WO2001036016A2 - Cavo-tricuspid isthmus ablation catheter - Google Patents
Cavo-tricuspid isthmus ablation catheter Download PDFInfo
- Publication number
- WO2001036016A2 WO2001036016A2 PCT/US2000/041913 US0041913W WO0136016A2 WO 2001036016 A2 WO2001036016 A2 WO 2001036016A2 US 0041913 W US0041913 W US 0041913W WO 0136016 A2 WO0136016 A2 WO 0136016A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- catheter
- cavo
- arm portion
- shaft portion
- isthmus
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00369—Heart valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00577—Ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1472—Probes or electrodes therefor for use with liquid electrolyte, e.g. virtual electrodes
Definitions
- the cavo-tricuspid isthmus is an area of the right atrium which has importance for the promulgation of type I (typical or isthmus-dependent) atrial flutter (AFL). a type of arrhythmia. Although AFL is the most common arrhythmia which utilizes the CTI, other atrial arrhythmias may also utilize the CTI. Examples of these are atrial fibrillation (AF) and atypical (type II or non- isthmus dependent) atrial flutter (AAFL).
- CTI cavo-tricuspid isthmus
- ablation of the CTI can be performed by creating a myocardial lesion extending from the inferior vena caval orifice to an inferior aspect of the tricuspid annulus. This lesion must be contiguous and transmural throughout its course, so as to prohibit impulses from traversing the CTI.
- ablation in the CTI has been accomplished by moving a standard ablation electrode catheter along a perceptual line in the CTI, effectively "connecting the points" to form a full length CTI lesion.
- some publications have preliminarily reported the use of prototype devices with multiple electrodes which conceptually can result in CTI ablation with a single catheter positioning. However, these catheters have not been designed specifically for the unique
- catheters which perform ablation are inserted in the femoral vein and enter the heart via the inferior caval orifice 2.
- the CTI 1 spans between the inferior caval orifice and the tricuspid annulus 3. This entire distance must be ablated to achieve successful CTI ablation.
- the topography of the CTI is highly variable. It can range from a relatively flat surface (see Figure 1A), or it can be very "pouch-like," extending well below the inferior caval orifice (see Figure IB).
- a Eustachian ridge 4 adds an additional barrier between the inferior caval access port and the CTI.
- a catheter introduced from the inferior cava can sit anywhere within the cava, ranging from posterior to anterior (see Figure 1A).
- Variation in catheter position in the inferior cava has major ramifications for catheter design for CTI ablation. For example, if the catheter dwells in the posterior aspect of the inferior cava, the CTI ablation catheter must reach across a long distance in order to simply reach the posterior aspect of the CTI, and then must reach further and in increments to reach the tricuspid annulus aspect of the CTI. If the catheter dwells anteriorly in the CTI, then the requirements would be completely different.
- the general shape of these catheters is shown in Figure 2.
- the catheter has a single electrode which can be of variable length.
- the catheter has no adjustment for its shaft position in the inferior vena cava.
- the "reach" of the catheter is fixed, so that if the catheter cannot reach far enough into the CTI. then ancillary equipment (e.g. long vascular sheaths) is necessary.
- the catheter deflection is not designed to conform to the CTI topography.
- the electrodes are platinum and may contain lumen(s) to irrigate with biological fluids such as saline.
- Some of these catheters also contain multiple electrodes with the same limitations as to shape.
- These catheters contain support elements such as shims in the arm section which render the arm relatively firm and unlikely to adhere to the CTI topography.
- a catheter assembly for cavo-tricuspid isthmus ablation includes a catheter body having a shaft portion and arm portion.
- the arm portion of the catheter body has two regions capable of deflection adjustment in plane and out-of-plane as defined by the shaft portion, respectively.
- At least one electrode is disposed within the arm portion of the catheter body such that upon energizing at least one electrode, the cavo-t ⁇ cuspid isthmus region of a heart is ablated without repositioning of the catheter body
- a process of ablating cavo-tricuspid isthmus tissue of a heart includes positioning a catheter electrode in a contact position with the cavo-tricuspid isthmus region and thereafter energizing the catheter electrode to ablate the entire cavo-tricuspid isthmus while in the contact position.
- Figure 1A-B is a schematic illustrating the range of anatomical differences m the cavo-tricuspid isthmus of individuals
- Figure 2 is a schematic of a standard ablation catheter having a single electrode and a single plane deflection
- Figure 3 is a schematic of a catheter according to the present invention: (A) spanning the cavo-tricuspid isthmus, (B) alone in an in-plane configuration, (C) in cross-section through the shaft portion, (D) in bottom view through the shaft portion showing irrigation apertures sized an spaced to facilitate uniform irrigation therethrough, and (E) alone m an out-of-plane configuration.
- the present invention provides a catheter assembly which has a shape. deflection, and electrode array designed specifically for rapid ablation of the entire CTI with a single catheter positioning.
- the catheter assembly is generally shown at 20 and designed to enter the heart via the inferior caval orifice 2 of the inferior vena cava 24, after standard introduction via the right femoral vein.
- the catheter assembly 20 includes a shaft portion 28 and an arm portion 30 generally formed of a single piece of material.
- the catheter arm portion 30 is constructed of a material which allows the catheter assembly to conform to complex topology in the CTI.
- the catheter assembly 20 preferably has a maximal diameter of 9 French.
