[go: up one dir, main page]

WO2023244854A1 - Systèmes de fibrillation auriculaire à champ pulsé et procédés d'utilisation - Google Patents

Systèmes de fibrillation auriculaire à champ pulsé et procédés d'utilisation Download PDF

Info

Publication number
WO2023244854A1
WO2023244854A1 PCT/US2023/025645 US2023025645W WO2023244854A1 WO 2023244854 A1 WO2023244854 A1 WO 2023244854A1 US 2023025645 W US2023025645 W US 2023025645W WO 2023244854 A1 WO2023244854 A1 WO 2023244854A1
Authority
WO
WIPO (PCT)
Prior art keywords
electrodes
ablation
tissue
devices
heart
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2023/025645
Other languages
English (en)
Inventor
Paul Johnson WANG
Meghedi Babakhanian
Anson Michael LEE
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Leland Stanford Junior University
Original Assignee
Leland Stanford Junior University
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Leland Stanford Junior University filed Critical Leland Stanford Junior University
Publication of WO2023244854A1 publication Critical patent/WO2023244854A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00026—Conductivity or impedance, e.g. of tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • A61B2017/00044—Sensing electrocardiography, i.e. ECG
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • A61B2017/00044—Sensing electrocardiography, i.e. ECG
    • A61B2017/00048—Spectral analysis
    • A61B2017/00053—Mapping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00084—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00876—Material properties magnetic
    • 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
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00023—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
    • 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
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/0016—Energy applicators arranged in a two- or three dimensional array
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022—Balloons
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/00267—Expandable means emitting energy, e.g. by elements carried thereon having a basket shaped structure
    • 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
    • A61B2018/00357—Endocardium
    • 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
    • A61B2018/00363—Epicardium
    • 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
    • A61B2018/00375—Ostium, e.g. ostium of pulmonary vein or artery
    • 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
    • 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
    • A61B2018/00613—Irreversible electroporation
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00839—Bioelectrical parameters, e.g. ECG, EEG
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance
    • 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
    • A61B18/1206—Generators therefor
    • A61B2018/124—Generators therefor switching the output to different electrodes, e.g. sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems

Definitions

  • the present application relates to medical devices and, more particularly, to devices, systems, and methods for performing ablation, e.g., pulsed field ablation (PF A) for treating atrial fibrillation (AF).
  • ablation e.g., pulsed field ablation (PF A) for treating atrial fibrillation (AF).
  • PF A pulsed field ablation
  • AF atrial fibrillation
  • Atrial fibrillation is a form of cardiac arrhythmia.
  • Atrial refers to the top two chambers of the heart known as the atria, where irregularity in AF occurs.
  • the atria are designed to send blood efficiently and rhythmically into the ventricles by way of regular electrical signals. From there, blood is pumped to the rest of the body. In AF, the electrical signals are rapid, irregular, and disorganized, and the heart may not pump as efficiently.
  • Atrial Fibrillation is the most common irregular heartbeat, affecting about three to five million Americans. Medications are not typically sufficient to control AF. AF is associated with an increased risk of stroke and heart failure and significantly diminished quality of life. While open heart surgery called Cox Maze surgery has shown 80-90% success for creating lasting surgical incisions at one year and 70% success at five years, very few patients are willing to undergo such an invasive procedure.
  • Catheter ablation has been introduced for the treatment of AF; however, up to 50% of patients have recurrent arrhythmias after catheter ablation within one year and require repeat catheter ablation or continue to have arrhythmias. The long-term success of catheter ablation for many patients is even lower.
  • Pulmonary vein isolation is the standard element of AF ablation and is generally successful for paroxysmal AF. However, catheter ablation of persistent AF has been much less successful. Randomized studies such as STAR AF-II have not been able to demonstrate that any of the multiple other strategies such as linear lesions and ablation of complex fractionated electrogram improve the results of catheter ablation beyond pulmonary vein isolation. Thus, it may be desirable to recreate the Cox Maze surgical lesions in a minimally-invasive manner, to better understand key sites to ablation, or both.
  • the present application is directed to medical devices and, more particularly, to devices, systems, and methods for performing ablation, e.g., pulsed field ablation (PF A) for treating atrial fibrillation (AF).
  • ablation e.g., pulsed field ablation (PF A) for treating atrial fibrillation (AF).
  • PF A pulsed field ablation
  • AF atrial fibrillation
  • One of the goals of AF ablation is to create an ablation strategy that is widely applicable to prevent AF recurrences after a single ablation procedure with a minimal degree of invasiveness and with maximal ease of use.
  • Most recent advances in AF treatment are directed at only some part of these gaps but are unable to provide a unified solution.
  • Pulsed field ablation may provide a better energy source compared to radiofrequency (RF) ablation as PFA may facilitate rapid reliable formation of ablation lesions. Further, unlike RF ablation, PFA is considered a non-thermal energy source, and may reduce risk of collateral damage to non-targeted tissues, particularly the esophagus.
  • Pulsed Field Ablation or pulsed electric field energy delivery, utilizes brief pulses of high voltage that generate locally high electric fields that break down cell membranes and result in cell death, a process also referred to as irreversible electroporation.
  • PFA devices are designed either as single point devices, single shot pulmonary vein devices, or an intermediate device that creates overlapping lesions for pulmonary vein isolation. None are designed specifically for optimizing all the Cox Maze surgical lesions, which may be most likely to result in successful treatment of most patients.
  • the systems and methods herein may be used to perform PF A, e.g. using a combination of epicardial and endocardial approaches, to optimally create lesions corresponding substantially to each of the Cox Maze lesions, e.g., to create generate a comprehensive PFA lesion set incorporating mapping, which may be completed in a single procedure for applicable patients.
  • a system for performing pulsed- field ablation to treat atrial fibrillation that includes a first endocardial device comprising a proximal end, a distal end sized for introduction into a heart and carrying a first array of electrodes configured for placement against endocardial tissue; a second epicardial device comprising a proximal end, a distal end sized for introduction into a pericardial space adjacent the heart and carrying a second array of electrodes configured for placement against epicardial tissue; a cooling source configured to provide cooling to the distal ends to cool tissue therebetween; a generator; and a controller coupled to the electrodes and the generator configured to receive signals from the electrodes to identify changes in electrophysiological properties of the cooled tissue between the distal ends to identify one or more target sites for ablation, deliver energy from the generator to one or more of the electrodes to generate electrical pulses to ablate the one or more target sites.
  • system for treating atrial fibrillation that includes a first endocardial device comprising a proximal end, a distal end sized for introduction into a heart and carrying a first array of electrodes configured for placement against endocardial tissue; a second epicardial device comprising a proximal end, a distal end sized for introduction into a pericardial space adjacent the heart and carrying a second array of electrodes configured for placement against epicardial tissue; a cooling source configured to provide cooling to the distal ends to cool tissue therebetween; and a controller coupled to the electrodes to receive signals from the electrodes to identify changes in electrophysiological properties of the cooled tissue between the distal ends to identify one or more target sites for ablation.
  • the system may also include a generator, and the controller may be coupled to the generator to deliver energy from the generator to one or more of the electrodes to generate electrical pulses to ablate the one or more target sites.
  • the system may include an ablation device including a proximal end, a distal end carrying one or more ablation electrodes configured to be introduced independently of the first and second devices, the controller coupled to the generator and the one or more ablation electrodes to deliver energy from the generator to the one or more ablation electrodes to generate electrical pulses to ablate one or more target sites.
