EP4185225A1

EP4185225A1 - Electroporation ablation catheter

Info

Publication number: EP4185225A1
Application number: EP21755237.1A
Authority: EP
Inventors: Allan C. Shuros; Brendan E. Koop; Michael S. Coe
Original assignee: Boston Scientific Scimed Inc
Current assignee: Boston Scientific Scimed Inc
Priority date: 2020-07-24
Filing date: 2021-07-22
Publication date: 2023-05-31
Also published as: JP2023535080A; WO2022020591A1; CN116157084A

Abstract

At least some embodiments of the present disclosures are directed to a hybrid electroporation ablation catheter. In some embodiments, the hybrid electroporation ablation catheter comprises a catheter shaft having a proximal end and an opposite distal end and an electrode assembly extending from the distal end of the catheter shaft and the electrode assembly comprising a plurality of energy-delivering electrodes. The electrode assembly is configured to be selectively operable in a plurality of different operation modes.

Description

ELECTROPORATION ABLATION CATHETER

CROSS REFERENCE TO RELATED APPLICATION

[0001] This application claims priority to Provisional Application No. 63/056,300, filed July 24, 2020, which is herein incorporated by reference in its entirety.

TECHNICAL FIELD

[0002] The present disclosure relates to medical systems and methods for ablating tissue in a patient. More specifically, the present disclosure relates to medical systems and methods for ablation of tissue by electroporation.

BACKGROUND

[0003] Ablation procedures are used to treat many different conditions in patients. Ablation can be used to treat cardiac arrhythmias, benign tumors, cancerous tumors, and to control bleeding during surgery. Usually, ablation is accomplished through thermal ablation techniques including radio-frequency (RF) ablation and cryoablation.

In RF ablation, a probe is inserted into the patient and radio frequency waves are transmitted through the probe to the surrounding tissue. The radio frequency waves generate heat, which destroys surrounding tissue and cauterizes blood vessels. In cryoablation, a hollow needle or cryoprobe is inserted into the patient and cold, thermally conductive fluid is circulated through the probe to freeze and kill the surrounding tissue. RF ablation and cryoablation techniques indiscriminately kill tissue through cell necrosis, which may damage or kill otherwise healthy tissue, such as tissue in the esophagus, phrenic nerve cells, and tissue in the coronary arteries.

[0004] Another ablation technique uses electroporation. In electroporation, or electro-permeabilization, an electrical field is applied to cells in order to increase the permeability of the cell membrane. The electroporation can be reversible or irreversible, depending on the strength of the electric field. If the electroporation is reversible, the increased permeability of the cell membrane can be used to introduce chemicals, drugs, and/or deoxyribonucleic acid (DNA) into the cell, prior to the cell healing and recovering. If the electroporation is irreversible, the affected cells are killed through apoptosis.

[0005] Irreversible electroporation can be used as a nonthermal ablation technique. In irreversible electroporation, trains of short, high voltage pulses are used to generate electric fields that are strong enough to kill cells through apoptosis. In ablation of cardiac tissue, irreversible electroporation can be a safe and effective alternative to the indiscriminate killing of thermal ablation techniques, such as RF ablation and cryoablation. irreversible electroporation can be used to kill targeted tissue, such as myocardium tissue, by using an electric field strength and duration that kills the targeted tissue but does not permanently damage other cells or tissue, such as non-targeted myocardium tissue, red blood cells, vascular smooth muscle tissue, endothelium tissue, and nerve cells.

SUMMARY

[0006] As recited in examples, Example 1 is a hybrid electroporation ablation catheter. The hybrid electroporation ablation catheter comprises a catheter shaft having a proximal end and an opposite distal end and an electrode assembly extending from the distal end of the catheter shaft, the electrode assembly comprising a plurality of energy-delivering electrodes. The electrode assembly is configured to be selectively operable in a first operation mode and a second operation mode. The electrode assembly comprises an inner shaft adapted to be extended from and retracted into the catheter shaft. The plurality of energy-delivering electrodes comprise a plurality of first electrodes and a plurality of second electrodes. When operating in the first operation mode, the inner shaft is extended from the catheter shaft, and the plurality of first electrodes and the plurality of second electrodes are activated. When operating in the second operation mode, the inner shaft is at least partially retracted into the catheter shaft, the plurality of first electrodes are activated, and the plurality of second electrodes are deactivated.

[0007] Example 2 is the hybrid electroporation ablation catheter of Example 1, wherein in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty millimeters and twenty-eight millimeters, and wherein in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between five millimeters and twenty millimeters [0008] Example 3 is the hybrid electroporation ablation catheter of Example 1, wherein the electrode assembly further comprises a plurality of splines connected to the inner shaft at a distal end of the inner shaft, wherein the plurality of energy-delivering electrodes are disposed on the plurality of splines.

[0009] Example 4 is the hybrid electroporation ablation catheter of Example 3, wherein the plurality of splines form a first cavity having a first diameter in the first operation mode, wherein the plurality of splines form a second cavity having a second diameter in the second operation mode, and wherein the first diameter is larger than the second diameter.

[0010] Example 5 is the hybrid electroporation ablation catheter of Example 1, wherein the plurality of second electrodes are disposed closer to a distal end of the inner shaft than the plurality of first electrodes.

[0011] Example 6 is the hybrid electroporation ablation catheter of any one of Examples 1-5, wherein the catheter shaft is deflectable.

[0012] Example 7 is the hybrid electroporation ablation catheter of any one of Examples 1-6, wherein the plurality of second electrodes are retracted into the catheter shaft in the second operation mode.

[0013] Example 8 is the hybrid electroporation ablation catheter of Example 1, further comprising: one or more return electrodes disposed on the catheter shaft.

[0014] Example 9 is the hybrid electroporation ablation catheter of any one of Examples 1-8, further comprising: an actuator configured to move the inner shaft relative to the catheter shaft, and a sensor configured to detect a position of the actuator.

[0015] Example 10 is the hybrid electroporation ablation catheter of Example 9, wherein the hybrid electroporation ablation catheter is configured to set to one of the first operation mode and the second operation mode based on the detected position of the actuator. [0016] Example 11 is the hybrid electroporation ablation catheter of Example 1, wherein the plurality of first electrodes is individually controllable.

