CN109953812A - A kind of mapping cryoablation integral type conduit - Google Patents
A kind of mapping cryoablation integral type conduit Download PDFInfo
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- CN109953812A CN109953812A CN201711421997.8A CN201711421997A CN109953812A CN 109953812 A CN109953812 A CN 109953812A CN 201711421997 A CN201711421997 A CN 201711421997A CN 109953812 A CN109953812 A CN 109953812A
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Abstract
The present invention relates to cryoablation field, especially a kind of mapping cryoablation integral type conduit comprising: have the tube body of front end rigion, front end rigion has free end;Sacculus, sacculus are arranged on the free end of front end rigion and can be frozen media filler and realize expansion or shrinkage;Control handle, front end rigion are installed on control handle and can be steered handle control bending;Outer surface is provided with strip carrier on sacculus, one end of strip carrier connects free end, the other end connects one end of opposed free ends on sacculus, array electrode is distributed on strip carrier, all array electrodes are along sacculus outer surface array spherical in shape, goal of the invention of the invention is to provide a kind of modeling more efficiency, can preferably detect sacculus and orifices of pulmonary veins target tissue mated condition during cryoablation pulmonary vein, finally keep ablation effect more preferable, while to the ablation more accurate mapping cryoablation integral type conduit of effect detection.
Description
Technical field
The present invention relates to cryoablation field, especially a kind of mapping cryoablation integral type conduit.
Background technique
Radio frequency ablation catheter or cryoablation conduit are clinically widely used to treat the arrhythmia cordis in atrium at present,
It is intraventricular if atrial premature beats contraction, auricular flutter, bypass property tachycardia, atrial fibrillation and AV tie reciprocal tachycardia
Ventricular arrhythmia, such as ventricular premature beat, Ventricular Tachycardia, the heart diseases such as ventricular fibrillation and long-term QT syndrome.
For most for the treatment of irregular heart pulse, RF ablation is all that safely effectively, but RF ablation still has office
Sex-limited and disadvantage.RF energy can destroy the structure and integrality of endothelium and tissue, be easy to cause formation and the embolism of thrombus
Generation.Heat is excessively high in radio frequency, impedance can be caused to increase, and can cause barotrauma and myocardial perforation.
In order to reach deeper depth of ablation, it clinically will use higher ablation energy, often will cause cardiac muscle in this way
Tissue local overheats and causes to form a scab, and is in the prior art usually to pass through spray to affect the validity and safety of operation
It spills salt water to cool down to ablation part, constantly conveys physiological saline to patient when due to operation, it may occur that a series of complication.
Meanwhile RF ablation is applied to atrial fibrillation therapy and is also faced with many clinical problems: such as the risk of cardiac perforation, the heart
Fleshy exterior layer and internal temperature are inconsistent, injury of phrenic nerve, melt the formation of carbonization/coagulum, atrial fibrillation ablation operation learning curve
Long, operating difficulty and technical requirements are very high, and different patients hardly results in consistent as a result, success rate differs greatly.Disappear point by point
The method melted is very time-consuming, and the operating time of many patients is all at 3 hours or more.
And cryoablation treatment is then a kind of interventional technique for applying to treat arrhythmia cordis in recent years.Since cryoablation is led
Pipe has the characteristics that freezing adherency, freezing mapping, cryoablation, along with tissue damage coating caused by freezing is complete, side
Boundary is clear, and the incidence of thrombus is extremely low, at a certain temperature cryoablation or a reversible process, it is possible to reduce III
The generation of the complication such as Aminophyline.From the mode of energy, RF ablation is to provide thermal energy to tissue, and freeze
Ablation is that thermal energy is absorbed from tissue.Therefore, this determines that cryoablation has unique advantage.Theoretically, freezing disappears
The operability and safety melted are superior to RF ablation.Document system shows that cryoablation effect is imitated no less than RF ablation
Fruit.
