 4 i C
Fig. 3 is a schematic, sectional illustration of a portion of a left atrium 50 of heart 44, showing the distal portion of catheter 20 partially inserted into a pulmonary vein 52, in accordance with a preferred embodiment of the present invention.
During a procedure, catheter 20 is advanced into Left atrium 50, and ioint 36 is placed at or near an ostium 52 of PV 52 so that curved section 22 is within the PV and in substantially continuous contact with the tissue of the wall of the PV. The computer housed in console 43 determines the five-dimensional dispositions of single-coil position sensors 30, and the six-dimensional disposition of mufti-coil position sensor 32. Using these determined positions, the generally known measurement of angle alpha, the Length of curved section 22, and the generally known flexing behavior of curved section 22, control unit 40 preferably calculates the six-dimensional position and angle coordinates of sensing electrodes 26. Alternatively, other calculation techniques, as will be evident to one skilled in the art having read this application, are used.
Typically, the positions of sensing electrodes 26 and the electrical data measured by sensing electrodes 26 are used in combination to determine the location of electrical abnormalities in PV tissue, and to select target tissue to which ablation can be usefully and accurately applied in order to create non-conducting lesions so as to interrupt the inappropriate conduction pathways, and/or to terminate the electrical 2 0 abnormalities. In a preferred embodiment of the present invention, catheter 20 is removed upon the completion of electrophysiological mapping, and the target tissue is ablated using methods and apparatus known in the art, such as those described in one or more of the references cited hereinabove. Alternatively, a catheter similar to catheter 20, but comprising ablation elements instead of sensing electrodes, is used to perform this ablation. Qptionally, catheter 20 is reinserted into the PV after the completion of ablation, in order to confnn that the ablation has blocked or terminated the signals causing arrhythmia.
Alternatively or additionally, sensing electrodes 26 are adapted to additionally perform ablation, or catheter 20 further comprises ablation elements 28 fixed thereto.
3 0 thereby generally eliminating the need for insertion of dedicated ablation apparatus.
Ablation elements 28 are preferably electrodes that perform ablation using radiofrequency energy. Alternatively, ablation elements 28 perform ablation by applying other local treatments, such as by applying ultrasound or laser energy, or by applying a cryogenic treatment. Preferably, each element adapted to perform ablation (whether a sensing electrode 26 or an ablation element 28) has an associated temperature sensor incorporated therein or separate therefrom, for sensing temperature at the surface where ablation is being performed. Control unit 40 preferably uses the sensed temperatures to regulate the supplied energy, and thereby generally maintain the ablation temperature at a desired level. Preferably, the blocking or termination of the abnormal electrical activity is confirmed using sensing electrodes 26 prior to removal of catheter 20.
In a preferred embodiment, ablation elements 2$ and sensing electrodes 26 are preferably attached to catheter 20 and operative, muratis mutandis, in accordance with one of the arrangements described in European Patent Application EP 1 125 549 and corresponding US Patent Application 09/506,766 to Ben-Haim et al., which are assigned to the assignee of the present application and which are incorporated herein by reference. Alternatively or additionally, the electrodes may comprise ring electrodes, or substantially any other suitable type of surface electrodes, as are known in the art.
In a preferred embodiment of the present invention, apparatus for accurately mapping electrophysiological characteristics of the heart comprises a Biosense 2 o Webster LASSO Circular Mapping Catheter. Typically, in this embodiment, 10 sensing electrodes are located on the curved and flexible distal section of the catheter, one single-coil five-dimensional location sensor is located on the distal end of the distal section, and one single-coil five-dimensional location sensor is located at the proximal end or near the center of the distal section. The three-coil six-dimensional 2 5 location sensor is placed on the base section proximate to the point of connection with the complexly curved proximal section.
Advantageously, position sensors 30, which are generally substantially smaller than position sensor 32, are fixed to curved section 22, which preferably is relatively small in order to be readily placed in the PV. Larger position sensor 32 is 3 0 fixed to base section 24, which can be relatively large because it remains within the atrium. Six-dimensional information from position sensor 32, combined with the generally known angle of joint 36 and predetermined flexing behavior of curved 1 %
section 22; compensates for the more limited information from position sensors 30.
The resulting accurate position information for sensing electrodes 26 enables high-resolution electrophysioIogical mapping of the PV and accurate location of regions of abnormal electrical behavior.
It is to be understood that whereas preferred embodiments of the present invention are generally described hereinabove with respect to accurately mapping the electrical characteristics of pulmonary veins, the scope of the present invention includes applying analogous techniques to other areas of the body wherein accurate mapping of particular characteristics can be useful in enabling therapeutic techniques.
It will be appreciated by persons skilled in the ari 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 that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
Claims (48)
1. Apparatus for electrical mapping of a pulmonary vein of a heart, comprising a catheter, which comprises:
a curved section comprising a single-coil position sensor, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
and a base section having a distal end attached to a proximal end of the curved section, the base section comprising a multi-coil position sensor within 3 mm of the distal end thereof.
a curved section comprising a single-coil position sensor, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
and a base section having a distal end attached to a proximal end of the curved section, the base section comprising a multi-coil position sensor within 3 mm of the distal end thereof.