[0017] Example 12 is the hybrid electroporation ablation catheter of Example 1, wherein the plurality of second electrodes is individually controllable.

[0018] Example 13 is a system comprising any one of the hybrid electroporation ablation catheter of Examples 1-12.

[0019] Example 14 is the system of Example 13, further comprising: a pulse generator configured to generate and deliver electroporation pulse to the hybrid electroporation ablation device.

[0020] Example 15 is the system of Example 14, further comprising: a controller coupled to the pulse generator and the hybrid electroporation ablation device and configured to select an operation mode of the hybrid electroporation ablation device. [0021] Example 16 is a hybrid electroporation ablation catheter. The hybrid electroporation ablation catheter comprises a catheter shaft having a proximal end and an opposite distal end and an electrode assembly extending from the distal end of the catheter shaft, the electrode assembly comprising a plurality of energy-delivering electrodes. The electrode assembly is configured to be selectively operable in a first operation mode and a second operation mode. The electrode assembly comprises an inner shaft adapted to be extended from and retracted into the catheter shaft. The plurality of energy-delivering electrodes comprise a plurality of first electrodes and a plurality of second electrodes. When operating in the first operation mode, the inner shaft is extended from the catheter shaft, and the plurality of first electrodes and the plurality of second electrodes are activated. When operating in the second operation mode, the inner shaft is at least partially retracted into the catheter shaft, the plurality of first electrodes are activated, and the plurality of second electrodes are deactivated. [0022] Example 17 is the hybrid electroporation ablation catheter of Example 16, wherein in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty millimeters and twenty-eight millimeters, and wherein in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between five millimeters and twenty millimeters [0023] Example 18 is the hybrid electroporation ablation catheter of Example 16, wherein the electrode assembly further comprises a plurality of splines connected to the inner shaft at a distal end of the inner shaft, wherein the plurality of energy-delivering electrodes are disposed on the plurality of splines.

[0024] Example 19 is the hybrid electroporation ablation catheter of Example 18, wherein the plurality of splines form a first cavity having a first diameter in the first operation mode, wherein the plurality of splines form a second cavity having a second diameter in the second operation mode, and wherein the first diameter is larger than the second diameter.

[0025] Example 20 is the hybrid electroporation ablation catheter of Example 16, wherein the plurality of second electrodes are disposed closer to a distal end of the inner shaft than the plurality of first electrodes.

[0026] Example 21 is the hybrid electroporation ablation catheter of Example 16, wherein the catheter shaft is deflectable.

[0027] Example 22 is the hybrid electroporation ablation catheter of Example 16, wherein the plurality of second electrodes are retracted into the catheter shaft in the second operation mode.

[0028] Example 23 is the hybrid electroporation ablation catheter of Example 16, further comprising: one or more return electrodes disposed on the catheter shaft.

[0029] Example 24 is the hybrid electroporation ablation catheter of Example 16, further comprising: an actuator configured to move the inner shaft relative to the catheter shaft, and a sensor configured to detect a position of the actuator.

[0030] Example 25 is the hybrid electroporation ablation catheter of Example 24, wherein the hybrid electroporation ablation catheter is configured to set to one of the first operation mode and the second operation mode based on the detected position of the actuator.

[0031] Example 26 is the hybrid electroporation ablation catheter of Example 16, wherein the plurality of first electrodes is individually controllable.

[0032] Example 27 is the hybrid electroporation ablation catheter of Example 16, wherein the plurality of second electrodes is individually controllable. [0033] Example 28 is a hybrid electroporation ablation system. The hybrid electroporation ablation system comprises a hybrid electroporation ablation catheter, a pulse generator configured to generate and deliver electroporation pulse to the hybrid electroporation ablation device, and a controller coupled to the pulse generator and the electroporation ablation device. The hybrid electroporation ablation catheter comprises a catheter shaft having a proximal end and an opposite distal end and an electrode assembly extending from the distal end of the catheter shaft, the electrode assembly comprising a plurality of energy-delivering electrodes. The electrode assembly is configured to be selectively operable in a first operation mode and a second operation mode. The electrode assembly comprises an inner shaft adapted to be extended from and retracted into the catheter shaft. The plurality of energy-delivering electrodes comprise a plurality of first electrodes and a plurality of second electrodes. When operating in the first operation mode, the inner shaft is extended from the catheter shaft, and the plurality of first electrodes and the plurality of second electrodes are activated. When operating in the second operation mode, the inner shaft is at least partially retracted into the catheter shaft, the plurality of first electrodes are activated, and the plurality of second electrodes are deactivated.

[0034] Example 29 is the hybrid electroporation ablation system of Example 28, wherein in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty millimeters and twenty-eight millimeters, and wherein in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between five millimeters and twenty millimeters [0035] Example 30 is the hybrid electroporation ablation system of Example 28, wherein the electrode assembly further comprises a plurality of splines connected to the inner shaft at a distal end of the inner shaft, wherein the plurality of energy-delivering electrodes are disposed on the plurality of splines.

[0036] Example 31 is the hybrid electroporation ablation system of Example 28, wherein the controller is configured to select an operation mode of the hybrid electroporation ablation device. [0037] Example 32 is a method for electroporation ablations. The method includes the steps of: deploying a hybrid electroporation ablation catheter approximate to a target tissue, the hybrid electroporation ablation catheter operable in a plurality of operation modes, the plurality of operation modes comprising a first operation mode and a second operation mode, the hybrid electroporation ablation catheter configured to deliver ablative energy to form circumferential ablation lesion in the first operation mode and configured to deliver ablative energy to form a focal ablation lesion in the second operation mode; selecting an operation mode from the plurality of operation modes of the hybrid electroporation ablation catheter; operating the hybrid electroporation ablation catheter in the selected operation mode; and generating an electric field at a plurality of electrodes of the catheter according to the selected operation mode, the electric field having an electric field strength sufficient for ablating target tissue via irreversible electroporation.

