US20010021867A1 - Cardiac mapping and ablation systems - Google Patents

Abstract

A probe for cardiac diagnosis and/or treatment has a catheter tube. The distal end of the catheter tube carries first and second electrode elements. The probe includes a mechanism for steering the first electrode element relative to the second electrode element in multiple directions.

Description

FIELD OF THE INVENTION
• The invention relates to systems and methods for mapping and ablating the interior regions of the heart for treatment of cardiac conditions.[0001]
BACKGROUND OF THE INVENTION
• Physicians make use of catheters today in medical procedures to gain access into interior regions of the body to ablate targeted tissue areas. It is important for the physician to be able to carefully and precisely control the position of the catheter and its emission of energy within the body during tissue ablation procedures.[0002]
• The need for careful and precise control over the catheter is especially critical during procedures that ablate tissue within the heart. These procedures, called electrophysiological therapy, are becoming more widespread for treating cardiac rhythm disturbances.[0003]
• During these procedures, a physician steers a catheter through a main vein or artery into the interior region of the heart that is to be treated. The physician then further manipulates a steering mechanism to place the electrode carried on the distal tip of the catheter into direct contact with the tissue that is to be ablated. The physician directs energy from the electrode through tissue to an indifferent electrode (in a uni-polar electrode arrangement) or to an adjacent electrode (in a bi-polar electrode arrangement) to ablate the tissue and form a lesion.[0004]
• Cardiac mapping can be used before ablation to locate aberrant conductive pathways within the heart. The aberrant conductive pathways constitute peculiar and life threatening patterns, called dysrhythmias. Mapping identifies regions along these pathways, called foci, which are then ablated to treat the dysrhythmia.[0005]
• There is a need for cardiac mapping and ablation systems and procedures that can be easily deployed with a minimum of manipulation and effort.[0006]
• There is also a need for systems and procedures that are capable of performing cardiac mapping in tandem with cardiac ablation. Such multipurpose systems must also be easily. introduced into the heart. Once deployed, such multipurpose systems also must be capable of mapping and ablating with a minimum of manipulation and effort.[0007]
SUMMARY OF THE INVENTION
• A principal objective of the invention is to provide improved probes to carry out cardiac mapping and/or cardiac ablation procedures quickly and accurately.[0008]
• Another principal objective of the invention is to provide improved probes that integrate mapping and ablation functions.[0009]
• The invention provides a probe for use within the heart to contact endocardial tissue. The probe includes a catheter tube having a distal end that carries a first electrode element. The probe also includes a second electrode element on the distal end. The second electrode element defines a three-dimensional structure that extends along an axis and that has an open interior. The probe includes a mechanism for moving the first electrode element within the open interior of the second electrode element in a first direction along the axis of the second electrode element, in a second direction rotating about the axis of the second electrode element, and in a third direction normal to the axis of the second electrode element.[0010]
• In a preferred embodiment, the movable first electrode element serves to ablate myocardial tissue. The second electrode element independently serves to sense electrical activity in endocardial tissue.[0011]
• Other features and advantages of the inventions are set forth in the following Description and Drawings, as well as in the appended claims.[0012]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a side view, with portions fragmented and in section, of an endocardial mapping system that embodies the features of the invention, shown deployed and ready for use inside a heart chamber;[0013]
• FIG. 2 is a side view of endocardial mapping system shown in FIG. 1, with portions fragmented and in section, showing the electrode-carrying basket in a collapsed condition before deployment inside the heart chamber;[0014]
• FIG. 3 is an enlarged side view of the electrode-carrying basket and movable guide sheath shown in FIG. 2, with portions fragmented and in section, showing the electrode-carrying basket in a collapsed condition before deployment;[0015]
• FIG. 4 is an enlarged side view of the electrode-carrying basket and movable guide sheath shown in FIG. 1, with portions fragmented and in section, showing the electrode-carrying basket in a deployed condition;[0016]
• FIG. 5 is a side view of two splines of the basket, when deployed, showing the arrangement of electrodes on the splines;[0017]
• FIG. 6 is a section view taken generally along line[0018]6-6 in FIG. 1, showing the interior of the catheter body for the mapping probe;
• FIG. 7 is a plan view, with portions fragmented, of the introducer and outer guide sheath being introduced into the vein or artery access site in the process of forming the system shown in FIG. 1;[0019]
• FIG. 8 is a plan view of the introducer, the outer guide sheath, and the steerable catheter being introduced into the access site in the process of forming the system shown in FIG. 1;[0020]
• FIG. 9 is a plan view of the interior of the handle for the steerable catheter, partially broken away and in section, showing the mechanism for steering the distal tip of the catheter body;[0021]
• FIG. 10 is a side view, with portions fragmented and in section, of advancing the steerable catheter body and outer guide sheath into the desired heart chamber;[0022]
• FIG. 10A is a plan view of the interior of the hemostatic valve that systems embodying features of the invention use, showing the resilient slotted membrane present within the valve;[0023]
• FIG. 11 is a side view, with portions fragmented and in section, of the guide sheath and the steerable catheter body advanced into the deployment position within the desired heart region;[0024]
• FIG. 12 is a side view, with portions fragmented and in section, of the mapping probe just before being introduced for advancement within the outer guide sheath, with the hemostat sheath fully forward to enclose the electrode-carrying basket;[0025]