2. The apparatus according to claim 1, wherein the multi-coil position sensor is positioned within 1 mm of the distal end of the base section.
3. The apparatus according to claim 1, wherein the curved section comprises a material that is flexible, and maintains a substantially fixed length of the curved section.
4. The apparatus according to claim 1, wherein the curved section has an elasticity that is generally constant over at least a quarter of the curved section.
5. The apparatus according to claim 1, wherein the multi-coil position sensor comprises exactly two coils.
6. The apparatus according to claim 1, wherein the multi-coil position sensor comprises exactly three coils.
7. The apparatus according to claim 1. wherein the catheter comprises one or more ablation elements.
8. The apparatus according to claim 1, wherein at least one of the electrodes is adapted to perform ablation.
9. The apparatus according to claim 1, wherein the single-coil position sensor is positioned in a vicinity of a distal end of the curved section.
10. The apparatus according to claim 1, wherein the curved section comprises a center single-coil position sensor in a vicinity of a center thereof.
11. The apparatus according to claim 1, wherein the curved section is shaped to generally conform to a shape of an interior surface of the pulmonary vein.
12. The apparatus according to claim 1, wherein the apparatus comprises a processor, adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes, responsive to respective position signals generated by the single-coil and multi-coil position sensors.
13. The apparatus according to claim 1, wherein the apparatus comprises a processor, adapted to generate an electrophysiological map of the pulmonary vein responsive to respective position signals generated by the single-coil and multi-coil position sensors, and responsive to the electrical property.
14. The apparatus according to claim 1, wherein the multi-coil position sensor comprises two or more non-concentric coils.
35. The apparatus according to claim 14, wherein the two or more non-concentric coils are arranged so as to be mutually orthogonal.
16. Apparatus for electrical mapping of a pulmonary vein of a heart, comprising a catheter, which comprises:
a curved section comprising a first position sensor, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
and a base section having a distal end attached to a proximal end of the curved section, the base section comprising, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
a curved section comprising a first position sensor, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
and a base section having a distal end attached to a proximal end of the curved section, the base section comprising, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
17. The apparatus according to claim 16, wherein the second position sensor is positioned within 1 mm of the distal end of the base section.
18. The apparatus according to claim 16, wherein the curved section comprises a material that is flexible, and maintains a substantially fixed length of the curved section.
19. The apparatus according to claim 16, wherein the curved section has an elasticity that is generally constant over at least a quarter of the curved section.
20. The apparatus according to claim 16, wherein the catheter comprises one or more ablation elements.
21. The apparatus according to claim 16, wherein at least one of the electrodes is adapted to perform ablation.
22. The apparatus according to claim 16, wherein the first position sensor is capable of generating exactly five dimensions of position and orientation information.
23. The apparatus according to claim 16, wherein the first position sensor is positioned in a vicinity of a distal end of the curved section.
24. The apparatus according to claim 16, wherein the curved section comprises a third position sensor in a vicinity of a center thereof, capable of generating fewer than six dimensions of position and orientation information.
25. The apparatus according to claim 16, wherein the curved section is shaped to generally conform to a shape of an interior surface of the pulmonary vein.
26. The apparatus according to claim 16, wherein the apparatus comprises a processor, adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes, responsive to respective position signals generated by the first and second position sensors.
27. The apparatus according to claim 16, wherein the apparatus comprises a processor, adapted to generate an electrophysiological map of the pulmonary vein responsive to respective position signals generated by the first and second position sensors, and responsive to the electrical property.
28. Apparatus for electrical mapping of a pulmonary vein of a heart, comprising a catheter, which comprises;
a curved section comprising a first position sensor in a vicinity of the distal end, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
a base section having a distal end attached to a proximal end of the curved section, the base section comprising, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information; and a processor, adapted to generate an electrophysiological map of the pulmonary vein responsive to respective position signals generated by the first and second position sensors, and responsive to the electrical property.
a curved section comprising a first position sensor in a vicinity of the distal end, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the pulmonary vein;
a base section having a distal end attached to a proximal end of the curved section, the base section comprising, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information; and a processor, adapted to generate an electrophysiological map of the pulmonary vein responsive to respective position signals generated by the first and second position sensors, and responsive to the electrical property.
29. The apparatus according to claim 28, wherein the processor is adapted to calculate respective six-dimensional position and orientation coordinates of the one or more electrodes, responsive to the respective position signals.
30. Apparatus for electrical mapping of a chamber of a body of a subject, comprising a catheter, which comprises:
a curved section comprising a first position sensor, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the chamber; and a base section having a distal end attached to a proximal end of the curved section, the base section comprising, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
a curved section comprising a first position sensor, capable of generating fewer than six dimensions of position and orientation information, and one or more electrodes, adapted to measure an electrical property of the chamber; and a base section having a distal end attached to a proximal end of the curved section, the base section comprising, within 3 mm of the distal end thereof, a second position sensor, capable of generating six dimensions of position and orientation information.
31. The apparatus according to claim 30, wherein the first position sensor is positioned in a vicinity of a distal end of the curved section.
32. The apparatus according to claim 30, wherein the curved section comprises a third position sensor in a vicinity of a center thereof, capable of generating fewer than six dimensions of position and orientation information.
