JP5265589B2 - Electrode catheter - Google Patents

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 different catheter tip portions are placed at symmetrical positions with the ablation line as an axis, and the potential transmission speed is measured. . Here, when cauterization is performed reliably, the potential transmission path between the two electrodes is interrupted by the ablation line, and the potential is bypassed and transmitted, so that the transmission speed is delayed. On the other hand, when cauterization is not performed reliably, the potential is transmitted between the two electrodes at the shortest distance, and therefore the transmission speed is not delayed.

(1) When confirming whether or not cauterization is reliably performed by a catheter having a plurality of catheter tip portions, electrodes (hereinafter referred to as such a kind) It is desirable that all of the electrodes be called “corresponding electrodes” or “corresponding electrodes”) at an equal distance from the ablation line.

However, in the catheter described in the above patent document, it is impossible to place all of the corresponding five electrodes at an equal distance from the ablation line.
For example, as shown in FIG. 9, among five catheter tip portions 81, 82, 83, 84, 85 extending radially from the tip of the catheter body 80, each of the adjacent catheter tip portions 81 and 82 is provided. When the two mounted tip electrodes 91 and 92 (corresponding electrodes) are placed at symmetrical positions around the ablation line AL, the distance from the ablation line AL at each of the tip electrodes 95 and 93 is Each of the tip electrodes 91 and 92 is longer than the separation distance from the ablation line AL, and the remaining tip electrode 94 is positioned on the ablation line AL. 94 cannot be used for potential measurement.

(2) In the catheter described in the above-mentioned patent document, after positioning the electrode to be subjected to potential measurement with respect to the ablation line, the distal end portion of the catheter body is bent to move the distal end portion of the catheter. Thus, it is conceivable that the electrode to be subjected to the potential measurement is brought close to (in contact with) the inner wall of the heart or moved along the ablation line.
For example, by arranging two adjacent catheter tips across the ablation line, the tip electrodes (corresponding electrodes) attached to each of these catheter tips are symmetrically positioned about the ablation line. Then, it is conceivable that the catheter body is bent and the tip electrode approaches (contacts) the inner wall of the heart.

  However, in the catheter described in the above-mentioned patent document, the positional relationship adjusted between the catheter tip (electrode to be subjected to potential measurement) and the ablation line by bending the tip of the catheter body. There is a problem that shifts. For example, by bending the distal end portion of the catheter body, it is impossible to maintain the state where the two catheter distal portions straddle the ablation line (positional relationship before bending), and the distal end approached the inner wall of the heart The electrode may deviate greatly from the ablation line.

(3) In the catheter described in the above-mentioned patent document, when the bending direction of the distal end portion of the catheter body matches the direction in which any catheter distal end portion extends, the distal end portion of the catheter body is bent. Sometimes, the distal electrode attached to the distal end of the catheter extending in the same direction as the bending direction may press (pierce) the inner wall of the heart and damage the inner wall.

(4) Various diagnosis and treatment actions using a catheter, such as an operation for confirming whether or not cauterization is performed reliably after ablation treatment, are usually performed while viewing an X-ray image.
Moreover, since the measured potential data is displayed on the monitor of the electrocardiograph for each electrode used (between), the potential data (waveform) displayed on this monitor was measured by which electrode (between). It is necessary to know whether it is a thing.
For this reason, the operator knows which electrode is displayed on the X-ray image at which position at which tip of the catheter is attached (for example, the number of rings attached from the tip) It is required to grasp whether it is a shaped electrode.