• FIG. 13 is a side view, with portions fragmented and in section, of the mapping probe being advanced through the hemostatic valve of the outer guide sheath, with the hemostat sheath fully forward to enclose the electrode-carrying basket;[0026]
• FIG. 14 is a side view, with portions fragmented and in section, of the mapping probe after advancement through the hemostatic valve of the outer guide sheath, with the hemostat sheath pulled back to uncover the electrode-carrying basket;[0027]
• FIG. 15 is an enlarged view, with portions in section, of the electrode-carrying basket deployed inside the heart chamber in use in association with a separate ablation probe;[0028]
• FIG. 16 is an enlarged plan view of an alternative three dimensional structure, partially in section, that can be deployed using the system shown in FIG. 1, in use in association with a separate ablation probe;[0029]
• FIG. 17 is an enlarged side section view of the structure shown in FIG. 16 in a collapsed condition before deployment;[0030]
• FIG. 18 is an enlarged plan view of an alternative three dimensional structure that can be deployed using the system shown in FIG. 1, in use in association with a separate ablation probe;[0031]
• FIG. 19 is an enlarged side section view of the structure shown in FIG. 18 in a collapsed condition before deployment;[0032]
• FIG. 20 is a perspective view, partially fragmented, of an alternative embodiment of an outer guide sheath having a preformed complex curvature;[0033]
• FIG. 21 is an enlarged plan view, partially in section, of the guide sheath shown in FIG. 20 deployed inside the heart chamber and in use in association with a separate steerable ablation probe;[0034]
• FIG. 22 is a perspective view, partially fragmented, of an alternative embodiment of an outer guide sheath having a steerable distal tip;[0035]
• FIG. 23 is an enlarged plan view, partially in section, of the guide sheath shown in FIG. 22 deployed inside the heart chamber and in use in association with a separate ablation probe;[0036]
• FIG. 24 is a plan view, with portions fragmented and in section, of an integrated mapping and ablation system that embodies the features of the invention;[0037]
• FIGS. 25 and 26 are enlarged side elevation views of the electrode-carrying basket of the mapping probe that the system shown in FIG. 24 uses, showing the range of movement of the steerable ablating element carried within the basket;[0038]
• FIG. 27 is a diagrammatic view of the integrated mapping and ablation system shown in FIG. 24;[0039]
• FIG. 28 is an end elevation view, taken generally along line[0040]28-28 in FIG. 26, of the electrode-carrying basket of the mapping probe that the system shown in FIG. 24 uses, showing the range of movement of the steerable ablating element carried within the basket;
• FIG. 29 is an enlarged side section view of the distal end of the electrode-carrying basket of the mapping probe that the system shown in FIG. 24 uses, showing the basket in a collapsed condition about the steerable ablating element before deployment;[0041]
• FIG. 30 is an end section view of the collapsed basket, taken generally along line[0042]30-30 in FIG. 29;
• FIG. 31 is a side section view of the multiple layer catheter body of the mapping probe used in the system shown in FIG. 24;[0043]
• FIG. 32 is a perspective view of the multiple layers of the catheter body shown in section in FIG. 31;[0044]
• FIG. 33 is a view, partially in section, showing the formation of the first layer of the multiple layer catheter body shown in FIGS. 31 and 32;[0045]
• FIG. 34 is a view, partially in section, showing the formation of the second layer of the multiple layer catheter body shown in FIGS. 31 and 32;[0046]
• FIG. 35 is a view showing the formation of the third layer of the multiple layer catheter body shown in FIGS. 31 and 32;[0047]
• FIG. 36 is a view showing the formation of the fourth layer of the multiple layer catheter body shown in FIGS. 31 and 32; and[0048]
• FIGS. 37 and 38 are views showing the formation of the fifth and final layer of the multiple layer catheter body shown in FIGS. 31 and 32.[0049]
DESCRIPTION OF THE PREFERRED EMBODIMENTS
• FIG. 1 shows an[0050]endocardial mapping system10 that embodies features of the invention, when deployed and ready for use within a selectedregion12 inside the heart.
• The Figures generally show the selected[0051]region12 to be the left ventricle of the heart. However, it should be noted that the heart shown in the Figures is not anatomically accurate. The Figures show the heart in diagrammatic form to demonstrate the features of the invention.
• When deployed, the[0052]system10 includes anintroducer14, anouter guide sheath16, and amapping probe18.
• As FIG. 1 shows, the[0053]introducer14 establishes access to a vein or artery. Theouter guide sheath16 enters the access through theintroducer14. Theguide sheath16 extends through the vein or artery to enter the selectedheart chamber12.
• Together, the[0054]introducer14 and theouter sheath16 establish a passageway that guides themapping probe18 through the access vein or artery and into the selectedheart chamber12.
• The[0055]mapping probe18 has a handle20 (which FIG. 12 shows in its entirety), an attachedflexible catheter body22, and amovable hemostat sheath30 with associatedcarriage52.
• The distal end of the[0056]catheter body22 carries a threedimensional structure24. In FIG. 1, thestructure24 takes the form of a basket. FIGS. 16 and 18 show alternative structures, which will be described in greater detail later.
• The three dimensional structure of the[0057]basket24 includes anexterior surface27 that encloses an openinterior area25. Thebasket24 carries a three dimensional array ofelectrodes26 on its exterior surface27 (see FIG. 4 also).
• As FIG. 1 shows, when deployed inside the[0058]heart chamber12, theexterior surface27 of thebasket24 holds theelectrodes26 against the endocardial surface.
• When fully deployed, the[0059]outer guide sheath16 holds thecatheter body22. Thesheath16 is made from an inert plastic material. In the preferred embodiment, thesheath16 is made from a nylon composite material.
• The[0060]sheath16 has an inner diameter that is greater than the outer diameter of the-catheter body22. As a result, thesheath16 can slide along thecatheter body22.
