CN114423345A - 用于在脉冲式电场消融期间检测异位心电图信号的系统、装置和方法 - Google Patents
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Abstract
本文描述了用于消融治疗的系统、装置和方法，其中处理器用于确认起搏捕获或检测异位搏动。一种装置包括处理器，该处理器用于：接收由一组电极捕获的心脏信号数据；提取心脏信号数据的滑动窗口；标识与所提取的滑动窗口相关联的频率的子范围上的峰值频率；至少基于频率的子范围上的峰值频率的度量来检测异位活动；响应于检测到异位活动，将异位活动的指示发送到被配置为生成用于心脏消融的脉冲式波形的信号发生器，使得该信号发生器被去激活或关闭以不生成脉冲波形。一种装置还可以包括处理器，该处理器用于基于心脏信号数据确认一组起搏脉冲的起搏捕获。
Description
相关申请的交叉引用
本申请要求于2020年5月19日提交的美国专利申请序列号16/877,705(该申请是2020年1月13日提交的、现在颁发了美国专利号10,688,305的美国专利申请序列号16/741,506(其是于2019年9月17日提交的、现在颁发了美国专利号10,625,080的美国专利申请序列号16/573,704的延续申请)的延续申请)的优先权并且是其延续申请。本申请还要求美国专利申请序列号16/741,506和美国专利申请序列号为16/573,704的优先权。前述申请中的每一个的全部公开内容通过引用整体结合于此。
背景技术
通过不可逆电穿孔的生物物理机制，向组织施加短暂的超短高压脉冲可以在组织中生成高电场，以生成消融组织的局部区域。
然而，在心脏应用中，如果在心脏活动的特定时段期间递送高压脉冲，则高压脉冲可能导致诸如诱发心律失常(例如心室纤颤)的并发症。因此，会期望的是与心动周期同步地递送用于脉冲式电场消融的高压脉冲，以避免这种并发症的风险。
附图说明
图1是根据实施例的系统的框图。
图2是根据实施例的设置在心脏中的消融导管和起搏导管的示意性剖视图示。
图3A和图3B是根据实施例的心电图和心脏起搏信号的时间序列的示意性图示。
图4示意性地描绘了根据实施例的用于生成脉冲式电场消融的设备。
图5描绘了根据实施例的用于检测心脏活动的设备的组件。
图6示出了根据实施例的用于组织消融的方法。
图7示出了根据实施例的用于检测异位心脏活动的方法。
图8示出了根据实施例的用于组织消融的方法。
图9示出了根据实施例的用于检测异位心脏活动的方法。
图10示出了根据实施例的用于检测异位心脏活动并确认起搏捕获的方法。
具体实施方式
本文描述了用于检测与向组织递送消融能量(诸如脉冲式电场消融)有关的异位心脏活动的系统、设备和方法。脉冲式电场消融使用超短高压脉冲在期望的感兴趣区域处生成较大电场，以通过不可逆电穿孔生成消融组织的局部区域。在某些应用(包括心脏应用)中，会期望与心动周期同步地生成用于脉冲式电场消融的脉冲。使消融能量递送与心动周期同步可以降低诱发心律失常(诸如心房和/或心室纤颤)的风险。同步递送脉冲的一种方法可以是利用具有预定时间周期的周期性起搏信号来起搏刺激一个或多个心腔。例如，心脏刺激器可以用于向一个或多个心腔递送起搏脉冲，使得患者的心律与起搏脉冲同步。在一些实施例中，起搏脉冲可以通过适当定位在(多个)腔室中的心内导管递送到(多个)心腔。心内导管可以包括用于将起搏信号传导到心脏中的一个或多个电极。例如，导管可以具有一对电极(例如，最远侧电极和邻近远侧电极的电极)，该对电极用作递送起搏信号的双极对，其中两个电极为起搏信号提供正向和反向电流路径。起搏脉冲可以使心腔同步于起搏脉冲而生成其心电图(electrocardiogram，ECG)脉冲，从而控制心动周期的定时。
一旦心动周期的周期性被例如医生建立和确认，高压消融脉冲的递送就可以被定时为与起搏信号同步地开始。例如，消融脉冲可以以相对于起搏信号的预定偏移来递送，使得它们的递送落在心动周期的QRS波形之后的不应期窗口内。在一些实施例中，可以使用被配置用于脉冲式电场消融的消融导管将消融脉冲递送到心腔。
然而，在正在对心腔起搏的同时，局部电活动(例如，心室前收缩(pre-ventricular contraction，PVC))可能触发异位心脏活动，这些异位心脏活动生成附加的局部T波(例如，异位搏动)，其可能与下一起搏脉冲重叠。在这些局部T波期间递送的消融能量可能具有诱发纤颤的高风险。
因此，会期望检测消融期间连续起搏脉冲之间可能出现的这种局部或异位ECG活动，使得消融系统能够确保在这些时间期间不递送消融。例如，消融设备可以被配置为当检测到异位活动时与信号发生器断开。通过断开或关闭消融设备(例如，利用合适的继电器)，可以降低诱发纤颤事件的风险。
本文描述的系统、设备和方法可以被配置成检测异位信号，并基于这种检测来控制消融设备的操作。例如，本文描述的系统可以包括心脏刺激器和起搏设备，该起搏设备用于对心脏进行电起搏并确保起搏捕获，以建立心动周期的周期性和可预测性。起搏设备可以被配置成测量用于确认起搏捕获和/或检测异位心脏活动的心脏电活动(例如，心电图(ECG)信号)。例如，可以针对异位搏动和起搏脉冲与心动周期之间的同步来分析ECG信号的预定部分。可以输出心脏活动状态以指示起搏捕获和/或异位心脏活动的状态，并将其用于控制消融能量到组织的递送。
该系统还可以包括信号发生器和处理器，该处理器被配置为向消融设备的所选择的电极组施加一个或多个电压脉冲波形，以向感兴趣区域递送能量(例如，用于肺静脉口中的一组组织的消融能量)。本文公开的脉冲波形可以有助于各种心律失常(例如心房纤颤)的治疗处置。
心脏刺激器可以使脉冲波形的生成与起搏的心跳同步，以便减少非预期的组织损伤。例如，周期性心动周期的不应期内的时间窗口可以被选择用于电压脉冲波形递送。因此，可以在心动周期的不应期递送电压脉冲波形，以便避免心脏的窦性心律的中断。可以基于指示不存在异位搏动的心脏活动状态和起搏捕获的确认来生成脉冲波形。例如，脉冲波形可以与心脏的起搏信号同步地生成，以避免心脏的窦性心律的中断，并且可以在检测到的异位活动的时段之外递送。脉冲波形可以被递送到一个或多个导管的一个或多个电极，这些导管心外膜和/或心内膜地放置在心脏周围，使得这些电极生成脉冲式电场来消融组织。在一些实施例中，脉冲波形可以包括分级波形，以帮助组织消融并减少对健康组织的损伤。
在一些实施例中，一种装置包括存储器和可操作地耦合到存储器的处理器。处理器可以被配置成接收由一组电极捕获的心脏信号数据；提取心脏信号数据的滑动窗口；标识与所提取的滑动窗口相关联的频率的子范围内的峰值频率；至少基于频率的子范围内的峰值频率的度量来检测异位活动；并且响应于检测到异位活动，将异位活动的指示发送到被配置为生成用于心脏消融的脉冲式波形的信号发生器，使得信号发生器被去激活或关闭以不生成脉冲波形。
在一些实施例中，一种装置，包括存储器和可操作地耦合到存储器的处理器。处理器可以被配置成接收由一组电极捕获的心脏信号数据；接收向心脏组织递送一组起搏脉冲的指示；在递送该组起搏脉冲中的连续起搏脉冲的子集之后，提取心脏信号数据的各部分；为每个所提取的部分计算与这个所提取的部分相关联的函数的一组矩；至少基于为每个所提取的部分计算的该组矩，确认该组起搏脉冲的起搏捕获；并且响应于确认起搏捕获，向被配置为生成用于心脏消融的脉冲式波形的信号发生器发送起搏捕获的指示，使得信号发生器被激活用于生成脉冲式波形。在一些实施例中，处理器还被配置成：分析心脏信号数据的局部峰值频率以检测异位活动；并且响应于检测到异位活动，向信号发生器发送异位活动的指示，使得信号发生器被关闭而不生成脉冲波形。
在一些实施例中，一种系统包括：第一控制器，该第一控制器被配置成生成脉冲式波形并将该脉冲式波形与一组起搏脉冲同步地递送到消融设备；以及第二控制器，该第二控制器可操作地耦合到第一控制器，该第二控制器被配置成：生成一组起搏脉冲并将该组起搏脉冲递送到起搏设备；接收由一组电极捕获的心脏信号数据；基于心脏信号数据确认该组起搏脉冲的起搏捕获；并且响应于确认起搏捕获，向第一控制器发送起搏捕获的指示以激活脉冲式波形的生成。在一些实施例中，第二控制器还被配置成：监控心脏信号数据以获得异位活动；并且当存在异位活动时，向第一控制器发送异位活动的指示以关闭脉冲式波形的生成。
在一些实施例中，一种方法包括：接收由设置在心脏组织附近的一组电极捕获的心脏信号数据；提取心脏信号数据的滑动窗口；标识与所提取的滑动窗口相关联的频率的子范围内的峰值频率；至少基于频率的子范围内的峰值频率的度量来检测异位活动；并且响应于检测到异位活动，将异位活动的指示发送到被配置为生成用于心脏消融的脉冲式波形的信号发生器，使得信号发生器被关闭以不生成脉冲波形。该方法还可以包括基于心脏信号数据确认该组起搏脉冲的起搏捕获。
如本文所用的术语“电穿孔”是指向细胞膜施加电场以改变细胞膜对细胞外环境的渗透性。如本文所用的术语“可逆电穿孔”是指向细胞膜施加电场以暂时地改变细胞膜对细胞外环境的渗透性。例如，经历可逆电穿孔的细胞可以观察到其细胞膜中一个或多个孔的暂时和/或间歇形成，这些孔在去除电场时闭合。如本文所用的术语“不可逆电穿孔”是指向细胞膜施加电场以永久地改变细胞膜对细胞外环境的渗透性。例如，经历不可逆电穿孔的细胞可以观察到其细胞膜中一个或多个孔的形成，该一个或多个孔在去除电场后仍然存在。
本文公开的用于电穿孔能量递送的脉冲波形可以通过降低与不可逆电穿孔相关联的电场阈值来增强到组织的能量递送的安全性、效率和有效性，从而产生更有效的消融损伤，而递送的总能量降低。在一些实施例中，本文公开的电压脉冲波形可以是分级的并且具有嵌套结构。例如，脉冲波形可以包括具有相关联的时标的分级脉冲分组。在一些实施例中，本文公开的方法、系统和设备可以包括在于2019年1月18日提交的、于2019年7月25日作为国际公开号WO2019/143960公开、并且题为“SYSTEMS,DEVICES AND METHODS FOR FOCALABLATION”的国际申请序列号PCT/US2019/014226中描述的方法、系统和设备中的一种或多种，该申请的内容通过引用整体结合于此。
系统
本文公开了被配置用于监控与电压脉冲的选择性和快速性施加而产生不可逆电穿孔的组织消融相关的异位心脏活动的系统和设备。一般来说，本文描述的用于消融组织的系统可以包括心脏刺激器，用于生成由起搏设备递送到心脏的起搏信号。该系统还测量心脏电活动，用于标识异位搏动和/或确认心脏的起搏捕获。检测到的起搏信号和/或检测到的心脏活动可以用于控制由信号发生器生成的脉冲波形到具有一个或多个电极的消融设备的递送。如本文所述，该系统和设备可以心外膜和/或心内膜地部署以治疗心脏病症，例如心房纤颤。电压可以施加到电极的所选择的子集，对于阳极和阴极电极选择，子集选择是独立的。
一般而言，本文描述的系统和设备包括被配置为消融心脏的左心房腔中的组织的一个或多个设备(例如导管)。图1示出了被配置为递送电压脉冲波形的系统(100)。系统(100)可以包括装置(120)，该装置包括一个或多个处理器或控制器(124)和存储器(126)。(多个)处理器(124)可以作为信号发生器(122)和/或心脏刺激器(128)起作用、集成到信号发生器(122)和/或心脏刺激器(128)中、和/或控制信号发生器(122)和/或心脏刺激器(128)。
一个或多个处理器(124)中的每一个可以是被配置为运行和/或执行一组指令或代码的任何合适的处理设备。处理器可以是例如通用处理器、现场可编程门阵列(FPGA)、专用集成电路(ASIC)、数字信号处理器(DSP)等。处理器可以被配置为运行和/或执行应用进程和/或与系统和/或与其相关联的网络(未示出)相关联的其他模块、进程和/或功能。底层设备技术可以以各种部件类型提供，例如，像互补金属氧化物半导体(CMOS)的金属氧化物半导体场效应晶体管(MOSFET)技术、像发射极耦合逻辑(ECL)的双极技术、聚合物技术(例如，硅共轭聚合物和金属共轭聚合物-金属结构)、混合模拟和数字等。
存储器(126)可以包括数据库(未示出)，并且可以是例如随机存取存储器(RAM)、存储器缓冲器、硬盘驱动器、可擦除可编程只读存储器(EPROM)、电可擦除只读存储器(EEPROM)、只读存储器(ROM)、闪存等。存储器(126)可以存储指令以使处理器(124)执行与系统(100)相关联的模块、进程和/或功能，诸如脉冲波形生成和/或心脏起搏。
该装置(120)可以耦合到消融设备(110)和/或起搏设备(130)。当耦合到消融设备(110)和起搏设备(130)时，装置(120)的一个或多个组件(例如，作为信号发生器(122)和/或心脏刺激器(128)起作用的处理器(124))可以与消融设备(110)和/或起搏设备(130)电通信，以控制经由消融设备(110)和起搏设备(130)进行的起搏信号、消融信号等的递送，和/或从消融设备(110)和起搏设备(130)接收数据(例如，所感测的信号)。如果装置(120)包括多个处理器(124)，处理器(124)中的一个或多个可以相互通信以控制起搏和/或消融。装置(120)还可以包括输入/输出设备(127)，该输入/输出设备使得装置(120)能够与其他设备(例如，消融设备(110)和/或起搏设备(130))和/或用户对接。例如，装置(120)可以包括能够向用户呈现输出和/或从用户接收输入的用户接口，例如显示器、音频设备等。
信号发生器(122)可以被配置为生成消融脉冲波形，用于组织(例如肺静脉口)的不可逆电穿孔。例如，信号发生器(122)可以是电压脉冲波形发生器，并向消融设备(110)递送脉冲波形。处理器(124)可以结合从存储器(126)、心脏刺激器(128)和起搏设备(130)接收的数据，以确定将由信号发生器(122)生成的脉冲波形的参数(例如，定时、幅值、宽度、占空比等)。存储器(126)还可以存储指令，以使信号发生器(122)执行与系统(100)相关联的模块、进程和/或功能，诸如异位心脏活动检测、脉冲波形生成和/或心脏起搏同步。例如，存储器(126)可以被配置为存储心脏活动数据、脉搏波形和心脏起搏数据中的一个或多个。
设置在患者体内的起搏设备(130)可以被配置为接收由用于心脏刺激的装置(120)的心脏刺激器(128)生成的心脏起搏信号。可以由心脏刺激器(128)将起搏信号的指示传输到信号发生器(122)。基于起搏信号，电压脉冲波形的指示可以由处理器(124)选择、计算和/或以其他方式标识，并由信号发生器(122)生成。在一些实施例中，信号发生器(122)被配置成基于心脏活动状态生成脉冲波形，其中脉冲波形与起搏信号的指示同步(例如，在共同的不应期窗口内)。例如，在一些实施例中，共同的不应期窗口可以在心室起搏信号之后基本上立即开始(或在非常小的延迟之后)，并在其后持续大约250毫秒(ms)或更短的持续时间。在这样的实施例中，可以在这个持续时间内递送整个脉冲波形。
在一些实施例中，例如起搏设备(130)和/或消融设备(110)的一个或多个心内电极可以被配置成感测心脏内的信号并将这些信号递送给(多个)处理器124中的一个或多个。一个或多个处理器124可以分析所感测的信号以获得异位活动，并基于这种分析控制信号发生器(122)的操作，如下面进一步描述的那样。
系统(100)可以经由例如一个或多个网络与其他设备(未示出)通信，一个或多个网络中的每一个可以是任何类型的网络。无线网络可以指不通过任何类型的线缆连接的任何类型的数字网络。然而，无线网络可以连接到有线网络，以便与互联网、其他运营商语音和数据网络、商业网络和个人网络对接。有线网络通常由铜双绞线、同轴线缆或光纤线缆承载。存在许多不同类型的有线网络，包括广域网(WAN)、城域网(MAN)、局域网(LAN)、校园区域网(CAN)、全球局域网(GAN)，如互联网和虚拟专用网络(VPN)。下文中，网络是指通常通过互联网互连的组合无线、有线、公共和专用数据网络的任意组合，以提供统一的联网和信息访问解决方案。系统(100)还可以包括一个或多个输出设备，诸如显示器、音频设备、触摸屏、它们的组合等。
图2是根据本文描述的实施例的心脏(200)的示意性图示，例如如从包括设置在其中的消融设备(220)和起搏设备(210)的前侧(例如，受试者的前部)观看的。起搏设备(210)可以被配置为测量心脏活动和/或向心脏(200)递送起搏信号，并且消融设备(220)可以被配置为接收脉冲波形和/或向心脏组织递送脉冲波形。如所示出的那样，在图2中描绘的心脏(200)的前横截面中，虚线(201)示意性地近似了包括右心室RV(202)和左心房LA(204)的四个心腔的边界。起搏设备(210)可以被引入到右心室(202)中并被定位成使得其可以刺激右心室(202)并获得起搏捕获。起搏设备(210)可以包括第一电极(212)、第二电极(214)、第三电极(216)和第四电极(218)。第一电极(212)和第二电极(214)可以被配置为双极起搏电极对，以对右心室(202)起搏。起搏电极(212，214)可以耦合到心脏刺激器(例如，心脏刺激器(128))。第三电极(216)和第四电极(218)可以被配置为传感器元件，以测量心脏(200)的心内活动(例如，ECG信号)。虽然起搏设备(210)被描述为被定位在右心室(202)中，但是可以理解的是，起搏设备(210)可以被定位在其他合适的部位。例如，起搏设备(210)可以被放置在冠状窦中，并且合适的电极对(例如，电极(212，214))可以被用于对心室起搏。
消融设备(220)可以通过经间隔穿刺穿过房间隔引入到左心房(204)的心内膜空间中。消融设备(220)的远端部分可以包括被配置为向组织递送消融能量(例如，脉冲电场能量)的一组电极(222，224)。在一些实施例中，消融设备(220)的电极(222，224)可以是一组可独立寻址的电极。每个电极可以包括绝缘电引线，该绝缘电引线被配置为维持至少约700V的电压电势，而没有其相对应的绝缘部的介电击穿。在一些实施例中，电引线中的每一个上的绝缘部可以在其厚度上维持约200V到约2500V之间的电势差，而没有介电击穿。在一些实施例中，该组电极可以包括多个电极。多个电极可以被分组为一个或多个阳极-阴极子集，例如包括一个阳极和一个阴极的子集、包括两个阳极和两个阴极的子集、包括两个阳极和一个阴极的子集、包括一个阳极和两个阴极的子集、包括三个阳极和一个阴极的子集、包括三个阳极和两个阴极的子集等。虽然描绘了两个电极(222，224)，但是可以理解的是，消融设备(220)可以包括一个或多个附加电极，其中一组或多组电极可以被配置为具有相反的极性，以递送脉冲式电场来消融组织。
用于检测起搏信号和/或异位活动的系统和设备的操作可以参考图3A和图3B来理解，图3A和图3B示意性地示出了根据本文描述的实施例的伴随心脏活动的周期性起搏脉冲的时间序列。
图3A是心电图(300)和心脏起搏信号(310)的时间序列的示意图。起搏信号(310)可以包括一组周期性起搏脉冲(312)。例如，起搏脉冲(312)可以包括具有在大约1ms到大约5ms之间的宽度的矩形脉冲。在一些实施例中，起搏脉冲(312)可以使用本文所述的任何起搏设备(例如，起搏设备(130，210))来递送。例如，起搏脉冲(312)可以经由起搏导管(210)的起搏电极(212，214)递送。响应于起搏脉冲(312)，心脏的心动周期可以与起搏脉冲同步(312)。例如，图3A中的QRS波形(302)与相应的起搏脉冲(312)同步。QRS波形(302)之后的T波(304)对应于心肌细胞中出现的复极的开始。由此，在T波之后开始递送消融脉冲波形可能导致并发症(例如心房和/或心室纤颤)并且因此应避免。从起搏脉冲(312)的开端开始并在T波(304)之前结束的时间段(330)代表在其期间消融脉冲式电场可以被递送到心脏的安全时间窗口。在一些实施例中，在起搏脉冲(312)之后的心动周期的不应期(320)内递送消融脉冲波形。在一些实施例中，可以对一个以上的心腔起搏(例如，心房和心室的同时起搏)，以建立用于一个以上心腔的共同的不应期。在这样的实施例中，起搏脉冲(312)可以在共同的不应期期间递送或在与每个心腔相关联的不应期中重叠。
图3B是心电图(340)和心脏起搏信号(350)的时间序列的示意图。类似于图3A中示出的周期性起搏脉冲(312)，每个起搏脉冲(352)可以包括具有在大约1ms到大约5ms之间的宽度的矩形脉冲，并且可以使用本文描述的起搏设备(例如，起搏设备(130，210))中的任何一个来递送。例如，起搏脉冲(352)可以经由起搏导管(210)的起搏电极(212，214)递送。响应于起搏脉冲(352)，心脏的自然起搏功能可以与QRS波形同步(342)。QRS波形(342)之后的T波(344)对应于心肌细胞中的复极的开始。在没有异位活动的情况下，从起搏脉冲(352)的开端开始并在T波(344)之前结束的时间段(370)代表在其期间消融脉冲式电场可以被递送到心脏的安全时间窗口。心电图(340)包括在其期间可以递送消融的不应期(360)。在具有异位活动的情况下，例如，如由心电图(340)中的异位脉冲(380)所表示的异位活动，在时间段(370)期间递送脉冲式电场消融可能诱发纤颤。如图3B所描绘的，异位脉冲或复合脉冲(380)可以在与起搏脉冲(352)同步的QRS波形(342)之前。异位脉冲(380)可以生成在QRS波形(342)的T波(344)之前的异位T波(382)。如果在异位脉冲(380)之后的时段(328)期间递送脉冲波形，则脉冲波形可能与异位T波(382)重叠，并且从而导致并发症，例如通过诱发纤颤。因此，可能期望在消融程序期间(例如，实时地)检测诸如异位脉冲(380)的异位复合脉冲的出现，并且在检测到时，中断脉冲式电场消融脉冲的递送。如本文更详细描述的那样，本文描述的系统、设备和方法能够实时检测异位搏动(例如，在起搏和/或消融过程期间)，并响应于此控制消融能量到组织的递送(例如，中断脉冲波形脉冲的递送)。例如，这样的系统、设备和方法可以被配置用于异位ECG活动的自动检测，使得如果检测到异位搏动，则可以终止随后的消融递送，例如，直到用户已经重新定位设备、调节起搏参数或进行其他临床调整以获得与不包括异位活动的起搏脉冲同步的ECG波形。
图4示意性地描绘了用于生成用于组织消融的脉冲式电场能量的示例装置(903)。装置(903)可以包括结构上和/或功能上类似于上面参照图1描述的装置(120)的那些部件的部件。在实施例中，装置(903)包括至少两个控制器或处理器(907，908)。控制器(907)可以被配置成经由消融输出(911)生成用于脉冲式电场消融的波形，该消融输出连接到能量递送设备，例如消融导管(例如消融设备(110))。
控制器(908)可以被配置成生成起搏刺激，并且经由起搏输出(920)将这个起搏刺激发送到心内起搏导管或类似的医疗设备(例如，起搏设备(130))。控制器(908)还可以向控制器(907)发送起搏刺激的指示(915)，使得脉冲式电场能量的递送可以与心脏起搏同步。控制器(907，908)可以例如通过通信总线(917)可操作地彼此耦合。如上所述，通过使脉冲式电场消融能量的递送与起搏刺激同步，装置(903)可以确保脉冲式电场能量在不应期期间递送到敏感的解剖结构(例如，心腔)，从而避免诱发心律失常(诸如纤颤事件)的风险。
在某些情况下，异位搏动可以由来自心室腔的自主生成产生。如上所述，在异位活动的时段期间递送的脉冲式电场消融可能增加诱发心律失常的风险。因此，会期望检测这种异位活动。为了检测这种活动，来自心内电极对的心脏信号(例如，ECG记录)可以作为感测信号(922)发送到控制器(908)。控制器(908)可以被配置为分析心脏信号以获得异位搏动。当控制器(908)检测到异位搏动时，控制器(908)可以被配置成例如经由通信总线(917)与负责生成消融波形的控制器(907)通信，以停止脉冲电场能量的递送。例如，响应于检测到异位活动，控制器(908)可以向控制器(907)发送停止或中断消融的信号。
在一些实施例中，装置(903)可以被配置为在递送脉冲式电场能量之前确认起搏捕获。例如，装置(903)通过控制器(908)可以分析所感测的心脏信号(922)并与控制器(907)通信，以在确认起搏捕获时递送消融。在一些实施例中，装置(903)可以配备有用于确认起搏捕获的用户界面，例如通过用户进行的手动输入(927)。例如，装置(903)可以包括显示起搏信号和心脏信号的显示器，以允许用户确认起搏捕获并向装置(903)指示这种确认(例如，通过按下用户界面上的按钮)。在一些实施例中，装置(903)可以分析所感测的心脏活动，并且如果发现这样的心脏活动与起搏刺激不同步，则不执行消融递送和/或通知用户起搏捕获不存在(例如，通过用户界面或消息)。然后，用户和/或装置(903)可以修改起搏条件，例如，尝试以不同的速率进行起搏捕获，或者将起搏导管移动到具有更好的解剖接合的定位或位置。
图5示意性地描绘了信号(例如，ECG信号)通过控制器(例如，图4中更详细地描绘的控制器(908))的一个或多个组件的示例流。如所描绘的那样，到来的信号(1003)(例如，使用心内电极捕获的原始模拟心脏活动信号)可以在放大器(1007)处被接收。放大器(1007)可以被配置为放大信号(1003)，以便由模数转换器(ADC)(1009)进行数字化。ADC(1009)可以输出经处理的心脏数据作为数字化数据流。数字化数据可以作为心脏活动数据存储或缓冲在存储器中(1011)。处理器(1013)可以针对异位心脏活动来分析和/或处理以预定大小的片段(例如，窗口化数据)缓冲的心脏数据。
在一些实施例中，分析可以基于将数据与一个或多个阈值进行比较，该一个或多个阈值例如是预定的并被预编程到处理器(1013)中和/或由用户通过用户输入(1017)提供给用户界面(例如，触摸屏监控器或其他类型的监控器等)。基于该分析，处理器(1013)可以被配置为向用于生成消融波形的控制器或脉冲发生器控制器(例如，信号发生器(122)或控制器(907))输出心脏活动状态。
信号(1015)可以指示起搏捕获状态(例如，与起搏脉冲同步/不同步的ECG信号)和异位心脏活动状态中的一个或多个。例如，如果没有检测到起搏捕获，处理器(1013)可以向脉冲发生器控制器发送指示缺少起搏捕获的相对应的状态信号(1015)。处理器(1013)和/或脉冲发生器控制器然后可以例如通过用户界面警告用户起搏捕获不存在并且不能执行消融。用户然后可以采取适当的行动，例如停止消融程序和/或重新配置系统。例如，用户可以重新定位消融设备(例如，消融设备(110))和/或起搏设备(例如，起搏设备(130))中的一个或多个，和/或调节其他系统参数。如果由处理器(1013)确认了起搏捕获，则可以向脉冲发生器控制器发送指示消融准备就绪的不同信号(1015)，由此脉冲发生器控制器可以被配置为当由用户请求时启动消融。在一些实施例中，本文描述的系统和设备可以在消融能量递送之前、期间和之后测量心脏活动。
附加地或替代性地，处理器(1013)可以检测异位搏动。例如，如果起搏捕获被确认但是检测到异位搏动，处理器(1013)可以被配置为向脉冲发生器控制器发送信号(1015)，使得脉冲发生器控制器不生成用于消融的脉冲波形。处理器(1013)和/或脉冲发生器控制器可以例如通过用户界面通知用户异位搏动的存在以及不能执行消融。处理器(1013)还可以继续监控所感测的ECG信号，以获得消融期间可能发生的异位搏动。如果检测到这种异位搏动，处理器(1013)可以向脉冲发生器控制器发送指示消融应该暂停或中断的信号(1015)。响应于接收到信号(1015)，脉冲发生器控制器然后可以停止进一步的消融递送，例如，直到用户调节系统和/或没有检测到异位搏动活动。
方法
本文还描述了用于使用上述系统和设备在心腔中进行的组织消融过程期间检测异位心脏活动的方法。心腔可以是左心房腔，并包括其相关联的肺静脉。一般来说，本文描述的方法包括引入和设置与一个或多个心腔接触的起搏设备(例如，起搏设备(130)、起搏设备(210))。起搏设备可以使用心脏刺激器或其他处理器(例如，心脏刺激器(128)、控制器(908)、处理器(1013))来测量心脏活动并将起搏信号递送到心脏。所测量的信号可以被处理和分析，以检测起搏捕获和/或可能干扰组织消融的异位心脏活动，例如，通过本文描述的这种处理器和控制器。消融设备(例如，消融设备(110)、消融设备(220))可以被引入并设置成与一个或多个肺静脉口或窦区接触。脉冲波形可以由消融设备的一个或多个电极(例如，电极(112)、电极(222、224))递送，以消融组织。在一些实施例中，自主生成的异位心脏活动的检测可以促使消融能量递送的迅速中断，从而降低诱发心律失常(例如，纤颤)的风险。另外，心脏起搏信号(例如，由起搏设备(例如，起搏设备(130)、起搏设备(210))递送的)可以使所递送的脉冲波形与心动周期同步。通过使消融能量的递送与起搏刺激同步(例如，在不应期期间)，可以进一步降低诱发心律失常(诸如纤颤)的风险。
附加地或替代性地，脉冲波形可以包括分级结构的多个层级以减少总能量递送，例如，如在于2019年5月7日提交的并且题为“SYSTEMS,APPARATUSES AND METHODS FORDELIVERY OF ABLATIVE ENERGY TO TISSUE”的国际申请序列号PCT/US2019/031135中描述的那样，其内容通过引用整体结合于此。这样进行的组织消融可以在没有异位心脏活动的情况下并且与起搏的心跳同步地递送，以降低心房和/或心室纤颤的风险和对健康组织的损伤。应当理解的是，本文描述的消融设备(例如，消融设备(110)、消融设备(220))中的任何一个可以适当地使用下面讨论的方法来消融组织。
在一些实施例中，本文描述的消融设备(例如，消融设备(110)、消融设备(220))可以用于心外膜和/或心内膜消融。合适的消融导管的示例在国际申请序列号PCT/US2019/014226中描述。
图6是组织消融的示例方法(400)。在一些实施例中，本文描述的电压脉冲波形可以在心动周期的不应期期间施加，以便避免心脏的窦性心律的中断。该方法(400)包括在(402)将起搏设备(例如，起搏设备(130，210))引入到例如右心室的心内膜空间中。在(404)，起搏设备可以被推进以被放设置为与心脏组织接触。例如，被配置为用于心脏活动测量(例如，ECG信号)的传感器电极和被配置用于递送起搏信号的起搏电极可以被设置成与右心室的内表面接触。在(406)处，消融设备(例如，消融设备(110，220))可以被引入到例如左心房的心内膜空间中。在(408)处，消融设备可以被推进以被设置为与肺静脉口接触。在一些实施例中，在(410)，起搏信号可以由心脏刺激器(例如，心脏刺激器(128))生成，用于心脏的心脏刺激。然后可以在(412)使用起搏设备的起搏电极将起搏信号施加到心脏。例如，可以利用起搏信号对心脏进行电起搏，以确保起搏捕获，从而建立心动周期的周期性和可预测性。可以应用心房起搏和心室起搏中的一个或多个。本文参照图3A和图3B更详细地描述了与患者心脏活动相关的所施加的起搏信号的示例。在(414)，起搏设备和/或消融设备的一个或多个电极可以进一步测量对应于心脏的电心脏活动的心脏活动(例如，ECG信号)。在一些实施例中，可以在心脏刺激和组织消融之前、期间和/或之后测量心脏活动。
装置(例如，装置(120，903))可以处理和/或分析由一个或多个电极感测的心脏信号。基于对心脏数据的分析，可以在(416)生成状态信号。状态信号可以指示起搏捕获和/或异位心脏活动中的一个或多个的状态。例如，图7、图9和图10提供了检测异位心脏活动的更详细的示例。在(418)，状态信号可以被输出到信号发生器(例如，信号发生器(122))或与消融设备(110，220)相关联的任何处理器中的一个或多个、和/或被输出到用户界面。基于状态信号，在(420)处，信号发生器可以生成或可以不生成脉冲波形，例如，基于本文描述的预定标准。例如，当状态信号指示心脏数据中不存在异位心脏活动(例如，异位搏动)和确认起搏捕获(例如，起搏信号和心动周期之间的同步)中的一个或多个时，脉冲波形可以与起搏信号同步地生成(例如，在不应期期间)。例如，当在几次心跳中观察到起搏捕获而没有异位心脏活动时，则信号发生器可以在用户(例如，操作者)激活时生成脉冲波形。相反，信号发生器可以被配置为当心脏活动状态指示心脏数据中的异位心脏活动(例如，异位搏动)和/或没有起搏捕获中的一个或多个时，禁止脉冲波形生成和/或向用户输出警报。
在一些实施例中，起搏捕获可以由本文描述的装置(例如，装置(120，903))基于所接收的心脏数据进行自动确认。附加地或替代性地，起搏捕获可以由用户确认，例如，在查看起搏信号和心脏信号数据的输出之后。例如，用户可以基于显示器上的心脏活动输出，使用用户界面(例如，诸如触摸屏监控器或其他类型的监控器的输入/输出设备)来确认起搏捕获。如果信号发生器和/或处理器或者查看所显示的心脏活动输出的用户确定存在异位心脏活动和没有起搏捕获中的一个或多个，则可以禁止脉冲波形生成，并且可以提示用户通过例如重新定位起搏设备来调节系统参数，以改善组织接合和/或修改起搏信号参数(例如，脉冲宽度、脉冲幅度、脉冲频率等)。
