JP6316821B2 - 切除システム - Google Patents
切除システム Download PDFInfo
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- JP6316821B2 JP6316821B2 JP2015530101A JP2015530101A JP6316821B2 JP 6316821 B2 JP6316821 B2 JP 6316821B2 JP 2015530101 A JP2015530101 A JP 2015530101A JP 2015530101 A JP2015530101 A JP 2015530101A JP 6316821 B2 JP6316821 B2 JP 6316821B2
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- catheter
- ablation
- electrodes
- electrode
- assembly
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/06—Arrangements of multiple sensors of different types
-
- 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
- A61B5/0538—Measuring electrical impedance or conductance of a portion of the body invasively, e.g. using a catheter
-
- 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
- A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
- A61B5/361—Detecting fibrillation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
- A61B5/363—Detecting tachycardia or bradycardia
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
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- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
- A61B5/6859—Catheters with multiple distal splines
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
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Description
本出願は、2012年8月31日に出願された「心臓組織を診断および治療するためのシステムおよび方法」という名称の米国仮特許出願第61/695,535号についての特許法第119条(e)項に基づく優先権を主張し、その内容は参照により全体として本明細書に組み込まれる。
Claims (30)
- 切除カテーテルであって、
遠位部分を備える長尺シャフトと、
切除カテーテルシャフト遠位部分に配置されて組織へエネルギーを送達するように構成される少なくとも一つの切除要素と、
を包含する切除カテーテルと、
診断カテーテルであって、
遠位端部を包含する長尺シャフトであって、前記切除カテーテルシャフトの前記遠位部分を摺動式に収容するように構成される診断カテーテルシャフトである、長尺シャフトと、
前記診断カテーテルシャフトに取り付けられて、圧縮状態から拡開状態へ移行するように構成される拡開アセンブリと、
前記拡開アセンブリに結合される複数の双極子マッピング電極と、
前記拡開アセンブリに結合される複数の超音波トランスデューサと、
を包含する診断カテーテルと、
距離測定アセンブリであって、前記複数の超音波トランスデューサの各超音波トランスデューサと各超音波トランスデューサに直交する組織表面との間の距離を表すデータセットを作成する距離測定アセンブリと、
を包含し、
前記拡開アセンブリが複数の屈曲スプラインを包含し、各スプラインが近位端部と遠位端部と離間した双極子マッピング電極のセットとを包含し、
各スプラインの近位端部が診断カテーテル長尺シャフト遠位端部に近接する位置に固定装着され、各スプラインの遠位端部が周方向配設形態で接続され、
前記拡開アセンブリが拡開状態にあるときに前記周方向配設形態が開口部を画定し、
前記拡開アセンブリが2つ以上のガイド要素であって、前記長尺シャフトの遠位部分と前記周方向配設形態との間に設けられた線状のガイド要素、をさらに包含し、前記切除カテーテルの遠位端部が前記開口部を通過するように前記ガイド要素が前記切除カテーテルの遠位端部を案内する切除システム。 - 2つ以上の前記ガイド要素は、前記切除カテーテルの遠位端部が前記開口部を通過する向きに前記切除カテーテルを付勢する一方、前記切除カテーテルの遠位端部は操縦により曲がって前記ガイド要素の付勢力を克服して、2つの前記ガイド要素の間を通過する、請求項1に記載のシステム。