  • a method for performing pulsed-field ablation to treat atrial fibrillation includes introducing a distal end of a first device into a heart; positioning a first array of electrodes on the distal end of the first device against endocardial tissue within the heart; introducing a distal end of a second epicardial device into a pericardial space adjacent the heart; positioning a second array of electrodes on the distal end of the second device against epicardial tissue adjacent the first array; cooling tissue between the distal ends; activating a controller to receive signals from the first and second arrays of electrodes to identify changes in electrophysiological properties of the cooled tissue between the distal ends to identify one or more target sites for ablation; and delivering energy to one or more of the electrodes to generate electrical pulses to ablate the one or more target sites.
  • a method for performing ablation to generate a lesion set on a patient’s heart that includes introducing one or more ablation devices from an access site in a subxiphoid region into the patient’s chest and pericardium; positioning a first device of the one or more ablation devices within a transverse sinus of the heart adjacent a roof of the left atrium of the heart; delivering energy from the first device to create a plurality of lesions along the roof of the left atrium; delivering energy from one of the one or more ablation devices to create a plurality of lesions around the left pulmonary veins of the heart; delivering energy from one of the one or more ablation devices to create a plurality of lesions around the right pulmonary veins of the heart; positioning a second device of the one or more ablation devices against the epicardium adjacent a floor of the left atrium; and delivering energy from the second device to create a plurality of lesions along the roof of the left atrium.
  • FIG. 1 shows an example of a system 10 for performing pulsed field ablation that includes an endocardial device, an epicardial device, and a console for operating the devices.
  • FIG. 2 shows an example of a distal end including a two-dimensional array of electrodes that may be included on one or both of epicardial and endocardial ablation devices.
  • FIG. 3 shows another example of a distal end including a two-dimensional array of electrodes that may be included on one or both of epicardial and endocardial ablation devices.
  • FIG. 4 shows a cross-section of myocardial tissue of a heart with the distal ends of the devices shown in FIG. 1 positioned opposite one another.
  • FIG. 5 shows another example of a distal end including a three-dimensional array of electrodes that may be included on one or both of epicardial and endocardial ablation devices.
  • FIG. 6 shows another example of a distal end including an expandable mesh electrode that may be included on one or both of epicardial and endocardial ablation devices.
  • FIGS. 7A-7J show a cross-section of a chest cavity with the heart removed showing an exemplary method for performing a series of ablations to create Cox Maze lesion set.
  • FIG. 1 shows an example of a system 10 for performing pulsed-field ablation, e.g., to treat atrial fibrillation within a patient’s heart (not shown).
  • the systems and methods herein may be used to treat other conditions, e.g., ventricular tachycardia and/or other arrhythmias.
  • the system 10 includes a first or endocardial device 20 and a second or epicardial device 40, each coupled to a console or controller 60 including the components to operate the system 10 during a procedure.
  • the console 60 may include one or more components for operating the devices 20, 40 during a procedure, e.g., a generator 62, a source of cooling 64, and/or one or more processors 66 (one shown for simplicity), as described further elsewhere herein.
  • the console 60 may include one or more additional components, e.g., a display for presenting information related to the procedure, e.g., representations of the heart including mapping information, target ablation sites, and/or other information (not shown), memory for storing software and/or other information for operating the console and/or devices 20, 40, a power source, and the like (not shown).
  • the system 10 may include one or more additional components, e.g., one or more introducer sheaths or catheters, guidewires, and the like (not shown) to facilitate introduction and/or positioning of the devices 20, 40 during a procedure.
  • the system may include a steerable delivery sheath 70, e.g., as shown in FIG. 7A.
  • the system 10 may include one or more external electrodes, e.g., carried on one or more patches or other devices that may be secured to the patient’s skin or other locations (not shown), e.g., for delivering electrical stimuli, to provide a ground for ablation, for mapping, and the like.
  • the first device 20 may be a catheter or other tubular member including a proximal end 22, a distal end 24 sized for introduction into a patient’s heart, and carrying an array of electrodes 26.
  • the second device 40 may be a catheter or other tubular member including a proximal end 42, a distal end 44 sized for introduction into a patient’s heart, and carrying an array of electrodes 46.
  • the devices 20, 40 may include one or more lumens (not shown) extending at least partially between the proximal ends 22, 42 and distal ends 24, 44, along a longitudinal axis 28, 48 of the devices 20, 40, as described further below.
  • each device 20, 40 may include one or more cooling lumens extending between the proximal 22, 42 and distal ends 24, 44 to deliver cooling fluid to the distal ends 24, 44 from the cooling source 64, as described further elsewhere herein.
  • one or both devices 20, 40 may include one or more accessory lumens (not shown), e.g., extending from the proximal end 22, 42 to an outlet (also not shown) in the distal end 24, 44, e.g., for receiving a guidewire or other rail to facilitate introduction and/or advancement of the devices 20, 40.
  • the devices 20, 40 may include a hub or handle 30, 50 on the proximal end 22, 42, e.g., which may be shaped or otherwise formed to facilitate manipulation of the devices 20, 40 during a procedure.
  • the hubs 30, 50 may include one or more ports and/or connectors for coupling the devices 20, 40 to components of the console 60.
  • an electrical connector 32, 52 may be provided on each hub 30, 50 for electrically connecting the devices 20, 40 to the generator 62 and/or processor 66, e.g., via one or more cables 63, and one or more ports 34, 54 may be provided for coupling the cooling source 64 to the devices 20, 40, e.g., via one or more tubes 65.
  • the connectors 32, 52 and connectors 34, 54 may be separate, e.g., requiring the cables 63 and tubes 65 to be connected to the devices 20, 40 separately, or a single connector (not shown) may be provided on the hub 30, 50 of each device 20, 40 that allows all of the connections to be made the console 60 at the same time.
  • one or both of the devices 20, 40 may include one or more steering wires or elements (not shown) extending from the proximal end 22, 42 to the distal end 24, 44, e.g., to allow a distal portion of the devices 20, 40 to be deflected or otherwise manipulated, if desired.
  • an actuator may be provided on the hub 30, 50, e.g., a slider, dial, switch, and the like (not shown), which may be coupled to the steering element to control deflection of the steerable portion.
