JP2012130392A - Electrode catheter - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an electrode catheter which allows easy confirmation of whether an ablation line wherein desired cautery is performed in a position intended by an operator is formed, and wherein a blood vessel inner wall is hardly damaged by the tip of a catheter tip part.SOLUTION: This electrode catheter includes: a catheter body 10; a control handle 20 connected to the base end thereof; three catheter tip parts extending out from the tip of the catheter body 10 such that the three catheter tip parts expand in a fan shape. In the three catheter tip parts, a first catheter tip part 31 extending out in the axial direction of the catheter body 10, a second catheter tip part 32 extending out to one side of the first catheter tip part 31 at a prescribed angle (α), and a third catheter tip part 33 extending out to the other side of the first catheter tip part at the prescribed angle (α) are disposed on a substantially identical plane.

Description

  The present invention relates to an electrode catheter having a plurality of catheter tip portions.

As a catheter for mapping the electrical activity in the heart, a catheter having a plurality of catheter tips extending radially from the tip of the catheter body, specifically, five catheter tips (projections 14) is known. (See Patent Document 1 and Patent Document 2).
A tip electrode and a ring electrode are attached to each of the catheter tip portions in this catheter, and the potential of an in-circle region having the radius of the length of the catheter tip portion as a radius can be simultaneously measured with one catheter. it can.

Japanese Patent Laid-Open No. 2003-235821 JP 2004-130114 A

  The catheter described in the above-mentioned patent document can be used for various diagnostic / therapeutic actions in addition to mapping of electrical activity.

  For example, it may be possible to confirm whether or not the intended cauterization has been performed after ablation treatment. Specifically, two electrodes (tip electrode or ring electrode) attached to each of the different catheter tip portions are arranged at symmetrical positions with the ablation line (line-shaped ablation site) as an axis, The transmission speed of the electric potential (electric signal) between the two electrodes is measured. When cauterization is performed reliably, the transmission path of the electrical signal directly connecting the two electrodes is blocked by the ablation line, and the electrical signal is bypassed and transmitted, so that the transmission speed is reduced. Delay. On the other hand, when cauterization is not performed reliably, an electrical signal is transmitted between the two electrodes at the shortest distance, so that transmission speed is not delayed. Note that the delay in the transmission speed can be confirmed, for example, by comparing with the transmission speed measured between the two electrodes arranged in the part not cauterized.

  Such a transmission speed measurement is usually performed over the entire length of the ablation line. For this reason, it is necessary to move the catheter tip portions (electrodes attached to each) along the ablation line while maintaining the state where the two catheter tip portions straddle the ablation line.

By the way, various diagnosis and treatment actions using a catheter are usually performed while viewing an X-ray image.
However, since the ablation line cannot be confirmed on the X-ray image, it is not easy to move the two catheter tips along the ablation line while maintaining the state. For this reason, the catheter tip may be displaced from the ablation line. In this case, the ablation that interrupts the electrical signal transmission path between the two electrodes attached to each of the catheter tips. As a result, the delay in the transmission speed of the electric signal is eliminated.

  Including the above cases, when measuring the transmission speed of the electrical signal along the ablation line, the delay of the transmission speed of the electrical signal between the two electrodes (the electrical signal is bypassed by the ablation line) When the delay associated with the transmission was resolved, the cause was that the ablation line could not be formed at the position intended by the operator (problem with the ablation line formation position), or the ablation line was crossed. Is it because the tips of the two catheters have deviated from the ablation line (measurement problem), or because there is an insufficient part of the ablation line (a part where electrical signal transmission cannot be interrupted) in part of the ablation line? It is difficult to judge.

  For this reason, depending on the catheter described in the above-mentioned patent document, it cannot be easily confirmed whether or not an ablation line in which the intended cauterization is reliably performed is formed at the position intended by the operator. .

  Further, depending on the catheter described in the above-mentioned patent document (particularly, the catheter shown in FIG. 7 of Patent Document 1 and Patent Document 2), the distal end (tip electrode) may be formed with a plurality of catheter distal end portions raised to some extent. ) Is brought into contact with the inner wall of the blood vessel, so that the inner wall of the blood vessel may be damaged by the distal electrode at the distal end of the catheter.

The present invention has been made based on the above situation.
A first object of the present invention is to provide an electrode catheter capable of easily confirming whether or not an ablation line formed by intended ablation is formed at a position intended by an operator after ablation treatment. There is to do.
The second object of the present invention is to provide an electrode catheter that is less susceptible to damage to the inner wall of the blood vessel due to the distal end of the distal end portion of the catheter, and that can be suitably used for various diagnostic and therapeutic actions.

(1) An electrode catheter of the present invention includes a catheter body having at least one inner hole,
A control handle connected to the proximal end of the catheter body;
Comprising three catheter tips extending from the tip of the catheter body so as to spread in a fan shape,
The three catheter tip portions extend in the axial direction of the catheter body, and have a first catheter tip portion on which at least two electrodes are mounted,
A second catheter tip attached to at least one electrode on one side of the first catheter tip and extending at a predetermined angle from the first catheter tip;
On the other side of the first catheter tip, the third catheter tip attached to at least one electrode extending at a predetermined angle from the first catheter tip is substantially flush with the first catheter tip. It is characterized by being arranged above.

  According to the electrode catheter configured as described above, by providing three catheter tip portions extending so as to expand in a fan shape from the tip of the catheter body, the catheter tip portions (the plane on which they are located) are tilted. In this state, each tip can be brought into contact with the inner wall of the blood vessel. Thereby, since the pressing force to the blood vessel inner wall by each tip of the catheter tip portion (particularly, the pressing force when moving the catheter tip portion along the blood vessel inner wall) can be sufficiently reduced, The inner wall of the blood vessel is less likely to be damaged by the tips of the catheter tips.