- the catheter assembly 20 has a preformed deflection in the shaft portion 28 which causes the shaft portion 28 to lie parallel to and in contact with the anterior wall 32 of the inferior vena cava 24.
- the arm portion 30 forms an in-plane angle with the shaft portion 28 which is preferable, but can be acute up to 180 degrees and is operator adjustable with a deflection mechanism which is well known in the art and located in a catheter handle (not shown) in order to adjust the angle to firmly contact the anterior wall 32 of the inferior vena cava.
- the arm portion 30 also forms an out-of-plane angle (see Figure 3E) with the catheter shaft portion 28 which forces it into contact in a relatively medial portion or aspect 30 of the CTI.
- This medial portion 30 (the posteroseptal space) is like a "gutter" or corner which further constrains the catheter assembly 20 from lateral movement.
- a secondary bend 34 ensures contact of electrode material with the lip 36 of the tricuspid annulus 3.
- the arm portion 30 preferably contains only electrode wires - no shims or other support structures, so as to make it very flexible and able to comply with the expected highly variable interindividual isthmus topographical requirements.
- the cross-section of the catheter shaft portion 28 ( Figure 3C) shows it to be oval rather than round, to provide further lateral stability.
- the "electrode” material (E) is located along the arm portion 30 of the catheter assembly 20 and may be multiple components or a single component. The material is designed to conduct radiofrequency current in the form of flowing saline or similarly conductive biocompatible fluid as a "virtual" electrode.
- At least one irrigation aperture 38 disposed in fluid communication with the shaft portion 28 of the catheter assembly 20 can be utilized as a conduit for conducting the saline or other similar conductive, biocompatible fluid therethrough forming the "virtual" electrode through which radiofrequency or similar energy from an energy source well known in the art can be applied to the endocardium of the CTI.
- the location and size of the apertures 38 along the shaft portion 28 can be varied to achieve uniform flow therealong. For example, the apertures 38 can be progressively larger moving from the proximal to the distal ends.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Plasma & Fusion (AREA)
- Medical Informatics (AREA)
- Otolaryngology (AREA)
- Physics & Mathematics (AREA)
- Cardiology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU27512/01A AU2751201A (en) | 1999-11-05 | 2000-11-06 | Cavo-tricuspid isthmus ablation catheter |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US16387899P | 1999-11-05 | 1999-11-05 | |
US60/163,878 | 1999-11-05 |
Publications (3)
Publication Number | Publication Date |
---|---|
WO2001036016A2 true WO2001036016A2 (en) | 2001-05-25 |
WO2001036016A3 WO2001036016A3 (en) | 2002-03-07 |
WO2001036016A9 WO2001036016A9 (en) | 2002-08-01 |
Family
ID=22591972
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2000/041913 WO2001036016A2 (en) | 1999-11-05 | 2000-11-06 | Cavo-tricuspid isthmus ablation catheter |
Country Status (2)
Country | Link |
---|---|
AU (1) | AU2751201A (en) |
WO (1) | WO2001036016A2 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10617459B2 (en) * | 2014-04-17 | 2020-04-14 | Adagio Medical, Inc. | Endovascular near critical fluid based cryoablation catheter having plurality of preformed treatment shapes |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5327905A (en) * | 1992-02-14 | 1994-07-12 | Boaz Avitall | Biplanar deflectable catheter for arrhythmogenic tissue ablation |
US5423882A (en) * | 1991-12-26 | 1995-06-13 | Cordis-Webster, Inc. | Catheter having electrode with annular recess and method of using same |
US5545200A (en) * | 1993-07-20 | 1996-08-13 | Medtronic Cardiorhythm | Steerable electrophysiology catheter |
US5617854A (en) * | 1994-06-22 | 1997-04-08 | Munsif; Anand | Shaped catheter device and method |
US5755760A (en) * | 1996-03-11 | 1998-05-26 | Medtronic, Inc. | Deflectable catheter |
US5893885A (en) * | 1996-11-01 | 1999-04-13 | Cordis Webster, Inc. | Multi-electrode ablation catheter |
-
2000
- 2000-11-06 AU AU27512/01A patent/AU2751201A/en not_active Abandoned
- 2000-11-06 WO PCT/US2000/041913 patent/WO2001036016A2/en active Application Filing
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5423882A (en) * | 1991-12-26 | 1995-06-13 | Cordis-Webster, Inc. | Catheter having electrode with annular recess and method of using same |
US5327905A (en) * | 1992-02-14 | 1994-07-12 | Boaz Avitall | Biplanar deflectable catheter for arrhythmogenic tissue ablation |
US5545200A (en) * | 1993-07-20 | 1996-08-13 | Medtronic Cardiorhythm | Steerable electrophysiology catheter |
US5617854A (en) * | 1994-06-22 | 1997-04-08 | Munsif; Anand | Shaped catheter device and method |
US5755760A (en) * | 1996-03-11 | 1998-05-26 | Medtronic, Inc. | Deflectable catheter |
US5893885A (en) * | 1996-11-01 | 1999-04-13 | Cordis Webster, Inc. | Multi-electrode ablation catheter |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10617459B2 (en) * | 2014-04-17 | 2020-04-14 | Adagio Medical, Inc. | Endovascular near critical fluid based cryoablation catheter having plurality of preformed treatment shapes |
Also Published As
Publication number | Publication date |
---|---|
AU2751201A (en) | 2001-05-30 |
WO2001036016A9 (en) | 2002-08-01 |
WO2001036016A3 (en) | 2002-03-07 |
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