CN112274238A

CN112274238A - Interventional therapy system and method

Info

Publication number: CN112274238A
Application number: CN201910677233.8A
Authority: CN
Inventors: 赵东生; 章东; 蔡云飞; 缪莹莹; 张冬宇; 王静
Original assignee: Jiangsu Tingsn Technology Co ltd
Current assignee: Jiangsu Tingsn Technology Co ltd
Priority date: 2019-07-25
Filing date: 2019-07-25
Publication date: 2021-01-29
Also published as: WO2021012638A1

Abstract

The embodiment of the invention relates to an interventional therapy system and a method, wherein the interventional therapy system comprises a catheter and a holding piece which are connected, wherein a mapping electrode is embedded in the front end of the catheter, a balloon is installed on the catheter, a therapeutic transducer and an imaging transducer are sequentially arranged in the catheter, an electric motor is arranged in the holding piece, and the therapeutic transducer and the imaging transducer are both connected with the electric motor and can be driven by the electric motor to rotate. The technical scheme that this application provided can carry out damage electrical isolation to pulmonary vein and the focus outside the pulmonary vein.

Description

Interventional therapy system and method

Technical Field

The present application relates to the field of ablation therapy technologies, and in particular, to an interventional therapy system and method.

Background

Atrial fibrillation is the most common arrhythmia disease in clinic at present, can not only induce cardiac insufficiency, but also increase the occurrence of stroke events of patients, and further increase the hospitalization rate and the death rate of the patients. Percutaneous catheter ablation has become the first line treatment for atrial fibrillation. Studies have shown that pulmonary veins are the source of more than 80% of atrial fibrillation lesions, and some patients with atrial fibrillation (about 20% -30%) have lesions outside the pulmonary veins. Pulmonary Venous Isolation (PVI) has been the basis for all atrial fibrillation catheter ablation strategies. Currently, there are two mainstream methods of ablation of atrial fibrillation in clinic, namely thermal ablation (radiofrequency ablation) and cold ablation (cryoballoon). Thermal ablation (radiofrequency ablation) refers to real-time three-dimensional space positioning of a radiofrequency ablation catheter under a three-dimensional mapping system, a heart three-dimensional model is established by contacting the catheter with the heart, point-by-point circling is carried out around pulmonary veins for PVI, and ablation is carried out on non-pulmonary vein trigger foci through electrical mapping. The surgical method has the advantages of reliable isolation, ablation aiming at non-pulmonary vein trigger range, expensive equipment, high operation complexity and long learning curve. The cryoballoon is passed into the left atrium by puncturing the atrial septum, a flexible sheath is implanted, a coordinated mapping catheter is used to deliver the cryoballoon to the pulmonary veins over a guidewire, and the balloon is inflated and positioned at each pulmonary vein ostium. Pulmonary vein occlusion was confirmed using contrast injection and based thereon, the balloon was cooled for pulmonary vein isolation. The operation type has the advantages of simple operation and the defect that the non-pulmonary vein trigger range can not be ablated.

Disclosure of Invention

The present application is directed to interventional therapy systems and methods that enable lesion electrical isolation of pulmonary veins and lesions outside the pulmonary veins.

In order to achieve the above object, the present application provides an interventional therapy system, the interventional therapy system includes a catheter and a holding part which are connected, wherein, the catheter front end is embedded with a mapping electrode, a balloon is installed on the catheter, a therapeutic transducer and an imaging transducer are sequentially arranged inside the catheter, an electric motor is arranged in the holding part, the therapeutic transducer and the imaging transducer are all connected with the electric motor, and can be driven by the electric motor to rotate.

Further, after the leading end of the catheter is placed into the pulmonary vein, the balloon is inflated to inflate to secure the catheter.

Further, the therapeutic transducer and the imaging transducer are connected with the electric motor through a motor linkage guide wire.

Furthermore, two mapping electrodes with a fixed interval are embedded in the front end of the catheter, and the two mapping electrodes are connected with an internal circuit through an electrode guide wire.