33. A method for electrical mapping of a pulmonary vein of a heart, comprising:
introducing into the heart a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the pulmonary vein.
introducing into the heart a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the pulmonary vein.
34. The method according to claim 33. wherein generating the first position signal comprises generating the first position signal having exactly five dimensions of position and orientation information.
35. The method according to claim 33, wherein generating the first position signal comprises generating the first position signal at a vicinity of a distal end of the curved section.
36. The method according to claim 33, comprising generating, at a vicinity of a center of the curved section, a third position signal having fewer than six dimensions of position and orientation information.
37. The method according to claim 33, comprising calculating respective six-dimensional position and orientation coordinates of the one or more locations on the curved section at which the electrical property is measured, responsive to the first and second position signals.
38. The method according to claim 33, comprising generating an electrophysiological map of the pulmonary vein responsive to the first position signal, the second position signal, and the electrical property.
39. The method according to claim 33, wherein generating the second position signal comprises generating the second position signal at a location within 3 mm of the distal end of the base section.
40. The method according to claim 39, wherein generating the second position signal comprises generating the second position signal at a location within 1 mm of the distal end of the base section.
41. The method according to claim 33, comprising ablating tissue of the pulmonary vein responsive to the first position signal, the second position signal, and the electrical property.
42. The method according to claim 41, wherein ablating the tissue comprises determining a location of an electrical abnormality in the tissue responsive to the first position signal, the second position signal, and the electrical property, and ablating the tissue substantially at the location.
43. The method according to claim 33, wherein introducing the catheter into the heart comprises positioning the curved section within the pulmonary vein.
44. The method according to claim 43, wherein positioning the curved section within the pulmonary vein comprises positioning the base section within a left atrium of the heart.
45. The method according to claim 43, wherein positioning the curved section within the pulmonary vein comprises generally maintaining a point of attachment of the curved and base sections in a vicinity of an ostium of the pulmonary vein while mapping the pulmonary vein.
46. A method for electrical mapping of a chamber of a body of a subject, comprising:
introducing into the chamber a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the chamber.
introducing into the chamber a catheter having a curved section and a base section, the base section having a distal end attached to a proximal end of the curved section;
generating, at a location on the curved section, a first position signal having fewer than six dimensions of position and orientation information, and, at a vicinity of the distal end of the base section, a second position signal having six dimensions of position and orientation information; and measuring, at one or more locations on the curved section, an electrical property of the chamber.
47. The method according to claim 46, wherein generating the first position signal comprises generating the first position signal at a vicinity of a distal end of the curved section.
48. The method according to claim 46, comprising generating, at a vicinity of a center of the curved section, a third position signal having fewer than six dimensions of position and orientation information.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US10/629,661 US6973339B2 (en) | 2003-07-29 | 2003-07-29 | Lasso for pulmonary vein mapping and ablation |
| US10/629,661 | 2003-07-29 |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2475919A1 true CA2475919A1 (en) | 2005-01-29 |
| CA2475919C CA2475919C (en) | 2016-07-12 |
Family
ID=33541482
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA2475919A Expired - Fee Related CA2475919C (en) | 2003-07-29 | 2004-07-29 | Lasso for pulmonary vein mapping and ablation |
Country Status (7)
| Country | Link |
|---|---|
| US (1) | US6973339B2 (en) |
| EP (2) | EP1502555B1 (en) |
| JP (1) | JP4975243B2 (en) |
| KR (1) | KR20050013981A (en) |
| AU (1) | AU2004203441B2 (en) |
| CA (1) | CA2475919C (en) |
