CN104039257A - 电生理学系统 - Google Patents

电生理学系统 Download PDF

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CN104039257A
CN104039257A CN201380005080.3A CN201380005080A CN104039257A CN 104039257 A CN104039257 A CN 104039257A CN 201380005080 A CN201380005080 A CN 201380005080A CN 104039257 A CN104039257 A CN 104039257A
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microelectrode
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约瑟夫·V·科布利什
艾萨克·J·金姆
德斯蒙德·张
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Boston Scientific Scimed Inc
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Abstract

电生理学系统包括：消融导管、射频发生器和映射处理器。消融导管具有组织消融电极和多个微型电极，其中，多个微型电极分布在组织消融电极的圆周周围并且与组织消融电极电隔离。多个微型电极限定多个双性微型电极对。映射处理器被配置为获得来自双性微型电极对的输出信号，比较输出信号，并且生成到显示器的输出，以提供微型电极和组织消融电极相对于待被映射和/或消融的心肌组织的特征的可视指示。

Description

电生理学系统
相关申请的交叉引用
本申请要求下列权益：于2012年10月17日提交的临时申请No.61/715,032、以及于2012年1月10日提交的临时申请No.61/585,083，通过引用方式将每个申请的全部内容并入本文中。
技术领域
本公开涉及心脏疾病的治疗方法。更具体而言，本公开涉及用于消融心脏组织以治疗心律失常的方法和系统。
背景技术
异常传导通路破坏心脏的电脉冲的正常通路。例如，传导阻滞可以导致电脉冲衰退成破坏心房或者心室的正常激活的几个圆形小波。异常传导通路造成异常的、不整齐的并且有时威胁生命的心律称为心律失常。消融是治疗心律失常并且恢复正常收缩的一种方法。使用位于期望位置的映射电极来放置或者映射异常通路的来源(称为病灶性心律失常基质)。在映射之后，内科医生可以消融异常组织。在射频(RF)消融中，RF能量从消融电极穿过组织到电极以对组织消融并且形成损伤。
发明内容
在示例1中，本发明涉及电生理学方法，该方法包括：使消融导管的远端部分在血管内前进到心室内最靠近心肌组织的位置。消融导管的远端部分包括组织消融电极和多个微型电极，该多个微型电极圆周地分布在组织消融电极的周围并且与组织消融电极电隔离。组织消融电极被配置为将消融能量施加到心肌组织，并且多个微型电极限定多个双性微型电极对，每个双性微型电极对被配置为生成输出信号。该方法还包括：获得来自每个双性微型电极对的输出信号，并且将来自每个双性微型电极对的输出信号的幅度与来自多个双性微型电极对中的其它双性微型电极对的输出信号的幅度进行比较。该方法还包括：向内科医生显示组织消融电极到心肌组织的接近度的可视指示。可视指示包括：如果任何一个输出信号的幅度与一个或多个其它输出信号的幅度之间的差值超过预先确定的阈值则所述组织消融电极与心肌组织接触的指示；以及如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值未超过预先确定的阈值则所述组织消融电极与心肌组织未接触的指示。
在示例2中(根据示例1的方法)，其中，所述获得和比较步骤由可操作地耦合到所述微型电极的映射处理器来执行。
在示例3中(根据示例1或者示例2的方法)，其中，所述多个微型电极包括限定第一、第二和第三双性微型电极对的三个微型电极。