The common refrigerant of cryoablation has N2、(N2) and dry ice (CO O2), before refrigerant (i.e. refrigerant) enters equipment
The sacculus at end makes sacculus recline sacculus swell simultaneously, and (sacculus has central axis to target tissue, is provided simultaneously with equator, i.e. equator
The plane and central axis upright at place and be located at sacculus in the middle part of), target tissue temperature is dropped to 0 DEG C hereinafter, keeping cell inside and outside
Tissue fluid form ice crystal, eucaryotic cell structure is destroyed.To make cell dehydration, the lipoprotein denaturation of membranous system, down to necrosis.Compared with
M- 10 DEG C to -25 DEG C of freezing in short-term is only capable of making cell appearance at ice crystal, can not destroy histocyte completely, but increase freezing
Time can reach completely destroy histocyte, -40 DEG C and it is following can make in a short time intraor extracellular formed ice crystal so that cell
Necrosis selects design parameter (temperature and time) according to clinical disease demand.
When cryoablation targetedly carries out cryoablation to orifices of pulmonary veins, presently, there are some defects.
When being expanded after sacculus reaches orifices of pulmonary veins (filling refrigerant or gas at normal temperature in sacculus), it can not learn
The degree of sacculus to recline, the position of sacculus not to, expansion it is too excessive to the pressure of tissue greatly or expansion not enough and tissue match
Can all the effect of cryoablation be impacted by closing defective tightness;
Meanwhile after the completion of ablation, the ablation effect of tissue can not be measured well, and the measurement of effectiveness of cryoablation is at present
Spiral helicine electrode is set in sacculus front end, the pulmonary vein tissue that then electrode touches sacculus front end carries out providing stimulation letter
Number, the setting of sacculus rear end receives the electrode of signal, if stimulus signal can be received, then it represents that it melts successfully, but this mode
Inaccuracy cannot understand the specific ablation situation for knowing the circumferentially upper corresponding target tissue region of sacculus, if because it pastes early period
By situation is undesirable or the factor controllings such as latter temperature are bad, an only very narrow circle is ablated to success, then sacculus at this time
Rear end is also that can not receive stimulus signal, is determined successfully, but actually ablation effect is bad, most of aura target tissue
The processing of cryoablation is not obtained;
Secondly, after sacculus reaches in atrium sinistrum or reaches orifices of pulmonary veins, the sacculus front end spiral helicine mapping component of stretching into
Row modeling, current modeling speed is slow, and modeling efficiency is low.
Summary of the invention
In view of the problems of the existing technology, goal of the invention of the invention is to provide a kind of modeling more efficiency, is freezing
Sacculus and orifices of pulmonary veins target tissue mated condition can be preferably detected during ablation pulmonary vein, finally makes ablation effect more
It is good, while to the ablation more accurate mapping cryoablation integral type conduit of effect detection.
To achieve the goals above, the technical solution adopted by the present invention are as follows:
A kind of mapping cryoablation integral type conduit comprising:
Has the tube body of front end rigion, the front end rigion has free end;
Sacculus, the sacculus are arranged on the free end of the front end rigion and can be frozen media filler and realize
Expansion or shrinkage;
Control handle, the tube body are installed on the control handle and can be controlled by the control handle and be bent;
Outer surface is provided with strip carrier on the sacculus, one end of the strip carrier connects the free end, separately
One end connects one end of the relatively described free end on the sacculus, and array electrode, all institutes are distributed on the strip carrier
Array electrode is stated along the sacculus outer surface array spherical in shape.
