CN103156683B - Monitoring and tracking bipolar ablation - Google Patents
Monitoring and tracking bipolar ablation Download PDFInfo
- Publication number
- CN103156683B CN103156683B CN201210544527.1A CN201210544527A CN103156683B CN 103156683 B CN103156683 B CN 103156683B CN 201210544527 A CN201210544527 A CN 201210544527A CN 103156683 B CN103156683 B CN 103156683B
- Authority
- CN
- China
- Prior art keywords
- electrode
- ablating electrode
- ablating
- operation pattern
- probe
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Active
Links
- 238000002679 ablation Methods 0.000 title claims abstract description 26
- 210000001519 tissues Anatomy 0.000 claims abstract description 22
- 230000000694 effects Effects 0.000 claims abstract description 14
- 239000000523 sample Substances 0.000 claims abstract description 12
- 238000000034 method Methods 0.000 claims description 7
- 238000007689 inspection Methods 0.000 claims description 5
- 238000002372 labelling Methods 0.000 claims description 2
- 230000002159 abnormal effect Effects 0.000 abstract description 5
- 239000000155 melt Substances 0.000 description 5
- 238000002844 melting Methods 0.000 description 5
- 206010003119 Arrhythmia Diseases 0.000 description 4
- 206010007521 Cardiac arrhythmias Diseases 0.000 description 4
- 238000005516 engineering process Methods 0.000 description 4
- 238000001356 surgical procedure Methods 0.000 description 4
- 238000010586 diagram Methods 0.000 description 3
- 230000004913 activation Effects 0.000 description 2
- 230000005611 electricity Effects 0.000 description 2
- 238000003780 insertion Methods 0.000 description 2
- 210000001699 lower leg Anatomy 0.000 description 2
- 210000004204 Blood Vessels Anatomy 0.000 description 1
- 210000004165 Myocardium Anatomy 0.000 description 1
- 241000338310 Pseudofabraea citricarpa Species 0.000 description 1
- 210000003491 Skin Anatomy 0.000 description 1
- 238000001816 cooling Methods 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 229910003460 diamond Inorganic materials 0.000 description 1
- 239000010432 diamond Substances 0.000 description 1
- 238000004070 electrodeposition Methods 0.000 description 1
- 230000036541 health Effects 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 239000000203 mixture Substances 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000006011 modification reaction Methods 0.000 description 1
- 230000036651 mood Effects 0.000 description 1
- 230000037361 pathway Effects 0.000 description 1
- 230000004044 response Effects 0.000 description 1
- 230000033764 rhythmic process Effects 0.000 description 1
- 230000005619 thermoelectricity Effects 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
Abstract
The invention discloses the method and system that treatment abnormal electrocardiogram is movable, including: using probe, it has the first ablating electrode on the distal portions being arranged on described probe and the second ablating electrode and is arranged on the sensing electrode between described first ablating electrode and the second ablating electrode；Described probe is made to contact with heart tissue；And apply energy to melt target tissue along ablation path by described first ablating electrode and the second ablating electrode；Utilize described sensing electrode to monitor electrocardio-activity to detect described electrocardio-activity.After observing that described sensing electrode is no longer able to described electrocardio-activity be detected, terminate applying energy.
Description
Background technology
Technical field
The present invention relates to intrusive mood medical treatment device.More particularly, it relates to use such device
Carry out ablation tissue.
2. background technology
Use electric energy to melt bodily tissue to be well known in the art.Generally disappear with the following method
Melt: apply alternating current to electrode being enough to destroy the power of target tissue, such as radio-frequency (RF) energy.Generally,
Electrode is arranged on the distal head of the conduit inserted in person under inspection's body.Can use known in the art multiple not
Distal head is followed the tracks of, such as by measuring coil generation external by person under inspection at distal head with mode
Distal head is followed the tracks of in magnetic field.Conduit can be provided with one pole ablating electrode or bipolar ablation electrode.
U.S. Patent Application Publication No.20080275440 of Kratoska relates to providing about ablation
The method of the feedback of result.Provide the method for obtaining the feedback about ablation of tissue result, described
Method includes being formulated in target tissue from conduit by one or more pins, by the one or more pin
At least one come delivery of energy to melt at least some of of target tissue in case formed melt stove, stop logical
Cross the energy of at least one in the one or more pin to deliver and logical after energy delivers stopping
Cross at least one in the one or more pin to measure tissue characteristics.Measured tissue characteristics can be
Temperature or impedance.It addition, measured tissue characteristics can be used for determining is melted stove by what ablation was formed
Volume.
