CN103281978B - 多极心外膜射频消融 - Google Patents

多极心外膜射频消融 Download PDF

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CN103281978B
CN103281978B CN201180064171.5A CN201180064171A CN103281978B CN 103281978 B CN103281978 B CN 103281978B CN 201180064171 A CN201180064171 A CN 201180064171A CN 103281978 B CN103281978 B CN 103281978B
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electrode
medical treatment
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tissue
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CN103281978A (zh
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C·R·康迪
S·E·阿尔伯格
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Medtronic Ablation Frontiers LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/00267—Expandable means emitting energy, e.g. by elements carried thereon having a basket shaped structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00363—Epicardium
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A61B2018/00821—Temperature measured by a thermocouple
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation

Abstract

一种消融心外膜组织区域的方法，包括：将医疗装置与心外膜组织区域相邻定位，该医疗装置具有第一、第二和第三电极，第三电极位于第一与第二电极之间；向组织区域递送灌注流体；以及通过顺次以单极射频递送模式启用第三电极、以及用双极射频递送模式启用第一和第二电极，来消融组织区域的至少一部分。

Description

多极心外膜射频消融
发明领域
本发明涉及医疗装置及其使用方法，且具体涉及用于组织的热处理的医疗装置。
发明背景
最小侵入装置通常使用在医疗程序中，包括涉及消融、扩张等的医疗程序。在特定情况下，消融程序可涉及形成一系列互联或以其它方式连续的损伤，从而将认为是心率失常来源的组织电隔离。可采用各种不同的能量传递模式形成这种损伤，诸如用射频（“RF”）能量低温冷冻或加热。
采用低温冷却的导管或装置可用于将诸如心脏壁组织之类组织的温度降低到一定程度，使得信号产生和传导暂时停止，并允许人员绘制或确认导管定位在特定损伤或心律失常传导部位。低温导管也可在较低温度下操作以进行消融处理，例如将组织冷却到冷冻破坏组织生存能力的程度，且在心脏组织的情况下，作为信号产生或信号传导位置将其永久去除。电驱动的RF消融导管通常包括电极布置，该电极布置构造成与组织接触并对其施加RF能量，从而由于电阻加热而将组织加热，形成消融损伤。
无论采用怎样的具体消融模式，基本上所有的心脏或其它消融处理共同的处理目标是形成有效损伤和/或提供所选组织的所需受控破坏。特定处理是否成功很大程度取决于损伤的质量或特性，诸如其深度、均匀度、位置等。例如，对于心律失常，可能需要特定的损伤深度来有效地阻碍通过有问题组织区域的不想要的信号传递。