• The proximal end of the[0061]sheath16 includes ahandle17. Thehandle17 helps the user slide thesheath16 along thecatheter body22, as the arrows in FIGS. 1 and 2 depict. FIGS. 1 and 2 show the range of sheath movement.
• As FIGS. 2 and 3 show, forward movement of the handle[0062]17 (i.e., toward the introducer14) advances the distal end of theslidable sheath16 upon thebasket24. Theslidable sheath16 captures and collapses the basket24 (as FIG. 3 also shows in greater detail). In this position, the distal end of thesheath16 entirely encloses thebasket24.
• As FIGS. 1 and 4 show, rearward movement of the handle[0063]17 (i.e., away from the introducer14) retracts theslidable sheath16 away from thebasket24. This removes the compression force. Thebasket24 opens to assume a prescribed three dimensional shape.
• The[0064]basket electrodes26 record the electrical potentials in myocardial tissue.Connectors44 on the handle20 (see FIGS. 12 and 13) attach to an external processor (not shown). The processor derives the activation times, the distribution, and the waveforms of the potentials recorded by thebasket electrodes26.
• The[0065]basket24 can be variously constructed. In the illustrated and preferred embodiment (best shown by FIG. 4), thebasket24 comprises abase member32 and anend cap34. Generallyflexible splines36 extend in a circumferentially spaced relationship between thebase member32 and theend cap34.
• In the illustrated embodiment, eight[0066]splines36 form thebasket24. However, additional orfewer splines36 could be used, depending upon application.
• In this arrangement, the[0067]splines36 are made of a resilient inert material, like Nitinol metal or silicone rubber. Thesplines36 are connected between thebase member32 and theend cap34 in a resilient, pretensed condition.
• The resilient splines[0068]36 bend and conform to the tissue surface they contact. As FIGS. 2 and 3 show, thesplines36 also collapse into a closed, compact bundle in response to an external compression force.
• In the illustrated embodiment (as FIGS. 4 and 5 best show), each[0069]spline36 carries eightelectrodes26. Of course, additional orfewer electrodes26 can be used. Furthermore, one ormore electrodes26 can also be located on theend cap34.
• The[0070]electrodes26 can be arranged in thirty-two bi-polar pairs, or as sixty-four uni-polar elements. In the preferred embodiment, theelectrodes26 are made of platinum or gold plated stainless steel.
• A[0071]signal wire38 made from a highly conductive metal, like copper, leads from eachelectrode26. Thesignal wires38 extend down the associatedspline36, by thebase member32, and into thecatheter body22. An inertplastic sheath40 preferably covers eachspline36 to enclose the signal wires38 (see FIGS. 4 and 5). In the preferred embodiment, thesheath40 is made of polyurethane material.
• The eight[0072]signal wires38 for eachspline36 are twisted together to form acommon bundle42. As FIG. 6 shows, the eightcommon bundle42 are, in turn, passed through thecatheter body22 of themapping probe18. The common bundles42 extend withincatheter body22 and into the probe handle20.
• The sixty-four[0073]signal wires38 are distributed within the probe handle20 to one or moreexternal connectors44, as FIG. 12 shows. In the illustrated embodiment, each connector contains thirty-two pins to service thirty-two signal wires. Theconnectors44 attach to the external processor.
• As FIG. 6 shows, the[0074]catheter body22 also includes an inner sleeve that forms acentral lumen46. The wire bundles42 are oriented in an equally spaced array about thislumen46. In the preferred embodiment, the sleeve of thecentral lumen46 is made of a Teflon material.
• The proximal end of the[0075]central lumen46 is attached to a flushingport48 that extends outside thehandle20, as FIG. 12 shows. The distal end of thecentral lumen46 opens at thebase member32 of thebasket24. Anticoagulant or saline can be introduced through the flushingport48 into theheart chamber12 that thebasket24 occupies.
• In the illustrated and preferred embodiment (as FIG. 5 best shows), a[0076]first region54 on the proximal end of eachspline36 is free ofelectrodes26. Likewise, a second region56 on the distal end of eachspline36 is also free ofelectrodes26. These two fore andaft regions54 and56 generally fail to make stable surface contact with the endocardial tissue. Therefore,electrodes26 in these regions may not uniformly provide reliable signals.
• The eight[0077]electrodes26 on eachspline36 are arranged in4 groups of equally spaced pairs in athird region58 between the twoend regions54 and56. Thethird region58 uniformly makes stable surface contact with the endocardial tissue, creating reliable signals from theelectrodes26.
• FIGS.[0078]7 to14 show the details of introducing thesystem10 into theheart chamber12.
• The[0079]system10 includes a steerable catheter60 (see FIG. 8) to facilitate the introduction and positioning of theouter guide sheath16.
• The[0080]catheter60 directs the introduction of theouter guide sheath16, which is otherwise free of any onboard steering mechanism. Theguide sheath16, in turn, directs the introduction of themapping probe18, which is likewise free of any onboard steering mechanism.
• Use of a[0081]separate catheter60 for steering purposes results in a significant reduction in the overall size of the system components.
• If the[0082]mapping probe18 carried its own onboard steering mechanism, thecatheter body22 would have to be of sufficient size to accommodate it. Typically, this would require acatheter body22 with a diameter of about 12-14 French (one French is 0.33 mm in diameter).
• Furthermore, if carried onboard the[0083]mapping probe18, the steering mechanism would also have to be of sufficient strength to deflect the entire structure of thebasket24 when in a collapsed condition.
• According to this aspect of the invention, use of a separate, dedicated[0084]steerable catheter60 permits the introduction of theentire system10 through the access vessel and into the heart chamber using an outer guide sheath of about only 10 French. Thecatheter body22 of themapping probe18 can also be significantly smaller, being on the order of 6 to 8 French. In addition, a smaller steering mechanism can also be used, because only theouter sheath16 needs to be steered.
• As FIG. 7 shows, the[0085]introducer14 has a skin-piercingcannula62. The physician uses thecannula62 to establish percutaneous access into the selected vein or artery (which is typically the femoral vein or artery). The other end of theintroducer14 includes a conventionalhemostatic valve64.
