CN1085416A - 用于心脏的可弯曲的环形电极阵列探查主切除导管 - Google Patents
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Abstract
一种心脏的心律不齐探查及切除导管有一个主
导管,该主导管配置一个固定在其远端的探查及切除
系统,此远端包括一个携载有一个电极阵列的可调节
环,该电极阵列包括多个并联的、可分别操作的探查
/切除电极,这些电极与外部环境是导电关系并且沿
环按顺序间隔开。被绝缘的导体把电极与导管外的
输入/输出装置电连接起来以探查接触到的腔壁的
电活动以及按指示切除组织。用牵引控制金属绳来
控制环的尺寸、形状以及弯曲或姿态。
Description
本专利申请是申请日为1992年2月24日,申请号为07/840.162未决申请的一个部分继续申请。
现参考申请号为07/835.553和07/840.026的共同申请。这些互作参考的申请也是为了改进导管。
本发明涉及一种用于心脏心律不齐切除领域的改进的导管。本发明尤其涉及一种可弯曲的电极阵列环形导管(最好尺寸及形状可调),该导管允许操作者迅速探查心腔和三尖瓣环,并且用该阵列中的探查电极切除需切除的组织,切除时把电极放在将要被切除的位置上或其附近。
在健康的心脏中正常的心跳速度是由一个称作窦房结(SA结)的特殊结构控制。这是心脏的自然起搏器并且是位于右心房肌壁内的一个特殊组织。SA结提供了支配心脏心房和心室的固有的或自然的节律性收缩的搏动。这种支配或控制涉及在心房和心室中通过心脏传导路径的离子搏动的传输,这种搏动导致心脏以一个有顺序的次序按SA结决定的速率收缩和舒张。这个次序保证了血液流到体循环中或者伴随着每次心室的收缩肺系统的机能达到最大。SA结有其固中有的速率,该速率可以由来自神经系统的信号进行改变,响应于刺激、身体活动等等,交感神经和副交感神经系统作出反应以改变速率。
去极化搏动开始于SA结并作为一种电波从其在右心房中的位置向左心房和朝下向过渡区域扩散,该过渡区域位于心房和心室之间,称为房室(A-V)结或接点的另一个结位于其中。该搏动以一个较慢的方式通过A-V结传导并延续到一个位于右和左心室之间的共同路径(该共同路径被称作为希斯氏束)上,然后进入被称作右和左束支的多路径上,每个束支连接一个心室。这些束支然后分进一个广延的传导组织的更细的路径网,该网从心脏内表面向外表面扩散并被称为浦肯野氏纤维。这些纤维把去极化搏动送到心室心肌的所有部分。
只要此系统是无伤的,可以正常地传输搏动并且保持心脏的节律。然而可以导致形成瘢痕组织的先天的缺陷、疾病或损伤可能阻断或改变在心脏传导系统中的自然搏动或电流。当在心脏传导路径中或在心室的心肌中有足够严重的损伤或先天缺陷时,电搏动不能正常地传输并且可能发生称为心脏心律不齐的节律失调。关于这样的失调,术语“心搏徐缓”用来描述心脏收缩的异常缓慢,术语“心搏过速”用来描述异常的快速心脏活动。虽然这两种情况中的任何一个都危害患者的生命,但心脏过速危害更大,尤其是对于具有潜在心脏疾病的患者。
已用一些药物,例如利多卡因、奎尼丁和普鲁卡因胺,来治疗心室心搏过速和其它心室心律不齐。如果有过分的交感神经活动或肾上腺分泌时,可使用Beta阻滞药物。一旦防止快速型心律紊乱的药物疗法没有效果时,可以使用一定的外科手术来从心房或心室上切除产生心律不齐的组织。这种手术涉及延伸外科(extensive sur gery),在该手术中需要通过心包和心肌作一个切口以确定产生心律不齐的组织的位置,该组织然后被冷冻或用外科手术的方法去除以瘢痕组织代替。
