CN103347456B - Conduit system for cardiac arrhythmia ablation - Google Patents

Abstract

The invention provides multiple conduit ablation device embodiment, relate to processing multizone atrium target tissue, it is characterized in that contacting by stable and coherent ablation element and tissue, produce effectively continuous damage.

Description

Conduit system for cardiac arrhythmia ablation

Mutual reference with related application

The application is the invention entitled " for cardiac arrhythmia ablation of December in 2010 submission on the 7th Conduit system " the part continuation application of patent application No.12/961,781.Original application is considered as at this Entirety integrates with the application.

Statement about federal government's patronage research and development

Inapplicable.

Technical field

The invention mainly relates to tissue based on conduit ablation device and technology field thereof, particularly a kind of slow Solve the ablation system that atrial heart rate is not normal.In particular it relates to one is by using percutaneous menses The ablation of pipe conduit reaches the effect of maze operation, to cure atrial fibrillation.

Background technology

Arrhythmia, particularly atrial fibrillation, be the common dangerous doctor causing cardiac function abnormal, unstable Treatment situation.Atrial fibrillation is caused, in being especially mainly in by abnormal conduction and the automaticity of cardiac tissue site Elderly patients.Chronic Atrial Fibrillation likely causes more serious situation, including apoplexy, and heart failure, Fatigue and cardiopalmus.Treatment Chronic Atrial Fibrillation needs to produce the continuously linear damage of some transmural.Operation Damage mode and the operative scar that thereby results in for blocking abnormal circuit, the maze operation being i.e. commonly called as, Become the standard procedures of the effective surgical intervention for atrial fibrillation.This operation needs a series of holostromes to damage Wound is with isolation of pulmonary veins and the rear wall of left atrium.The linear damage problem of plural number comprises the formation of damage, Its from rear wall to mitral malfunction, gorge, atrium line and superior vena cava to postcava and with the right heart Ear connects.

The development of conduit promotes the wound of corrective procedure less.Designing such conduit is to melt with tissue The mode removed produces damage and completes the function of surgical injury further.Including attempting connecting a series of local Damage or use single electrode cause the conduit that the speckle of linear damage damages.At present it has been suggested that use linear The spaced-apart electrodes of arrangement or the device of the electrode along catheter length extension.

Recently, outside division ring type multiple electrode catheter device, about low temperature and the skill of radio frequency (RF) airbag apparatus Art is also proposed to cut off pulmonary vein.Clinical trial certificate, can be by using pulmonary vein low temperature air bag Device is to reach the final effect of pulmonary vein isolation.While it is true, the most any technology can not begin Causing the linear damage of effective transmural eventually safely, its effectiveness more damages less than maze operation Chinese and foreign department Effectiveness.

In existing method find great fundamental flaws may be caused by several factors, including ablation device with Lasting contact is lacked, it is impossible to determine that pathological changes is the most ripe and damage can not be connected to manufacture between target tissue Transmural line produces a kind of conductivity retardance.

Summary of the invention

The invention provides multiple conduit ablation device embodiment, relate to processing multizone atrium target tissue, It is characterized in that contacting by stable and coherent ablation element and tissue, produce effectively continuous linear damage Wound.

The present invention ablation device all extend self energy penetrate the heart diaphragm tissue entrance target chambers of the heart master draw Conductor or the distal portion of deflection sheath.More diaphragm guide body sheath device is by the technology people of this technical field Member knows.The distal portion of guide body or the sheath airbag apparatus of inflatable that is equipped with preferably is to prevent from protecting It is enclosed within operation process logical overpenetrated diaphragm to retract.Diaphragm can be damaged by prominent guide wire.This protection Property air bag can expand by using gentle solution, the such as saline of saline or mixing tester can increase Visual.

Having some examples to use the air bag of inflatable in the ablation device of existing concept, they are by fortune With the guide wire ring of inflatable, adhere to and position thereon；The guide wire ring of this inflatable is solid Catheter tip sheath due to a deflection.The length of the guide wire ring that bootstrap body or sheath are launched Adjustable controlled, to apply pressure to and to be firmly pasted on neighbouring atrial tissue.Compare guide wire, a kind of air bag Ablation device is suitable for reducing the state of deflation, until air bag is in the target location along ring.Once gas Capsule is placed on appropriate position, its just can expand and move along guide wire with swelling state and position from And allow radio frequency transmission or cryogenic energy to be transferred to destination organization to reach purpose is efficiently ablated.Guide wire ring one end Or attachment bracing wire fix guide wire end relative to sheath distal end.Can by with a control handle toward sheath In insert extra guide wire and make intra-auricular guide wire ring extend, it is also possible to by by guide wire from sheath Withdrawal makes ring shrink.These operations can be used to control size and the configuration of guide wire ring.

Air bag example typically has 2 kinds or two or more type, a kind of by using radio-frequency (RF) energy heat to melt Except tissue, also one is freezing tissue to be efficiently ablated with this by cryogenics.But, other energy Amount form is also available, such as laser energy.Radio frequency ablation air bag has an outer surface, is equipped with multiple The radio frequency ablation electrode of segmentation and the critesistor of testing temperature.The radio-frequency power of radio frequency ablation, electrode temperature Degree and local amplitude rule and percentage ratio change all by close supervision.To the excessive tissue heating being efficiently ablated May cause serious problem, radio-frequency electrode is preferably used circulating cooling saline solution or the like at radio frequency During cool down, described saline or the like also can containing contrast medium in case preferably implement location Follow the trail of.Described ablation air bag includes that multiple element is with its three-dimensional localization, tissue temperature during startup ablation And the detection of electrical activity (local electrograms).Temperature and the pressure transducer implanted can accurately measure pressure And surface temperature.Brine recycling can control air bag temperature；As the damage at deeper position need to be caused then to need more High-output power, the most described brine recycling is used for cooling down air bag.

Meanwhile, low temperature balloon embodiment is designed to be transmitted in guide wire transmission and tracing system.Institute State low temperature air bag to be preferably made up of two coaxial air bags, including a capsula interna and an external capsule.In described Capsule is used for receiving and accommodating cryogen, usually the liquid nitrous oxide of negative pressure；And described external capsule fills Full a kind of low-voltage insulation gas that can be highly absorbed in the target analyte in blood, such as nitrogen or carbon dioxide, and Pressure residing for this gas is just on normal atrium pressure.Consequently, it is possible to external capsule is by the low temperature in capsula interna Fluid is opened with the isolation of warm atrial blood stream, thus reduces the impact for blood and allows a large amount of low temperature Power imports destination organization.

The expansion of the guide wire ring of relative rigid forces capsula interna close and presses organizationally, causes in external capsule Insulating gas displacement, and tissue in this place with two air bags be in close contact, thus reach this interface relevant group The maximum cooling effect knitted.It addition, two ring-shaped electrodes to be preferably placed at far and near both ends known to allow 3D guidance system carries out electronical record and location to conduit.In addition, as above-mentioned, the temperature-sensitive of implantation Resistance and extra electronical record electrode can be sprayed on the surface of external capsule, for electrocardiogram and lesion assessment. One simpler embodiment can comprise a monolayer low temperature air bag, be equipped with segmentation be sprayed on surface electrode and Critesistor.