Furthermore, the therapeutic transducer rotates under the drive of the electric motor, and performs damage electrical isolation on the pulmonary vein in the rotating process, the imaging transducer rotates under the drive of the electric motor, and obtains two-dimensional images of the heart with different sections, and a three-dimensional model of the heart is constructed based on the obtained two-dimensional images of the heart.

Further, when the electrical isolation of the lesion and the modeling of the three-dimensional model of the heart are completed, the gas in the balloon is evacuated and the catheter is removed to a trigger outside the pulmonary vein for single point ablation of the trigger by the therapeutic transducer.

Further, the electric motor is turned off while the trigger is single-point ablated by the therapeutic transducer.

To achieve the above object, the present application also provides an interventional therapy method, the method comprising: placing the front end of the catheter into the pulmonary vein and inflating the balloon to secure the catheter; starting an electric motor to drive a therapeutic transducer and an imaging transducer to rotate, performing injury electrical isolation on the pulmonary vein through the therapeutic transducer, and constructing a heart three-dimensional model through the imaging transducer; after the injury electrical isolation and the modeling of the heart three-dimensional model are finished, gas in the saccule is pumped out, and the catheter is moved out to a trigger focus outside the pulmonary vein, so that the single-point ablation is carried out on the trigger focus through the therapeutic transducer.

Further, electrically isolating the lesion to the pulmonary vein with the therapy transducer, and constructing a three-dimensional model of the heart with the imaging transducer includes:

the therapeutic transducer rotates under the drive of the electric motor and electrically isolates the pulmonary veins in a damage way in the rotating process, the imaging transducer rotates under the drive of the electric motor and acquires two-dimensional images of the heart with different sections, and a three-dimensional model of the heart is constructed based on the acquired two-dimensional images of the heart.

Further, the method further comprises:

turning off the electric motor while the trigger is single-point ablated by the therapeutic transducer.

From the above, the technical scheme provided by the application is an innovative treatment method for performing heart modeling, catheter positioning and low-frequency ultrasonic lesion ablation by using ultrasound. Specifically, one catheter incorporating an ultrasound transducer may be designed and manufactured with the mapping electrode at the very front end, followed by an inflatable balloon, followed by a therapeutic transducer and an imaging transducer, both in conjunction with an electric motor. In practical application, the head end of the catheter can be placed into a pulmonary vein, the balloon is inflated to fix the catheter, the electric motor is started to rotate the therapeutic transducer and the imaging transducer, and at the moment, the heart ultrasonic image is obtained while lesion electrical isolation is carried out along the pulmonary vein to construct a heart three-dimensional model. And then, after the pulmonary vein isolation and the heart three-dimensional model construction are synchronously finished, pumping out the gas in the balloon, moving out the catheter, and carrying out single-point ablation on the trigger focus outside the pulmonary vein. The technical scheme provided by the application combines the advantages of the existing heat ablation and cold ablation, and the PVI is simple and quick to operate and can damage any focus outside the pulmonary vein.

Drawings

FIG. 1 is a schematic diagram of an interventional treatment system according to an embodiment of the present application;

fig. 2 is a step diagram of an interventional therapy method in an embodiment of the present application.

Detailed Description

In order to make those skilled in the art better understand the technical solutions in the present application, the technical solutions in the embodiments of the present application will be clearly and completely described below with reference to the drawings in the embodiments of the present application, and it is obvious that the described embodiments are only a part of the embodiments of the present application, and not all of the embodiments. All other embodiments obtained by a person of ordinary skill in the art without any inventive work based on the embodiments in the present application shall fall within the scope of protection of the present application.

The application provides an interventional therapy system, please refer to fig. 1, the interventional therapy system comprises a catheter 4 and a holding part 9 which are connected, wherein a mapping electrode 1 is embedded in the front end of the catheter 4, a balloon 3 is mounted on the catheter 4, a therapeutic transducer 5 and an imaging transducer 6 are sequentially arranged in the catheter 4, an electric motor 8 is arranged in the holding part 9, and the therapeutic transducer 5 and the imaging transducer 6 are both connected with the electric motor 8 and can be driven by the electric motor 8 to rotate.