| IL (1) | IL163236A (en) |
Families Citing this family (98)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE102004030834A1 (en) | 2004-06-25 | 2006-01-26 | Siemens Ag | Device for determining the relative position of several catheters in the human body |
| US20060089637A1 (en) | 2004-10-14 | 2006-04-27 | Werneth Randell L | Ablation catheter |
| US8409191B2 (en) | 2004-11-04 | 2013-04-02 | Boston Scientific Scimed, Inc. | Preshaped ablation catheter for ablating pulmonary vein ostia within the heart |
| US8617152B2 (en) | 2004-11-15 | 2013-12-31 | Medtronic Ablation Frontiers Llc | Ablation system with feedback |
| US7468062B2 (en) | 2004-11-24 | 2008-12-23 | Ablation Frontiers, Inc. | Atrial ablation catheter adapted for treatment of septal wall arrhythmogenic foci and method of use |
| US7429261B2 (en) | 2004-11-24 | 2008-09-30 | Ablation Frontiers, Inc. | Atrial ablation catheter and method of use |
| CA2607935C (en) * | 2005-05-05 | 2014-07-08 | Boston Scientific Limited | Preshaped localization catheter and system for graphically reconstructing pulmonary vein ostia |
| AU2006262447A1 (en) | 2005-06-20 | 2007-01-04 | Medtronic Ablation Frontiers Llc | Ablation catheter |
| CA2615267A1 (en) | 2005-07-11 | 2007-01-18 | Ablation Frontiers, Inc. | Low power tissue ablation system |
| US7324915B2 (en) * | 2005-07-14 | 2008-01-29 | Biosense Webster, Inc. | Data transmission to a position sensor |
| US7536218B2 (en) * | 2005-07-15 | 2009-05-19 | Biosense Webster, Inc. | Hybrid magnetic-based and impedance-based position sensing |
| US8657814B2 (en) | 2005-08-22 | 2014-02-25 | Medtronic Ablation Frontiers Llc | User interface for tissue ablation system |
| US7918793B2 (en) * | 2005-10-28 | 2011-04-05 | Biosense Webster, Inc. | Synchronization of ultrasound imaging data with electrical mapping |
| US8172758B2 (en) * | 2006-03-06 | 2012-05-08 | Imacor Inc. | Transesophageal ultrasound probe with an adaptive bending section |
| US9480552B2 (en) | 2006-04-26 | 2016-11-01 | The Cleveland Clinic Foundation | Apparatus and method for treating cardiovascular diseases |
| US8641704B2 (en) | 2007-05-11 | 2014-02-04 | Medtronic Ablation Frontiers Llc | Ablation therapy system and method for treating continuous atrial fibrillation |
| US10398393B2 (en) | 2007-10-02 | 2019-09-03 | Stryker European Holdings I, Llc | Dynamic reference method and system for interventional procedures |
| US8315690B2 (en) * | 2007-10-02 | 2012-11-20 | General Electric Company | Dynamic reference method and system for interventional procedures |
| US8535308B2 (en) * | 2007-10-08 | 2013-09-17 | Biosense Webster (Israel), Ltd. | High-sensitivity pressure-sensing probe |
| US8357152B2 (en) | 2007-10-08 | 2013-01-22 | Biosense Webster (Israel), Ltd. | Catheter with pressure sensing |
| US8437832B2 (en) | 2008-06-06 | 2013-05-07 | Biosense Webster, Inc. | Catheter with bendable tip |
| US9101734B2 (en) * | 2008-09-09 | 2015-08-11 | Biosense Webster, Inc. | Force-sensing catheter with bonded center strut |
| US20100152728A1 (en) * | 2008-12-11 | 2010-06-17 | Park Christopher J | Method and apparatus for determining the efficacy of a lesion |
| US9326700B2 (en) | 2008-12-23 | 2016-05-03 | Biosense Webster (Israel) Ltd. | Catheter display showing tip angle and pressure |
| US8712550B2 (en) | 2008-12-30 | 2014-04-29 | Biosense Webster, Inc. | Catheter with multiple electrode assemblies for use at or near tubular regions of the heart |
| US8475450B2 (en) * | 2008-12-30 | 2013-07-02 | Biosense Webster, Inc. | Dual-purpose lasso catheter with irrigation |
| US8600472B2 (en) * | 2008-12-30 | 2013-12-03 | Biosense Webster (Israel), Ltd. | Dual-purpose lasso catheter with irrigation using circumferentially arranged ring bump electrodes |
| CN101836862B (en) * | 2009-03-16 | 2014-03-26 | 上海微创医疗器械（集团）有限公司 | Three-dimensional mapping method of human chamber inner wall and equipment and system thereof |
| US8287532B2 (en) | 2009-04-13 | 2012-10-16 | Biosense Webster, Inc. | Epicardial mapping and ablation catheter |
| US10688278B2 (en) * | 2009-11-30 | 2020-06-23 | Biosense Webster (Israel), Ltd. | Catheter with pressure measuring tip |
| US9861438B2 (en) * | 2009-12-11 | 2018-01-09 | Biosense Webster (Israel), Ltd. | Pre-formed curved ablation catheter |
| US8920415B2 (en) | 2009-12-16 | 2014-12-30 | Biosense Webster (Israel) Ltd. | Catheter with helical electrode |
| US8668686B2 (en) * | 2009-12-23 | 2014-03-11 | Biosense Webster (Israel) Ltd. | Sensing contact of ablation catheter using differential temperature measurements |
| US8521462B2 (en) | 2009-12-23 | 2013-08-27 | Biosense Webster (Israel), Ltd. | Calibration system for a pressure-sensitive catheter |