By the way that strip carrier is arranged along outer surface on sacculus, (more optimized structure is easier to grouping array electrode while also just
In the relevant electrode cable of arrangement, the electrode cable of array electrode is connected on front end rigion out of sacculus or strip carrier, finally
It is connected on the ablatograph of rear end), then array electrode is set on strip carrier again, all array electrodes are along the ball
Capsule outer surface array spherical in shape, is more evenly distributed, and when sacculus enters left ventricle, can cooperate with the ablatograph of rear end, into
Row quickly modeling, modeling efficiency is higher, while also more acurrate, and the arrangement of array electrode is from one end of sacculus edge to the other end
(head end and tail end of sacculus can be construed to here, the tail end of sacculus is the one end for connecting the free end of the front end rigion), by
It is to form ball array between array electrode, it is possible to the reality of sacculus is judged by the potential difference between different array electrodes
Shi great little is matched and is adjusted when with the modeling of heart, orifices of pulmonary veins target tissue is more accurately moved to convenient for sacculus, works as sacculus
Expansion to a certain extent when touch orifices of pulmonary veins target tissue, by discharge between the different array electrodes on sacculus into
Row impedance detection, detection recline the impedance of tissue, converse the degree that suitably reclines (recline closer, impedance is smaller, it is on the contrary then
Bigger, in corresponding background technique stress problems, judge the effect that reclines with impedance here, instead of falling the side judged by pressure
Formula), therefore feed back by the size of sacculus and the degree that reclines the effect of balloon occluder orifices of pulmonary veins in real time, when block it is good with
Afterwards, that is, start to carry out cryoablation, ablation effect is more preferable;
Meanwhile after the completion of ablation, array electrode can provide stimulation, then (the sacculus head end/tail end direction on the outside of pulmonary vein
Or outer) detect whether to detect stimulus signal, success is melted if it cannot detect stimulus signal, on the contrary fail, by
After array electrode is to extend to tail end from the head end of sacculus in array fashion, so be equivalent on the axis of pulmonary vein,
Array electrode can touch more tissues, that is to say, that even such in background technique, " an only very narrow circle is disappeared
Melt success ", array electrode can also touch this circle tissue other than it can be ablated to successfully organize contact with this part
Two sides, so, on array electrode more positioned at outside part issue stimulus signal can then be received, then it represents that ablation not
Success successfully recognizes in background technique the failed state of " an only very narrow circle is ablated to success " at this time, detects more quasi-
Really.
Meanwhile can carry out providing stimulation stimulus signal with one between adjacent array electrode, another carries out reception stimulation
Signal, principle is as above, if can receive, proves to melt unsuccessful, but is their ability to " laterally (along sacculus equatorial direction
For transverse direction) " more accurately successful range is melted in detection and above-mentioned detection mode cooperates, it detects more acurrate.
Meanwhile traditional spiral helicine mapping component is eliminated, make more optimized structure, operation is also simpler when use, preceding
End section can be made thinner, be more convenient for intervening patient's body.
As a preferred solution of the present invention, the strip carrier is three or more, and is in fixed angles between adjacent strip carrier
Degree ground is distributed centered on the central axis of sacculus.
As a preferred solution of the present invention, the strip carrier quantity is odd number, and in fixation between adjacent strip carrier
It is distributed centered on the central axis of sacculus to angle.
As a preferred solution of the present invention, the strip carrier quantity is even number, and in fixation between adjacent strip carrier
It is distributed centered on the central axis of sacculus to angle.
As a preferred solution of the present invention, the strip carrier quantity is eight, and between adjacent strip carrier in 45 ° of ground with
It is distributed centered on the central axis of sacculus.
As a preferred solution of the present invention, the outer surface of the free end of the front end rigion is provided with cricoid proximal end electricity
Pole, proximal electrode can cooperate with array electrode, and the size of sacculus is preferably judged during above-mentioned survey potential difference,
It is more accurately moved to orifices of pulmonary veins target tissue convenient for sacculus, while can also be matched with array electrode and carry out above-mentioned impedance
Detection, convenient for more comprehensively judge sacculus and tissue the degree that reclines, certainly, the effect detection after ablation, also can as detection
The device of stimulus signal, structure are more preferably also convenient for the judgement of ablation effect simultaneously.
As a preferred solution of the present invention, the one end connecting on the sacculus with the free end of the front end rigion is ball
Capsule tail end, one end opposite with sacculus tail end are sacculus head end, and the protrusion paid outward, the protrusion is arranged in the sacculus head end
Outer surface be provided with cricoid remote electrode, in effect detection after ablation, as detection stimulus signal device and battle array
Column electrode cooperates the first half contact group that can be used for determining sacculus (especially in the array electrode of sacculus first half)
The case where impedance knitted, convenient for the judgement of ablation effect, while sacculus is to use to the ablation major part situation of orifices of pulmonary veins
The first half of sacculus and tissue contact, the setting of remote electrode the detection of ablation effect can be made more acurrate also more applicable with now
Shape.
As a preferred solution of the present invention, the top of the protrusion is provided with the antisitic defect structure of arc, to orifices of pulmonary veins
And atrium sinistrum inner wall is preferably protected.