In one embodiment, the balloon 3 is inflated to hold the catheter 4 after the leading end of the catheter 4 is placed into the pulmonary vein.

In one embodiment, the therapeutic transducer 5 and the imaging transducer 6 are connected to the electric motor 8 by a motor-linked guidewire 7.

In one embodiment, two mapping electrodes 1 are embedded at a fixed interval at the front end of the catheter 4, and the two mapping electrodes 1 are connected with an internal circuit through an electrode guide wire 2.

In one embodiment, the therapeutic transducer 5 is driven by the electric motor 8 to rotate and electrically isolate the pulmonary vein from the lesion during the rotation, and the imaging transducer 6 is driven by the electric motor 8 to rotate and acquire two-dimensional images of the heart with different sections, and construct a three-dimensional model of the heart based on the acquired two-dimensional images of the heart.

In one embodiment, after electrically isolating the lesion and modeling the three-dimensional model of the heart, the gas in the balloon 3 is evacuated and the catheter 4 is moved out to a trigger outside the pulmonary vein for single point ablation of the trigger by the therapeutic transducer 5.

Specifically, the therapeutic transducer emits low frequency ultrasound waves perpendicular to the long axis of the catheter, which, when not rotated, are directed toward the tip electrode when bent.

In one embodiment, the electric motor 8 is turned off while the trigger is ablated at a single point by the therapeutic transducer 5.

In particular, the therapy transducer emits low frequency ultrasound waves to cause damage to cardiac tissue, similar to an ultrasonic blade. The treatment transducer rotates 360 degrees along the long axis of the catheter, the emitted linear low-frequency ultrasonic waves draw a circle along the pulmonary vein opening for treatment, and meanwhile, the imaging transducer rotates to obtain two-dimensional images of the heart with different sections, so that a three-dimensional model of the heart is constructed.

The imaging transducer can be understood as a strip-shaped back plate, N ultrasonic probes are sequentially arranged on the strip-shaped back plate, each probe can be understood as point-shaped linear distance measurement (the time difference of flight of sound wave emission and echo reception is acoustic velocity), in a two-dimensional plane of the strip-shaped ultrasonic array, the probes can be controlled to carry out detection at different angles (0-180 degrees) according to certain angle intervals (for example, 0.1 degree is increased progressively), and therefore space depth information and echo intensity information of the two-dimensional plane can be obtained. And then, obtaining distance and echo intensity information in a three-dimensional space through the rotation (increasing by 0-360 degrees and 0.1 degree) of the ultrasonic array, and constructing a three-dimensional space model with the ultrasonic array as the center of a circle.

The imaging transducer continuously and periodically refreshes a three-dimensional image of a scanned space, simultaneously scans and positions the treatment transducer and the position of a mapping electrode on the catheter, fits the real-time shape and the relative position of the catheter in the heart, and associates the front and back position change conditions of the catheter through a 3D matching technology.

Referring to fig. 2, the present application further provides an interventional therapy method applied in the interventional therapy system, the method includes:

s1: placing the front end of the catheter into the pulmonary vein and inflating the balloon to secure the catheter;

s2: starting an electric motor to drive a therapeutic transducer and an imaging transducer to rotate, performing injury electrical isolation on the pulmonary vein through the therapeutic transducer, and constructing a heart three-dimensional model through the imaging transducer;

s3: after the injury electrical isolation and the modeling of the heart three-dimensional model are finished, gas in the saccule is pumped out, and the catheter is moved out to a trigger focus outside the pulmonary vein, so that the single-point ablation is carried out on the trigger focus through the therapeutic transducer.