在示例4中(根据示例3的方法)，其中，所述三个微型电极沿着所述组织消融电极被布置在相同纵向方向。
在示例5中(根据示例1至4中任一项的方法)，还包括：基于来自所述第一、第二以及第三双性微型电极对的输出信号的幅度向内科医师显示所述组织消融电极相对于所述心肌组织的定向的可视指示。
在示例6中(根据示例1至5中任一项的方法)，还包括：获得来自最靠近所述组织消融电极的在所述消融导管上放置的一个或多个环形电极的输出信号，将来自每个双性微型电极对的所述输出信号与所述环形电极输出信号进行比较，以识别双性微型电极对信号中的心内(intrinsic cardiac)激活信号，并且生成到显示器的输出，以指示在感测所述心内激活信号的所述双性微型电极对的位置处的消融损伤组中的缺口。
在示例7中(根据示例1至6中任一项的方法)，所述消融导管还包括：在所述组织消融电极中的多个冲洗端口，其流体地且可操作地耦合到冲洗流体储液室和泵。
在示例8中(根据示例1至7中任一项的方法)，所述消融导管还包括：近端手柄，其具有由使用者操控的控制元件，并且其中，使所述消融导管的所述远端部分前进包括：操控所述控制元件以使用于定位接近所述心肌组织的所述组织消融电极的所述远端部分偏转。
在示例9中，一种电生理学系统包括消融导管、射频(RF)发生器和映射处理器。消融导管包括：具有远端部分的柔性导管体、组织消融电极以及多个微型电极。组织消融电极被配置为将消融能量施加到所述心肌组织。多个微型电极圆周地分布在所述组织消融电极周围并且与所述组织消融电极电隔离，所述多个微型电极限定多个双性微型电极对，每个双性微型电极对被配置为生成输出信号。RF发生器可操作地耦合到所述组织消融电极以生成待传送到所述组织消融电极的所述消融能量。映射处理器被配置为：获得来自每个双性微型电极对的所述输出信号，将来自所述每个双性微型电极对的所述输出信号的幅度与来自所述多个双性微型电极对中的其它双性微型电极对的所述输出信号的幅度进行比较，并且生成到显示器的输出，以给临床医生提供所述组织消融电极到所述心肌组织的接近度的可视指示。可视指示包括：如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值超过预先确定的阈值则所述组织消融电极与心肌组织接触的指示；以及如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值未超过预先确定的阈值则所述组织消融电极与心肌组织未接触的指示。
在示例10中(根据示例9的系统)，其中，所述多个微型电极包括限定第一、第二和第三双性微型电极对的三个微型电极。
在示例11中(根据示例9或10的权利要求的系统)，其中，所述三个微型电极沿着所述组织消融电极被布置在相同纵向位置。
在示例12中(根据示例9至11中任一项的系统)，其中，所述映射处理器还被配置为：生成到显示器的输出，以基于来自所述第一、第二以及第三双性微型电极对的输出信号的幅度给内科医师提供所述组织消融电极相对于所述心肌组织的定向的可视指示。
在示例13中(根据示例9至12中任一项的系统)，其中，所述映射处理器还被配置为：获得来自最靠近所述组织消融电极的在所述消融导管上放置的一个或多个环形电极的输出信号，将来自所述双性微型电极对的所述输出信号与所述环形电极输出信号进行比较，以识别在双性微型电极对输出信号中的感应到的心内激活信号，并且生成到所述显示器的输出，以用于指示在感测所述心内激活信号的所述双性微型电极对的位置处的消融损伤模式中的缺口。
在示例14中(根据示例9至13中任一项的系统)，其中，所述消融导管还包括：在所述组织消融电极中的多个冲洗端口，其流体地且可操作地耦合到冲洗流体储液室和泵。
在示例15中(根据示例9至14中任一项的系统)，其中，所述消融导管还包括：近端手柄，其具有由使用者操控的控制元件，并且其中，所述消融导管的所述远端部分在所述控制元件的操控之下是可偏转的。
虽然公开了多个实施例，但是对于本领域的那些技术人员而言，本发明的其它实施例将从示出且描述本发明的说明性实施例的下面详细描述中变得显而易见。因此，附图和详细描述将被认为是本质说明而非限制。
附图说明