  In addition, when the first catheter tip is moved onto a line intended to be an ablation line (with this, the second catheter tip and the third catheter tip also move along the line) ), An electrical signal is not transmitted between the two electrodes attached to the first catheter tip, which are in contact with this line, and the electrode attached to the second catheter tip, and the third catheter tip This line is an ablation line (intended) if there is a delay in the transmission speed of the electrical signal (delay due to the electrical signal being detoured and transmitted) between the electrodes attached to the part. It can be judged that the desired shochu is made in a line shape).

  When the first catheter tip deviates from the ablation line and the two electrodes attached to the first catheter tip deviate from the ablation line, an electrical signal is transmitted between the two electrodes. Therefore, the first catheter tip can be moved again onto the ablation catheter by correcting the direction of movement of the first catheter tip in a direction in which the electrical signal is not transmitted again.

In addition, when the first catheter tip is moved on the ablation line, the transmission speed of the electrical signal between the electrode attached to the second catheter tip and the electrode attached to the third catheter tip When the delay is eliminated (electrical signals are transmitted at a shortest distance), in the vicinity of the positions of these catheter tips, there is insufficient ablation (a transmission of electrical signals) in part of the ablation line. It can be determined that there is a possibility that there is a portion that cannot be blocked.
Thus, the defect of the ablation line is confirmed by monitoring the transmission speed of the electrical signal between the electrode attached to the second catheter tip and the electrode attached to the third catheter tip. Can do.

Furthermore, as the first catheter tip moving on the ablation line approaches the end (termination) of the ablation line, the electrode attached to the second catheter tip and the third catheter tip are attached. Since the detour of the electrical signal between the electrodes is shortened, the transmission speed of the electrical signal is increased (the transmission time is shortened). When the tip of the first catheter reaches the end of the ablation line, the transmission speed of the electric signal between the electrode attached to the tip of the second catheter and the electrode attached to the tip of the third catheter is increased. The delay is completely eliminated and the electric signal is transmitted in the shortest distance.
Thus, by monitoring the change in the transmission speed of the electrical signal between the electrode attached to the second catheter tip and the electrode attached to the third catheter tip, the end of the ablation line is monitored. The position can be confirmed.

(2) In the electrode catheter of the present invention, a tip electrode and at least one ring-shaped electrode are attached to the tip of the first catheter, and at least one of the ring-shaped electrodes is the first catheter. It is preferable that it is attached to the proximal end portion of the distal end portion.

According to the electrode catheter configured as described above, when the first catheter tip is moved on a line intended to be an ablation line, the tip electrode mounted on the first catheter tip and the first catheter An electrical signal is not transmitted to and from the ring-shaped electrode attached to the proximal end portion of the distal end portion, and an electrode attached to the distal end portion of the second catheter and an electrode attached to the distal end portion of the third catheter If there is a delay in the transmission speed of the electric signal, this line can be determined to be an ablation line.
In addition, as the two electrodes for confirming the presence / absence of electrical signal transmission at the distal end portion of the first catheter, a distal end electrode attached to the distal end portion and a ring electrode attached to the proximal end portion are used. Thus, operations such as correction of the moving direction can be performed more easily.

(3) Moreover, it is preferable that a tip electrode and at least one ring-shaped electrode are attached to the second catheter tip and the third catheter tip, respectively.

  According to the electrode catheter configured as described above, when the first catheter tip is moved on a line intended to be an ablation line, the tip electrode mounted on the first catheter tip and the first catheter No electrical signal is transmitted to and from the ring-like electrode attached to the proximal end portion of the distal end portion, and the electrode attached to the distal end portion of the second catheter (for example, the distal end electrode) and the distal end portion of the third catheter are attached. This line can be determined to be an ablation line when there is a delay in the transmission speed of the electrical signal between the formed electrode (for example, the tip electrode).

(4) In addition, the electrode width of one ring-shaped electrode attached to the second catheter tip is equal to that of another ring-shaped electrode (ring electrode attached to the first catheter tip, third catheter tip It is preferable that the electrode width of the ring-shaped electrode mounted on the second catheter and the other ring-shaped electrode mounted on the distal end portion of the second catheter is different.

  According to the electrode catheter configured as described above, by finding a ring-shaped electrode different from the electrode width of the other ring-shaped electrode on the X-ray image, the distal end portion of the catheter to which the ring-shaped electrode is attached becomes the first one. It can be recognized that they are the two catheter tip portions, and this makes it possible to clearly distinguish the second catheter tip portion and the third catheter tip portion, which are easily misunderstood on the X-ray image. In addition, since the arrangement positions of the tip electrode and the ring electrode attached to each of the catheter tip portions can be easily grasped on the X-ray image, all the electrodes (tip electrode) on the X-ray image can be thereby obtained. And the ring-shaped electrode), it is possible to easily grasp which catheter tip portion is mounted at which position.

(5) In the electrode catheter of the present invention, a deflection mechanism (swinging) that bends the distal end portion of the catheter body in one direction and / or the other direction (only) along the plane on which the three catheter distal end portions are located. (Mechanism) is preferably provided.

According to the electrode catheter having the above-described configuration, by operating this deflection mechanism, the distal end portion of the catheter body is bent on a plane on which the three catheter distal end portions are located, and the three catheters. The tips move on the plane in which they are located.
Here, even if the deflection mechanism is operated with the tips (tip electrodes) of the three catheter tips in contact with the inner wall of the blood vessel, and the three catheter tips are moved on the plane where they are located, The tip of the catheter tip does not press the inner wall of the blood vessel. Therefore, when operating the deflection mechanism, the tip of the catheter tip can be prevented from damaging the inner wall of the blood vessel.
In addition, operations such as correction of the moving direction of the catheter tip can be performed more easily using the deflection mechanism.

(6) In the electrode catheter of the present invention, a deflection mechanism for bending the distal end portion of the catheter body in one direction and / or the other direction (only) perpendicular to the plane on which the three catheter distal end portions are located (only). (Swing mechanism) may be provided.