• The[0086]valve64 includes a resilient slotted membrane65 (as FIG. 10A shows). The slottedmembrane65 blocks the outflow of blood and other fluids from the access. The slot in themembrane65 yields to permit the introduction of theouter guide sheath16 through it. Theresilient membrane65 conforms about the outer surface of thesheath16, thereby maintaining a fluid tight seal.
• The[0087]introducer14 also includes a flushingport66 for introducing anticoagulant or other fluid at the access site.
• As FIG. 8 shows, the[0088]steerable catheter60 includes acatheter body68 having asteerable tip70 at its distal end. Ahandle72 is attached to the proximal end of thecatheter body68. Thehandle12 encloses asteering mechanism74 for thedistal tip70.
• The[0089]steering mechanism74 can vary. In the illustrated embodiment (see FIG. 9), the steering mechanism is the one shown in Copending U.S. application Ser. No. 07/789,260, which is incorporated by reference.
• As FIG. 9 shows, the[0090]steering mechanism74 of this construction includes arotating cam wheel76 within thehandle72. Anexternal steering lever78 rotates the cam wheel. Thecam wheel76 holds the proximal ends of right and leftsteering wires80.
• The[0091]steering wires80 extend along the associated left and right side surfaces of thecam wheel76 and through thecatheter body68. Thesteering wires80 connect to the left and right sides of a resilient bendable wire or spring (not shown) that deflects the steerabledistal tip70 of thecatheter body68.
• As FIG. 8 shows, forward movement of the steering[0092]lever80 bends thedistal tip70 down. Rearward movement of the steeringlever80 rearward bends thedistal tip70 up. By rotating thehandle70, thereby rotating thedistal tip70, and thereafter manipulating the steeringlever80 as required, it is possible to maneuver thedistal tip70 virtually in any direction.
• In an alternative arrangement (shown in phantom line view A in FIG. 8), the steerable[0093]distal tip70 can also be bent out of a normal coaxial relationship with thecatheter body68 using custom shapedwire stiffeners71. Thestiffeners71 create a pre-formed, complex curve configuration. The complex curvature simplifies access to difficult-to-reach locations within the heart, such as the aortic approach through the left ventricle to the left atrium.
• FIGS. 10 and 11 show the details of using the[0094]steerable catheter60 to guide theouter sheath16 into position.
• The[0095]outer guide sheath16 includes aninterior bore82 that receives thesteerable catheter body68 of thecatheter60. The physician can slide theouter guide sheath16 along thesteerable body68 of thecatheter60.
• The[0096]handle17 of theouter sheath16 includes a conventionalhemostatic valve84. Thevalve84, like thevalve64, includes a resilient slotted membrane65 (as FIG. 10A shows) that blocks the outflow of blood and other fluids. Like thevalve64, the slottedmembrane65 yields to permit the introduction of thebody22 of themapping probe18 through it. At the same time, themembrane65 conforms about the outer surface of thebody22 to maintain a fluid tight seal.
• Together, the[0097]valves64 and84 provide an effective hemostatic system that allows a procedure to be performed in a clean and relatively bloodless manner.
• In use, the[0098]steerable catheter body68 enters thebore82 of theguide sheath16 through thevalve84, as FIG. 10 shows. Thehandle17 of theouter sheath16 also preferably includes a flushingport28 for the introduction of an anticoagulant or saline into the interior bore82.
• As FIG. 10 also shows, the physician advances the[0099]catheter body68 and theouter guide sheath16 together through the access vein or artery. The physician retains the sheath handle17 near the catheter handle72 to keep thecatheter tip70 outside the distal end of theouter sheath16. In this way, the physician can operate the steeringlever78 to remotely point and steer thedistal end70 of thecatheter body68 while jointly advancing thecatheter body68 and guidesheath16 through the access vein or artery.
• The physician can observe the progress of the[0100]catheter body68 using fluoroscopic or ultrasound imaging, or the like. Theouter sheath16 can include an radio-opaque compound, such a barium, for this purpose. Alternatively, a radio-opaque marker can be placed at the distal end of theouter sheath16.
• This allows the physician to maneuver the[0101]catheter body68 through the vein or artery into the selectedinterior heart chamber12, as FIG. 10 shows.
• As FIG. 11 shows, when the physician locates the[0102]distal end70 of thecatheter body68 in the desiredendocardial chamber12, he/she slides the outer sheath handle17 forward along thecatheter body68, away from thehandle72 and toward theintroducer14. Thecatheter body68 directs theguide sheath16 fully into theheart chamber12, coextensive with thedistal tip70.
• Holding the[0103]handle17 of theouter sheath16, the physician withdraws thesteerable catheter body68 from theouter guide sheath16.
• The[0104]system10 is now deployed in the condition generally shown in FIG. 12. As FIG. 12 shows, the guide sheath bore82 establishes a passageway that leads directly from theintroducer14 into the selectedheart chamber12. Themapping probe18 follows this passageway for deployment inside thechamber12.
• As FIG. 12 shows, before introducing the[0105]mapping probe18, the physician advances thehemostat sheath30, by pushing on thecarriage52. Thesheath30 captures and collapses thebasket24.
• As FIG. 13 shows, the physician introduces the[0106]hemostat sheath30, withenclosed basket24, through thehemostatic valve84 of theouter sheath handle17. Thehemostat sheath30 protects thebasket electrodes26 from damage during insertion through thevalve84.
• As FIG. 14 shows, when the[0107]catheter body22 is advanced approximately three inches into theguide sheath16, the physician pulls back on thesheath carriage52 to withdraw thehemostat sheath30 from thevalve84. Thehemostat valve84 seals about thecatheter body22. Theguide sheath16 now itself encloses thecollapsed basket24.
• As FIG. 2 shows, the[0108]outer sheath16 directs thebasket24 ofmapping probe18 to the desired location inside theheart chamber12. As FIG. 1 shows, the physician then moves thehandle17 rearward. The distal end of thesheath16 slides back to deploy thebasket24 for use.