图1是根据本发明的一个实施例的射频(RF)消融系统1的示意图。
图2是示出在左边为传统消融导管并且在右边为本公开的高分辨率消融导管的实施例的示意图。
图3示出图2中示出的每个导管在消融之前和消融之后电压变化(面板A)之间的比较以及在消融之前和消融之后频谱变化(面板B)之间的比较。
图4示出在心房心动过速期间在消融之前和消融之后的测量信号幅度的比较。
图5是示出图2的导管与待被映射和消融的心脏组织的表面大体平行定向的示意图。
图6A和图6B示出由图2的导管上的微型电极和环形电极感测的心脏电信号的幅度。
图7是示出图2的导管与待被映射和消融的心脏组织的表面大体上垂直定向的示意图。
图8示出用于图7的配置的对应电记录图信号。
图9是示出根据各个实施例的用于评估图1或者图2的消融导管的组织消融电极的特征(即组织接触)的方法的流程图。
图10示出当怀疑远场噪声时能够由图1的系统在确定尖端位置的方法中使用的多个双性微型电极对的输出。
图11示出当导管在不同心脏结构之间导航时能够由图1的系统在辨别不同组织类型的多个双性微型电极对的输出。
图12示出能够由图1的系统在基于消融电极和微型电极之间的信号的比较来识别损伤组的缺口的方法中使用的多个双性微型电极对的输出。
图13示出能够由图1的系统在用于评估消融期间的电记录图衰减的方法中使用的多个双性微型电极对的输出。
图14和图15示出根据本发明实施例的使用包括高分辨率微型电极的导管来生成的示例性电解剖图。
虽然本发明接收各种修改和替代形式，但是具体实施例例如在附图中被示出且在下面被详细描述。然而，本发明不限于所述的特定实施例。相反，本发明旨在涵盖落入到由所附权利要求限定的本发明的范围之内的所有修改、等同物以及替代。
具体实施方式
图1是根据本发明的一个实施例的射频(RF)消融系统1的示意图。如图1所示，系统1包括消融导管2、RF发生器3和映射处理器4。消融导管2可操作地耦合到RF发生器2和映射处理器4，这在本文中将被更详细地描述。如所示出的，消融导管2包括：具有控制旋钮6的近端手柄5、具有远端部分的柔性体，其包括多个环形电极7、组织消融电极8以及多个映射微型电极9(在本文中也称为“针状”电极)，该多个映射微型电极9布置在组织消融电极8之内且与组织消融电极8电隔离。
在各个实施例中，消融导管2被配置为能够通过患者的血管导入，并且进入到心脏的心室之一中，在该心室中，消融导管可以用于使用微型电极9和组织消融电极8来映射并且消融心肌组织。因此，组织消融电极8被配置为将消融能量施加到心肌组织。在示出的实施例中，消融导管2是可操纵的，从而可以通过操纵控制旋钮6来使远端部分偏转(如由图1中的虚线轮廓所指示的那样)。在其它实施例中，消融导管2的远端部分具有预制形状，该预制形状适合于促进与具体目标组织邻近的组织消融电极8和微型电极9的定位。在一个这种实施例中，预制形状通常为圆形的或者半圆形的，并且在与导管体的大致方向垂直的平面中定向。
在各个实施例中，微型电极9圆周地分布在组织消融电极8的周围并且与组织消融电极8电隔离。微型电极9可以被配置为以单极或者双极感应模式进行操作。在各个实施例中，多个微型电极9限定多个双极微型电极对，每个双极微型电极对被配置为生成以下输出信号，该输出信号与接近该双极微型电极对的心肌组织的感应到的电活动对应。来自微型电极9的生成的输出信号可以被发送给映射处理器4以用于本文所述的处理。
可以用作消融导管2的示例性导管可以包括在名称为“High ResolutionElectrophysiology Catheter”的美国专利申请公开号为US2008/0243214以及名称为“Map and Ablate Open Irrigated Hybrid Catheter”的美国专利申请公开号为US2010/0331658中描述的那些导管，出于一切目的，上述全部内容通过引用方式全部并入本文中。在各个示例性实施例中，组织消融导管8可以具有6mm至14mm之间的长度，并且多个微型电极9相等地间隔在组织消融电极的圆周的周围。在一个实施例中，组织消融电极8可以具有大约8mm的轴向长度。在一个实施例中，消融导管2至少包括三个微型电极9，该三个微型电极9相等地间隔在组织消融电极8的圆周的周围并且沿着组织消融电极8的纵轴处于相同的纵向位置，微型电极9至少形成第一、第二和第三双极微型电极对。在一个实施例中，导管2包括在组织消融导管8内大致中心地放置的前向微型电极9。在前面提及的US专利申请公开号为2008/0243214的图3和图4中示出了示例性的这种RF消融导管。