The beneficial effects of the present invention are:
By the way that strip carrier is arranged along outer surface on sacculus, (more optimized structure is easier to grouping array electrode while also just
In the relevant electrode cable of arrangement, the electrode cable of array electrode is connected on front end rigion out of sacculus or strip carrier, finally
It is connected on the ablatograph of rear end), then array electrode is set on strip carrier again, all array electrodes are along the ball
Capsule outer surface array spherical in shape, is more evenly distributed, and when sacculus enters left ventricle, can cooperate with the ablatograph of rear end, into
Row quickly modeling, modeling efficiency is higher, while also more acurrate, and the arrangement of array electrode is from one end of sacculus edge to the other end
(head end and tail end of sacculus can be construed to here, the tail end of sacculus is the one end for connecting the free end of the front end rigion), by
It is to form ball array between array electrode, it is possible to the reality of sacculus is judged by the potential difference between different array electrodes
Shi great little is matched and is adjusted when with the modeling of heart, orifices of pulmonary veins target tissue is more accurately moved to convenient for sacculus, works as sacculus
Expansion to a certain extent when touch orifices of pulmonary veins target tissue, by discharge between the different array electrodes on sacculus into
Row impedance detection, detection recline the impedance of tissue, converse the degree that suitably reclines (recline closer, impedance is smaller, it is on the contrary then
Bigger, in corresponding background technique stress problems, judge the effect that reclines with impedance here, instead of falling the side judged by pressure
Formula), therefore feed back by the size of sacculus and the degree that reclines the effect of balloon occluder orifices of pulmonary veins in real time, when block it is good with
Afterwards, that is, start to carry out cryoablation, ablation effect is more preferable;
Meanwhile after the completion of ablation, array electrode can provide stimulation, then (the sacculus head end/tail end direction on the outside of pulmonary vein
Or outer) detect whether to detect stimulus signal, success is melted if it cannot detect stimulus signal, on the contrary fail, by
After array electrode is to extend to tail end from the head end of sacculus in array fashion, so be equivalent on the axis of pulmonary vein,
Array electrode can touch more tissues, that is to say, that even such in background technique, " an only very narrow circle is disappeared
Melt success ", array electrode can also touch this circle tissue other than it can be ablated to successfully organize contact with this part
Two sides, so, on array electrode more positioned at outside part issue stimulus signal can then be received, then it represents that ablation not
Success successfully recognizes in background technique the failed state of " an only very narrow circle is ablated to success " at this time, detects more quasi-
Really.
Meanwhile can carry out providing stimulation stimulus signal with one between adjacent array electrode, another carries out reception stimulation
Signal, principle is as above, if can receive, proves to melt unsuccessful, but is their ability to " laterally (along sacculus equatorial direction
For transverse direction) " more accurately successful range is melted in detection and above-mentioned detection mode cooperates, it detects more acurrate.
Meanwhile traditional spiral helicine mapping component is eliminated, make more optimized structure, operation is also simpler when use, preceding
End section can be made thinner, be more convenient for intervening patient's body.
Detailed description of the invention
Fig. 1 is the first viewing angle constructions schematic diagram of the embodiment of the present invention 1;
Fig. 2 is the second viewing angle constructions schematic diagram of the embodiment of the present invention 1;
Fig. 3 is the schematic diagram when sacculus of the embodiment of the present invention 1 is just extend into atrium sinistrum;
Schematic diagram when Fig. 4 is expansion progress mapping after the sacculus of the embodiment of the present invention 1 is extend into atrium sinistrum;
Fig. 5 is the sacculus of the embodiment of the present invention 1 and orifices of pulmonary veins reclines schematic diagram;
Structural schematic diagram when Fig. 6 is 1 balloon inflation state of the embodiment of the present invention;
Structural schematic diagram when Fig. 7 is 1 sacculus contraction state of the embodiment of the present invention;
Marked in the figure: 1- sacculus, 2- array electrode A, 3- array electrode B, 4- array electrode C, 5- array electrode D, 6- gust
Column electrode E, 71- remote electrode A, 72- remote electrode B, 81- proximal electrode A, 82- proximal electrode B, 61- strip carrier, 9- into
Feed channel, 10- outlet pipe, 11- magnetic position sensor, 12- antisitic defect structure, 22- sheath, 13- control handle, 14- tube body,
15- pressure and flow sensor, 16- electrode connector, 17- freeze attachment device.