• Once deployed, the physician can again collapse the basket[0109]24 (by pushing forward on the handle17), as FIG. 2 shows. The physician can then rotate thesheath16 andprobe18 to change the angular orientation of thebasket electrodes26 inside thechamber12, without contacting and perhaps damaging endocardial tissue. The physician can then redeploy thebasket24 in its new orientation by pulling back on thehandle17, as FIG. 1 shows.
• The physician analyses the signals received from the[0110]basket electrodes26 to locate likely efficacious sites for ablation.
• The physician can now takes steps to ablate the myocardial tissue areas located by the[0111]basket electrodes26. The physician can accomplish this result by using an electrode to thermally destroy myocardial tissue, either by heating or cooling the tissue. Alternatively, the physician can inject a chemical substance that destroys myocardial tissue. The physician can use other means for destroying myocardial tissue as well.
• The illustrated and preferred embodiment accomplishes ablation by using an endocardial electrode to emit energy that heats myocardial tissue to thermally destroy it. The energy is transmitted between the endocardial electrode and an exterior indifferent electrode on the patient.[0112]
• The type of ablating energy can vary. It can, for example, be radio frequency energy or microwave energy. The ablating energy heats and thermally destroys the tissue to form a lesion, thereby restoring normal heart rhythm.[0113]
• Ablating energy can be conveyed to one or[0114]more electrodes26 carried by thebasket24. In this way, one or more of thesensing electrodes26 on thebasket24 can also be used for tissue ablation.
• As FIG. 15 shows, an external[0115]steerable ablating probe150 can be used in association with thebasket24. The physician steers theprobe150 under fluoroscopic control to maneuver theablating element152 into thebasket24. Once inside thebasket24, the physician steers theablating element152 into contact with the tissue region identified by thebasket electrodes26 as the likely efficacious site for ablation. The physician then conveys ablating energy to theelement152.
• In this arrangement, the[0116]basket24 serves, not only to identify the likely ablation sites, but also to stabilize theexternal ablating probe150 within a confined region within theheart chamber12.
• FIGS. 16 and 17 show an alternative configuration for a three[0117]dimensional structure154 that themapping probe18 can carry.
• In this embodiment, the[0118]structure154 comprises a single length of inert wire material, such a Nitinol metal wire, preformed into a helical array. While the particular shape of the helical array can vary, in the illustrated embodiment, the array has a larger diameter in its midsection than on its proximal and distal ends.
• As FIG. 16 shows, the[0119]structure154 can be used to stabilize the externalsteerable ablation probe150 in the same fashion as thebasket24 shown in FIG. 15 does.
• The[0120]structure154 can also carryelectrodes156, like thebasket24, for mapping and/or ablating purposes.
• As FIG. 17 shows, the[0121]structure154 can be collapsed in response to an external compression force. The distal end of theslidable guide sheath16 provides this compression force to retract and deploy thestructure154 inside the selected heart chamber, just like thebasket structure24.
• FIGS. 18 and 19 show yet another alternative configuration for a three[0122]dimensional structure158 that can be carried by themapping probe18. In this embodiment, thestructure158 comprises twoindependent loops160 and162 of inert wire material, such a Nitinol metal wire.
• The[0123]loop160 nests within theloop162. The distal ends of the nestedloops160 and162 are not joined. Instead, the nestedloops160 and162 are free to flex and bend independently of each other.
• In the illustrated configuration, the[0124]loops160 and162 form right angles to each other. Of course, other angular relationships can be used. Additional independent loops can also be included to form thestructure158.
• As FIG. 18 shows, the[0125]loop structure158 can be used to stabilize the externalsteerable probe150 in the same fashion as thestructures24 and154 shown in FIGS. 15 and 16 do.
• One or more of the[0126]loops160 and162 can also carryelectrodes164 for mapping and/or ablating purposes.
• As the[0127]previous structures24 and154, thestructure158 can be collapsed in response to an external compression force, as FIG. 19 shows. The distal end of theslidable guide sheath16 provides this compression force to retract and deploy thestructure158 inside the selectedheart chamber12.
• FIGS. 20 and 21 show an alternative embodiment of a[0128]guide sheath166 that can be used in association with theintroducer14 to locate asteerable ablation probe168 inside the selectedheart chamber12.
• Unlike the[0129]guide sheath22, theguide sheath166 is preformed with a memory that assumes a prescribed complex curvature in the absence of an external stretching or compressing force.
• FIG. 20 shows in phantom lines the[0130]guide sheath166 in a stretched or compressed condition, as it would be when being advanced along thesteerable catheter body68 through the access vein or artery.
• Upon entering the less constricted space of the[0131]heart chamber12, as FIG. 21 shows, thesheath166 assumes its complex curved condition. The complex curve is selected to simplify access to difficult-to-reach locations within the heart, such as through the inferior vena cava into the right ventricle, as FIG. 21 shows.
• Like the[0132]sheath16, thesheath166 preferably includes a conventionalhemostatic valve169 on its proximal end. As previously described, thehemostatic valve169 includes a resilient slotted membrane to block the outflow of fluids, while allowing passage of a catheter body.
• FIG. 21 shows the[0133]sheath166 in use in association with asteerable ablating probe168, which enters thesheath166 through thehemostatic valve169. Thesheath166, like thesheath16, guides theprobe168 through the access vein or artery into theheart chamber12.
• The complex curvature of the[0134]sheath166 more precisely orients thesteerable ablation probe168 with respect to the intended ablation site than thesheath16. As FIG. 21 shows, the complex curvature points the distal end of thesheath166 in a general orientation toward the intended ablation site. This allows the physician to finally orient the ablating element170 with the intended site using fine steering adjustments under fluoroscopic control.