在一些实施例中，除了组织消融电极8中的微型电极9之外或者代替组织消融电极8中的微型电极9，微型电极9可以放置在沿着消融导管2的其它位置。
在各个实施例中，组织消融电极8具有限定敞开的内部区域(未示出)的外壁。外壁包括用于容纳微型电极9的映射电极开口以及在一些实施例中的冲洗端口(未示出)。当存在冲洗端口时，冲洗端口与外部冲洗流体储液室和泵(未示出)流体连通，以给被映射和/或消融的心肌组织提供冲洗流体。用作导管2的示例性冲洗导管可以为在前面提及的美国专利申请公开号2010/0331658中描述的任何导管。在各个实施例中，导管系统还可以包括噪声工件隔离器(未示出)，其中，微型电极9通过噪声工件隔离器与外壁电绝缘。
在各个实施例中，映射处理器4被配置为经由消融导管2来检测、处理并且记录心脏内的电信号。基于这些电信号，内科医师可以识别心脏内的具体目标组织位置，并且确保心律失常致使的基质已由消融治疗电隔离了。映射处理器4被配置为处理来自微型电极9和/或环形电极7的输出信号，并且生成到显示器(未示出)的输出以供内科医师使用。在一些实施例中，显示器可以包括心电图(ECG)信息，该心电图信息可以由使用者分析，以确定心脏之内心律失常基质的存在和/或位置并且/或者确定心脏内消融导管2的位置。在各个实施例中，来自映射处理器4的输出可以用于经由显示器向临床医生提供与消融导管2和/或被映射的心肌组织的特征有关的指示。
RF发生器3被配置为以可控方式向消融导管2递送消融能量，以消融由映射处理器4识别的目标组织位置。心脏内的组织的消融是本领域公知的，并且因此出于简洁的目的，RF发生器3将不进一步被详细描述。在美国专利号为5，383，874中提供了与RF发生器有关的进一步的细节，该专利的全部内容通过引用方式全部并入本文中。虽然映射处理器4和RF发生器3被示作分立元件，但是它们能够可替选地被并入到单个集成设备中。
所述RF消融导管2可以用于执行各种诊断功能以在消融治疗中辅助内科医师。例如，在一些实施例中，导管用于消融心律失常，并且同时提供在RF消融期间形成的损伤的实时评估。损伤的实时评估可以涉及(例如，使用计算机断层扫描、磁共振成像、超声等)监视在损伤处或者损伤周围的表面温度和/或组织温度、心电图信号方面的减少、阻抗的下降、损伤位置的直接和/或表面可视化以及组织位置的成像中的任意项。此外，RF尖端电极之内的微型电极的存在可以用于辅助内科医师将尖端电极放置且定位在期望治疗位置，并且确定尖端电极相对于待消融的组织的定位和定向。
图2是示出在左边为传统消融导管10(即在组织消融电极内缺少任何微型电极的消融导管)并且在右边为本公开的高分辨率消融导管100的实施例的示意图。对于心脏映射而言，传统导管依赖于从消融尖端电极18沿着映射电极一个距离而布置的传统环形电极12、14、16，从而导致映射/起搏中心和消融中心之间的较大距离。相反，本公开的导管包括在消融尖端电极118的映射电极开口114中的映射微型电极110，以允许映射/起搏中心的位置能够与消融中心的位置基本上相同。
图3示出图2中示出的每个导管在消融之前和消融之后电压变化(面板A)之间的比较以及在消融之前和消融之后频谱变化(面板B)之间的比较。如所示出的，对于电压和频域(箭头A和B)二者而言，传统消融导管中的尖端至环形(tip-to-ring)信号变化是最低程度的。相反，本公开的导管中从针状到针状(即，映射微型电极之间)的所记录的变化是深刻的(箭头C和D)。
图4示出在心房心动过速期间在消融之前和消融之后的测量信号幅度的比较。如所示出，与针状到针状信号变化相比，传统消融导管(顶部箭头)中的尖端到环形再次信号变化是较小的。因此，针状电极在识别对缺口的形成和心房心动过速的感应负有责任的活体组织的过程中是更成功的。