[0038] Example 33 is the method of Example 32, wherein the hybrid electroporation ablation catheter comprises a catheter shaft and an electrode assembly extending from a distal end of the catheter shaft.

[0039] Example 34 is the method of Example 33, wherein the electrode assembly comprises a plurality of electrodes, and wherein at least one of the plurality of electrodes is deactivated in one of the plurality of operation modes.

[0040] Example 35 is the method of Example 32, wherein the electrode assembly is configured to form a plurality of shapes in the plurality of operation modes, and wherein the plurality of shapes have a different volume from each other.

[0041] While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS [0042] FIG. 1 depicts an illustrative system diagram for an electroporation ablation system or device, in accordance with embodiments of the subject matter of the disclosure.

[0043] FIG. 2A is a diagram illustrating a hybrid electroporation ablation catheter in a first operation mode, in accordance with embodiments of the subject matter of the disclosure.

[0044] FIG. 2B is a diagram illustrating the hybrid electroporation ablation catheter illustrated in FIG. 2A in a second operation mode, in accordance with embodiments of the subject matter of the disclosure.

[0045] FIG. 2C is a diagram illustrating the hybrid electroporation ablation catheter illustrated in FIG. 2A with additional components, in accordance with embodiments of the subject matter of the disclosure.

[0046] FIG. 3 is another diagram illustrating a hybrid electroporation ablation catheter, in accordance with embodiments of the subject matter of the disclosure [0047] FIG. 4 is an example flow diagram depicting an illustrative method of using a hybrid electroporation ablation catheter, in accordance with some embodiments of the present disclosure.

[0048] While the invention is amenable to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and are described in detail below. The intention, however, is not to limit the invention to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the scope of the invention as defined by the appended claims.

DETAILED DESCRIPTION

[0049] As the terms are used herein with respect to measurements (e.g., dimensions, characteristics, attributes, components, etc.), and ranges thereof, of tangible things (e.g., products, inventory, etc.) and/or intangible things (e.g., data, electronic representations of currency, accounts, information, portions of things (e.g., percentages, fractions), calculations, data models, dynamic system models, algorithms, parameters, etc.), "about" and “approximately” may be used, interchangeably, to refer to a measurement that includes the stated measurement and that also includes any measurements that are reasonably close to the stated measurement, but that may differ by a reasonably small amount such as will be understood, and readily ascertained, by individuals having ordinary skill in the relevant arts to be attributable to measurement error; differences in measurement and/or manufacturing equipment calibration; human error in reading and/or setting measurements; adjustments made to optimize performance and/or structural parameters in view of other measurements (e.g., measurements associated with other things); particular implementation scenarios; imprecise adjustment and/or manipulation of things, settings, and/or measurements by a person, a computing device, and/or a machine; system tolerances; control loops; machine-learning; foreseeable variations (e.g., statistically insignificant variations, chaotic variations, system and/or model instabilities, etc.); preferences; and/or the like. [0050] Although illustrative methods may be represented by one or more drawings (e.g., flow diagrams, communication flows, etc.), the drawings should not be interpreted as implying any requirement of, or particular order among or between, various steps disclosed herein. However, certain some embodiments may require certain steps and/or certain orders between certain steps, as may be explicitly described herein and/or as may be understood from the nature of the steps themselves (e.g., the performance of some steps may depend on the outcome of a previous step). Additionally, a “set,” “subset,” or “group” of items (e.g., inputs, algorithms, data values, etc.) may include one or more items, and, similarly, a subset or subgroup of items may include one or more items. A “plurality” means more than one.

[0051] As used herein, the term “based on” is not meant to be restrictive, but rather indicates that a determination, identification, prediction, calculation, and/or the like, is performed by using, at least, the term following “based on” as an input. For example, predicting an outcome based on a particular piece of information may additionally, or alternatively, base the same determination on another piece of information.

[0052] Cryo energy and radio-frequency (RF) energy kill tissues indiscriminately through cell necrosis, which can damage the esophagus, the phrenic nerve, coronary arteries, in addition to other undesired effects. Irreversible electroporation (IRE) uses high voltage, short (e.g., 100 microseconds or shorter) pulses to kill ceils through apoptosis. IRE can be targeted to kill myocardium, sparing other adjacent tissues including the esophageal vascular smooth muscle and endothelium.

[0053] The present disclosure describes devices and methods for implementing multiple ablation strategies, i.e., circumferential ablation and focal ablation, using a single IRE ablation catheter. Circumferential ablation involves forming substantially circular, ring-shaped ablation lesions of relatively large diameter, and is particularly useful for ablating the pulmonary vein ostia in so-called “pulmonary vein isolation” (PVI) procedures for treating paroxysmal AF. This requires an IRE ablation catheter with an electrode set having a relatively larger footprint to treat the pulmonary vein ostia, ideally with a single energy application. Focal ablation, in contrast, creates lesions that are significantly smaller than circumferential lesions formed in PVI procedures, and is generally employed to create lines of electrical block using sequential energy applications, e.g., along the cardiac chamber wall, to treat atrial tachycardias, AV reentrant arrhythmias, persistent AF, and the like. Focal ablation via IRE requires an IRE ablation catheter with electrode sets arranged in a smaller footprint as compared to the aforementioned catheters for forming circumferential lesions. Currently, circumferential ablation and focal ablation require catheters specifically designed for each ablation strategy, which in turn require removal of one ablation catheter, e.g., the circumferential ablation catheter following PVI, and replacement with a focal ablation catheter if both circumferetial and focal ablation strategies are warranted in a single clinical procedure.

[0054] Embodiments of the present disclosure are directed to systems/devices and methods for IRE that are capable of implementing two or more ablation strategies (e.g., circumferential and focal ablation) using a single catheter, referred to as hybrid electroporation ablation catheter. In some embodiments, a hybrid exploration ablation catheter is configured to have two operation modes, with one suitable for circumferential ablation and one suitable for focal ablation. In some cases, the hybrid catheter in different operation modes has different shapes of the electrode assembly. In some cases, the hybrid catheter in different operation modes has different sets of electrodes being activated in the electrode assembly. In some cases, the hybrid catheter in different operation modes has both different sets of electrodes being activated and different shapes in the electrode assembly. In some embodiments, the two or more operation modes can be selected by an operator depending on the intended ablation strategy. In some embodiments, the two or more operation modes can be selected by a controller automatically depending on the intended ablation strategy and/or sensing data.