  According to the electrode catheter having the above-described configuration, by operating this deflection mechanism, it is possible to easily perform the operation of pressing the three catheter tip portions (electrodes attached to each) against the inner wall of the blood vessel. .

According to the electrode catheter of the present invention, it can be easily confirmed whether or not an ablation line formed by intended cauterization is formed at a position intended by the operator after the ablation treatment.
Further, according to the electrode catheter of the present invention, the inner wall of the blood vessel is not easily damaged by the distal end of the catheter distal end portion, and the electrode catheter of the present invention can be suitably used for various diagnostic and therapeutic actions.

It is a top view of the electrode catheter which concerns on one Embodiment of this invention. It is a top view which shows the front-end | tip part which is the principal part of the electrode catheter shown in FIG. It is a side view (III-III arrow line view of FIG. 2) which shows the front-end | tip part of the electrode catheter shown in FIG. It is a front view (IV-IV arrow line view of FIG. 2) which shows the front-end | tip part of the electrode catheter shown in FIG. FIG. 5 is a cross-sectional view (a VV cross-sectional view of FIG. 4) showing a distal end portion of the electrode catheter shown in FIG. 1. FIG. 5 is a cross-sectional view (cross-sectional view taken along the line VI-VI in FIG. 4) showing the distal end portion of the electrode catheter shown in FIG. 1. It is sectional drawing (VII-VII sectional drawing of FIG. 4) which shows the front-end | tip part of the electrode catheter shown in FIG. It is a schematic diagram which shows the state which has arrange | positioned the front-end | tip part of the electrode catheter shown in FIG. 1 on the line intended as an ablation line of the blood vessel inner wall. It is a schematic diagram which shows the state which the front-end | tip part of the electrode catheter shown in FIG. 1 deviates from an ablation line, and moves. It is a schematic diagram which shows the state which the front-end | tip part of the electrode catheter shown in FIG. 1 deviates from an ablation line, and moves. It is a schematic diagram which shows the state which reaches the part in which cauterization is inadequate when the front-end | tip part of the electrode catheter shown in FIG. 1 is moved along an ablation line. It is a schematic diagram which shows the state which has moved the front-end | tip part of the electrode catheter shown in FIG. 1 toward the edge part of an ablation line.

Hereinafter, an electrode catheter according to an embodiment of the present invention will be described with reference to the drawings.
The electrode catheter 1 of this embodiment is used for diagnosis or treatment of arrhythmia in the heart, for example.

The electrode catheter 1 includes a catheter body 10, a control handle 20 connected to the proximal end of the catheter body 10, and three catheter distal end portions 31, 32, 33 that extend from the distal end of the catheter body 10 so as to fan out. And a deflection mechanism that bends the distal end portion of the catheter body 10 in the directions indicated by arrows A and B in FIG.
The three catheter tip portions extend in the axial direction of the catheter body 10, the first catheter tip portion 31 to which the tip electrode 41 a and the three ring electrodes 41 b, 41 c, 41 d are attached, and the first catheter tip portion A tip electrode 42a and two ring electrodes 42B and 42c are attached to one side (lower side in FIG. 1) 31 and extend from the first catheter tip 31 at a predetermined angle (α). The distal electrode 43a extends from the second catheter tip 32 and the other side of the first catheter tip 31 (upper side in FIG. 1) at a predetermined angle (α) from the first catheter tip 31. And the third catheter tip 33 to which the two ring-shaped electrodes 43b and 43c are attached are arranged on substantially the same plane.

The catheter body 10 includes a tube member 11 and a tip member 12.
In FIG. 1, the length of the catheter body 10 is illustrated as being short, but actually, the length is several times to several tens of times longer than the length of the control handle 20 in the Z-axis direction.

  The tube member 11 constituting the catheter body 10 has at least one inner hole (lumen). The lumen of the tube member 11 is led through a lead wire (not shown) connected to the tip electrode and the ring electrode, and a pulling wire (shown by 51 and 52 in FIG. 5) constituting a deflection mechanism of the catheter tip portion. Yes.

  The tube member 11 may be made of a material having the same characteristics along the axial direction, but is preferably formed integrally using materials having different rigidity (hardness) along the axial direction. Specifically, it is preferable that the constituent material on the proximal end side has relatively high rigidity, and the constituent material on the distal end side has relatively low rigidity.

  The tube member 11 is made of a synthetic resin such as polyolefin, polyamide, polyether polyamide, polyurethane, nylon, or PEBAX (polyether block amide). The proximal end side of the tube member 11 may be a blade tube obtained by braiding a tube made of these synthetic resins with a stainless steel wire.

The outer diameter of the tube member 11 is preferably 1.0 to 3.0 mm, and more preferably 1.6 to 2.7 mm.
The length of the tube member 11 is preferably 600 to 1500 mm, and more preferably 900 to 1200 mm.

  As shown in FIG. 5, the distal end member 12 constituting the catheter body 10 includes a cylindrical portion 121 having an inner hole into which the distal end portion of the tube member 11 is inserted, and proximal end portions of the three catheter distal end portions. Is formed integrally with a holding portion 122 having three pores. In FIG. 5 showing the VV cross section of FIG. 4, the second catheter distal end portion 32 and the third catheter distal end portion 33 among the three catheter distal end portions are illustrated.

The tip member 12 can be made of the same material as the tube member 11, for example, PEBAX.
The outer diameter of the tip member 12 is preferably the same as the outer diameter of the tube member 11.
The length of the tip member 12 is preferably 2 to 60 mm, and more preferably 5 to 10 mm.

  The control handle 20 is connected to the proximal end of the catheter body 10 (tube member 11). In FIG. 1, 21 is a gripping part, and 22 is a rotating plate constituting a deflection mechanism for bending the distal end portion of the catheter body.

The electrode catheter 1 of this embodiment includes three catheter tip portions (a first catheter tip portion 31, a second catheter tip portion 32, and a third catheter tip portion 33).
As shown in FIGS. 1 to 6, the three catheter tip portions are arranged on substantially the same plane, and extend from the tip of the catheter body 10 (tip member 12) so as to spread in a fan shape.