如之前解释的，微型电极110可以有利地提供与心脏之内的电极触头和尖端电极定向有关的反馈。图5是示出导管100与待被映射和消融的心脏组织的表面200大体平行定向的示意图。图6A和图6B示出由导管100上的环形电极以及微型电极110感测的心脏电信号的幅度，环形电极以及微型电极的数据可以用于实现用于确定电极接触和导管尖端定向的方法。在图6A和图6B中，示出了双极微型电极对110的ECG踪迹(如由限定的标签指示的那样)，并且示出了微型电极对应的ECG信号。具体地，在图6A中，消融导管具有在组织消融电极的圆周周围分布的四个微型电极(标记为49、50、51和52)，从而标签49-50、50-51、51-52和49-52标出相邻微型电极的相应双极微型电极对。同理，在图6B中示出的示例中，示出了三个双极微型电极对(标记为Q1-Q2、Q2-Q3和Q3-Q4)的ECG踪迹。
在示出的示例中，如图6A所示，两个双极微型电极对(由参考标记210、220指示)中的每一个对示出明显心房信号，而其它双极微型电极对(由参考标记230、240)示出最小幅度。具有最小幅度的信号的多个映射微型电极指示在血液中漂浮，这暗示平行尖端定向。图6B示出类似结果，两个双性微型电极对(Q1-Q2和Q2-Q3对)示出心房信号，并且一对(Q3-Q4)示出最小信号幅度。该数据允许系统1确认具有心脏组织的尖端接触以及尖端相对于组织表面的定向，这可能无法仅使用导管100上的环形电极来实现，所有的环形电极示出暗示没有组织接触的最小信号幅度(如图6A和图6B所示)。
图7是示出导管100与带被映射和消融的心脏组织的表面200大体上垂直定向的示意图，并且图8示出用于图7的配置的对应电记录图信号。从图8中可以看到，所有的双极微型电极对(由R3-R1、R2-R3和R1-R2指定)示出基本上相等信号幅度，指示出所有的微型电极正在血液中漂浮并且不与表面200接触。
图9是示出根据本文所述的各个实施例的用于评估消融导管2、100的组织消融电极的特征(即组织接触)的方法250的流程图。如图9所示，方法250包括：在步骤255处，首先使消融导管的远端部分在血管内前进到最靠近待被映射和/或消融的心肌组织的位置。消融导管可以为本文所述的消融导管2或者100。在各个实施例中，特定的消融导管包括在组织消融电极中限定为多个双极微型电极对的多个微型电极。在一个实施例中，消融导管包括在组织消融电极的圆周周围布置的限定为第一、第二以及第三双极微型电极对的至少三个微型电极。
然后，在步骤260处，系统获得来自每个双极电极对的输出信号。此后，如步骤265处所示，该方法将来自每个双极微型电极对的输出信号的幅度与来自多个双性微型电极对的其它双性微型电极对的输出信号的幅度进行比较。然后，如步骤70所示，基于输出信号的幅度之间的差值来生成用于指示组织消融电极相对于心肌组织的状况的显示。
在一个实施例中，被显示的状况可以包括：组织消融电极到心肌组织的接近度的可视指示。在一个实施例中，该接近度的可视指示可以包括：如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值超过预先确定的阈值则组织消融电极与心肌组织接触的指示。此外，接近度的可视指示可以包括：如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值未超过预先确定的阈值则组织消融电极与心肌组织未接触的指示。
在各个实施例中，获得并且比较来自双极微型电极对的输出信号的步骤由可操作地耦合到微型电极(见图1)的映射处理器来执行。
在一个实施例中，微型电极即第一、第二、第三双极微型电极对每个均关于组织消融电极和其它微型电极具有已知位置。在这种实施例中，方法250还可以包括：基于来自第一、第二、第三双极微型电极对的输出信号的幅度向临床医师显示组织消融电极相对于心肌组织的定向的可视指示。
在一个实施例中，方法250可以使用冲洗消融导管来实施，该冲洗消融导管具有在组织消融电极中的多个冲洗端口，该多个冲洗端口流体地且可操作地耦合到冲洗流体储液室和泵，并且方法250包括：在映射并且/或者消融程序期间通过冲洗端口供应冲洗流体。