现有治疗方法通常限于其有限范围的操作，这可能需要冗长的处理程序，涉及在完成处理程序之前多次重复消融损伤形成以及重新成像或检查损伤质量或症状存在。这些步骤可能需要大量的时间来进行，因此将患者暴露于不希望的风险。
因而，仍然需要实现扩展范围热传递同时更有效地且更大深度地消融组织的医疗装置和方法。
发明内容
本发明有利地提供实现扩展范围热传递同时更有效地且更大深度地消融组织的方法和系统。例如，提供一种处理组织区域的方法，包括：将第一、第二和第三电极靠近组织区域定位，第二和第三电极定位在第一电极的相对两侧上；通过在第一电极与和组织区域间隔开的接地电极之间传导电流来消融组织区域的至少一部分；以及通过在第二电极与第三电极之间传导电流来消融组织区域的至少一部分。第一、第二和第三电极可在医疗装置上以大致线性构造布置；可在医疗装置上以大致弧形构造布置；可以大致平行构造并排布置；或者可以大致同心构造布置。该方法可包括从射频信号发生器向第一电极递送射频信号；测量第一、第二和第三电极中至少一个的温度；和/或至少部分地基于测得的温度更改射频信号的递送。该组织区域可包括心脏的心外膜表面或隔膜壁。
提供一种消融心外膜组织区域的方法，包括：将医疗装置与心外膜组织区域相邻定位，医疗装置具有第一、第二和第三电极，第三电极大致位于第一与第二电极之间；通过在第三电极与和心外膜组织区域间隔开的返回电极之间传导射频信号来消融组织区域的至少一部分；以及通过在第一与第二电极之间传导射频信号来消融组织区域的至少一部分。该方法可包括：将医疗装置的至少一部分行进穿过剑突下切口或穿过胸廓切口；和/或重新定位医疗装置，并运行第一、第二和第三电极以形成多个消融创口。该方法可包括灌注第一、第二和第三电极的至少一部分。
提供一种消融心外膜组织区域的方法，包括：将医疗装置与心外膜组织区域相邻定位，医疗装置具有第一、第二和第三电极，第三电极位于第一与第二电极之间；向组织区域递送灌注流体；以及通过顺次以单极射频递送模式启用第三电极、以及用双极射频递送模式启用第一和第二电极，来消融组织区域的至少一部分。该方法可包括：测量心外膜组织区域的电活动。
还提供一种处理组织的方法，包括：用医疗装置的第一部分消融第一组织区域；以及用医疗装置的第二部分消融第二组织区域，第二组织区域围绕第一组织区域。消融第一组织区域可包括：在医疗装置与和医疗装置分开的返回电极之间传导电流，而消融第二组织区域可包括在医疗装置的两部分之间传导电流。
附图的简要描述
当结合附图考虑时，参照以下详细描述会更容易理解本发明的更完整理解及其附属优点和特征，附图中：
图1是根据本发明原理构造的医疗系统的实例的示意图；
图2是用于图1所示医疗系统的电极构造的实例的示意图；
图3是用于图1所示医疗系统的电极构造的另一实例的示意图；
图4是用于图1所示医疗系统的电极构造的又一实例的示意图；
图5是用于图1所示医疗系统的电极构造的再一实例的示意图；
图6是用于图1所示医疗系统的电极构造的另一实例的示意图；
图7是用于图1所示医疗系统的电极构造的又一实例的端视图；
图8是根据本发明原理构造的医疗装置的示例使用的示意图；
图9是根据本发明原理构造的医疗装置的另一示例使用的示意图；
图10-12示出了用于根据本发明远离的医疗装置的示例处理方法。
具体实施方式
本发明有利地提供实现扩展范围热传递同时更有效地且更大深度地消融组织的系统及其使用方法。现参照附图，其中相同的附图标记标示相同的构件，图1中示出了根据本发明原理构造并总体标示为“10”的医疗系统的一实施例。系统10总体包括医疗装置12，医疗装置12可联接至控制单元14或操作控制台。
现参照图2-6，医疗装置12可包括可穿过患者脉管和/或可插入穿过靠近诊断或处理的目标组织区域的最小侵入开口的细长本体16。细长本体16可限定近部（未示出），该近部具有手柄或终端用户可触及的其它可控实施件。医疗装置12还可包括远部18，该远部18具有用于进行医疗装置12与患者的组织处理部位之间进行能量、治疗和/或研究相互作用的一个或多个诊断或处理组件。细长本体16可包括设置在内部的一个或多个内腔，该一个或多个内腔提供细长本体16的近部与远部18之间的机械、电气和/或流体连通。