[0055] FIG. 1 depicts an illustrative system diagram for an electroporation ablation system or device 100, in accordance with embodiments of the subject matter of the disclosure. The electroporation ablation system/device 100 includes one or more hybrid electroporation ablation catheters 110, an introducer sheath 130, a controller 140, a pulse generator 150, and a memory 160. In embodiments, the electroporation ablation system/device 100 is configured to deliver electric field energy to target tissue in a patient’s heart to create tissue apoptosis, rendering the tissue incapable of conducting electrical signals. In some cases, the electroporation ablation system/device 100 may connect with other system(s) 170, for example, a mapping system, an electrophysiology system, and/or the like.

[0056] In embodiments, the hybrid electroporation ablation catheter 110 is designed to have two or more operation modes, each operation mode is suitable for a type of ablation operation (e.g., circumferential or single shot ablation, focal ablation, segment ablation, etc.). The catheter 110 is designed to be disposed by a target ablation location in the intracardiac chamber. As used herein, an intracardiac chamber refers to cardiac chamber and its surrounding blood vessels (e.g., pulmonary veins).

The pulse generator 150 is configured to generate ablative pulse/energy, or referred to as electroporation pulse/energy, to be delivered to electrodes of the catheter 110. The electroporation pulse is typically high voltage and short pulse. The electroporation controller 140 is configured to control functional aspects of the electroporation ablation system/device 100. In embodiments, the electroporation controller 140 is configured to control the pulse generator 150 on the generation and delivery of ablative energy to electrodes of the catheter 110. In embodiments, the controller 140 is configured to control the operation mode of the hybrid electroporation ablation catheter 110. [0057] In one embodiment, the catheter 110 has one or more electrodes. In some embodiments, the catheter 110 includes an electrode assembly including one or more electrodes. In some cases, the electrode assembly is configured to deliver different electric field energies in magnitude in different operation modes. In some cases, the electrode assembly includes an expandable component that is configured to have different expanded shapes in different operation modes. In some cases, the operation modes are varied with the shapes and/or diameter of the electrode assembly. In some cases, each of the one or more electrodes of the catheter 110 is individually addressable and controllable. In some cases, the controller 140 may control the ablative energy delivery to each electrode, such that the electric field formed by the plurality of electrodes can be controlled and adjusted. In some cases, a part of the one or more electrodes can be deactivated by the controller 140.

[0058] In some cases, a specific set of electrodes can be activated by the controller 140 for an operation mode. In some cases, a part of the one or more electrodes can be retracted into a shaft of the catheter 110 in a specific operation mode. In some cases, a distance between adjacent active electrodes is generally the same among all active electrodes or a subset of active electrodes. In one example, the electrodes are active every other ones in an operation mode, for example, when the electrode assembly has a relatively small operation diameter. In one embodiment, a distance between adjacent active electrodes is generally the same (e.g., within 10% variation from the average distance) at a first operation (e.g., circumferential ablation) as at a second distance (e.g., focal ablation), while other electrodes are deactivated. [0059] In some cases, the electroporation controller 140 receives sensor data collected by sensor(s) of catheter(s). In some cases, the electroporation controller 140 can change the operation mode of the catheter 110 in response to the receiving sensing data. In some cases, the electroporation system/device 100 may include an actuator 120 configured to change the operational shape of the electrode assembly of the catheter 110. In some cases, the electroporation system/device 100 may further include a position sensor to monitor the position of the actuator. In one example, the controller 140 can receive sensing data generated by the position sensor and change the operation mode of the catheter in response to the position of the actuator. In embodiments, the actuator 120 is integrated with or connected to the catheter 110. [0060] In some cases, the electroporation controller 140 can change the ablative energy delivered to electrodes in response to the sensing data. In some cases, the electroporation controller 140 is configured to model the electric fields that can be generated by the catheter 110, which often includes consideration of the physical characteristics of the electroporation ablation catheter 110 including the electrodes and spatial relationships of the electrodes on the electroporation ablation catheter 110. In embodiments, the electroporation controller 140 is configured to control the electric field strength of the electric field formed by the electrodes of the catheter 110 to be no higher than 1500 volts per centimeter.

[0061] In embodiments, the electroporation controller 140 includes one or more controllers, microprocessors, and/or computers that execute code out of memory 160, for example, non-transitory machine readable medium, to control and/or perform the functional aspects of the electroporation ablation system/device 100. In embodiments, the memory 160 can be part of the one or more controllers, microprocessors, and/or computers, and/or part of memory capacity accessible through a network, such as the world wide web. In embodiments, the memory 160 comprises a data repository 165, which is configured to store ablation data (e.g., location, energy, etc.), sensed data, modelled electric field data, treatment plan data, and/or the like.

[0062] In embodiments, the introducer sheath 130 is operable to provide a delivery conduit through which the hybrid electroporation ablation catheter 110 can be deployed to specific target sites within a patient’s cardiac chamber.

[0063] In embodiments, the other systems 170 includes an electro-anatomical mapping (EAM) system. In some cases, the EAM system is operable to track the location of the various functional components of the electroporation ablation system/device 100, and to generate high-fidelity three-dimensional anatomical and electro-anatomical maps of the cardiac chambers of interest. In embodiments, the EAM system can be the RHYTHMIA™ HDx mapping system marketed by Boston Scientific Corporation. Also, in embodiments, the mapping and navigation controller of the EAM system includes one or more controllers, microprocessors, and/or computers that execute code out of memory to control and/or perform functional aspects of the EAM system.