| US8529476B2 (en) | 2009-12-28 | 2013-09-10 | Biosense Webster (Israel), Ltd. | Catheter with strain gauge sensor |
| US8608735B2 (en) * | 2009-12-30 | 2013-12-17 | Biosense Webster (Israel) Ltd. | Catheter with arcuate end section |
| US8374670B2 (en) * | 2010-01-22 | 2013-02-12 | Biosense Webster, Inc. | Catheter having a force sensing distal tip |
| US8798952B2 (en) | 2010-06-10 | 2014-08-05 | Biosense Webster (Israel) Ltd. | Weight-based calibration system for a pressure sensitive catheter |
| US8226580B2 (en) | 2010-06-30 | 2012-07-24 | Biosense Webster (Israel), Ltd. | Pressure sensing for a multi-arm catheter |
| US8380276B2 (en) | 2010-08-16 | 2013-02-19 | Biosense Webster, Inc. | Catheter with thin film pressure sensing distal tip |
| US8731859B2 (en) | 2010-10-07 | 2014-05-20 | Biosense Webster (Israel) Ltd. | Calibration system for a force-sensing catheter |
| US8979772B2 (en) | 2010-11-03 | 2015-03-17 | Biosense Webster (Israel), Ltd. | Zero-drift detection and correction in contact force measurements |
| US9308041B2 (en) * | 2010-12-22 | 2016-04-12 | Biosense Webster (Israel) Ltd. | Lasso catheter with rotating ultrasound transducer |
| US8880147B2 (en) | 2011-05-02 | 2014-11-04 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Sensor assembly tethered within catheter wall |
| US9220433B2 (en) | 2011-06-30 | 2015-12-29 | Biosense Webster (Israel), Ltd. | Catheter with variable arcuate distal section |
| US9662169B2 (en) | 2011-07-30 | 2017-05-30 | Biosense Webster (Israel) Ltd. | Catheter with flow balancing valve |
| US8876726B2 (en) | 2011-12-08 | 2014-11-04 | Biosense Webster (Israel) Ltd. | Prevention of incorrect catheter rotation |
| US10595937B2 (en) * | 2011-12-29 | 2020-03-24 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System for optimized coupling of ablation catheters to body tissues and evaluation of lesions formed by the catheters |
| US9687289B2 (en) | 2012-01-04 | 2017-06-27 | Biosense Webster (Israel) Ltd. | Contact assessment based on phase measurement |
| CN102579031B (en) * | 2012-01-19 | 2014-10-01 | 洪浪 | Right ventricular outflow tract mapping and angiographic catheter and preparation method of angiographic catheter |
| US9717555B2 (en) | 2012-05-14 | 2017-08-01 | Biosense Webster (Israel), Ltd. | Catheter with helical end section for vessel ablation |
| WO2014025394A1 (en) | 2012-08-09 | 2014-02-13 | University Of Iowa Research Foundation | Catheters, catheter systems, and methods for puncturing through a tissue structure |
| US9023036B2 (en) | 2012-12-07 | 2015-05-05 | Biosense Webster (Israel) Ltd. | Lasso catheter with tip electrode |
| US9474850B2 (en) | 2012-12-11 | 2016-10-25 | Biosense Webster (Israel) Ltd. | Lasso catheter with guide wire |
| US9282916B2 (en) | 2013-03-01 | 2016-03-15 | Pacesetter, Inc. | Vascular branch characterization |
| US9717442B2 (en) | 2013-03-15 | 2017-08-01 | Medtronic Navigation, Inc. | Method and system for navigating an instrument |
| US10568686B2 (en) | 2013-11-21 | 2020-02-25 | Biosense Webster (Israel) Ltd. | Multi-electrode balloon catheter with circumferential and point electrodes |
| EP3091921B1 (en) | 2014-01-06 | 2019-06-19 | Farapulse, Inc. | Apparatus for renal denervation ablation |
| US9795315B2 (en) * | 2014-01-28 | 2017-10-24 | John Bullinga | Catheter system for mapping of the left atrium, right atrium and coronary sinus |
| EP3495018B1 (en) | 2014-05-07 | 2023-09-06 | Farapulse, Inc. | Apparatus for selective tissue ablation |
| US9468407B2 (en) | 2014-05-30 | 2016-10-18 | Biosense Webster (Israel) Ltd. | Catheter with distal section having side-by-side loops |
| WO2015192027A1 (en) | 2014-06-12 | 2015-12-17 | Iowa Approach Inc. | Method and apparatus for rapid and selective transurethral tissue ablation |
| EP3154464A4 (en) | 2014-06-12 | 2018-01-24 | Iowa Approach Inc. | Method and apparatus for rapid and selective tissue ablation with cooling |
| WO2016060983A1 (en) | 2014-10-14 | 2016-04-21 | Iowa Approach Inc. | Method and apparatus for rapid and safe pulmonary vein cardiac ablation |
| US9788893B2 (en) | 2014-11-20 | 2017-10-17 | Biosense Webster (Israel) Ltd. | Catheter with soft distal tip for mapping and ablating tubular region |
| US20160338769A1 (en) | 2015-05-18 | 2016-11-24 | Biosense Webster (Israel) Ltd. | Catheter with anchoring balloon assembly |
| US11154186B2 (en) | 2015-07-31 | 2021-10-26 | University Of Utah Research Foundation | Devices, systems, and methods for imaging and treating a selected tissue |
| US20170189097A1 (en) | 2016-01-05 | 2017-07-06 | Iowa Approach Inc. | Systems, apparatuses and methods for delivery of ablative energy to tissue |
| US10130423B1 (en) | 2017-07-06 | 2018-11-20 | Farapulse, Inc. | Systems, devices, and methods for focal ablation |