可以由本文所述的消融导管2、100的微型电极的存在和配置有利地促进其它方法。例如，图10示出当怀疑远场噪声时能够由系统1在用于确定尖端位置的方法中使用的多个双性微型电极对(分别标记为49-50、50-51、51-52和49-52)的输出生成的ECG。在所示出的示例中，位于组织消融电极处的微型电极仅拾起心室信号，指示出组织消融电极处于心室中。另一方面，环形电极拾起心房信号和心室信号二者。基于这些信号，可以确定消融电极可能半途通过三尖瓣。
图11示出当导管在不同心脏结构之间导航时能够由系统1在辨别不同组织类型的方法中使用的多个双性微型电极对(分别标记为49-50、50-51、51-52和49-52)的输出生成的ECG。在示出的实施例中，当导管位于上腔静脉之内时，微型电极展示最小响应。当导管退出上腔静脉且进入右心房时，由微型电极生成的信号基本上改变。
图12示出能够由系统1在用于识别损伤组的缺口的方法中使用的多个双性微型电极对(分别标记为T1-T2、T2-T3、T3-T1)的输出生成的ECG。在示出的示例中，消融电极拾起最小信号而位于消融电极尖端处的微型电极拾起明显心房信号，指示出损伤组的缺口。因此，在示例性方法中，映射处理器4可以识别来自双极微型电极对的输出信号中的明显心内激活信号，并且其后基于这些双性微型电极对的位置来生成到显示器的输出以识别损伤组中的对应缺口。在各个实施例中，映射处理器4还可以获得来自环形电极7(或者由两个环形电极7或者一个环形电极7和组织消融电极8限定的双性电极对)(见图1)的输出信号，将来自双性微型电极对的输出信号与来自环形电极的对应输出进行比较，并且使用该比较来识别心内激活信号和损伤组中的对应缺口。
图13示出能够由系统1在用于评估消融期间的电记录图衰减的方法中使用的多个双性微型电极对(分别标记为49-50、50-51、51-52和49-52)的输出生成的ECG。在示出的示例中，与组织接触的微型电极的电记录图幅度大于血液中的电记录图幅度。当在消融期间打开RF能量时，微型电极示出幅度方面的减少。
各个实施例的微型电极消融导管2、100还可以与三维心脏映射系统有利地集成以用于生成心脏的高分辨率电解剖图来在诊断心律失常(例如，心房颤动)、识别治疗方案(例如，消融过程诸如肺静脉分离)并且验证治疗的充分性的过程中辅助内科医师。图14和图15示出示例性电解剖图300、400、500和600。在图14中，图300为使用传统消融导管例如图2中的导管10而生成的示例性主频率图，并且图400为使用包括在RF消融电极之内空间放置的多个微型电极的图1的导管2或者图2的导管100而生成的示例性主频率图。由导管2、100的小型电极提供的特定高信号保真度允许内科医师准确地识别在纤维组织中找到的异常组织基质，因此允许内科医师更轻而易举地辨别不同组织类型并且识别能够使用图2的传统消融导管10完成的待被消融的基质(例如，通过分析同类或者异类去极化)。图15说明了由导管2、100提供的优势，示出示例性传统导管10和各个实施例的导管100在病理学确认的心脏组织上生成的电解剖图的比较，以展示类型1纤维化。从图15中可以看到(左图)，使用传统导管10生成的图示出了纤维组织内的正常电压分布。相反，使用具有微型电极9、110(分别图1、图2)的导管2、100(右图)生成的图确认纤维组织中的异常电压。
可以在不脱离本发明的范围的情况下对所讨论的示例性实施例做出各种修改和添加。例如，虽然上述的实施例指代特定特征，但是本发明的范围还包括具有不同特征和不包括所有所述特征的实施例的组合的实施例。因此，本发明的范围旨在包含落入权利要求的范围之内的所有这种替代、修改和变型以及其所有等同物。

Claims (14)

1.一种电生理学方法，包括：
使消融导管的远端部分在血管内前进到心室之内最靠近心肌组织的位置，所述消融导管的所述远端部分包括：
组织消融电极，其被配置为将消融能量施加到所述心肌组织；
多个微型电极，其圆周地分布在所述组织消融电极周围并且与所述组织消融电极电隔离，所述多个微型电极限定多个双性微型电极对，每个双性微型电极对被配置为生成输出信号；
获得来自所述每个双性微型电极对的所述输出信号；
将来自所述每个双性微型电极对的所述输出信号的幅度与来自所述多个双性微型电极对中的其它双性微型电极对的所述输出信号的幅度进行比较；并且