[0064] The EAM system generates a localization field, via a field generator, to define a localization volume about the heart, and one or more location sensors or sensing elements on the tracked device(s), e.g., the electroporation ablation catheter pair 105, generate an output that can be processed by a mapping and navigation controller to track the location of the sensor, and consequently, the corresponding device, within the localization volume. In one embodiment, the device tracking is accomplished using magnetic tracking techniques, whereby the field generator is a magnetic field generator that generates a magnetic field defining the localization volume, and the location sensors on the tracked devices are magnetic field sensors. [0065] In some embodiments, impedance tracking methodologies may be employed to track the locations of the various devices. In such embodiments, the localization field is an electric field generated, for example, by an external field generator arrangement, e.g., surface electrodes, by intra-body or intra-cardiac devices, e.g., an intracardiac catheter, or both. In these embodiments, the location sensing elements can constitute electrodes on the tracked devices that generate outputs received and processed by the mapping and navigation controller to track the location of the various location sensing electrodes within the localization volume.

[0066] In embodiments, the EAM system is equipped for both magnetic and impedance tracking capabilities. In such embodiments, impedance tracking accuracy can, in some instances be enhanced by first creating a map of the electric field induced by the electric field generator within the cardiac chamber of interest using a probe equipped with a magnetic location sensor, as is possible using the aforementioned RHYTHMIA HDx™ mapping system. One exemplary probe is the INTELLAMAP ORION™ mapping catheter marketed by Boston Scientific Corporation.

[0067] Regardless of the tracking methodology employed, the EAM system utilizes the location information for the various tracked devices, along with cardiac electrical activity acquired by, for example, the electroporation ablation catheter pair 105 or another catheter or probe equipped with sensing electrodes, to generate, and display via a display, detailed three-dimensional geometric anatomical maps or representations of the cardiac chambers as well as electro-anatomical maps in which cardiac electrical activity of interest is superimposed on the geometric anatomical maps. Furthermore, the EAM system can generate a graphical representation of the various tracked devices within the geometric anatomical map and/or the electro-anatomical map.

[0068] According to embodiments, various components (e.g., the controller 140) of the electrophysiology system 100 may be implemented on one or more computing devices. A computing device may include any type of computing device suitable for implementing embodiments of the disclosure. Examples of computing devices include specialized computing devices or general-purpose computing devices such “workstations,” “servers,” “laptops,” “desktops,” “tablet computers,” “hand-held devices,” “general-purpose graphics processing units (GPGPUs),” and the like, all of which are contemplated within the scope of FIG. 1 with reference to various components of the system 100.

[0069] In some embodiments, a computing device includes a bus that, directly and/or indirectly, couples the following devices: a processor, a memory, an input/output (I/O) port, an I/O component, and a power supply. Any number of additional components, different components, and/or combinations of components may also be included in the computing device. The bus represents what may be one or more busses (such as, for example, an address bus, data bus, or combination thereof). Similarly, in some embodiments, the computing device may include a number of processors, a number of memory components, a number of I/O ports, a number of I/O components, and/or a number of power supplies. Additionally, any number of these components, or combinations thereof, may be distributed and/or duplicated across a number of computing devices.

[0070] In some embodiments, the memory 160 includes computer-readable media in the form of volatile and/or nonvolatile memory, transitory and/or non-transitory storage media and may be removable, nonremovable, or a combination thereof. Media examples include Random Access Memory (RAM); Read Only Memory (ROM); Electronically Erasable Programmable Read Only Memory (EEPROM); flash memory; optical or holographic media; magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices; data transmissions; and/or any other medium that can be used to store information and can be accessed by a computing device such as, for example, quantum state memory, and/or the like. In some embodiments, the memory 160 stores computer-executable instructions for causing a processor (e.g., the controller 140) to implement aspects of embodiments of system components discussed herein and/or to perform aspects of embodiments of methods and procedures discussed herein.

[0071] Computer-executable instructions may include, for example, computer code, machine-useable instructions, and the like such as, for example, program components capable of being executed by one or more processors associated with a computing device. Program components may be programmed using any number of different programming environments, including various languages, development kits, frameworks, and/or the like. Some or all of the functionality contemplated herein may also, or alternatively, be implemented in hardware and/or firmware.

[0072] The data repository 165 may be implemented using any one of the configurations described below. A data repository may include random access memories, flat files, XML files, and/or one or more database management systems (DBMS) executing on one or more database servers or a data center. A database management system may be a relational (RDBMS), hierarchical (HDBMS), multidimensional (MDBMS), object oriented (ODBMS or OODBMS) or object relational (ORDBMS) database management system, and the like. The data repository may be, for example, a single relational database. In some cases, the data repository may include a plurality of databases that can exchange and aggregate data by data integration process or software application. In an exemplary embodiment, at least part of the data repository 165 may be hosted in a cloud data center. In some cases, a data repository may be hosted on a single computer, a server, a storage device, a cloud server, or the like. In some other cases, a data repository may be hosted on a series of networked computers, servers, or devices. In some cases, a data repository may be hosted on tiers of data storage devices including local, regional, and central.

[0073] Various components of the system/device 100 can communicate via or be coupled to via a communication interface, for example, a wired or wireless interface. The communication interface includes, but not limited to, any wired or wireless short- range and long-range communication interfaces. The wired interface can use cables, umbilicals, and the like. The short-range communication interfaces may be, for example, local area network (LAN), interfaces conforming known communications standard, such as Bluetooth® standard, IEEE 802 standards (e.g., IEEE 802.11), a ZigBee® or similar specification, such as those based on the IEEE 802.15.4 standard, or other public or proprietary wireless protocol. The long-range communication interfaces may be, for example, wide area network (WAN), cellular network interfaces, satellite communication interfaces, etc. The communication interface may be either within a private computer network, such as intranet, or on a public computer network, such as the internet.

[0074] FIG. 2A is a diagram illustrating a portion of a hybrid electroporation ablation catheter 200 in a first operation mode; FIG. 2B is a diagram illustrating the hybrid electroporation ablation catheter 200 in a second operation mode, in accordance with embodiments of the subject matter of the disclosure. As shown, the catheter 200 includes a catheter shaft 202 and an inner shaft 203 disposed within the catheter shaft 202, and extending distally from a distal end 206 of the catheter shaft 202. As will be appreciated, the catheter shaft 202 is coupled, at its proximal end, to a handle assembly (not shown) configured to be manipulated by a user during an electroporation ablation procedure. As further shown, the catheter 200 includes an electrode assembly 220 at a distal end extending from the distal end 206 of the catheter shaft 202.