| US10660702B2 (en) | 2016-01-05 | 2020-05-26 | Farapulse, Inc. | Systems, devices, and methods for focal ablation |
| US10172673B2 (en) | 2016-01-05 | 2019-01-08 | Farapulse, Inc. | Systems devices, and methods for delivery of pulsed electric field ablative energy to endocardial tissue |
| US10512505B2 (en) | 2018-05-07 | 2019-12-24 | Farapulse, Inc. | Systems, apparatuses and methods for delivery of ablative energy to tissue |
| US10624554B2 (en) | 2016-01-14 | 2020-04-21 | Biosense Webster (Israel) Ltd. | Non-overlapping loop-type or spline-type catheter to determine activation source direction and activation source type |
| US10314542B2 (en) | 2016-01-14 | 2019-06-11 | Biosense Webster (Israel) Ltd. | Identification of fractionated signals |
| US11006887B2 (en) | 2016-01-14 | 2021-05-18 | Biosense Webster (Israel) Ltd. | Region of interest focal source detection using comparisons of R-S wave magnitudes and LATs of RS complexes |
| US10517496B2 (en) | 2016-01-14 | 2019-12-31 | Biosense Webster (Israel) Ltd. | Region of interest focal source detection |
| US10582894B2 (en) | 2016-01-14 | 2020-03-10 | Biosense Webster (Israel) Ltd. | Region of interest rotational activity pattern detection |
| US10905329B2 (en) * | 2016-06-09 | 2021-02-02 | Biosense Webster (Israel) Ltd. | Multi-function conducting elements for a catheter |
| EP3471631A4 (en) | 2016-06-16 | 2020-03-04 | Farapulse, Inc. | Systems, apparatuses, and methods for guide wire delivery |
| US10828091B2 (en) | 2016-12-28 | 2020-11-10 | Biosense Webster (Israel) Ltd. | Catheter with tapered support member for variable arcuate distal assembly |
| CN110494076B (en) * | 2017-02-01 | 2023-07-21 | 犹他大学研究基金会 | Apparatus and method for mapping cardiac tissue |
| US10918832B2 (en) | 2017-03-27 | 2021-02-16 | Biosense Webster (Israel) Ltd | Catheter with improved loop contraction and greater contraction displacement |
| US9987081B1 (en) | 2017-04-27 | 2018-06-05 | Iowa Approach, Inc. | Systems, devices, and methods for signal generation |
| US10617867B2 (en) | 2017-04-28 | 2020-04-14 | Farapulse, Inc. | Systems, devices, and methods for delivery of pulsed electric field ablative energy to esophageal tissue |
| WO2019055512A1 (en) | 2017-09-12 | 2019-03-21 | Farapulse, Inc. | Systems, apparatuses, and methods for ventricular focal ablation |
| EP3790485A1 (en) | 2018-05-07 | 2021-03-17 | Farapulse, Inc. | Epicardial ablation catheter |
| EP3790483A1 (en) | 2018-05-07 | 2021-03-17 | Farapulse, Inc. | Systems, apparatuses, and methods for filtering high voltage noise induced by pulsed electric field ablation |
| JP2022501112A (en) | 2018-09-20 | 2022-01-06 | ファラパルス，インコーポレイテッド | Systems, devices, and methods for the delivery of pulsed field ablation energy to endocardial tissue |
| RU2700675C1 (en) * | 2018-11-02 | 2019-09-18 | Федеральное государственное бюджетное учреждение "Национальный медицинский исследовательский центр профилактической медицины" Министерства здравоохранения Российской Федерации (ФГБУ "НМИЦПМ" Минздрава России) | Method of personalized physical rehabilitation of patients with atrial fibrillation at early postoperative period of radio-frequency ablation of mouths of pulmonary veins |
| US10625080B1 (en) | 2019-09-17 | 2020-04-21 | Farapulse, Inc. | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
| US11541212B2 (en) | 2019-10-18 | 2023-01-03 | Biosense Wester (Israel) Ltd. | Verifying proper withdrawal of catheter into sheath |
| US11497541B2 (en) | 2019-11-20 | 2022-11-15 | Boston Scientific Scimed, Inc. | Systems, apparatuses, and methods for protecting electronic components from high power noise induced by high voltage pulses |
| US11065047B2 (en) | 2019-11-20 | 2021-07-20 | Farapulse, Inc. | Systems, apparatuses, and methods for protecting electronic components from high power noise induced by high voltage pulses |
| US10842572B1 (en) | 2019-11-25 | 2020-11-24 | Farapulse, Inc. | Methods, systems, and apparatuses for tracking ablation devices and generating lesion lines |
| US11484367B2 (en) | 2019-12-27 | 2022-11-01 | Biosense Webster (Israel) Ltd. | Device and method of determining location of sheath using electromagnetic sensors on sheath |
| US20210290283A1 (en) * | 2020-03-19 | 2021-09-23 | Boston Scientific Scimed Inc. | Navigation-Enabled Cryoablation System with Indirect Device Tracking |
| US20230008044A1 (en) | 2021-07-09 | 2023-01-12 | Biosense Webster (Israel) Ltd. | Pulsed field ablation catheter |
| EP4338695A1 (en) | 2022-09-11 | 2024-03-20 | Biosense Webster (Israel) Ltd. | System for combined ablation modalities |
Family Cites Families (57)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CA1265586A (en) * | 1984-08-14 | 1990-02-06 | Consiglio Nazionale Delle Ricerche | Method and device for quick location of starting site of ventricular arrhythmias |