由于切开心脏的外科手术是一个需要长期住院治疗及恢复的高风险操作,就需要一个造成较少创伤的解决方法。结果,发明了不同型式的导管并且用它们诊断和治疗一些心脏异常以避免切开心脏手术的创伤。例如,作为一个去除动脉粥状硬化斑块的方法,现在常规地使用囊血管成形术来舒通狭窄的损害。在此过程中,让携载导管的囊通过患者的脉管系统到达狭窄的位置。靠通过导管腔注入的液体使囊膨胀以向阻塞的脉管壁施加压力,从而舒通它。
导管装置也已被用来定位及切除心脏传导路径。一个这样的装置见美国专利4785815,其中导管在其远端携载至少一个电极以检测在心脏中的膜电位,还携载一个加热装置以切除由检测装置定位的路径的至少一部分。在美国专利4869248中显示及描述了另一种用来作为心脏的导路径微小横切或大横切的导管,该导管在其远端用一个阻抗性加热元件以作高度定位处理。一旦把切除部件适当地放到了感兴趣的定位区域,这些装置一般是有效的。所述的这类导管装置已经得到发展,该导管采用了一个单柄操纵的弯曲金属线。这样的装置在美国专利4960134中公开。
大多数现在的心组织切除手术都涉及通过一个导管而传输到组织的无线电频率(RF)电流的使用,该导管尽可能近地放在位于心房或心室的产生心律不齐的位置上。无线电频率的电流加热导管周围的组织,产生一个不连续的(discrete),强烈的损伤。为治愈患者的心律不齐,必须在心律不齐发生区域制造损伤。由于这些装置操作法的改进以及它们进入难以到达但却是异常心律通常来源区域的能力的改进,这大大地有助于心律不齐的最佳定位以及在切除前准确放置导管。
在许多心律不齐的患者中,造成异常心律的组织位于三尖瓣环上的或其附近的右侧上腔(心房)中。对切除的最合适的定位是靠为了识别最早的电活动而对一个大面积的探查来确定的。探查过程以及导管解剖学位置的识别有时是困难且费力的,其结果是使操作者和患者遭受长时间的X射线辐射。
不象切除围绕二尖瓣环的组织的操作,其中冠状的窦导管很容易提供产生心律不齐的组织的位置的关键信息并且作为放置切除导管的导引物,而在围绕三尖瓣的心脏的右侧不存在这样的结构。一种既提供了迅速探查整个三尖瓣环及其邻近区域能力以及用同一导管向最需要的位置供应切除能量的能力的装置将不仅加速切除过程,而且使该操作更容易有效。
本发明涉及一种独特的探查及切除导管装置,该装置提供了迅速探查心腔和整个三尖瓣环及其邻近区域的能力,还用同一导管提供了向最需要的位置供应切除能量的能力。这个能力使得探查感兴趣的区域更容易,并且加速了切除过程并使其更有效。本发明是一个包括有一个远端环部件的新的导管设计,该远端环部件可以靠拉紧从导管柄中伸出的牵引金属线被张开和关闭。在一个应用中,环的尺寸被设计成围绕着三尖瓣配合。在环的最远端设置有一个柔软的聚氨酯管的短长度形式的伸长部分,该伸长部分可以插进三尖瓣环的最前面的角中。不带这个伸长部分,此装置适合于探查任何其它心脏区域。尽管尺寸不关键,伸长部分一般直径为4弗伦奇(Frech)且其长度小于1英寸(18mm)。环伸长部分为环的远端和导管轴上提供了一个锚状物,在这里环被设计得向前伸展进入下腔静脉(inferior vena cava)并且在其近端为环提供了锚状物。
环上配备有一对间隔开的按顺序分布的电极阵列,连接形式允许从环上或围绕三尖瓣环的任何位置进行记录。在一个布局中,把每个电极背面刮平或修平以使得大多数的暴露的表面与组织接触而不是与血液接触。在一个实施例中,电极长度约为4mm并被隔开2mm。该系统中包括穿进环的弓形物的相对两侧中的两个弯曲金属线,该金属线沿着环和主导管腔充分延伸进入控制环的尺寸和形状的柄中。在此结构中,当这些控制金属线处于正常(未拉伸)状态时,环保持闭合,环弓形物相对两侧基本平行。施加在两条金属线上基本相同的牵引力使得环对称张开并对应于施加的牵引力保持在一恒定的位置;然而,只拉或牵引一个金属绳使得环不对称张开并且弯向对着被弯曲的环弓形物一侧。把环进一步固定在一个牢固的热塑材料的硬性护套上,该护套能维持在弯曲金属线上的高拉力而不损坏,并且维持一个预定的形状,该形状是按特定手术操作的需要靠加热且弯曲轴而改变得到。一旦热塑性导管轴冷却,在加热过程中施加到导管上的角度就得以维持。这种结构能使操作者以更主动的方式转动导管环并控制其顶端的位置。
