JP2021522898A - 心外膜アブレーションカテーテル - Google Patents
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Abstract
【選択図】図1
Description
本出願は、2018年5月7日出願の米国仮出願第62/667,964号の利益を主張し、その開示全体は、参照することによってその全体が本明細書に組み込まれる。
I.システム
概要
信号発生器
アブレーションデバイスおよびシンチデバイス
基準
II.方法
パルス波形
Claims (39)
- 近位部分、遠位部分、および中央部分を含むアブレーションデバイスであって、前記中央部分が、上に配置される電極のセットを含む、アブレーションデバイスと、
前記アブレーションデバイスの前記近位および遠位部分を、シンチ(cinch)デバイスの第1および第2の内腔の中で受け取るとき、前記アブレーションデバイスの前記中央部分が、調整可能なループを形成するように、前記アブレーションデバイスの前記近位部分を摺動可能に受け取るように構成される、前記第1の内腔と、前記第1の内腔と平行に延在し、前記アブレーションデバイスの前記遠位部分を摺動可能に受け取るように構成される、前記第2の内腔とを画定するシンチデバイスと、を備える、システム。 - 前記電極のセットが、電極のサブセットを含み、電極の各サブセットが、第1の長さを有し、電極の隣接するサブセットは、第2の長さだけ互いに離隔する、請求項1に記載のシステム。
- 前記電極のセットが、約4つの電極サブセットと約20個の電極サブセットとの間を含む、請求項2に記載のシステム。
- 前記アブレーションデバイスが、基準の第1および第2のセットを含み、前記基準の第1および第2のセットのうちの基準が、前記アブレーションデバイスの全長に沿って交互に配置され、前記基準の第1のセットは、1つ以上の特性によって前記基準の第2のセットとは異なる、請求項2または3に記載のシステム。
- 前記基準の第1のセットのうちの隣接する基準は、前記第1および第2の長さの合計だけ相隔たる、請求項4に記載のシステム。
- 前記基準の第1および第2のセットが、前記アブレーションデバイスの前記近位および遠位部分のうちの少なくとも1つに沿って配置される、請求項4または5に記載のシステム。
- 前記1つ以上の特性が、長さ、厚さ、深さ、形状、色、模様、配向、質感、または材料のうちの少なくとも1つを含む、請求項4〜6のいずれか一項に記載のシステム。
- 前記基準の第1のセットのうちの基準は、前記電極のセットのうちの電極の幅に等しい第3の長さだけ、前記基準の第2のセットのうちの隣接する基準から離隔する、請求項4〜7のいずれか一項に記載のシステム。
- 前記シンチデバイスが、前記第1および第2の長さの合計の整数倍である、第4の長さを有する、請求項2〜8のいずれか一項に記載のシステム。
- 電極の各サブセットは、複数の電極を含み、前記複数の電極の各電極が、第3の長さを有し、前記複数の電極のうちの隣接する電極から、ある距離だけ離隔し、
隣接する近位基準間に間隙を伴う基準のセットを含む、前記アブレーションデバイスが、前記第3の長さに等しい第4の長さと、前記ある距離に等しい第5の長さとを交互に繰り返す、請求項2または3に記載のシステム。 - 電極の各サブセットは、複数の電極を含み、前記複数の電極のうちの第1の電極は、第3の長さを有し、前記複数の電極のうちの第2の電極は、前記第3の長さより大きい第4の長さを有し、
前記アブレーションデバイスが、前記アブレーションデバイスの全長に沿って交互に配置される、基準の第1および第2のセットを含み、前記基準の第1のセットのうちの基準が、前記基準の第2のセットのうちの隣接する基準から、前記第3の長さだけ離隔している、請求項2または3に記載のシステム。 - 前記アブレーションデバイスが直線的に延在する第1の構成と、前記アブレーションデバイスの前記中央部分が、前記調整可能なループを形成する第2の構成との間を、前記アブレーションデバイスが移行するように構成される、請求項1〜11のいずれか一項に記載のシステム。
- 前記調整可能なループが、心臓の肺静脈のセットの周りに位置づけられるように構成される、請求項1〜12のいずれか一項に記載のシステム。
- 前記電極のセットが、電圧パルス波形の受信に応答して、パルス電界を生成して、心組織をアブレーションするように構成される、請求項1〜13のいずれか一項に記載のシステム。
- 前記アブレーションデバイスが、前記アブレーションデバイスの前記近位部分の近位端に結合されるハンドルを含む、請求項1〜14のいずれか一項に記載のシステム。
- 前記アブレーションデバイスが、ガイドワイヤを使用して、カテーテルを心臓の肺静脈のセットの周りに位置づけることができるように、ガイドワイヤを受け取るよう構成されるガイドワイヤ内腔を含む、前記カテーテルである、請求項1〜15のいずれか一項に記載のシステム。
- 前記アブレーションデバイスを、前記シンチデバイスに対して適所に保持するように構成される、ロックをさらに備える、請求項1〜16のいずれか一項に記載のシステム。
- 前記電極のセットの各電極が、約1mmと約12mmとの間の長さを含む、請求項1〜17のいずれか一項に記載のシステム。
- 前記アブレーションデバイスの前記遠位部分が、約20cmと約70cmとの間の長さを有する、請求項1〜18のいずれか一項に記載のシステム。