| US4940064A (en) * | 1986-11-14 | 1990-07-10 | Desai Jawahar M | Catheter for mapping and ablation and method therefor |
| US5699796A (en) | 1993-01-29 | 1997-12-23 | Cardima, Inc. | High resolution intravascular signal detection |
| US5239999A (en) * | 1992-03-27 | 1993-08-31 | Cardiac Pathways Corporation | Helical endocardial catheter probe |
| US5662108A (en) * | 1992-09-23 | 1997-09-02 | Endocardial Solutions, Inc. | Electrophysiology mapping system |
| US5311866A (en) * | 1992-09-23 | 1994-05-17 | Endocardial Therapeutics, Inc. | Heart mapping catheter |
| US5297549A (en) * | 1992-09-23 | 1994-03-29 | Endocardial Therapeutics, Inc. | Endocardial mapping system |
| US5385146A (en) * | 1993-01-08 | 1995-01-31 | Goldreyer; Bruce N. | Orthogonal sensing for use in clinical electrophysiology |
| DE69432148T2 (en) | 1993-07-01 | 2003-10-16 | Boston Scient Ltd | CATHETER FOR IMAGE DISPLAY, DISPLAY OF ELECTRICAL SIGNALS AND ABLATION |
| WO1996005768A1 (en) | 1994-08-19 | 1996-02-29 | Biosense, Inc. | Medical diagnosis, treatment and imaging systems |
| US5807395A (en) * | 1993-08-27 | 1998-09-15 | Medtronic, Inc. | Method and apparatus for RF ablation and hyperthermia |
| WO1995009561A1 (en) * | 1993-10-01 | 1995-04-13 | Target Therapeutics, Inc. | Sheathed multipolar catheter and multipolar guidewire for sensing cardiac electrical activity |
| US5582609A (en) * | 1993-10-14 | 1996-12-10 | Ep Technologies, Inc. | Systems and methods for forming large lesions in body tissue using curvilinear electrode elements |
| US5487391A (en) * | 1994-01-28 | 1996-01-30 | Ep Technologies, Inc. | Systems and methods for deriving and displaying the propagation velocities of electrical events in the heart |
| US6090084A (en) * | 1994-07-08 | 2000-07-18 | Daig Corporation | Shaped guiding introducers for use with a catheter for the treatment of atrial arrhythmia |
| US6152920A (en) * | 1997-10-10 | 2000-11-28 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body |
| US6142994A (en) * | 1994-10-07 | 2000-11-07 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic a therapeutic element within the body |
| US6690963B2 (en) * | 1995-01-24 | 2004-02-10 | Biosense, Inc. | System for determining the location and orientation of an invasive medical instrument |
| US5848972A (en) * | 1995-09-15 | 1998-12-15 | Children's Medical Center Corporation | Method for endocardial activation mapping using a multi-electrode catheter |
| US5837001A (en) * | 1995-12-08 | 1998-11-17 | C. R. Bard | Radio frequency energy delivery system for multipolar electrode catheters |
| US5779669A (en) | 1996-10-28 | 1998-07-14 | C. R. Bard, Inc. | Steerable catheter with fixed curve |
| US6332880B1 (en) * | 1996-12-19 | 2001-12-25 | Ep Technologies, Inc. | Loop structures for supporting multiple electrode elements |
| SI0901341T1 (en) * | 1997-01-03 | 2005-04-30 | Biosense Webster, Inc. | Bend-responsive catheter |
| JP3949729B2 (en) * | 1997-01-03 | 2007-07-25 | バイオセンス・インコーポレイテッド | Shape adaptive catheter |
| US5771298A (en) * | 1997-01-13 | 1998-06-23 | Larson-Davis, Inc. | Apparatus and method for simulating a human mastoid |
| US5916213A (en) * | 1997-02-04 | 1999-06-29 | Medtronic, Inc. | Systems and methods for tissue mapping and ablation |
| US6024740A (en) | 1997-07-08 | 2000-02-15 | The Regents Of The University Of California | Circumferential ablation device assembly |
| US5971983A (en) * | 1997-05-09 | 1999-10-26 | The Regents Of The University Of California | Tissue ablation device and method of use |
| US6012457A (en) * | 1997-07-08 | 2000-01-11 | The Regents Of The University Of California | Device and method for forming a circumferential conduction block in a pulmonary vein |
| US5938660A (en) * | 1997-06-27 | 1999-08-17 | Daig Corporation | Process and device for the treatment of atrial arrhythmia |
| US6251109B1 (en) * | 1997-06-27 | 2001-06-26 | Daig Corporation | Process and device for the treatment of atrial arrhythmia |
| US6117101A (en) * | 1997-07-08 | 2000-09-12 | The Regents Of The University Of California | Circumferential ablation device assembly |
| US6164283A (en) * | 1997-07-08 | 2000-12-26 | The Regents Of The University Of California | Device and method for forming a circumferential conduction block in a pulmonary vein |
| US6245064B1 (en) * | 1997-07-08 | 2001-06-12 | Atrionix, Inc. | Circumferential ablation device assembly |
| US6080151A (en) * | 1997-07-21 | 2000-06-27 | Daig Corporation | Ablation catheter |
| US6120496A (en) | 1998-05-05 | 2000-09-19 | Scimed Life Systems, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body and coupling device for use with same |