预先选定的轴的形状允许操作者更容易地把携载有环的导管护套从下静脉腔推进三尖瓣环中。该结构使得轴的转动导致环绕着三尖瓣的轴转动,这允许操作者在三尖瓣环的后外表和前外表上探查心房和心室的电活动。操作者靠在一个牵引金属线上施加拉力可以容易地改变导管弯曲以改变相对于导管轴的环的角度,因而提供了灵活性很大的角度和形状以适应变化的三尖瓣环的解剖学位置。
在附图中,相同的序号用来表示相同的部件。
图1A是本发明电极阵列环的大大放大了的示意图。
图1B是沿图1A的1B-1B线剖开的剖面图。
图2A-2E是各种不同布置及张开程度的电极阵列环的示意图。
图3A和3B是从带有电极阵列的导管和柄上切下的部件的部分显示其截面的示意侧视图和顶视图。
图4是从带有电极阵列的导管和柄上切下的部件的部分显示其截面的示意顶视图。
图5是图3A、3B和4的柄的部件的大大放大了的分解平面图;
图6A-6D是表示各种不同弯曲布置的电极阵列环的示意图。
下面将参照附图详细描述本发明。在图1A的放大了的示意图中,环20是由厚但柔性的强化聚合导管(一般直径为1.7mm)制成,该导管的构造使得当它被打开时形成一个椭圆。在此实施例中,为聚合管环提供一个远端延伸部分或附属部分22,该部分22也是用兼容的聚合材料(例如聚氨酯)制成。顺便举例,延伸部分22可以是18mm长×4French(直径),环20还包括一对弯曲控制金属线24和26,这对金属线中的每一个靠其对应的T型销钉32和34锚接于空心椭圆形环的对应半部28和30的远端部分。环还在椭圆形环的每个半部上包括有一连串隔离的管状贵金属电极36,这些电极36还连接到各自对应的隔离的导线25和27上,这些导线捆扎为捆束38和40。弯曲控制金属线24和26以及导线38和40都穿过对应的环腔和主导管护套到控制柄,弯曲控制线24和26分别穿过各自的携载管46和48。
如图2A更好地显示的,当环完全闭合时,它基本上形成一个直线形。尽管尺寸并非十分关键,纵轴长度一般为6cm,环延伸段22为大约18mm。电极36最好由2mm厚、4mm长的铂管制成。
在固定电极之前,把每个铂管段36连接到对应的低电阻导线25和27上,这些导线25和27的标称直径为0.08mm,它们穿过管(未示出)中的小孔。把每组导线38、40插进一个聚合物(优选聚四氟乙烯(PTFE))管42、44中,该聚合物管是被放置在主导管轴18的内部并沿其长度伸展。这保护导线并把它们携载到一个固定在位于导管柄近端的短电缆上的插头上(图3A和3B)。
管状电极还在图6A-6C中显示,其中管状段的全视图如136所示。把电极136同样地连接到集束在138和140上的各自对应的隔离导线上,集束捆138和140分别由在图6D中的管142和144携载。如电极36的情况一样,电极136一般为4-5mm长,去掉任何毛刺,且由任何希望长度的间隔物137隔离开,但隔离物长度一般为大约2mm。如在图1A和图1B的实施例中所示,控制金属线携载管146和148分别携载控制金属线124和126。对于探查动作及对于切除的各个电极的控制与图1A-1B和2A-2E的情况相同。
不考虑电极结构,如图1B所示主导管轴18包括4个PTFE管,管42携载来自环20的30一侧的电极的导线集束捆。管44携载来自管20的28一侧电极的导线集束捆。管46携载为使下部环段28弯曲的牵引金属线24,管48携载为使环段30弯曲的牵引金属线26,弯曲金属线24,26最好是不锈钢的,标称厚度是0.22mm,并且靠把对应的销钉压接在金属线上把弯曲金属线连接到T型销钉32和34(图1A)上。T型销钉和牵引金属线通过一个在环管内的小孔插进环管中。每个T型销钉可以嵌入管中并且用一种兼容的粘结剂固定,如用聚氨酯胶固定。