A kind of extra fixing means relates to a flexible distal tip portion of a hard guide wire is implanted left auricle In, and follow the trail of ablation air bag to cause linear damage by guide wire.It is efficiently ablated with the radio frequency of type and leads Pipe can import pulmonary vein by same or like guide wire, to cause circumference pulmonary vein isolation lesion vein isolation.

Invention also provides the embodiment of a kind of conduit system, described conduit system utilizes pulmonary vein to enter Mouth, as the basis of fixing multi-electrode system, causes linear damage between pulmonary vein.Described linear damage Needing the rear wall of electrical resistance isolation left atrium between pulmonary vein, this region is proved to be the work of atrial fibrillation Property drive.

The embodiment that described pulmonary vein is fixed includes that one gets over diaphragm sheath, the most nominal 10-11F sheath, uses Left atrium is entered in crossing atrial septum.In more diaphragm sheath, place two extra sheaths, be equipped with solid Determine angle of deflection to allow each sheath to insert pulmonary vein.Described sheath provides for multiple electrode catheter ablation section Fixing and support, this section is supporting one bridge joint of formation between sheath.By electrode being efficiently ablated on stretching conduit Segmentation forms good contact tissue, and then forms the linear damage of a transmural between pulmonary vein.Not With placing in pulmonary vein, support sheath is fixing can cause linear damage between all pulmonary vein.Above-mentioned damage Wound is typically the additional injuries caused after pulmonary vein is by radio frequency or low temperature gasbag isolation, as mentioned above.On Stating embodiment has an advantage to be in organizational interface, external force to be acted on conduit, thus manufactures good Ablation electrode and contact tissue are to guarantee good damage.

In another embodiment, ablation conduit is placed on inside a guiding flexure sheath, by conduit Pushing generation one hard ring in sheath, this hard ring connects with tissue generation by moving or bend described guiding sheath Touch.For minimizing described guiding sheath, described sheath end can be attached to flexibly in the side of ablation conduit, Thereafter adjust the described conduit described sheath of turnover and then can manufacture an extended loop.Another method is by far End is inserted in described sheath with the ablation conduit of bracing wire.When conduit enters the target chambers of the heart, and bracing wire can quilt Shrink, make the end of multi-electrode ablation conduit against sheath tip, be efficiently ablated in the close end propelling sheath of conduit, It is consequently formed a ring.

The boom of one electric isolution can be attached to electrod-array is efficiently ablated to assist ring extension and tissue to connect further Touch.

The balloon catheter of the present invention also can be in conjunction with the J of an attachment annular record pulmonary vein and measurement impedance Conduit sections, the latter be equipped with record and stimulating electrode with record electrical activity and inspection pulmonary vein isolation and Damage quality.

Last embodiment uses radio-frequency signal generator by radio frequency applications in the electrode contacted with tissue tight, Movable according to described tissue uses titrimetry to measure conduction time.The method of this ablation can prevent Guarantee to damage the infringement of tissue outside maturation process center.

Accompanying drawing explanation

In figure:

Fig. 1 is the schematic diagram of an embodiment, and it includes a radio frequency air bag ablation device, is equipped with adjustable loop and draws The segmented electrode that godet system controls；

Fig. 2 is the schematic diagram describing an embodiment, and it includes one with the low temperature air bag of inside and outside coaxial air bag Ablation device, described inside and outside coaxial air bag moves along an adjustable loop guide wire；

Fig. 3 is the partial schematic diagram describing an air bag ablation device, and described air bag ablation device is furnished with a control Handle processed, it is adaptable to the use of air bag of the present invention ablation pipe guide；

Fig. 4 A-4E shows described ablation airbag apparatus from different perspectives, and can be by described adjustable guide silk Coordinate the variously-shaped and ring that a bracing wire generates；

Fig. 5 is a radio frequency or the schematic diagram of low temperature air bag ablation device, is placed in a left side by a ring guide wire Atrium is to form annular lesions；

Fig. 6 is to describe a radio frequency or the schematic diagram of low temperature air bag ablation device, and described device uses one to fix Fixing guide wire in left auricle；

Fig. 7 for show a radio frequency or low temperature ablation air bag, be equipped with in upper left chamber pulmonary vein segmented electrode with And the critesistor guided by guide wire, to form a pulmonary vein isolation lesion vein isolation；

Fig. 8 is that a balloon catheter combines J ring pulmonary vein record and a schematic diagram for impedance measurement pipe guide, Can measure pulmonary vein Guan Bi and damage quality, ripe and electrically isolate；

Fig. 9 describes the multi-electrode manufacturing linear damage, the schematic diagram of ring class conduit；

Figure 10 is the schematic diagram of the conduit being similar in Fig. 9, and in display pulmonary vein, the fixing sheath that supports is on the right side The layout of the linear damage between epicoele pulmonary vein and upper left chamber pulmonary vein；

Figure 11 is the schematic diagram being similar to Figure 10, between display upper left chamber pulmonary vein and left inferior pulmonary vein The layout of linear damage；

Figure 12 is the schematic diagram being similar to Figure 10, shows between left inferior pulmonary vein and right inferior pulmonary vein The layout of linear damage；

Figure 13 is the schematic diagram being similar to Figure 10, shows between right inferior pulmonary vein and upper right chamber pulmonary vein The layout of linear damage；

Figure 14 is the schematic diagram of the alternate embodiment of a multi-electrode ring class conduit, and described conduit includes an isolation Boom；

Figure 15 illustrates the multiple electrode catheter in Figure 14, and described conduit may be used for making between pulmonary vein Make linear damage；

Figure 16 is diagram and the partial process view of an ablation control system；

Figure 17 is the schematic diagram of another radio frequency air bag ablation device embodiment, and described device is furnished with contraction state Under air bag, and for clarity sake, part air bag is removed；

Figure 18 A and 18B compared for respectively the air bag under the band contraction state in Figure 17 ablation device and Ablation device with the air bag under swelling state；

Figure 19 is fragment or the partial view of a pipe guide, device is efficiently ablated including the air bag in Figure 17；

Figure 20 A Yu 20B is the schematic diagram of air bag transverse section in Figure 17；

Figure 21 A with 21B is the schematic diagram of a radio frequency air bag ablation device being slightly different, described device electricity The configuration of pole is to tilt；

Figure 22 A Yu 22B is that another air bag ablation device is under contraction state and under swelling state respectively Schematic diagram.

Detailed description of the invention

Detailed description below belongs to the multiple embodiments including concept of the present invention.Described embodiment is only Presently preferred embodiments of the present invention, but this does not illustrate to present invention is limited only to these embodiments.

It should be noted that the present invention is planning the atrial fibrillation of a kind of relative efficiency and Wicresoft in the future Therapeutic Method, with by using the tissue ablation manufacture damage of conduit to replace the operation that tradition maze operation produces Damage, it is to avoid needs to radical surgery.Ablation device of the present invention provides for contact tissue Firm and lasting ablation interface.

