JP2018038861A - 心不整脈をアブレーションするためのカテーテル・システム - Google Patents
心不整脈をアブレーションするためのカテーテル・システム Download PDFInfo
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- A—HUMAN NECESSITIES
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
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- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00023—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
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- A—HUMAN NECESSITIES
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
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- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00357—Endocardium
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00375—Ostium, e.g. ostium of pulmonary vein or artery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00577—Ablation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
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- A—HUMAN NECESSITIES
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
- A61B2018/00815—Temperature measured by a thermistor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00875—Resistance or impedance
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/124—Generators therefor switching the output to different electrodes, e.g. sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1407—Loop
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
- A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
- A61B5/6853—Catheters with a balloon
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Abstract
Description
該当なし。
1. 接触後に組織の生存能力が、容認可能なパラメータ、例えば
a. 局所的なエレクトログラム>1mV
b. 最大エレクトログラム周波数>8Hz
c.インピーダンス<180オームに従って規定される。
低電力の設定で開始し、電力が増大することで、事前設定されたレベル、例えば5℃/秒=dT/dtにおける電極の温度変化の割合を制御する。
2. 最大限の事前設定温度、例えば65℃に到達する。
3. インピーダンスが事前設定されたレベル(例えば150〜180オーム)を超えて上昇した場合、或は局所的なエレクトログラムがベースライン・レベルから50%又はそれ以上低下した場合(及び/又はエレクトログラム振幅と連動して)、或いは局所的なエレクトログラム周波数が、例えばベースライン値から30%低下した場合、電力の入力を終了する。
4. 手術中、望ましい場合、項目3における特定の値を無効にすることができる。
5. エレクトログラム・データ及びインピーダンスによってアブレーションが成功したことが示される場合、電力を最小限まで低下させる。
Claims (9)
- (a)中に開口を有する偏向可能な遠位端部を有するガイド本体シースと、
(b)前記ガイド本体の前記遠位端部から伸張可能であり、複数の記録要素を備えたJ形状のタイプのループ遠位端部を有する誘導及び記録カテーテルと、
(c)前記誘導及び記録カテーテル・デバイス上を進むように設計され、前記誘導及び記録カテーテル・デバイスによって誘導され安定される膨張可能なアブレーション・バルーン・デバイスと、
(d)前記ガイド本体シースからの前記誘導及び記録カテーテルの伸張を調節するための制御要素と
を備える、組織をアブレーションするためのデバイス。 - 前記誘導及び記録カテーテルの前記J形状のループがさらに、肺静脈の開口部又は他の導管に挿入されるように設計されたループ部分を備え、前記ループ部分がさらに、複数の離間した記録及び刺激電極と、サーミスタを装備することで、アブレーション後の損傷の形成及び有効性を評価する、請求項1に記載の組織をアブレーションするためのデバイス。
- 前記膨張可能なアブレーション・バルーン・デバイスがさらに、近位リング電極を備えることで、前記Jカテーテル・ループ電極による損傷の妥当性と完全性を判定する、請求項2に記載の組織をアブレーションするためのデバイス。
- 前記膨張可能なアブレーション・バルーン・デバイスがさらに、前記バルーンに対する遠位と近位の両方に配置されたリング電極を備える、請求項3に記載の組織をアブレーションするためのデバイス。
- 前記アブレーション・バルーンが、肺静脈の開口部に配置される際、肺静脈の閉鎖及びアブレーションを、前記遠位と近位のリング電極間で伝達される低電力で高周波数のエネルギーを印加することによる、前記リング電極間のインピーダンス測定値によって評価することができる、請求項4に記載の組織をアブレーションするためのデバイス。
- 前記アブレーション・バルーン・デバイスが、前記誘導及び記録カテーテル上を進み、前記アブレーション・バルーン・デバイスの前記誘導及び記録カテーテルに沿った位置を調節するための制御要素を含むバルーン・カテーテル・シャフトに接続される、請求項1に記載の組織をアブレーションするためのデバイス。
- 前記アブレーション・バルーン・デバイスが、高周波及び極低温から選択されたアブレーション技術を適用する、請求項1に記載の組織をアブレーションするためのデバイス。
- アブレーション中の横隔神経機能を評価することを目的とし、高い強度のパルス電気刺激を与える要素と、横隔膜運動を監視するための要素とを含む手段をさらに備える、請求項1に記載の組織をアブレーションするためのデバイス。
- 前記バルーン・デバイスが、損傷とバルーンの位置を示し、電気的な活動を測定し、及びバルーンを通過するインピーダンスを測定するために、遠位のバルーンの縁と近位のバルーンの縁に電極をさらに備える、請求項1に記載の組織をアブレーションするためのデバイス。
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/961,781 | 2010-12-07 | ||
US12/961,781 US11246653B2 (en) | 2010-12-07 | 2010-12-07 | Catheter systems for cardiac arrhythmia ablation |
US13/106,309 | 2011-05-12 | ||
US13/106,309 US8998893B2 (en) | 2010-12-07 | 2011-05-12 | Catheter systems for cardiac arrhythmia ablation |
JP2015182209A JP2016013466A (ja) | 2010-12-07 | 2015-09-15 | 心不整脈をアブレーションするためのカテーテル・システム |
Related Parent Applications (1)
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JP2015182209A Division JP2016013466A (ja) | 2010-12-07 | 2015-09-15 | 心不整脈をアブレーションするためのカテーテル・システム |
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JP2018038861A true JP2018038861A (ja) | 2018-03-15 |
JP6978286B2 JP6978286B2 (ja) | 2021-12-08 |
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JP2013543264A Pending JP2014504909A (ja) | 2010-12-07 | 2011-12-06 | 心不整脈をアブレーションするためのカテーテル・システム |
JP2015182209A Pending JP2016013466A (ja) | 2010-12-07 | 2015-09-15 | 心不整脈をアブレーションするためのカテーテル・システム |
JP2017218572A Active JP6978286B2 (ja) | 2010-12-07 | 2017-11-13 | 心不整脈をアブレーションするためのカテーテル・システム |
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JP2013543264A Pending JP2014504909A (ja) | 2010-12-07 | 2011-12-06 | 心不整脈をアブレーションするためのカテーテル・システム |
JP2015182209A Pending JP2016013466A (ja) | 2010-12-07 | 2015-09-15 | 心不整脈をアブレーションするためのカテーテル・システム |
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Country | Link |
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US (1) | US8998893B2 (ja) |
EP (1) | EP2648638B1 (ja) |
JP (3) | JP2014504909A (ja) |
CA (1) | CA2819056C (ja) |
WO (1) | WO2012078612A2 (ja) |
Cited By (1)
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JP2022032070A (ja) * | 2020-08-11 | 2022-02-25 | 有限会社日本エレクテル | 高周波ホットバルーンカテーテルシステム |
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JP6978286B2 (ja) | 2021-12-08 |
JP2016013466A (ja) | 2016-01-28 |
CA2819056A1 (en) | 2012-06-14 |
CN103347456A (zh) | 2013-10-09 |
US8998893B2 (en) | 2015-04-07 |
WO2012078612A3 (en) | 2012-09-13 |
JP2014504909A (ja) | 2014-02-27 |
EP2648638A4 (en) | 2014-06-04 |
EP2648638B1 (en) | 2020-12-02 |
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