如图2A-2E所示,当在弯曲金属线24、26上施加拉力时,上部和下部段28和30将弯曲经形成环状,这导致环张开(2C)。当单独拉金属线26或拉的程度较大时,环将张开并向下弯曲(如图2D所示)。当拉金属线24的下部时,情形相反(如图2E所示)。
在图2D中,所示的控制金属线124和126相对于导线束138和140偏置,这与图1B的其本呈直线排列的结构不同,此直线排列平行于没有弯曲的电极环在平行于主导管段18的正常位置上的平面。所示的基本为90°的偏置安排代表一个图6B和6C所示的有关使用控制金属线以使不从一侧到另一侧弯曲夸张的演示。即使图1A和1B的直线布置,除环形状的控制外也可控制一些环从一侧到另一侧的弯曲;并且,可以意识到采用任何所希望程度的偏置,对称的或不对称的。
尽管尺寸并不关键,导管主轴18的远端部分直径最好是大约8F,该导管主轴最好用靠加热可重新成形的强化热固聚合管制成。该管设计为在使用前加热并成形。一旦冷却,新的形状将被保持,即使在环弯曲控制或牵引金属线上施加较大的拉力,轴也只有极小的弯曲。
本发明导管控制柄部件近端的结构如图3-5所示。图3A和3B一般地表示柄50的顶视图和侧视图。导管护套18安装在柄中,并且含有连接在环上每个电极的导线的两个集束捆穿过导管段52进入并通过柄的长度到达柄20的近端,在这里导线连接到一个多路输入/输出接线器上。
把两个牵引金属连接到分开的牵引金属线拉伸控制系统上,详细细节如图4和5所示。如图5的分解图所示,拉伸控制系统及柄装置包括一对彼此隔开的对称的柄机构。拉伸控制系统是一个相对的手操可松脱齿杆机构,在此机构中带有各自指状物操作柄段68和70的一对拉伸控制杆部件64和66靠螺钉76和78连接到中空的、通常为圆柱形的齿杆部件72和74上。齿杆部件72和74分别有一组设计用来与一个弹性啮合和松脱机构配合的单方向啮合齿轮齿82和84,该弹性啮合和松脱机构包括一对相反设置的锁定部件,这对锁定部件具有设计用来插进孔90和92中的轴86和88,这对锁定部件还具有齿轮齿94和96,当弹簧部件98向外驱动锁定部件时,这些齿轮齿与对应的齿系列82和84啮合。如图5最好显示的,在齿杆部件72和74上提供沟槽100和102,当拉伸控制系统装配在柄孔104中(图4)时,沟槽100和102用来容纳锁定销钉104。
如图4所示,把环弯曲控制金属线24和26穿过开孔110和112,并且固定在齿杆部件72和74上并围绕它们缠绕。拉伸控制杆柄68和70的向柄近端的运动牵引金属线24和26并使环张开。一旦松开,每个杆用弹簧加载齿轮齿锁定系统维持其位置,靠弹簧部件98使得该弹簧加载齿轮齿锁定系统持续啮合。由两组齿106和108分别阻止部件86和88转动,这两组齿设置在每个与柄部件50中的沟槽103(图4)啮合的锁定部件上。由于每个杆可以彼此独立地移动,环的弯曲可以扭动或偏置,因而可以调整以便更好地适合任何所要探查的腔的任何形状。只要简便地接进部件86和88的松脱钮端就可以各自解除弯曲控制金属线的牵引以去除齿轮齿的啮合和松脱弯曲控制齿杆圆柱,允许相应的柄移回闭环位置。为了弯曲或张开此环,可以在不按压锁定控制钮的情况下移动有关的弯曲控制柄,这是因为作为一个单向杆机构单向锁定齿组82、94和84、96可以彼此滑动。
在手术中,靠一个切口把导管系统引入患者的脉管系统并通过脉管系统进入下静脉腔,这样使得主导管的远端伸进患者心脏的右房腔中。一旦到达合适的位置,靠柄68和70的往复运动可以精确地控制环20的尺寸和形状,使得环20的电极36容易到达瓣壁上的任何一点。也可以把导管远端经过三尖瓣伸进右心室,以便用环20探查三类瓣的室壁。电极部件36可以用来探查遍及瓣褶层(valve folds)和表面的心脏去极化电位,从而可对早期活化(activation)位置进行定位和探查。为了探查以及为了组织切除的目的顶端伸展是用来稳定环位置。