医疗装置12的处理组件可递送例如射频能量或与诸如心脏组织的处理区域附近的组织区域进行其它能量传递。具体来说，医疗装置12可包括定位在细长本体16上或周围的一个或多个导电段或电极20，用于将电信号、电流或电压传送到指定组织区域和/或用于测量、记录或以其它方式评估周围组织的一个或多个电活动、特性或特征。电极20可构造成多种不同几何构造或可控可展开形状，且数量也可变化以适应特定应用、目标组织结构或生理特征。例如，如图2所示，电极20可包括构造成环形或大致圆形构造的电极阵列。如图3所示医疗装置12中的电极20设置在多个臂22上，电极20在臂22上沿面向近侧的方向或定向定位。图4包括方形或“X”形构造的具有多个电极20的多个可延伸或可展开臂22。转向图5，示出了多个电极20呈沿医疗装置12的细长本体16的一部分延伸的大致线性阵列。图6示出了具有三个细长电极20的电极阵列，三个细长电极20布置成大致平行布置、大致彼此并排。在图7中，示出了电极20的端视图（诸如远向近视图）。电极20可布置成可抵靠组织区域定位的大致同心构造，且各电极可用于单极和/或双极能量递送的各种组合，如下文更详细描述的。
医疗装置可包括一个或多个护套或囊套23，一个或多个护套或囊套23封围或以其它方式围绕一个或多个电极20的至少一部分。例如，如图6所示，囊套23大致围绕每个电极20的一部分。囊套23可便于电极20相对于组织段锚固或定位。例如，囊套23可与例如控制单元14的真空或抽吸源（未示出）流体连通。电极20可暴露于囊套23下侧上的组织，使得当电极20抵靠组织放置时，真空产生囊套23将电极抵靠组织密封或锚固。囊套23还可与诸如盐水的流体源（未示出）流体连通，流体在囊套23内循环以在使用期间冷却电极20。通过提供流体递送，囊套23便于降低电极的操作温度，并还包括任何这种递送的流体以通过所递送流体防止两电极之间不希望的电短路。
在2008年5月7日提交的题为“Ablation Therapy System and Method forTreating Continuous Atrial Fibrillation（用于治疗连续心房纤颤的消融治疗系统和方法）”的美国专利申请序列号第12/116,753号中提供了关于医疗装置12特征的构造、操纵和示例使用以及电极构造的其它细节，其全文以参见的方式纳入本文。
无论医疗装置12的处理组件的具体几何形状或构造如何，每个电极20可耦合到控制单元14的射频信号发生器26的单独可控通道24。每个通道24的独立控制允许唯一的可编程功率递送信号发送到所附连医疗装置12的每个电极。每个输出通道24的独立控制还允许唯一（独立）闭环功率递送，诸如通过从与所附连医疗装置12一体的一个或多个温度传感器和/或从包括在独立装置内的传感器接收的组织温度信息调节的功率递送。例如，每个电极20可包括耦合到电极20或与电极20通信的传感器，诸如热电偶、电导率传感器、光谱仪、压力传感器、流体流量传感器、pH传感器、和/或热力传感器（未示出）。各传感器也可与控制单元14的反馈特征通信，从而在达到或超过预定序列、特性或测量值时触发或致动操作变化。
射频发生器26可用一种或多种操作模式操作，包括例如：患者体内医疗装置12上至少两个电极20之间的双极能量递送，(ii)患者体内医疗装置12上一个或多个电极20与和医疗装置12的电极20间隔开、诸如患者皮肤上的患者回路或接地电极28之间的单极能量递送，以及(iii)单极和双极模式的组合。由射频发生器26提供的信号可以是大致连续的或包括能量递送的开/关周期的工作循环。控制单元14可包括包含指令或算法的一个或多个控制器、处理器和/或软件模块，从而提供本文所述的特征、序列、计算或程序的自动操作和执行。在2008年5月8日提交的题为“RF Energy Delivery System10and Method（射频能量递送系统10和方法）”的美国专利申请序列号第12/117,596号中提供了关于射频信号发生器26的构造、操纵和示例使用的其它细节，其全文以参见的方式纳入本文。
再参照图1，控制单元14可包括用于输入、控制和/或监测系统10的一个或多个运行参数的用户界面30。该界面30可包括触屏显示器、键盘或与控制单元14的壳体整合或分开的其它用户输入部件（例如考虑分开的遥控构造），以允许操作员输入系统参数和输出配置信息，包括但不限于：电极选择；功率递送设定/参数、一个或多个温度目标；以及其它信息。用户界面30还可包括用户输出部件，诸如文本和/或图形显示屏、指示灯、以及其他用户输出部件，以向操作者提供信息，诸如视觉和听觉信息，包括但不限于电极选择、功率递送参数和其它信息。