  • the distal ends 24, 44 may include a single linear array of electrodes , e.g., a plurality of electrodes 26, 46 spaced apart from one another along the distal end 24, 44.
  • FIG. 1 shows the arrays of electrodes 26, 46 including three electrodes each, it will be appreciated that the arrays may include any desired number of electrodes. For example, it may be desirable to provide a tip electrode and three or more ring electrodes spaced apart from one another on the distal end 24, 44.
  • the electrodes 26, 46 may be electrically coupled to one or more wires or leads (not shown) that extend from the distal ends 24, 44 to the proximal ends 22, 42.
  • each of the devices 20, 40 may include an enclosed lumen that extends between the proximal 22, 42, and distal ends 24, 44 to protect leads coupled to the electrodes 26, 46 and the connector 32, 52 on the hub 30, 50, which may, in turn, be connected to the console 60, e.g., to deliver signals from the electrodes 26, 36 to the processor 66 to perform mapping and/or to deliver signals from the generator 62 to the electrodes 26, 36 to deliver high voltage pulses to tissue contacted by the electrodes 26, 36, e.g., to perform pulsed field ablation.
  • the generator 62 may be configured to deliver radiofrequency signals to the electrodes 26, 36, e.g., to perform RF ablation.
  • the electrodes 26, 46 may be configured to perform monopolar or bipolar ablation, e.g., using conventional circuits and/or other components within the processor 66 and console 60.
  • the electrodes 26, 46 on the devices 20, 40 are used for both mapping and energy delivery, as described elsewhere herein.
  • separate electrodes may be provided, e.g., a first subset of electrodes dedicated to mapping and a second subset of electrodes dedicated to delivering ablation energy (not shown), which may be operated independently during a procedure, as described elsewhere herein.
  • each of the devices 20, 40 includes a single linear array of electrodes 26, 46.
  • one or both of the devices may include a two- dimensional array of electrodes.
  • FIG. 2 shows an example of a distal end 124 of a catheter 120 that may be provided on either of the devices in FIG. 1, if desired.
  • the distal end 124 includes a substantially planar contact surface 125 including a plurality of electrodes 126 arranged in multiple rows 127 adjacent one another, e.g., arranged in four rows 127 extending substantially parallel to the longitudinal axis 128, with each row including five electrodes 126. It will be appreciated that fewer or more rows and/or fewer or more electrodes may be provided on the surface 125 to provide a desired two-dimensional array of electrodes.
  • the distal end 124 may be biased to a substantially flat shape yet may be configured to be rolled, compressed, or otherwise directed to a contracted configuration, e.g., to allow introduction through a sheath or other delivery device (not shown).
  • the distal end 124 may be biased to a curved shape, e.g., such that the contact surface 125 defines a concave shape, e.g., curving along the axis 128 or perpendicular to the axis 128.
  • the distal end 124 may have a fixed shape, e.g., having a width sufficiently narrow to allow the distal end 124 to be introduced through a sheath or other delivery device.
  • FIG. 3 shows another example of a distal end 224 of a catheter 220 that includes a plurality of individual elongate members 227, each carrying a plurality of electrodes 226.
  • the elongate members 227 are connected together at their first or proximal ends 227a and their second or distal ends 227b to provide a two-dimensional array of electrodes arranged in rows that extend substantially parallel to the longitudinal axis 228 and lie generally within a common plane.
  • the elongate members 227 may be biased to a curved shape in a relaxed configuration, e.g., curving between the first and second ends 227a, 227b, e.g., to provide a concave or convex shape.
  • the elongate members 227 may be biased to a substantially straight shape, yet may be sufficiently flexible to conform to contacted surfaces, e.g., the epicardium of a heart.
  • the elongate members 227 may be compressible to a contracted condition, e.g., to allow the distal end 224 to be introduced through a sheath or other delivery device (not shown).
  • any of the devices herein may include one or more features to facilitate aligning the devices relative to one another, e.g., on opposite sides of the myocardium of a heart.
  • endocardial device 20 may be introduced into a heart, e.g., into the left atrium
  • epicardial device 40 may be introduced into the pericardial space and positioned generally opposite the endocardial device 20, e.g., as shown in FIG. 4.
  • the distal ends 24, 44 may include one or more magnetic elements 36, 56, e.g., fixed at similar locations such that the distal ends 24, 44 may be attracted to one another.
  • the magnetic elements 36, 56 may include static magnets that have opposite polarities to attract the distal ends 24, 44 together in a desired orientation, or electromagnets that may be selectively activated, as desired during a procedure.
  • a magnet (not shown) may be provided on or adjacent each of the distal tips 25, 45 of the devices 20, 40, which may be used to attract the distal tips 25, 45 towards one another, e.g., from opposite sides of the myocardium to facilitate positioning the distal ends 24, 44 adjacent one another, as described further elsewhere herein.
  • a plurality of magnetic elements 36, 56 may be provided on each of the distal ends 24, 44 (or any of the devices herein) to facilitate aligning the arrays of electrodes 26, 46 relative to one another.
  • the polarity of the magnets (or combination of magnets and ferromagnetic materials) may be arranged on the distal ends 24, 44 such that the longitudinal axes 28, 48 are substantially parallel to one another when the distal ends 24, 44 are drawn towards one another.
  • the magnetic elements 36, 56 may have sufficient attraction strength to cause the distal ends 24, 44 to partially compress the myocardium or other tissue located therebetween, which may enhance stabilization of the distal ends 24, 44 and/or enhance cooling of the tissue.
  • one or both of the devices 20, 40 may include a gripping element on the distal ends 24, 44, e.g., to secure the distal end(s) 24, 44 relative to contacted tissue.
  • a gripping element on the distal ends 24, 44, e.g., to secure the distal end(s) 24, 44 relative to contacted tissue.
  • a hook, tines, and/or other features may be provided on the distal end(s) 24, 44, e.g., at the distal tip 25, 45, which may engage with contacted tissue to stabilize the distal ends 24, 44.
  • the epicardial device 40 may include a gripping element (not shown) on the distal end 44 to engage the epicardium of a heart, and the devices 20, 40 may include magnetic elements to facilitate orienting the distal end 24 of the endocardial device 20 within the atrium or other chamber adjacent the distal end 44 placed against the epicardium.