• The embodiment shown in FIGS. 20 and 21 uses the preformed[0135]sheath166 to provide relatively coarse steering guidance for theablation probe168 into theheart chamber12. Thesheath166 simplifies the task of final alignment and positioning of the ablating element with respect to the precise ablation region, which the physician can accomplish using a few, relatively fine remote steering adjustments.
• FIGS. 22 and 23 show yet another alternative embodiment of a[0136]guide sheath172 that can be used in association with theintroducer14 to locate an ablation probe174 inside the selectedheart chamber12.
• In FIGS. 22 and 23, the[0137]guide sheath172 includes asheath body176 with a steerabledistal tip178. As FIG. 22 shows, thesheath body176 is extruded to include acenter guide lumen180 and twoside lumens182.Steering wires183 extend through theside lumens182, which are located near the exterior surface of thebody176.
• The distal ends of the[0138]steering wires183 are attached to theside lumens182 at thedistal tip178 of thesheath body176. The proximal ends of thesteering wires183 are attached to asteering mechanism186 within a handle188 attached at the proximal end of thesheath body176.
• The[0139]steering mechanism186 can vary. In the illustrated embodiment, themechanism186 is the rotating cam arrangement shown in FIG. 9. In this arrangement, thesteering mechanism186 includes anexterior steering lever190. Fore and aft movement of thesteering lever190 deflects thedistal tip178 of theguide sheath176, as FIG. 22 shows.
• Like the[0140]sheath16, thesheath172 preferably includes a conventionalhemostatic valve185 on its proximal end to block the outflow of fluids while allowing the passage of a catheter body.
• The[0141]steerable guide sheath172 is used in association with theintroducer14. The physician steers theguide sheath172 through the access vein or artery and into the selectedheart chamber12 under fluoroscopic control, as FIG. 23 shows. The physician then introduces the probe174 through thecenter guide lumen180.
• In this arrangement, the probe[0142]174 can carry a mapping structure, like those shown in FIGS. 1;16; and18. Alternatively (as FIG. 23 shows), the probe174 carries an ablating element192.
• Because the guide sheath[0143]174 is itself the catheter body194 of the probe174 need not include a steering mechanism. The catheter body194 need only carry the electrical conduction wires its function requires. The catheter body194 can therefore be downsized. Alternatively, the absence of a steering mechanism frees space within the catheter body194 for additional or larger electrical conduction wires, as ablating elements using coaxial cable or temperature sensing elements may require.
• FIG. 24 shows an[0144]integrated system86 for performing endocardial mapping and ablation.
• Like the first described[0145]system10, theintegrated system86 includes amapping probe18 withsensing electrodes26 carried by a threedimensional basket24. In addition, theintegrated system86 includes, as an integral part, asteerable ablating element88 that is carried within the openinterior area25 of thebasket24.
• The[0146]ablating element88 can be moved relative to thesensing electrodes26 in three principal directions. First, the ablatingelement88 moves along the axis of themapping probe body96. Second, the ablatingelement88 moves rotationally about the axis of themapping probe body96. Third, the ablatingelement88 moves in a direction normal to the axis of themapping probe body96. FIGS.25 to28 show the range of movement the preferred embodiment provides.
• Movement of the[0147]ablating element88 does not effect the contact between thesensing electrodes26 and the endocardial tissue. In other words, theelectrodes26 and theablating element88 are capable of making contact with endocardial tissue independent of each other.
• More specifically, the[0148]system86 includes asteerable ablation catheter90 that is an integral part of themapping probe18. Theablation catheter90 includes asteering assembly92 with a steerabledistal tip84. The steerabledistal tip84 carries theablating element88.
• As FIG. 27 shows diagrammatically, the[0149]mapping probe18 includes acatheter body96 through which thesteering assembly92 of theablation catheter90 passes during use. The proximal end of thecatheter body96 communicates with an opening at the rear of thehandle20. The distal end of thecatheter body96 opens into theinterior area25 of thebasket24. A conventionalhemostatic valve95 is located at this junction. As previously described, thevalve95 includes a resilient slotted membrane that blocks the outflow of fluid while allowing the passage of thesteering assembly92.
• The proximal end of the[0150]steering assembly92 of theablation catheter90 is attached to a handle98 (as FIG. 24 best shows). By pulling and pushing thehandle98, the physician moves the ablatingelement88 along the axis of themapping probe body96. By rotating thehandle98, the physician rotates the ablatingelement88 about the axis of themapping probe body96.
• The[0151]handle98 further encloses asteering mechanism74 for thetip84. Thesteering mechanism74 for the ablatingcatheter90 is the same as thesteering mechanism74 for thecatheter60 used in the first describedsystem10, and thereby shares the same reference number.
• As FIG. 27 generally shows, movement of the steering[0152]lever78 forward bends thedistal tip84, and with it, the ablatingelement88, down. Movement of the steeringlever78 rearward bends thedistal tip84, and with it, the ablatingelement88, up.
• FIGS. 25 and 26 also show the movement of the[0153]distal tip84 andelement88 through thebasket24 between a generally straight configuration (FIG. 25) and a deflected position, placing theablating element88 in contact with endocardial tissue (FIG. 26).
• By coordinating lateral (i.e., pushing and pulling) movement of the[0154]handle98 with handle rotation and tip deflection, it is possible to move theablating element88 in virtually any direction normal to the axis of thecatheter body96, as FIG. 28 shows.
• By rotating and moving the[0155]handle98 in these ways, it is possible to maneuver theablating element88 under fluoroscopic control through thebasket24 into contact with any point of the endocardial surface of thechamber12. The ablating88 can be moved through thebasket24 to tissue locations either in contact with the exterior surface of thebasket24 or laying outside the reach of thebasket24 itself.
