JP2005192725A - Ablation catheter with balloon - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a catheter safer to a patient by reducing burdens on the patient due to catheter invasion and suppressing heat generation at parts other than a target lesion at the time of ablation. <P>SOLUTION: In this ablation catheter, a potential detection mechanism is attached, the properness / improperness of the ablation are judged by detecting a potential around an ablation treated part without pulling out the ablation catheter after the ablation of the target lesion, and an ablation process is repeatedly performed by expanding a balloon again immediately when a judged result is the improperness. Thus, invasion burdens due to the introduction of a catheter for potential detection and the re-introduction of the ablation catheter in the case that the ablation is improper are completely eliminated and the burdens on the patient are reduced. Further, since an electrode for high frequency energizing is made bipolar, a high frequency current does not flow to the electrode for the potential detection and a guide wire at the time of the ablation and the ablation at parts other than the target lesion is suppressed. Also, since a counter electrode plate is not used, the heat generation on the counter electrode plate is dissolved. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention provides a target lesion site by heating a target lesion site by heating with a high frequency dielectric heating and Joule heat in a state where a balloon disposed on the distal end side of the catheter is in close contact with the target lesion site in a patient. In particular, the present invention relates to a technique for reducing a burden on a patient due to catheter invasion in a cauterization treatment for a target lesion site in a patient body.

  In recent years, ablation catheters for the treatment of cardiac arrhythmia have been developed. For example, JP-A-2002-78809 (Patent Document 1) describes an ablation catheter with a balloon for pulmonary vein electrical isolation for performing cardiac arrhythmia treatment. When pulmonary veins are electrically isolated using such an ablation catheter with a balloon, as shown in FIG. 8, the inflatable / deflated balloon 52 disposed on the distal end side of the catheter 51 is lowered percutaneously. The balloon 52 is introduced into the vena cava QA and pierced through the atrial septum Hw from the right atrium Ha of the heart HA while being pushed by the catheter 51 to reach the left atrium Hb. Then, the balloon 52 inflated by the supply of the liquid containing the contrast medium into the balloon is brought into close contact with the pulmonary vein opening Qa, and a round electric wire having a cross section of about 0.5 mm in diameter is spirally formed. A high frequency power supply 55 is applied to a high frequency power supply coil electrode 53 that is wound around and shaped into a coil body and installed in the balloon 52. ) (Referred to as a counter electrode plate).

  The annular peripheral portion of the pulmonary vein port Qa is cauterized as a whole by high-frequency dielectric heating and heating by Joule heat that occur in association with high-frequency energization between the high-frequency energization coil electrode 53 and the counter electrode plate 54. Following cauterization of the pulmonary vein opening Qa, cauterization of the remaining three pulmonary vein openings Qb to Qd opened on the inner wall of the left atrium Hb is sequentially performed in the same manner. All the four pulmonary veins are electrically isolated by cauterizing the annular peripheral edge of each pulmonary vein opening Qa to Qd. When the annular peripheral edge of each pulmonary vein opening Qa to Qd is cauterized and each of the four pulmonary veins is in the form of electrical isolation, the electrical signal that causes arrhythmia is cut off and the cardiac arrhythmia is almost eliminated.

  As described above, according to the ablation catheter with a balloon described in Japanese Patent Application Laid-Open No. 2002-78809 (Patent Document 1), the annular peripheral edge of each pulmonary vein port Qa to Qd is cauterized as a whole. It is not necessary to repeat the cauterization, and only the annular peripheral edge portion of each pulmonary vein opening Qa to Qd is cauterized, so that it is not necessary to cauterize an extra portion (for example, a healthy portion).

  However, after cauterization with the ablation catheter with balloon, after the ablation catheter with balloon is pulled out, another potential detection catheter (not shown) for detecting the electric potential around the ablation treatment site is introduced, and the ablation is performed. I had to check if it was done properly (whether it was electrically isolated). If cauterization has not been performed properly, the introduction and withdrawal of the ablation catheter with balloon and the potential detection catheter will be repeated again.

  Therefore, it is conceivable to attach the potential detection means to the ablation catheter with a balloon. However, in the case of the ablation catheter with a balloon using a counter electrode plate as described in Patent Document 1, the potential detection means is used for detecting the potential by high-frequency energization during ablation. A high-frequency current also flows to the electrode and the potential detection electrode is heated, which may ablate blood vessels and tissues other than the target lesion site.

  Furthermore, a guide wire is required to introduce the ablation catheter with a balloon into a target lesion site in a patient. However, in the case of an ablation catheter with a balloon using a counter electrode, a metal coil type or a thin resin-coated guide wire is used. As a result of the high-frequency energization at the time of ablation, a high-frequency current flows to the tip of the guide wire and the tip of the guide wire is heated, which may ablate blood vessels and tissues other than the target lesion site.

  Further, in the case of an ablation catheter with a balloon using a counter electrode plate, there is a possibility that the counter electrode plate 54 affixed to the patient's body surface by high-frequency energization at the time of ablation may generate heat due to high-frequency energization.

  On the other hand, as another means for heating the inside of the balloon, there is a method described in JP-T-10-503407 (Patent Document 2). Japanese Patent Laid-Open No. 10-503407 (Patent Document 2) describes a medical device in which bipolar high-frequency energizing electrodes are arranged in a balloon as means for warming the inside of the balloon. As shown in FIG. 10, this is a rigid instrument having a sharp end, and a medical device having a balloon and a bipolar high-frequency energizing electrode inside the balloon near the end. During the operation, the balloon is deflated, the pointed tip is punctured into the organ to be treated, and then the balloon is inflated at the treatment site to perform high-frequency energization between the electrodes for high-frequency energization. In addition, high-frequency dielectric heating and heating by Joule heat that occur in association with high-frequency energization between the electrodes for high-frequency energization destroys unwanted cells inside the living body, and the target tissue is a malignant or benign tumor, sac Excessive tissue that exogenously narrows the nearby body cavity.

However, the medical device described in JP-T-10-503407 (Patent Document 2) only heats and necroses the cells around the puncture part as a whole, and is delicate and delicate like pulmonary vein electrical isolation. It was not used for operation.
Japanese Unexamined Patent Publication No. 2002-78809 (all pages of detailed description, FIGS. 1 to 6) Japanese translation of PCT publication No. 10-503407 (all pages of detailed description, FIG. 1 to FIG. 17)

  The present invention eliminates the burden on the patient due to the repeated introduction and withdrawal of the ablation catheter with balloon and the potential detection catheter described above, and also eliminates ablation other than the target lesion site due to the use of the counter electrode or damage to the body surface. It is an object to provide an attached ablation catheter.