- 各前記ガイド要素は、前記拡開アセンブリを前記拡開状態に付勢する、請求項1または請求項2に記載のシステム。
- 切除カテーテルであって、
遠位部分を備える長尺シャフトと、
切除カテーテルシャフト遠位部分に配置されて組織へエネルギーを送達するように構成される少なくとも一つの切除要素と、
を包含する切除カテーテルと、
診断カテーテルであって、
遠位端部を包含する長尺シャフトであって、前記切除カテーテルシャフトの前記遠位部分を摺動式に収容するように構成される診断カテーテルシャフトである、長尺シャフトと、
前記診断カテーテルシャフトに取り付けられて、圧縮状態から拡開状態へ移行するように構成される拡開アセンブリと、
前記拡開アセンブリに結合される複数の双極子マッピング電極と、
前記拡開アセンブリに結合される複数の超音波トランスデューサと、
を包含する診断カテーテルと、
距離測定アセンブリであって、前記複数の超音波トランスデューサの各超音波トランスデューサと各超音波トランスデューサに直交する組織表面との間の距離を表すデータセットを作成する距離測定アセンブリと、
を包含し、
前記拡開アセンブリが複数の屈曲スプラインを包含し、各スプラインが近位端部と遠位端部と離間した双極子マッピング電極のセットとを包含し、
各スプラインの近位端部が診断カテーテル長尺シャフト遠位端部に近接する位置に固定装着され、各スプラインの遠位端部が周方向配設形態で接続され、
前記拡開アセンブリが拡開状態にあるときに前記周方向配設形態が開口部を画定し、
前記拡開アセンブリが、前記長尺シャフトの遠位部分と前記周方向配設形態との間に設けられた中空管状のガイド要素、をさらに包含し、前記切除カテーテルの遠位端部が前記開口部を通過するように前記ガイド要素が前記切除カテーテルの遠位端部を案内する切除システム。 - 表面単極電圧情報と、
表面双極電圧情報と、
表面電荷密度情報と、
単相活動電位情報と、
心臓壁位置および心臓壁厚情報などの解剖学的幾何学形状情報と、
以上の組み合わせと、
から成るグループから選択される情報を提供するように前記診断カテーテルが構成される、請求項1から請求項4のいずれか1項のシステム。 - 遠位端部を備えるシースをさらに包含し、前記拡開アセンブリが、シース遠位端部から出る際に径方向に拡開するように構成される、請求項1から請求項4のいずれか1項のシステム。
- 前記拡開アセンブリが、形状記憶合金か形状記憶ポリマーの少なくとも一方、または両方を包含する複数の拡開部材を包含する、請求項1から請求項4のいずれか1項のシステム。
- 前記離間した双極子マッピング電極のセットが少なくとも4個の双極子マッピング電極を包含する、請求項1から請求項4のいずれか1項のシステム。
- 各スプラインが離間した超音波トランスデューサのセットをさらに包含する、請求項1から請求項4のいずれか1項のシステム。
- 前記離間した超音波トランスデューサのセットが少なくとも4個の超音波トランスデューサを包含する、請求項9のシステム。
- 各スプラインがさらに、前記複数の双極子マッピング電極を少なくとも2つと、前記複数の超音波トランスデューサを少なくとも2つ包含し、各スプラインで、2つの隣接する超音波トランスデューサの間に前記複数の双極子マッピング電極が一つまたは複数配設される、請求項1から請求項4のいずれか1項のシステム。
- 前記診断カテーテルシャフトが、中心軸線を画定する遠位部分を包含し、前記開口部が前記軸線で相対的にセンタリングされ、前記切除カテーテルの遠位端部を収容するのに十分な大きさである、請求項1から請求項4のいずれか1項のシステム。
- 前記切除カテーテルが遠位端部を包含し、各スプラインがさらに、近位端部と遠位端部との間に配置される中央部分を包含し、前記切除カテーテル遠位端部が、前記屈曲スプラインが拡開状態にあるときに径方向に撓曲して、前記切除カテーテル遠位端部に第1スプライン中央部分と第2スプライン中央部分との間を通過させるように構成される、請求項2のシステム。
- 前記複数の双極子マッピング電極が、0.1ヘルツを上回る周波数について10,000オーム未満のインピーダンスを持つ少なくとも一つの双極子マッピング電極を包含する、請求項1から請求項4のいずれか1項のシステム。
- 前記複数の超音波トランスデューサが、
単要素または多要素の圧電セラミックスと、
圧電微細加工による超音波トランスデューサ(pMUT)と、
容量性微細加工による超音波トランスデューサ(cMUT)と、
圧電ポリマーと、
以上の組み合わせと、
から成るグループから選択されるアセンブリを包含する、請求項1から請求項4のいずれか1項のシステム。 - 前記複数の超音波トランスデューサの各々が2つの双極子マッピング電極の間に設置される、請求項1から請求項4のいずれか1項のシステム。
- 前記診断カテーテルシャフトが、中に配置される2つ以上の電気導体を包含する壁を包含する、請求項1から請求項4のいずれか1項のシステム。
- 前記2つ以上の電気導体が2つ以上の同軸ケーブルを包含する、請求項17のシステム。
- 前記切除カテーテルが、エネルギーを送達して電気信号を記録するように構成される多数の電極を包含する、請求項1から請求項4のいずれか1項のシステム。
- 前記少なくとも一つの切除要素が、
電極と、
低温エネルギーを送達するように構成される導管と、
レーザダイオードと、