Fig. 1 is the schematic diagram of a radio frequency air bag ablation device embodiment, represents with reference 20.Institute Stating ablation device and include an ablation air bag 22 being in inflation state, it is soft that described air bag is installed on one Property to draw admittance tube rod 24, described flexibility to draw admittance tube rod to may be about 4 feet (122 centimetres) long 7F flexibility draws admittance pipe guide post.All ablation control and DATA REASONING conductor or electric wire the most implanted In axial wall, described axial wall moves in guide wire 26.The distal end of described guide wire 26 about 2 lis Rice is long, uses flexible relative, flexible material, it is desirable to more soft than the remainder of ring and flexible, ring Remainder relative rigid.Guide wire can be attached to or pull through the far-end of the transdermal sheath in a deflection Portion, the fragment of described sheath represents with 28.One more diaphragm breach protection air bag represents with 30, at this air bag In the state of inflation, saline is generally used to prevent it from retracting from sheath 28 in operation process. A near-end lever is used to move adjustable rod 24 to adjust the position of described conduit relative to described guide wire 26 Put, see Fig. 3.

Described air bag 22 farther includes the radio-frequency electrode 32 of the conductive ink coating of multiple segmentation, wherein Each electrode is provided with one, and to be in the recording electrode at center movable with faradism, and one record-temperature-sensitive electricity The element 34 that resistance combines is for temperature sensor.Electrode is the coating that balloon surface is highly conductive, can be A kind of by known mode, optional and be activated independently and sense.Described air bag itself is Any size, a typical embodiment is that about 25-30 millimeter is long, and when expanding completely, diameter reaches 15 millimeters.Described air bag select suitable, optimum, can the macromolecular material of coating, remain stable Dilation dimension, and comprise for organize ablation and set separate conductive section, be positioned over each ablation The critesistor of electrode centers and recording electrode.Described preferred material is polyethylene terephthalate (PET), it is possible to select other suitable materials.

As it has been described above, described radio frequency air bag is coated with the compound of high conductance in electrode segment 32, as Shown in Fig. 1.Air bag in one typical preferred embodiment is about 30 millimeters, and diameter is about 15 millimeters.Institute State the air bag electrode coated segmentation 32 containing 8 segmentation conduction, non-conductive band 36 separate, about 1.5 Mm wide.The diameter of described record and critesistor binding member is typically about 2 millimeters, by 1 milli Rice isolation outer shroud 35 separates with described conductive section 32.It is located substantially at the described of each ablation element central Recording electrode and critesistor monitor the electrical activity before and after ablation and temperature.Described radio frequency ablation air bag is excellent It is selected under lower pressure and fills the saline being mixed with low concentration contrasting fluid.Described saline circulates in air bag, In maintaining described air bag, constant air pressure is to keep the low temperature of air bag itself simultaneously, and then ensures more effectively to melt Remove.

Fig. 2 describes the embodiment of low temperature based on a present invention ablation device, and described device uses a pair of Gas-bag system, it includes a low temperature air bag and for the low pressure isolation air bag being thermally isolated.Described double bolloon is tied In structure includes one, air bag 44 isolated outward by low temperature air bag 42 and.Ring electrode 46 and 48 lays respectively at institute State distal portion and the close end of air bag, to record electrical activity and positional.Implant critesistor and record Electrode, represents with 50, is positioned on external capsule appointment position, and is connected the most mutually Connect.Described airbag apparatus is arranged on a flexible conduit bar 52, and described flexible conduit bar is in guide wire 54 Upper movement.As described radio-frequency unit, push-and-pull in described guide wire can be passed through in the position of described air bag Described balloon catheter guide rod and change.Described recording electrode activates electrocardiogram and lesion assessment.Configuration system May look like the system of radio frequency air bag described in Fig. 1.Therefore, have with the 54 guide wire rings represented The cross section that flexible relative is flexible, can be attached to a pull bar by the end of a flexure sheath 56 (does not has figure Show).Described sheath 56 includes that a more diaphragm protects air bag 58.

In two air bag cryogenic systems, described capsula interna receives and accommodates a cryogen material, optional liquid State nitrous oxide, it is in subzero 88.5 DEG C of boilings；Described external capsule is full of a separation gas, and optional two Carbonoxide or nitrogen, pressure is just above left atrial pressure.Consequently, it is possible to described liquefied gas at low temp is then Keep apart with described interior atrium blood flow.During ablation, the extension of described guide wire ring promotes described Air bag presses to the tissue of position interested, and the separation gas in tissue contact region is shifted by this pressure, Thus promote described low temperature capsula interna and described external capsule to be in close contact, and external capsule is described air bag and described group Maximum heat transfer is produced, to obtain local organization cooling to greatest extent between knitting.

Providing a control handle (Fig. 3) promotes described air bag bar to advance in described guide wire, adjusts it Position in described guide wire, as shown in figs. 4 a-4b.

Fig. 3 be one balloon catheter ablation system 80 embodiment schematic diagram, this system include one containing radio frequency/ The flat control handle component 81 of fridge adapter 82, for being applied to an air bag 88 by flowing material. Slide with a distal catheter shaft or ablation (radio frequency/cryogen) balloon catheter of lever 83 stretches into one and leads Sheath 84, as shown in the figure.Described distal stem 83 is the distal portion of described air bag ablation conduit 90.Institute State conduit to be slidably disposed in guide wire 86, both pass through described in lead sheath 84 and be transferred into atrium, Or another chambers of the heart.Described ablation balloon catheter axle is from deflection described in the partial insertion of guide wire relative rigid Sheath.When described balloon catheter moves along described guide wire, the part of described guide wire flexible relative Extend from described sheath, and guide wire can be locked against further to the drift of described sheath or shifting Dynamic.For reaching this purpose, one need to be provided to may move locking device, represent with 87.By along and On described guide wire cross section 86, mobile described distal end of catheter handle 83 can change described air bag along described guide wire The position of ring.The fixing lock of guide wire represents with 92.The guide wire that described fixing lock allows variable-length is solid Fixed point changes the size of described Projective Rings, and makes described ablation air bag cover additional distance.By described handle The 83 described ablation balloon catheters controlled sliding scale such as arrow 85 institute on adjustable guide silk ring 94 Show.Deflection sheath cross section represents with 98, and flexible guide wire ring segment represents with 94.Sheath flexure ring Represent with 100.

Five width figures in Fig. 4 A-4E show that an ablation catheter shaft 120 is flexible from one in a guide wire 121 Bent sheath 122 is internal to be promoted forward.The distal portion of described guide wire 124 is attached to a bracing wire or wire drawing 126, a lever (being not shown) control.Air bag ablation device represents with 128, draws described Advance on seal wire.Described ablation device is in Figure 4 A in flat shape.In this case, described deflection is led Sheath has penetrated into left atrium or other chambers of the heart.In Fig. 4 B, described air bag is swelling state, and institute State bracing wire 126 and the end of described guide wire 124 is pulled to described sheath, be consequently formed a guide wire ring. In Fig. 4 C, the end of described guide wire is pulled in described sheath, forms a ring 130.Fig. 4 D and 4E Illustrate and described guide wire is advanced or the size of ring 130 described in adjustable in retraction sheath.Described air bag 128 can be by described ablation balloon shaft 83 (Fig. 3) in described guide wire in the position of described guide wire Advance or shrink and adjust, as shown in Fig. 4 D to 4E.