  In order to achieve the above object, the present invention has the following configuration.

  (1) In an ablation catheter having a balloon on the distal end side of the catheter, and further comprising a high-frequency energizing electrode and a temperature sensor in the balloon, potential detection for detecting the potential around the ablation site on the catheter distal end surface An ablation catheter with a balloon, characterized in that the high-frequency energizing electrode is bipolar.

(2) In the ablation catheter with a balloon according to (1), at least one of the electrodes for high-frequency energization is cylindrical, and both electrodes have a surface area of 20 mm ² or more. Ablation catheter with balloon.

  (3) In the ablation catheter with a balloon according to (1) or (2), the potential detecting means is attached to the potential measuring electrode attached before the front end of the balloon and before the rear end of the balloon. Ablation catheter with a balloon, which is one of an electrode for potential measurement, or an electrode for potential measurement attached before the front end of the balloon and an electrode for potential measurement attached before the rear end of the balloon .

  (4) In the ablation catheter with a balloon according to (1) or (2), the double cylindrical catheter in which the outer cylindrical shaft and the inner cylindrical shaft are concentrically connected with each other so that the outer cylindrical shaft and the inner cylindrical shaft are movable in the axial direction. The tip of the balloon is fixed to the tip of the inner cylinder shaft, the rear end of the balloon is fixed to the tip of the outer cylinder shaft, and the outer cylinder shaft and the inner cylinder shaft slide between each other. An ablation catheter with a balloon, wherein the balloon can be deformed by the above.

  (5) In the ablation catheter with a balloon as described in (4), the detection potential extraction lead wire for extracting the detection potential from the potential detection electrode is covered with the electrically insulating protective coating, An ablation catheter with a balloon led out through a gap with a tube shaft.

  (6) In the ablation catheter with a balloon according to (4), the lead for detecting the detection potential is covered with an electrically insulating protective film, and the thickness of at least one of the outer cylindrical shaft and the inner cylindrical shaft Ablation catheter with balloon that is routed through the thick section.

  (7) In the ablation catheter with a balloon according to any one of (1) to (6), for a sensor for extracting a temperature measurement signal from a power supply lead wire for supplying high-frequency power to a high-frequency energization electrode and a temperature sensor An ablation catheter with a balloon in which both lead wires are passed through the catheter while being covered with an electrically insulating protective coating.

  (8) The ablation catheter with a balloon according to any one of (1) to (7) has a liquid introduction port at a rear end of the balloon, and further feeds the liquid into the balloon via the catheter. An ablation catheter with a balloon comprising liquid supply means and power supply means for supplying high-frequency power in a supply amount corresponding to a temperature measurement result of the temperature sensor.

  (9) The ablation catheter with a balloon according to (8), wherein the liquid fed by the liquid feeding means passes through a clearance between the outer cylinder shaft and the inner cylinder shaft.

  (10) In the ablation catheter with a balloon according to any one of (1) and (9), the liquid filled in the balloon by the ablation mechanism is heated to 50 ° C. to 80 ° C. by high-frequency energization in the range of 100 KHz to 2.45 GHz. An ablation catheter with a balloon characterized by that.

  (11) In the ablation catheter with a balloon according to (9) or (10), the liquid in the balloon in an inflated state by the liquid fed from the liquid introduction port by the liquid feeding means enters and exits between the catheter and the balloon. An ablation catheter with a balloon provided with liquid stirring means for stirring the liquid in the balloon.

  According to the first aspect of the present invention, the potential detection means for detecting the potential around the ablation treatment site attached to the surface of the catheter tip is attached, and when the target lesion site is cauterized, the ablation catheter is pulled out. Without using the attached potential detection means, the potential around the ablation treatment site is detected to determine the appropriateness / inappropriateness of the ablation, and if the determination result is inappropriate, the balloon is immediately inflated again to ablate. Therefore, it is not necessary to introduce a potential detection catheter or reintroduce an ablation catheter, thereby reducing the burden on the patient.

  Furthermore, according to the invention according to claim 1, since the high-frequency energizing electrode is installed inside the balloon that is an electric high-resistance material for both bipolar electrodes, the high-frequency current does not flow to the potential detection electrode during ablation. There is no risk of ablation of blood vessels and tissues other than the target lesion site due to heating of the potential detection electrode.

  Furthermore, according to the first aspect of the present invention, since the high-frequency energizing electrode is installed inside the balloon which is an electric high-resistance material for both bipolar electrodes, no high-frequency current flows to the tip of the guide wire during ablation. There is no risk of ablation of blood vessels and tissues other than the target lesion site due to heating of the wire tip.

  Furthermore, according to the first aspect of the present invention, since both high-frequency energizing electrodes are installed inside the balloon, a counter electrode plate is not required and the possibility of heat generation of the counter electrode plate is eliminated.

  Further, in ablation using a conventional ablation catheter (having an electrode of several mm at the tip and being cauterized several times in a dotted manner), the potential must be confirmed at a plurality of positions. Otherwise, it is not possible to identify the location where the shochu is defective, and it is not possible to identify the shochu point. Further, if it is attempted to confirm the potentials at many points at once, it is necessary to attach a large number of potential detection electrodes to the potential measurement catheter, which causes an increase in the cost and size of the catheter.

  On the other hand, according to the invention according to claim 1, since a wide range of cauterization is performed in a ring shape along the entire circumference of the balloon with a single cauterization, it is necessary to specify the location of the cauterization abnormality as in the conventional example. In other words, it is only necessary to determine whether or not there is an abnormality (whether or not a potential is detected) in the cauterized area. If there is an abnormality, the area can be cauterized again. Therefore, unlike the conventional example, it is not necessary to provide a large number of potential detection electrodes on the catheter. In addition, since it is not necessary to identify an abnormal part, it is not necessary to apply (contact) the electrode to the specific part as in the conventional example, and it is only necessary to position the electrode in the vicinity of the ring-shaped cauterized region. . Therefore, according to the first aspect of the present invention, the number of expensive potential detection electrodes can be reduced, and the cost and size of the catheter can be reduced.

  According to the invention of claim 2, the temperature in the balloon can be raised without boiling the liquid in the balloon.

  Further, according to the invention of claim 2, since the high-frequency energizing electrode is installed inside the balloon, which is an electric high resistance material for both bipolar electrodes, no high-frequency current flows to the tip of the guide wire during ablation. There is no risk of ablation of blood vessels and tissues other than the target lesion site due to heating of the wire tip. In addition, since both high-frequency energizing electrodes are installed inside the balloon, a counter electrode plate is not necessary, and there is no possibility of generating heat of the counter electrode plate.

  According to the invention of claim 3, since the potential detection electrode is attached at a position ahead of the front end of the balloon, the potential at a location ahead of the front end of the balloon can be easily detected even around the ablation site. . For example, since the potential of the part can be detected without inserting a catheter deep into the pulmonary vein, damage to the deep part of the pulmonary vein can be avoided.

  According to the invention of claim 4, since the potential detection electrode is attached at a position in front of the rear end of the balloon, the potential at the position in front of the rear end of the balloon can be easily obtained even around the ablation treatment site. Since the potential detection electrode is attached to both the position ahead of the front end of the balloon and the position before the rear end of the balloon, the position of the balloon ahead of the front end of the balloon around the ablation treatment site and the balloon In addition to being able to easily detect any potential at a location in front of the rear end, or by changing the shape of the balloon in various ways by moving the outer cylinder shaft or the inner cylinder shaft in the axial direction, high frequency Since the inner electrode for energization is inserted concentrically with the inner cylinder shaft, the inner electrode for high-frequency energization is substantially integrated with the inner cylinder shaft. The Gayori smoothly.

  According to the fifth aspect of the present invention, since the catheter also serves as a pipe for leading out the lead for extracting the detection potential, the lead does not interfere with the cauterization process.

  According to the sixth aspect of the present invention, since the lead wire for taking out the detected potential is led out through the thick portion of at least one of the outer tube shaft and the inner tube shaft, the lead wire can be easily electrically connected. Can be insulated.

  According to the seventh aspect of the present invention, the sensor lead wire for extracting the temperature measurement signal from the temperature sensor and the power supply lead wire for supplying high frequency power to the high frequency energization inner electrode are passed through the catheter. Therefore, the catheter can also serve as the lead pipe. In addition, since both the sensor lead wire and the power supply lead wire have an electrically insulating protective coating, there is no risk of short-circuit between the lead wires, and at the same time, leakage and intrusion of high-frequency power can be suppressed. As a result, the heat generation of the catheter due to leakage and intrusion of high-frequency power is suppressed, and the forced cooling mechanism of the catheter can be omitted.

  According to the eighth aspect of the present invention, the balloon can be inflated firmly by feeding the liquid into the balloon via the catheter by the liquid feeding means. In addition, the heating temperature of the high-frequency dielectric heating and Joule heat can be accurately controlled by supplying high-frequency power with a supply amount corresponding to the temperature measurement result of the temperature sensor by the power supply means.

  According to the invention which concerns on Claim 9, the clearance between an outer cylinder shaft and an inner cylinder shaft can be used as a flow path for liquid supply by a liquid supply means.

  According to the invention which concerns on Claim 10, even if an electric current flows into a human body, there is no electric shock. In addition, the balloon surface temperature can be maintained at a temperature at which the myocardial tissue is coagulated and necrotized.

  According to the eleventh aspect of the present invention, during the execution of heating by high frequency dielectric heating and Joule heat, the liquid in the balloon in an inflated state by introducing the liquid is made to enter and exit between the catheter and the balloon by the liquid stirring means. When the liquids are agitated, liquids with different temperatures are mixed with each other so that the temperature of the liquid in the balloon becomes uniform, and uneven heating due to high frequency dielectric heating and Joule heat can be suppressed.

  A preferred embodiment of the present invention will be described with reference to the drawings.

  FIG. 1 is a plan view showing the overall configuration of the ablation catheter according to the present embodiment, FIG. 2 is a cross-sectional view showing the inside of the balloon of the ablation catheter of the present embodiment, and FIG. 3 is when the balloon of the ablation catheter of the present embodiment is inflated. It is a front view which shows the external shape. The ablation catheter of this embodiment is suitable for performing pulmonary vein electrical isolation as a treatment for cardiac arrhythmia.

  In the ablation catheter of this embodiment, a balloon 2 that can be inflated and deflated is disposed on the distal end side of the catheter 1. The catheter 1 is a double tube type catheter in which an outer tube shaft 3 and an inner tube shaft 4 are concentrically threaded so as to be movable in the axial direction, and the distal end portion of the balloon 2 is fixed to the distal end of the inner tube shaft 4. The rear end portion of the balloon 2 is fixed to the front end of the outer cylinder shaft 3, and a liquid introduction port 2A is provided at the rear end of the balloon. In the case of the double tube type catheter 1, the shape of the balloon 2 can be variously changed by moving the outer tube shaft 3 or the inner tube shaft 4 in the axial direction. Therefore, in the present invention, the catheter 1 is preferably a double tube catheter, but the catheter 1 is not necessarily limited to a double tube catheter, and a single tube catheter is preferable depending on the type of treatment. There is also.

  The length of the outer cylinder shaft 3 and the inner cylinder shaft 4 is about 1 m to about 1 m and several tens of centimeters. The outer diameter of the outer cylinder shaft 3 is about 3 mm to 5 mm, and the inner diameter is about 2 mm to 4 mm. The outer diameter of the inner cylinder shaft 4 is about 1 mm to 3 mm, and the inner diameter is about 0.5 mm to 2 mm.

  As the material of the outer cylinder shaft 3 and the inner cylinder shaft 4, a flexible material having excellent antithrombogenicity is used. Specifically, a fluororesin, a polyamide resin, a polyimide resin, etc. are mentioned, for example.

  As shown in FIG. 3, the balloon 2 has a conical shape (conical tip conical shape) whose diameter is reduced on the distal end side in the inflated state. The balloon 2 has a length (length d along the balloon center axis 2a that virtually connects the balloon tip and the balloon rear end) of about 20 mm to 40 mm, and the maximum outer diameter on the rear end side is about 10 mm to 40 mm. The film thickness is 100 μm to 300 μm. When the outer diameter of the balloon 2 has a conical shape with a tapered shape, the balloon can be prevented from entering the pulmonary vein, and the balloon 2 can be inserted into the pulmonary vein mouth by slightly inserting the tip of the balloon 2 into the pulmonary vein mouth. Since it is closely attached, the entire annular peripheral edge of the pulmonary vein opening can be reliably cauterized.

  As the material of the balloon 2, a stretchable material excellent in antithrombogenicity is used. Furthermore, in order to prevent the high frequency current from leaking outside the balloon when the high frequency energization electrodes 5A and 5B are energized, it is desirable that the material be an electrical high resistance material. That is, polyurethane-based polymer materials are particularly preferable, and specific examples include thermoplastic polyether urethane, polyether polyurethane urea, fluorine polyether urethane urea, polyether polyurethane urea resin, and polyether polyurethane urea amide.

  Further, in the case of the ablation catheter of the present embodiment, the high-frequency energizing electrodes 5A and 5B are installed in the balloon 2, and the liquid that feeds the liquid from the liquid introduction port 2A through the catheter 1 into the balloon 2. A feeding device (liquid feeding means) 6 is connected to the distal end side of the catheter 1 via a four-way connector 7.

  As the high-frequency energizing electrode, it is important that the high-frequency energizing electrode inside the balloon is bipolar, like the high-frequency energizing electrodes 5A and 5B shown in FIG.

In the figure, the high-frequency energizing electrodes 5A and 5B are illustrated as a high-frequency energizing electrode wound around an electric wire and shaped into a coil shape, but the shape is not limited to a coil shape, Also good. However, a cylindrical high-frequency energizing electrode such as a coil or cylinder is particularly preferable. Further, the high-frequency energizing electrode preferably has a surface area of 20 mm ² or more, more preferably 40 mm ² or more. Thereby, favorable heating efficiency can be obtained. The surface area is desirably 400 mm ² or less. Here, the surface area means the total surface area including the outer side, the inner side, and the thickness portion in the case of a cylindrical object, and can approximate the surface area of the electric wire corresponding to the electrode portion in the case of a coil shape.

  The diameter of the electric wire in the case of the coil shape is not particularly limited, but about 0.1 mm to 1 mm is practical and preferable.

  As a material for the high-frequency energizing electrode, a high conductivity metal (wire) such as silver (wire), gold (wire), platinum (wire), copper (wire) or the like is used.

  The high-frequency energizing electrodes 5A and 5B are concentrically inserted on the inner cylinder shaft 4 without restricting the inner cylinder shaft 4. The inner diameters of the high-frequency energizing electrodes 5A and 5B are slightly larger than the outer diameter of the inner cylindrical shaft 4, and there is a small gap between the inner surfaces of the high-frequency energizing electrodes 5A and 5B and the outer surface of the inner cylindrical shaft 4. When the high-frequency energizing electrodes 5A and 5B are thus concentrically inserted on the inner cylindrical shaft, the center axis 5a of the high-frequency energizing electrodes 5A and 5B is automatically aligned with the central axis 1a of the catheter 1. In addition, the high-frequency energizing electrodes 5A and 5B are substantially integrated with the inner cylindrical shaft 4. Further, since the high frequency energizing electrodes 5A and 5B do not restrain the inner cylinder shaft 4, the inner cylinder shaft 4 can be moved smoothly.

  In the case of the ablation catheter of this embodiment, high-frequency energization at the time of ablation is performed between the high-frequency energization electrodes 5A and 5B inside the balloon, whereby high-frequency dielectric heating and heating by Joule heat are performed. That is, in the case of the ablation catheter of the embodiment, the counter electrode plate arranged outside the patient body, which is necessary in the conventional ablation catheter, is unnecessary. Moreover, the appropriate temperature of the tissue cauterization at the time of high frequency dielectric heating and Joule heating is usually in the range of 50 ° C to 70 ° C.

  On the other hand, the liquid feeding device 6 is provided with a liquid feeding roller pump (not shown), and the liquid fed by the liquid feeding roller pump passes through the clearance between the outer cylinder shaft 3 and the inner cylinder shaft 4. Then, it is fed into the balloon 2 from the liquid inlet 2A. As the liquid from the liquid feeding device 6 is fed into the balloon 2, the balloon 2 is inflated. That is, the clearance between the outer cylinder shaft 3 and the inner cylinder shaft 4 is used as a flow path for liquid feeding by the liquid feeding device 6.

  In the case of the ablation catheter of the present embodiment, a diaphragm type liquid agitating mechanism (liquid) that agitates the liquid in the balloon by allowing the liquid in the balloon 2 in an inflated state by liquid supply to enter and exit the balloon 2 via the catheter 1. (Stirring means) 8 is provided. By the stirring by the stirring mechanism 8, liquids with different temperatures are mixed to make the liquid temperature in the balloon uniform, and heating unevenness due to high frequency dielectric heating and Joule heat can be suppressed.

  Furthermore, in the ablation catheter of the present embodiment, a temperature sensor 9 installed in the balloon 2, a high-frequency power source (power supply means) 10 that supplies high-frequency power with a supply amount corresponding to the temperature measurement result of the temperature sensor 9, and It has. The frequency of the high frequency power is in the range of 100 KHz to 2.45 GHz. During execution of heating by high-frequency dielectric heating and Joule heat, the heating temperature is detected by the temperature sensor 9 in the balloon 2 and fed back to the high-frequency power source 10, and the high-frequency power source 10 responds to the temperature measurement result of the temperature sensor 9. By supplying high-frequency power with the supply amount, the heating temperature by high-frequency dielectric heating and Joule heat is controlled.

  In addition, the high frequency energizing electrodes 5A and 5B are fixed to the outer cylindrical shaft 3 to which the rear end portion of the balloon 2 is attached, and the temperature sensor 9 is fixed to the high frequency energizing electrode 5A or 5B. As a result, the installation positions of the high-frequency energizing electrodes 5A and 5B and the temperature sensor 9 in the balloon 2 are stabilized. The temperature sensor 9 is exemplified by a thermocouple, but is not limited to a thermocouple, and for example, a semiconductor type temperature measuring element or the like can be used.

  Further, as shown in FIG. 4, both the sensor lead wire 11 for extracting the temperature signal from the temperature sensor 9 and the power feeding lead wires 12A and 12B for feeding the high frequency power to the high frequency energizing electrodes 5A and 5B are both electric. Insulating protective coatings 13 and 14 are passed through the clearance between the outer tube shaft 3 and the inner tube shaft 4 of the catheter 1. That is, the clearance between the outer cylinder shaft 3 and the inner cylinder shaft 4 is used as piping for the sensor lead wire 11 and the power supply lead wires 12A and 12B. In addition, since both the sensor lead wire 11 and the power supply lead wires 12A and 12B are provided with the electrically insulating protective coatings 13 and 14, there is no fear of short-circuiting between the lead wires, and at the same time, the high frequency power As a result of suppressing leakage and intrusion and suppressing heat generation of the outer tube shaft 3 and the inner tube shaft 4 due to leakage and intrusion of high-frequency power, the forced cooling mechanism of the catheter 1 is omitted in the case of the ablation catheter of the embodiment. However, a forced cooling mechanism for the catheter 1 may be provided in the catheter 1 as necessary.

  Examples of the material of the sensor lead wire 11 and the power supply lead wires 12A and 12B include wires such as copper, silver, platinum, tungsten, and alloys.

  Specific examples of the material for the electrical insulating protective coatings 13 and 14 include fluorine-based polymers such as polytetrafluoroethylene (PTFE) and tetrafluoroethylene-6-fluoropropylene copolymer (FEP). In addition to the compound, polyethylene, polypropylene, polyimide resin, polyamide resin, and the like can be given.

  In the case of the present embodiment, the power supply leads 12A and 12B also use the same conducting wires as the high frequency energization electrodes 5A and 5B, but the power supply lead wires separately manufactured for the high frequency energization electrodes 5A and 5B. 12A and 12B may be connected.

  Further, radiation shielding metal pipes 3A and 4A are attached to the front ends of the outer cylinder shaft 3 and the inner cylinder shaft 4, and the front end portion and the rear end portion of the balloon 2 are attached to the metal pipes 3A and 4A, respectively. The outer cylinder shaft 3 and the inner cylinder shaft 4 are fixed. By providing the radiation shielding metal pipes 3A and 4A, when performing X-ray fluoroscopy, the radiation shielding metal pipes 3A and 4A appear on the X-ray fluoroscopic image. It becomes possible to grasp. Examples of the material of the radiation shielding metal pipes 3A and 4A include gold, platinum, and stainless steel.

  The ablation catheter of the present embodiment has a potential detection electrode 16A for detecting the potential around the ablation treatment site attached to the front end surface of the inner cylindrical shaft 4, and the inside of the catheter 1 from the rear end of the catheter 1. A potential detection mechanism 15A comprising a detection potential take-out lead wire 17A that is passed through and connected to the potential detection electrode 16A, and a potential around the ablation treatment site that is affixed to the distal end surface of the outer cylindrical shaft 3 A potential detection mechanism 15B including a potential detection electrode 16B for detecting the detection potential, and a detection potential extraction lead wire 17B that is passed through the catheter 1 from the rear end of the catheter 1 and connected to the potential detection electrode 16B; It has.

  The potential detection electrode 16A is shaped into a short cylinder having a height (length) of about 3 mm, and a synthetic resin pipe 19 is added to the end of the radiation shielding metal pipe 4A at the tip of the inner cylinder shaft 4. The potential detection electrode 16 </ b> A is directly fitted directly on the outer periphery of the synthetic resin pipe 19. The potential detection electrode 16 </ b> B is also shaped into a short cylindrical shape having a height (length) of about 3 mm, and is directly fitted to the outer periphery of the outer cylindrical shaft 3. As a material for the potential detection electrodes 16A and 16B, platinum, silver, copper with silver plating, or the like is used.

  As shown in FIG. 4, the lead wires 17 </ b> A and 17 </ b> B for extracting electric potential are also passed through the clearance between the outer cylinder shaft 3 and the inner cylinder shaft 4 with the electrically insulating protective coating 18. The lead wires 17A and 17B may be led out through an elongated hole formed in the thick part of at least one of the outer cylinder shaft 3 and the inner cylinder shaft 4. In this case, if the lead wires 17A and 17B are electrically insulated by the thick portions of the shafts 3 and 4, it is not always necessary to cover the lead wires 17A and 17B with the electrically insulating protective coating 18.

  The potential detected by the potential detection electrodes 16A and 16B can be checked by connecting the detection potential extraction leads 17A and 17B to a normal electrocardiograph 20 as shown in FIG. (Or display monitor) and check.

  The usage of the ablation catheter of the present embodiment having the above-described configuration will be described by taking as an example the case where the peripheral edge of the pulmonary vein opening of the heart is cauterized. As shown in FIG. 5, while the balloon 2 in a contracted state is pushed forward by the catheter 1 along the guide wire GW introduced percutaneously into the patient's body, the inferior vena cava QA passes through the left atrium Ha and further through the atrial septum. After reaching the right atrium Hb, the balloon 2 is applied to the peripheral edge of the pulmonary vein opening Qa and brought into close contact therewith. Then, high-frequency energization is performed between the high-frequency energization electrodes 5A and 5B inside the balloon to heat and cauterize the peripheral edge of the pulmonary vein opening Qa. The remaining three pulmonary vein margins are cauterized in the same manner.

  When cauterization of the peripheral edge of the pulmonary vein is completed, the appropriateness / inappropriateness of cauterization is determined using the potential detection mechanism 15A or the potential detection mechanism 15B. When the potential detection mechanism 15A is used, as shown in FIG. 6, the ablation catheter is not pulled out (the balloon 2 is deflated as necessary. In FIG. 6, the balloon is in a deflated state). The electrode 16A is positioned in the vicinity of the ablation site (for example, the inner surface of the atrium), and at the same time, the electrode 16A is extracted by the detection potential extraction lead wire 17A and displayed on the chart of the electrocardiograph 20. Appropriate / inappropriate cauterization is determined from the detection results displayed on the chart. When the determination result is inappropriate, the balloon 2 is inflated again and the cauterization process is repeated.

  Even when the potential detection mechanism 15B is used, as shown in FIG. 7, the ablation catheter is not pulled out (the balloon 2 is deflated as necessary. In FIG. 7, the balloon is in a deflated state). The electrode 16B is positioned in the vicinity of the ablation site (for example, the inner surface of the atrium), and at the same time, the electrode 16B is taken out by the detection potential take-out lead wire 17B and displayed on the chart of the electrocardiograph 23. Appropriate / inappropriate cauterization is determined from the detection results displayed on the chart. When the determination result is inappropriate, the balloon 2 is inflated again and the cauterization process is repeated.

  Depending on the part for detecting the potential, the potential detection mechanism 15A and the potential detection mechanism 15B can be operated simultaneously to detect and check the potentials of the two parts at the same time.

  When all of the cautery is determined to be appropriate, the ablation catheter is withdrawn and treatment is completed.

  As described above, when the ablation catheter of this embodiment has been cauterized, the potential around the ablation treatment site can be obtained by the potential detection mechanism 15A and the potential detection electrode 15B attached to the catheter 1 without pulling the ablation catheter out of the body. Is detected to determine whether the cauterization is appropriate or inappropriate, and when the determination result is inappropriate, the balloon 2 can be inflated again to repeat the cauterization process. If this is inappropriate, reintroduction of the ablation catheter becomes unnecessary, and the burden of invasion due to introduction of the potential detection catheter and reintroduction of the ablation catheter is completely eliminated. As a result, the burden on the patient due to catheter invasion can be reduced.

  Next, specific examples of the ablation catheter of the present invention will be described.

〔Example〕
First, a balloon 2 having a conical shape with a conical tip having a length from the balloon tip to the rear end of the balloon of 30 mm, a maximum outer diameter of 30 mm at the rear end, and a film thickness of 160 μm was prepared as follows. That is, a glass balloon mold having a mold surface corresponding to a desired balloon shape is immersed in a 13% concentration polyurethane solution, and the solvent is evaporated by applying heat to form a urethane polymer film on the mold surface. Balloon 2 was manufactured by the method.

  On the other hand, a polyvinyl chloride tube containing 12 Fr, an inner diameter of 2.7 mm, a total length of 800 mm and containing 30% of barium sulfate is used as the outer cylindrical shaft 3 of the catheter 1, and the outer surface is 2.8 mm in diameter and 7 mm in length and sandblasted. A stainless steel pipe is inserted into the end of the tube as a metal pipe 3A, and then tied and fixed with a 0.1 mm nylon thread, and a potential detection electrode 16B having an outer diameter of 4.0 mm, an inner diameter of 3.8 mm, and a height of 3 mm is provided. Extrapolate to the tip and fix with adhesive, and connect the lead wire 17B for detection potential detection with electrical insulation protection coating from the inside of the outer cylindrical shaft 3 in the portion covered with the potential detection electrode 16B. After that, the four-way connector 7 was inserted and fitted to the rear end, and then tied and fixed with a 0.1 mm nylon thread.

  On the other hand, a nylon tube having 4 Fr, an inner diameter of 1.1 mm, and an overall length of 900 mm is used as the inner cylindrical shaft 4, and a stainless steel pipe having a diameter of 1.2 mm and a length of 6 mm and having a sandblasted outer surface is used as a metal pipe 4A. After being internally inserted and fitted, it was tied and fixed with 0.1 mm nylon thread. Further, after a synthetic resin pipe 19 having an outer diameter of 2.0 mm, an inner diameter of 1.1 mm, and a length of about 10 mm is extrapolated and joined to the metal pipe 4A, the inner diameter is 2.0 mm, the outer diameter is 2.5 mm, and the height is increased. A 3 mm potential detection electrode 16A was extrapolated to the tip of the synthetic resin pipe 19, fixed with an adhesive, and connected to a detection potential extraction lead wire 17B with an electrical insulation protective coating. Then, while the lead wires 17A and 17B for extracting the detection potential are pulled out to the rear end side of the catheter 1, the inner cylinder shaft 4 is inserted through the four-way connector 7 and then the cap of the four-way connector 7 is tightened to double the cylinder. A catheter 1 of the type was manufactured.

  In addition, as the high-frequency energizing electrodes 5A and 5B, the tip of a 0.5 mm diameter annealed copper wire with a silver plating of 0.1 μm is shaped into a coil shape with an inner diameter of 1.6 mm and a length of 10 mm. An electrically insulating protective coating 14 was applied to the other parts using a fluorinated ethylene-6 fluoropropylene copolymer (FEP) to form power supply leads 12A and 12B.

  Further, as the temperature sensor 9, an ultrafine thermocouple double (copper-constantan) wire made of polytetrafluoroethylene and provided with an electrically insulating protective coating 13 was manufactured with a sensor lead wire 11.

  After the temperature sensor 9 is fixed to the high frequency energizing electrode 5A, the high frequency energizing electrodes 5A and 5B are inserted into the tip of the inner cylindrical shaft 4, and then the sensor lead wire 11 and the power feeding lead wires 12A and 12B are connected. The clearance between the outer cylinder shaft 3 and the inner cylinder shaft 4 is pulled through, the sensor lead wire 11 and the rear ends of the power supply lead wires 12A and 12B are pulled out from the four-way connector 7, and the sensor lead wire 11 and The tips of the power supply lead wires 12A and 12B were fixed to the metal pipe 3A with an aramid fiber fixture so that the interval between the high frequency energizing electrodes 5A and 5B was 2 mm.

  Finally, the front end of the balloon 2 is tied and fixed to the metal pipe 4A with 0.1 mm nylon thread, and the rear end of the balloon 2 is tied and fixed to the metal pipe 3A with 0.1 mm nylon thread. Completed (hereinafter abbreviated as the ablation catheter in the Examples).

[Potential detection test]
Subsequently, a potential detection test for checking the potential detection function of the potential detection mechanism 15A and the potential detection mechanism 15B was performed on the ablation catheter of the example.

  A test object (pig) as a potential detection target was prepared in advance, and lead wires 17A and 17B for extracting a detection potential were connected to the electrocardiograph 20.

  First, the potential detection electrode 16A of the potential detection mechanism 15A was applied to the body surface near the heart of the test object, and the detection potential was recorded on the chart by the electrocardiograph 20.

  Next, the potential detection electrode 16B of the potential detection mechanism 15B was applied to the body surface near the heart of the test object, and the detection potential was recorded on the chart by the electrocardiograph 20.

  The recorded results on the chart were all normal. This potential detection test detects the body surface potential of the test object, but if the body surface potential of the test body can be detected normally, the body potential of the test body can also be detected normally. It was confirmed that both the potential detection mechanism 15A and the potential detection mechanism 15B can properly detect the potential in the patient body.

[Electrode heating test for potential detection]
Furthermore, regarding the ablation catheter of the example, the heat generation of the potential detection electrode was compared with a conventional ablation catheter using a counter electrode arranged outside the patient's body.

  First, the heat generation of the potential detection electrode was investigated when the potential detection electrode was attached to a conventional ablation catheter using a counter electrode placed outside the patient's body.

  As an example of a conventional ablation catheter, one obtained by removing one of the high frequency energization electrodes 5B from the ablation catheter shown in FIG. 9 was used (hereinafter abbreviated as the ablation catheter of Comparative Example 1). As an example of the counter electrode plate 21, an aluminum sheet having a length of 7.5 cm × width of 15 cm and a thickness of 100 μm was manufactured.

  The ablation catheter of Comparative Example 1 was immersed in a water tank filled with physiological saline at 37 ° C., and the power supply lead wire 12 A was connected to the high-frequency power source 10. The counter electrode plate 21 was installed on the outer wall surface of the water tank and connected to the high frequency power source 10. The balloon was infused with a contrast medium (Ioxaglic acid injection solution: trade name Hexabrix 320) diluted to 50% with physiological saline, and the maximum outer diameter on the rear end side was expanded to 30 mm.

  The frequency of the high frequency power source 10 was set to 13.56 MHz, the set temperature in the balloon 2 was set to 70 ° C., and high frequency was applied for 5 minutes. A thermocouple was attached immediately above the potential detection electrode 16B, and the temperature was measured. As a result, the temperature of the potential detection electrode rose to 60 ° C. in about 30 seconds, and was always around 60 ° C. (60 ° C. ± 3 ° C.) thereafter.

  As described above, in the ablation using the ablation catheter of Comparative Example 1, a high-frequency current flows to the potential detection electrode by high-frequency energization, and the potential detection electrode is also heated.

  Next, heat generation of the potential detection electrode of the ablation catheter of the example was investigated.

  The ablation catheter of the example was immersed in a water tank filled with physiological saline at 37 ° C., and the power supply leads 12 A and 12 B were connected to the high frequency power source 10. The balloon was infused with a contrast medium (Ioxaglic acid injection solution: trade name Hexabrix 320) diluted to 50% with physiological saline, and the maximum outer diameter on the rear end side was expanded to 30 mm.

  The frequency of the high frequency power source 10 was set to 13.56 MHz, the set temperature in the balloon 2 was set to 75 ° C., and high frequency was applied for 5 minutes. A thermocouple was attached immediately above the potential detection electrode 16B, and the temperature was measured. As a result, even after 5 minutes, the temperature of the potential detection electrode was around 40 ° C. (40 ° C. ± 3 ° C.).

  As described above, in the ablation using the ablation catheter of the embodiment, the high-frequency energizing electrode is installed inside the balloon, which is an electric high resistance material for both bipolar electrodes, so that a high-frequency current flows to the potential detection electrode during ablation. This eliminates the risk of ablation of blood vessels and tissues other than the target lesion site due to heating of the potential detection electrode.

[Metal guide wire heat generation test]
Furthermore, the heat generation of the conventional ablation catheter and the metal guide wire was compared for the ablation catheter of the example.

  First, the heat generation of a metal guide wire when a metal guide wire was used for a conventional ablation catheter was investigated.

  The ablation catheter of Comparative Example 1 was immersed in a water tank filled with physiological saline at 37 ° C., and the power supply lead wire 12 A was connected to the high-frequency power source 10. The counter electrode plate 21 was installed on the outer wall surface of the water tank and connected to the high frequency power source 10. The balloon was infused with a contrast medium (Ioxaglic acid injection solution: trade name Hexabrix 320) diluted to 50% with physiological saline, and the maximum outer diameter on the rear end side was expanded to 30 mm. The guide wire was made of SUS304, and a guide wire having a diameter of 0.025 inches and a length of 1500 mm was used. A guide wire was inserted into the inner cylindrical shaft of the ablation catheter of Comparative Example 1, and a thermocouple was attached to the tip of the guide wire with the tip of the guide wire protruding about 1 cm from the tip of the conventional ablation catheter.

  The frequency of the high frequency power source 10 was set to 13.56 MHz, the set temperature in the balloon 2 was set to 70 ° C., and high frequency was applied for 5 minutes. As a result, the temperature at the tip of the guide wire rose to 50 ° C. in about 60 seconds, and was always around 50 ° C. (50 ° C. ± 3 ° C.).

  As described above, in the ablation using the ablation catheter of Comparative Example 1, a high-frequency current flows through the metal guide wire by high-frequency energization, and the metal guide wire is also heated.

  Next, the heat generation of the metal guide wire when the metal guide wire was used for the ablation catheter of the example was investigated.

  The ablation catheter of the example was immersed in a water tank filled with physiological saline at 37 ° C., and the power supply leads 12 A and 12 B were connected to the high frequency power source 10. The balloon was infused with a contrast medium (Ioxaglic acid injection solution: trade name Hexabrix 320) diluted to 50% with physiological saline, and the maximum outer diameter on the rear end side was expanded to 30 mm. The guide wire was made of SUS304, and a guide wire having a diameter of 0.025 inches and a length of 1500 mm was used. A guide wire was inserted into the inner tube of the ablation catheter of the example, and a thermocouple was attached to the tip of the guide wire with the tip of the guide wire protruding about 1 cm from the tip of the conventional ablation catheter.

  The frequency of the high frequency power source 10 was set to 13.56 MHz, the set temperature in the balloon 2 was set to 75 ° C., and high frequency was applied for 5 minutes. As a result, the temperature of the tip end of the metal guide wire was around 40 ° C. (40 ° C. ± 3 ° C.) even after 5 minutes.

  As described above, in the ablation using the ablation catheter of the example, since the high-frequency energizing electrode is installed inside the balloon which is an electric high resistance material for both bipolar electrodes, a high-frequency current may flow to the metal guide wire during ablation. This eliminates the risk of ablation of blood vessels and tissues other than the target lesion site due to heating of the metal guide wire.

[Examination of surface area of electrode for high-frequency energization]
For comparison, the ablation catheter (hereinafter abbreviated as the ablation catheter of Comparative Example 2) in which the axial lengths of the high-frequency energizing electrodes 5A and 5B are each 0.5 mm, that is, the surface area is approximately 10 mm ² , and the high frequency. An ablation catheter (hereinafter abbreviated as the ablation catheter of Comparative Example 3) in which the axial lengths of the energizing electrodes 5A and 5B are each 1 mm, that is, the surface area is approximately 20 mm ² , is manufactured. The length in the axial direction of the high-frequency energizing electrodes 5A and 5B is 10 mm, that is, the surface area is approximately 200 mm ² ). Each ablation catheter was immersed in a water tank filled with 37 ° C. physiological saline, and the power supply leads 12 A and 12 B were connected to the high-frequency power source 10. In each balloon, a contrast agent (Ioxaglic acid injection solution: trade name Hexabrix 320) diluted with physiological saline to 50% was injected, and the maximum outer diameter on the rear end side was expanded to 30 mm.

The frequency of the high frequency power source 10 was set to 13.56 MHz, the set temperature in the balloon 2 was set to 75 ° C., and high frequency was applied for 5 minutes. As a result, in the ablation catheter of Comparative Example 2, since the surface area of the high-frequency energizing electrode is small, the high-frequency current is concentrated and reaches only 100 ° C. around the high-frequency energizing electrodes 5A and 5B. It was observed that boiled and bubbles were generated. Obviously, it is undesirable for the patient to be so hot that boiling occurs in the patient's body. In the ablation catheter of Comparative Example 3, no appearance of liquid boiling was observed. In addition, in the ablation catheter of the example, it was not recognized that the liquid boiled. The surface area of the high-frequency energizing electrodes 5A and 5B is desirably 20 mm ² or more where boiling is not observed.

  Furthermore, in the ablation catheter of Comparative Example 3, the surface temperature of the balloon 2 was raised only to about 50 ° C., whereas in the ablation catheter of the example, the surface temperature of the balloon 2 was raised to about 60 ° C. . This is because the high-frequency current is concentrated in the ablation catheter of Comparative Example 3 because the surface area of the high-frequency energization electrode is small compared to the ablation catheter of the example, and only around the high-frequency energization electrodes 5A and 5B. To reach. That is, in the ablation catheter of Comparative Example 3, it was confirmed that the set temperature in the balloon 2 needs to be set to 90 ° C. in order to set the surface temperature of the balloon 2 to 60 ° C. In view of safety, it is clear that a lower maximum temperature is desirable from the viewpoint of safety, and it can be said that the ablation catheter of the example is superior to the ablation catheter of Comparative Example 3 from the viewpoint of safety. .