  As shown in FIG. 4 and FIG. 6, the first catheter tip 31, the second catheter tip 32, and the third catheter tip 33 are not completely located on the same plane. They are located on substantially the same plane.

  Here, in order to say that the three catheter tip portions are substantially on the same plane, when a plane including the axis of each catheter tip portion is considered, the separation distance between the farthest planes is 1. If it is within 5 mm, it can be said that the three catheter tips are substantially on the same plane.

Of the three catheter tip portions, the first catheter tip portion 31 at the center extends linearly from the tip of the catheter body 10 in the axial direction of the catheter body 10. That is, the first catheter tip 31 is located on the extension line of the catheter body 10.
Thereby, the operativity (especially operativity when moving the three catheter front-end | tip parts along a line) of the electrode catheter 1 can be aimed at.

  The second catheter tip 32 is separated from the first catheter tip 31 at a predetermined angle (α) on one side of the first catheter tip 31 (the lower side in FIGS. 1 and 2). 10 extends from the tip.

  Further, the third catheter tip 33 is located at a predetermined angle (with the second catheter tip 32 and the second catheter tip 32) on the other side of the first catheter tip 31 (the upper side in FIGS. 1 and 2). It extends from the distal end of the catheter body 10 with an angle (α) that is the same as the angle formed with the first catheter distal end 31.

  Here, the angle (α) formed between the second catheter distal end portion 32 (third catheter distal end portion 33) and the first catheter distal end portion 31 is preferably 5 to 85 °, and more preferably 10 to 20 °. °.

The outer diameter of the distal end portion of the catheter (the portion extending from the distal end member 12) is preferably 0.3 to 1.4 mm, and more preferably 0.5 to 1.0 mm.
The outer diameter of the catheter tip is preferably 0.15 to 0.4 times the outer diameter of the tube member 11.
The length of the catheter tip (the portion extending from the tip member 12) is preferably 10 to 50 mm, and more preferably 20 to 30 mm.

  As shown in FIGS. 5 to 7, the first catheter tip 31, the second catheter tip 32, and the third catheter tip 33 are composed of plate-like core members 311, 321, 331, and covered tubes 312, 322, 332.

As shown in FIG. 5, the core member 321 constituting the second catheter distal end portion 32 extends along the inner hole of the covering tube 322, and the distal end portion is fixed in a state of being embedded in the distal end electrode 42a.
Further, the core member 331 constituting the third catheter distal end portion 33 extends along the inner hole of the covering tube 332, and the distal end portion is fixed in a state of being embedded in the distal end electrode 43a. The internal structure of the first catheter tip 31 is the same as that of the second catheter tip 32 and the third catheter tip 33.

  As shown in FIGS. 6 and 7, the cross-section (transverse cross-section) shape of the core members 311, 321, and 331 is a rectangle. The rectangular short side is perpendicular to the plane on which the three catheter tip portions are located. According to the core member having such a cross-sectional shape, the three catheter tip portions are arranged on the plane on which they are located. Can be easily bent in the vertical direction.

The core members 311, 321, and 331 store the shapes of the catheter tip portions 31, 32, and 33, and are deformed by applying a force (for example, deformed linearly), but when the force is removed, the stored shape ( Return to the developed shape as shown in FIGS.
Examples of the constituent material of the core member include Ni-Ti alloys. The ratio of Ni and Ti in the Ni—Ti alloy is preferably 54:46 to 57:43. Nitinol can be mentioned as a preferred Ni-Ti alloy.
Examples of the constituent material of the coated tube include a bio-acceptable resin material such as polyurethane or PEBAX.

  The proximal end portions of the three catheter tip portions (first catheter tip portion 31, second catheter tip portion 32, and third catheter tip portion 33) are pores formed in the tip member 12 (holding portion 122), respectively. And the covering tubes 312, 322, and 332 at the proximal end portion and the holding portion 122 are heat-sealed, whereby each of the three catheter tip portions is fixed to the catheter body 10 (tip member 12). Has been.

A distal electrode 41a and three ring-shaped electrodes 41b, 41c, and 41d are attached to the first catheter distal end portion 31.
A distal electrode 42 a and two ring-shaped electrodes 42 B and 42 c are attached to the second catheter distal end portion 32.
A distal electrode 43a and two ring-shaped electrodes 43b and 43c are attached to the third catheter distal end portion 33.

  Conductive wires (not shown) connected to the distal electrode and the ring-shaped electrode are passed through the inner hole of the catheter distal end portion (covered tube) and the lumen of the catheter body 10 while being insulated from each other.

  The tip electrode and the ring electrode are made of a metal having good electrical conductivity such as aluminum, copper, stainless steel, gold, platinum, iridium, or an alloy thereof. The outer diameters of the tip electrode and the ring-shaped electrode are not particularly limited, but are preferably approximately the same as the outer diameter of the catheter tip.

As shown in FIGS. 1 to 4, of the seven ring-shaped electrodes 41 b, 41 c, 41 d, 42 B, 42 c, 43 b, 43 c constituting the electrode catheter 1, a ring shape mounted on the second catheter tip 32. The electrode 42B has an electrode width (length in the tube axis direction) wider than that of other ring electrodes, specifically 1.5 to 2.0 times.
Here, the electrode width of the ring electrodes other than the ring electrode 42B is preferably 0.5 to 4.0 mm, and more preferably 0.6 to 1.2 mm.