Summary of the invention
According to embodiments of the invention, it is provided that for treating the method that abnormal electrocardiogram is movable, described side
Method performs by the following: provide probe, and described probe has on the distal portions being arranged on probe the
One ablating electrode and the second ablating electrode and be arranged between the first ablating electrode and the second ablating electrode
Sensing electrode；Probe is made to contact with the target tissue in person under inspection's heart；And by the first ablating electrode and
Second ablating electrode applies energy to melt target tissue along ablation path.Described method is also by as follows
Perform: upon application of energy, utilize sensing electrode to monitor electrocardio-activity and live to detect described electrocardio
Move, observe that sensing electrode is no longer able to described electrocardio-activity detected and come in response to described observation
Terminate applying energy.
According to another aspect of described method, described electrocardio-activity is that near field is movable.
According to another aspect of described method, between the E field and H field of electrocardio-activity, there are 90 °
Phase shift.
According to another aspect of described method, apply energy and be included in bipolar operation pattern and one pole behaviour
Between operation mode alternately, under bipolar operation pattern, the first ablating electrode and the second ablating electrode serve as
Bipolar electrode, under monopolar operation pattern, at least one in the first ablating electrode and the second ablating electrode is filled
Work as monopolar electrode.
Another aspect of described method includes monitoring applying energy in the following way: graphically side
Formula show a part for the described heart including target tissue figure and along described ablation path energy apply
Process.
According to the additional aspect of described method, apply energy and be additionally included in bipolar operation pattern and one pole behaviour
Between operation mode alternately, under bipolar operation pattern, the first ablating electrode and the second ablating electrode serve as
Bipolar electrode, under monopolar operation pattern, at least one in the first ablating electrode and the second ablating electrode is filled
Work as monopolar electrode, and wherein monitoring electrocardio-activity include figure described in labelling with instruction respectively with bipolar operation
The Part I of the ablation path that pattern and monopolar operation pattern are associated and Part II.
An aspect according to described method, probe has and is arranged on the first ablating electrode and second and melts
At least two sensing electrode between electrode.
According to other embodiments of the invention, additionally provide the equipment for implementing said method.
Accompanying drawing explanation
For being more fully understood that the present invention, provide detailed description of the invention by way of example.In conjunction with
Detailed description read by lower accompanying drawing, and element identical in accompanying drawing represents by identical drawing reference numeral, and
Wherein:
Fig. 1 is the diagram of the system for performing ablative surgery, and described system is the public affairs according to the present invention
Open that embodiment constructs and be operable to；And
Fig. 2 is the electro-anatomical of the postero-anterior position projection of the heart standing to melt according to embodiments of the invention
Figure.
Concrete executive mode
In order to fully understand the various principles of the present invention, elaborate many concrete thin in the following description
Joint.However, it will be apparent to those skilled in the art that the most all these details are the most all
It is carried out essential to the invention.In this case, in order to not make key concept unnecessarily become mould
Stick with paste, be not shown specifically known to circuit, control logic and the computer journey for conventional algorithm and process
Sequence order details.
The many aspects of the present invention may be embodied in software programming code, and described software programming code is usual
It is maintained in permanent memory (such as computer-readable medium).In client/server environment
In, this software programming code is storable in client or server.Software programming code may be embodied in
Multiple known non-transitory medium (such as, floppy disk, the hard drive being used together with data handling system
Device, electronic media or CD-ROM) in any one on.Described code can be distributed in this kind of medium
On, or can by through certain form of network from the memorizer of a computer system to other computer
Storage device in system and be distributed to user, the user for these other systems uses.
System explanation
Turning now to accompanying drawing, referring first to Fig. 1, it is at living subject or the heart of patient
Performing the diagram of the system 10 of ablative surgery on 12, system 10 is according to disclosure of the invention embodiment
Structure and be operable to.This system includes conduit 14, by operator 16 by conduit 14 via skin
Skin passes in ventricle or the blood vessel structure of the vascular system insertion heart 12 of patient.Operator 16 is (generally
For doctor) make the distal head 18 of conduit contact with heart wall at target spot melting.Then can be special according to the U.S.