[0075] In embodiments, the electrode assembly 220 comprising a plurality of energy-delivering electrodes 225, where the electrode assembly 220 is configured to be selectively operable in a first operation mode and a second operation mode. In some cases, in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty (20) millimeters and twenty-eight (28) millimeters. In some cases, in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty-two (22) millimeters and thirty-five (35) millimeters. In some cases, in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty (20) millimeters and thirty-five (35) millimeters. In some cases, in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between five (5) millimeters and twenty (20) millimeters. In some cases, in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between two (2) millimeters and sixteen (16) millimeters. In some cases, in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between two (2) millimeters and twenty (20) millimeters. In some cases, in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a depth of three (3) millimeters and four (4) millimeters.

[0076] In some embodiments, the electrode assembly 220 includes an inner shaft 203, where the inner shaft 203 is adapted to be extended from and retracted into the catheter shaft 202. In some cases, the electrode assembly 220 includes a plurality of splines 204 connected to the inner shaft 203 at a distal end 211 of the inner shaft 203.

In some cases, the electrode assembly 220 further includes a center shaft 203a having a proximal end 211a (overlapped with the distal end 211 of the inner shaft 203) and a distal end 212. In some cases, the plurality of splines 204 are connected to the distal end 212 of the center shaft 203a. In embodiments, the electrodes 225 includes a plurality of first electrodes 208 and a plurality of second electrodes 210 disposed on the plurality of splines 204. In one example, the plurality of second electrodes 210 are disposed close to the distal end 212 of the center shaft 203a and the plurality of first electrodes 208 are disposed close to the proximal end 211a of the center shaft 203a. [0077] In some cases, when operating in the first operation mode, the inner shaft 203 and the center shaft 203a are extended from the catheter shaft 202, for example, as illustrated in FIG. 2A. In some cases, in the first operation mode, both the plurality of first electrodes 208 and the plurality of second electrodes 210 are activated selectively energized to form relatively large diameter, circumferential ablation lesions, e.g., such as are created in a PVI procedure.

[0078] In some embodiments, when operating in the second operation mode, the inner shaft 203 and the center shaft 203a are at least partially retracted into the catheter shaft 202 such that all or a part of the plurality of first electrodes 208 are retracted into the catheter shaft 202, for example, as illustrated in FIG. 2B. In some cases, in the second operation mode, the plurality of first electrodes 208 are deactivated (e.g., by electrically disconnecting the first electrodes 208 from any pulse generator circuitry) and the plurality of second electrodes 210 are activated and used to create focal ablation lesions via electroporation.

[0079] The hybrid electroporation ablation catheter 200 has a longitudinal axis 222. As used herein, a longitudinal axis refers to a line passing through the centroid of the cross sections of an object. In embodiments, the plurality of splines 204 forms a cavity 224. The plurality of splines 204 forms a cavity 224a in the first operation mode and forms a cavity 224b in the second operation mode. In embodiments, the cavity 224a is larger than the cavity 224b in volume. In some embodiments, in the first operation mode, the largest cross-sectional area generally perpendicular to the longitudinal axis 222 of the cavity 224a has a diameter d1. In some embodiments, in the second operation mode, the largest cross-sectional area generally perpendicular to the longitudinal axis 222 of the cavity 224b has a diameter d2. In some cases, the diameter d1 is larger than the diameter d2. In some examples, the diameter d1 is in the range of twenty (20) millimeters and thirty-five (35) millimeters. In some examples, the diameter d2 is in the range of five (5) millimeters and sixteen (16) millimeters. In one example, the diameter d1 is greater than the diameter d2 by 30% to 100%. In one example, the diameter d1 is greater than the diameter d2 by at least 30%. In one example, the diameter d1 is greater than the diameter d2 by at least 100% (i.e., at least two times of the diameter d2). In one example, the diameter d1 is greater than the diameter d2 by at least 150% (i.e., at least two and a half times of the diameter d2). [0080] In some cases, the catheter shaft 202 is deflectable, implemented using techniques generally known in the art. In some cases, the catheter 200 includes an inflatable balloon (not shown) disposed in the cavity 224 of the splines 204. FIG. 2C is a diagram illustrating the hybrid electroporation ablation catheter illustrated in FIG. 2A with additional features, in accordance with embodiments of the subject matter of the disclosure. In some embodiments, the catheter 200C includes one or more return electrodes 205. In some cases, the one or more return electrodes 205 are disposed on the catheter shaft 202. In some cases, the catheter 200C may include an actuator (not shown) configured to move the inner shaft 203 relative to the catheter shaft 202. In some cases, the actuator is external of the catheter 200C but connected to the catheter 200C. In some cases, the catheter 200 may include a sensor 213 configured to detect a position of the actuator. In one embodiment, the operation mode of the hybrid electroporation ablation catheter 200 is set based on the detected position of the actuator. In one embodiment, the operation mode of the hybrid electroporation ablation catheter 200 is set based on a sensor signal generated by the sensor 213.

[0081] In some cases, the first group of electrodes 208 disposed at or proximate the circumference of the plurality of splines 204 and the second group of electrodes 210 disposed proximate to the distal end 212 of the catheter 200. In some cases, the first group of electrodes 208 are referred to as proximal electrodes, and the second group of electrodes 210 are referred to as distal electrodes, where the distal electrodes 210 are disposed closer to the distal end 212 of the electroporation ablation catheter 200 than the proximal electrodes 208. In some implementations, the electrodes 225 can include a thin film of an electro-conductive or optical ink. The ink can be polymer-based. The ink may additionally comprise materials such as carbon and/or graphite in combination with conductive materials. The electrode can include a biocompatible, low resistance metal such as silver, silver flake, gold, and platinum which are additionally radiopaque. [0082] Each of the electrodes in the first group of electrodes 208 and each of the electrodes in the second group of electrodes 210 is configured to conduct electricity and to be operably connected to a controller (e.g., the controller 140 in FIG. 1) and an ablative energy generator (e.g., the pulse generator 150 of FIG. 1). In embodiments, one or more of the electrodes in the first group of electrodes 208 and the second group of electrodes 210 includes flex circuits. In some cases, the plurality of first electrodes 208 are individually controllable. In some cases, the plurality of second electrodes are individually controllable. In some cases, all or a part of the plurality of first electrodes 208 are deactivated in the second operation mode. In some cases, a part of the plurality of second electrodes 210 are deactivated in the second operation mode.