• A[0156]cable100 with an outer insulating sheath is attached to the ablating element88 (see FIGS. 27 and 29). The electrically insulatedcable100 extends down the length of thesteering assembly92. Thecable100 conveys ablating energy to theelement88.
• A[0157]plug102 attached to the proximal end of the cable100 (see FIGS. 24 and 27) extends outside thehandle98 for connection to a source of ablating energy (not shown).
• The integrated mapping and[0158]ablation system86 shown in FIG. 24 shares various other components and methodologies with the first describedsystem10. Elements shared by the two embodiments are given common reference numbers.
• The integrated[0159]system86 uses thesame introducer14 to establish an access. It also uses the sameouter guide sheath16 and the same steerable catheter60 (with steerable catheter body68) to position theouter guide sheath16. Theouter sheath16 is inserted through theintroducer14 and positioned inside the heart by thesteerable catheter body68 in the same fashion as earlier described (and as shown in FIGS. 10 and 11).
• As also earlier described (and as FIG. 2 shows), the[0160]mapping probe18 is guided by theouter sheath16 into position. Themapping probe18 in theintegrated system86 also includes theslidable sheath16 to enclose and deploy thebasket24, in the same manner as earlier described. When enclosed by thesheath16, thebasket24 collapses about the distal tip94 and ablating element88 (as FIGS. 29 and 30 show).
• In use, the physician guides the[0161]mapping probe18 withintegral ablating catheter90 into position through theouter sheath16. The physician then deploys thebasket24, freeing theablating element88 for use, as FIG. 24 shows.
• As FIG. 24 shows, the basket structure contacts the surrounding endocardial tissue to hold and stabilize the[0162]ablating element88 in a desired confined region within the heart while thebasket electrodes26 provide mapping signals. The ablatingelement88 can be remotely steered to sites identified by the basket electrodes26 (as FIG. 26 shows). Ablating energy can then be applied to thermally destroy the tissue.
• As in the first described embodiment, the[0163]basket electrodes26 can be used for ablation purposes, too.
• As FIGS. 31 and 32 show, the[0164]catheter body96 of themapping probe18 comprises an integral multiple layer structure. In this structure, thesignal wires38 for thesensing electrodes26 on thebasket24 are imbedded within the walls of thecatheter body96. This structure frees space at the interior ofcatheter body96 to accommodate passage of thesteering assembly92.
• As FIGS. 31 and 32 show, the[0165]catheter body96 includes acenter tube106 made from a plastic material, such as Pebax tubing. Thecenter tube106 has aninterior bore108 of a size that accommodates thesteering assembly92 of the ablatingcatheter90.
• The[0166]catheter body96 includes twolayers110 and112 of copper signal wire38 (42 gauge) wrapped about thecenter tube106. Eachcopper signal wire38 carries an outer insulating sheath. In addition, the twolayers110 and112 are separated from each other by aninsulation layer114 of Teflon plastic or the like. Thelayer114 provides an added measure of insulation between thewires38, particularly in regions where point contact between the overlapping wire layers110 and112 could occur.
• In the illustrated embodiment, where the[0167]basket24 has sixty-four electrodes, eachlayer110 and112 carries eight groups of foursignal wires38. Thesignal wires38 are preferably wound helically along the length of thecatheter body96.
• The[0168]catheter body96 further includes a metalized plastic layer116 (such as metalized polyamide) that surrounds thesecond layer112 ofsignal wires38. Thelayer116 protection against electromagnetic interference (EMI). Thelayer116 is, in turn, enclosed within an outerplastic tube118 of a material such as Pebax.
• FIGS.[0169]33 to38 show a process for making the multiplelayer catheter body96.
• As FIG. 33 shows, the[0170]center tube106 is fastened byclamps124 to amandrel126. Themandrel126 is rotated during the assembly process. In the illustrated embodiment, themandrel126 rotates in a clockwise direction.
• A[0171]wire holder128 dispenses thirty-two shieldedsignal wires38 in eight groups of four each. During the assembly process, theholder128 advances along the axis of themandrel126 upon arotating lead screw130. In the illustrated embodiment, thelead screw130 is rotated clockwise to advance theholder128 from left to right along the axis of therotating mandrel126.
• By synchronizing the rotation of the[0172]mandrel126 with the translation of theholder128, the wire groups dispensed by theholder128 are helically wrapped about thecenter tube106. This forms thefirst layer110 ofsignal wires38 about thecenter tube106.
• As FIG. 34 shows, another[0173]holder132 is advanced by thelead screw130 along the axis of therotating mandrel126. Theholder132 helically wraps insulating Teflonplastic tape134 about thefirst layer110 ofsignal wires38. This forms the added insulatinglayer114 of thecatheter body96.
• As FIG. 35 shows, the[0174]wire holder128 is again advanced by thelead screw130 along the axis of therotating mandrel126, which during this step is rotated counterclockwise. Theholder128 dispenses thirty-twoadditional signal wires38 in eight groups of four each about the insulatinglayer114. Therotating lead screw130 advances theholder128 from right to left while themandrel126 rotates counterclockwise to helically wrap thesecond layer112 ofsignal wires38 about the insulatinglayer114, counterwound to thefirst layer110.
• The counterwinding of the signal wire layers[0175]110 and112 provides greater torque transmission for rotating thebasket24 in response to rotating thehandle20. While counterwinding is preferred for this reason, the signal wire layers110 and112 can be wrapped in the same direction.
• As FIG. 36 shows, another[0176]holder136 is advanced by thelead screw130 along the axis of therotating mandrel126. Theholder136 helically wraps metalizedplastic material138 about thesecond wire layer112, creating theEMI shield layer116.
• As FIG. 37 shows, another[0177]holder140 advanced by thelead screw130 dispenses adhesive142 upon the metalizedlayer116.
• As FIG. 38 shows, the[0178]outer sleeve118 is pulled over the adhesive142 to complete the structure of the multiplelayer catheter body96.
• Various features of the invention are set forth in the following claims.[0179]