Specific embodiment
Below with reference to embodiment and specific embodiment, the present invention is described in further detail.But this should not be understood
For the scope of the above subject matter of the present invention is limited to the following embodiments, all technologies realized based on summary of the invention of the invention are equal
Belong to the scope of the present invention.
Embodiment 1
Such as Fig. 1,2,6 and 7, a kind of mapping cryoablation integral type conduit comprising:
Has the tube body 14 of front end rigion, the front end rigion has free end;
Sacculus 1, the sacculus 1 are arranged on the free end of the front end rigion and can be frozen media filler and reality
Existing expansion or shrinkage;
Control handle 13, the tube body 14 are installed on the control handle 13 and can be controlled by the control handle 13
Bending.
Outer surface is provided with strip carrier 61 on the sacculus 1, one end of the strip carrier 61 connects the freedom
End, the other end connect one end of the relatively described free end on the sacculus 1, array electrode are distributed on the strip carrier 61,
All array electrodes are along 1 outer surface of sacculus array spherical in shape.
In the present embodiment, the strip carrier 61 be three or more, and between adjacent strip carrier 61 in fixed angle with
It is distributed centered on the central axis of sacculus 1, specifically, 61 quantity of the strip carrier is even number, can be seen that in Fig. 1-2, it is real
Applying 61 quantity of strip carrier in example is eight, and is divided centered on the central axis of sacculus 1 between adjacent strip carrier 61 in 45 ° of ground
5 array electrodes are distributed on single strip carrier 61 in cloth, as shown in figure 1, array electrode A2, array electrode B3, array electrode
Shown in C4, array electrode D5 and array electrode E6.
The one end connecting on the sacculus 1 with the free end of the front end rigion is 1 tail end of sacculus, with 1 tail end of sacculus
Opposite one end is 1 head end of sacculus, and the protrusion paid outward is arranged in 1 head end of sacculus, and the outer surface of the protrusion is provided with
Cricoid remote electrode, in the present embodiment there are two remote electrodes, respectively remote electrode A71 and remote electrode B72 are described convex
The top risen is provided with the antisitic defect structure 12 of arc, and the outer surface of the free end of the front end rigion is provided with cricoid close
Termination electrode, in embodiment there are two proximal electrodes, respectively proximal electrode A81 and proximal electrode B82, in shown front end rigion from
The admission line 9 and outlet pipe 10 protruded into sacculus 1, the freezing up to standard for the delivery temperature into sacculus 1 are provided with by end
Medium freezes, while output temperature has built up the refrigerant for needing to cool down again, and refrigerant is the gas after pressurization
System is at such as N2、(N2) and dry ice (CO O2) etc..
It is additionally provided with magnetic position sensor 11 by the proximal electrode, is used to help judge 1 position of sacculus, the manipulation
Electrode connector 16, freezing attachment device 17 are provided in handle 13, the electrode connector 16 passes through manipulation hand by conducting wire
Handle 13 is finally connected with array electrode, remote electrode with proximal electrode, and array electrode, remote electrode and proximal electrode pass through electrode
Connector 16 is connected with the ablatograph of rear end, ablatograph respectively between array electrode, remote electrode, proximal electrode carry out electric energy with
And the transmitting of signal, and array electrode, remote electrode and proximal electrode are carried out different working conditions, the sacculus 1 by control
Inner space by freeze attachment device 17 connect with ablatograph, ablatograph by freeze attachment device 17 it is defeated into sacculus 1
It send cooling medium and passes through the control parameters such as flow and temperature, control the process of ablation, setting in the freezing attachment device 17
There are pressure and flow sensor 15, whether in safe range to monitor the pressure for the cooling medium that ablatograph conveys.