- 互いと平行に延在する第1および第2の内腔を画定する、細長いシャフトを備え、アブレーションカテーテルの対向端部を、前記第1および第2の内腔内で受け取るときに、前記アブレーションカテーテルが、前記細長いシャフトから延在する調整可能なループを形成するように、前記第1および第2の内腔が、前記アブレーションカテーテルの前記対向端部を摺動可能に受け取るよう構成され、
前記細長いシャフトが、縦軸を画定する近位部分と、前記近位部分の前記縦軸に対して湾曲を有する遠位部分とを含む、装置。 - 前記遠位部分の前記湾曲が、前記近位部分の前記縦軸に対して、約30度と約60度との間である、請求項20に記載の装置。
- 前記細長いシャフトが、約6cmと約30cmとの間の長さを有する、請求項20または21に記載の装置。
- 前記細長いシャフトの少なくとも遠位端は、蛍光顕微鏡で可視化されるように構成される、請求項20〜22のいずれか一項に記載の装置。
- 前記第1および第2の内腔が、同じ直径を有する、請求項20〜23のいずれか一項に記載の装置。
- 前記第1および第2の内腔が、1つ以上の電極を上に配置する前記アブレーションデバイスの一部分を、摺動可能に受け取るように構成される、請求項20〜24のいずれか一項に記載の装置。
- 前記アブレーションデバイスの前記対向端部の少なくとも1つが、前記調整可能なループを心臓の一部分の周りに位置づけるのを調整するために、前記細長いシャフトに対して移動できるように、前記第1および第2の内腔が、前記アブレーションカテーテルの前記対向端部を摺動可能に受け取るように構成される、請求項20〜25のいずれか一項に記載の装置。
- 前記管状シャフトの少なくとも一部分は、心膜腔内に配置されるように構成される、20〜26のいずれか一項に記載の装置。
- アブレーションデバイスの遠位端を、シンチデバイスの第1の内腔を通って、近位から遠位の方向に前進させることと、
前記アブレーションデバイスが、心臓の肺静脈のセットを一周する調整可能なループを形成するように、前記アブレーションデバイスを対象の前記心臓の心組織の周りに位置づけることと、
前記アブレーションデバイスの前記遠位端を、前記シンチデバイスの第2の内腔を通って、遠位から近位の方向に前進させることであって、前記第2の内腔が、前記第1の内腔と実質的に平行に延在することと、
前記アブレーションデバイスの前記遠位端または近位端のうちの少なくとも1つを、前記シンチデバイスの近位端から近位に移動させて、前記調整可能なループのサイズを減少させ、前記アブレーションデバイスと前記心組織との間の接触を増大させることと、を含む方法。 - 前記アブレーションデバイスの前記調整可能なループが、前記心臓の心膜翻転部を通って延在する、請求項28に記載の方法。
- 前記アブレーションデバイスの前記遠位端または近位端のうちの前記少なくとも1つを、前記シンチデバイスの近位端から近位に移動させることによって、前記アブレーションデバイスを通して前記心組織に所定の力を印加する、請求項28または29に記載の方法。
- 前記シンチデバイスを、前記対象の心膜腔中へ前進させることをさらに含む、請求項28〜30のいずれか一項に記載の方法。
- 前記シンチデバイスを前記心臓の後側に位置づけることをさらに含む、請求項28〜30のいずれか一項に記載の方法。
- クリンチデバイスが前記対象の胸部に対して斜めに角度がつくように、前記シンチデバイスを位置づけることをさらに含む、請求項28〜30のいずれか一項に記載の方法。
- 前記アブレーションデバイスの前記遠位端または近位端のうちの前記少なくとも1つを移動させた後、前記シンチデバイスに対して前記アブレーションデバイスの位置をロックすることをさらに含む、請求項28〜33のいずれか一項に記載の方法。
- 前記アブレーションデバイスの電極のセットを介して、前記心組織へパルス電界を送達して、前記心組織をアブレーションすることをさらに含む、請求項28〜34のいずれか一項に記載の方法。
- アブレーションデバイスの遠位端を、シンチデバイスの第1の内腔を通って、近位から遠位の方向に前進させることと、
前記アブレーションデバイスが、心臓の肺静脈のセットを一周する調整可能なループを形成するように、前記アブレーションデバイスを対象の前記心臓の心組織の周りに位置づけることと、
前記アブレーションデバイスの前記遠位端を、前記シンチデバイスの第2の内腔を通って、遠位から近位の方向に前進させることであって、前記第2の内腔が、前記第1の内腔と実質的に平行に延在することと、
前記アブレーションデバイスの遠位または近位部分のうちの少なくとも1つの上に配置される、基準のセットに少なくとも基づいて、前記シンチデバイスに対して、前記アブレーションデバイスの電極のセットの位置を検証することと、を含む方法。 - 前記シンチデバイスの外側に配置される前記アブレーションデバイスの一部分に配置される、前記アブレーションデバイスの前記基準のセットのうちの1つ以上の基準を可視化することをさらに備える、請求項36に記載の方法。
- 前記アブレーションデバイスの前記電極のセットの位置を検証することが、前記基準のセットを使用して、前記シンチデバイスより遠位に配置される前記電極のセットのうちの少なくとも1つの電極を識別することを含む、請求項36または37に記載の方法。
- 前記電極のセットの残りの電極にではなく、前記シンチデバイスより遠位に配置される前記少なくとも1つの電極に、パルス波形を印加することをさらに含む、請求項38に記載の方法。
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CN112087978A (zh) | 2020-12-15 |
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