In profit No.6,226,542 and 6,301,496 and commonly assigned United States Patent (USP) No.6,892,091, institute is public
The method opened prepares electrical activation figure, and disclosures of these patents is the most incorporated herein by reference.System
A kind of commodity embodying element of system 10 are permissible3 systems are purchased from Biosense Webster,
Inc. (3333Diamond Canyon Road, Diamond Bar, CA91765).
Can melt being such as assessed as abnormal region by electrical activation figure by applying heat energy, example
As by radio-frequency current is conducted the one or more electricity to distal head 18 by the metal wire in conduit
Pole, radio-frequency (RF) energy is applied to cardiac muscle by these electrodes.Energy is absorbed in tissue, thus is added by tissue
Heat is to uniform temperature (normally about 50 DEG C), and tissue permanent can lose its electrostimulation at such a temperature
Property.After this successful surgery, formed in heart tissue and non-conducting melt stove, these melt stove can in
Break and cause ARR abnormal electric pathway.The principle of the present invention can be applied to different ventricles, application
In sinus rhythm mapping, and apply when treating multiple different arrhythmia.
One pole melts and produces the deepest stove that melts being centrally located at ablating electrode position, and bipolar electric
Pole tends to producing the shallower elongated ablation stove extended between a pair bipolar electrode.These bipolar ablation stoves
Characteristic and position can to melt stove assessment and follow the tracks of produce difficulty.
Conduit 14 generally includes shank 20, has suitable controller so that operator 16 on shank
Can be handled by far-end to conduit needed for ablative surgery, position and be oriented.For auxiliary operation person
16, the distal portions of conduit 14 includes aspect sensor (not shown), and it is to being positioned in control station 24
Location processor 22 signal is provided.
Ablation energy and the signal of telecommunication can be made to be placed through at distal head 18 by cable 34 or neighbouring by one
Individual or multiple ablating electrodes 32, transmit between heart 12 and control station 24 back and forth.Cable can be passed through
34 and electrode 32 pacing signal and other control signal are sent to heart 12 from control station 24.Equally
The sensing electrode 33 being connected to control station 24 is arranged between ablating electrode 32 and has been connected to cable
34.Melting period, ablating electrode 32 generally works under bi-polar configuration.But, in ablating electrode
One or both can by use configuration circuit and be used as monopolar electrode, described configuration circuit be used for basis
Ablation procedure is required and changes operator scheme between double pole mode and monopolar mode.
Other parts of control station 24 with external electrode 30 and positioning subsystem are connected to one by wiring 35
Rise.Electrode 32 and external electrode 30 can be used for measuring the tissue impedance at ablation points, as authorized
United States Patent (USP) No.7 of Govari et al., as proposed in 536,218, this patent is with way of reference
It is expressly incorporated herein.Mounting temperature sensor 37 on or near each electrode 32, usually thermoelectricity is the warmmest
Sensitive resistor.
Control station 24 generally includes one or more ablation power generator 25.Conduit 14 may be adapted to profit
By any of ablation techniques, by ablation energy, (such as, radio-frequency (RF) energy, ultrasonic energy and laser produce
Luminous energy) conduction to heart.Commonly assigned United States Patent (USP) No.6,814,733, No.6,997,924 and
No.7, discloses this type of method in 156,816, these patents are incorporated by reference herein.
Location processor 22 is the element of the positioning subsystem of system 10, and it measures the position of conduit 14
And orientation coordinate.
In one embodiment, positioning subsystem includes that structure is followed the tracks of in magnetic orientation, and this structure uses and generates
The coil 28 in magnetic field, with predetermined working volume generate at magnetic field sensing tube about these
Magnetic field, so that it is determined that the position of conduit 14 and orientation.
As it has been described above, conduit 14 is connected to control station 24, this control station makes operator 16 to see
Examine and regulate and control the operation of conduit 14.Control station 24 includes processor, it is however preferred to have at suitable signal
The computer of reason circuit.Described processor is connected to drive monitor 29.Signal processing circuit is usual
Receiving, amplify, filter and digitized is from the signal of conduit 14, these signals include the sensor
Signal produced by electrode (not shown) is sensed with the multiple positions being positioned at conduit 14 far-end.Control
Platform 24 and positioning subsystem receive and use digitized signal, to calculate the location of conduit 14 and to be orientated also
Analyze the signal of telecommunication of self-electrode.