Like the electrode catheter 1, two catheter tip portions (second catheter tip portion 32 and third catheter tip portion 33) extending so as to spread at equal angles (α) on both sides of the first catheter tip portion 31 are It is easy to misunderstand on the X-ray image.
Therefore, if the electrode width of the ring-shaped electrode attached to the second catheter tip 32 is increased as in the electrode catheter 1, the ring-shaped electrode 42B having a wider electrode width than the other ring-shaped electrodes on the X-ray image. Thus, it is possible to recognize that the catheter distal end portion to which the ring-shaped electrode 42B is attached is the second catheter distal end portion 32, so that the second catheter distal end portion is easily misunderstood on the X-ray image. 32 and the third catheter tip 33 can be clearly distinguished.
In addition, since the arrangement positions of the tip electrode and the ring electrode attached to each of the catheter tip portions can be easily grasped on the X-ray image, all the ring electrodes 41b, 41c,. For 41d, 42B / 42c, 43b / 43c, it is possible to easily grasp which catheter tip is mounted at which position.

The electrode catheter 1 of this embodiment includes a deflection mechanism that bends the distal end portion of the catheter body 10 along a plane on which three catheter distal end portions are located.
By operating this deflection mechanism, the distal end portion of the catheter body 10 can be bent in the directions indicated by the arrows A and B in FIG. 1 on the plane where the three catheter distal end portions are located.
The distal end portion of the catheter body 10 is bent in the direction indicated by the arrow A or the arrow B, whereby three catheter distal end portions (a first catheter distal end portion 31, a second catheter distal end portion 32, and a third catheter distal end portion are formed. 33) moves integrally in the direction indicated by arrow A or arrow B on the plane in which they are located.

Although it does not specifically limit as a deflection | deviation mechanism, For example, the leaf | plate spring (illustration omitted) accommodated in the distal end part of the tube member 11 and the lumen | rumen of the tube member 11 in the front and back side of this leaf | plate spring are carried out. Mention may be made of a mechanism comprising two tension wires to be drawn (indicated by 51 and 52 in FIG. 5) and a rotating plate 22 to which the proximal ends of each of the two tension wires are connected. .
Here, each of the distal ends of the two tension wires may be fixed to the inner wall of the tube member 11 at a position opposed to each other with the leaf spring interposed therebetween, and the front and back surfaces of the flat plate portion at the distal end of the leaf spring. It may be fixed to.

On the other hand, the proximal ends of the pull wires 51 and 52 are connected to positions separated from each other on the rotary plate 22 of the control handle 20, and the rotary plate 22 is centered on a rotary axis perpendicular to the Z axis shown in FIG. And can be rotated freely.
The operator holds the grip portion 21 of the control handle 20 with one hand, and operates (rotates in a predetermined direction) the rotating plate 22 with the finger of the one hand. Thereby, the tension | tensile_strength of the tension | pulling wires 51 and 52 changes, and the front-end | tip part of the catheter main body 10 bends in the direction shown by the arrow A or the arrow B in FIG.1 and FIG.2.

  That is, for example, when the rotating plate 22 is rotated in the A1 direction shown in FIG. 1, the pulling wire 52 is pulled and the pulling wire 51 is loosened. As a result, the distal end portion of the catheter body 10 bends in the direction indicated by the arrow A on the plane on which the three catheter tip portions are located, so that the three catheter tip portions are on the plane on which they are located. , Move integrally in the direction of arrow A.

  Similarly, when the rotating plate 22 is rotated in the B1 direction shown in FIG. 1, for example, the pulling wire 51 is pulled and the pulling wire 52 is loosened. As a result, the distal end portion of the catheter body 10 bends in the direction indicated by the arrow B on the plane on which the three catheter tip portions are located, so that the three catheter tip portions are on the plane on which they are located. , Move integrally in the direction of arrow B.

Here, the deflection mechanism is operated with the tips of the three catheter tips (tip electrode 41a, tip electrode 42a, tip electrode 43a) in contact with the inner wall of the blood vessel, and the three catheter tips are positioned. Even if it is moved on the flat surface, the tip of the catheter tip contacting the inner wall of the blood vessel does not substantially press the inner wall of the blood vessel. Therefore, when operating the deflection mechanism, it is possible to prevent the tip of the catheter tip from damaging the inner wall of the blood vessel.
In addition, when the three catheter tip portions are moved along the line, the movement direction of the catheter tip portion can be easily corrected by operating the deflection mechanism.

Below, an example of the usage method of the electrode catheter 1 of this embodiment is shown.
First, the electrode catheter 1 is inserted into a cylindrical sheath, and the target site (for example, ablation line formation site) in the heart chamber is obtained with the three catheter tips deformed linearly (closed). The electrode catheter 1 is moved to the vicinity of and the three catheter tip portions are pushed out of the sheath in the vicinity of the target site to restore the memory shape of the catheter tip portion (fan shape as shown in FIGS. 1 to 6). Let

  Next, while viewing the X-ray image, as shown in FIG. 8, the first catheter tip 31 is placed on a line L (a line that is not actually visible) that the operator intends to be an ablation line, The tip electrode 41a and the three ring electrodes 41b, 41c, 41d attached to the one catheter tip 31 are brought into contact with the line L (blood vessel inner wall).

  As a result, the second catheter tip 32 and the third catheter tip 33 on both sides of the first catheter tip 31 are arranged in a state of straddling the line L and attached to the second catheter tip 32. The tip electrode 42a and the two ring-shaped electrodes 42B and 42c, and the tip electrode 43a and the two ring-shaped electrodes 43b and 43c attached to the third catheter tip 33 are symmetrical about the line L. In contact with the inner wall of the blood vessel in position.

Here, when the line L is an ablation line (cauterization is performed along the line L), the tip electrode 41a attached to the first catheter tip 31 and the three ring electrodes No electrical signal is transmitted between 41b, 41c and 41d.
In this case, the electrode (tip electrode 41a, ring-shaped electrode 41b, ring-shaped electrode 41c, ring-shaped electrode 41d) attached to the first catheter distal end 31 is ablated on a line L (ablation line). Since they are in contact, the electrodes (tip electrode 42a, ring electrode 42B, ring electrode 42c, tip electrode 43a, ring electrode 43b, ring attached to the second catheter tip 32 or third catheter tip 33 are attached. No electrical signal is transmitted between the electrode 43c) and the electrode attached to the first catheter tip 31.
Further, in this case, the electrodes (tip electrode 42a, ring-shaped electrode 42B, ring-shaped electrode 42c) attached to the second catheter tip 32 and the electrodes (tip) attached to the third catheter tip 33 Between the electrode 43a, the ring-shaped electrode 43b, and the ring-shaped electrode 43c), the electric signal is detoured and transmitted, so that the transmission speed is delayed.