| US6267760B1 (en) * | 1998-05-05 | 2001-07-31 | Scimed Life Systems, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body and forming an incision in tissue with minimal blood loss |
| US6104944A (en) | 1997-11-17 | 2000-08-15 | Martinelli; Michael A. | System and method for navigating a multiple electrode catheter |
| US6104994A (en) * | 1998-01-13 | 2000-08-15 | Conexant Systems, Inc. | Method for speech coding under background noise conditions |
| US6102496A (en) * | 1998-02-10 | 2000-08-15 | Display Industries, Llc. | Merchandising display cabinet |
| US6064902A (en) * | 1998-04-16 | 2000-05-16 | C.R. Bard, Inc. | Pulmonary vein ablation catheter |
| US6190382B1 (en) * | 1998-12-14 | 2001-02-20 | Medwaves, Inc. | Radio-frequency based catheter system for ablation of body tissues |
| US6217528B1 (en) * | 1999-02-11 | 2001-04-17 | Scimed Life Systems, Inc. | Loop structure having improved tissue contact capability |
| US6348082B1 (en) * | 1999-05-14 | 2002-02-19 | Respironics, Inc. | Gas fractionalization system and associated method |
| US6290699B1 (en) * | 1999-07-07 | 2001-09-18 | Uab Research Foundation | Ablation tool for forming lesions in body tissue |
| US6332881B1 (en) * | 1999-09-01 | 2001-12-25 | Cardima, Inc. | Surgical ablation tool |
| US6308093B1 (en) * | 1999-10-07 | 2001-10-23 | Massachusetts Institute Of Technology | Method and apparatus for guiding ablative therapy of abnormal biological electrical excitation |
| US6711428B2 (en) * | 2000-01-27 | 2004-03-23 | Biosense Webster, Inc. | Catheter having mapping assembly |
| US6892091B1 (en) * | 2000-02-18 | 2005-05-10 | Biosense, Inc. | Catheter, method and apparatus for generating an electrical map of a chamber of the heart |
| US6227371B1 (en) * | 2000-05-12 | 2001-05-08 | Julie Song | Medical container and system |
| US6400981B1 (en) * | 2000-06-21 | 2002-06-04 | Biosense, Inc. | Rapid mapping of electrical activity in the heart |
| AU2002307150A1 (en) * | 2001-04-06 | 2002-10-21 | Steven Solomon | Cardiological mapping and navigation system |
| DE60223794T2 (en) * | 2001-04-27 | 2008-10-30 | C.R. Bard, Inc. | ELECTROPHYSIOLOGY CATHETERS FOR MAPPING AND ABLATION |
| US6748255B2 (en) * | 2001-12-14 | 2004-06-08 | Biosense Webster, Inc. | Basket catheter with multiple location sensors |
| US7588568B2 (en) * | 2002-07-19 | 2009-09-15 | Biosense Webster, Inc. | Atrial ablation catheter and method for treating atrial fibrillation |
| US6957101B2 (en) * | 2002-08-21 | 2005-10-18 | Joshua Porath | Transient event mapping in the heart |
| JP5328074B2 (en) * | 2002-10-31 | 2013-10-30 | シー・アール・バード・インコーポレーテッド | Improved electrophysiology catheter |
-
2003
- 2003-07-29 US US10/629,661 patent/US6973339B2/en not_active Expired - Lifetime
-
2004
- 2004-07-27 IL IL163236A patent/IL163236A/en active IP Right Grant
- 2004-07-28 JP JP2004220424A patent/JP4975243B2/en active Active
- 2004-07-28 AU AU2004203441A patent/AU2004203441B2/en not_active Ceased
- 2004-07-28 EP EP04254530.1A patent/EP1502555B1/en active Active
- 2004-07-28 EP EP10177021.2A patent/EP2289450B1/en active Active
- 2004-07-29 CA CA2475919A patent/CA2475919C/en not_active Expired - Fee Related
- 2004-07-29 KR KR1020040059944A patent/KR20050013981A/en not_active Application Discontinuation
Also Published As
| Publication number | Publication date |
|---|---|
| AU2004203441B2 (en) | 2010-04-01 |
| JP2005052641A (en) | 2005-03-03 |
| EP2289450A1 (en) | 2011-03-02 |
| US6973339B2 (en) | 2005-12-06 |
| CA2475919C (en) | 2016-07-12 |
| EP1502555B1 (en) | 2015-08-19 |
| EP2289450B1 (en) | 2017-07-19 |
| AU2004203441A1 (en) | 2005-02-17 |
| JP4975243B2 (en) | 2012-07-11 |
| IL163236A (en) | 2011-01-31 |
| US20050033135A1 (en) | 2005-02-10 |
| KR20050013981A (en) | 2005-02-05 |
| EP1502555A1 (en) | 2005-02-02 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US6973339B2 (en) | Lasso for pulmonary vein mapping and ablation | |
| AU2015234342B2 (en) | Dual-purpose lasso catheter with irrigation field of the invention | |
| US8600472B2 (en) | Dual-purpose lasso catheter with irrigation using circumferentially arranged ring bump electrodes | |
| US8979835B2 (en) | Sensing contact of ablation catheter using differential temperature measurements | |
| US6895267B2 (en) | Systems and methods for guiding and locating functional elements on medical devices positioned in a body | |
| US6735465B2 (en) | Systems and processes for refining a registered map of a body cavity | |
| JP3949729B2 (en) | Shape adaptive catheter | |
| AU2010257206B2 (en) | Sensing contact of ablation catheter using differential temperature measurements |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKLA | Lapsed |
Effective date: 20210729 |