Generally, system 10 includes other element, but these yuan are not shown for simplicity
Part.Such as, system 10 can include electrocardiogram (ECG) monitor, and it is coupled to receive from one
Or the signal of multiple external electrode, in order to provide ECG synchronization signal for control station 24.As it has been described above,
System 10 generally also includes home position sensor, and it is positioned at the outside being connected to outside person under inspection's health
Apply on benchmark paster, or be positioned at insertion heart 12 and be maintained at fixed position relative to heart 12
On built-in catheter.Provide for make liquid circulate through conduit 14 with cooling ablation points conventional pumps and
Pipeline.
Conduit 14 generally includes one or more pairs of ablating electrode 32, as it is shown in figure 1, wherein sense electrode
One or more in 33 are arranged between each pair of ablating electrode 32.Generally, ablating electrode 32 has
There is larger area so that RF power is delivered to tissue effectively, and sensing electrode 33 can be relatively
Little, as shown in the figure.In the ring electrode shown in Fig. 1, ablating electrode 32 should than sensing electrode 33 more
Wide.
Although diagram embodiment includes two parallel type ring electrodes, but be used as single sense electrode or
Use single driffractive ring to serve as a pair sensing electrode.Sensing electrode 33 senses the local electrical activity in heart
And by means of suitably detecting with observation circuit (not shown) by detection electricity amplitude in control station 24
Decline follow the tracks of melt stove formed process.Therefore, a pair sensing electrode is preferably as it is permitted
Permitted the bipolar measurement of the near field signal of telecommunication (there is between E field and H field the phase shift of 90 °), so that not having
There is energy to be transmitted and therefore obtain more accurately indicating of local electrical activity.Disappearing by local electrical activity
Lose to indicate and melt completely.Dynamically reconfigure ablating electrode 32 needed for melting stove according to generation
Local requirement optionally to work under double pole mode and monopolar mode.
Melt monitoring
When bipolar ablation is carried out along path, follow the tracks of bipolar ablation the most to graphically, with
Operator is made to may easily be determined line or time that ring is melted completely.Referring now to Fig. 2, according to it
The expection of electro-anatomical Figure 37 of the postero-anterior position projection of the heart standing to melt of embodiments of the invention is real
Example.Above-mentioned CARTO3 system can produce this figure.In this example, the region of plexus nervorum is comprised
Marked by circle 39.These regions will guide to select the position melting stove 41 by melting establishment
With orientation to treat arrhythmia, the such as arrhythmia being associated with complex fractionated AE.With
In positioning and treating this ARR technology at commonly assigned co-pending patent application
Proposing in No.12/275380, this patent application is incorporated by reference herein.Certainly, can be according to this
Bright principle treats other arrhythmia multiple and abnormal conduction path.
When melt carry out time, follow the tracks of this process and it is shown as on Figure 37 a series of connect mark
Note, the rectangle 43 wherein with intersection hatch patterns represents the interval of bipolar ablation, and is generally oriented
The rectangle 45 becoming to be perpendicular to rectangle 43 represents the interval that one pole melts.Melt stove 41 to appear as linearly
's；But it is true not necessarily so.This melt stove can be curve or not even continuous print.Can be such as
By graph technology (such as, color), rectangle 43 is distinguished with rectangle 45.
It will be appreciated by those skilled in the art that the present invention to be not limited to above and specifically illustrate and retouch
The content stated.More precisely, the scope of the present invention includes combination and the subgroup of various feature mentioned above
Close, and these features in the range of prior art, do not change and modifications form, these changes and repairing
Reshaping formula be those skilled in the art after reading the above description it is contemplated that.
Claims (6)
1. an armarium, including:
Probe, described probe has the first ablating electrode on the distal portions being arranged on described probe and the second ablating electrode and is arranged on the sensing electrode between described first ablating electrode and the second ablating electrode；
It is connected to described first ablating electrode and the ablation energy generator of the second ablating electrode；And
Monitor, described monitor is connected to described sensing electrode and is operable to when described probe contacts with the target tissue in person under inspection's heart detect electrocardio-activity by described sensing electrode, described monitor includes that pictorial displays, described pictorial displays are operable to include the figure of a part for the described heart of described target tissue and the process of the energy applying along ablation path for display.
Equipment the most according to claim 1, wherein said electrocardio-activity is that near field is movable.
Equipment the most according to claim 1, wherein exists 90 between the E field and H field of described electrocardio-activity°Phase shift.