靠本发明导管系统方便及准确的探查可以使得对早期活化位置的定位以及对与三尖瓣区域相关的组织的切除更方便及更准确。
为了附合专利法规以及为了向熟悉本领域的技术人员提供为应用新颖的原理并制造和使用本发明的实施例所必需的信息,在此已对本发明作了相当详细的描述。然而,可以理解本发明可以用专门的其它装置实现,并且在不超出本发明范围的情况下可以完成不同的变型。例如,可以把环制成与一个固定的预先确定的形状相一致,如一个完全张开的环,当它一旦从导管腔中出来时它就展开。在这样一个实施例中可以使用记忆材料,例如柔性的但有记忆的塑料或金属材料,金属材料可以是镍钛合金(一般称为nitinol)。
Claims (23)
1、一种心脏心律不齐探查及切除导管包括:
一个主导管,该主导管包括一个伸长的、柔性的塑料管,该塑料管具有一个近端和一个远端,以及一个足够小的外径以能够从导入位置通过脉管系统进入所希望的心腔中,该塑料管还具有所需要的通过脉管系统的能力,该主导管还沿从该近端向该远端伸展的一个主内腔运动;
一个固定互该主导管的塑料管远端上的探查和切除系统,该系统还包括:
一个携载有一个电极阵列的可调节的管状远侧环部件,该电极阵列包括多个并联连接的探查/切除电极,这些电极与外部环境是导电联系的并且沿着该可调节的管状环彼此间隔地按顺序排列,
把各个电极与该导管外的一个输入/输出设备电连接起来的被绝缘的导电装置,以便探查接触到的腔壁的电活动并按指示切除组织,用来调整和控制该可调节阵列环的形状和姿态或弯曲的控制装置。
2、根据权利要求1所述的心脏心律不齐切除导管,其特征在于:用来调节和控制该电极阵列环的形状及弯曲的该控制装置还包括一对拉伸牵引金属线。
3、根据权利要求4所述的心脏心律不齐切除导管,其特征在于:该导管还包括用于分别控制每个牵引金属线拉伸的装置。
4、根据权利要求3所述的心脏心律不齐切除导管,其特征在于:该拉伸牵引金属线也可用来控制该电极阵列环的弯曲。
5、根据权利要求4所述的心脏心律不齐切除导管,其特征在于:相对于该电极阵列环的不弯曲平面至少稍微偏置该拉伸牵引金属线以增加对该电极阵列环的相对的弯曲控制。
6、根据权利要求2所述的心脏心律不齐切除导管,其特征在于:该导管装置还包括:
连接到外部导管的远端的柄装置;
一对在该导管柄中的拉伸控制装置,用来分别控制在这对牵引金属线中每一个的拉伸;
其中这对牵引金属线穿在该环的相对两侧边中并穿过该环以及该主导管腔的长度,并且每个牵引金属线分别连接到这对拉伸控制装置的对应的一个上。
7、根据权利要求6所述的心脏心律不齐切除导管,其特征在于:这对拉伸控制系统中的每一个还包括有手操作可松脱齿杆机构,该机构上固定有拉伸控制杆部件以转动一个通常为圆柱形的齿杆部件,相对应的牵引金属线固定在该齿杆部件上,因而导致牵引金属线的缠紧和松脱并相应地拉紧和松开环的相关部分。
8、根据权利要求7所述的心脏心律不齐切除导管,其特征在于:该拉伸控制系统还包括弹性松脱装置用来各自去除每个齿杆装置的啮合,因而放松在对应牵引金属线上的牵引。
9、根据权利要求4所述的心脏心律不齐切除导管,其特征在于:该导管装置还包括:
连接到该外部导管远端的柄装置;
一对在导管柄中的拉伸控制装置,用来分别控制在这对牵引金属线中每一个的拉伸;
其中这对牵引金属线穿在该环的相对两侧边中并穿过该环以及该主导管的长度,并且每个牵引金属线分别连接到一对拉伸控制装置的对应的一个上。