在(422)，所生成的脉冲波形可以被递送到组织。在一些实施例中，可以在与心房起搏信号和心室起搏信号相关联的共同不应期内施加电压脉冲波形。根据所捕获的心脏数据和/或与消融递送相关联的其他参数，可以相对于起搏信号的指示生成具有时间偏移的脉冲波形。例如，不应期可以从起搏信号偏移预定的时间段，并且消融设备可以被配置为在从起搏信号偏移的不应期期间递送脉冲。在一些实施例中，可以在相对应的不应期(例如，共同的不应期)中的一系列心跳上施加(多个)电压脉冲波形。
在一些实施例中，脉冲波形可以经由消融设备(例如，消融设备(110，220))的一组花键中的一个或多个花键递送到患者的心脏的肺静脉口。在其他实施例中，如本文所述的电压脉冲波形可以被选择性地递送到电极子集，诸如用于肺静脉的消融和隔离的阳极-阴极子集。例如，电极群组中的第一电极可以被配置为阳极，并且电极群组中的第二电极可以被配置为阴极。对于期望数量的要消融的肺静脉口或窦区(例如，1个、2个、3个或4个窦口)，可以重复这些步骤。在国际申请号PCT/US2019/014226中描述了消融设备和方法的合适示例。
图7是用于检测异位心脏活动的示例方法(500)。在一些实施例中，方法(500)的一个或多个步骤可以由本文描述的装置(例如，装置(120，903))中的任何一个或与本文描述的设备和方法相关联的任何合适的处理器来执行。方法(500)包括在(502)接收对应于心脏的电心脏活动(例如，ECG波形)的心脏活动信号。例如，心脏活动信号可以包括从与心脏的腔室(例如右心室)接触的起搏设备(例如，起搏设备(210))的一组电极(例如，电极(216，218))连续接收的模拟数据。在一些实施例中，处理器(例如，控制器(908)、处理器(1013))或与消融设备相关联的其他处理器可以接收心脏活动信号并执行异位心脏活动检测。可以在(504)接收和处理原始心脏活动信号，以生成经处理的心脏活动数据。例如，信号处理可以包括信号调理(例如，滤波)、放大和数字化(例如，使用模数转换器(ADC))以生成经处理的心脏活动数据。例如，心脏活动信号可以以大约1kHz范围内的频率或大约1ms的采样时间间隔采样，并以预定的分辨率存储(例如，16位有符号整数数据的离散时间序列)。1ms的采样时间间隔对应于500Hz的Nyquist频率。在(506)，经处理的心脏活动数据被存储在存储器中，诸如缓冲器。在一些实施例中，缓冲器基于所接收的起搏信号清除所存储的心脏数据。例如，缓冲器在接收到下一起搏脉冲时删除先前存储的心脏数据。在一些实施例中，起搏信号可以包括预定的起搏频率。
在(508)，可以针对异位心脏活动和起搏捕获中的一个或多个来分析经处理的心脏活动数据。例如，可以通过提取数据的滑动窗口来分析经处理的心脏活动数据，并且可以例如使用离散傅立叶变换方法来评估每个滑动窗口以获得异位心脏活动。参考图9和图10进一步描述这种分析的具体实施方式。可选地，在一些实施例中，在(512)，可以分析经处理的心脏活动数据以确认起搏捕获。
在一些实施例中，在(510)的异位心脏活动检测可以与在(512)的起搏捕获检测并行执行。在其他实施例中，可以在(510)执行异位心脏活动检测之前，在(512)执行起搏捕获检测。
基于所检测的异位心脏活动和/或起搏捕获的结果，可以在(514)生成状态信号。在一些实施例中，状态信号可以被输出到消融装置(例如，装置(120))的一个或多个组件，包括例如信号或脉冲发生器(例如，信号发生器(122))和/或另一计算设备。例如，组织消融系统的用户界面(例如，诸如显示器的用户界面，包括在装置(120)中)可以被配置为显示确认起搏捕获的指示(例如，“起搏捕获已确认”)并显示“消融”图标，该图标被配置为允许用户启动向组织递送消融能量。在一些实施例中，如果起搏捕获被确认并且没有检测到异位搏动，则不需要向用户输出心脏活动状态。相反，当无法确认起搏捕获或检测到异位搏动时，可以做出指示(例如，音频和/或视觉警报)。
图9和图10是描绘检测异位心脏活动和/或确认起搏捕获的示例方法的流程图。方法的一个或多个步骤可以由本文描述的装置(120，903)中的任何一个或者与本文描述的设备和方法相关联的任何合适的处理器来执行。如图9所示，检测异位心脏活动的方法包括在(702)接收ECG输入。ECG输入可以是例如从起搏设备的一组电极(例如，起搏设备(210)的电极(216，218))接收的ECG信号数据。ECG信号可以是模拟信号。在(704)处，可以例如通过调理(例如，滤波)和/或放大信号来处理ECG输入。在(706)，可以例如使用ADC将ECG信号从模拟转换成数字。在一些实施例中，可以以实现足够分辨率的频率对数据进行采样，例如，以大约1kHz的频率或大约1ms的采样时间间隔，并将其存储为基于位的整数数据(例如，16位有符号整数数据、32位有符号整数数据等)。在(708)，数字化或采样的数据可以被存储在存储器(例如，存储器(126，1011))中。例如，可以从每个起搏信号开始缓冲数据，使得每组缓冲的数据与单个心跳或心动周期相关联。在(737)，起搏信号数据可以例如由起搏设备(例如，起搏设备(130，210))和/或与起搏设备相关联的处理器(例如，处理器(124，908，1013))来提供。当接收与第二起搏信号相关联的后一组数据时，可以清除现有缓冲器，并且可以将与第二起搏信号相关联的这个新数据存储在缓冲器中。
在(710)，可以通过提取预定长度的滑动窗口来分析所缓冲的数据。例如，从等于起搏脉冲的前沿之后的起搏脉冲宽度的时间间隔开始，在预定长度的滑动窗口(例如，220个数据点的窗口)中提取所缓冲的数据，这对应于大约4.54Hz的频率分辨率。滑动窗口可以在起搏脉冲之后(即，在等于脉冲宽度的时间间隔之后)开始，并且以离散的步长推进，例如，其中步长大小等于预设数量的采样时间间隔(诸如10个采样时间间隔)。从每个心动周期的所缓冲的数据中提取的滑动窗口的数量可以取决于一个或多个参数，例如起搏脉冲之间的长度、窗口长度和/或步长大小，这些参数中的每一个可以是预定参数。
在(712)，可以对每个滑动窗口执行离散傅立叶变换(例如，快速傅立叶变换)。在(714)，傅立叶变换的结果(例如，幅值)可以被滤波(例如，通过平滑滤波器)以输出对应于每个数据点周围的一组相邻值上的局部平均值的函数f。函数f中的局部峰值可以在每个滑动窗口的数据的子范围内被标识。例如，如果滑动窗口具有220个数据点的长度，则可以使用范围从大约12到大约100(第12个数据点到第100个数据点)的子范围，这个对应于从约54Hz到约454Hz的频带。虽然提供这些特定的滑动窗口长度和频带作为示例，但是可以理解的是，可以使用其他滑动窗口长度和频带，例如取决于期望的参数、处理能力等。在(720)，频带内的峰值的分析可以用于确定是否存在异位心脏活动。
每个滑动窗口内的经处理的ECG数据可以用于检测异位心脏活动。在实施例中，可以基于预定间隔(或子范围或频带)上f的峰值(ap)与最大到Nyquist频率的f的最大值(amax)的比率与预定阈值t之间的比较来检测异位搏动。在一些实施例中，当比率ap/ama大于t时，可以在滑动窗口中检测到异位搏动。因为异位搏动增加了ECG信号中的某些频率的量，所以可以通过标识其中采样的心脏数据中存在大于正常量的频率的情况来完成检测。在一些实施例中，t可以在约0.01到约0.25之间，在约0.01到约0.2之间，在约0.01到约0.15之间，包括所有的子值和在它们之间的范围。在一些实施例中，在(716)，用户可以将t输入到组织消融系统的用户界面中。阈值t可以表示系统的灵敏度，也就是说，具有较低阈值t的系统比具有较高阈值t的系统具有更高的灵敏度。
当在特定滑动窗口中没有检测到异位搏动(720：否)时，该过程继续到下一滑动窗口。当检测到异位搏动(720：是)时，则可以在(724)生成状态信号，该状态信号例如向计算设备和/或用户通知异位活动，如上文参考图7中的(514)所述。
在一些实施例中，所接收的ECG数据可以用于确认起搏捕获。例如，如图10所描绘的那样，描绘了用于检测异位搏动和确认起搏捕获的示例方法。类似于图9中描绘的方法，在(802)，可以接收ECG输入。在(804)，可以例如通过调理(例如，滤波)和/或放大信号来处理ECG输入。在(806)，可以例如使用ADC将ECG信号从模拟转换成数字。在(808)，数字化数据可以存储在存储器(例如，存储器(126))中。例如，数字化数据可以从每个起搏信号开始缓冲在存储器中，使得每组缓冲的数据与单个心跳或心动周期相关联。
在(810)，可以通过提取数据的滑动窗口来分析缓冲的数据，每个滑动窗口具有预定的长度并且以离散的步长被推进通过缓冲的数据。在(812)的异位搏动的检测(例如通过数据的离散傅立叶变换)、在(814)的数据的滤波和分析、以及在(820)的检测到傅立叶变换数据中大于预设阈值的峰值可以类似于图9中描述的那些。在一些实施例中，这种检测可以基于用户输入(816)。
在ECG数据可用的情况下，还可以在(822)确认起搏捕获。为了确认起搏捕获，可以在起搏信号开始时从ECG数据中提取采样的数据的子集，如由(837)所指示的那样。例如，可以提取与从起搏脉冲的开端开始的预定时间间隔T(例如，起搏脉冲持续时间)相关联的ECG数据。例如，时间段可以具有约5ms到约50ms之间的长度。因此，根据采样频率和时间间隔T，采样的数据的子集可以例如包括前十到五十个数据点。函数g(t)可以由时间间隔T上的采样的数据的子集来定义。在一些实施例中，g(t)可以表示相对于时间间隔T上的ECG信号的最大幅值缩放的ECG信号。时间间隔T上的这个函数的一组矩(例如，M0、M1、……、Mn)可以被计算，并且可以在预定数量的连续起搏时段(例如，1、2、3、4、5个连续起搏时段)上被跟踪。该函数的该组矩可以包括例如前三个矩，其可以以离散化的形式被计算为平均值，或者计算为在时间间隔T上g(t)、tg(t)和t2g(t)的其他合适的积分表示(例如，使用梯形规则、Simpson规则或其他积分度量)。
利用所计算的矩，一组i个连续时段上的第n个矩的平均值An可以由下式给出：An＝(Mn 1+Mn 2+Mn 3+…+Mn i)/i。因此，对于5个连续起搏时间段的前三个矩，平均值将为：
A0＝(M0 1+M0 2+…M0 5)/5
A1＝(M1 1+M1 2+…M1 5)/5
A2＝(M2 1+M2 2+…M2 5)/5
可以计算平均矩值An和给定矩n的第i个时间段(例如，对于五个时间段，i＝1、2、……、5)的矩值之间的归一化差值。对于前三个矩(n＝1，2，3)，下面的一组方程提供了这个归一化差值：
Si＝|A0–M0 i|/A0
Ti＝|A1–M1 i|/A1
Ui＝|A2–M2 i|/A2
其中当A0、A1或A2中的相对应的一个为零时，Si、Ti和Ui值被设置为零。
可以基于Si、Ti和Ui值来检测起搏捕获的确认。例如，如果对于An的每个非零值，其相对应的Si、Ti和Ui值小于预定阈值或一组阈值，则可以确认在i个预定时间段内的起搏捕获。例如，矩M0的这个阈值可以在0和0.1之间的范围内。矩Mn i与相对应的平均值的微小偏差指示，在连续的起搏时段内，ECG信号的时间行为(作为时间的函数来观看)在形态学上是一致的，从而证明了起搏捕获。在一些实施例中，这个阈值可以由用户定义，例如，经由由(例如，输入/输出设备(127)的)用户界面提供的输入(816)。如果起搏捕获被确认(822)，则这可以通过高亮显示“起搏捕获已确认”指示符来例如在用户界面上指示。
如上参考图7所述，如果没有检测到异位搏动活动并且起搏捕获被确认，则消融设备和与之相关联的(多个)处理器(例如，脉冲发生控制器(907)和本文所述的其他设备)可以被设置为递送脉冲式电场消融。如果检测到异位搏动活动和/或起搏捕获未被确认，则消融设备和/或相关联的(多个)处理器可以被去激活和/或不被设置为递送脉冲式电场消融，例如，通过激活将消融设备与消融发生器断开的合适继电器。具体来说，如果检测到异位搏动活动，则不期望递送脉冲式电场消融，因为它会导致纤颤。
在一些实施例中，如本文所述的具有嵌套结构和时间间隔的分级结构的分级电压脉冲波形对于不可逆电穿孔会是有用的，从而在不同组织类型中提供控制和选择性。图8是组织消融过程的实施例的流程图(600)。方法(600)包括在(602)将设备(例如，消融设备(110，220))引入到例如左心房的心内膜空间中。在(604)处，消融设备可以被推进为设置在肺静脉口中。在其中设备可以包括第一和第二配置(例如，紧凑和膨胀)的实施例中，设备可以第一配置被引入，并在(606)被转变成第二配置以接触肺静脉窦或口处或附近的组织，其中在国际申请号PCT/US2019/014226中提供了合适消融设备的进一步描述。消融设备可以包括电极，并且可以在(608)以阳极-阴极子集来配置，如上面详细讨论的那样。例如，设备的电极的子集可以被选择为阳极，而设备的电极的另一子集可以被选择为阴极，其中电压脉冲波形被施加在阳极和阴极之间。
在(610)，脉冲波形可以由信号发生器(例如，信号发生器(122))生成，并且可以包括分级结构中的多个层级。如本文所公开的那样，可以利用信号发生器生成各种分级波形。例如，脉冲波形可以包括包含第一组脉冲的脉冲波形的分级结构的第一层级。每个脉冲具有脉冲持续时间和将连续脉冲隔开的第一时间间隔。脉冲波形的分级结构的第二层级可以包括多个第一组脉冲作为第二组脉冲。第二时间间隔可以将连续的第一组脉冲隔开。第二时间间隔可以是第一时间间隔的持续时间的至少三倍。脉冲波形的分级结构的第三层级可以包括多个第二组脉冲作为第三组脉冲。第三时间间隔可以将连续的第二组脉冲隔开。第三时间间隔可以是第二级别时间间隔的持续时间的至少三十倍。在(612)，可以使用消融设备将由信号发生器生成的脉冲波形递送到组织。如本文所述，如果检测到异位搏动活动或起搏捕获未被确认，则脉冲波形活动的传递可以被中断，例如在(608)或(610)。于2016年10月19日提交的、题为“Systems,apparatuses and methods for delivery of ablativeenergy to tissue”的国际申请号PCT/US2016/57664中提供了可以与本文所述的消融设备一起使用的脉冲波形的示例，其全部内容通过引用结合于此。
应当理解的是，虽然本文中的示例标识了分离的单相和双相波形，但是应当理解的是，也可以生成组合波形，其中波形分级结构的一些部分是单相的，而其他部分是双相的。具有分级结构的电压脉冲波形可以施加在不同的阳极-阴极子集上(可选地具有时间延迟)。如上所讨论那样，施加在阳极-阴极子集上的波形中的一个或多个可以在心动周期的不应期期间施加。脉冲波形可以被递送到组织。应当理解的是，在某些附图中描述的步骤可以被适当地组合和修改。
应当理解的是，本公开中的示例和图示用于示例性目的，并且在不脱离本发明的范围的情况下，可以根据本文中的教导构建和部署偏离和变化，诸如花键的数量、电极的数量等。虽然在本文的描述中仅仅出于示例性目的给出了诸如采样频率、时间间隔等特定参数，但是应当理解的是，基于本公开中呈现的教导，可以由本领域技术人员方便地使用各种参数的其他值用于应用。
如本文所用，当与数值和/或范围结合使用时术语“约”和/或“大约”通常指接近所陈述的数值和/或范围的那些数值和/或范围。在一些情况下，术语“约”和“大约”可以表示在所陈述的值的±10％以内。例如，在某些情况下，“约100[单位]”可能意味着100的±10％以内(例如，从90到110)。术语“约”和“大约”可以互换使用。
本文描述的一些实施例涉及带有其上具有用于执行各种计算机实施的操作的指令或计算机代码的非暂时性计算机可读介质(也可以称为非暂时性处理器可读介质)的计算机存储产品。计算机可读介质(或处理器可读介质)在其不包括瞬时传播信号本身(例如，在诸如空间或线缆的传输介质上携载信息的传播电磁波)的意义上是非瞬时的。媒体和计算机代码(也可以称为代码或算法)可以是为一个或多个特定目的而设计和构造的那些媒体和计算机代码。非暂时性计算机可读介质的示例包括但不限于磁存储介质，诸如硬盘、软盘和磁带；光学存储介质，诸如光盘/数字视频光盘(CD/DVD)、光盘只读存储器(CD-ROM)和全息设备；磁光存储介质，诸如光盘；载波信号处理模块；以及专门配置来存储和执行程序代码的硬件设备，诸如专用集成电路(ASIC)、可编程逻辑器件(PLD)、只读存储器(ROM)和随机存取存储器(RAM)设备。本文描述的其他实施例涉及计算机程序产品，该计算机程序产品可以包括例如本文公开的指令和/或计算机代码。
本文描述的系统、设备和/或方法可以由软件(在硬件上执行的)、硬件或其组合来执行。硬件模块可以包括例如通用处理器(或微处理器或微控制器)、现场可编程门阵列(FPGA)和/或专用集成电路(ASIC)。软件模块(在硬件上执行的)可以以各种软件语言(例如，计算机代码)来表达，包括C、C++、
Ruby、Visual 
和/或其他面向对象、过程的编程语言或其他编程语言和开发工具。计算机代码的示例包括但不限于微代码或微指令、诸如由编译器产生的机器指令、用于产生网络服务的代码以及包含由计算机使用解释器执行的高级指令的文件。计算机代码的附加示例包括但不限于控制信号、经加密的代码和经压缩的代码。
本文中的具体示例和描述本质上是示例性的，并且在不脱离本发明的范围的情况下，本领域技术人员可以基于本文中教导的材料来开发实施例。
Claims (44)
1.一种系统，包括：
第一控制器，所述第一控制器被配置成生成脉冲式波形并将所述脉冲式波形与一组起搏脉冲同步地递送到消融设备；以及
第二控制器，所述第二控制器被配置为：
生成所述一组起搏脉冲并将所述一组起搏脉冲递送到起搏设备，以用于心脏的心脏刺激；
接收所述心脏的心脏信号数据；
基于所述心脏信号数据确认所述心脏的起搏捕获；
通过分析与所述心脏信号数据相关联的频率分量来监控所述心脏的异位活动；以及
基于所述确认和所述监控生成一组信号并将其发送到所述第一控制器。
2.根据权利要求1所述的系统，其中所述第二控制器被配置为通过以下方式来监控异位活动：
在递送所述一组起搏脉冲中的每个起搏脉冲之后，提取所述心脏信号数据的滑动窗口；
执行所述滑动窗口的离散傅立叶变换，以获得所述滑动窗口的频率分量；
标识所述滑动窗口的频率分量中的频率的子范围上的峰值频率；以及
基于分析所述峰值频率来确定是否存在异位活动。
3.根据权利要求2所述的系统，其中所述第二控制器被配置成对于每个滑动窗口，通过以下方式来确定是否存在异位活动：
计算该滑动窗口的所述峰值频率的幅值与最大到所述滑动窗口的频率分量的Nyquist频率的频率的最大幅值的比率；以及
确定所述比率是否大于阈值。
4.根据权利要求1所述的系统，其中所述第二控制器被配置为通过以下方式确认起搏捕获：
在递送来自所述一组起搏脉冲的连续起搏脉冲的子集之后，提取所述心脏信号数据的各部分；
为每个提取的部分计算与该提取的部分相关联的函数的一组矩；以及
至少基于为每个提取的部分计算的所述一组矩来确认所述一组起搏脉冲的起搏捕获。
5.根据权利要求4所述的系统，其中所述心脏信号数据的每个提取的部分包括在来自连续起搏脉冲的所述子集的起搏脉冲的开端之后的预定时间间隔内的心脏信号数据。
6.根据权利要求1所述的系统，还包括所述起搏设备，所述起搏设备包括用于心脏的心脏刺激的第一组电极和用于捕获所述心脏信号数据的第二组电极。
7.根据权利要求1所述的系统，还包括所述消融设备，所述消融设备包括用于响应于接收到所述脉冲式波形而生成脉冲式电场以消融心脏组织的一组电极。
8.根据权利要求1所述的系统，其中所述一组信号包括指示起搏捕获的信号，
所述第二控制器被配置为响应于确认起搏捕获生成并发送指示起搏捕获的信号。
9.根据权利要求8所述的系统，其中所述一组信号包括指示异位活动的信号，
所述第二控制器被配置为响应于基于所述监控检测到异位活动，生成并发送指示异位活动的信号。
10.一种装置，包括：
存储器；以及
处理器，所述处理器可操作地耦合到所述存储器，所述处理器被配置成：
在向心脏递送一组连续起搏脉冲之后，提取心脏信号数据的各部分；
为每个提取的部分计算与所述提取的部分相关联的函数的一组矩；
至少基于为每个提取的部分计算的所述一组矩来确认心脏的起搏捕获；以及
响应于确认起搏捕获，生成指示起搏捕获的信号并将其发送到被配置为生成用于心脏消融的脉冲式波形的信号发生器，使得所述信号发生器响应于接收到所述信号而被激活以生成所述脉冲式波形。
11.根据权利要求10所述的装置，其中所述心脏信号数据的每个提取的部分包括在来自连续起搏脉冲的子集的起搏脉冲的开端之后的预定时间间隔内的心脏信号数据。
12.根据权利要求11所述的装置，其中所述预定时间间隔在约5毫秒和约50毫秒之间。
13.根据权利要求10所述的装置，其中所述处理器被配置为通过以下方式确认起搏捕获：
对于来自所述一组矩的每个矩，通过对为所述提取的部分计算的所述矩的值求平均值来计算该矩的平均值；
对于来自所述一组矩的每个矩，计算该矩的平均值和为每个提取的部分计算的该矩的值之间的归一化差值；以及
基于为来自所述一组矩的每个矩计算的归一化差值来确认起搏捕获。
14.根据权利要求10所述的装置，其中所述处理器被配置为通过以下方式确认起搏捕获：
计算所述一组矩中的每一个矩的平均值；
计算所述一组矩中的每一个矩的平均值和为所述提取的部分计算的矩的值之间的归一化差值；以及
确定每个归一化差值何时小于相应的预定阈值。
15.根据权利要求10所述的装置，其中所述处理器还被配置成：
分析所述心脏信号数据的局部峰值频率以检测心脏的异位活动；以及
响应于检测到异位活动，生成指示异位活动的信号并将其发送到所述信号发生器，使得所述信号发生器响应于接收到指示异位活动的信号而被去激活以不生成所述脉冲式波形。
16.根据权利要求15所述的装置，其中所述处理器被配置成分析所述心脏信号数据的局部峰值频率，以通过以下方式检测异位活动：
提取所述心脏信号数据的滑动窗口；
执行提取的滑动窗口的离散傅立叶变换，并将滤波器应用于所得到的离散傅立叶变换，以产生所述提取的滑动窗口的经滤波的频率输出；
标识经滤波的频率输出中的局部峰值频率；以及
至少基于所述经滤波的频率输出中的峰值频率的值来检测异位活动。
17.一种装置，包括：
存储器；以及
处理器，所述处理器可操作地耦合到所述存储器，所述处理器被配置成：
提取心脏的心脏信号数据的滑动窗口；
执行所述滑动窗口的变换以获得频率范围内的所述数据的频率分量；
标识所述频率范围的子范围内的峰值频率，所述峰值频率具有大于所述频率的子范围中的剩余频率的值的值；
基于所述峰值频率的值与所述频率范围内的最大值的相对度量和预定值之间的比较来检测心脏的异位活动；以及
响应于检测到异位活动，生成指示异位活动的信号并将其发送到被配置为生成用于心脏消融的脉冲式波形的信号发生器，使得所述信号发生器响应于接收到所述信号而中断脉冲波形的生成。
18.根据权利要求17所述的装置，其中所述变换是离散傅立叶变换。
19.根据权利要求17所述的装置，其中所述处理器被配置成通过以下方式检测异位活动：
计算所述峰值频率的值与所述最大值的比率；以及
确定所述比率大于所述预定值。
20.根据权利要求19所述的装置，其中所述预定值在约0.01和约0.25之间。
21.根据权利要求19所述的装置，其中所述预定值在约0.01和约0.15之间。
22.根据权利要求17所述的装置，其中所述处理器可操作地耦合到用户界面，并且所述预定值由用户经由所述用户界面来设置。
23.一种装置，包括：
存储器；以及
处理器，所述处理器可操作地耦接到所述存储器，所述处理器被配置成：
接收由一组电极捕获的心脏信号数据；
提取所述心脏信号数据的滑动窗口；
处理来自提取的滑动窗口的数据；
通过以下方式标识与来自所述提取的滑动窗口的经处理的数据相关联的频率的子范围上的峰值频率：
执行来自所述提取的滑动窗口的经处理的数据的离散傅立叶变换；
对所述经处理的数据的离散傅立叶变换进行滤波，以产生经滤波的傅立叶变换数据；以及
从经滤波的傅立叶变换数据中将所述峰值频率标识为所述频率的子范围上的、在经滤波的傅立叶变换数据中具有大于所述频率的子范围中的剩余频率的幅值的幅值的频率；
至少基于所述频率的子范围上的所述峰值频率的度量来检测异位活动；以及
响应于检测到异位活动，将异位活动的指示发送到被配置为生成用于心脏消融的脉冲式波形的信号发生器。
24.根据权利要求23所述的装置，其中所述处理器被配置为向所述信号发生器发送异位活动的指示，使得所述信号发生器被去激活以不生成所述脉冲式波形。
25.根据权利要求23所述的装置，其中所述处理器还被配置成：
通过以下方式处理所述心脏信号数据：
对所述心脏信号数据进行放大和滤波；以及
数字化所述心脏信号数据；以及
在所述存储器中缓冲经处理的心脏信号数据，
所述处理器被配置为从缓冲的心脏信号数据中提取所述滑动窗口。
26.根据权利要求23所述的装置，其中所述处理器被配置成通过以下方式检测异位活动：
计算所述频率的子范围上的所述峰值频率的幅值与最大到频率输出的Nyquist频率的频率的最大幅值的比率；
确定所述比率是否大于阈值；以及
基于确定所述比率大于所述阈值，检测到所述异位活动。
27.根据权利要求26所述的装置，其中所述阈值在约0.01和约0.25之间。
28.根据权利要求26所述的装置，其中所述阈值在约0.01和约0.25之间。
29.根据权利要求26所述的装置，其中所述阈值在约0.01和约0.15之间。
30.根据权利要求26所述的装置，其中所述处理器可操作地耦合到用户界面，并且所述阈值由用户经由所述用户界面来设置。
31.一种装置，包括：
存储器；以及
处理器，所述处理器可操作地耦合到所述存储器，所述处理器被配置成：
接收由一组电极捕获的心脏信号数据；
通过以下方式处理所述心脏信号数据：
对所述心脏信号数据进行放大和滤波；以及
数字化所述心脏信号数据；
在所述存储器中缓冲经处理的心脏信号数据；
接收向心脏组织递送一组起搏脉冲的指示；
在递送来自所述一组起搏脉冲的连续起搏脉冲的子集之后，从所缓冲的心脏信号数据中提取所述心脏信号数据的各部分，所述心脏信号数据的每个提取的部分包括在来自连续起搏脉冲的所述子集的起搏脉冲的开端之后的预定时间间隔内的心脏信号数据；
为每个提取的部分计算与所述提取的部分相关联的函数的一组矩；
至少基于为每个提取的部分计算的所述一组矩来确认所述一组起搏脉冲的起搏捕获；以及
响应于确认起搏捕获，向被配置为生成用于心脏消融的脉冲式波形的信号发生器发送起搏捕获的指示，使得所述信号发生器被激活以生成所述脉冲式波形。
32.根据权利要求31所述的装置，其中所述预定时间间隔在约5毫秒和约50毫秒之间。
33.根据权利要求31所述的装置，其中所述处理器被配置为通过以下方式确认起搏捕获：
针对来自所述一组矩的每个矩，通过对为所述提取的部分计算的所述矩的值求平均值来计算该矩的平均值；
对于来自所述一组矩的每个矩，计算该矩的平均值和为每个提取的部分计算的该矩的值之间的归一化差值；以及
基于为来自所述一组矩的每个矩计算的归一化差值来确认起搏捕获。
34.根据权利要求31所述的装置，其中所述处理器被配置为通过以下方式确认起搏捕获：
计算所述一组矩中的每一个矩的平均值；
计算所述一组矩中的每一个矩的平均值和为所述提取的部分计算的所述矩的值之间的归一化差值；以及
确定每个归一化差值何时小于相应的预定阈值。
35.根据权利要求31所述的装置，其中所述处理器还被配置成：
分析所述心脏信号数据的局部峰值频率以检测异位活动；以及
响应于检测到异位活动，向所述信号发生器发送异位活动的指示，使得所述信号发生器被去激活以不生成所述脉冲式波形。
36.根据权利要求35所述的装置，其中所述处理器被配置成分析所述心脏信号数据的局部峰值频率，以通过以下方式检测异位活动：
提取所述心脏信号数据的滑动窗口；
执行提取的滑动窗口的离散傅立叶变换，并将滤波器应用于所得到的离散傅立叶变换，以产生所述提取的滑动窗口的经滤波的频率输出；
标识经滤波的频率输出中的局部峰值频率；以及
至少基于所述经滤波的频率输出中的峰值频率的幅值来检测异位活动。
37.一种系统，包括：
第一控制器，所述第一控制器被配置成生成脉冲式波形并将所述脉冲式波形与一组起搏脉冲同步地递送到消融设备；以及
第二控制器，所述第二控制器可操作地耦合到所述第一控制器，所述第二控制器被配置成：
生成所述一组起搏脉冲并将所述一组起搏脉冲递送到起搏设备；
接收由一组电极捕获的心脏信号数据；
基于所述心脏信号数据确认所述一组起搏脉冲的起搏捕获；以及
响应于确认起搏捕获，向所述第一控制器发送起搏捕获的指示以激活所述脉冲式波形的生成。
38.根据权利要求37所述的系统，其中所述起搏设备包括用于对心脏的腔室起搏的一对电极和用于捕获所述心脏信号数据的所述一组电极。
39.根据权利要求37所述的系统，其中所述第二控制器还被配置为向所述第一控制器发送所述一组起搏脉冲的指示，使得所述第一控制器能够以与所述一组起搏脉冲同步的方式递送所述脉冲式波形。
40.根据权利要求37所述的系统，其中所述第二控制器被配置为通过以下方式确认起搏捕获：
在递送来自所述一组起搏脉冲中的连续起搏脉冲的子集之后，提取所述心脏信号数据的各部分；
为每个提取的部分计算与所述提取的部分相关联的函数的一组矩；以及
至少基于为每个提取的部分计算的所述一组矩来确认所述一组起搏脉冲的起搏捕获。
41.根据权利要求40所述的系统，其中所述心脏信号数据的每个提取的部分包括在来自连续起搏脉冲的所述子集的起搏脉冲的开端之后的预定时间间隔内的心脏信号数据。
42.根据权利要求37所述的系统，其中所述第二控制器还被配置成：
监控所述心脏信号数据以获得异位活动；以及
当存在异位活动时，向所述第一控制器发送异位活动的指示，以去激活所述脉冲式波形的生成。
43.根据权利要求42所述的系统，其中所述第二控制器被配置为通过以下方式监控异位活动：
在递送所述一组起搏脉冲中的每个起搏脉冲之后，提取所述心脏信号数据的滑动窗口；
执行提取的滑动窗口的离散傅立叶变换，并将滤波器应用于所得到的离散傅立叶变换，以产生所述提取的滑动窗口的经滤波的频率输出；以及
分析所述经滤波的频率输出中的频率子范围上的峰值频率。
44.根据权利要求42所述的系统，其中所述第二控制器可操作地耦合到用户界面，所述第二控制器还被配置成当存在异位活动时，使所述用户界面显示指示存在异位活动的警报。
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| US16/573,704 | 2019-09-17 | ||
| US16/573,704 US10625080B1 (en) | 2019-09-17 | 2019-09-17 | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
| US16/741,506 | 2020-01-13 | ||
| US16/741,506 US10688305B1 (en) | 2019-09-17 | 2020-01-13 | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
| US16/877,705 US11738200B2 (en) | 2019-09-17 | 2020-05-19 | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
| US16/877,705 | 2020-05-19 | ||
| PCT/US2020/051272 WO2021055604A1 (en) | 2019-09-17 | 2020-09-17 | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
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Families Citing this family (14)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20170189097A1 (en) | 2016-01-05 | 2017-07-06 | Iowa Approach Inc. | Systems, apparatuses and methods for delivery of ablative energy to tissue |
| US9987081B1 (en) | 2017-04-27 | 2018-06-05 | Iowa Approach, Inc. | Systems, devices, and methods for signal generation |
| CN115836908A (zh) | 2018-05-07 | 2023-03-24 | 波士顿科学医学有限公司 | 用于将消融能量递送到组织的系统、设备和方法 |
| CN112118798A (zh) | 2018-05-07 | 2020-12-22 | 法拉普尔赛股份有限公司 | 用于过滤由脉冲电场消融诱导的高压噪声的系统、设备和方法 |
| US10625080B1 (en) | 2019-09-17 | 2020-04-21 | Farapulse, Inc. | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
| US11896395B2 (en) * | 2019-09-17 | 2024-02-13 | Biosense Webster (Israel) Ltd. | Catheter with insert-molded microelectrode |
| US11497541B2 (en) | 2019-11-20 | 2022-11-15 | Boston Scientific Scimed, Inc. | Systems, apparatuses, and methods for protecting electronic components from high power noise induced by high voltage pulses |
| US11065047B2 (en) | 2019-11-20 | 2021-07-20 | Farapulse, Inc. | Systems, apparatuses, and methods for protecting electronic components from high power noise induced by high voltage pulses |
| US10842572B1 (en) | 2019-11-25 | 2020-11-24 | Farapulse, Inc. | Methods, systems, and apparatuses for tracking ablation devices and generating lesion lines |
| CN114652426A (zh) * | 2020-12-23 | 2022-06-24 | 上海微创电生理医疗科技股份有限公司 | 脉冲消融设备、系统、控制方法及可读存储介质 |
| US11389234B1 (en) | 2021-02-11 | 2022-07-19 | Boston Scientific Scimed, Inc. | Systems, apparatuses, and methods for pre-ablation pulses in pulsed field ablation applications |
| JP2024509644A (ja) | 2021-04-07 | 2024-03-04 | ビーティーエル メディカル デベロップメント エー．エス． | パルス場アブレーション装置および方法 |
| IL309432A (en) | 2021-07-06 | 2024-02-01 | Btl Medical Dev A S | Apparatus and method for ablation (burning) by electric pulse field |
| CN116473662B (zh) * | 2023-04-18 | 2024-04-09 | 上海玮启医疗器械有限公司 | 一种基于fpga的脉冲消融阻抗检测方法 |
Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20110098699A1 (en) * | 2005-08-11 | 2011-04-28 | Jose Carlos Pachon Mateos | Apparatus and Methods for Arrhythmia Treatment Based on Spectral Mapping During Sinus Rhythm |
| CN107921258A (zh) * | 2015-08-06 | 2018-04-17 | 美敦力公司 | 心脏脉冲场消融 |
| CN108778173A (zh) * | 2016-01-05 | 2018-11-09 | 法拉普尔赛股份有限公司 | 用于将脉冲电场消融能量递送到心内膜组织的系统、装置和方法 |
Family Cites Families (595)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4200104A (en) | 1977-11-17 | 1980-04-29 | Valleylab, Inc. | Contact area measurement apparatus for use in electrosurgery |
| US4438766A (en) | 1981-09-03 | 1984-03-27 | C. R. Bard, Inc. | Electrosurgical generator |
| US4470407A (en) | 1982-03-11 | 1984-09-11 | Laserscope, Inc. | Endoscopic device |
| US4739759A (en) | 1985-02-26 | 1988-04-26 | Concept, Inc. | Microprocessor controlled electrosurgical generator |
| US5547467A (en) | 1988-01-21 | 1996-08-20 | Massachusettes Institute Of Technology | Method for rapid temporal control of molecular transport across tissue |
| US5344435A (en) | 1988-07-28 | 1994-09-06 | Bsd Medical Corporation | Urethral inserted applicator prostate hyperthermia |
| FR2639238B1 (fr) | 1988-11-21 | 1991-02-22 | Technomed Int Sa | Appareil de traitement chirurgical de tissus par hyperthermie, de preference la prostate, comprenant des moyens de protection thermique comprenant de preference des moyens formant ecran radioreflechissant |
| US5257635A (en) | 1988-11-25 | 1993-11-02 | Sensor Electronics, Inc. | Electrical heating catheter |
| US5749914A (en) | 1989-01-06 | 1998-05-12 | Advanced Coronary Intervention | Catheter for obstructed stent |
| US5342301A (en) | 1992-08-13 | 1994-08-30 | Advanced Polymers Incorporated | Multi-lumen balloons and catheters made therewith |
| JPH06507797A (ja) | 1991-05-24 | 1994-09-08 | イーピー・テクノロジーズ・インコーポレーテッド | 単相活動電位／切除の組み合わせ型カテーテル及び高機能フィルターシステム |
| US6029671A (en) | 1991-07-16 | 2000-02-29 | Heartport, Inc. | System and methods for performing endovascular procedures |
| US5697281A (en) | 1991-10-09 | 1997-12-16 | Arthrocare Corporation | System and method for electrosurgical cutting and ablation |
| US5524338A (en) | 1991-10-22 | 1996-06-11 | Pi Medical Corporation | Method of making implantable microelectrode |
| US5304214A (en) | 1992-01-21 | 1994-04-19 | Med Institute, Inc. | Transurethral ablation catheter |
| US5306296A (en) | 1992-08-21 | 1994-04-26 | Medtronic, Inc. | Annuloplasty and suture rings |
| US5242441A (en) | 1992-02-24 | 1993-09-07 | Boaz Avitall | Deflectable catheter with rotatable tip electrode |
| US5281213A (en) | 1992-04-16 | 1994-01-25 | Implemed, Inc. | Catheter for ice mapping and ablation |
| US5443463A (en) | 1992-05-01 | 1995-08-22 | Vesta Medical, Inc. | Coagulating forceps |
| US5341807A (en) | 1992-06-30 | 1994-08-30 | American Cardiac Ablation Co., Inc. | Ablation catheter positioning system |
| US5662108A (en) | 1992-09-23 | 1997-09-02 | Endocardial Solutions, Inc. | Electrophysiology mapping system |
| US5313943A (en) | 1992-09-25 | 1994-05-24 | Ep Technologies, Inc. | Catheters and methods for performing cardiac diagnosis and treatment |
| US5700243A (en) | 1992-10-30 | 1997-12-23 | Pdt Systems, Inc. | Balloon perfusion catheter |
| US6068653A (en) | 1992-11-13 | 2000-05-30 | Scimed Life Systems, Inc. | Electrophysiology catheter device |
| US5334193A (en) | 1992-11-13 | 1994-08-02 | American Cardiac Ablation Co., Inc. | Fluid cooled ablation catheter |
| US5545161A (en) | 1992-12-01 | 1996-08-13 | Cardiac Pathways Corporation | Catheter for RF ablation having cooled electrode with electrically insulated sleeve |
| US6749604B1 (en) | 1993-05-10 | 2004-06-15 | Arthrocare Corporation | Electrosurgical instrument with axially-spaced electrodes |
| US5531685A (en) | 1993-06-11 | 1996-07-02 | Catheter Research, Inc. | Steerable variable stiffness device |
| FR2708860B1 (fr) | 1993-08-11 | 1995-10-13 | Ela Medical Sa | Circuit de protection pour dispositif électronique implantable. |
| US5558091A (en) | 1993-10-06 | 1996-09-24 | Biosense, Inc. | Magnetic determination of position and orientation |
| US5545193A (en) | 1993-10-15 | 1996-08-13 | Ep Technologies, Inc. | Helically wound radio-frequency emitting electrodes for creating lesions in body tissue |
| US5722400A (en) | 1995-02-16 | 1998-03-03 | Daig Corporation | Guiding introducers for use in the treatment of left ventricular tachycardia |
| US5454370A (en) | 1993-12-03 | 1995-10-03 | Avitall; Boaz | Mapping and ablation electrode configuration |
| US5921924A (en) | 1993-12-03 | 1999-07-13 | Avitall; Boaz | Mapping and ablation catheter system utilizing multiple control elements |
| US5928269A (en) | 1994-04-04 | 1999-07-27 | Alt; Eckhard | Apparatus and method for temporary atrial defibrillation with external defibrillator and implanted transvenous catheter and electrodes |
| US5578040A (en) | 1994-06-14 | 1996-11-26 | Smith; Albert C. | Ocular repair system and apparatus |
| US5617854A (en) | 1994-06-22 | 1997-04-08 | Munsif; Anand | Shaped catheter device and method |
| US6071274A (en) | 1996-12-19 | 2000-06-06 | Ep Technologies, Inc. | Loop structures for supporting multiple electrode elements |
| US5836947A (en) | 1994-10-07 | 1998-11-17 | Ep Technologies, Inc. | Flexible structures having movable splines for supporting electrode elements |
| US5885278A (en) | 1994-10-07 | 1999-03-23 | E.P. Technologies, Inc. | Structures for deploying movable electrode elements |
| US5722402A (en) | 1994-10-11 | 1998-03-03 | Ep Technologies, Inc. | Systems and methods for guiding movable electrode elements within multiple-electrode structures |
| US5876336A (en) | 1994-10-11 | 1999-03-02 | Ep Technologies, Inc. | Systems and methods for guiding movable electrode elements within multiple-electrode structure |
| US5624430A (en) | 1994-11-28 | 1997-04-29 | Eton; Darwin | Magnetic device to assist transcorporeal guidewire placement |
| US5647871A (en) | 1995-03-10 | 1997-07-15 | Microsurge, Inc. | Electrosurgery with cooled electrodes |
| US5810762A (en) | 1995-04-10 | 1998-09-22 | Genetronics, Inc. | Electroporation system with voltage control feedback for clinical applications |
| US20060024359A1 (en) | 1995-06-07 | 2006-02-02 | Walker Jeffrey P | Drug delivery system and method |
| US6090104A (en) | 1995-06-07 | 2000-07-18 | Cordis Webster, Inc. | Catheter with a spirally wound flat ribbon electrode |
| US5702438A (en) | 1995-06-08 | 1997-12-30 | Avitall; Boaz | Expandable recording and ablation catheter system |
| US5788692A (en) | 1995-06-30 | 1998-08-04 | Fidus Medical Technology Corporation | Mapping ablation catheter |
| US6023638A (en) | 1995-07-28 | 2000-02-08 | Scimed Life Systems, Inc. | System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissue |
| US5706823A (en) | 1995-08-18 | 1998-01-13 | Quinton Instrument Company | Electrophysiology filtering system |
| US5836875A (en) | 1995-10-06 | 1998-11-17 | Cordis Webster, Inc. | Split tip electrode catheter |
| DE29519651U1 (de) | 1995-12-14 | 1996-02-01 | Muntermann Axel | Vorrichtung zur linienförmigen Radiofrequenz-Katheterablation endomyokardialen Gewebes |
| BR9612395A (pt) | 1995-12-29 | 1999-07-13 | Gyrus Medical Ltd | Instrumento eletrocirúrgico e um conjunto de eltrodo eletrocirúrgico |
| US7141049B2 (en) | 1999-03-09 | 2006-11-28 | Thermage, Inc. | Handpiece for treatment of tissue |
| US5836874A (en) | 1996-04-08 | 1998-11-17 | Ep Technologies, Inc. | Multi-function electrode structures for electrically analyzing and heating body tissue |
| US5868736A (en) | 1996-04-12 | 1999-02-09 | Ep Technologies, Inc. | Systems and methods to control tissue heating or ablation with porous electrode structures |
| CA2243595A1 (en) | 1996-01-19 | 1997-07-24 | Ep Technologies, Inc. | Multi-function electrode structures for electrically analyzing and heating body tissue |
| US5800482A (en) | 1996-03-06 | 1998-09-01 | Cardiac Pathways Corporation | Apparatus and method for linear lesion ablation |
| US5830224A (en) | 1996-03-15 | 1998-11-03 | Beth Israel Deaconess Medical Center | Catheter apparatus and methodology for generating a fistula on-demand between closely associated blood vessels at a pre-chosen anatomic site in-vivo |
| US5779699A (en) | 1996-03-29 | 1998-07-14 | Medtronic, Inc. | Slip resistant field focusing ablation catheter electrode |
| US5836942A (en) | 1996-04-04 | 1998-11-17 | Minnesota Mining And Manufacturing Company | Biomedical electrode with lossy dielectric properties |
| US5863291A (en) | 1996-04-08 | 1999-01-26 | Cardima, Inc. | Linear ablation assembly |
| US5904709A (en) | 1996-04-17 | 1999-05-18 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Microwave treatment for cardiac arrhythmias |
| US5672170A (en) | 1996-06-20 | 1997-09-30 | Cynosure, Inc. | Laser transmyocardial revascularization arrangement |
| US6006131A (en) | 1996-08-13 | 1999-12-21 | Uab Research Foundation | Dual current pathway atrial defibrillation apparatus |
| DE59610941D1 (de) | 1996-09-27 | 2004-04-22 | Sulzer Osypka Gmbh | Einrichtung zur Durchführung von diagnostischen und/oder therapeutischen Herzeingriffen mit Katheter |
| US6464697B1 (en) | 1998-02-19 | 2002-10-15 | Curon Medical, Inc. | Stomach and adjoining tissue regions in the esophagus |
| US6805128B1 (en) | 1996-10-22 | 2004-10-19 | Epicor Medical, Inc. | Apparatus and method for ablating tissue |
| US7052493B2 (en) | 1996-10-22 | 2006-05-30 | Epicor Medical, Inc. | Methods and devices for ablation |
| US6311692B1 (en) | 1996-10-22 | 2001-11-06 | Epicor, Inc. | Apparatus and method for diagnosis and therapy of electrophysiological disease |
| US6096036A (en) | 1998-05-05 | 2000-08-01 | Cardiac Pacemakers, Inc. | Steerable catheter with preformed distal shape and method for use |
| US6002955A (en) | 1996-11-08 | 1999-12-14 | Medtronic, Inc. | Stabilized electrophysiology catheter and method for use |
| US6035238A (en) | 1997-08-13 | 2000-03-07 | Surx, Inc. | Noninvasive devices, methods, and systems for shrinking of tissues |
| US6076012A (en) | 1996-12-19 | 2000-06-13 | Ep Technologies, Inc. | Structures for supporting porous electrode elements |
| US5916213A (en) | 1997-02-04 | 1999-06-29 | Medtronic, Inc. | Systems and methods for tissue mapping and ablation |
| US5899917A (en) | 1997-03-12 | 1999-05-04 | Cardiosynopsis, Inc. | Method for forming a stent in situ |
| US6223085B1 (en) | 1997-05-06 | 2001-04-24 | Urologix, Inc. | Device and method for preventing restenosis |
| US6012457A (en) | 1997-07-08 | 2000-01-11 | The Regents Of The University Of California | Device and method for forming a circumferential conduction block in a pulmonary vein |
| US5849028A (en) | 1997-05-16 | 1998-12-15 | Irvine Biomedical, Inc. | Catheter and method for radiofrequency ablation of cardiac tissue |
| US5978704A (en) | 1997-06-03 | 1999-11-02 | Uab Research Foundation | Method and apparatus for treating cardiac arrhythmia |
| US5938660A (en) | 1997-06-27 | 1999-08-17 | Daig Corporation | Process and device for the treatment of atrial arrhythmia |
| US6966908B2 (en) | 1997-07-08 | 2005-11-22 | Atrionix, Inc. | Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wall |
| US6164283A (en) | 1997-07-08 | 2000-12-26 | The Regents Of The University Of California | Device and method for forming a circumferential conduction block in a pulmonary vein |
| BR9811101A (pt) | 1997-07-08 | 2001-12-26 | Univ California | Montagem de dispositivo e método de ablaçãocircunferencial |
| US6245064B1 (en) | 1997-07-08 | 2001-06-12 | Atrionix, Inc. | Circumferential ablation device assembly |
| US6009351A (en) | 1997-07-14 | 1999-12-28 | Urologix, Inc. | System and method for transurethral heating with rectal cooling |
| US6014579A (en) | 1997-07-21 | 2000-01-11 | Cardiac Pathways Corp. | Endocardial mapping catheter with movable electrode |
| AU8659598A (en) | 1997-07-22 | 1999-02-16 | Emed Corporation | Iontophoretic delivery of an agent into cardiac tissue |
| US6216034B1 (en) | 1997-08-01 | 2001-04-10 | Genetronics, Inc. | Method of programming an array of needle electrodes for electroporation therapy of tissue |
| US5895404A (en) | 1997-09-29 | 1999-04-20 | Ruiz; Carlos E. | Apparatus and methods for percutaneously forming a passageway between adjacent vessels or portions of a vessel |
| US6645200B1 (en) | 1997-10-10 | 2003-11-11 | Scimed Life Systems, Inc. | Method and apparatus for positioning a diagnostic or therapeutic element within the body and tip electrode for use with same |
| US6071281A (en) | 1998-05-05 | 2000-06-06 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body and remote power control unit for use with same |
| US6464699B1 (en) | 1997-10-10 | 2002-10-15 | Scimed Life Systems, Inc. | Method and apparatus for positioning a diagnostic or therapeutic element on body tissue and mask element for use with same |
| WO1999022659A1 (en) | 1997-10-31 | 1999-05-14 | C.R. Bard, Inc. | Ring electrode structure for diagnostic and ablation catheters |
| US6120500A (en) | 1997-11-12 | 2000-09-19 | Daig Corporation | Rail catheter ablation and mapping system |
| US5928270A (en) | 1997-12-02 | 1999-07-27 | Cardiocommand, Inc. | Method and apparatus for incremental cardioversion or defibrillation |
| US6517534B1 (en) | 1998-02-11 | 2003-02-11 | Cosman Company, Inc. | Peri-urethral ablation |
| US6447505B2 (en) | 1998-02-11 | 2002-09-10 | Cosman Company, Inc. | Balloon catheter method for intra-urethral radio-frequency urethral enlargement |
| US7214230B2 (en) | 1998-02-24 | 2007-05-08 | Hansen Medical, Inc. | Flexible instrument |
| US6167291A (en) | 1998-03-12 | 2000-12-26 | Cardima, Inc. | Protected pin connector for an electrophysiology catheter |
| DE19817553A1 (de) | 1998-04-15 | 1999-10-21 | Biotronik Mess & Therapieg | Ablationsanordnung |
| US6030384A (en) | 1998-05-01 | 2000-02-29 | Nezhat; Camran | Bipolar surgical instruments having focused electrical fields |
| US6592581B2 (en) | 1998-05-05 | 2003-07-15 | Cardiac Pacemakers, Inc. | Preformed steerable catheter with movable outer sleeve and method for use |
| US6045550A (en) | 1998-05-05 | 2000-04-04 | Cardiac Peacemakers, Inc. | Electrode having non-joined thermocouple for providing multiple temperature-sensitive junctions |
| US6146381A (en) | 1998-05-05 | 2000-11-14 | Cardiac Pacemakers, Inc. | Catheter having distal region for deflecting axial forces |
| US6171305B1 (en) | 1998-05-05 | 2001-01-09 | Cardiac Pacemakers, Inc. | RF ablation apparatus and method having high output impedance drivers |
| US6527767B2 (en) | 1998-05-20 | 2003-03-04 | New England Medical Center | Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization |
| US6231518B1 (en) | 1998-05-26 | 2001-05-15 | Comedicus Incorporated | Intrapericardial electrophysiological procedures |
| US6287306B1 (en) | 1998-06-22 | 2001-09-11 | Daig Corporation | Even temperature linear lesion ablation catheter |
| US6251107B1 (en) | 1998-06-25 | 2001-06-26 | Cardima, Inc. | Ep catheter |
| US6322559B1 (en) | 1998-07-06 | 2001-11-27 | Vnus Medical Technologies, Inc. | Electrode catheter having coil structure |
| US6623480B1 (en) | 1998-07-24 | 2003-09-23 | University Of Kentucky Research Foundation | Flexible recording/high energy electrode catheter with anchor for ablation of atrial flutter by radio frequency energy |
| US7435247B2 (en) | 1998-08-11 | 2008-10-14 | Arthrocare Corporation | Systems and methods for electrosurgical tissue treatment |
| US6251128B1 (en) | 1998-09-01 | 2001-06-26 | Fidus Medical Technology Corporation | Microwave ablation catheter with loop configuration |
| US8308719B2 (en) | 1998-09-21 | 2012-11-13 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Apparatus and method for ablating tissue |
| US6807447B2 (en) | 1998-09-25 | 2004-10-19 | Ep Medsystems, Inc. | Triple array defibrillation catheter and method of using the same |
| US6033403A (en) | 1998-10-08 | 2000-03-07 | Irvine Biomedical, Inc. | Long electrode catheter system and methods thereof |
| US6638278B2 (en) | 1998-11-23 | 2003-10-28 | C. R. Bard, Inc. | Intracardiac grasp catheter |
| IT1302900B1 (it) | 1998-12-04 | 2000-10-10 | Riccardo Fenici | Catetere amagnetico per la registrazione monocatetere di potenzialid'azione monofasici multipli, localizzabile tridimensionalmente e |
| US20070066972A1 (en) | 2001-11-29 | 2007-03-22 | Medwaves, Inc. | Ablation catheter apparatus with one or more electrodes |
| US6219582B1 (en) | 1998-12-30 | 2001-04-17 | Daig Corporation | Temporary atrial cardioversion catheter |
| US6206831B1 (en) | 1999-01-06 | 2001-03-27 | Scimed Life Systems, Inc. | Ultrasound-guided ablation catheter and methods of use |
| US6702811B2 (en) | 1999-04-05 | 2004-03-09 | Medtronic, Inc. | Ablation catheter assembly with radially decreasing helix and method of use |
| US20010007070A1 (en) | 1999-04-05 | 2001-07-05 | Medtronic, Inc. | Ablation catheter assembly and method for isolating a pulmonary vein |
| US6325797B1 (en) | 1999-04-05 | 2001-12-04 | Medtronic, Inc. | Ablation catheter and method for isolating a pulmonary vein |
| US6270476B1 (en) | 1999-04-23 | 2001-08-07 | Cryocath Technologies, Inc. | Catheter |
| US6272384B1 (en) | 1999-05-27 | 2001-08-07 | Urologix, Inc. | Microwave therapy apparatus |
| US7171263B2 (en) | 1999-06-04 | 2007-01-30 | Impulse Dynamics Nv | Drug delivery device |
| US6391024B1 (en) | 1999-06-17 | 2002-05-21 | Cardiac Pacemakers, Inc. | RF ablation apparatus and method having electrode/tissue contact assessment scheme and electrocardiogram filtering |
| US6300108B1 (en) | 1999-07-21 | 2001-10-09 | The Regents Of The University Of California | Controlled electroporation and mass transfer across cell membranes |
| DE19938558A1 (de) | 1999-08-17 | 2001-02-22 | Axel Muntermann | Katheter mit verbesserten elektrischen Eigenschaften sowie Behandlungsverfahren zur Verbesserung von elektrischen Eigenschaften von Kathetern |
| US6607520B2 (en) | 1999-09-15 | 2003-08-19 | The General Hospital Corporation | Coiled ablation catheter system |
| US6370412B1 (en) | 1999-10-07 | 2002-04-09 | Massachusetts Institute Of Technology | Method and apparatus for guiding ablative therapy of abnormal biological electrical excitation |
| US6613062B1 (en) | 1999-10-29 | 2003-09-02 | Medtronic, Inc. | Method and apparatus for providing intra-pericardial access |
| US6529756B1 (en) | 1999-11-22 | 2003-03-04 | Scimed Life Systems, Inc. | Apparatus for mapping and coagulating soft tissue in or around body orifices |
| US6892091B1 (en) | 2000-02-18 | 2005-05-10 | Biosense, Inc. | Catheter, method and apparatus for generating an electrical map of a chamber of the heart |
| DE10008918A1 (de) | 2000-02-25 | 2001-08-30 | Biotronik Mess & Therapieg | Ablationskatheter zur Erzeugung linearer Läsionen in Herzmuskelgewebe |
| US7497844B2 (en) | 2000-03-31 | 2009-03-03 | Medtronic, Inc. | System and method for positioning implantable medical devices within coronary veins |
| WO2001072368A2 (en) | 2000-03-31 | 2001-10-04 | Medtronic, Inc. | Intralumenal visualization system with deflectable mechanism |
| US6652517B1 (en) | 2000-04-25 | 2003-11-25 | Uab Research Foundation | Ablation catheter, system, and method of use thereof |
| US6546935B2 (en) | 2000-04-27 | 2003-04-15 | Atricure, Inc. | Method for transmural ablation |
| US6932811B2 (en) | 2000-04-27 | 2005-08-23 | Atricure, Inc. | Transmural ablation device with integral EKG sensor |
| US20020107514A1 (en) | 2000-04-27 | 2002-08-08 | Hooven Michael D. | Transmural ablation device with parallel jaws |
| US6743239B1 (en) | 2000-05-25 | 2004-06-01 | St. Jude Medical, Inc. | Devices with a bendable tip for medical procedures |
| WO2002032335A1 (en) | 2000-07-25 | 2002-04-25 | Rita Medical Systems Inc. | Apparatus for detecting and treating tumors using localized impedance measurement |
| US8251986B2 (en) | 2000-08-17 | 2012-08-28 | Angiodynamics, Inc. | Method of destroying tissue cells by eletroporation |
| US7081114B2 (en) | 2000-11-29 | 2006-07-25 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Electrophysiology/ablation catheter having lariat configuration of variable radius |
| US6728563B2 (en) | 2000-11-29 | 2004-04-27 | St. Jude Medical, Daig Division, Inc. | Electrophysiology/ablation catheter having “halo” configuration |
| WO2002060523A2 (en) | 2000-12-15 | 2002-08-08 | Brown Tony R | Atrial fibrillation rf treatment device and method |
| US6620157B1 (en) | 2000-12-28 | 2003-09-16 | Senorx, Inc. | High frequency power source |
| DE10102089C1 (de) | 2001-01-18 | 2002-07-25 | Wolf Gmbh Richard | Chirurgisches Instrument |
| DE10102254A1 (de) | 2001-01-19 | 2002-08-08 | Celon Ag Medical Instruments | Vorrichtung zur elektrothermischen Behandlung des menschlichen oder tierischen Körpers |
| US7229402B2 (en) | 2001-02-09 | 2007-06-12 | Cardiac Output Technologies, Inc. | Minimally invasive ventricular assist technology and method |
| US6743226B2 (en) | 2001-02-09 | 2004-06-01 | Cosman Company, Inc. | Adjustable trans-urethral radio-frequency ablation |
| US7137975B2 (en) | 2001-02-13 | 2006-11-21 | Aciont, Inc. | Method for increasing the battery life of an alternating current iontophoresis device using a barrier-modifying agent |
| US6666863B2 (en) | 2001-03-01 | 2003-12-23 | Scimed Life Systems, Inc. | Device and method for percutaneous myocardial revascularization |
| US6666862B2 (en) | 2001-03-01 | 2003-12-23 | Cardiac Pacemakers, Inc. | Radio frequency ablation system and method linking energy delivery with fluid flow |
| US6743225B2 (en) | 2001-03-27 | 2004-06-01 | Uab Research Foundation | Electrophysiologic measure of endpoints for ablation lesions created in fibrillating substrates |
| US6619291B2 (en) | 2001-04-24 | 2003-09-16 | Edwin J. Hlavka | Method and apparatus for catheter-based annuloplasty |
| US7300438B2 (en) | 2001-04-27 | 2007-11-27 | C.R. Bard, Inc. | Electrophysiology catheter for mapping and/or ablation |
| US6972016B2 (en) | 2001-05-01 | 2005-12-06 | Cardima, Inc. | Helically shaped electrophysiology catheter |
| US6771996B2 (en) | 2001-05-24 | 2004-08-03 | Cardiac Pacemakers, Inc. | Ablation and high-resolution mapping catheter system for pulmonary vein foci elimination |
| US6685702B2 (en) | 2001-07-06 | 2004-02-03 | Rodolfo C. Quijano | Device for treating tissue and methods thereof |
| US20030018374A1 (en) | 2001-07-16 | 2003-01-23 | Paulos Lonnie E. | Treatment probe using RF energy |
| US6994706B2 (en) | 2001-08-13 | 2006-02-07 | Minnesota Medical Physics, Llc | Apparatus and method for treatment of benign prostatic hyperplasia |
| US8623012B2 (en) | 2001-08-15 | 2014-01-07 | Nuortho Surgical, Inc. | Electrosurgical plenum |
| CA2460174A1 (en) | 2001-09-24 | 2003-04-03 | Novoste Corporation | Methods and apparatus employing ionizing radiation for treatment of cardiac arrhythmia |
| WO2003026525A1 (en) | 2001-09-28 | 2003-04-03 | Rita Medical Systems, Inc. | Impedance controlled tissue ablation apparatus and method |
| US7285116B2 (en) | 2004-05-15 | 2007-10-23 | Irvine Biomedical Inc. | Non-contact tissue ablation device and methods thereof |
| US6895267B2 (en) | 2001-10-24 | 2005-05-17 | Scimed Life Systems, Inc. | Systems and methods for guiding and locating functional elements on medical devices positioned in a body |
| US8175680B2 (en) | 2001-11-09 | 2012-05-08 | Boston Scientific Scimed, Inc. | Systems and methods for guiding catheters using registered images |
| US6669693B2 (en) | 2001-11-13 | 2003-12-30 | Mayo Foundation For Medical Education And Research | Tissue ablation device and methods of using |
| US7542807B2 (en) | 2001-12-04 | 2009-06-02 | Endoscopic Technologies, Inc. | Conduction block verification probe and method of use |
| US6740084B2 (en) | 2001-12-18 | 2004-05-25 | Ethicon, Inc. | Method and device to enhance RF electrode performance |
| EP1465555B1 (en) | 2001-12-21 | 2015-05-06 | QuickRing Medical Technologies Ltd. | Implantation system for annuloplasty rings |
| US7493156B2 (en) | 2002-01-07 | 2009-02-17 | Cardiac Pacemakers, Inc. | Steerable guide catheter with pre-shaped rotatable shaft |
| US8062251B2 (en) | 2002-02-01 | 2011-11-22 | Vascular Designs, Inc. | Multi-function catheter and use thereof |
| US6926714B1 (en) | 2002-02-05 | 2005-08-09 | Jasbir S. Sra | Method for pulmonary vein isolation and catheter ablation of other structures in the left atrium in atrial fibrillation |
| US6932816B2 (en) | 2002-02-19 | 2005-08-23 | Boston Scientific Scimed, Inc. | Apparatus for converting a clamp into an electrophysiology device |
| US6733499B2 (en) | 2002-02-28 | 2004-05-11 | Biosense Webster, Inc. | Catheter having circular ablation assembly |
| US6869414B2 (en) | 2002-03-22 | 2005-03-22 | Cardiac Pacemakers, Inc. | Pre-shaped catheter with proximal articulation and pre-formed distal end |
| US8347891B2 (en) | 2002-04-08 | 2013-01-08 | Medtronic Ardian Luxembourg S.A.R.L. | Methods and apparatus for performing a non-continuous circumferential treatment of a body lumen |
| US7756583B2 (en) | 2002-04-08 | 2010-07-13 | Ardian, Inc. | Methods and apparatus for intravascularly-induced neuromodulation |
| US8774913B2 (en) | 2002-04-08 | 2014-07-08 | Medtronic Ardian Luxembourg S.A.R.L. | Methods and apparatus for intravasculary-induced neuromodulation |
| US7617005B2 (en) | 2002-04-08 | 2009-11-10 | Ardian, Inc. | Methods and apparatus for thermally-induced renal neuromodulation |
| US7653438B2 (en) | 2002-04-08 | 2010-01-26 | Ardian, Inc. | Methods and apparatus for renal neuromodulation |
| US6764486B2 (en) | 2002-04-24 | 2004-07-20 | Biotronik Mess- und Therapieger{haeck over (a)}te GmbH & Co. Ingenieurbüro Berlin | Ablation device for cardiac tissue, especially for forming a circular lesion around a vessel orifice in the heart |
| DE10218427A1 (de) | 2002-04-24 | 2003-11-06 | Biotronik Mess & Therapieg | Ablationsvorrichtung für Herzgewebe, insbesondere zur Erzeugung einer zirkulären Läsion um eine Gefäßmündung im Herzen |
| US20030204161A1 (en) | 2002-04-25 | 2003-10-30 | Bozidar Ferek-Petric | Implantable electroporation therapy device and method for using same |
| US6780178B2 (en) | 2002-05-03 | 2004-08-24 | The Board Of Trustees Of The Leland Stanford Junior University | Method and apparatus for plasma-mediated thermo-electrical ablation |
| AU2003239474A1 (en) | 2002-05-17 | 2003-12-02 | Stan F. Obino | Device and method for the treatment of cardiac disorders |
| US8216219B2 (en) | 2002-05-27 | 2012-07-10 | Celon Ag | Device for electrosurgically destroying body tissue |
| US20030229379A1 (en) | 2002-06-06 | 2003-12-11 | Maynard Ramsey | Method for cardioversion or defibrillation using electrical impulses at pacing strength |
| US7367974B2 (en) | 2004-09-20 | 2008-05-06 | Wisconsin Alumni Research Foundation | Electrode array for tissue ablation |
| US20040082859A1 (en) | 2002-07-01 | 2004-04-29 | Alan Schaer | Method and apparatus employing ultrasound energy to treat body sphincters |
| US7306593B2 (en) | 2002-10-21 | 2007-12-11 | Biosense, Inc. | Prediction and assessment of ablation of cardiac tissue |
| US7001383B2 (en) | 2002-10-21 | 2006-02-21 | Biosense, Inc. | Real-time monitoring and mapping of ablation lesion formation in the heart |
| US20040082947A1 (en) | 2002-10-25 | 2004-04-29 | The Regents Of The University Of Michigan | Ablation catheters |
| US9730100B2 (en) | 2002-10-28 | 2017-08-08 | MeshDynamics | Terse message networks |
| US9819747B2 (en) | 2008-11-24 | 2017-11-14 | MeshDynamics | Chirp networks |
| AU2003290806A1 (en) | 2002-11-15 | 2004-06-15 | The Government Of The United States As Represented By The Secretary Of The Department Of Health And Human Services | Variable curve catheter |
| DE60327650D1 (de) | 2002-11-15 | 2009-06-25 | Bard Inc C R | Elektrophysiologiekatheter mit ablationselektrode |
| US7195628B2 (en) | 2002-12-11 | 2007-03-27 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Atrial fibrillation therapy with pulmonary vein support |
| AU2003300295A1 (en) | 2002-12-20 | 2004-07-22 | Cardiac Inventions Unlimited, Inc. | Left ventricular pacing lead and implantation method |
| US6984232B2 (en) | 2003-01-17 | 2006-01-10 | St. Jude Medical, Daig Division, Inc. | Ablation catheter assembly having a virtual electrode comprising portholes |
| US6960207B2 (en) | 2003-01-21 | 2005-11-01 | St Jude Medical, Daig Division, Inc. | Ablation catheter having a virtual electrode comprising portholes and a porous conductor |
| US7387629B2 (en) | 2003-01-21 | 2008-06-17 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Catheter design that facilitates positioning at tissue to be diagnosed or treated |
| US8192425B2 (en) | 2006-09-29 | 2012-06-05 | Baylis Medical Company Inc. | Radiofrequency perforation apparatus |
| US7622172B2 (en) | 2003-02-19 | 2009-11-24 | Erick Keenan | Composite flexible and conductive catheter electrode |
| WO2004086994A1 (en) | 2003-03-28 | 2004-10-14 | C.R. Bard, Inc. | Method and apparatus for electrosurgical ablation |
| US6985776B2 (en) | 2003-04-25 | 2006-01-10 | Medtronic, Inc. | Method and apparatus for coronary sinus cannulation |
| US6980843B2 (en) | 2003-05-21 | 2005-12-27 | Stereotaxis, Inc. | Electrophysiology catheter |
| US7163537B2 (en) | 2003-06-02 | 2007-01-16 | Biosense Webster, Inc. | Enhanced ablation and mapping catheter and method for treating atrial fibrillation |
| US7044946B2 (en) | 2003-06-10 | 2006-05-16 | Cryocath Technologies Inc. | Surgical clamp having treatment elements |
| US7540853B2 (en) | 2003-06-30 | 2009-06-02 | Cardiac Pacemakers, Inc. | Method and apparatus for diverting blood flow during ablation procedures |
| US6973339B2 (en) | 2003-07-29 | 2005-12-06 | Biosense, Inc | Lasso for pulmonary vein mapping and ablation |
| US20060009755A1 (en) | 2003-09-04 | 2006-01-12 | Sra Jasbir S | Method and system for ablation of atrial fibrillation and other cardiac arrhythmias |
| US7229437B2 (en) | 2003-09-22 | 2007-06-12 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Medical device having integral traces and formed electrodes |
| US8147486B2 (en) | 2003-09-22 | 2012-04-03 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Medical device with flexible printed circuit |
| US7435248B2 (en) | 2003-09-26 | 2008-10-14 | Boston Scientific Scimed, Inc. | Medical probes for creating and diagnosing circumferential lesions within or around the ostium of a vessel |
| US7179256B2 (en) | 2003-10-24 | 2007-02-20 | Biosense Webster, Inc. | Catheter with ablation needle and mapping assembly |
| US7207989B2 (en) | 2003-10-27 | 2007-04-24 | Biosense Webster, Inc. | Method for ablating with needle electrode |
| JP4496223B2 (ja) | 2003-11-06 | 2010-07-07 | エヌエムティー メディカル， インコーポレイティッド | 中隔貫通穿刺装置 |
| FR2861997A1 (fr) | 2003-11-06 | 2005-05-13 | Fred Zacouto | Stimulateur cardiaque orthorythmique inotrope |
| WO2005053555A1 (de) | 2003-12-01 | 2005-06-16 | Biotronik Crm Patent Ag | Elektrodenleitung für die elektrotherapie von herzgewebe |
| AU2004311842C1 (en) | 2003-12-24 | 2011-01-06 | The Regents Of The University Of California | Tissue ablation with irreversible electroporation |
| US20050187545A1 (en) | 2004-02-20 | 2005-08-25 | Hooven Michael D. | Magnetic catheter ablation device and method |
| US20060100610A1 (en) | 2004-03-05 | 2006-05-11 | Wallace Daniel T | Methods using a robotic catheter system |
| JP4755638B2 (ja) | 2004-03-05 | 2011-08-24 | ハンセン メディカル，インク． | ロボットガイドカテーテルシステム |
| US7324845B2 (en) | 2004-05-17 | 2008-01-29 | Beth Israel Deaconess Medical Center | Assessment of sleep quality and sleep disordered breathing based on cardiopulmonary coupling |
| US20050261672A1 (en) | 2004-05-18 | 2005-11-24 | Mark Deem | Systems and methods for selective denervation of heart dysrhythmias |
| US7250049B2 (en) | 2004-05-27 | 2007-07-31 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ablation catheter with suspension system incorporating rigid and flexible components |
| WO2005120375A2 (en) | 2004-06-02 | 2005-12-22 | Medtronic, Inc. | Loop ablation apparatus and method |
| US7527625B2 (en) | 2004-08-04 | 2009-05-05 | Olympus Corporation | Transparent electrode for the radiofrequency ablation of tissue |
| US7556627B2 (en) | 2004-09-13 | 2009-07-07 | Ethicon Endo-Surgery, Inc. | Mucosal ablation device |
| US7282049B2 (en) | 2004-10-08 | 2007-10-16 | Sherwood Services Ag | Electrosurgical system employing multiple electrodes and method thereof |
| US20060089637A1 (en) | 2004-10-14 | 2006-04-27 | Werneth Randell L | Ablation catheter |
| FR2877207B1 (fr) | 2004-10-29 | 2007-02-23 | Jacques Hamou | Dispositif de resection de tissus organiques utilise notamment en urologie ou en hysteroscopie |
| US8409191B2 (en) | 2004-11-04 | 2013-04-02 | Boston Scientific Scimed, Inc. | Preshaped ablation catheter for ablating pulmonary vein ostia within the heart |
| US7468062B2 (en) | 2004-11-24 | 2008-12-23 | Ablation Frontiers, Inc. | Atrial ablation catheter adapted for treatment of septal wall arrhythmogenic foci and method of use |
| US7429261B2 (en) | 2004-11-24 | 2008-09-30 | Ablation Frontiers, Inc. | Atrial ablation catheter and method of use |
| US7731715B2 (en) | 2004-12-10 | 2010-06-08 | Edwards Lifesciences Corporation | Ablative treatment of atrial fibrillation via the coronary sinus |
| US7869865B2 (en) | 2005-01-07 | 2011-01-11 | Biosense Webster, Inc. | Current-based position sensing |
| US20070225589A1 (en) | 2005-01-11 | 2007-09-27 | Viswanathan Raju R | Single catheter diagnosis, navigation and treatment of arrhythmias |
| JP4926981B2 (ja) | 2005-01-31 | 2012-05-09 | コーニンクレッカ フィリップス エレクトロニクス エヌ ヴィ | 電気生理学的介入においてカテーテルを誘導するシステム及び方法 |
| US9821158B2 (en) | 2005-02-17 | 2017-11-21 | Metacure Limited | Non-immediate effects of therapy |
| US7588567B2 (en) | 2005-04-22 | 2009-09-15 | Abl Technologies, Llc | Method and system of stopping energy delivery of an ablation procedure with a computer based device for increasing safety of ablation procedures |
| US7578816B2 (en) | 2005-04-22 | 2009-08-25 | Abl Technologies, Llc | Method and system of increasing safety of cardiac ablation procedures |
| US7512447B2 (en) | 2005-04-25 | 2009-03-31 | Medtronic, Inc. | Medical electrical electrodes with conductive polymer |
| US20060264752A1 (en) | 2005-04-27 | 2006-11-23 | The Regents Of The University Of California | Electroporation controlled with real time imaging |
| US8571635B2 (en) | 2005-04-28 | 2013-10-29 | Boston Scientific Scimed, Inc. | Automated activation/deactivation of imaging device based on tracked medical device position |
| EP1898991B1 (en) | 2005-05-04 | 2016-06-29 | Impulse Dynamics NV | Protein activity modification |
| US20060270900A1 (en) | 2005-05-26 | 2006-11-30 | Chin Albert K | Apparatus and methods for performing ablation |
| US8932208B2 (en) | 2005-05-26 | 2015-01-13 | Maquet Cardiovascular Llc | Apparatus and methods for performing minimally-invasive surgical procedures |
| US9861836B2 (en) | 2005-06-16 | 2018-01-09 | Biosense Webster, Inc. | Less invasive methods for ablation of fat pads |
| JP2009500052A (ja) | 2005-06-20 | 2009-01-08 | アブレーション フロンティアズ，インコーポレーテッド | アブレーションカテーテル |
| US20060293730A1 (en) | 2005-06-24 | 2006-12-28 | Boris Rubinsky | Methods and systems for treating restenosis sites using electroporation |
| US20060293731A1 (en) | 2005-06-24 | 2006-12-28 | Boris Rubinsky | Methods and systems for treating tumors using electroporation |
| US20070005053A1 (en) | 2005-06-30 | 2007-01-04 | Dando Jeremy D | Ablation catheter with contoured openings in insulated electrodes |
| WO2007006055A2 (en) | 2005-07-06 | 2007-01-11 | Vascular Pathways Inc. | Intravenous catheter insertion device and method of use |
| US20070021744A1 (en) | 2005-07-07 | 2007-01-25 | Creighton Francis M Iv | Apparatus and method for performing ablation with imaging feedback |
| AU2006268238A1 (en) | 2005-07-11 | 2007-01-18 | Medtronic Ablation Frontiers Llc | Low power tissue ablation system |
| ITBO20050495A1 (it) | 2005-07-22 | 2007-01-23 | Fiab Spa | Elettrocatetere esogageo |
| US7681579B2 (en) | 2005-08-02 | 2010-03-23 | Biosense Webster, Inc. | Guided procedures for treating atrial fibrillation |
| US7416552B2 (en) | 2005-08-22 | 2008-08-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Multipolar, multi-lumen, virtual-electrode catheter with at least one surface electrode and method for ablation |
| US8657814B2 (en) | 2005-08-22 | 2014-02-25 | Medtronic Ablation Frontiers Llc | User interface for tissue ablation system |
| JP2009506873A (ja) | 2005-09-07 | 2009-02-19 | ザ ファウンドリー， インコーポレイテッド | 皮下構造を破壊するための装置および方法 |
| US7623899B2 (en) | 2005-09-16 | 2009-11-24 | Biosense Webster, Inc. | Catheter with flexible pre-shaped tip section |
| WO2007063443A2 (en) | 2005-12-02 | 2007-06-07 | Koninklijke Philips Electronics, N.V. | Automating the ablation procedure to minimize the need for manual intervention |
| US8403925B2 (en) | 2006-12-06 | 2013-03-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing lesions in tissue |
| US8449535B2 (en) | 2005-12-06 | 2013-05-28 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing coupling between an electrode and tissue |
| US8406866B2 (en) | 2005-12-06 | 2013-03-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing coupling between an electrode and tissue |
| US8603084B2 (en) | 2005-12-06 | 2013-12-10 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing the formation of a lesion in tissue |
| US10362959B2 (en) | 2005-12-06 | 2019-07-30 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for assessing the proximity of an electrode to tissue in a body |
| US9492226B2 (en) | 2005-12-06 | 2016-11-15 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Graphical user interface for real-time RF lesion depth display |
| US8137342B2 (en) | 2005-12-24 | 2012-03-20 | Crossman Arthur W | Circumferential ablation guide wire system and related method of using the same |
| US20070167740A1 (en) | 2005-12-30 | 2007-07-19 | Grunewald Debby E | Magnetic stabilization of catheter location sensor |
| US7879029B2 (en) | 2005-12-30 | 2011-02-01 | Biosense Webster, Inc. | System and method for selectively energizing catheter electrodes |
| US7857809B2 (en) | 2005-12-30 | 2010-12-28 | Biosense Webster, Inc. | Injection molded irrigated tip electrode and catheter having the same |
| US20090240248A1 (en) | 2005-12-30 | 2009-09-24 | C.R. Bard , Inc | Methods and Apparatus for Ablation of Cardiac Tissue |
| US20070156135A1 (en) | 2006-01-03 | 2007-07-05 | Boris Rubinsky | System and methods for treating atrial fibrillation using electroporation |
| US7513896B2 (en) | 2006-01-24 | 2009-04-07 | Covidien Ag | Dual synchro-resonant electrosurgical apparatus with bi-directional magnetic coupling |
| US7374567B2 (en) | 2006-01-25 | 2008-05-20 | Heuser Richard R | Catheter system for connecting adjacent blood vessels |
| US7918850B2 (en) | 2006-02-17 | 2011-04-05 | Biosense Wabster, Inc. | Lesion assessment by pacing |
| EP2007466A4 (en) | 2006-03-31 | 2012-01-18 | Automated Medical Instr Inc | SYSTEM AND METHOD FOR ADVANCING, ORIENTATION, AND IMMOBILIZATION ON AN INTERNAL BODY TISSUE OF A CATHETER OR ANY OTHER THERAPEUTIC DEVICE |
| US7615044B2 (en) | 2006-05-03 | 2009-11-10 | Greatbatch Ltd. | Deflectable sheath handle assembly and method therefor |
| WO2007134039A2 (en) | 2006-05-08 | 2007-11-22 | Medeikon Corporation | Interferometric characterization of ablated tissue |
| US20140276782A1 (en) | 2013-03-15 | 2014-09-18 | Larry D. Paskar | Catheter system |
| US7729752B2 (en) | 2006-06-13 | 2010-06-01 | Rhythmia Medical, Inc. | Non-contact cardiac mapping, including resolution map |
| US7515954B2 (en) | 2006-06-13 | 2009-04-07 | Rhythmia Medical, Inc. | Non-contact cardiac mapping, including moving catheter and multi-beat integration |
| US7783352B1 (en) | 2006-06-23 | 2010-08-24 | Pacesetter, Inc. | Optimizing anti-tachycardia pacing for terminating atrial fibrillation |
| US8920411B2 (en) | 2006-06-28 | 2014-12-30 | Kardium Inc. | Apparatus and method for intra-cardiac mapping and ablation |
| US9119633B2 (en) | 2006-06-28 | 2015-09-01 | Kardium Inc. | Apparatus and method for intra-cardiac mapping and ablation |
| WO2008134245A1 (en) | 2007-04-27 | 2008-11-06 | Cvdevices, Llc | Devices, systems, and methods for promotion of infarct healing and reinforcement of border zone |
| EP2037828A2 (en) | 2006-07-12 | 2009-03-25 | Les Hôpitaux Universitaires De Geneve | Medical device for tissue ablation |
| US8010186B1 (en) | 2006-07-19 | 2011-08-30 | Pacesetter, Inc. | System and related methods for identifying a fibrillation driver |
| US20080033426A1 (en) | 2006-07-27 | 2008-02-07 | Machell Charles H | Catheter system and method of use thereof |
| US8339256B2 (en) | 2006-08-02 | 2012-12-25 | Koninklijke Philips Electronics N.V. | Radiofrequency safety of switchable segmented transmission lines |
| US8273081B2 (en) | 2006-09-08 | 2012-09-25 | Stereotaxis, Inc. | Impedance-based cardiac therapy planning method with a remote surgical navigation system |
| GB0618522D0 (en) | 2006-09-20 | 2006-11-01 | Imp Innovations Ltd | Atrial fibrillation analysis |
| WO2008048471A2 (en) | 2006-10-13 | 2008-04-24 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
| AU2007231704B2 (en) | 2006-11-29 | 2011-02-24 | Cathrx Ltd | Heat treating a biological site in a patient's body |
| US20080132884A1 (en) | 2006-12-01 | 2008-06-05 | Boris Rubinsky | Systems for treating tissue sites using electroporation |
| US20080132885A1 (en) | 2006-12-01 | 2008-06-05 | Boris Rubinsky | Methods for treating tissue sites using electroporation |
| WO2008078294A1 (en) | 2006-12-22 | 2008-07-03 | Philips Intellectual Property & Standards Gmbh | Transmission line for use in magnetic resonance system |
| US7883508B2 (en) | 2006-12-29 | 2011-02-08 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Contact-sensitive pressure-sensitive conductive composite electrode and method for ablation |
| US8226648B2 (en) | 2007-12-31 | 2012-07-24 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Pressure-sensitive flexible polymer bipolar electrode |
| US8449537B2 (en) | 2006-12-29 | 2013-05-28 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ablation catheter with thermally mediated catheter body for mitigating blood coagulation and creating larger lesion |
| US8108069B2 (en) | 2007-01-10 | 2012-01-31 | Hansen Medical, Inc. | Robotic catheter system and methods |
| US9924998B2 (en) | 2007-01-12 | 2018-03-27 | Atricure, Inc. | Ablation system, clamp and method of use |
| US8267927B2 (en) | 2007-01-24 | 2012-09-18 | Koninklijke Philips Electronics N.V. | Advanced ablation planning |
| US20080200913A1 (en) | 2007-02-07 | 2008-08-21 | Viswanathan Raju R | Single Catheter Navigation for Diagnosis and Treatment of Arrhythmias |
| US7655004B2 (en) | 2007-02-15 | 2010-02-02 | Ethicon Endo-Surgery, Inc. | Electroporation ablation apparatus, system, and method |
| US9468396B2 (en) | 2007-03-19 | 2016-10-18 | University Of Virginia Patent Foundation | Systems and methods for determining location of an access needle in a subject |
| US11058354B2 (en) | 2007-03-19 | 2021-07-13 | University Of Virginia Patent Foundation | Access needle with direct visualization and related methods |
| US9211405B2 (en) | 2007-03-22 | 2015-12-15 | University Of Virginia Patent Foundation | Electrode catheter for ablation purposes and related method thereof |
| EP3000390A1 (en) | 2007-03-26 | 2016-03-30 | Boston Scientific Limited | High resolution electrophysiology catheter |
| US8597288B2 (en) | 2008-10-01 | 2013-12-03 | St. Jude Medical, Artial Fibrillation Division, Inc. | Vacuum-stabilized ablation system |
| EP2532320A3 (en) | 2007-04-19 | 2013-04-03 | Miramar Labs, Inc. | Apparatus for reducing sweat production |
| EP2139416B1 (en) | 2007-05-09 | 2015-08-19 | Irvine Biomedical, Inc. | Basket catheter having multiple electrodes |
| US8588885B2 (en) | 2007-05-09 | 2013-11-19 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Bendable catheter arms having varied flexibility |
| US8100900B2 (en) | 2007-05-11 | 2012-01-24 | Board Of Trustees Of The Leland Stanford Junior University | System for delivering therapy |
| US8641704B2 (en) | 2007-05-11 | 2014-02-04 | Medtronic Ablation Frontiers Llc | Ablation therapy system and method for treating continuous atrial fibrillation |
| US8216221B2 (en) | 2007-05-21 | 2012-07-10 | Estech, Inc. | Cardiac ablation systems and methods |
| US10220187B2 (en) | 2010-06-16 | 2019-03-05 | St. Jude Medical, Llc | Ablation catheter having flexible tip with multiple flexible electrode segments |
| US7742810B2 (en) | 2007-05-23 | 2010-06-22 | Boston Scientific Neuromodulation Corporation | Short duration pre-pulsing to reduce stimulation-evoked side-effects |
| US8160690B2 (en) | 2007-06-14 | 2012-04-17 | Hansen Medical, Inc. | System and method for determining electrode-tissue contact based on amplitude modulation of sensed signal |
| WO2009001357A2 (en) | 2007-06-25 | 2008-12-31 | Real Imaging Ltd. | Method, device and system for thermography |
| US20090024084A1 (en) | 2007-07-16 | 2009-01-22 | Peritec Biosciences Ltd. | Multi-lumen catheter assembly and method of providing relative motion thereto |
| US20090062788A1 (en) | 2007-08-31 | 2009-03-05 | Long Gary L | Electrical ablation surgical instruments |
| US20090076500A1 (en) | 2007-09-14 | 2009-03-19 | Lazure Technologies, Llc | Multi-tine probe and treatment by activation of opposing tines |
| WO2009036472A1 (en) | 2007-09-14 | 2009-03-19 | Lazure Technologies, Llc | Prostate cancer ablation |
| US8308763B2 (en) | 2007-10-05 | 2012-11-13 | Coaptus Medical Corporation | Systems and methods for transeptal cardiac procedures, including separable guidewires |
| US8500697B2 (en) | 2007-10-19 | 2013-08-06 | Pressure Products Medical Supplies, Inc. | Transseptal guidewire |
| US8231618B2 (en) | 2007-11-05 | 2012-07-31 | Stereotaxis, Inc. | Magnetically guided energy delivery apparatus |
| WO2009062061A1 (en) | 2007-11-09 | 2009-05-14 | University Of Virginia Patent Foundation | Steerable epicardial pacing catheter system placed via the subxiphoid process |
| US8906011B2 (en) | 2007-11-16 | 2014-12-09 | Kardium Inc. | Medical device for use in bodily lumens, for example an atrium |
| US9717501B2 (en) | 2007-11-21 | 2017-08-01 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Methods and systems for occluding vessels during cardiac ablation including optional electroanatomical guidance |
| US9452288B2 (en) | 2007-12-06 | 2016-09-27 | Boston Scientific Neuromodulation Corporation | Multimodal neurostimulation systems and methods |
| US8353907B2 (en) | 2007-12-21 | 2013-01-15 | Atricure, Inc. | Ablation device with internally cooled electrodes |
| CA2746083C (en) | 2007-12-21 | 2016-02-23 | Medical And Surgical Review, P.C. | Methods and devices for endoscopically creating an anastomosis |
| US8562600B2 (en) | 2007-12-27 | 2013-10-22 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Integration of control software with a medical device and system |
| US9204927B2 (en) | 2009-05-13 | 2015-12-08 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for presenting information representative of lesion formation in tissue during an ablation procedure |
| WO2009089415A1 (en) | 2008-01-09 | 2009-07-16 | Mayo Foundation For Medical Education And Research | Mapping and ablation catheter system |
| EP2231253B1 (en) | 2008-01-16 | 2019-06-12 | Catheter Precision, Inc. | Remotely controlled catheter insertion system |
| WO2009094588A2 (en) | 2008-01-24 | 2009-07-30 | Coherex Medical, Inc. | Systems and methods for reduction of atrial fibrillation |
| US8617145B2 (en) | 2008-01-25 | 2013-12-31 | Intrepid Medical, Inc. | Methods of treating a cardiac arrhythmia by thoracoscopic production of a Cox maze III lesion set |
| US20090228003A1 (en) | 2008-03-04 | 2009-09-10 | Prorhythm, Inc. | Tissue ablation device using radiofrequency and high intensity focused ultrasound |
| WO2009112269A2 (en) | 2008-03-12 | 2009-09-17 | Afreeze Gmbh | Ablation system |
| US20100004623A1 (en) | 2008-03-27 | 2010-01-07 | Angiodynamics, Inc. | Method for Treatment of Complications Associated with Arteriovenous Grafts and Fistulas Using Electroporation |
| US8538509B2 (en) | 2008-04-02 | 2013-09-17 | Rhythmia Medical, Inc. | Intracardiac tracking system |
| US10117707B2 (en) | 2008-04-29 | 2018-11-06 | Virginia Tech Intellectual Properties, Inc. | System and method for estimating tissue heating of a target ablation zone for electrical-energy based therapies |
| US9867652B2 (en) | 2008-04-29 | 2018-01-16 | Virginia Tech Intellectual Properties, Inc. | Irreversible electroporation using tissue vasculature to treat aberrant cell masses or create tissue scaffolds |
| US8926606B2 (en) | 2009-04-09 | 2015-01-06 | Virginia Tech Intellectual Properties, Inc. | Integration of very short electric pulses for minimally to noninvasive electroporation |
| US10702326B2 (en) | 2011-07-15 | 2020-07-07 | Virginia Tech Intellectual Properties, Inc. | Device and method for electroporation based treatment of stenosis of a tubular body part |
| US8992517B2 (en) | 2008-04-29 | 2015-03-31 | Virginia Tech Intellectual Properties Inc. | Irreversible electroporation to treat aberrant cell masses |
| US9198733B2 (en) | 2008-04-29 | 2015-12-01 | Virginia Tech Intellectual Properties, Inc. | Treatment planning for electroporation-based therapies |
| US11254926B2 (en) | 2008-04-29 | 2022-02-22 | Virginia Tech Intellectual Properties, Inc. | Devices and methods for high frequency electroporation |
| WO2009137800A2 (en) | 2008-05-09 | 2009-11-12 | Angiodynamics, Inc. | Electroporation device and method |
| US9474574B2 (en) | 2008-05-21 | 2016-10-25 | Atricure, Inc. | Stabilized ablation systems and methods |
| US20090306651A1 (en) | 2008-06-09 | 2009-12-10 | Clint Schneider | Catheter assembly with front-loaded tip |
| US8206385B2 (en) | 2008-06-09 | 2012-06-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Catheter assembly with front-loaded tip and multi-contact connector |
| WO2010007600A1 (en) | 2008-07-17 | 2010-01-21 | Maestroheart Sa | Medical device for tissue ablation |
| US8585695B2 (en) | 2008-07-22 | 2013-11-19 | Hue-Teh Shih | Systems and methods for noncontact ablation |
| US8221411B2 (en) | 2008-07-28 | 2012-07-17 | Medtronic, Inc. | Systems and methods for cardiac tissue electroporation ablation |
| JP4545210B2 (ja) | 2008-09-11 | 2010-09-15 | 日本ライフライン株式会社 | 除細動カテーテル |
| US9119533B2 (en) | 2008-10-07 | 2015-09-01 | Mc10, Inc. | Systems, methods, and devices having stretchable integrated circuitry for sensing and delivering therapy |
| CN107898498B (zh) | 2008-10-21 | 2021-06-11 | 微立方有限责任公司 | 将能量应用于身体组织的方法及装置 |
| US8137343B2 (en) | 2008-10-27 | 2012-03-20 | Rhythmia Medical, Inc. | Tracking system using field mapping |
| US8414508B2 (en) | 2008-10-30 | 2013-04-09 | Vytronus, Inc. | System and method for delivery of energy to tissue while compensating for collateral tissue |
| US9220924B2 (en) | 2008-10-30 | 2015-12-29 | Vytronus, Inc. | System and method for energy delivery to tissue while monitoring position, lesion depth, and wall motion |
| US9192789B2 (en) | 2008-10-30 | 2015-11-24 | Vytronus, Inc. | System and method for anatomical mapping of tissue and planning ablation paths therein |
| US9192769B2 (en) | 2008-10-31 | 2015-11-24 | Medtronic, Inc. | Shunt-current reduction techniques for an implantable therapy system |
| US9795442B2 (en) | 2008-11-11 | 2017-10-24 | Shifamed Holdings, Llc | Ablation catheters |
| US8475445B2 (en) | 2008-12-01 | 2013-07-02 | Daniel Soroff | Spectral analysis of intracardiac electrograms to predict identification of radiofrequency ablation sites |
| US8475450B2 (en) | 2008-12-30 | 2013-07-02 | Biosense Webster, Inc. | Dual-purpose lasso catheter with irrigation |
| US9307931B2 (en) | 2008-12-31 | 2016-04-12 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Multiple shell construction to emulate chamber contraction with a mapping system |
| US8361066B2 (en) | 2009-01-12 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices |
| US20100191232A1 (en) | 2009-01-27 | 2010-07-29 | Boveda Marco Medical Llc | Catheters and methods for performing electrophysiological interventions |
| WO2010093692A2 (en) | 2009-02-10 | 2010-08-19 | Hobbs Eamonn P | Irreversible electroporation and tissue regeneration |
| WO2010093603A1 (en) | 2009-02-11 | 2010-08-19 | Boston Scientific Scimed, Inc. | Insulated ablation catheter devices and methods of use |
| WO2010091701A1 (en) | 2009-02-12 | 2010-08-19 | Umc Utrecht Holding B.V. | Ablation catheter and method for electrically isolating cardiac tissue |
| US8500733B2 (en) | 2009-02-20 | 2013-08-06 | Boston Scientific Scimed, Inc. | Asymmetric dual directional steerable catheter sheath |
| US8747297B2 (en) | 2009-03-02 | 2014-06-10 | Olympus Corporation | Endoscopic heart surgery method |
| JP2012521863A (ja) | 2009-03-31 | 2012-09-20 | アンジオダイナミツクス・インコーポレイテツド | 治療装置の治療領域推定およびインタラクティブな患者治療計画のためのシステムおよび方法 |
| US8632534B2 (en) | 2009-04-03 | 2014-01-21 | Angiodynamics, Inc. | Irreversible electroporation (IRE) for congestive obstructive pulmonary disease (COPD) |
| US11382681B2 (en) | 2009-04-09 | 2022-07-12 | Virginia Tech Intellectual Properties, Inc. | Device and methods for delivery of high frequency electrical pulses for non-thermal ablation |
| US11638603B2 (en) | 2009-04-09 | 2023-05-02 | Virginia Tech Intellectual Properties, Inc. | Selective modulation of intracellular effects of cells using pulsed electric fields |
| US8287532B2 (en) | 2009-04-13 | 2012-10-16 | Biosense Webster, Inc. | Epicardial mapping and ablation catheter |
| WO2010120847A1 (en) | 2009-04-14 | 2010-10-21 | Old Dominion University Research Foundation | System and method for applying plasma sparks to tissue |
| US9566107B2 (en) | 2009-04-22 | 2017-02-14 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Method and apparatus for radiofrequency ablation with increased depth and/or decreased volume of ablated tissue |
| CN104605928B (zh) | 2009-05-08 | 2018-01-05 | 圣犹达医疗用品国际控股有限公司 | 用于在基于导管的消融治疗中控制损伤尺寸的系统 |
| US8103338B2 (en) | 2009-05-08 | 2012-01-24 | Rhythmia Medical, Inc. | Impedance based anatomy generation |
| US8571647B2 (en) | 2009-05-08 | 2013-10-29 | Rhythmia Medical, Inc. | Impedance based anatomy generation |
| US8551096B2 (en) | 2009-05-13 | 2013-10-08 | Boston Scientific Scimed, Inc. | Directional delivery of energy and bioactives |
| US8430875B2 (en) | 2009-05-19 | 2013-04-30 | Estech, Inc. (Endoscopic Technologies, Inc.) | Magnetic navigation systems and methods |
| WO2010138919A2 (en) | 2009-05-28 | 2010-12-02 | Angiodynamics, Inc. | System and method for synchronizing energy delivery to the cardiac rhythm |
| WO2010144419A2 (en) | 2009-06-08 | 2010-12-16 | Surgivision, Inc. | Mri-guided interventional systems that can track and generate dynamic visualizations of flexible intrabody devices in near real time |
| GB2472216A (en) | 2009-07-28 | 2011-02-02 | Gyrus Medical Ltd | Bipolar electrosurgical instrument with four electrodes |
| US20110028962A1 (en) | 2009-07-31 | 2011-02-03 | Randell Werneth | Adjustable pulmonary vein ablation catheter |
| CN102639071B (zh) | 2009-08-05 | 2016-01-20 | Scr有限公司 | 用于通过消融术治疗心脏的系统、装置和方法 |
| US9042969B2 (en) * | 2009-08-12 | 2015-05-26 | Angel Medical Systems, Inc. | Heart rate correction system and methods for the detection of cardiac events |
| US20110054487A1 (en) | 2009-09-02 | 2011-03-03 | Circulite, Inc. | Coaxial transseptal guide-wire and needle assembly |
| US20150321021A1 (en) | 2009-09-03 | 2015-11-12 | The Johns Hopkins University | Method and device for treating cardiac arrhythmias |
| US9642534B2 (en) | 2009-09-11 | 2017-05-09 | University Of Virginia Patent Foundation | Systems and methods for determining location of an access needle in a subject |
| US20110098694A1 (en) | 2009-10-28 | 2011-04-28 | Ethicon Endo-Surgery, Inc. | Methods and instruments for treating cardiac tissue through a natural orifice |
| US9861438B2 (en) | 2009-12-11 | 2018-01-09 | Biosense Webster (Israel), Ltd. | Pre-formed curved ablation catheter |
| US8608735B2 (en) | 2009-12-30 | 2013-12-17 | Biosense Webster (Israel) Ltd. | Catheter with arcuate end section |
| US9005198B2 (en) | 2010-01-29 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an electrode |
| US20110190727A1 (en) | 2010-02-02 | 2011-08-04 | Boston Scientific Scimed, Inc. | Intervascular catheter, system and method |
| US8556891B2 (en) | 2010-03-03 | 2013-10-15 | Medtronic Ablation Frontiers Llc | Variable-output radiofrequency ablation power supply |
| US20120046570A1 (en) | 2010-03-08 | 2012-02-23 | Alpha Orthopaedics, Inc. | Methods and devices for real time monitoring of collagen content and for altering collagen status |
| RU2015122311A (ru) | 2010-04-08 | 2015-11-27 | Де Реджентс Оф Де Юниверсити Оф Калифорния | Способы, система и устройство для обнаружения, диагностики и лечения нарушений биологического ритма |
| US8986278B2 (en) | 2010-04-13 | 2015-03-24 | Sentreheart, Inc. | Methods and devices for pericardial access |
| CN104997574B (zh) | 2010-04-13 | 2017-06-06 | 森特里心脏股份有限公司 | 用于向心脏介入和置放装置的方法和装置 |
| US9943363B2 (en) | 2010-04-28 | 2018-04-17 | Biosense Webster, Inc. | Irrigated ablation catheter with improved fluid flow |
| US9510894B2 (en) | 2010-04-28 | 2016-12-06 | Biosense Webster (Israel) Ltd. | Irrigated ablation catheter having irrigation ports with reduced hydraulic resistance |
| EP3338852B1 (en) | 2010-05-05 | 2023-01-04 | ElectroPhysiology Frontiers S.p.A. | Anchored cardiac ablation catheter |
| US9924997B2 (en) | 2010-05-05 | 2018-03-27 | Ablacor Medical Corporation | Anchored ablation catheter |
| US9655677B2 (en) | 2010-05-12 | 2017-05-23 | Shifamed Holdings, Llc | Ablation catheters including a balloon and electrodes |
| JP5870694B2 (ja) | 2010-06-08 | 2016-03-01 | 東レ株式会社 | 電位測定用カテーテル |
| ITRM20100314A1 (it) | 2010-06-09 | 2011-12-10 | Luca Viviana De | Catetere ad adesività reversibile, per la stabilizzazione durante l'ablazione transcatetere mediante radiofrequenza. |
| CN103153384B (zh) | 2010-06-28 | 2016-03-09 | 科利柏心脏瓣膜有限责任公司 | 用于经腔输送血管内器件的装置 |
| EP2598066B8 (en) | 2010-07-30 | 2017-10-18 | St. Jude Medical Atrial Fibrillation Division Inc. | Generator and combination of a generator and a catheter for providing an electrical pulse |
| US20120029512A1 (en) | 2010-07-30 | 2012-02-02 | Willard Martin R | Balloon with surface electrodes and integral cooling for renal nerve ablation |
| JP2012050538A (ja) | 2010-08-31 | 2012-03-15 | Terumo Corp | アブレーションデバイス |
| US9289606B2 (en) | 2010-09-02 | 2016-03-22 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System for electroporation therapy |
| US20120078320A1 (en) | 2010-09-29 | 2012-03-29 | Medtronic, Inc. | Prioritized programming of multi-electrode pacing leads |
| US20120089089A1 (en) | 2010-10-12 | 2012-04-12 | Ethicon Endo-Surgery, Inc. | Methods of magnetically guiding and axially aligning distal ends of surgical devices |
| EP2627274B1 (en) | 2010-10-13 | 2022-12-14 | AngioDynamics, Inc. | System for electrically ablating tissue of a patient |
| US20120101413A1 (en) | 2010-10-20 | 2012-04-26 | Medtronic Ardian Luxembourg S.a.r.I. | Catheter apparatuses having expandable mesh structures for renal neuromodulation and associated systems and methods |
| US8406875B2 (en) | 2010-10-28 | 2013-03-26 | Biosense Webster (Israel), Ltd. | Routing of pacing signals |
| AU2011329669B2 (en) | 2010-11-19 | 2016-07-28 | Boston Scientific Scimed, Inc. | Renal nerve detection and ablation apparatus and method |
| WO2012068505A1 (en) | 2010-11-19 | 2012-05-24 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Electrode catheter device with indifferent electrode for direct current tissue therapies |
| US20120158021A1 (en) | 2010-12-19 | 2012-06-21 | Mitralign, Inc. | Steerable guide catheter having preformed curved shape |
| WO2012088149A2 (en) | 2010-12-20 | 2012-06-28 | Virginia Tech Intellectual Properties, Inc. | High-frequency electroporation for cancer therapy |
| US9308041B2 (en) | 2010-12-22 | 2016-04-12 | Biosense Webster (Israel) Ltd. | Lasso catheter with rotating ultrasound transducer |
| DE102010064101B4 (de) | 2010-12-23 | 2017-02-23 | Siemens Healthcare Gmbh | Paar aus endokardialem und epikardialem Katheter sowie Katheter |
| US20120303019A1 (en) | 2010-12-25 | 2012-11-29 | Xue Zhao | Kind of cardiac ablation catheter with guide-wire |
| WO2012092275A1 (en) | 2010-12-27 | 2012-07-05 | Endosense S.A. | Prediction of atrial wall electrical reconnection based on contact force measured during rf ablation |
| US9149327B2 (en) | 2010-12-27 | 2015-10-06 | St. Jude Medical Luxembourg Holding S.À.R.L. | Prediction of atrial wall electrical reconnection based on contact force measured during RF ablation |
| US9572620B2 (en) | 2010-12-29 | 2017-02-21 | Kyungmoo Ryu | System and method for treating arrhythmias in the heart using information obtained from heart wall motion |
| US9095262B2 (en) | 2011-01-05 | 2015-08-04 | Mehdi Razavi | Guided ablation devices, systems, and methods |
| US9044245B2 (en) | 2011-01-05 | 2015-06-02 | Medtronic Ablation Frontiers Llc | Multipolarity epicardial radiofrequency ablation |
| US9002442B2 (en) | 2011-01-13 | 2015-04-07 | Rhythmia Medical, Inc. | Beat alignment and selection for cardiac mapping |
| US9480525B2 (en) | 2011-01-21 | 2016-11-01 | Kardium, Inc. | High-density electrode-based medical device system |
| CA2764494A1 (en) | 2011-01-21 | 2012-07-21 | Kardium Inc. | Enhanced medical device for use in bodily cavities, for example an atrium |
| US9314620B2 (en) | 2011-02-28 | 2016-04-19 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices and methods |
| WO2012122389A1 (en) | 2011-03-08 | 2012-09-13 | Cohen Todd J | Ablation catheter system with safety features |
| US9937002B2 (en) | 2011-03-08 | 2018-04-10 | Nexus Control Systems, Llc | Ablation catheter system with safety features |
| CN106510679A (zh) | 2011-04-13 | 2017-03-22 | 维特罗纳斯有限公司 | 集成式消融与标测系统 |
| EP3330894A1 (en) | 2011-05-02 | 2018-06-06 | Topera, Inc. | System and method for targeting heart rhythm disorders using shaped ablation |
| KR101248959B1 (ko) | 2011-05-12 | 2013-04-01 | 신경민 | 플렉시블관이 구비되는 고주파 열치료용 전극장치 |
| US9072518B2 (en) | 2011-05-31 | 2015-07-07 | Atricure, Inc. | High-voltage pulse ablation systems and methods |
| US20120310230A1 (en) | 2011-06-01 | 2012-12-06 | Angiodynamics, Inc. | Coaxial dual function probe and method of use |
| US20120316557A1 (en) | 2011-06-08 | 2012-12-13 | Tyco Healthcare Group Lp | Septoplasty Instrument |
| JP5850379B2 (ja) | 2011-06-15 | 2016-02-03 | マックス−プランク−ゲゼルシャフト ツア フェーデルンク デア ヴィッセンシャフテン エー．ファオ． | 生物学的組織の高周波不整脈電気状態を終結させる装置 |
| JP6139518B2 (ja) | 2011-07-05 | 2017-05-31 | カーディオインサイト テクノロジーズ インコーポレイテッド | 心電図マッピングのための位置決め |
| WO2013013099A1 (en) | 2011-07-19 | 2013-01-24 | Adagio Medical, Inc. | Methods and devices for the treatment of atrial fibrillation |
| US20130030430A1 (en) | 2011-07-29 | 2013-01-31 | Stewart Mark T | Intracardiac tools and methods for delivery of electroporation therapies |
| US10085799B2 (en) | 2011-10-11 | 2018-10-02 | Boston Scientific Scimed, Inc. | Off-wall electrode device and methods for nerve modulation |
| WO2013096199A1 (en) * | 2011-12-20 | 2013-06-27 | Cardiac Pacemakers, Inc. | Ectopic-triggered para-his stimulation |
| US8825130B2 (en) | 2011-12-30 | 2014-09-02 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Electrode support structure assemblies |
| US9687289B2 (en) | 2012-01-04 | 2017-06-27 | Biosense Webster (Israel) Ltd. | Contact assessment based on phase measurement |
| CN104039257A (zh) | 2012-01-10 | 2014-09-10 | 波士顿科学医学有限公司 | 电生理学系统 |
| US9414881B2 (en) | 2012-02-08 | 2016-08-16 | Angiodynamics, Inc. | System and method for increasing a target zone for electrical ablation |
| US8808273B2 (en) | 2012-02-10 | 2014-08-19 | Biosense Webster (Israel) Ltd. | Electrophysiology catheter with mechanical use limiter |
| US9095350B2 (en) | 2012-05-01 | 2015-08-04 | Medtronic Ablation Frontiers Llc | Impedance detection of venous placement of multi-electrode catheters |
| WO2013165584A1 (en) | 2012-05-04 | 2013-11-07 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for controlling delivery of ablation energy to tissue |
| US9011423B2 (en) | 2012-05-21 | 2015-04-21 | Kardium, Inc. | Systems and methods for selecting, activating, or selecting and activating transducers |
| US9554847B2 (en) | 2012-07-02 | 2017-01-31 | Biosense Webster (Israel) Ltd. | Real time assessment of ablation from electrocardiogram signals |
| US9101374B1 (en) | 2012-08-07 | 2015-08-11 | David Harris Hoch | Method for guiding an ablation catheter based on real time intracardiac electrical signals and apparatus for performing the method |
| US9861802B2 (en) | 2012-08-09 | 2018-01-09 | University Of Iowa Research Foundation | Catheters, catheter systems, and methods for puncturing through a tissue structure |
| US20140052216A1 (en) | 2012-08-15 | 2014-02-20 | Ethicon Endo-Surgery, Inc. | Methods for promoting wound healing |
| US9277957B2 (en) | 2012-08-15 | 2016-03-08 | Ethicon Endo-Surgery, Inc. | Electrosurgical devices and methods |
| US9801681B2 (en) | 2012-08-17 | 2017-10-31 | Medtronic Ablation Frontiers Llc | Catheters and methods for intracardiac electrical mapping |
| US9168004B2 (en) | 2012-08-20 | 2015-10-27 | Biosense Webster (Israel) Ltd. | Machine learning in determining catheter electrode contact |
| WO2014031800A1 (en) | 2012-08-22 | 2014-02-27 | Energize Medical Llc | Therapeutic energy systems |
| JP6316821B2 (ja) | 2012-08-31 | 2018-04-25 | アクタス メディカル インクＡｃｕｔｕｓ Ｍｅｄｉｃａｌ，Ｉｎｃ． | 切除システム |
| JP2014054430A (ja) | 2012-09-13 | 2014-03-27 | Nippon Koden Corp | カテーテル |
| US11096741B2 (en) | 2012-10-10 | 2021-08-24 | Biosense Webster (Israel) Ltd. | Ablation power control based on contact force |
| US9827036B2 (en) | 2012-11-13 | 2017-11-28 | Pulnovo Medical (Wuxi) Co., Ltd. | Multi-pole synchronous pulmonary artery radiofrequency ablation catheter |
| US9757185B2 (en) | 2012-11-29 | 2017-09-12 | Gyrus Acmi, Inc. | Quadripolar forceps |
| WO2014089373A1 (en) | 2012-12-05 | 2014-06-12 | University Of Rochester | Catheter with integrated transeptal puncture needle |
| US9023036B2 (en) | 2012-12-07 | 2015-05-05 | Biosense Webster (Israel) Ltd. | Lasso catheter with tip electrode |
| US9078667B2 (en) | 2012-12-11 | 2015-07-14 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Catheter having reduced force concentration at tissue contact site |
| US9474850B2 (en) | 2012-12-11 | 2016-10-25 | Biosense Webster (Israel) Ltd. | Lasso catheter with guide wire |
| EP2934307B1 (en) | 2012-12-21 | 2020-08-05 | Volcano Corporation | Functional gain measurement technique and representation |
| US9204820B2 (en) | 2012-12-31 | 2015-12-08 | Biosense Webster (Israel) Ltd. | Catheter with combined position and pressure sensing structures |
| US10537286B2 (en) | 2013-01-08 | 2020-01-21 | Biosense Webster (Israel) Ltd. | Catheter with multiple spines of different lengths arranged in one or more distal assemblies |
| CN104869932B (zh) | 2013-01-31 | 2018-03-23 | 雷纳尔动力有限公司 | 单极和/或双极消融导管 |
| US9031642B2 (en) | 2013-02-21 | 2015-05-12 | Medtronic, Inc. | Methods for simultaneous cardiac substrate mapping using spatial correlation maps between neighboring unipolar electrograms |
| US9474486B2 (en) | 2013-03-08 | 2016-10-25 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Basket for a multi-electrode array catheter |
| US9519021B2 (en) | 2013-03-11 | 2016-12-13 | Covidien Lp | Systems and methods for detecting abnormalities within a circuit of an electrosurgical generator |
| US9486272B2 (en) | 2013-03-12 | 2016-11-08 | Biosense Webster (Israel) Ltd. | Force feedback device and method for catheters |
| EP2967738A1 (en) | 2013-03-15 | 2016-01-20 | Medtronic Ardian Luxembourg S.à.r.l. | Treatment device with electrode contact surface configured for enhancing uniformity of electrical energy distribution and associated devices and methods |
| ES2719955T3 (es) | 2013-03-27 | 2019-07-17 | Autonomix Medical Inc | Sistemas de evaluación y modificación del tráfico y de los receptores neurológicos |
| AU2014251039B2 (en) | 2013-04-08 | 2018-12-06 | Apama Medical, Inc. | Cardiac ablation catheters and methods of use thereof |
| US10575743B2 (en) | 2013-04-11 | 2020-03-03 | Biosense Webster (Israel) Ltd. | High electrode density basket catheter |
| US20160113709A1 (en) | 2013-06-05 | 2016-04-28 | Tel Hashomer Medical Research Infrastructure And Services Ltd | Myocardial ablation by irreversible electroporation |
| EP3030185B1 (en) | 2013-08-06 | 2023-05-10 | Memorial Sloan Kettering Cancer Center | System and computer-accessible medium for in-vivo tissue ablation and/or damage |
| CN105722549B (zh) | 2013-08-29 | 2018-08-07 | 波士顿科学神经调制公司 | 用于调节神经调制设备中的顺从电压的系统和方法 |
| US9204929B2 (en) | 2013-09-16 | 2015-12-08 | Biosense Webster (Israel) Ltd. | Basket catheter with deflectable spine |
| US9931046B2 (en) | 2013-10-25 | 2018-04-03 | Ablative Solutions, Inc. | Intravascular catheter with peri-vascular nerve activity sensors |
| CN105636514B (zh) | 2013-11-01 | 2020-06-05 | 波士顿科学医学有限公司 | 使用延迟内插的心脏标测 |
| CN105873536A (zh) | 2013-11-20 | 2016-08-17 | 波士顿科学医学有限公司 | 消融医疗装置以及用于制备和使用消融医疗装置的方法 |
| US20150173828A1 (en) | 2013-12-23 | 2015-06-25 | Boaz Avitall | Small loop ablation catheter |
| US20160324564A1 (en) | 2013-12-27 | 2016-11-10 | Empire Technology Development Llc | Devices and techniques for ablative treatment |
| WO2015103574A1 (en) | 2014-01-06 | 2015-07-09 | Iowa Approach Inc. | Apparatus and methods for renal denervation ablation |
| EP3091925A1 (en) | 2014-01-06 | 2016-11-16 | Iowa Approach Inc. | Devices and methods for delivering therapeutic electrical impulses |
| US20150223902A1 (en) | 2014-02-07 | 2015-08-13 | Hansen Medical, Inc. | Navigation with 3d localization using 2d images |
| CN105979896A (zh) | 2014-02-11 | 2016-09-28 | 圣犹达医疗用品心脏病学部门有限公司 | 消融导管和相关联的方法 |
| WO2015123700A1 (en) | 2014-02-17 | 2015-08-20 | Children's National Medical Center | Delivery tool and method for devices in the pericardial space |
| WO2015130829A1 (en) | 2014-02-25 | 2015-09-03 | St. Jude Medical, Cardiology Division, Inc. | Systems and methods for using electrophysiology properties for classifying arrhythmia sources |
| RU2678229C1 (ru) | 2014-03-20 | 2019-01-24 | Атрикат С.П.А. | Абляционный катетер и абляционное устройство |
| WO2015143327A1 (en) | 2014-03-21 | 2015-09-24 | Mayo Foundation For Medical Education And Research | Multi-electrode epicardial pacing |
| US9956035B2 (en) | 2014-03-27 | 2018-05-01 | Biosense Webster (Israel) Ltd. | Temperature measurement in catheter |
| US20150289923A1 (en) | 2014-04-14 | 2015-10-15 | Virginia Tech Intellectual Properties, Inc. | Treatment planning for electrical-energy based therapies based on cell characteristics |
| US10111703B2 (en) | 2014-05-06 | 2018-10-30 | Cosman Instruments, Llc | Electrosurgical generator |
| EP4238521A3 (en) | 2014-05-07 | 2023-11-29 | Farapulse, Inc. | Methods and apparatus for selective tissue ablation |
| WO2015175944A1 (en) | 2014-05-16 | 2015-11-19 | Gary Long | Methods and apparatus for multi-catheter tissue ablation |
| JP2017516588A (ja) | 2014-06-04 | 2017-06-22 | ボストン サイエンティフィック サイムド，インコーポレイテッドＢｏｓｔｏｎ Ｓｃｉｅｎｔｉｆｉｃ Ｓｃｉｍｅｄ，Ｉｎｃ． | 電極組立体 |
| WO2015192027A1 (en) | 2014-06-12 | 2015-12-17 | Iowa Approach Inc. | Method and apparatus for rapid and selective transurethral tissue ablation |
| WO2015192018A1 (en) | 2014-06-12 | 2015-12-17 | Iowa Approach Inc. | Method and apparatus for rapid and selective tissue ablation with cooling |
| US20160058493A1 (en) | 2014-08-28 | 2016-03-03 | Angiodynamics, Inc. | System and method for ablating a tissue site by electroporation with real-time pulse monitoring |
| WO2016059027A1 (en) | 2014-10-13 | 2016-04-21 | Dr Philippe Debruyne Bvba | Limited ablation for the treatment of sick sinus syndrome and other inappropriate sinus bradycardias |
| WO2016061002A1 (en) | 2014-10-13 | 2016-04-21 | Boston Scientific Scimed Inc. | Tissue diagnosis and treatment using mini-electrodes |
| EP3206613B1 (en) | 2014-10-14 | 2019-07-03 | Farapulse, Inc. | Apparatus for rapid and safe pulmonary vein cardiac ablation |
| US10231778B2 (en) | 2014-10-20 | 2019-03-19 | Biosense Webster (Israel) Ltd. | Methods for contemporaneous assessment of renal denervation |
| CN106604675B (zh) | 2014-10-24 | 2020-01-10 | 波士顿科学医学有限公司 | 具有耦接到消融尖头的柔性电极组件的医疗设备 |
| SG11201703943VA (en) | 2014-11-19 | 2017-06-29 | Advanced Cardiac Therapeutics Inc | Ablation devices, systems and methods of using a high-resolution electrode assembly |
| EP3226795B1 (en) | 2014-12-03 | 2020-08-26 | Metavention, Inc. | Systems for modulating nerves or other tissue |
| US10271893B2 (en) | 2014-12-15 | 2019-04-30 | Medtronic Ablation Frontiers Llc | Timed energy delivery |
| EP3232969A1 (en) | 2014-12-18 | 2017-10-25 | Boston Scientific Scimed Inc. | Real-time morphology analysis for lesion assessment |
| WO2016109207A1 (en) | 2014-12-31 | 2016-07-07 | St. Jude Medical, Cardiology Division, Inc. | Filter circuit for electrophysiology system |
| US9782099B2 (en) | 2014-12-31 | 2017-10-10 | Biosense Webster (Israel) Ltd. | Basket catheter with improved spine flexibility |
| US11298175B2 (en) | 2015-05-12 | 2022-04-12 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Asymmetric balanced waveform for AC cardiac irreversible electroporation |
| AU2016262085B2 (en) | 2015-05-12 | 2020-10-22 | National University Of Ireland Galway | Devices for therapeutic nasal neuromodulation and associated methods and systems |
| US20160361109A1 (en) | 2015-06-11 | 2016-12-15 | Massachusetts Institute Of Technology | Methods for inducing electroporation and tissue ablation |
| US9949656B2 (en) | 2015-06-29 | 2018-04-24 | Biosense Webster (Israel) Ltd. | Catheter with stacked spine electrode assembly |
| US10583294B2 (en) | 2015-07-02 | 2020-03-10 | Dirk De Ridder | Methods and apparatus for sensing cross-frequency coupling and neuromodulation |
| US9931487B2 (en) | 2015-08-06 | 2018-04-03 | Boston Scientific Scimed, Inc. | Bidirectional steering control apparatus for a catheter |
| US20170071543A1 (en) | 2015-09-14 | 2017-03-16 | Biosense Webster (Israel) Ltd. | Convertible basket catheter |
| US20170095291A1 (en) | 2015-10-06 | 2017-04-06 | Halcyon Medical, Inc. | Aorticorenal Ganglion Detection |
| US20170105793A1 (en) | 2015-10-15 | 2017-04-20 | Boston Scientific Scimed, Inc. | Energy delivery devices and related methods of use |
| CN108601616B (zh) | 2015-12-01 | 2022-04-12 | 苏州信迈医疗器械有限公司 | 用于标测支配动脉壁功能性神经的系统和方法以及可实现相同功能的3d标测法和导管 |
| US10660702B2 (en) | 2016-01-05 | 2020-05-26 | Farapulse, Inc. | Systems, devices, and methods for focal ablation |
| US10130423B1 (en) | 2017-07-06 | 2018-11-20 | Farapulse, Inc. | Systems, devices, and methods for focal ablation |
| CN113813045A (zh) | 2016-01-05 | 2021-12-21 | 法拉普尔赛股份有限公司 | 用于将消融能量递送至组织的系统、设备和方法 |
| US10172673B2 (en) | 2016-01-05 | 2019-01-08 | Farapulse, Inc. | Systems devices, and methods for delivery of pulsed electric field ablative energy to endocardial tissue |
| US20170189097A1 (en) | 2016-01-05 | 2017-07-06 | Iowa Approach Inc. | Systems, apparatuses and methods for delivery of ablative energy to tissue |
| US10874451B2 (en) | 2016-02-29 | 2020-12-29 | Pulse Biosciences, Inc. | High-voltage analog circuit pulser and pulse generator discharge circuit |
| US10548665B2 (en) | 2016-02-29 | 2020-02-04 | Pulse Biosciences, Inc. | High-voltage analog circuit pulser with feedback control |
| KR20180124070A (ko) | 2016-03-15 | 2018-11-20 | 에픽스 테라퓨틱스, 인크. | 관개 절제를 위한 개선된 장치, 시스템 및 방법 |
| CN108883279B (zh) | 2016-04-06 | 2022-05-03 | 心脏起搏器股份公司 | 心律失常检测的置信度 |
| WO2017192477A1 (en) | 2016-05-02 | 2017-11-09 | Affera, Inc. | Method of inserting a catheter with an expandable tip and a system comprising a catheter, a sheath and an insertion sleeve |
| EP3451918B1 (en) | 2016-05-03 | 2020-09-23 | CardioInsight Technologies, Inc. | Detection and analysis of electrograms |
| GB2551140B (en) | 2016-06-07 | 2022-01-12 | Dot Medical Ltd | Apparatus and method for cardiac ablation |
| WO2017218734A1 (en) | 2016-06-16 | 2017-12-21 | Iowa Approach, Inc. | Systems, apparatuses, and methods for guide wire delivery |
| CN109788979B (zh) | 2016-06-27 | 2022-04-19 | 盖能适治疗股份有限公司 | 发生器和具有电极的导管以及用于治疗肺通道的方法 |
| WO2019133606A1 (en) | 2017-12-26 | 2019-07-04 | Gala Therapeutics, Inc. | Methods, apparatuses, and systems for the treatment of disease states and disorders |
| EP3537954B1 (en) | 2016-11-11 | 2021-07-21 | National University of Ireland, Galway | Devices, systems, and methods for specializing, monitoring, and/or evaluating therapeutic nasal neuromodulation |
| US10148169B2 (en) | 2016-11-23 | 2018-12-04 | Infineon Technologies Austria Ag | Bridgeless flyback converter circuit and method of operating thereof |
| WO2018118798A1 (en) | 2016-12-19 | 2018-06-28 | Boston Scientific Scimed Inc. | Distally-facing electrode array with longitudinally mounted splines |
| US20180184982A1 (en) | 2017-01-05 | 2018-07-05 | Biosense Webster (Israel) Ltd. | Hybrid balloon basket catheter |
| US10912609B2 (en) | 2017-01-06 | 2021-02-09 | St. Jude Medical, Cardiology Division, Inc. | Pulmonary vein isolation balloon catheter |
| US10849677B2 (en) | 2017-01-27 | 2020-12-01 | Medtronic, Inc. | Methods of ensuring pulsed field ablation generator system electrical safety |
| US11364072B2 (en) | 2017-01-27 | 2022-06-21 | Medtronic, Inc. | Catheter electrodes for energy management |
| US11229478B2 (en) | 2017-02-08 | 2022-01-25 | Medtronic, Inc. | Profile parameter selection algorithm for electroporation |
| US10946193B2 (en) | 2017-02-28 | 2021-03-16 | Pulse Biosciences, Inc. | Pulse generator with independent panel triggering |
| US10569081B2 (en) | 2017-03-03 | 2020-02-25 | Medtronic, Inc. | Stacked potential electroporation |
| EP3576839B1 (en) | 2017-04-10 | 2022-10-26 | St. Jude Medical, Cardiology Division, Inc. | Electroporation system and method of preconditioning tissue for electroporation therapy |
| EP4005500A1 (en) | 2017-04-20 | 2022-06-01 | Medtronic, Inc. | Stabilization of a transseptal delivery device |
| US20180303543A1 (en) | 2017-04-24 | 2018-10-25 | Medtronic Cryocath Lp | Enhanced electroporation of cardiac tissue |
| US9987081B1 (en) | 2017-04-27 | 2018-06-05 | Iowa Approach, Inc. | Systems, devices, and methods for signal generation |
| US10617867B2 (en) | 2017-04-28 | 2020-04-14 | Farapulse, Inc. | Systems, devices, and methods for delivery of pulsed electric field ablative energy to esophageal tissue |
| US11690669B2 (en) | 2017-05-12 | 2023-07-04 | St. Jude Medical, Cardiology Division, Inc. | Electroporation systems and catheters for electroporation systems |
| US11426233B2 (en) | 2017-06-06 | 2022-08-30 | Cardiac Pacemakers, Inc. | Ablation delivery using a catheter having a semipermeable inflatable balloon structure |
| US20180360534A1 (en) | 2017-06-19 | 2018-12-20 | St. Jude Medical, Cardiology Division, Inc. | Apparatuses and methods for high-density sensing and ablation during a medical procedure |
| US11052246B2 (en) * | 2017-07-28 | 2021-07-06 | Medtronic, Inc. | Expandable elements for delivery of electric fields |
| US11633121B2 (en) | 2017-08-04 | 2023-04-25 | Medtronic, Inc. | Ablation check pulse routine and integration for electroporation |
| WO2019040458A1 (en) | 2017-08-24 | 2019-02-28 | Cardiac Pacemakers, Inc. | ELECTROPORATION DELIVERY SYSTEMS AND METHODS OF USING ELECTROPORATION DELIVERY SYSTEMS |
| EP3668395B1 (en) | 2017-10-26 | 2023-10-11 | Boston Scientific Scimed Inc. | Use of electromagnetic fields in ire device delivery and therapy monitoring |
| WO2019118436A1 (en) | 2017-12-11 | 2019-06-20 | Mayo Foundation For Medical Education And Research | Methods and systems for electroporation |
| CN111479497B (zh) | 2017-12-19 | 2023-06-09 | 圣犹达医疗用品心脏病学部门有限公司 | 使用复阻抗测量评估电极与组织之间的接触的方法 |
| JP2021508533A (ja) | 2017-12-26 | 2021-03-11 | ギャラリー，インコーポレイテッド | 様々な用途のためのエネルギー送達の最適化 |
| EP3740148A1 (en) | 2018-01-18 | 2020-11-25 | Farapulse, Inc. | Systems, devices, and methods for focal ablation |
| US20190223949A1 (en) | 2018-01-24 | 2019-07-25 | Medtronic Ardian Luxembourg S.A.R.L. | Multielectrode catheter |
| JP7396988B2 (ja) | 2018-02-05 | 2023-12-12 | マヨ ファウンデーション フォー メディカル エデュケーション アンド リサーチ | 再分極をマッピング及び調整するためのシステム及び方法 |
| US20200405387A1 (en) | 2018-03-06 | 2020-12-31 | St. Jude Medical, Cardiology Division, Inc. | Systems and methods for limiting arcing in electroporation systems |
| US20190336198A1 (en) | 2018-05-03 | 2019-11-07 | Farapulse, Inc. | Systems, devices, and methods for ablation using surgical clamps |
| CN115836908A (zh) | 2018-05-07 | 2023-03-24 | 波士顿科学医学有限公司 | 用于将消融能量递送到组织的系统、设备和方法 |
| US20190350647A1 (en) | 2018-05-21 | 2019-11-21 | Medtronic, Inc. | Handheld pulsed field ablation generator |
| US10625080B1 (en) | 2019-09-17 | 2020-04-21 | Farapulse, Inc. | Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation |
-
2019
- 2019-09-17 US US16/573,704 patent/US10625080B1/en active Active
-
2020
- 2020-01-13 US US16/741,506 patent/US10688305B1/en active Active
- 2020-05-19 US US16/877,705 patent/US11738200B2/en active Active
- 2020-09-17 CN CN202080065395.7A patent/CN114423345A/zh active Pending
- 2020-09-17 EP EP20781704.0A patent/EP4031043A1/en active Pending
- 2020-09-17 JP JP2022517174A patent/JP7404516B2/ja active Active
- 2020-09-17 WO PCT/US2020/051272 patent/WO2021055604A1/en unknown
-
2023
- 2023-12-13 JP JP2023209907A patent/JP2024015384A/ja active Pending
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20110098699A1 (en) * | 2005-08-11 | 2011-04-28 | Jose Carlos Pachon Mateos | Apparatus and Methods for Arrhythmia Treatment Based on Spectral Mapping During Sinus Rhythm |
| CN107921258A (zh) * | 2015-08-06 | 2018-04-17 | 美敦力公司 | 心脏脉冲场消融 |
| CN108778173A (zh) * | 2016-01-05 | 2018-11-09 | 法拉普尔赛股份有限公司 | 用于将脉冲电场消融能量递送到心内膜组织的系统、装置和方法 |
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| US20210077816A1 (en) | 2021-03-18 |
| JP2024015384A (ja) | 2024-02-01 |
| WO2021055604A1 (en) | 2021-03-25 |
| US11738200B2 (en) | 2023-08-29 |
| JP2022547734A (ja) | 2022-11-15 |
| EP4031043A1 (en) | 2022-07-27 |
| US10688305B1 (en) | 2020-06-23 |
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