The present invention has been made based on the above situation.
A first object of the present invention is an electrode catheter in which an electrode is attached to each of a plurality of catheter tips extending from the tip of a catheter body, and all the corresponding electrodes are placed at an equal distance from the ablation line. It is an object of the present invention to provide an electrode catheter. The second object of the present invention is to provide an arrangement state of the catheter tip with respect to the ablation line, which is adjusted before bending even if the tip of the catheter body is bent (for example, two catheter tips are ablation lines). An electrode catheter capable of maintaining the positional relationship of the electrode with respect to the ablation line (for example, the relationship in which two corresponding electrodes are in a symmetric position about the ablation line) .
A third object of the present invention is to provide an electrode catheter in which the distal electrode attached to the distal end portion of the catheter does not damage the inner wall of the heart even if the distal end portion of the catheter body is bent.

(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;
Four catheter tips extending from the tip of the catheter body at equiangular intervals along the circumferential direction of the axis of the catheter body;
An electrode attached to each of the catheter tips;
A deflection mechanism that bends the distal end portion of the catheter body in a direction that bisects the angle formed by two adjacent catheter distal end portions.

In the electrode catheter of the present invention having such a configuration, the four corresponding electrodes (for example, the tip electrodes) mounted on the tip portions of the four catheters are respectively located at the apexes of the square.
According to the electrode catheter of the present invention in which each of the four corresponding electrodes is located at the apex of the square (the electrode catheter having four catheter tips), the four corresponding electrodes are placed at an equal distance from the ablation line. can do.
For example, among the four tip electrodes that are the corresponding electrodes, the two tip electrodes that are attached to the adjacent catheter tip portions are placed at symmetrical positions with the ablation line as an axis, so that the remaining two These tip electrodes can also be placed at symmetrical positions with the ablation line as an axis. As a result, the four tip electrodes can be easily placed at an equal distance from the ablation line.

The deflection mechanism constituting the electrode catheter of the present invention bends the distal end portion of the catheter body in a direction that bisects the angle formed by two adjacent catheter distal end portions.
That is, the direction in which the distal end portion of the catheter body is bent by the deflection mechanism (a plane including the trajectory of the bent distal end portion) and the direction in which the bisector of the angle formed by two adjacent catheter distal end portions moves (the two And the plane including the locus of the equidistant line).
According to this deflection mechanism, the adjacent catheter tip portions are maintained in a state in which they cross the ablation line (the relationship that the corresponding electrodes mounted on each of the catheter tip portions are in symmetrical positions with the ablation line as an axis). However, the electrode to be subjected to potential measurement can be moved closer to (in contact with) the inner wall of the heart or moved along the ablation line.

(2) In the electrode catheter of the present invention, it is preferable that the deflection mechanism be a bi-directional control that bends the distal end portion of the catheter body in both directions around the axis of the catheter body.

There is a lot of tissue called tendon around the inner wall of the heart, especially around the valve, and in order to avoid entanglement of the catheter tip and the like with this tendon, the catheter body inserted into the heart chamber is It is preferable not to rotate around the axis as much as possible.
Thus, according to the electrode catheter of the present invention having the deflection mechanism as described above, for example, even when the distal end portion of the catheter is deflected by 180 °, it is not necessary to rotate the catheter body around the axis. (In such a case, it is necessary to rotate the catheter body around the axis) It is advantageous in that the distal end portion of the catheter is less likely to be entangled with the tendon than the one having a mechanism that can be bent only in one direction.

(3) In the electrode catheter of the present invention, it is preferable that each of the catheter tip portions is provided with a tip electrode and at least one, particularly 2-3 ring electrodes.

(4) Also, the electrode width of the first ring-shaped electrode from the distal end side in the first catheter distal end portion and the second ring from the distal end side in the second catheter distal end portion adjacent to the first catheter distal end portion It is preferable that the electrode width of the electrode is wider than the electrode widths of the other ring electrodes.
According to the electrode catheter of the present invention having such a configuration, a catheter having the ring electrode mounted thereon is found by finding a ring electrode having the first wide electrode width from the distal end side on the X-ray image. It can be recognized that the tip is the first catheter tip. Further, by finding the ring electrode having the second wide electrode width from the distal end side, it is possible to recognize that the catheter distal end portion to which the ring electrode is attached is the second catheter distal end portion. If the first catheter tip and the second catheter tip can be recognized, the catheter tip next to the second catheter tip is the third catheter tip, and the catheter next to it. It can be recognized that the tip is the fourth catheter tip. In addition, the arrangement position of the ring-shaped electrode mounted on each of the catheter tip portions (which electrode is mounted from the tip) can be easily grasped on the X-ray image. As a result, it is possible to easily grasp at which catheter tip portion the electrode is mounted at which position with respect to all the ring-shaped electrodes on the X-ray image.