In one embodiment, electrically isolating the lesion from the pulmonary vein with the therapy transducer, and constructing a three-dimensional model of the heart with the imaging transducer comprises:

In one embodiment, the method further comprises:

From the above, the technical scheme provided by the application is an innovative treatment method for performing heart modeling, catheter positioning and low-frequency ultrasonic lesion ablation by using ultrasound. Specifically, one catheter incorporating an ultrasound transducer may be designed and manufactured with the mapping electrode at the very front end, followed by an inflatable balloon, followed by a therapeutic transducer and an imaging transducer, both in conjunction with an electric motor. In practical application, the head end of the catheter can be placed into a pulmonary vein, the catheter is fixed by balloon inflation, the electric motor is started to rotate the therapy and imaging transducer, and at the moment, the heart ultrasonic image is obtained while lesion electrical isolation is carried out along the pulmonary vein to construct a heart three-dimensional model. And then, after the pulmonary vein isolation and the heart three-dimensional model construction are synchronously finished, pumping out the gas in the balloon, moving out the catheter, and carrying out single-point ablation on the trigger focus outside the pulmonary vein. The technical scheme provided by the application combines the advantages of the existing heat ablation and cold ablation, the PVI is simple and quick to operate, and the pulmonary vein and any focus outside the pulmonary vein can be damaged.

The foregoing description of various embodiments of the present application is provided for the purpose of illustration to those skilled in the art. It is not intended to be exhaustive or to limit the invention to a single disclosed embodiment. As described above, various alternatives and modifications of the present application will be apparent to those skilled in the art to which the above-described technology pertains. Thus, while some alternative embodiments have been discussed in detail, other embodiments will be apparent or relatively easy to derive by those of ordinary skill in the art. This application is intended to cover all alternatives, modifications, and variations of the invention that have been discussed herein, as well as other embodiments that fall within the spirit and scope of the above-described application.

Claims

1. An interventional therapy system is characterized by comprising a catheter and a holding part which are connected, wherein a mapping electrode is embedded at the front end of the catheter, a balloon is mounted on the catheter, a therapeutic transducer and an imaging transducer are sequentially arranged in the catheter, an electric motor is arranged in the holding part, and the therapeutic transducer and the imaging transducer are both connected with the electric motor and can be driven by the electric motor to rotate.

2. The interventional therapy system of claim 1, wherein the balloon is inflated to secure the catheter after the leading end of the catheter is placed into the pulmonary vein.

3. The interventional therapy system of claim 1, wherein the therapeutic transducer and the imaging transducer are connected to the electric motor by a motorized linkage guidewire.

4. The interventional therapy system of claim 1, wherein two mapping electrodes are embedded at a fixed spacing within the catheter tip and are connected to internal circuitry by an electrode guidewire.

5. The interventional therapy system of claim 1, wherein the therapeutic transducer is rotated by the electric motor and electrically isolates the pulmonary vein from damage during rotation; the imaging transducer is driven by the electric motor to rotate, so that two-dimensional images of the heart with different sections are obtained, and a three-dimensional model of the heart is constructed based on the obtained two-dimensional images of the heart.

6. The interventional therapy system of claim 5, wherein when electrical isolation of a lesion and modeling of a three-dimensional model of a heart is completed, gas in the balloon is evacuated and the catheter is removed to a trigger outside of a pulmonary vein for single point ablation of the trigger by the therapy transducer.

7. The interventional therapy system of claim 6, wherein the electric motor is turned off upon single point ablation of the trigger by the therapy transducer.

8. An interventional therapy method applied in the interventional therapy system according to any one of claims 1 to 7, wherein the method comprises:

placing the front end of the catheter into the pulmonary vein and inflating the balloon to secure the catheter;

starting an electric motor to drive a therapeutic transducer and an imaging transducer to rotate, performing injury electrical isolation on the pulmonary vein through the therapeutic transducer, and constructing a heart three-dimensional model through the imaging transducer;

after the injury electrical isolation and the modeling of the heart three-dimensional model are finished, gas in the saccule is pumped out, and the catheter is moved out to a trigger focus outside the pulmonary vein, so that the single-point ablation is carried out on the trigger focus through the therapeutic transducer.

9. The method of claim 8, wherein electrically isolating the lesion on the pulmonary vein with the therapy transducer and constructing a three-dimensional model of a heart with the imaging transducer comprises:

10. The method of claim 8, further comprising: