CN102113907A - 具有弓形末端段的导管 - Google Patents

具有弓形末端段的导管 Download PDF

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CN102113907A
CN102113907A CN2010106246774A CN201010624677A CN102113907A CN 102113907 A CN102113907 A CN 102113907A CN 2010106246774 A CN2010106246774 A CN 2010106246774A CN 201010624677 A CN201010624677 A CN 201010624677A CN 102113907 A CN102113907 A CN 102113907A
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A·戈瓦里
S·莫亚德布
M·O·齐尔克尔
C·比克勒
P·希尔
A·C·阿尔特曼
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Abstract

本发明具有弓形末端段的导管提供了一种医疗装置，所述装置包括插入轴，所述插入轴具有纵向轴线，并具有适于插入患者体内的远端。有回弹力的末端段被固定到所述插入轴的所述远端，并且被形成为可在不受约束时限定相对于所述轴线倾斜取向的弧形，所述弧形具有在所述轴线上的曲率中心。一个或多个电极被设置在沿所述末端段10的各自位置上。

Description

具有弓形末端段的导管
技术领域
本发明总体上涉及用于侵入性治疗的方法和装置，具体地涉及导管。
背景技术
心肌组织消融是熟知的心律失常治疗手段。例如，在射频(RF)消融中，将导管插入心脏并在目标位置处与组织接触。然后通过导管上的电极施加RF能量，以便形成消融灶，其目的是破坏组织中的致心律失常电流通路。
最近，肺部静脉口的周边消融作为心房心律失常，尤其是心房纤维性颤动的治疗手段已被接受。例如，其公开内容以引用方式并入本文的美国专利6,064,902描述了用于消融血管(如肺部静脉)内壁上的组织的导管。导管的顶端部分可从大致直的第一构型(其中近端和远端部分基本上是共线的)转向J形的第二构型(其中近端和远端部分大致平行，其之间的间距与血管的内径基本上相同)。导管的远端部分围绕导管的纵向轴线旋转，使得导管上的近端和远端消融电极沿着肺部静脉的内壁进行圆周位移。这样，可使用电极导管在肺部静脉内壁上消融一些周向间隔的位点，方法是在每个周向位置消融一个或两个位点。
美国专利申请公布2005/0033135描述了用于肺部静脉标测和消融的环状导管，该专利的公开内容以引用方式并入本文中。用于周向地标测肺部静脉(PV)的导管包括弯曲段，该弯曲段被成形为大致适形于PV内表面的形状。该弯曲段包括一个或多个感测电极，并且其近端以固定或通常已知的角度连接到导管的基段。位置传感器被固定在导管的弯曲段上并固定在基段的远端。导管被插入心脏，弯曲段被定位成与PV的壁接触，同时基段保留在左心房内，通常被定位成使得其与弯曲段的接头位于静脉口处。利用三个位置传感器产生的信息计算感测电极的位置和取向，使得可以标测PV表面。感测电极可附加地进行对所选部位的消融，或者说导管可另外包括消融元件。
美国专利7,008,401描述了可用于诊断和治疗应用中的复合转向组件，这些组件用于将导管的远侧段转向成处于多个平面或者说复杂曲线，所述专利的公开内容以引用方式并入本文中。据称，这些组件使得医师可以快速准确地将消融和/或标测电极定位并保持与体内表面紧密接触。美国专利5,820,591类似地描述了这类复合转向组件，该专利的公开内容以引用方式并入本文中。
发明内容
下文描述的本发明实施例提供了更容易且可靠地接触体内组织的侵入性装置和方法。
因此，根据本发明的实施例提供了一种包括插入轴的医疗装置，其中插入轴具有纵向轴线并具有适于插入患者体内的远端。有回弹力的末端段被固定在插入轴的远端，并且被形成为可在其不受约束时限定相对于该轴线倾斜取向的弧形，所述弧形具有位于轴线上的曲率中心。一个或多个电极被设置在沿末端段的各自位置上。
在一个实施例中，弧形所对的角度大于300°。在其他实施例中，弧形所对的角度小于270°，并且可能为180°。通常，末端段包括顶端和连接到插入轴远端的基部，并且具有螺旋形而使得顶端在基部的远侧方向轴向伸出。
在一些实施例中，一个或多个电极包括在顶端上延伸的顶端电极和沿末端段分配的多个近侧电极。末端段被构造成当不受约束的末端段被轴向推进而抵住体内的组织表面时，末端段沿弧形接合组织表面，使得顶端电极和至少一些近侧电极同时接触组织表面。任选地，末端段包括一个或多个接头，这些接头可被伸直和转向，以使顶端电极单独接触组织表面。
在本发明所公开的实施例中，所述装置包括至少一个位置换能器，并且可能包括多个在末端段内分配的位置换能器。
根据本发明的实施例还提供了一种包括插入轴的医疗装置，其中插入轴具有纵向轴线并具有适于穿过体内通道插入患者体内的腔体内的远端。有回弹力的末端段包括顶端和连接到插入轴远端的基部，被形成为可在其不受约束时限定相对于该轴线倾斜取向的弧形，并且具有螺旋形而使得顶端在基部的远侧方向轴向伸出。一个或多个电极被设置在沿末端段的各自位置上。
根据本发明的实施例还提供了包括用于插入患者体内的探针的医疗设备。探针包括插入轴，插入轴具有纵向轴线并具有适于插入体内的远端。有回弹力的末端段被固定在插入轴的远端，并且被形成为可在其不受约束时限定相对于该轴线倾斜取向的弧形，所述弧形具有轴线上的曲率中心。一个或多个电极被设置在沿末端段的各自位置上，并且被构造成可接触体内的组织。射频(RF)发生器被连接成可经由探针向至少一个电极提供RF能量，以消融组织。
在本发明所公开的实施例中，所述探针包括位于末端段的位置换能器，并且所述设备包括位置感测系统，其被构造成可与位置换能器通信，以确定末端段在体内的位置。
在一些实施例中，所述设备包括被构造成可经体内通道插入体腔内的套管，并且所述探针被构造成可经套管插入体内的腔体内。在一个实施例中，所述套管被构造成可经血管插入心室，并且其中所述末端段被构造成沿弧形接合心室内的组织。通常，所述插入轴被构造成可在套管内围绕轴线旋转，以使弧形在组织上划出环状路径。
根据本发明的实施例还提供了用于治疗的方法，该方法包括向患者体内插入包括插入轴和有回弹力的末端段的探针，其中插入轴具有纵向轴线和远端，有回弹力的末端段被固定在插入轴的远端，并且被形成为可在其不受约束时限定相对于该轴线倾斜取向的弧形，所述弧形具有轴线上的曲率中心，同时电极被设置在沿末端段的各自位置上。探针沿轴向推进，以使得末端段沿弧形接合体内组织，使得至少一些电极同时接触组织。插入轴围绕轴线旋转，以使得在至少一些电极接触组织的同时弧形在组织上划出环状路径。
在本发明所公开的实施例中，所述方法包括通过电极来施加能量，以沿状形路径消融组织。在一个实施例中，插入探针包括将探针经血管穿入心室，以及围绕心脏左心房内的肺部静脉口勾画环状路径。
通过以下结合附图的实施例的详细说明，将更全面地理解本发明：
附图说明
图1为根据本发明实施例的用于心脏组织消融的系统的示意性说明图；
图2为根据本发明实施例的示出左心房中插有导管的心脏的示意性剖视图；
图3A和3B分别为根据本发明实施例的导管的示意性侧视图和剖视图；以及
图4A和4B分别为根据本发明另一个实施例的导管的示意性侧视图和剖视图。
具体实施方式
概述
如上所述环状导管可用于沿围绕解剖结构(如肺部静脉口)的弧形消融组织。为便于操纵，环状导管通常制作得薄而柔软，并具有大的环形电极，以最小化电阻。提交于2008年12月30日、转让给本专利申请的受让人的美国专利申请12/345,720描述了一种其中环状导管较厚且较硬的替代设计，该专利的公开内容以引用方式并入本文中。即便如此，操作者常常发现很难在心脏内操纵环状导管，尤其是很难定位成使环状导管的整个周长与组织接触，而这是(例如)将肺部静脉有效隔离的理想方式。
下文所述的本发明实施例提供了具有改善的环状导管结构的探针(例如导管)，以有助于在心脏内操纵和定位该结构。此类导管可用来形成弯曲的消融路径，以及感测沿曲线的位点处的电活动。
在本发明所公开的实施例中，导管包括具有纵向轴线的插入轴。沿其长度设有电极的有回弹力的末端段被固定在插入轴的远端。该末端段被形成为在不受约束时限定相对于插入轴的纵向轴线倾斜取向的弧形，所述弧形具有轴线上的曲率中心。在本专利申请和权利要求书的上下文中，术语“倾斜”意指在空间上与弧形最佳拟合的平面相对于轴的轴线所成的角度。平面与轴线之间的角度通常为至少45°，在下文所示实施例中为约90°。
操作者将导管插入体腔(例如心室)，并将导管远端轴向推向体内的组织，例如心内壁。(术语“轴向”是指平行于插入轴纵向轴线的方向。)因此，导管末端段将沿弧形正面接合组织表面，并且末端段上的一些或全部电极将因此同时接触组织表面。
为了改善接触，所述弧形可具有螺旋形，从而使末端段的远端头在相对于末端段基部的远侧方向上轴向伸出，其中基部连接于插入轴(即，当末端段不受约束时远端头略微超出基部)。所述螺旋形被轴向压缩并在末端段推进到抵住组织时被压平，以使得每个电极与组织之间存在正压力。
在将末端段与组织在目标位置接合之后，操作者围绕轴线旋转插入轴，使所述弧形在电极接触组织的同时在组织上划出环状路径。由于所述弧形的中心在轴线上，仅将轴旋转就足以产生此环形运动，通常不需要对导管进行另外的操纵或转向。通过这种方式(例如)，操作者能够使末端段围绕解剖结构(例如左心房内的肺部静脉口)勾画环形路径。操作者可通过电极施加能量(例如射频(RF)电流)，以沿该环形路径消融组织。这种布置提供了一种在组织内形成环形消融灶并且沿环形路径感测信号的容易且可靠的方式。
系统具体实施方式
图1是根据本发明实施例的用于消融患者28的心脏26的组织的系统20的示意性说明图。操作者22(如心脏病医生)通过患者28的血管系统插入导管24，使得导管的远端进入患者心室内。操作者22推进导管，使得导管末端段在所需的一个或多个位置处接合心内膜组织，如后续的附图所示。用合适的连接器将导管24在其近端与控制台30连接。控制台包括RF发生器36，其通过导管末端段的电极施加RF能量，以消融由远端段接触的组织。作为另外一种选择或除此之外，导管24可以用于其他诊断和/或治疗功能，如心电标测或其他类型的消融疗法。
在图示的实施例中，系统20使用磁性位置感测来确定导管末端段在心脏26内的位置坐标。确定位置坐标时，控制台30中的驱动电路34驱动磁场发生器32，使其在患者28体内产生磁场。磁场发生器32通常包括线圈，其放置在患者躯干下面的已知体外位置处。这些线圈在包含心脏26在内的预定工作容积内产生磁场。导管24末端段内的一个或多个磁场传感器(如图3所示)在这些磁场作用下产生电信号。控制台处理这些信号，以确定导管24末端段的方位(位置和/或取向)坐标，并且还能够确定末端段的变形，如下文说明。控制台30可以在驱动显示器38时使用坐标，使其显示导管的位置和状态。这种位置感测和处理方法在(例如)PCT国际公布WO 96/05768(该专利的公开内容以引用方式并入本文中)有详细描述，并且在Biosense Webster Inc.(Diamond Bar，California)制造的CARTOTM系统中实现。
作为另外一种选择或除此之外，系统20可以包括用于在患者28体内操纵和操作导管24的自动化机构(未示出)。此类机构通常能够控制导管24的纵向运动(前进/收回)和旋转。在此类实施例中，控制台30根据位置感测系统提供的信号生成用于控制导管运动的控制输入。
尽管图1示出了具体的系统配置，但也可在本发明的可供选择的实施例中使用其他系统配置。例如，可以用其他类型的位置换能器实施下文描述的方法，如阻抗型或超声位置传感器。如本文所用，术语“位置换能器”是指安装在导管24之上或之内的元件，该元件使控制台30接收指示元件坐标的信号。因而该位置换能器可包括导管中的接收器，其根据换能器接收到的能量产生位置信号至控制器；或传感器可以包括发射器，其发射探针外部的接收器可感测的能量。此外，类似地，实施下文描述的方法时，不仅可以使用导管，而且可以使用其他类型的探针在心脏和其他身体器官及区域进行标测和测量应用。
图2为根据本发明实施例的、示出插入心脏中的导管24的心脏26的示意性剖视图。在图示的实施例中插入导管时，操作者首先将套管40经由皮肤通过血管系统的上行腔静脉42插入心脏的右心房44。套管通常经由卵圆窝穿过心房间隔膜48进入左心房46。作为另外一种选择，可以使用其他进入路径。然后将导管24通过套管插入，直到导管的末端段52穿出套管末端的远侧开口进入左心房，如图所示。末端段被形成为可在不受约束时限定弧形，如下文所更详细说明和描述。
操作者22将左心房46内的套管40(和导管24的)的纵向轴线与肺部静脉50之一的轴线对齐。操作者可以用上文所述的位置感测方法以及预先获得的心脏26的示意图或图像进行该对齐操作。作为另外一种选择或除此之外，可以在荧光镜或其他可视化装置的帮助下进行该对齐操作。操作者将导管的末端段52向目标肺部静脉推进，以使得弧形接触静脉口，并使末端段部分地或全部地围绕静脉(这取决于弧形所对的角度)。接着，操作者围绕套管内的导管轴线旋转导管，以使得末端段围绕静脉周边勾画环形路径。同时，操作者启动RF发生器36，以便沿着该路径消融组织。在一个肺部静脉周围完成该手术过程后，操作者可以移动套管和导管，在一个或多个其他肺部静脉周围重复该手术过程。
可以在导管24中不使用任何转向机构的情况下进行以上手术过程。由于导管的弯曲形状，只需要导管的前进/收回和旋转。相对于本领域公知的装置，没有内部转向机构可以减小导管的尺寸并降低成本。如前文所述，可以用自动化机构进行上述手术过程，而不是如图1所示由操作者手动进行。
任选地，导管24可包含转向机构(未示出)，该机构使操作者22能够伸直末端段52的接头。在此配置下，操作者可操纵导管24，以勾画(并可能消融)其他类型的路径，或者在心壁内的具体离散点处(在左心房46内或别处)感测或消融组织。
导管结构
现在参见图3A和3B，图中示意性地示出根据本发明实施例的导管24的远端部分的详图。图3A为侧视图，而图3B为沿图3A的IIIB-IIIB线截取的剖视图。导管包括插入轴54，插入轴在其远端连接于末端段52的基部。在这些图中取Z轴作为插入轴的纵向轴线，如图3A的虚线所示。末端段52大致取向在X-Y平面内，但具有螺旋形，以使得末端段52的远端头在远侧方向(图3A中向右)沿Z轴轴向伸出。
轴54和末端段52通常包括由合适的柔性生物相容性材料(例如聚氨酯)制成的直径约2-3mm的外壳，并且必要时可具有内部线材和管材。在导管被设计成用于治疗性消融的一个实施例中，轴的尺寸为7Fr(直径约2.3mm)，而末端段则具有相同或略大的尺寸(例如7.5Fr)。在用于诊断测量的其他实施例中，轴为7Fr，而末端段则具有1和2.5mm之间的直径。
末端段52被成形为部分环状，即预成形的弓形结构，该结构以轴54的轴线为中心，并且环绕的角度远小于360°，通常小于270°。例如，在图示实施例中，导管末端为约180°的半环状弧形。这种形状使得更容易准确操纵和定位末端段。末端段52的曲率半径在不受约束时通常在7.5mm和15mm之间。由于弧形结构具有回弹力，并且在末端段52位于心脏内(例如，半包围肺部静脉口)时可能略呈螺旋形，并且插入轴54向远侧推进，因此末端段会在整个弧形长度上紧贴心脏组织，从而有助于很好地接触组织。
通过(例如)将镍钛诺之类的形状记忆材料制成的薄支撑以所需形状(图中未示出)装配到末端段内，可保持末端段52的弓形螺旋形状。所述支撑通常被制作得足够柔韧，以允许末端段在穿过套管40插入时伸直，然后在心室内不受约束时再恢复其弓形形状。通常，所述支撑被设计成使得需要5克或以上的轴向力来将螺旋形状压平，以使弓形末端段的整个长度都紧贴组织。
末端段52包括沿其长度的电极排列，在此例中包括在末端段的远端头上延伸的顶端电极56和沿末端段分配的近侧电极58。通常，电极具有在1mm和4mm之间的宽度，并且以1mm和10mm之间隔开。这些电极通过穿过导管24的线材(未示出)在导管的近端连接到连接器。作为另外一种选择，可以采用其他电极配置方式。例如，末端段可以只包括环形电极而没有顶端电极。又如，末端段可包括较小的“凸起”电极，如上述美国专利申请12/345,720中所描述。在任一种此类配置方式中，电极都可用于感测和/或消融。为了消融(例如)肺部静脉周围的整个环面，可以将导管24围绕其轴线旋转(顺时针旋转)，如上所述。
为了在消融过程中进行局部冷却并防止粘结，电极56和58可具有用于冲洗的孔眼。(这类孔眼在美国专利申请12/345,720中有所描述和说明。)这些孔眼在末端段52内连接到内腔(未示出)，将冲洗液从轴54送至电极及它们周围的组织。冲洗液的压力在末端段的远端往往会低于近侧。为了抵消这种压力差，远侧电极内的冲洗孔可以比近侧电极内的相对更大和/或更多。
任选地，末端段52包括内部转向机构(未示出)，通过操纵该机构可以伸直末端段的接头，并且只让顶端电极56接触组织表面。例如，转向机构可包括一根或多根本领域公知的拉线，拉线在导管中穿过内腔。(导管可包括多个内腔，以用于拉线和上述支撑、用于冲洗液和用于连接到电极和位置换能器的电线。)当需要在单点上消融或感测时，可以让顶端电极接触该点并自行激励。另一方面，当采用图3A和3B的半环状构造时，可以将顶端电极与沿末端段长度的环形电极一起激励。因此，导管24既可用于单点又可用于弯曲的消融和/或感测路径，以增强进行不同类型手术时的实用性和通用性。
导管24也可包括一个或多个位置换能器，例如图3A和3B所示的位置传感器60和62。在该实施例中，传感器60和62包括线圈，该线圈在磁场发生器32(图1)的磁场作用下输出位置信号。例如，传感器60可包括三个线圈，以提供有关末端段52基部的全面的位置和取向信息，而传感器62则各包括一个线圈，以提供位置和部分的取向信息。这种布置方式在上述美国专利申请公布2005/0033135中有进一步的描述。该布置方式允许控制台30跟踪基部位置和末端段的变形，以使操作者能够确认末端段位置正确并与组织良好接触。作为另外一种选择，可以在导管24和系统20内采用其他类型的位置换能器和感测配置方式。
图4A和4B示意性地示出根据本发明另一个实施例的导管70的远端部分。图4A为侧视图，而图4B为沿图4A的IVB-IVB线截取的剖视图。导管70的某些元件(例如，插入轴54和电极56与58)类似于上述导管24的对应元件，因而用同样的编号标示。导管70可具有类似于导管24的其他特征，例如内部支撑、转向元件、位置换能器和各种电极类型和冲洗结构，但为了简明起见，附图及本具体实施方式中已将这些特征略去。
导管70不同于导管24，因为导管70的弓形末端段72被形成为完整(或接近完整)的环，其所对的角大于300°，并且可能为整个圆周360°。因此，末端段72能够在少量旋转或不旋转轴54的情况下覆盖整个环状消融或感测路径。类似于导管24的末端段52，末端段72以轴54的轴线为中心，并具有螺旋形。这些特征使得该末端段更容易定位在所需的解剖位置，并且有助于电极58和目标组织在末端段的整个长度上良好接触。
虽然以上描述的实施例具体涉及用于某些心内手术中的导管，但根据本专利申请提出的原理制作的探针可类似地用于其他类型的诊断和治疗手术中，既可用于心脏手术也可用于其他身体器官的手术。因此，应当理解，上述实施例是以举例的方式引用，并且本发明不限于上文所具体示出和描述的内容。更确切的说，本发明的范围包括上述各种特征的组合和子组合、以及本领域技术人员在阅读上述说明书时可能想到的并且现有技术中未公开的变型形式和修改形式。

Claims (21)

1.一种医疗装置，包括：
插入轴，所述插入轴具有纵向轴线并具有适于插入患者体内的远端；
有回弹力的末端段，所述末端段被固定到所述插入轴的所述远端，并且被形成为在不受约束时限定相对于所述轴线倾斜取向的弧形，所述弧形具有在所述轴线上的曲率中心；以及
一个或多个电极，所述一个或多个电极被设置在沿所述末端段的各自位置上。
2.根据权利要求1所述的装置，其中所述弧形所对的角度大于300°。
3.根据权利要求1所述的装置，其中所述弧形所对的角度小于270°。
4.根据权利要求3所述的装置，其中所述弧形所对的角度为180°。
5.根据权利要求1所述的装置，其中所述末端段包括基部和顶端，所述基部连接到所述插入轴的所述远端，并且所述末端段具有螺旋形，使得所述顶端在相对于所述基部的远侧方向上轴向伸出。
6.根据权利要求1所述的装置，其中所述末端段包括基部和顶端，所述基部连接到所述插入轴的所述远端，并且其中所述一个或多个电极包括在所述顶端上延伸的顶端电极和沿所述末端段分配的多个近侧电极。
7.根据权利要求6所述的装置，其中所述末端段被构造成当所述不受约束的末端段被轴向推进而抵住体内组织表面时，所述末端段沿所述弧形接合所述组织表面，使得所述顶端电极和至少一些所述近侧电极同时接触所述组织表面。
8.根据权利要求7所述的装置，其中所述末端段包括一个或多个接头，所述接头能伸直和转向，从而使所述顶端电极单独接触所述组织表面。
9.根据权利要求1所述的装置，还包括至少一个位置换能器。
10.根据权利要求9所述的装置，其中所述至少一个位置换能器包括在所述末端段内分配的多个位置换能器。
11.一种医疗装置，包括：
插入轴，所述插入轴具有纵向轴线，并具有适于通过体内通道插入患者体内的腔体内的远端；
有回弹力的末端段，所述末端段包括基部和顶端，所述基部连接到所述插入轴的所述远端，并且所述末端段被形成为在不受约束时限定相对于所述轴线倾斜取向的弧形，并且具有螺旋形，使得所述顶端在相对于所述基部的远侧方向上轴向伸出；以及
一个或多个电极，所述一个或多个电极被设置在沿所述末端段的各自位置上。
12.医疗设备，包括：
探针，所述探针用于插入患者体内并包括：
插入轴，所述插入轴具有纵向轴线并具有适于插入所述体内的远端；
有回弹力的末端段，所述末端段被固定到所述插入轴的所述远端，并且被形成为在不受约束时限定相对于所述轴线倾斜取向的弧形，所述弧形具有在所述轴线上的曲率中心；以及
一个或多个电极，所述一个或多个电极被设置在沿所述末端段的各自位置上，并且被构造成能接触所述体内的组织；以及
射频(RF)发生器，所述射频发生器被耦合成通过所述探针向至少一个所述电极提供RF能量，以消融所述组织。
13.根据权利要求12所述的设备，其中所述探针包括位于所述末端段内的位置换能器，并且其中所述设备包括位置感测系统，所述位置感测系统被构造成能与所述位置换能器通信，以确定所述末端段在所述体内的位置。
14.根据权利要求12所述的设备，还包括套管，所述套管被构造成能通过体内通道插入所述体内的腔体内，并且其中所述探针被构造成能通过所述套管插入所述腔体。
15.根据权利要求14所述的设备，其中所述套管被构造成能通过血管插入心室，并且其中所述末端段被构造成沿所述弧形接合所述心室内的组织。
16.根据权利要求15所述的设备，其中所述插入轴被构造成能围绕所述轴线在所述套管内旋转，以使所述弧形在所述组织上划出环形路径。
17.根据权利要求12所述的设备，其中所述末端段包括基部和顶端，所述基部连接到所述插入轴的所述远端，并且所述末端段具有螺旋形，使得所述顶端在相对于所述基部的远侧方向上轴向伸出。
18.一种医疗方法，包括：
向患者体内插入包括插入轴和有回弹力的末端段的探针，其中所述插入轴具有纵向轴线和远端，所述有回弹力的末端段被固定到所述插入轴的所述远端，并且被形成为在不受约束时限定相对于所述轴线倾斜取向的弧形，所述弧形具有在所述轴线上的曲率中心，同时电极被设置在沿所述末端段的各自位置上；
沿轴向推进所述探针，以使得所述末端段沿所述弧形接合所述体内的组织，使得至少一些所述电极同时接触所述组织；以及
围绕所述轴线旋转所述插入轴，以使得在所述至少一些所述电极接触所述组织的同时所述弧形在所述组织上划出环形路径。
19.根据权利要求18所述的方法，还包括通过所述电极施加能量，以沿着所述环形路径消融所述组织。
20.根据权利要求18所述的方法，其中插入所述探针包括使所述探针通过血管进入心室。
21.根据权利要求20所述的方法，其中旋转所述插入轴包括在所述心脏的左心房内的肺部静脉口周围勾画所述环形路径。
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