  As shown in FIG. 8, in this electrode catheter 1, each tip can be brought into contact with the inner wall of the blood vessel with the three catheter tips 31, 32, 33 tilted. Compared with the case where a plurality of catheter tip portions such as the catheter described in Patent Document 2 are erected, the tip portions of the catheter tip portions 31, 32, and 33 are brought into contact with the inner wall of the blood vessel. The pressing force on the inner wall of the blood vessel can be made sufficiently small, whereby the risk that the inner wall of the blood vessel is damaged by the tip electrodes 41a, 41a, 43a attached to the catheter tip portion is remarkably reduced.

Next, the three catheter tip portions are moved along the line L in the direction indicated by the arrow in FIG.
When moved in this way, the electrodes (tip electrode 41a, ring electrode 41b, ring electrode 41c, ring electrode 41d in contact with the line L) attached to the first catheter tip 31 are mutually connected. Between the electrodes (tip electrode 42a, ring-shaped electrode 42B, ring-shaped electrode 42c) attached to the second catheter tip 32 and the third catheter tip 33. When there is a delay in the transmission speed of the electrical signal between the electrodes (tip electrode 43a, ring electrode 43b, ring electrode 43c), this line L is an ablation line, and the line intended by the operator It can be determined that the desired shochu is being made along L.

9 and 10 show a state where the catheter tip portions 31, 32, and 33 are moved away from the ablation line AL.
Hereinafter, with deviation from the ablation line, between the electrodes attached to the catheter tip (the tip electrode 41a and the ring electrode 41d attached to the first catheter tip 31 and the second catheter tip 32 are attached). Next, how the electrical signal transmission state changes between the distal electrode 42a and the distal electrode 43a attached to the third catheter distal end portion 33 will be described.

  (P1) in FIG. 9 shows a state where the first catheter tip 31 is disposed on the ablation line AL (state shown in FIG. 8), and (P2) shows that the catheter tip is moved in the direction of the arrow. When the ring electrode 41d attached to the first catheter tip 31 deviates from the ablation line AL, (P3) further deviates to the left in the movement direction. Thus, the tip electrode 41a attached to the first catheter tip 31 is in a state of being detached from the ablation line AL.

In the state of (P1) in FIG. 9, no electrical signal is transmitted between the tip electrode 41a and the ring electrode 41d in contact with the ablation line AL.
In addition, since the tip electrode 41a and the ring electrode 41d are in contact with the ablation line AL, the tip electrode 42a and the tip electrode 41a, the tip electrode 43a and the tip electrode 41a, the tip electrode 42a and the ring electrode 41a are in contact with the ablation line AL. No electrical signal is transmitted between the tip electrode 43a and the ring-shaped electrode 41d.
And between the front-end | tip electrode 42a and the front-end | tip electrode 43a, the transmission speed is delayed by detouring and transmitting an electrical signal.

  In the state of (P2) in FIG. 9, since the tip electrode 41a is in contact with the ablation line AL, between the tip electrode 41a and the ring electrode 41d, between the tip electrode 42a and the tip electrode 41a, Although no electrical signal is transmitted between the tip electrode 43a and the tip electrode 41a, the electrical signal is transmitted in a detour (delay) between the tip electrode 42a and the ring electrode 41d, and the tip electrode 43a and the ring electrode 41d are transmitted. An electric signal is transmitted between the two at the shortest distance. Even in this state, the electrical signal is transmitted by detouring (delaying) between the tip electrode 42a and the tip electrode 43a.

  Furthermore, in the state of (P3) in FIG. 9, since the tip electrode 41a is also removed from the ablation line AL, the tip electrode 41a and the ring-shaped electrode 41d, the tip electrode 43a and the tip electrode 41a, An electrical signal is transmitted at the shortest distance between the electrode 43a and the ring electrode 41d, and the electrical signal is bypassed (delayed) between the tip electrode 42a and the tip electrode 41a, and between the tip electrode 42a and the ring electrode 41d. ) And transmitted. Even in this state, the electrical signal is transmitted by detouring (delaying) between the tip electrode 42a and the tip electrode 43a.

  (P1) in FIG. 10 shows a state in which the first catheter tip 31 is disposed on the ablation line AL (state shown in (P1) in FIGS. 8 and 9), and (P2) shows a catheter tip. When the electrode is moved in the direction of the arrow, the ring-shaped electrode 41d attached to the first catheter tip 31 is displaced from the ablation line AL by deviating to the right in the movement direction (left side of the paper), (P3) Further, the state is shifted to the right in the moving direction, and the distal end electrode 41a attached to the first catheter distal end portion 31 is in a state of being detached from the ablation line AL.

  In the state of (P2) in FIG. 10, since the tip electrode 41a is in contact with the ablation line AL, between the tip electrode 41a and the ring electrode 41d, between the tip electrode 42a and the tip electrode 41a, the tip electrode No electrical signal is transmitted between the tip electrode 43a and the tip electrode 41a, but an electrical signal is transmitted between the tip electrode 42a and the ring electrode 41d at the shortest distance, and between the tip electrode 43a and the ring electrode 41d. The signal is detoured (delayed) and transmitted. Even in this state, the electrical signal is transmitted by detouring (delaying) between the tip electrode 42a and the tip electrode 43a.