  In addition, this invention is not restricted to said Example, It is also possible to implement with the following forms.

  For example, the ablation catheter of the embodiment has a configuration including all of the liquid feeding device 6 and the high-frequency power source 10, but the liquid feeding device 6 and the high-frequency power source 10 can be separately procured when actually used. Therefore, the ablation catheter of the present invention may be the catheter 1 that does not include the liquid delivery device 6 or the high-frequency power source 10.

  Further, in the embodiment, the potential detection mechanism 15A where the attachment position of the potential detection electrode 16A is ahead of the front end of the balloon 2, and the potential where the potential detection electrode 16B is before the rear end of the balloon 2. Although both of the detection mechanisms 15B were arranged, the ablation catheter having the same structure as that of the example except that only one of the potential detection mechanism 15A and the potential detection mechanism 16B was arranged was modified. It is mentioned as an aspect.

  In the embodiment, only one potential detection mechanism 15A and one potential detection mechanism 16B are provided on the front end side and the rear end side of the balloon. However, the potential detection mechanism 15A and the potential detection mechanism 16B are different from each other. , Not limited to one each, a plurality of balloons may be provided on the front end side and rear end side of the balloon. Or it may be zero.

It is a top view which shows the whole structure of the ablation catheter of one Embodiment of this invention. It is sectional drawing which shows the inside of the balloon which concerns on one Embodiment of this invention. It is a front view which shows the external shape at the time of expansion | swelling of the balloon which concerns on one Embodiment of this invention. 1 is a cross-sectional view of a catheter according to an embodiment of the present invention. It is a mimetic diagram showing the situation at the time of cauterization of the pulmonary vein mouth by the ablation catheter of one embodiment of the present invention. It is a schematic diagram which shows the condition at the time of the electric potential detection by the electric potential detection mechanism attached to the ablation catheter of one Embodiment of this invention. It is a schematic diagram which shows the condition at the time of the electric potential detection by the other electric potential detection mechanism attached to the ablation catheter of one Embodiment of this invention. It is a schematic diagram which shows the cauterization situation of the pulmonary vein opening by the conventional ablation catheter using the counter electrode arrange | positioned out of a patient's body. It is an Example top view of the conventional ablation catheter which uses the counter electrode arrange | positioned outside a patient body. It is a schematic diagram showing a medical device in which the high-frequency energizing electrode in the balloon is bipolar as means for warming the inside of the balloon.

Explanation of symbols

1: Catheter 2: Balloon 3: Outer cylinder shaft 4: Inner cylinder shaft 5A, 5B: High frequency energizing electrode 6: Liquid feeding device (liquid feeding means)
7: Four-way connector 8: Diaphragm stirring mechanism (liquid stirring means)
9: Temperature sensor 10: High frequency power supply (power supply means)
11: Lead wire for sensor 12A, 12B: Lead wire for power supply 13, 14: Electrical insulation protective coating 15A, 15B: Potential detection mechanism (potential detection means)
16A, 16B: Potential detection electrodes 17A, 17B: Detection potential take-out lead wires 18: Electrical insulation protective coating 19: Synthetic resin pipe 20: Electrocardiograph 21: Counter electrode

Claims (11)

  An ablation catheter having a balloon on the distal end side of the catheter, further comprising a high-frequency energizing electrode in the balloon, and further comprising a temperature sensor capable of measuring the balloon temperature. An ablation catheter with a balloon comprising a potential detection electrode for detecting the potential of the high-frequency current and the high-frequency energization electrode being bipolar. The balloon ablation catheter according to claim 1, wherein at least one of the electrodes for high-frequency energization is cylindrical, and both electrodes have a surface area of 20 mm ² or more. With ablation catheter.   The ablation catheter with a balloon according to claim 1 or 2, wherein the potential detection means includes a potential measurement electrode attached before the front end of the balloon, a potential measurement electrode attached before the rear end of the balloon, Or the ablation catheter with a balloon which is either one of the electrode for potential measurement attached before the front end of the balloon and the electrode for potential measurement attached before the rear end of the balloon.   The ablation catheter with a balloon according to claim 1 or 2, wherein the catheter is a double-cylinder catheter in which an outer tube shaft and an inner tube shaft are concentrically connected in an axially movable manner. The tip of the tube is fixed to the tip of the inner cylinder shaft, the rear end of the balloon is fixed to the tip of the outer cylinder shaft, and the balloon can be deformed by sliding between the outer cylinder shaft and the inner cylinder shaft. An ablation catheter with a balloon characterized by the above.   The ablation catheter with a balloon according to claim 4, wherein the detection potential extraction lead wire for extracting the detection potential from the potential detection electrode is covered with an electrically insulating protective coating, and the outer cylindrical shaft, the inner cylindrical shaft, Ablation catheter with a balloon that is led out through the gap.   The ablation catheter with a balloon according to claim 4, wherein the lead wire for taking out the detection potential is covered with an electrically insulating protective coating and has a thick part of at least one of the outer cylindrical shaft and the inner cylindrical shaft. Ablation catheter with balloon that is led through.   In the ablation catheter with a balloon according to any one of claims 1 to 6, a power supply lead wire for feeding high-frequency power to the high-frequency energization electrode and a sensor lead wire for taking a temperature measurement signal from the temperature sensor, Both are ablation catheters with balloons that are passed through the catheter in a state covered with an electrically insulating protective coating.   The ablation catheter with a balloon according to any one of claims 1 to 7, further comprising a liquid introduction port at a rear end of the balloon, and further supplying liquid into the balloon via the catheter. And an ablation catheter with a balloon provided with power supply means for supplying high-frequency power with a supply amount corresponding to a temperature measurement result of the temperature sensor.   The ablation catheter with a balloon according to claim 8, wherein the liquid fed by the liquid feeding means passes through a clearance between the outer cylinder shaft and the inner cylinder shaft.   The ablation catheter with a balloon according to any one of claims 1 to 9, wherein the ablation mechanism heats the liquid filled in the balloon at 50 ° C to 80 ° C by high-frequency energization in a range of 100 KHz to 2.45 GHz. Ablation catheter with balloon.   The balloon ablation catheter according to claim 9 or 10, wherein the liquid in the balloon in an inflated state is caused to enter and exit between the catheter and the balloon by the liquid fed from the liquid introduction port by the liquid feeding means. An ablation catheter with a balloon provided with a liquid agitating means for agitating a liquid.

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