  • any of the devices herein may include one or more sensors on the distal end.
  • each device 20, 40 may include one or more contact sensors (not shown) on the distal end 24, 44, e.g., such that the electrical pulses are delivered when the processor 66 confirms that the electrodes 26, 46 are in sufficient contact with the tissue.
  • the sensors may include force sensors on the distal end 24, 44 that are coupled to the processor 66 such that the processor 66 receives and processes signals from the sensors to confirm tissue contact before performing an ablation.
  • the sensors may be provided, e.g., sensors configured to measure tissue impedance, electrocardiogram amplitudes, and the like to confirm tissue contact.
  • the processor 66 may automatically identify the optimal electrodes for delivering the energy based at least in part on the information from the sensors.
  • an endocardial device may be provided, e.g., for the system shown in FIG. 1, that includes a distal end that is expandable, e.g., to create a three- dimensional array of electrodes.
  • FIG. 5 shows an example of a device 320 with a distal end including a mesh sphere 324 that may be provided an endocardial device, e.g., in place of the distal end 24 shown in FIG. 1.
  • the mesh sphere 324 may carry a plurality of electrodes 326, e.g., arranged in a three-dimensional array that may be used to mapping and/or ablation, as desired.
  • the mesh sphere 324 may be a balloon, e.g., which may be expanded by delivering inflation media into an interior of the balloon.
  • a basket or other set of wires may be provided that may be mechanically expanded to deploy the array of electrodes 326, e.g., using an actuator on the proximal end (not shown) of the device 320.
  • an ablation device 420 that includes an elongate catheter or shaft 422 include a proximal end (not shown) and a distal end 424 including an expandable mesh electrode device 426.
  • the mesh electrode device 426 may surround a magnetic element 429 on the distal end 424, which may be used to position the distal end 424 relative to another device, similar to the magnetic elements described elsewhere herein.
  • the device 420 may include one or more pull wires or other actuators (not shown) to direct the mesh from a contracted, e.g., substantially linear, configuration, to an expanded configuration, for example, a bulbous or other shape, e.g., including a large central region 426a tapering to proximal and distal ends 426b, 426c of the mesh device 426.
  • a contracted e.g., substantially linear, configuration
  • an expanded configuration for example, a bulbous or other shape, e.g., including a large central region 426a tapering to proximal and distal ends 426b, 426c of the mesh device 426.
  • the opposite ends 426a, 426b of the mesh device 426 may be attached to the distal end 424 (or to telescoping shafts on the distal end) and directed towards one another to cause the central region 426a to bulge, buckle, or otherwise expand outwardly to the expanded configuration (not shown), and then directed away from one another to direct the mesh electrode 426 back to the contracted configuration shown in FIG. 6.
  • the mesh electrode device 426 may include a single electrode, e.g., extending around a perimeter of the mesh 426 (not shown) to create an annular or other shaped lesion, or a plurality of electrodes, e.g., spaced apart from one another around a perimeter of the expanded mesh, e.g., at the central region (also not shown).
  • a mesh electrode e.g., including four electrodes, that may be include the systems and methods herein is described in “A novel mesh electrode catheter for mapping and radiofrequency delivery at the left atrium -pulmonary vein junction: a single- catheter approach to pulmonary vein antrum isolation,” Arruda MS, He DS, Friedman P, Nakagawa H, Bruce C, Azegami K, Anders R, Kozel P, Chiavetta A, Marad P, MacAdam D, Jackman W, Wilber DJ; J. Cardiovasc Electrophysiol. 2007 Feb;18(2):206-l 1, the entire disclosure of which is expressly incorporated by reference herein.
  • the device 420 may include a gripping element (not shown) on the distal end 424, e.g., beyond the mesh electrode 426, which may be configured to secure the distal end 424 against tissue, e.g., to a mitral or tricuspid annulus and/or other structure of a heart, similar to other gripping elements described elsewhere herein.
  • a gripping element (not shown) on the distal end 424, e.g., beyond the mesh electrode 426, which may be configured to secure the distal end 424 against tissue, e.g., to a mitral or tricuspid annulus and/or other structure of a heart, similar to other gripping elements described elsewhere herein.
  • Electrodes may be positioned on opposite sides of the myocardium 90 of the heart and the system 10 may be used to perform mapping and/or field pulsed ablation.
  • the distal end 24 of the endocardial device 20 may be introduced into the patient’s heart, e.g., to position the first array of electrodes 26 against the wall of the heart.
  • the distal end 24 may be introduced into the patient’s body via percutaneous access, e.g., from an access site in a femoral vein through the inferior cava into the heart, e.g., into the right atrium and/or through the right atrium into the left atrium via transeptal access, using conventional methods.
  • the distal end 24 may be introduced through a delivery sheath and/or over a guidewire (not shown) into the target chamber and then the distal end 24 may be placed against the endocardium at a desired location.
  • the distal end 44 of the epicardial device 40 may be introduced into the pericardial space adjacent the heart, e.g., to position the second array of electrodes 46 against epicardial tissue adjacent the first array.
  • an access port or other introducer device may be introduced through the patient’s chest, e.g., at an access site in the subxiphoid region or elsewhere, and a sheath or other delivery device (not shown) may be introduced through the access site and advanced into the pericardium.
  • the sheath may include a steerable distal end, e.g., providing one or more axes of deflection, to facilitate positioning the distal end adjacent a target location, e.g., whereupon the distal end 44 of the device 40 may be introduced through a lumen of the sheath and introduced into the pericardial space through an outlet in the distal end of the sheath.
  • the distal end 44 may then be positioned against the epicardium, e.g., such that the electrodes 26, 46 are positioned on opposite sides of the myocardium, e.g., as shown in FIG. 4.
  • the distal ends 24, 44 of the devices 20, 40 may include one or more magnetic elements 36, 56, which may facilitate positioning the distal ends 24, 44.
  • the magnetic elements 36, 56 may attract the distal ends 24, 44 towards one another, which may facilitate placement of the electrodes 26, 46 against cardiac tissue on opposite sides of the myocardium 90.
  • a magnetic element may be provided on each of the distal tips 25, 45 that may be used to attract the distal tips 25, 45 towards one another.
  • One or both of the magnetic elements may be a static magnet or an electromagnet that may be activated during introduction of the devices 20, 40.
  • the magnetic elements may facilitate positioning the distal end 44 of the epicardial device 40 on the opposite side of the myocardium. For example, if the distal end 44 is placed within the vicinity of the distal end 24, the magnetic elements may draw the distal end 44 within the pericardial space towards the distal end 24 within the left atrium, thereby positioning the distal ends 24, 44 on opposite sides of the myocardium, e.g., as shown in FIG. 4.
  • the magnetic elements may be configured to orient the distal ends 24, 44 to align the electrode arrays 26, 46 axially, particularly if one or both of the distal ends 24, 44 include a two-dimensional array.
  • the strength of the magnetic elements 36, 56 may be sufficiently strong to stabilize or secure the distal ends 24, 44 against the cardiac tissue, e.g., compressing the tissue, and/or minimize movement of the electrodes 26, 46 relative to one another, and/or enhancing cooling, as described elsewhere herein.
  • the magnetic elements are electromagnets (or otherwise activatable)
  • the magnetic elements may be deactivated at any time, e.g., after mapping and/or ablation, to allow repositioning and/or removal of the devices 20, 40.
  • the electrodes 26, 46 may be used to map the cardiac tissue, e.g., to identify one or more target sites for ablation. For example, once the distal ends 24, 44 are positioned at a desired location, tissue between the distal ends 24, 44 may be cooled and the processor 66 may analyze signals from the electrodes 26, 46 to identify changes in electrophysiological properties of the cooled tissue to identify one or more target sites for ablation. For example, fluid from the cooling source 64 may be delivered through lumens of the devices 20, 40 to the distal ends 24, 44 to cool the tissue 90, e.g., to temperatures of zero degrees Celsius (0°C) or lower, whereupon the processor 66 may analyze signals from the electrodes 26, 46 to map the tissue and identify target sites for ablation.
  • fluid from the cooling source 64 may be delivered through lumens of the devices 20, 40 to the distal ends 24, 44 to cool the tissue 90, e.g., to temperatures of zero degrees Celsius (0°C) or lower, whereupon the processor 66 may analyze signals from the electrodes 26, 46 to map the tissue and
  • the signals from the electrodes 26, 46 may be combined with other electrical mapping, e.g., using monophasic action potential electrode records, to identify key AF circuits in the tissue.
  • Providing cooling from the both the endocardial and epicardial surfaces may enhance transmural cooling of the myocardium (particularly compared to cooling from only one location) to enhance identification of target ablation sites.
  • biocompatible fluid such as saline
  • the devices 20, 40 may include a closed cooling circuit, e.g., in which saline, refrigerant, or other cooling fluid, may be delivered from the cooling source 64 through one or more lumens of the devices 20, 40, e.g., through a delivery lumen (not shown), to cool the distal ends 24, 44 and, thereby conductively cool the tissue.
  • the cooling fluid may be returned to the cooling source 64, e.g., through a return lumen (also not shown), where the fluid may be collected and discarded or may be cooled again and recirculated through the devices 20, 40.
  • the processor 66 may be activated to deliver energy to one or more of the electrodes 26, 46 to generate electrical pulses to ablate the one or more target sites.
  • the processor 66 may present one or more images on a display (not shown) of the console 60 that identify target sites and the user may instruct the processor 66 to activate the generator 62 to deliver energy to electrodes 26, 46 adjacent the target sites to ablate the target tissue.
  • the processor 66 may automatically identify target sites and activate the generator 62 to deliver electrical pulses to the target sites.
  • the electrical pulses may be delivered in a bipolar manner, e.g., by activating one or more pairs of electrodes 26, 46 on the devices 20, 40.
  • the pairs may include electrodes on only one of the devices 20, 40 or may include an electrode on each of the devices 20, 40, e.g., such that the electrical pulses are delivered in a crisscross manner or otherwise across the myocardium, which may enhance ablation of locations deep within the myocardium.
  • signals from the sensors may be analyzed by the processor 66 to identify electrodes, e.g., electrode pairs, that are closest to the myocardial tissue at the target site, and the processor 66 may automatically select and activate the identified electrodes to deliver the electrical pulses.
  • additional cooling may be delivered during ablation, e.g., to prevent overheating of tissue.
  • PFA may generate minimal heat
  • cooling may be delivered, as desired to maintain a desired maximum temperature at the target sites.
  • cooling may facilitate maintaining desired temperatures at the target sites.
  • one or more temperature sensors may be provided on the distal ends 24, 44 to monitor the temperature and, if the temperature rises above a predetermined threshold, cooling fluid may be delivered to the distal ends 24, 44.
  • the distal ends 24, 44 of the devices 20, 40 may be moved to one or more additional locations within/adjacent the heart and the process repeated as many times as desired to sufficiently ablate target tissue, e.g., to treat the patient’s atrial fibrillation.
  • the devices 20, 40 may be removed from the patient’s body using conventional methods.
  • the devices 20, 40 may be introduced into the patient’s body to provide localized cooling and mapping and then one or more additional devices may be introduced to perform the ablation.
  • an ablation catheter may be introduced into the patient’s body, e.g., endocardially or epicardially, and positioned at one or more target sites identified by the devices 20, 40.
  • the devices 20, 40 may provide a reference frame to guide directing the ablation catheter to the target sites, e.g., alone or in combination with additional mapping and/or imaging systems (not shown).
  • an epicardial lesion set may be created from a single access site, e.g., in the subxiphoid region of the patient’s chest, and, optionally, one or more endocardial lesions sets may be created, e.g., using one or more devices introduced into the patient’s atria.
  • an access port or introducer set may be placed through the patient’s skin, e.g., between adjacent ribs, to provide access into the thoracic cavity, e.g., using conventional methods.
  • a distal end 74 of an access sheath 70 may be introduced through the access site and advanced into the pericardial space, e.g., to one or more locations adjacent the heart to facilitate deployment of one or more ablation devices.
  • the sheath 70 may include one or more lumens, e.g., a lumen 76 extending between a proximal end (not shown) and an outlet 77 in the distal end 74, sized for introducing one or more ablation devices therethrough, e.g., device 40 shown in FIG. 7A.
  • the distal end 74 of the sheath 70 may include a steerable portion for positioning the outlet 77 at a desired location and/or facilitate directing an ablation device in a desired direction from the outlet 77.
  • the sheath 70 may include one or more pull wires or other steering elements (not shown), e.g., to allow the distal portion to be deflected in a single or multiple planes.
  • the distal end 74 of the sheath 70 may be advanced within the pericardial space posteriorly to the posterior left atrial wall inside the pericardial reflections, e.g., to the space just outside of the left pulmonary vein recess (LPVR) to the transverse sinus (TV).
  • An ablation device 40 (which may be any of the devices described elsewhere herein) may be introduced through the lumen 76 of the sheath 70 until the distal end 44 is exposed from the outlet 77.
  • the distal end 44 may carry one or more electrodes 46 (one shown for simplicity) which may be placed against the epicardium of the heart to deliver ablation energy, e.g., pulsed field ablation pulses, at one or more locations on the roof of the left atrium.
  • ablation energy e.g., pulsed field ablation pulses
  • the distal end 44 may be advanced into the transverse sinus TV and energy delivered at a plurality of locations, e.g., sites 1-6, to generate a first lesion set along the roof of the left atrium.
  • an endocardial ablation device may be used along with the epicardial ablation device 40.
  • the distal end of an endocardial device e.g., similar to the device 20 or other devices herein
  • ablation energy may be delivered between electrodes on the distal ends, e.g., to create transmural lesions.
  • each device may include an electrode and a magnetic element on or adjacent the distal tip, which may be used to create each lesion.
  • the tip of the endocardial device may be positioned against the wall of the left atrium at a desired location, and the distal end 44 may be positioned in the vicinity of the tip, whereupon the magnetic elements may attract the tip of the distal end 44 towards the endocardial device tip, e.g., to draw the electrodes towards one another on opposite sides of the target site, whereupon pulsed field impulses may be delivered between the electrodes.
  • a second lesion set may be created around the left pulmonary veins, e.g., at sites 1-8.
  • the ablation device 40 may be withdrawn at least partially into the lumen 76, and the distal end 74 of the sheath 70 may be manipulated to one or more locations around the left pulmonary veins.
  • the ablation device 40 (or, optionally, a different ablation device) may be deployed from the sheath 70 to deliver ablation energy, e.g., pulsed field ablation pulses, to a plurality of locations around the left pulmonary veins (alone or in conjunction with an endocardial ablation device, not shown), e.g., to electrically isolate the left pulmonary veins.
  • ablation energy e.g., pulsed field ablation pulses
  • FIGS. 7E-7G another lesion set may be created around the right pulmonary veins.
  • the distal end 44 of the ablation device 40 may be positioned at one or more locations adjacent the right pulmonary veins (e.g., via the sheath 70) to deliver ablation energy, e.g., pulsed field ablation pulses, to a plurality of locations around the right pulmonary veins, e.g., to electrically isolate the right pulmonary veins.
  • ablation energy e.g., pulsed field ablation pulses
  • the distal end 44 may be positioned within the oblique sinus OS adjacent the heart, and a third set of lesions 1-3 may be created around the right pulmonary veins from the oblique sinus OS. As shown in FIG. 7G, the distal end 44 may then (or previously) be positioned within the right pulmonary vein recess region, and a fourth set of lesions 1-4 may be created around the right pulmonary veins (alone or in conjunction with an endocardial ablation device, not shown), e.g., to electrically isolate the right pulmonary veins.
  • the ablation device 40 (or, again a different ablation device) may be positioned adjacent the floor of the left atrium, and a fifth set of lesions 1-6 may be created in a similar manner.
  • the lesion sets may be created in any desired order and not necessarily the exemplary order just described.
  • the lesions of each set may be created individually or multiple lesions may be created at the same time, e.g., depending on the number of electrodes on the ablation device used.
  • one or more endocardial lesions may be created, e.g., to create a lesion set similar to the Cox Maze lesion set previously created using open surgical methods.
  • an endocardial ablation device e.g., similar to the device 20 shown in FIG. 1 or any of the other devices described herein, may be introduced into the left atrium of the heart and ablation energy, e.g., pulsed field pulses, may be delivered at one or more locations within the left atrium to complete the lesion set.
  • ablation energy e.g., pulsed field pulses
  • the ablation device may be positioned adjacent the left pulmonary veins and energy may be delivered to generate a lesion adjacent the left pulmonary veins, as represented by the dashed line adjacent the left pulmonary veins in FIG. 7J.
  • the ablation device may be positioned adjacent the right pulmonary veins and energy may be delivered, e.g., to generate lesions on either side of the right pulmonary veins, as represented by the dashed lines.
  • endocardial lesions may be created from the oblique sinus OS to a) the transverse sinus TS; b) the right pulmonary vein recess, and c) the postcaval recess. The device(s) may then be removed and the procedure completed using conventional methods.
  • any of the systems and methods herein it may be desirable to deliver electrical stimuli to the patient, e.g., to the chest wall, immediately before delivering ablation energy.
  • electrical stimuli may be delivered to the chest wall to result in nerve transmission and/or skeletal muscle activation (mechanisms similar to TENS).
  • the stimuli may be delivered by one or more of the electrodes on the mapping/ ablation devices or may be delivered by separate electrodes positioned at desired locations, e.g., adjacent the heart within the body, or electrodes on patches or otherwise located externally on the patient’s skin.
  • Pulsed signal ablation delivery may be timed after the delivery of the stimuli, which may result in the ablation energy being less likely to activate pain fibers and/or muscle fibers, e.g., such that the patient experiences less pain and/or discomfort during the procedure.
  • one or more external skin patches or intracardiac elements may be used to deliver electrical impulses, which may be coupled to the processor 66 to obtain electrical impedance measurements.
  • the impulses may be used to determine the impedance between the electrodes on the devices 20, 40, which the processor 66 may use for triangulation or otherwise identifying the locations of the electrodes 26, 46.

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)

Abstract

Dispositifs, systèmes et procédés pour effectuer une ablation, par exemple, pour effectuer une ablation par champ pulsé (PFA) pour traiter une fibrillation auriculaire (AF). Dans un exemple, les systèmes peuvent être utilisés pour créer des lésions similaires à l'ensemble de lésions de Cox Maze à l'aide de procédés minimalement invasifs, par exemple, la création d'ensembles de lésions endocardiaques et épicardiques à l'aide d'un ou de plusieurs dispositifs d'ablation introduits dans le corps d'un patient.
PCT/US2023/025645 2022-06-18 2023-06-18 Systèmes de fibrillation auriculaire à champ pulsé et procédés d'utilisation Ceased WO2023244854A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US202263353583P 2022-06-18 2022-06-18
US63/353,583 2022-06-18

Publications (1)

Publication Number Publication Date
WO2023244854A1 true WO2023244854A1 (fr) 2023-12-21

Family

ID=89191902

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2023/025645 Ceased WO2023244854A1 (fr) 2022-06-18 2023-06-18 Systèmes de fibrillation auriculaire à champ pulsé et procédés d'utilisation

Country Status (1)

Country Link
WO (1) WO2023244854A1 (fr)

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050187545A1 (en) * 2004-02-20 2005-08-25 Hooven Michael D. Magnetic catheter ablation device and method
US20130131665A1 (en) * 2009-11-30 2013-05-23 Paul J. Wang Transmural Ablation Device
WO2021087486A1 (fr) * 2019-11-01 2021-05-06 The Board Of Trustees Of The Leland Stanford Junior University Dispositifs et procédés impliquant des procédures tissulaires à capacité transmurale
US20210393327A1 (en) * 2019-12-18 2021-12-23 Galary, Inc. Treatment of cardiac tissue with pulsed electric fields
KR20220014275A (ko) * 2020-07-28 2022-02-04 바이오센스 웹스터 (이스라엘) 리미티드 접촉력 및 온도 센서를 갖는 초점 카테터를 이용한 비가역적 전기천공 절제 제어

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050187545A1 (en) * 2004-02-20 2005-08-25 Hooven Michael D. Magnetic catheter ablation device and method
US20130131665A1 (en) * 2009-11-30 2013-05-23 Paul J. Wang Transmural Ablation Device
WO2021087486A1 (fr) * 2019-11-01 2021-05-06 The Board Of Trustees Of The Leland Stanford Junior University Dispositifs et procédés impliquant des procédures tissulaires à capacité transmurale
US20210393327A1 (en) * 2019-12-18 2021-12-23 Galary, Inc. Treatment of cardiac tissue with pulsed electric fields
KR20220014275A (ko) * 2020-07-28 2022-02-04 바이오센스 웹스터 (이스라엘) 리미티드 접촉력 및 온도 센서를 갖는 초점 카테터를 이용한 비가역적 전기천공 절제 제어

Similar Documents

Publication Publication Date Title
EP3939529B1 (fr) Activation séquentielle de paires d'électrode pendant une électroporation irréversible (ire)
EP4284279B1 (fr) Systèmes et procédés pour dispositifs d'électroporation comprenant des configurations de panier et de ballonnet
CN111629683A (zh) 能量递送返回路径设备和方法
JP2002543908A (ja) 心不整脈病巣のマッピング用装置
JP2003230635A (ja) 心房除細動のための方法及び装置
US11179192B2 (en) Ablation devices and methods of use
EP4193947B1 (fr) Cathéter panier avec des colonnes reliées électriquement formant une électrode distribuée
US20240215854A1 (en) Cylindrical cage systems and methods for distributed tissue contact for mapping and ablation
WO2023244854A1 (fr) Systèmes de fibrillation auriculaire à champ pulsé et procédés d'utilisation
EP4626348A2 (fr) Dispositifs de cathéter multifonctionnel et méthodes de diagnostic et de traitement d'affections cardiaques
US20250107741A1 (en) Epicardial ablation and mapping catheter
US20250195131A1 (en) Simplified basket catheters having multiple spines
US20240398469A1 (en) Expandable basket assemblies and expandable basket assemblies with electrode wire strain relief
US20250099160A1 (en) Medical device with an end effector including connecting hubs and an electrode array
US20240374304A1 (en) Electrical connector for a catheter device
US20240216050A1 (en) Multi-electrode catheter with interlaced substrate
EP4574074A1 (fr) Cathéter de cartographie et d'ablation
US20250221753A1 (en) Systems and methods for pulsed field ablation
US20250032103A1 (en) Catheter end effector with nonplanar substrate

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 23824679

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 23824679

Country of ref document: EP

Kind code of ref document: A1