Fig. 5 is the signal that the interior ablation balloon-shaped guided by adjustable loop guide wire of left atrium circularizes damage Figure.Therefore obtain left atrial wall to represent with 140, be equipped with left auricle, represent with 142.One more diaphragm is led and is protected Set 144 between left atrium 146 through described diaphragm.Described sheath includes an overall inflatable Air bag 148, its full saline is not torn in more diaphragm indentation, there with protection diaphragm in operation process.Institute State balloon catheter axle to represent with 150, and the guide wire of described band flexibility segmentation represents with 152.Described The ablation air bag of segmentation can be radio frequency or low temperature ablation device, represents with 154, in each balloon surface Segmentation is furnished with critesistor and record electricity electrode, represents with 155 and 156 respectively.Further at described gas Every one end of capsule provides annular electrode, and one of them represents with 158.This figure also shows described pulmonary vein The position of outlet, including described upper right chamber pulmonary vein 160, upper left chamber pulmonary vein 162, chamber, bottom right lung is quiet Arteries and veins 164 and left inferior pulmonary vein 166.

Together with shown in Fig. 5, described segmentation ablation air bag 154 is securely resisted against institute by described guide wire ring State on the wall of left atrium 140.The size of described guide wire ring is adjusted by inserting more required guide wire, And increase the guide wire position with the described ablation air bag 154 of adjustment along described guide wire ring, can observe A complete continuous circular shape damage is formed to described left atrium.

Fig. 6 is shown close with Fig. 5, illustrates an alternative system for fixing described segmentation coating ablation gas Capsule 154, does not use described loop system, in the air bag 154 of this figure, uses the guiding of relative rigid The fixing soft of silk 170, is implanted into described left auricle 142, and this ablation air bag can be in institute afterwards State and follow the trail of in guide wire 170, to form linear damage around described left atrium.Bicuspid valve is with 174 tables Show.

Fig. 7 is a schematic diagram of similar Fig. 6, shows that the ablation air bag 154 that described segmentation coats is placed in Hole or region, room, just on described upper left chamber pulmonary vein 162, there ablation air bag 154 by with In the independent lesions forming pulmonary vein.So, all can to obtain independent lung quiet for every described pulmonary vein Arteries and veins damages.

Fig. 8 is schematic diagram, shows that a radio frequency or low temperature air bag 180 insert described upper left chamber pulmonary vein 196 Hole in.Described air bag imports described pulmonary vein by described more diaphragm sheath 182 and J-type 4F ring is remembered Record conduit 184.Described J ring includes record and stimulating electrode array 186, and described air bag further provides for Having distal loop electrode 188 and a proximal loop electrode 190, the impedance during measuring ablation is (special Under conditions of not being use low temperature air bag), to determine pulmonary vein Guan Bi and damage quality hereafter.The heart Room wall represents with 192, and pulmonary vein represents with 194,196,198 and 200 respectively.For coordinating in Fig. 8 Embodiment use, described balloon catheter 180 can use in Fig. 6 with Fig. 7 the identical structure of display.If Described conduit is a cryogenic system, forms ice hockey during described ablation, and during low temperature is efficiently ablated The damage of described ice hockey size can be completed and effect is efficiently ablated by record and impedance measurement to described ice hockey Confirm.

It should be noted that described J-type ring pulmonary vein record, stimulation and impedance measurement conduit combine described Air bag ablation device can realize pulmonary vein isolation by low temperature airbag technology；While it is true, it is successfully crucial Depend on described air bag and the rigid contact of described pulmonary vein tissue and the complete Guan Bi of described pulmonary vein, During described ablation, so do not have blood flow into the atrium around described air bag.Dyestuff is passed through institute The central chamber described pulmonary vein of injection stated in air bag guide wire can check said process.If described dyestuff exists Coagulation in vein, vein described in deducibility the most appropriately closes.If described vein is not fully closed, generation Damage incomplete annular lesions, such as, if jagged, or described tissue simply transitory loss function leads Cause isolation in short-term, operative failure and needs will be caused additionally to intervene.

It is noted that the purposes of described J-ring record/stimulating catheter is: (1) instructs air bag to melt Except described air bag longitudinally and is placed by center by conduit relative to target pulmonary vein hole；(2) lead described in fixing In vein described in Guan Yu, described ring is positioned over the position described in vein vestibule on hole；(3) radio frequency or During low temperature ablation, by described ring electrode 186 pacing (pacing) phrenic nerves, monitor diaphragm simultaneously Motion is to guarantee that phrenic nerves will not be efficiently ablated；(4) impedance detection during being efficiently ablated by monitoring low temperature is damaged Hinder Maturity；(5) vein is measured to atrium or atrium to the conduction of vein during radio frequency and low temperature ablation.

Low concentration radio-frequency (RF) energy also can be applied in described distal balloon ring electrode 188, described with being positioned at On balloon catheter axle, the reference electrode 190 (as shown in Figure 8) of near-end is measured together and is crossed over described air bag Conductance.If described air bag securely closes described pulmonary vein, impedance rise and measurement structure and can determine that lung is quiet Arteries and veins closes.Additionally, when described system includes a low temperature air bag, pulmonary vein Guan Bi is assessed and described low The size assessment of temperature ice hockey can by measure proximal balloon ring electrode 190 and distal balloon ring electrode 188 it Between impedance variation reach.In view of ice is the most inferior a kind of electric conductor, when described ice hockey gulps down completely Eat described pulmonary vein, it was observed that described impedance significantly rises, thus provide a kind of pulmonary vein reliably and close Close the indicator with low temperature injury Maturity.

In embodiment as shown in Figure 8, ring electrode 186 and the critesistor of being furnished with multiple interval (do not have Display) J eye be first positioned in described vein, represent with 196.Described J ring fixes described conduit In described vein, described ring is positioned in described venous lumen, is located just on described hole, as shown in the figure. Described air bag ablation conduit imports its position by advancing on described J catheter shaft.By transmitting low-power High-frequency electric current (can be selected for less than 1 watt, the electric current of 550 hertz) is on described J ring one or many Individual electrode 186 or to described distal loop electrode (188) and be positioned at described balloon proximal described ring electricity Baseline impedance is measured in pole 190.Also described air bag impedance can be measured by using electrode 188 and 190 Mode measures above-mentioned impedance.As above-mentioned, after described airbag inflation, if the firmest Guan Bi of described vein, Second impedance measurement should show impedance rise, if simply part Guan Bi, will not detect any impedance and become Change.Extra impedance rise by described low temperature air bag be efficiently ablated record, its display is eaten described remote electrode Ice hockey information.