  In the state of (P3) in FIG. 10, the tip electrode 41a is also removed from the ablation line AL. Therefore, between the tip electrode 41a and the ring electrode 41d, between the tip electrode 42a and the tip electrode 41a, and tip electrode 42a. Between the tip electrode 43a and the ring electrode 41d, and between the tip electrode 43a and the ring electrode 41d, the electric signal is detoured (delayed). Is transmitted. Even in this state, the electrical signal is transmitted by detouring (delaying) between the tip electrode 42a and the tip electrode 43a.

In the state shown in (P1) to (P3) of FIG. 9 and (P1) to (P3) of FIG. 10, the transmission state of the electric signal between the two electrodes is shown together in Table 1 below.
In Table 1, “◯” indicates that the electrical signal is transmitted without delay, “Δ” indicates that the electrical signal is transmitted in a detour (delayed), and “−” indicates that the electrical signal is transmitted. (The same applies to Tables 2 and 3 below.)

  As shown in FIG. 9 (P3) and FIG. 10 (P3), the first catheter tip 31 deviates from the ablation line AL, and two electrodes (tips) attached to the first catheter tip 31 are attached. When the electrode 41a and the ring-shaped electrode 41d) deviate from the ablation line AL, an electric signal is transmitted between the two electrodes (between the tip electrode 41a and the ring-shaped electrode 41d). The first catheter tip 31 can be moved again on the ablation line AL by correcting the moving direction of the first catheter tip 31 in the direction in which the signal is not transmitted again.

  As shown in Table 1, when the first catheter tip 31 deviates from the ablation line AL, an electrode (in FIG. 9, the third catheter tip 33 is attached to the catheter tip located on the deviated side). The tip electrode 43a attached to the tip, in FIG. 10, the tip electrode 42a attached to the second catheter tip 32, and the electrodes attached to the first catheter tip 31 (tip electrode 41a, ring electrode 41d) An electrical signal is transmitted between the two at the shortest distance.

  Therefore, an electrode (tip electrode 43a or tip electrode 42a) in which an electrical signal is transmitted at the shortest distance between the electrodes (tip electrode 41a, ring-shaped electrode 41d) attached to the first catheter tip 31. ) And the direction opposite to the side where the electrode tip (the third catheter tip 33 in FIG. 9 and the second catheter tip 32 in FIG. 10) is located (the second tip in FIG. 9). If the moving direction of the first catheter tip 31 is corrected in the direction in which the catheter tip 32 is located, that is, the direction in which the third catheter tip 33 is located in FIG. 10, it can be moved again on the ablation line AL. it can.

  By the way, even when cauterization is performed along the line intended by the operator (the ablation line is formed at the intended position), there is an insufficient portion of the cauterization at a part of the ablation line. There is a case. If there is such a part, the transmission of the electric signal cannot be cut off.

FIG. 11 schematically shows how the catheter tip portions 31, 32, and 33 move along the ablation line AL having such a cauterized portion C (hereinafter referred to as “cauterization defect portion C”). It shows.
FIG. 11 (1) shows a state in which the first catheter tip 31 is disposed at a position substantially before the ablation line C on the ablation line AL, and FIG. 11 (2) shows the first catheter tip. A state 31 is located on the ablation defect portion C of the ablation line AL.
In FIG. 2B, the ablation defect C is between the tip electrode 41a and the ring electrode 41d attached to the first catheter tip 31, and these electrodes are different from the ablation defect C. There is no contact.

In the state shown in FIG. 11 (1), no electrical signal is transmitted between the tip electrode 41a and the ring electrode 41d in contact with the ablation line AL.
In addition, since the tip electrode 41a and the ring electrode 41d are in contact with the ablation line AL, the tip electrode 42a and the tip electrode 41a, the tip electrode 43a and the tip electrode 41a, the tip electrode 42a and the ring electrode 41a are in contact with the ablation line AL. No electrical signal is transmitted between the tip electrode 43a and the ring-shaped electrode 41d. In addition, between the tip electrode 42a and the tip electrode 43a, the electric signal is detoured and transmitted, so that the transmission speed is delayed.

Also in the state shown in FIG. 11 (2), the tip electrode 41a and the ring electrode 41d are in contact with the ablation line AL (a part other than the ablation defect portion C), so that the tip electrode 41a and the ring electrode 41d are in contact with each other. Between the tip electrode 42a and the tip electrode 41a, between the tip electrode 43a and the tip electrode 41a, between the tip electrode 42a and the ring electrode 41d, and between the tip electrode 43a and the ring electrode 41d. However, no electrical signal is transmitted.
That is, even if there is an ablation line C in the ablation line AL, between the tip electrode 41a or the ring electrode 41d and the other electrodes (ring electrode 41d or tip electrode 41a, tip electrode 42a, tip electrode 43a) An electric signal cannot be transmitted, and the presence of the cauterization defect portion C cannot be detected.
On the other hand, since the electrical signal is transmitted between the tip electrode 42a and the tip electrode 43a through the cauterization defect portion C, the delay in the transmission speed of the electrical signal is eliminated.

  In the state shown in FIGS. 11 (1) to (2), the transmission state of the electric signal between the two electrodes is summarized in Table 2 below.

From this, when the delay in the transmission speed of the electric signal is eliminated between the distal electrode 42a attached to the second catheter distal end portion 32 and the distal electrode 43a attached to the third catheter distal end portion 33, It can be determined that there is a possibility that an ablation defect portion C that cannot interrupt the transmission of the electrical signal exists in the ablation line AL in the vicinity where these catheter tip portions 31, 32, and 33 are located.
In this way, the transmission speed (delay is delayed) of the electrical signal between the electrode (tip electrode 42a) attached to the second catheter tip 32 and the electrode (tip electrode 43a) attached to the third catheter tip. By monitoring whether it has been resolved, it is possible to confirm a defect in the ablation line.