Equipment the most according to claim 1, also include configuring circuit, described configuration circuit is used for configuring described first ablating electrode and the second ablating electrode to work under bipolar operation pattern and monopolar operation pattern, under described bipolar operation pattern, described first ablating electrode and the second ablating electrode serve as bipolar electrode, and under described monopolar operation pattern, at least one in described first ablating electrode and the second ablating electrode serves as monopolar electrode.
Equipment the most according to claim 4, wherein said monitor is operable to for figure described in labelling to indicate Part I and the Part II of the ablation path being associated respectively with described bipolar operation pattern and described monopolar operation pattern.
Equipment the most according to claim 1, wherein said sensing electrode includes at least two sensing electrode being arranged between described first ablating electrode and the second ablating electrode.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US13/326,456 | 2011-12-15 | ||
| US13/326456 | 2011-12-15 | ||
| US13/326,456 US10456196B2 (en) | 2011-12-15 | 2011-12-15 | Monitoring and tracking bipolar ablation |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN103156683A CN103156683A (en) | 2013-06-19 |
| CN103156683B true CN103156683B (en) | 2016-11-30 |
Family
ID=
Citations (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5404638A (en) * | 1991-02-15 | 1995-04-11 | Cardiac Pathways Corporation | Method of forming a flexible expandable member for use with a catheter probe |
| US5579764A (en) * | 1993-01-08 | 1996-12-03 | Goldreyer; Bruce N. | Method and apparatus for spatially specific electrophysiological sensing in a catheter with an enlarged ablating electrode |
| CN1187113A (en) * | 1995-06-07 | 1998-07-08 | 生物感觉有限公司 | Apparatus and method for treating cardiac arrhythmias with no discrete target |
| CN1193267A (en) * | 1995-08-22 | 1998-09-16 | 得克萨斯州立大学董事会 | Maneuverable electrophysiology catheter for percutaneous or intraoperative ablation of cardiac arrhythmias |
| US5954665A (en) * | 1995-06-07 | 1999-09-21 | Biosense, Inc. | Cardiac ablation catheter using correlation measure |
| CN1652728A (en) * | 2002-05-13 | 2005-08-10 | 导管治疗有限公司 | An ablation catheter |
| CN101199416A (en) * | 2006-09-06 | 2008-06-18 | 韦伯斯特生物官能公司 | Correlation of cardiac electrical maps with body surface measurements |
Patent Citations (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5404638A (en) * | 1991-02-15 | 1995-04-11 | Cardiac Pathways Corporation | Method of forming a flexible expandable member for use with a catheter probe |
| US5579764A (en) * | 1993-01-08 | 1996-12-03 | Goldreyer; Bruce N. | Method and apparatus for spatially specific electrophysiological sensing in a catheter with an enlarged ablating electrode |
| CN1187113A (en) * | 1995-06-07 | 1998-07-08 | 生物感觉有限公司 | Apparatus and method for treating cardiac arrhythmias with no discrete target |
| US5954665A (en) * | 1995-06-07 | 1999-09-21 | Biosense, Inc. | Cardiac ablation catheter using correlation measure |
| CN1193267A (en) * | 1995-08-22 | 1998-09-16 | 得克萨斯州立大学董事会 | Maneuverable electrophysiology catheter for percutaneous or intraoperative ablation of cardiac arrhythmias |
| CN1652728A (en) * | 2002-05-13 | 2005-08-10 | 导管治疗有限公司 | An ablation catheter |
| CN101199416A (en) * | 2006-09-06 | 2008-06-18 | 韦伯斯特生物官能公司 | Correlation of cardiac electrical maps with body surface measurements |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US11213347B2 (en) | Monitoring and tracking bipolar ablation | |
| US11382680B2 (en) | System for controlling tissue ablation using temperature sensors | |
| JP6095979B2 (en) | Contact evaluation based on phase measurement | |
| CN103720511B (en) | Ablation power control based on contact force | |
| CN105708449A (en) | Far Field-Insensitive Intracardiac Catheter Electrodes | |
| CN104414748A (en) | Graphical user interface for medical imaging system | |
| CN108201467A (en) | Temperature during estimation ablation | |
| CN104414738A (en) | Adaptive electrode for bi-polar ablation | |
| CN103156683B (en) | Monitoring and tracking bipolar ablation | |
| RU2771638C1 (en) | Assessment of the development of ablation by the irreversible electroporation method based on the amplitude of measured biopolar signals | |
| JP2023027024A (en) | phrenic nerve warning |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| PB01 | Publication | ||
| SE01 | Entry into force of request for substantive examination | ||
| GR01 | Patent grant |