Described J conduit is preferably a preformed 3-4F conduit, inserts in the central canal of described ablation air bag. In J-shaped partial insertion one vein of described conduit, the annular section of described conduit is around described pulmonary vein Atrium is furnished with loop record/stimulating electrode and critesistor.Described balloon catheter is as guide wire Advance on described J conduit.The location of described air bag can close described pulmonary vein, the most described conduit Annular section is around the distal portion of balloon contacts pulmonary vein.Low-power radio frequency is put on described balloon shaft or Ring electrode pre-selected on the loop section of described J conduit, with the impedance measured before and after airbag inflation and melt Impedance during removing, particularly in described low temperature balloon embodiment.

During use, it should be appreciated that, for radio frequency and low temperature balloon embodiment, described transmission and tissue Contact procedure can be the same.Described high conductance element and critesistor are around described radio frequency and outer low The outer surface circle distribution of wet capsule.

Fig. 9 schematic diagram includes an alternate embodiment of the present invention, and its form is many ablations electrode type conduit system System, forms linear damage to realize group for forming linear damage tissue especially between pulmonary vein The isolation knitted, this importance being considered to successfully reach atrial fibrillation ablation.As it is shown in figure 9, contain The line at interval has two accessories around the flexible multi-electrode ablation conduit 300 of ablation electrod-array 302 from one The support sheath device of 304 and 306 stretches out, thus constitutes to support and coilable ablation conduit support Sheath.Described conduit support sheath accessory 304 and 306 is led sheath 308 from main more diaphragm and is stretched out.Support is protected Set extension represents with 310 and 312, for lock described support sheath to a deflection get over diaphragm lead The locking device of sheath represents with 314.Flexure control handle represents with 316, be efficiently ablated catheter extension with 318 represent, provide power supply by connecting line 320 to described electrode 302.Although other sizes also can be used, 4F type generally selected by described flexible multi-electrode ablation conduit 300, optional 5 millis of shown wire-winding electrode 302 Rice 2 millimeters of breach of long Intermediate Gray.Each support and coilable conduit are led sheath 304 and 306 and are scheduled Shape, to be introduced into pulmonary vein.

Lead the sheath 304 and 306 layout in paired pulmonary vein as shown in figures 10-13, wherein left atrium Wall represents with 330, and pulmonary vein includes upper right chamber pulmonary vein 332, upper left chamber pulmonary vein 334, chamber, bottom right Pulmonary vein 336 and left inferior pulmonary vein 338.Left auricle represents with 340, Bicuspid valve 342 representing (see Figure 10).

Mode like this, Figure 10 illustrates a linear damage how at described upper right chamber pulmonary vein 332 and described Formed between upper left chamber pulmonary vein 334.Sheath 304 and 306 realization is led it is noted that stablize and support Penetrate into perforate and the chamber of pulmonary vein, and provide the support to described catheter electrode array.Temperature-sensitive Resistance 344 is placed between described ablation/recording electrode 302.Same mode, Figure 11 shows institute State the ablation between upper left chamber pulmonary vein 334 and described left inferior pulmonary vein 338.Figure 12 shows institute State the ablation between left inferior pulmonary vein 338 and described right inferior pulmonary vein 336.Figure 13 illustrates institute State the ablation between upper right chamber pulmonary vein 332 and described right inferior pulmonary vein 336.

Therefore, described flexible multi-electrode ablation conduit 300 is placed in a pair and harder leads sheath 304 And in 306, described in lead sheath and be placed in the leading in sheath 308, the most more diaphragm device of deflection again.During use, The most described main sheath enters the target chambers of the heart, described ablation conduit 300 and said two support and leads sheath 304 and 306 remove and enter in the described chambers of the heart from described main sheath.Sheath is led in each described support 304 and 306 are scheduled shape, to be introduced into pulmonary vein.Pushing away and/or rotate can described in the turnover of its close end The main sheath 308 of flexure, makes described support lead sheath 304 and 306 and individually advances.By scratching described Discharge on bent control handle 316 or fetter and support sheath described in described locking device 314 lockable suitable On position.The most described support sheath is forced into target pulmonary vein, keeps described ablation conduit to exist simultaneously Strain between described tissue, in this way it is ensured that with the good contact of destination organization with ablation conduit.Another is implemented Such as shown in Figure 14 and 15.The simple version of this embodiment substantially embodiment shown in Fig. 9-13, Wherein multiple electrode catheter 400 is furnished with coiling ablation and measures electrode 402 and middle critesistor 404, it It is plugged directly into the leading sheath 406 of described deflection to form ring in the end of described sheath.With 408 The boom represented is used for revising the shape of described ring.Handle and flexure controllers represent be furnished with locking with 410 Device 412 and multi-electrode thermistor connector, represent with 414.Boom controller represents with 416, String pulling with block represents with 418.Diaphragm protection air bag represents with 420.In Figure 15, left atrial wall Representing with 422, left auricle represents with 424.Described pulmonary vein hole is with 426,428,430 and 432 tables Showing, Bicuspid valve represents with 434.It was retracted in the hole of leading sheath of described deflection before launching Ablation conduit 400, can use described string pulling or bracing wire 418 by the described size mainly leading sheath 406 Littleization.It is noted that described isolation extends rods 408 provides further support to described conduit ring And stable, improve contact tissue situation.Leading sheath in being rotated by deflection, the torsion of ablation conduit Extend and the expansion of conduit ring, the expansion of spacer bar 408 or contraction, conduit can be made to move and position.

Figure 16 is the schematic diagram of the monitoring system that system is efficiently ablated according to the present invention for radio frequency.This system includes One conduit system 500, a balloon catheter 502 is installed in guide wire 506 catheter shaft 504 advanced On.Sheath represents with 508.Described balloon catheter include multiple critesistor and recording electrode 510 and Radio frequency ablation electrode 512.Described conduit farther includes mechanically actuated formula controller and liquid expands and follows Ring controller, represents with 514 pieces.

Radio frequency energy generator system includes that inputoutput data processes, and electrogram radio frequency filter is with 520 Represent, be connected to rf control system 522.Described radio-frequency signal generator is connected to visually to export or screen shows Showing device, represents with 524 pieces, linkage record system at 526.

Write the program of described radio frequency energy generator for controlling in any multiple electrode radio frequency conduit system Each ablation electrode also adjusts its radio frequency energy, and each electrode connects individually and controlled individually.Control The transmission of described energy, with ensure only with destination organization be in close contact electrode can with capacitation, and Required energy is under being accurately controlled, to avoid the tissue making blood or ablation overheated.Ablation tissue Overheated causing burn, even cause apoplexy.Therefore, each independent energy source can be according to sensing Temperature and the first derivative of variations in temperature of reflection specific temperature rise be adjusted.Local electrical activity in real time Also under monitor closely.Peak frequency when this includes recording electrograph amplitude, local electrograms and impedance variation Change.