By the way, there is a case where it is confirmed how far the ablation line is formed (end part of the ablation line).
FIG. 12 schematically shows how the catheter tip portions 31, 32, 33 move to the end portion D along the ablation line AL.
FIG. 12 (1) shows a state in which the first catheter distal end portion 31 is arranged at a position substantially before the end D on the ablation line AL, and FIG. 12 (2) moves in the direction of the arrow. The ring-shaped electrode 41d attached to the first catheter tip 31 shows a state where it has passed through the end D of the ablation line AL and is in contact with the non-cauterized part. FIG. The part 31 is further moved, and the attached tip electrode 41a passes through the end D of the ablation line AL and comes into contact with the part that has not been cauterized.

  In the state shown in FIG. 12A, between the tip electrode 41a and the ring electrode 41d, between the tip electrode 42a and the tip electrode 41a, between the tip electrode 43a and the tip electrode 41a, and between the tip electrode 42a and the ring. An electrical signal is not transmitted between the tip electrode 43d and the tip electrode 43a and the ring electrode 41d. In addition, between the tip electrode 42a and the tip electrode 43a, the electric signal is detoured and transmitted, so that the transmission speed is delayed.

  As the first catheter tip 31 approaches the end D of the ablation line AL, the tip electrode 42a attached to the second catheter tip 32 and the tip electrode attached to the third catheter tip 33 Since the detour of the electric signal is shortened with respect to 43a, the transmission speed of the electric signal is increased.

  In the state shown in FIG. 12 (2), since the tip electrode 41a is in contact with the ablation line AL, between the tip electrode 41a and the ring electrode 41d, and between the tip electrode 42a and the tip electrode 41a. The electrical signal is not transmitted between the tip electrode 43a and the tip electrode 41a, but the electrical signal is transmitted between the tip electrode 42a and the ring electrode 41d and between the tip electrode 43a and the ring electrode 41d at the shortest distance. Thus, an electrical signal is transmitted between the tip electrode 42a and the tip electrode 43a at a substantially shortest distance.

  In the state shown in FIG. 12 (3), the electrical signal is transmitted between all the electrodes with the shortest distance.

  In the state shown in FIGS. 12 (1) to 12 (3), the transmission state of the electrical signal between the two electrodes is summarized in Table 3 below.

  As described above, as the first catheter tip 31 approaches the end D of the ablation line AL, the tip electrode 42a attached to the second catheter tip 32 and the third catheter tip 33 are attached. Since the electrical signal transmission speed between the distal electrode 43a and the distal electrode 43a is increased, the change in the electrical signal transmission speed between the distal electrode 42a and the distal electrode 43a is monitored. The position of the end D of the ablation line AL is confirmed by monitoring the electrical signal transmission state between the attached tip electrode 41a or ring electrode 41d and the tip electrode 42a or tip electrode 43a. be able to.

  According to the electrode catheter 1 of this embodiment, whether or not cauterization is performed along the line L intended by the operator (that is, whether or not an ablation line is formed at the intended position) is further formed. It can be easily confirmed whether or not the ablation line has no cauterization defect.

  Further, in this electrode catheter 1, each tip (tip electrode) can be brought into contact with the blood vessel inner wall with the three catheter tip portions tilted, so that the tip electrode 41a mounted on the catheter tip portion, The risk that the inner wall of the blood vessel is damaged by 41a and 43a is remarkably small.

  As mentioned above, although embodiment of this invention was described, this invention is not limited to these, A various change is possible.

  For example, the number of ring-shaped electrodes attached to each catheter tip is not particularly limited. Moreover, the electrode width may be the same in all ring-shaped electrodes.

  In addition, the bending direction of the distal end portion of the catheter body by the deflection mechanism may not be a direction along the plane where the three catheter distal end portions are located (directions indicated by arrows A and B in FIG. 1). The direction may be perpendicular to the direction.

  The electrode catheter of the present invention can be used not only for confirmation after ablation treatment but also for various diagnoses or treatments. For example, since the electric potential in the in-circle region having the radius of the length of the distal end portion of the catheter can be measured simultaneously, it can be suitably used as a mapping catheter.

DESCRIPTION OF SYMBOLS 1 Electrode catheter 10 Catheter main body 11 Tube member 12 Tip member 121 Cylindrical part 122 Holding part 20 Control handle 21 Gripping part 22 Rotating plate 31 First catheter tip part 32 Second catheter tip part 33 Third catheter tip part 311, 321, 331, 341 Core member 312, 322, 332, 342 Covered tube 41a, 42a, 43a, 44a Tip electrode 41b / 41c / 41d, 42B / 42c, 43b / 43c Ring-shaped electrode 51, 52 Tension wire

Claims (6)

A catheter body having at least one inner bore;
A control handle connected to the proximal end of the catheter body;
Comprising three catheter tips extending from the tip of the catheter body so as to spread in a fan shape,
The three catheter tip portions extend in the axial direction of the catheter body, and have a first catheter tip portion on which at least two electrodes are mounted,
A second catheter tip attached to at least one electrode on one side of the first catheter tip and extending at a predetermined angle from the first catheter tip;
On the other side of the first catheter tip, the third catheter tip attached to at least one electrode extending at a predetermined angle from the first catheter tip is substantially flush with the first catheter tip. An electrode catheter characterized by being disposed on the top.   A distal electrode and at least one ring-shaped electrode are attached to the distal end portion of the first catheter, and at least one of the ring-shaped electrodes is attached to a proximal end portion of the distal end portion of the first catheter. The electrode catheter according to claim 1.   The electrode catheter according to claim 2, wherein a tip electrode and at least one ring-shaped electrode are respectively attached to the second catheter tip and the third catheter tip.   The electrode catheter according to claim 3, wherein an electrode width of one ring-shaped electrode attached to the distal end portion of the second catheter is different from an electrode width of another ring-shaped electrode.   5. A deflection mechanism for bending the distal end portion of the catheter main body in one direction and / or the other direction along a plane on which the three catheter distal end portions are located. The electrode catheter according to any one of the above.   2. A deflection mechanism for bending the distal end portion of the catheter body in one direction perpendicular to a plane on which the three catheter distal end portions are located and / or in another direction. Item 5. The electrode catheter according to Item 4.

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