[0083] Electrodes in the first group of electrodes 208 are spaced apart from electrodes in the second group of electrodes 210. The first group of electrodes 208 includes electrodes 208a-208f and the second group of electrodes 210 includes electrodes 210a-210f. Also, electrodes in the first group of electrodes 208, such as electrodes 208a-208f, are spaced apart from one another and electrodes in the second of electrodes 210, such as electrodes 210a-210f, are spaced apart from one another. [0084] The spatial relationships and orientation of the electrodes in the first group of electrodes 208 and the spatial relationships and orientation of the electrodes in the second group of electrodes 210 in relation to other electrodes on the same catheter 200 is known or can be determined. In embodiments, the spatial relationships and orientation of the electrodes in the first group of electrodes 208 and the spatial relationships and orientation of the electrodes in the second group of electrodes 210 in relation to other electrodes on the same catheter 200 is constant, once the catheter is deployed.

[0085] As to electric fields, in embodiments, each of the electrodes in the first group of electrodes 208 and each of the electrodes in the second group of electrodes 210 can be selected to be an anode or a cathode, such that electric fields can be set up between any two or more of the electrodes in the first and second groups of electrodes 208 and 210. Also, in embodiments, each of the electrodes in the first group of electrodes 208 and each of the electrodes in the second group of electrodes 210 can be selected to be a biphasic pole, such that the electrodes switch or take turns between being an anode and a cathode. Also, in embodiments, groups of the electrodes in the first group of electrodes 208 and groups of the electrodes in the second group of electrodes 210 can be selected to be an anode or a cathode or a biphasic pole, such that electric fields can be set up between any two or more groups of the electrodes in the first and second groups of electrodes 208 and 210.

[0086] In embodiments, electrodes in the first group of electrodes 208 and the second group of electrodes 210 can be selected to be biphasic pole electrodes, such that during a pulse train including a biphasic pulse train, the selected electrodes switch or take turns between being an anode and a cathode, and the electrodes are not relegated to monophasic delivery where one is always an anode and another is always a cathode. In some cases, the electrodes in the first and second group of electrodes 208 and 210 can form electric fields with electrode(s) of another catheter. In such cases, the electrodes in the first and second group of electrodes 208 and 210 can be anodes of the fields, or cathodes of the fields.

[0087] Further, as described herein, the electrodes are selected to be one of an anode and a cathode, however, it is to be understood without stating it that throughout the present disclosure the electrodes can be selected to be biphasic poles, such that they switch or take turns between being anodes and cathodes. In some cases, one or more of the electrodes in the first group of electrodes 208 are selected to be cathodes and one or more of the electrodes in the second group of electrodes 210 are selected to be anodes. In embodiments, one or more of the electrodes in the first group of electrodes 208 can be selected as a cathode and another one or more of the electrodes in the first group of electrodes 208 can be selected as an anode. In addition, in embodiments, one or more of the electrodes in the second group of electrodes 210 can be selected as a cathode and another one or more of the electrodes in the second group of electrodes 210 can be selected as an anode.

[0088] FIG. 3 is a diagram illustrating a hybrid electroporation ablation catheter 300, in accordance with embodiments of the subject matter of the disclosure. The catheter 300 includes an electrode assembly 305 extended from a distal end 306 of a catheter shaft 302. In the example illustrated, the electrode assembly 305 includes an expandable support structure 307 (e.g., a spline assembly as illustrated, although other expandable structures, e.g., inflatable balloon, may be used) a proximal first set of electrodes 310 disposed proximate the maximum diameter of the support structure 307, and , and a more distal second set of electrodes 320 disposed on the support structure 307 near its distal end.

[0089] As can be seen in FIG. 3, the proximal first set of electrodes 310 defines a ring of electrode pairs having a relatively large diameter, and can be suitable for forming relatively large substantially circumferential lesions, e.g., for isolating the pulmonary vein ostia in PVI procedures. In contrast, the distal second set of electrodes 320 defines a ring of electrode pairs having a relatively small diameter (compared to that formed by the first set of electrodes 310), and can be particularly configured for forming relatively small diameter focal ablation lesions on the cardiac chamber walls that may be delivered individually or sequentially through a series of energy deliveries to create a contiguous line of interconnected lesions forming a solid line of electrical conduction block.

[0090] In embodiments, the hybrid electroporation ablation catheter 300, the electrodes forming the first and second sets of electrodes 310, 320 are each individually addressable (e.g., by the controller 140 described above). As such, in some embodiments, the hybrid electroporation ablation catheter 300 has a first operation mode (e.g., circumferential ablation) and a second operation mode (e.g., focal ablation). In one example, the first set of electrodes 310 are activated and the second set of electrodes 320 are deactivated in the first operation mode. In one example, the first set of electrodes 310 are deactivated and the second set of electrodes 320 are activated in the second operation mode. The hybrid electroporation ablation catheter 300 thus provides the same dual-use capability as the electroporation ablation catheter 200 described above, but without requiring the user to change the geometry of the electrode assembly 305.