现转向图8-12，系统10可用于处理选定的目标组织区域，诸如心脏32的一部分。具体来说，医疗装置12的远部18上的处理区域可用于诊断或监测心脏32，与用电极20热处理心脏32结合。主要地，医疗装置12的远部18可定位成靠近所要诊断和/或处理的目标组织区域。这种定位可通过本领域已知的包括透视等的可视化方法来辅助和协助。组织区域可包括认为是心律失常或其它不希望状况的源头的心脏32的心外膜段。心外膜方法可包括使用例如使用剑突下方法或胸廓切开术方法。这些方法中的每个提供到心脏心外膜表面的外科通路，且如果需要允许随后定位并插入左心房以进行诊断或处理。
现参照图8，采用剑突下技术，心脏32可通过使用Tuohy针的穿刺技术通达。可形成长度通常小于10厘米的剑突下切口。当针在透视引导或其它成像方式下靠近心脏时，当其朝向心脏行进时，少量造影剂可能会注入针尖的文件渗透部。一旦在医学成像辅助下按指示适当定位，则导丝可穿过针。于是，标准导入器护套、且随后医疗装置12可穿入心脏附近的位置。
现参照图9，也可进行胸廓切开术来提供到心脏的通路。可在肋间的胸壁上形成一个或多个小胸廓切口以允许胸腔镜器具和摄像头进入，这提供用于插入和操纵诸如医疗装置12的医疗器具的心脏空间内的解剖和可视功能。小胸廓切口通常长度小于10厘米。
为了便于在最小侵入外科手术中使用医疗装置12，细长本体16的一部分的长度可从通过股动脉或远离心脏的其它插入点插入的典型导管的长度缩短。此外，可改变医疗装置12的各部分的挠性以提供增加的柔韧性，以便于远侧处理组件相对于心脏的精确定位。或者，牵拉丝或其它偏移机构可整合到或以其它方式联接到医疗装置12以进行转向和/或定位，如本领域已知的。
医疗装置12还可用于诊断和/或处理心脏32的内部区域，诸如隔膜壁。在这种情况下，医疗装置12可能经静脉行进穿过通向目标组织区域的股动脉或其它脉管路径。
一旦医疗装置12的远部18或处理组件处于要求位置，则医疗装置12可用于测量或评估组织的特性、行为或特征。例如，医疗装置12的电极20可用于监测或记录指示异常电路径或心律不齐的目标组织区域的电活动。各电极20也可用于测量组织的阻抗或其它特性以评估或确定与组织的接触，或识别先前所处理组织区域的位置。
系统10然后可运行以对目标组织进行热影响。具体来说，医疗装置12的一个或多个电极20可用于通过目标组织部位传导电流或射频信号以消融问题组织。各电极20的供电可包括在单极或多极操作中将致使电流流动且因此致使加热的射频信号或电流从射频信号发生器26递送到各电极20的一个或多个之间或彼此之间（例如双极RF递送）或接地/患者电极（未示出）。医疗装置12可被供电以消融或以其它方式处理组织，直到达到预选温度或功率递送阈值为止。预定温度或功率递送阈值可选择成确保受影响的组织不烧焦或以其它方式被加热到不希望的程度。
在具体实例中，多个电极20可与组织段或区域34相邻定位或接触。现参照图10，医疗装置12的多个电极20可包括第一电极36、第二电极38以及第三电极40。第一、第二和第三电极可构成例如图2-6所示电极阵列或构造的部分。第一和第三电极36、40可基本上围绕第二电极38或以其它方式定位在第二电极的相对侧。在图7的大致同心构造中，例如第一电极可以是最内部电极，第三电极时最外部电极，而第二电极在第一与第三之间。
各电极之一可首先以单极模式运行，使得电流在供电电极与远离组织部位、诸如在患者皮肤上定位的返回电极28之间传导。例如，第二电极38可通过射频信号发生器26供电以建立第二电极38与返回电极28之间的电流。在第二电极38和射频信号发生器26运行期间，可在第二电极38处或附近测量温度，将测得的温度传送到控制单元14进行分析。该分析或测量值可形成更改射频信号发生器26的功率递送参数或定时的基础，从而在组织部位上实现所得到的、要求的处理效果，包括具有特定深度或尺寸的紧邻第二电极38的第一消融组织区段或创口42的信息。