Claims (15)

What is claimed is:

1. A probe for use within the heart to contact endocardial tissue comprising

a catheter tube having a distal end,

a first electrode element on the distal end,

second electrode element on the distal end, the second electrode element defining a three-dimensional structure that extends along an axis and that has an open interior, and

means for moving the first electrode element within the open interior of the second electrode element in a first direction along the axis of the second electrode element, in a second direction rotating about the axis of the second electrode element, and in a third direction normal to the axis of the second electrode element.

2. A probe according to

claim 1

wherein at least one of the first and second electrode elements is operative for emitting energy to ablate myocardial tissue.

3. A probe according to

claim 1

wherein at least one of the first and second electrode elements is operative for sensing electrical activity in endocardial tissue.

4. A probe according to

claim 1

wherein one of the first and second electrode elements is operative for sensing electrical activity in endocardial tissue, and

wherein the other one of the first and second electrode elements is operative for emitting energy to ablate myocardial tissue.

5. A probe according to

claim 1

wherein at least one of the first and second electrode elements is operative in a first mode for sensing electrical activity in endocardial tissue and in a second mode for emitting energy to ablate myocardial tissue.

6. A system for use within the heart to contact endocardial tissue comprising

a first probe comprising

a catheter tube having a proximal end, a distal end, and a bore extending along an axis between the proximal and distal end, and

a three dimensional structure having an open interior area carried on the distal end of the catheter tube, the structure having an exterior surface for contacting endocardial tissue,

a second probe comprising

a guide body having a proximal end and a distal end, the guide body being slidably received with the catheter tube bore with the distal end of the guide body extending beyond the distal end of the catheter tube into the open interior area of the structure and with the proximal end of the guide body extending beyond the proximal end of the catheter tube,

an electrode element carried on the distal end of the guide body, and

means for steering the electrode element through the hollow interior area in a first direction along the axis of the catheter tube bore, in a second direction rotating about the axis of the catheter tube bore, and in a third direction normal to the axis of the catheter tube bore.

7. A system according to

claim 6

and further including means for collapsing the structure to close the interior area and for expanding the structure to open the interior area.

8. A system according to

claim 6

and further including a second electrode element on the exterior surface of the structure.

9. A system according to

claim 8

wherein at least one of the first and second electrode elements is operative for sensing electrical activity in endocardial tissue.

10. A system according to

claim 8

wherein the at least one of the first and second electrode elements is operative for emitting energy to ablate myocardial tissue.

11. A system according to

claim 6

wherein the electrode element is operative for emitting energy to ablate myocardial tissue.

12. A system according to

claim 6

and further including a second electrode element on the exterior surface operative for sensing electrical activity in endocardial tissue.

13. A system according to

claim 12

wherein the first electrode element is operative for emitting energy to ablate myocardial tissue.

14. A system according to

claim 13

wherein the second electrode element is further operative for emitting energy to ablate myocardial tissue.

15. A system according to

claim 6

and further including a handle attached to the proximal end of the guide body, and

wherein the handle includes control means attached to the steering means for remotely moving the electrode element in the third direction.

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