Once radio frequency can be opened, and described power generator system is preprogramed the described radio frequency of adjustment according to one Can, can be as follows:

1. after determining contact and tissue activity in acceptable parameter,

A. local electrograms > 1mV,

B. maximum electrograph frequency > 8Hz,

C. impedance < 180ohms.

Being set by mental retardation, energy is gradually increased to control the electrode temperature rate of change at a preset level, 5 DEG C=dT/dt the most per second；

2. reach maximum preset temperature, such as 65 DEG C；

3. if impedance rise is more than a preset level (such as 150-180ohms), if or described local electrograms Decline 50% or more from baseline values, and/or even consider with described electrograph amplitude, if described local Electrograph frequency from described baseline value decline such as 30%, then interrupt energy input.

The most in use, if if desirable, some value in the 3rd can be rewritten (override).

5., when electromyographic data and impedance measurement indicate and be efficiently ablated successfully, reduce energy to minimum.

Described radio frequency energy generator system is designed to be used as to receive the data about all call parameters, described Data are from described ablation electrode and critesistor, including local electrograms's amplitude and change percentage ratio, maximum Electrograph frequency temperature, temperature (dT/dt) impedance rate of change, output energy and application time.

The most successfully it is efficiently ablated in the data display local organization received, after the energy is also interrupted, described conduit Can be that the ablation of next local organization is reorientated.

Another embodiment of radio frequency air bag ablation pipe guide shows greatly 600 expression in Figure 17, is furnished with place Air bag in fully collapsed condition.Described device includes an outer tubular member, has the guiding catheter of segmentation 602 or lead sheath 603.Described guiding catheter or lead sheath and include the cell parts 604 of inflatable, Between segmentation.The part 604 of inflatable is furnished with conductive electrode ablation element 606, connects Between axle segmentation 602 and 603.Described electrode member first-selection is conductivity belt-like form, and being arranged on can The outside of the interior airbag apparatus 607 of inflation independent of this interior airbag apparatus 607.When described device Dilation 604 be in contraction as shown in fig. 20b or storage position time, in Figure 20 A and 20B Apparent electrode member is overlapping, slightly separates when described airbag apparatus 607 such as Figure 20 A expands. So, it is straight that the ablation device element that described expansion or airbag apparatus can be used to control launch is limited Footpath.Although above-mentioned legend describes four electrode members, any suitable quantity all can use.Described unit Part all separate connection, including ablation device, temperature device and electrical activity supervising device.

Outer catheter axle comprises extra interior concentric hollow tubes, including intermediate tubular part 608 and inner most Tube-like piece 610.Described inner most tube-like piece is connected to the tip of described conduit 612, and comprises an axle To adjustable guide wire 614.As shown in Figure 17.Tube-like piece 610 also provides for a paths for hands In art, the fluid of injection is from the conduction of described conduit handle and by described conduit transmission.Bigger intermediate tubular part 608 connect the inside of the described swelling gasbag device of 604 parts in 607, and provide one for inflation fluid Path.Described outer tube or catheter shaft accessory include with 616 electric wires represented, described in be wired to described Ablation element and critesistor accessories and record with the 618 described ablation elements 606 of implantation represented are electric Pole.

Figure 18 A and 18B shows that described hollow ablation device 600 is respectively at described expansion or airbag apparatus It is in contraction and the contrast of swelling state.As shown in fig. 20b, described band electrode accessory 606 is working as State when cell parts 604 is in contraction state or storage position and overlap, on the contrary, under swelling state Described electrode shown in Figure 18 B and 20A by as described in the expansion of air bag and slightly separated, fraction air bag Material 607 comes out.This makes the ablation electrode surface exposed maximize, but allows individually behaviour simultaneously Make described ablation element.Such configuration may be implemented in pulmonary vein together with the arrangement of single airbag apparatus Periphery is efficiently ablated.Described banding ablation element should be configured to after surgery, when described airbag apparatus shrink or When losing heart, described ablation element again recover described in overlap, and do not have sharpened edge to occur or sudden and violent After dew, adjacent tissue is produced ill effect.Because described segmentation is fixed in the end of described band electrode 606 Between 602 and 603, between these elements distance reduce with the expansion of described bag material 607, Each element of described system moves independently in described guide wire 614.In some embodiment the most more Adding hard structure, described axle can bend with described airbag inflation.

Especially as shown in Figure 18 B and 19, described air bag ablation pipe guide farther includes diaphragm in and protects Protect air bag 630 and extra lead jacket segment 632.As previous embodiment, the purpose of described device Be to penetrate described middle diaphragm tissue, the expansion in operation process of the described air bag 630 prevent described in lead sheath 632 are pushed back through described middle diaphragm tissue and likely cause diaphragm to damage.In general, if relating to Left atrium is efficiently ablated, and leads sheath with this and penetrates described diaphragm from right atrium to left atrium.Such as Figure 18 B and 19 Shown in, as previous embodiment, guide wire 614 guiding formed in the chambers of the heart (such as left atrium) Silk ring provides stable track for described ablation air bag, in order to lay ablation air bag in order, at the chambers of the heart Peripheral formation linear damage.Described airbag apparatus can be gone forward in described guide wire on demand in operation process Enter.Such as controller in previous embodiment, including handle controller shown in Fig. 3, can be applicable to any Embodiment.

Described by configuration such as Figure 21 A, 21B and the 22A substituted, 22B.In Figure 21 A Yu 21B, Radio frequency air bag ablation conduit 700 is similar to the guide-tube structure in Figure 17, the catheter shaft separated including interband The catheter shaft of accessory 702 and 703, by dilation 704 outside connection banding ablation element 706 connect. These elements are also equipped with critesistor and the recording electrode implanted, and represent with 718.Remaining structure and structure Part is similar to Figure 17, including the embodiment of coaxial tubular part 708 and 710, its function and Figure 17 In element 608 and 610 identical.In the present embodiment, described band electrode accessory 706 is with Helical Mode Formula is arranged in the periphery of described swelling gasbag ablation part 704.704B in crisscross pattern such as Figure 21 B Shown in.

At another with the similar embodiment described by Figure 22 A Yu 22B, radio frequency air bag ablation conduit fills Putting 800 patterns including band electrode 806, it is also disposed to grid or criss-cross pattern equally, its In separate ablation element or electrode be isolated from each other.Described conduit also includes segmentation 802,803 and 804. Guiding fiber tube to represent with 808, guide wire represents with 814.Described ablation element is also equipped with the temperature-sensitive implanted Resistance and electrical activity recording element 818.Such pattern also ensures that and realizes complete annular in pulmonary vein hole Ablation.Described device shows with the state of the state shunk or lose heart and expansion or air-blowing in the drawings.

Although a lot of sizes all can be used, described banding ablation element typically uses 30 millimeters long 3 mm wides Size, and shape is ellipticity.Described air bag ablation conduit diameter under fully expanded state should It is 20 millimeters, the about 11F (3.6 millimeters) when contraction or storage configuration.Described air bag and electrode can Use any suitable and biocompatible common material.