用第二电极38的单极运行实现所要求结果时，跨越或以其它方式相对于第二电极38彼此相对定位的第一和第三电极36、40可用双极模式运行以增加处理的深度和面积，如图11-12所示。例如，射频信号发生器26可向第一和/或第三电极36、40递送信号或电流，使得电流在两电极之间流动。在第一与第三电极36、40之间通过先前所处理组织42的电传导显著减小或完全消除，且因而第一与第三电极36、40之间的电流路径44围绕已消融组织区域42流动，因此驱动电流路径更深入目标组织区域以形成基本上围绕第一消融区域或创口42和/或与其连续的第二消融创口或区域46。第二消融区段或区域46可因此从第一消融区段42向外延伸以扩展总处理面积的总体深度和/或宽度。
通过可控地增加单极或双极运行的功率递送或期间参数，可首先消融增加的组织深度，因此驱使随后的双极电流路径甚至更深入目标组织区域，形成更深、可能更有效的组织创口或消融部位。上述系统和方法利用消融组织的电绝缘特性，通过在跨越或围绕首先运行的电极的电极对之间的二级消融或处理已迫使所提供的射频能量更深行进到先前消融组织的周围，因此促进更深的组织破坏和消融。可顺次进行所选电极的单极/双极操作，在二级消融阶段开始之前首先完成单极或最初消融阶段。或者，单极操作的时期可与单极操作的时期循环交替或脉冲，以逐渐扩大或增加受影响的处理面积。
尽管图10-12示出三个电极20，但考虑到本文描述的方法可实施成具有多个电极20的装置，因此跨越电极阵列或组件以多个和/或各种组合进行单极-双极操作。此外，尽管已经描述了在单个单极与返回电极之间使用单极递送形成第一消融区段或创口，但也考虑到两个或多个电极20的双极操作可用于形成最初消融区段，接着的二级处理包括跨越或以其它方式与在最初形成的消融创口任一侧上相对定位的电极20。
本领域技术人员将理解，本发明不限于以上已被特定示出并描述的内容。此外，除非以上有相反指示，应指出不是所有附图都按比例。考虑上述教示可能有各种更改和变型而不偏离仅由以下权利要求书限定的本发明的范围和精神。

Claims (12)

1.一种用于处理组织区域的医疗系统，包括：
医疗装置，所述医疗装置具有靠近所述组织区域定位的第一电极、第二电极和第三电极，所述第一电极和第三电极定位在所述第二电极的相对两侧上；
接地电极，所述接地电极远离所述组织区域定位；以及
控制单元，所述控制单元耦合到所述第一电极、第二电极和第三电极；射频发生器，所述射频发生器耦合至所述第一电极、第二电极和第三电极，所述射频发生器编程成：
在所述第一电极与所述第三电极之间引入电流，以便消融所述组织区域的至少一部分并形成第一消融区域；以及
在所述第二电极与所述接地电极之间引入电流，以便消融所述组织区域的至少一部分并形成第二消融区域，所述第一消融区域基本上围绕所述第二消融区域。
2.如权利要求1所述的系统，其特征在于，所述第一电极、第二电极和第三电极在医疗装置上以大致线性构造布置。
3.如权利要求1所述的系统，其特征在于，所述第一电极、第二电极和第三电极在医疗装置上以大致弧形构造布置。
4.如权利要求1所述的系统，其特征在于，所述第一电极、第二电极和第三电极以大致平行构造并排布置。
5.如权利要求1所述的系统，其特征在于，所述第一电极、第二电极和第三电极以大致同心构造布置。
6.如权利要求1所述的系统，其特征在于，还包括：温度传感器，所述温度传感器耦合至所述医疗装置，以便测量所述第一电极、第二电极和第三电极中至少一个的温度。
7.如权利要求6所述的系统，其特征在于，所述控制单元编程成至少部分地基于所测得的温度来更改所述第二电极与所述接地电极之间的电流。
8.如权利要求6所述的系统，其特征在于，所述控制单元编程成至少部分地基于所测得的温度来更改所述第一电极与所述第三电极之间的电流。
9.如权利要求1所述的系统，其特征在于，所述组织区域包括心脏的心外膜表面。
10.如权利要求1所述的系统，其特征在于，所述组织区域包括隔膜壁。
11.如权利要求1所述的系统，其特征在于，所述医疗装置限定内腔，所述内腔用于灌注所述第一电极、第二电极和第三电极的至少一部分。
12.如权利要求1所述的系统，其特征在于，所述控制单元编程成顺次以单极射频递送模式启用所述第二电极、以及用双极射频递送模式启用所述第一电极和第三电极，从而消融所述组织区域的至少一部分。
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