向临床医师显示所述组织消融电极到所述心肌组织的接近度的可视指示，所述可视指示包括：
如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值超过预先确定的阈值则所述组织消融电极与心肌组织接触的指示；以及
如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值未超过预先确定的阈值则所述组织消融电极与心肌组织未接触的指示。
2.根据权利要求1所述的方法，其中，所述获得和比较步骤由可操作地耦合到所述微型电极的映射处理器来执行。
3.根据权利要求1所述的方法，其中，所述多个微型电极包括限定第一、第二和第三双性微型电极对的三个微型电极。
4.根据权利要求3所述的方法，其中，所述三个微型电极沿着所述组织消融电极被布置在相同纵向位置。
5.根据权利要求4所述的方法，还包括：基于来自所述第一、第二以及第三双性微型电极对的输出信号的幅度来向内科医师显示所述组织消融电极相对于所述心肌组织的定向的可视指示。
6.根据权利要求5所述的方法，其中，所述消融导管还包括：在所述组织消融电极中的多个冲洗端口，其流体地且可操作地耦合到冲洗流体储液室和泵。
7.根据权利要求1所述的方法，其中，所述消融导管还包括：近端手柄，其具有由使用者操控的控制元件，并且其中，使所述消融导管的所述远端部分前进包括：操控所述控制元件以使用于定位接近所述心肌组织的所述组织消融电极的所述远端部分偏转。
8.一种电生理学系统，包括：
消融导管，包括：
具有远端部分的柔性导管体；
组织消融电极，其被配置为将消融能量施加到所述心肌组织；
多个微型电极，其圆周地分布在所述组织消融电极周围并且与所述组织消融电极电隔离，所述多个微型电极限定多个双性微型电极对，每个双性微型电极对被配置为生成输出信号；
射频(RF)发生器，其可操作地耦合到所述组织消融电极以用于生成待传送到所述组织消融电极的所述消融能量；以及
映射处理器，其被配置为：
获得来自所述每个双性微型电极对的所述输出信号；
将来自所述每个双性微型电极对的所述输出信号的幅度与来自所述多个双性微型电极对中的其它双性微型电极对的所述输出信号的幅度进行比较；并且
生成到显示器的输出，以给临床医生提供所述组织消融电极到所述心肌组织的接近度的可视指示，所述可视指示包括：
如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值超过预先确定的阈值则所述组织消融电极与心肌组织接触的指示；以及
如果任何一个输出信号的幅度与任何一个或多个其它输出信号的幅度之间的差值未超过预先确定的阈值则所述组织消融电极与心肌组织未接触的指示。
9.根据权利要求8所述的系统，其中，所述多个微型电极包括限定第一、第二和第三双性微型电极对的三个微型电极。
10.根据权利要求9所述的系统，其中，所述三个微型电极沿着所述组织消融电极被布置在相同纵向位置。
11.根据权利要求10所述的系统，其中，所述映射处理器还被配置为：生成到显示器的输出，以基于来自所述第一、第二以及第三双性微型电极对的输出信号的幅度来给内科医师提供所述组织消融电极相对于所述心肌组织的定向的可视指示。
12.根据权利要求8所述的系统，所述映射处理器还被配置为：获得来自最靠近所述组织消融电极在所述消融导管上放置的一个或多个环形电极的输出信号，将来自所述双性微型电极对的所述输出信号与所述环形电极输出信号进行比较，以识别双性微型电极对输出信号中的感应到的心内激活信号，并且生成到所述显示器的输出，以用于指示在感测所述心内激活信号的所述双性微型电极对的位置处的消融损伤模式中的缺口。
13.根据权利要求8所述的系统，其中，所述消融导管还包括：在所述组织消融电极中的多个冲洗端口，其流体地且可操作地耦合到冲洗流体储液室和泵。
14.根据权利要求8所述的系统，其中，所述消融导管还包括：近端手柄，其具有由使用者操控的控制元件，并且其中，所述消融导管的所述远端部分在所述控制元件的操控之下是可偏转的。
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