10、根据权利要求1所述的心脏心律不齐切除装置,其特征在于:该电极阵列的电极是凸出来的并且其表面在该管状环的外表面上基本是平整的以便为所接触的组织提供较大的表面,所接触的组织通常垂直于形成的该环的平面。
11、根据权利要求1所述的心脏心律不齐切除导管,其特征在于:该电极阵列的电极基本为管状的但可在任何角度接触组织。
12、根据权利要求1所述的心脏心律不齐切除导管,其中该主导管的管壁的特征在于:至少其上的一段伸向远端,具有热塑料的特性以提供被加热且按所希望的那样成形的性质,一旦冷却将保持形状。
13、根据权利要求1所述的心脏心律不齐切除导管,其特征在于:还包括连接到该环段远端的短长度的聚合物管,以帮助在三尖瓣中使用时该环的定位。
14、一种心脏心律不齐切除导管包括:
一个主导管,该主导管包括一个伸长的柔性的塑料管,该塑料管具有一个近端和一个远端,以及一个足够小的外径以便能够从导入位置通过脉管系统进入所希望的心腔中,该主导管还沿从该近端向该远端伸展的一个具有相对较大尺寸的主内腔运动,该主导管具有所需要的通过脉管系统的能力;
一个固定到该主导管的塑料管远端上的探查和切除系统,该系统还包括:
一个可调节的管状远侧环部件,该部件的构造是用来探查三尖瓣环并携载有一个电极阵列,该电极阵列包括多个并联的探查/切除电极,这些电极与外部环境是导电联系的并且沿着可调节的管状环彼此间隔地按顺序排列;
把这些电极与该导管外的一个输入/输出设备电连接起来的被绝缘的导电装置,以便探查接触到的腔壁的电活动并按指示切除组织,一对拉伸牵引金属线用来调节和控制可调节阵列环的形状和姿态;
连接到该外部导管远端的柄装置;
一对在该导管柄中的拉伸控制装置以便分别控制在这对牵引金属线中每一个的拉伸;
其中这对牵引金属线穿在该环的相对两侧边中并穿过该环以及该主导管腔的长度,并且每个牵引金属线分别连接到这对拉伸控制装置的对应的一个上。
15、根据权利要求14所的心脏心律不齐切除导管还包括连接到该环部件远端的短长度的柔性的管以帮助在三尖瓣中使用时该环的定位。
16、根据权利要求14所述的心脏心律不齐切除导管,其特征在于:相对于该电极阵列环的不弯曲平面至少稍微偏置该拉伸牵引金属线以增加对该电极阵列环的相对的弯曲控制。
17、根据权利要求14所述的心脏心律不齐切除导管,其特征在于:该电极阵列的电极是凸出来的并且其表面在该管状环的外表面上基本是平整的以便为所接触的组织提供较大的表面,所接触的组织通常垂直于形成的该环的平面。
18、根据权利要求14所述的心脏心律不齐切除导管,其特征在于:该电极阵列的电极基本上是管状的以便在任何角度与组织接触。
19、一种心脏心律不齐探查和切除导管包括:
一个主导管,该主导管包括一个伸长的、柔性的塑料管,该塑料管具有一个近端和一个远端,以及一个足够小的外径以能够从导入位置通过脉管系统进入所希望的心腔中,该塑料管还具有所需要的通过脉管系统的能力,该外部导管还沿从该近端向该远端伸展的一个主内腔运动;
一个固定到该主导管的塑料管远端上的探查和切除系统,该系统还包括:
一个管状的远端环部件,该部件的构造为一旦展开,即呈一个预定的形状和/或弯曲,该管状的远端环部件携载一个电极阵列,该电极阵列包括多个并联的探查/切除电极,这些电极与外部环境保持导电关系,并且沿着该管状环彼此间隔地按顺序排列,
把各个电极与该导管外的一个输入/输出设备电连接起来的被绝缘的导电装置,以便探查接触到的腔壁的电活动并按指示切除组织。
20、根据权利要求19所述的心脏心律不齐切除除导管,其特征在于:该环包含一种记忆材料。
21、一种在所关心的心腔中探查和切除组织的方法,该方法包括以下步骤:
导入一个心脏心律不齐切除导管,该心律不齐切除导管具有:
一个主导管,该主导管包括一个伸长的、柔性的塑料管,该塑料管具有一个近端和一个远端,以及一个足够小的外径以能够从导入位置通过脉管系统进入感兴趣的心腔中,该塑料管还具有所需要的通过脉管系统的能力,该主导管还沿从该近端向该远端的一个相对大尺寸的主内腔运动;