[0091] FIG. 4 is an example flow diagram depicting an illustrative method 400 of using a hybrid electroporation ablation catheter, in accordance with some embodiments of the present disclosure. Aspects of embodiments of the method 400 may be performed, for example, by an electroporation ablation system/device (e.g., the system/device 100 depicted in FIG. 1). One or more steps of method 400 are optional and/or can be modified by one or more steps of other embodiments described herein. Additionally, one or more steps of other embodiments described herein may be added to the method 400. First, the electroporation ablation system/device deploys the hybrid electroporation ablation catheter proximate to a target tissue (410). In one embodiment, the hybrid electroporation ablation catheter is operable in a plurality of operation modes. In some cases, the plurality of operation modes includes a first operation mode and a second operation mode, where the hybrid electroporation ablation catheter is configured to deliver ablative energy to form circumferential ablation lesion in the first operation mode and configured to deliver ablative energy to form focal ablation lesion in the second operation mode.

[0092] In some cases, the hybrid electroporation ablation catheter includes a catheter shaft and an electrode assembly extending from a distal end of the catheter shaft. In one example, the electrode assembly comprises a plurality of electrodes. In some designs, at least one of the plurality of electrodes is deactivated in one of the plurality of operation modes. In some designs, the electrode assembly is configured to form a plurality of shapes in the plurality of operation modes, where the plurality of shapes have a different volume from each other. In some embodiment, the electrode assembly includes an inner shaft and a plurality of splines connected to the inner shaft, where the inner shaft is movable along the longitudinal axis of the catheter relative to the catheter shaft. In some cases, the electrode assembly is connected to or integrated with an actuator, which is configured to control the movement of the inner shaft relative to the catheter shaft.

[0093] In some embodiments, the electroporation ablation system/device selects an operation mode from the plurality of operation modes of the hybrid electroporation ablation catheter (415). In some cases, the operation mode can be selected automatically, for example, by a controller (e.g., the controller 140 in FIG. 1). In some cases, the operation mode is selected in response to sensing data collected by one or more sensors. In one embodiment, the operation mode is selected in response to sensing data indicating a position of the actuator.

[0094] In embodiments, the electroporation ablation system/device operates the hybrid electroporation ablation catheter in the selected operation mode (420), for example, in an operation mode for a specific ablation strategy (e.g., circumferential ablation, focal ablation, segment ablation, etc.). In some cases, the electroporation ablation system/device is configured to generate an electric field according to the selected operation mode by the hybrid electroporation ablation system/device (425), for example, generating the electric field at the electrodes of the catheter. In some cases, the generated electric field has an electric field strength sufficient for ablating target tissue via irreversible electroporation according to the selected operation mode. In some cases, the electroporation ablation system/device is configured to deliver exploration pulse to the electrodes.

[0095] In some cases, the electroporation ablation system/device is further configured to adjust the electric field (430), for example, by changing the exploration pulse and/or the activated electrodes. In one embodiment, a selected set of electrodes are activated. In some cases, the selected set of electrodes are disposed in a specific spatial pattern.

[0096] Various modifications and additions can be made to the exemplary embodiments discussed without departing from the scope of the present invention. For example, while the embodiments described above refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications, and variations as fall within the scope of the claims, together with all equivalents thereof.

Claims

CLAIMS We claim:

1. A hybrid electroporation ablation catheter comprising: a catheter shaft having a proximal end and an opposite distal end; and an electrode assembly extending from the distal end of the catheter shaft, the electrode assembly comprising a plurality of energy-delivering electrodes, wherein the electrode assembly is configured to be selectively operable in a first operation mode and a second operation mode, wherein the electrode assembly comprises an inner shaft adapted to be extended from and retracted into the catheter shaft, wherein the plurality of energy-delivering electrodes comprise a plurality of first electrodes and a plurality of second electrodes, when operating in the first operation mode, the inner shaft is extended from the catheter shaft, and the plurality of first electrodes and the plurality of second electrodes are activated, when operating in the second operation mode, the inner shaft is at least partially retracted into the catheter shaft, the plurality of first electrodes are activated, and the plurality of second electrodes are deactivated.

2. The hybrid electroporation ablation catheter of claim 1, wherein in the first operation mode the electrode assembly is configured to deliver ablative energy to form circumferential ablation lesion having a diameter of between twenty millimeters and twenty-eight millimeters, and wherein in the second operation mode the electrode assembly is configured to deliver ablative energy to form a focal ablation lesion having a diameter of between five millimeters and twenty millimeters

3. The hybrid electroporation ablation catheter of claim 1, wherein the electrode assembly further comprises a plurality of splines connected to the inner shaft at a distal end of the inner shaft, wherein the plurality of energy-delivering electrodes are disposed on the plurality of splines.

4. The hybrid electroporation ablation catheter of claim 3, wherein the plurality of splines form a first cavity having a first diameter in the first operation mode, wherein the plurality of splines form a second cavity having a second diameter in the second operation mode, and wherein the first diameter is larger than the second diameter.

5. The hybrid electroporation ablation catheter of claim 1, wherein the plurality of second electrodes are disposed closer to a distal end of the inner shaft than the plurality of first electrodes.

6. The hybrid electroporation ablation catheter of any one of claims 1-5, wherein the catheter shaft is deflectable.

7. The hybrid electroporation ablation catheter of any one of claims 1-6, wherein the plurality of second electrodes are retracted into the catheter shaft in the second operation mode.

8 The hybrid electroporation ablation catheter of claim 1, further comprising: one or more return electrodes disposed on the catheter shaft.

9. The hybrid electroporation ablation catheter of any one of claims 1-8, further comprising: an actuator configured to move the inner shaft relative to the catheter shaft, and a sensor configured to detect a position of the actuator.

10. The hybrid electroporation ablation catheter of claim 9, wherein the hybrid electroporation ablation catheter is configured to set to one of the first operation mode and the second operation mode based on the detected position of the actuator.

11. The hybrid electroporation ablation catheter of claim 1, wherein the plurality of first electrodes is individually controllable.

12. The hybrid electroporation ablation catheter of claim 1, wherein the plurality of second electrodes is individually controllable.

13. A system comprising any one of the hybrid electroporation ablation catheter of claims 1-12.

14. The system of claim 13, further comprising: a pulse generator configured to generate and deliver electroporation pulse to the hybrid electroporation ablation device.

15. The system of claim 14, further comprising: a controller coupled to the pulse generator and the hybrid electroporation ablation device and configured to select an operation mode of the hybrid electroporation ablation device.