By above description and legend it is obvious that the peculiar property relevant with the present invention is described embodiment Complete the most outstanding ablation function, the especially control to the atrial fibrillation in human heart.Although such as This, described device and technology can be used for any part of heart.Therefore, can be used for the left and right chambers of the heart and the heart The tachycardiac electrocardiogram of chamber property and ablation.About atrial fibrillation, according to the conduit system pole of the present invention The earth improves contact tissue and conduit traceability, it is achieved that more predictable damages, will simultaneously The tissue mass of ablation is minimized.

The present invention is had been described in considerable detail at this, has observed patent article, skilled for technical ability in this field Personnel provide relevant information to help it to use new principle, and build and use such specialty on request Element.But it must be recognized that, the present invention can be able to reality by using the most different equipment and device Execute, and within the various amendment to instrument itself and operation sequence all should belong to the scope of the present invention.

Claims (52)

1. a device for the tissue for being efficiently ablated in the human organ chamber including the chambers of the heart, including:

A () guide body sheath, is furnished with the distal portions of deflection；

B () guide wire, can extend from the described distal portions of described guide body sheath to form guide wire ring, Described guide wire ring can be controlled so that described guide wire ring is forced to contact with tissue lumen tissue；

C the ablation airbag apparatus of () inflatable, it is arranged on flexible guide shaft, can be in described guiding Move on silk；

D () ring controls element, for controlling size, shape and the configuration of described guide wire ring；With

E () wherein said ablation airbag apparatus further includes at the ablation gas close to described inflatable Electrode on bag apparatus far-end and proximal balloon edge, for labelling damage and balloon positions, Electrical activity and across air bag impedance.

The most as described in the appended claim 1 for the device of tissue is efficiently ablated, farther include air bag controlled element, For along described guide wire ring advance and regain described ablation airbag apparatus, with facilitate contact tissue with And the formation of continuous damage.

The most as described in the appended claim 1 for the device of tissue is efficiently ablated, wherein said ring controls element and includes drawing Line.

The most as described in the appended claim 1 for the device of tissue is efficiently ablated, wherein said guide body sheath is further Including the guide body air bag of the inflatable being positioned at its distal portions, to prevent described guide body from protecting It is enclosed within saturating overpenetrated cavity wall in operation process to retract.

The most as described in the appended claim 1 for the device of tissue, the table of wherein said ablation airbag apparatus are efficiently ablated Face also comprises the critesistor of the real-time electrical activity of multiple monitoring temperature and assessment damage effect and Maturity And electrode.

The most as described in the appended claim 1 for the device of tissue is efficiently ablated, it is further that wherein said ring controls element Including the mechanism for locking described guide wire ring.

The most as described in the appended claim 1 for the device of tissue is efficiently ablated, wherein said ablation airbag apparatus uses Radio frequency is to be efficiently ablated tissue.

8. device as claimed in claim 1, wherein said guide wire ring includes the apical segment of flexible relative, described Apical segment is attached to the end of described guide body sheath by the technology of fixing junctional complex or wire drawing.

9. the device for tissue is efficiently ablated as claimed in claim 1, wherein said guide shaft is about 7F.

The most as recited in claim 7 for the device of tissue is efficiently ablated, wherein said ablation airbag apparatus includes Chiller, described chiller selectively includes in circulating gas-bag under specified pressure cold But the system of liquid.

11. as recited in claim 7 for being efficiently ablated the device of tissue, and wherein said ablation airbag apparatus has Outer surface, described outer surface includes the conduction ablation electrode that multiple segmentation separates, and described appearance The structure in face allows radio frequency can be transmitted only to selectively and organize the electrode contacted.

12., as claimed in claim 11 for the device of tissue is efficiently ablated, farther include and described ablation electrode Multiple critesistor on described ablation airbag apparatus surface of isolation and recording electrode, with monitoring Temperature and assess real-time electrical activity.

13., as described in the appended claim 1 for the device of tissue is efficiently ablated, farther include to be positioned at described guide body The control handle in sheath proximal end portion, described control handle contains the described guide wire ring of control and described ablation gas The device of bag apparatus.

14. as claimed in claim 13 for being efficiently ablated the device of tissue, and wherein said control handle farther includes For the element being connected with fluid source the inside of described ablation airbag apparatus, described fluid source is selected from Implant or recycle, including gas, liquid gas and solution.

15. as claimed in claim 13 for being efficiently ablated the device of tissue, and wherein said control handle farther includes It is connected to the pendulous device of described guide shaft, for along described guide wire and a guide wire locking device Control the position of described ablation airbag apparatus.

16. as claimed in claim 11 for being efficiently ablated the device of tissue, and wherein said ablation electrode is coated on institute State the outer surface of ablation airbag apparatus.

17. as claimed in claim 12 for being efficiently ablated the device of tissue, a wherein critesistor and multiple record Electrode is associated with the ablation airbag apparatus of described inflatable, and this ablation airbag apparatus is arranged on On the pliable and tough guide shaft that described guide wire moves.

18. as described in the appended claim 1 for being efficiently ablated the device of tissue, and wherein said ablation airbag apparatus is low Temperature device.

19. as claimed in claim 18 for being efficiently ablated the device of tissue, and wherein said ablation airbag apparatus comprises can The air bag of inflation.

20. as claimed in claim 18 for being efficiently ablated the device of tissue, and wherein said ablation airbag apparatus includes Low temperature capsula interna and isolation external capsule.

21. are used for being efficiently ablated the device of tissue as described in claim 20, and wherein said ablation airbag apparatus enters one Step includes ring electrode, and it is positioned at the side of described ablation airbag apparatus.

22. are used for being efficiently ablated the device of tissue as described in claim 20, and wherein said ablation airbag apparatus enters one Step includes the multiple critesistor along air bag circle distribution and recording electrode.

23. are used for being efficiently ablated the device of tissue as described in claim 20, and wherein said isolation external capsule wraps further Include the multiple critesistor along air bag circle distribution and recording electrode.

24. as claimed in claim 18 for being efficiently ablated the device of tissue, and wherein said ablation airbag apparatus is set Meter is used as to be selected from liquid nitrous oxide with coolant with the use of, this coolant.

25. are used for being efficiently ablated the device of tissue as described in claim 20, and wherein said external capsule is designed to use can The separation gas absorbed is filled.

26. as claimed in claim 25 for being efficiently ablated the device of tissue, and wherein said separation gas includes nitrogen.

27. devices as claimed in claim 25, including regulating in described external capsule air pressure to maintain swelling state also Displacement is allowed to force the device of the gas on contact tissue point.

28. are used for being efficiently ablated the device of tissue as described in claim 20, and wherein said external capsule is furnished with multiple along circle The recording element of the isolation of week distribution, described recording element is by the chemical combination being coated with high conductance coating Thing is made；Described external capsule is also equipped with the electrical activity before and after critesistor is efficiently ablated and temperature with record, by The efficiency of this assessment tissue ablation.