一个固定到该导管的塑料管远端上的探查和切除系统,该系统还包括:
一个携载有一个电极阵列的可调节的管状远侧环部件,该电极阵列包括多个并联连接的探查/切除电极,这些电极与外部环境是导电联系的并且沿着该可调节的管状环彼此间隔地按顺序排列,
把每个电极与该导管外的一个输入/输出设备电连接起来的被绝缘的导电装置,以便探查接触到的腔壁的电活动并按指示切除组织,
用来调整和控制该可调节阵列环的形状和姿态或弯曲并且把该环一直推到所希望位置的控制装置;
使用该控制装置来调整该环的形状和姿态以便如所要求的那样符合在所感兴趣的腔中内壁的形状,并且使用该电极探查那里的电活动;
使用该管状环的电极按要求切除早期活动的位置。
22、根据权利要求21所述的方法,其特征在于:该探查和切除导管系统还包括:
一个在该主导管中连接该可调节管状远端环部件的热塑料远端部件;
其中该方法还包括按要求使用加热方法使该主导管的热塑料远端部件成形的步骤,以允许该环去探查所感兴趣腔中的内壁。
23、根据权利要求21所述的方法,其特征在于:该探查和切除导管系统还包括:
一个连接到该环部件远端的短的聚合物管附属物,以帮助在三尖瓣中使用时该环的定位;并且其中该方法还包括以下步骤:
把该附属物插进三尖瓣环的最靠近的角度中;和
使用控制装置来调节该环的姿态和形状以适应内壁,并且按需要的那样进行探查和切除。
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US07/840,162 | 1992-02-24 | ||
US07/909,869 US5263493A (en) | 1992-02-24 | 1992-07-07 | Deflectable loop electrode array mapping and ablation catheter for cardiac chambers |
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CN93103186A Pending CN1085416A (zh) | 1992-02-24 | 1993-02-23 | 用于心脏的可弯曲的环形电极阵列探查主切除导管 |
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US (1) | US5263493A (zh) |
EP (1) | EP0632707B1 (zh) |
JP (1) | JP3338054B2 (zh) |
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Also Published As
Publication number | Publication date |
---|---|
JP3338054B2 (ja) | 2002-10-28 |
JPH07509147A (ja) | 1995-10-12 |
US5263493A (en) | 1993-11-23 |
DE69327455T2 (de) | 2000-08-03 |
DE69327455D1 (de) | 2000-02-03 |
EP0632707A4 (en) | 1996-02-28 |
EP0632707A1 (en) | 1995-01-11 |
WO1993016632A1 (en) | 1993-09-02 |
EP0632707B1 (en) | 1999-12-29 |
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