Ablation procedure such as Fig. 3-5, such as Fig. 3, catheter tube is introduced into atrium sinistrum under the guidance of sheath 22, then as schemed
4, the expansion of sacculus 1 (make the expansion of sacculus 1 in the step is not necessarily refrigerant, is also possible to the gas of room temperature) makes battle array
Then column electrode array spherical in shape is quickly modeled with ablatograph cooperation, then in array electrode, remote electrode and proximal end
The cooperation of electrode and magnetic position sensor 11 judges degrees of expansion and the position of sacculus 1, then compares with the model built up,
Find suitable and orifices of pulmonary veins the position that reclines, such as Fig. 5, then further according to array electrode, remote electrode and proximal electrode
Cooperation, the degree that reclines of sacculus 1 and orifices of pulmonary veins tissue is judged by way of above-mentioned measurement impedance, is then adjusted, looks for
To after optimum state, it is conveying to cooling medium is carried out in sacculus 1, carries out cryoablation.
Embodiment 2
In the present embodiment and embodiment 1 the difference is that, 61 quantity of strip carrier is odd number, and adjacent strip
It in fixed angle is distributed centered on the central axis of sacculus 1 between shape carrier 61.
Claims (8)
1. a kind of mapping cryoablation integral type conduit comprising:
Has the tube body of front end rigion, the front end rigion has free end;
Sacculus, the sacculus are arranged on the free end of the front end rigion and can be frozen media filler and realize expansion
Or it shrinks;
It is characterized in that, further including control handle, the tube body is installed on the control handle and can be by the manipulation hand
Handle control bending;
Outer surface is provided with strip carrier on the sacculus, one end of the strip carrier connects the free end, the other end
One end of the relatively described free end on the sacculus is connected, array electrode, all battle arrays are distributed on the strip carrier
Column electrode is along the sacculus outer surface array spherical in shape.
2. a kind of mapping cryoablation integral type conduit according to claim 1, which is characterized in that the strip carrier is
Three or more, and be distributed centered on the central axis of sacculus between adjacent strip carrier in fixed angle.
3. a kind of mapping cryoablation integral type conduit according to claim 2, which is characterized in that the strip carrier number
Amount is odd number, and is distributed centered on the central axis of sacculus between adjacent strip carrier in fixed angle.
4. a kind of mapping cryoablation integral type conduit according to claim 2, which is characterized in that the strip carrier number
Amount is even number, and is distributed centered on the central axis of sacculus between adjacent strip carrier in fixed angle.
5. a kind of mapping cryoablation integral type conduit according to claim 2, which is characterized in that the strip carrier number
Amount is eight, and is distributed centered on the central axis of sacculus between adjacent strip carrier in 45 ° of ground.
6. a kind of mapping cryoablation integral type conduit described in -5 any one according to claim 1, which is characterized in that described
The outer surface of the free end of front end rigion is provided with cricoid proximal electrode.
7. a kind of mapping cryoablation integral type conduit according to claim 6, which is characterized in that on the sacculus with institute
The one end for stating the free end connection of front end rigion is sacculus tail end, and one end opposite with sacculus tail end is sacculus head end, described
The protrusion paid outward is arranged in sacculus head end, and the outer surface of the protrusion is provided with cricoid remote electrode.
8. a kind of mapping cryoablation integral type conduit according to claim 7, which is characterized in that the top of the protrusion
It is provided with the antisitic defect structure of arc.
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CN201711421997.8A CN109953812B (en) | 2017-12-25 | 2017-12-25 | Mapping, freezing and ablation integrated catheter |
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CN112932647A (en) * | 2021-03-09 | 2021-06-11 | 中国人民解放军总医院第一医学中心 | Freezing sacculus |
CN113952020A (en) * | 2021-11-10 | 2022-01-21 | 心航路医学科技(广州)有限公司 | Sacculus-shaped pulse electric field ablation device |
CN114027967A (en) * | 2021-11-10 | 2022-02-11 | 心航路医学科技(广州)有限公司 | Pulsed electric field balloon component and ablation catheter device using same |
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Address after: No. 5, Wuke East 3rd Road, Wuhou District, Chengdu, Sichuan 610000 Patentee after: Sichuan Jinjiang Electronic Medical Device Technology Co.,Ltd. Address before: No.5, Wuke East 3rd road, Wuhou Science Park, Chengdu hi tech Industrial Development Zone, Sichuan 610045 Patentee before: SICHUAN JINJIANG ELECTRONIC SCIENCE AND TECHNOLOGY Co.,Ltd. |