切除エネルギーを送達するように構成される光ファイバと、
マイクロ波エネルギー送達要素と、
超音波エネルギー送達要素と、
薬品または他の薬剤の送達要素と、
以上の組み合わせと、
から成るグループから選択される切除要素を包含する、請求項1から請求項4のいずれか1項のシステム。 - 前記距離測定アセンブリが、前記診断カテーテルの複数の超音波トランスデューサへ信号を送達し、前記診断カテーテルの複数の超音波トランスデューサからの第1発生信号を記録し、前記第1発生信号の記録に基づいて第1距離情報セットを作成するように構成される、請求項1から請求項4のいずれか1項のシステム。
- 少なくとも第1電極と第2電極とを包含するシステムであり、前記距離測定アセンブリが、前記第1電極と前記第2電極との間の距離を表すデータを作成する、請求項1から請求項4のいずれか1項のシステム。
- 前記第1電極が電気信号を送達するように構成され、前記第2電極が前記第1電極により送達される前記電気信号を記録するように構成され、前記距離測定アセンブリが、前記記録された電気信号に基づいて前記データを作成する、請求項22のシステム。
- 前記第1電極が双極子マッピング電極を包含し、前記切除カテーテルが前記第2電極を包含し、前記距離測定アセンブリが、前記診断カテーテルと前記切除カテーテルとの間の距離を表すデータを作成する、請求項22のシステム。
- 前記診断カテーテルが少なくとも2つの電極を包含し、前記距離測定アセンブリが、前記診断カテーテルの少なくとも2つの電極へ信号を送達し、前記診断カテーテルの少なくとも2つの電極からの第1発生信号を記録し、前記第1発生信号の記録に基づいて第1距離情報セットを作成するように構成され、
前記第1距離情報セットが前記拡開アセンブリの幾何学的構成を表す、請求項1から請求項4のいずれか1項のシステム。 - さらに少なくとも一つの体表面電極を包含し、前記距離測定アセンブリがさらに、前記少なくとも一つの体表面電極へ信号を送達し、前記少なくとも一つの体表面電極からの第2発生信号を記録し、前記第2発生信号の記録に基づいて第2距離情報セットを作成するように構成される、請求項25のシステム。
- 前記切除カテーテルの前記少なくとも一つの切除要素へエネルギーを提供するように構成されるエネルギー源をさらに包含し、
無線周波数エネルギーと、
低温エネルギーと、
レーザエネルギーと、
光エネルギーと、
マイクロ波エネルギーと、
超音波エネルギーと、
化学エネルギーと、
以上の組み合わせと、
から成るグループから選択されるエネルギー形態を提供するように前記エネルギー源が構成される、請求項1から請求項4のいずれか1項のシステム。 - 電位図記録カテーテルをさらに包含する、請求項1から請求項4のいずれか1項のシステム。
- 第2切除カテーテルをさらに包含し、前記第2切除カテーテルが前記診断カテーテルシャフトにより摺動式に収容されるように構成される、請求項1から請求項4のいずれか1項のシステム。
- 前記診断カテーテルシャフトにより摺動式に収容されるように構成される第3カテーテル装置をさらに包含し、
前記第3カテーテル装置が、
電極の螺旋アレイを備えるカテーテルと、
ペーシングカテーテルと、
無線周波数エネルギー、マイクロ波エネルギー、低温エネルギー、レーザエネルギー、および/または超音波エネルギーを送達するように構築および配設されるエネルギー送達カテーテルと、
抗不整脈薬、幹細胞、または他の生物学的薬剤を送達するように構築および配設される薬品または他の薬剤の送達カテーテルと、
機械装置送達カテーテルと、
以上の組み合わせと、
から成るグループから選択される装置を包含する、請求項1から請求項4のいずれか1項のシステム。
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CA2881457C (en) | 2021-10-26 |
EP2890292A2 (en) | 2015-07-08 |
CN104812297A (zh) | 2015-07-29 |
JP2018108481A (ja) | 2018-07-12 |
US20190021673A1 (en) | 2019-01-24 |
AU2018211348B2 (en) | 2019-10-10 |
EP3868283A1 (en) | 2021-08-25 |
WO2014036439A2 (en) | 2014-03-06 |
JP6510104B2 (ja) | 2019-05-08 |
US10004459B2 (en) | 2018-06-26 |
USD782686S1 (en) | 2017-03-28 |
US10667753B2 (en) | 2020-06-02 |
USD954970S1 (en) | 2022-06-14 |
JP6785909B2 (ja) | 2020-11-18 |
US20150223757A1 (en) | 2015-08-13 |
AU2013308531B2 (en) | 2018-05-10 |
CA2881457A1 (en) | 2014-03-06 |
WO2014036439A3 (en) | 2015-06-04 |
CN104812297B (zh) | 2017-05-17 |
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