29. 1 kinds of devices being used for chambers of the heart inner tissue is efficiently ablated, including:

A () guide body sheath, described guide body sheath is furnished with the distal portions of deflection；

B guide wire that () can extend from the distal portions of described guide body sheath, described guide wire has fixed The distal securing portion of shape, to be fixed in the chambers of the heart tissue needing ablation by described guide wire On；

C the ablation airbag apparatus of () inflatable, selected from radio frequency or low temperature airbag apparatus, it can be swollen Move in guide wire under swollen or contraction state；

D () guide wire controls element, for controlling the extension of described guide wire；With

E () wherein said ablation airbag apparatus further includes at the ablation gas close to described inflatable Electrode on bag apparatus far-end and proximal balloon edge, for labelling damage and balloon positions, electricity Movable and across air bag impedance.

30. are used for being efficiently ablated the device of tissue, the described far-end of wherein said guide wire as described in claim 29 Standing part is designed to can be placed in the left auricle of heart.

31. are used for being efficiently ablated the device of tissue as described in claim 29, and the far-end of wherein said guide wire is fixed Portion is designed to be positioned in pulmonary vein to produce pulmonary vein isolation ablation, when described ablation air bag When device expands, described ablation airbag apparatus is filled and inaccessible described pulmonary vein.

32. are used for being efficiently ablated the device of tissue as described in claim 29, and wherein said ablation airbag apparatus is located at Can be in described guide wire on the flexible conduit guide shaft of movement.

33. 1 kinds include for the device of tissue is efficiently ablated:

A () guide body sheath, is furnished with the distal portion of deflection and has an opening being positioned in described distal portion；

B () guides and records conduit, it can launch from the distal portion of described guide body sheath, is provided with many The J-shaped ring distal portion of individual recording element；

C the ablation airbag apparatus of () inflatable, is designed at described guiding and record pipe guide Upper movement；The ablation airbag apparatus of described inflatable is by described guiding and record pipe guide Guide and stable；

D () controls element, be used for controlling described guiding and record conduit launches from described guide body sheath； With

E () wherein said ablation airbag apparatus further includes at the ablation gas close to described inflatable Electrode on bag apparatus far-end and proximal balloon edge, for labelling damage and balloon positions, electricity Movable and across air bag impedance.

34. are used for being efficiently ablated the device of tissue, wherein said guiding and record conduit as described in claim 33 Described J-shaped ring farther includes ring portion, and described ring portion is designed to can be inserted into pulmonary vein hole；Described Ring portion is further configured with the record at multiple interval and stimulating electrode and critesistor, melts for assessment Formation and effect except rear damage.

35. are used for being efficiently ablated the device of tissue, the ablation of wherein said inflatable as described in claim 34 Airbag apparatus farther includes proximal loop electrode, for coordinating described J-shaped ring to determine the suitable of damage Conjunction property and Maturity.

36. are used for being efficiently ablated the device of tissue, the ablation of wherein said inflatable as described in claim 35 Airbag apparatus farther includes to be placed on the ring electrode at described ablation airbag apparatus distance two ends.

37. are used for being efficiently ablated the device of tissue as described in claim 36, wherein put when described ablation airbag apparatus Time in the hole of pulmonary vein, by being applied between the ring electrode of described far and near two ends the low-power transmitted Altofrequency energy carries out the impedance measurement between the ring electrode of described far and near two ends, thus assesses pulmonary vein Guan Bi and ablation.

38. are used for being efficiently ablated the device of tissue as described in claim 33, and wherein said ablation airbag apparatus connects To guiding and the balloon catheter axle of movement on record conduit, and include controlling element with along guide with Record conduit adjusts the position of described ablation airbag apparatus.

39. are used for being efficiently ablated the device of tissue as described in claim 33, and wherein said ablation airbag apparatus uses Ablation technology selected from radio frequency or low temperature.

40. are used for being efficiently ablated the device of tissue as described in claim 33, assess during farther including ablation The device of phrenic nerve function, described device includes element and the prison providing high intensity pulses electricity irritation The element of control diaphragm motion.

41. 1 kinds of devices for the human organ intracavity ablation tissue including the chambers of the heart, including:

A () guide body sheath, is furnished with the distal portions of deflection；

B () guide wire, can extend from the described distal portions of described guide body sheath, with shape selectively Become guide wire ring, this guide wire ring can be controlled on each position and anatomical site with device Official jargon tissue forces contact；

C the ablation part in () described guide body sheath, including the expanding unit of inflatable, it can Described guide wire moves；

D the expanding unit of () wherein said inflatable includes conduction ablation element, institute outside multiple banding The excircle stating ablation element and the expanding unit of described inflatable separates and is positioned over institute State around excircle, when the expanding unit of described inflatable is in contraction or air deflating state Time, described ablation element is overlapping；With

E the expanding unit of () wherein said inflatable further includes at close to described inflatable Expanding unit far-end and proximal balloon edge on electrode, for labelling damage and air bag position Put, electrical activity and across air bag impedance.

42. as claimed in claim 41 for being efficiently ablated the device of tissue, the expansion of wherein said inflatable Device is a part for described guide body sheath, and connects the segmentation of described guide body sheath, wherein Described guide body sheath moves in described guide wire.

43. as claimed in claim 41 for being efficiently ablated the devices of tissue, wherein said ablation element described can The expanding unit of inflation separates when being in inflated condition.

44., as claimed in claim 41 for the device of tissue is efficiently ablated, conducts outside wherein said multiple bandings and melt Except element is by helical arrangement.

45., as claimed in claim 41 for the device of tissue is efficiently ablated, conducts outside wherein said multiple bandings and melt The device for monitoring temperature and electrical activity is respectively included except element.

46., as claimed in claim 41 for the device of tissue is efficiently ablated, conducts outside wherein said multiple bandings and melt Except cross-shaped arrangement pressed by element, to strengthen annular ablation pattern.

47., as claimed in claim 41 for the device of tissue is efficiently ablated, farther include along described guide wire ring Advance and shrink the control element of expanding unit of described inflatable, with facilitate contact tissue with And the formation of linear damage.

48. as claimed in claim 47 for being efficiently ablated the device of tissue, and wherein said control element includes drawing Silk.

49. as claimed in claim 41 for being efficiently ablated the device of tissue, and wherein said guide body sheath is further Including the guide body air bag of the inflatable being positioned at described guide body sheath distal end portion, it is used for preventing Guide body sheath in operation process by penetrate chamber retract.

50. as claimed in claim 47 for being efficiently ablated the device of tissue, and wherein said control element wraps further Include the mechanism for locking described guide wire ring, and allow the expanding unit of described inflatable to exist Controllably move in described guide wire.

51. as claimed in claim 41 for being efficiently ablated the device of tissue, and wherein said ablation element uses radio frequency So that tissue is efficiently ablated, and the expanding unit of described inflatable includes cooling body, described cooling Mechanism includes the system of coolant in circulating gas-bag under specified pressure.

52. as claimed in claim 43 for being efficiently ablated the device of tissue, wherein said multiple bandings conduction ablation element Recover when inflation rear gasbag shrinks to overlap.