(5) Also, the electrode width of the tip electrode attached to the first catheter tip is wider than the electrode width of the other tip electrode, and the electrode of one ring electrode attached to the second catheter tip The width is preferably wider than the electrode width of the other ring electrodes.
According to the electrode catheter of the present invention having such a configuration, by finding a tip electrode having an electrode width wider than that of other tip electrodes on an X-ray image, the tip of the catheter to which the tip electrode is attached can be obtained. It can be recognized that this is the first catheter tip. Further, by finding a ring-shaped electrode having a wider electrode width than other ring-shaped electrodes, it is possible to recognize that the catheter distal end portion to which the ring-shaped electrode is attached is the second catheter distal end portion. If the first catheter tip and the second catheter tip can be recognized, the catheter tip next to the second catheter tip is the third catheter tip, and the catheter next to it. It can be recognized that the tip is the fourth catheter tip. Moreover, 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. As a result, it is possible to easily grasp which electrode is mounted at which position of the catheter tip portion with respect to all the electrodes (tip electrode and ring-shaped electrode) on the X-ray image.

According to the electrode catheter of the present invention, the four corresponding electrodes mounted on each of the four catheter tip portions can be placed at an equal distance from the ablation line.
Further, even if the distal end portion of the catheter body is bent, the arrangement state of the catheter distal end portion with respect to the ablation line adjusted before bending the catheter body (for example, the state where the two catheter distal end portions straddle the ablation line), It is possible to maintain the positional relationship of the electrodes with respect to the ablation line (for example, the relationship in which two corresponding electrodes are in symmetrical positions with the ablation line as an axis). Therefore, while maintaining the arrangement of the catheter tip relative to the ablation line and the positional relationship of the electrodes, the electrode mounted on each catheter tip approaches (contacts) the inner wall of the heart or moves along the ablation line. Can be.
Furthermore, when the distal end portion of the catheter body is bent, the distal end electrode attached to the distal end portion of the catheter does not damage the inner wall of the heart.

It is a front view of the electrode catheter which concerns on one Embodiment of this invention. It is a side view (II arrow view of FIG. 1) of the electrode catheter shown in FIG. It is sectional drawing in the front-end | tip part of the electrode catheter shown in FIG. 1 (II-II sectional drawing of FIG. 2). FIG. 3 is a cross-sectional view (III-III cross-sectional view of FIG. 2) at the distal end portion of the electrode catheter shown in FIG. 1. FIG. 4 is a cross-sectional view (IV-IV cross-sectional view of FIG. 1) at the distal end portion of the electrode catheter shown in FIG. 1. It is the top view and side view which show the usage condition (state which the front-end | tip part of the catheter main body is not bent) of the electrode catheter shown in FIG. It is the top view and side view which show the usage condition (state in which the front-end | tip part of the catheter main body is bent) of the electrode catheter shown in FIG. It is a schematic side view which shows the usage aspect of the electrode catheter which concerns on a comparative example. It is a schematic plan view which shows the usage aspect of the conventional electrode catheter.

<First Embodiment>
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, and four catheter tips (first catheter tip 31, second catheter tip 32, third catheter tip 33, and fourth catheter. Tip part 34), tip electrodes 41a, 42a, 43a, 44a attached to each of the catheter tip parts, and eight ring electrodes 41B, 41c, 42b, two attached to each of the catheter tip parts. 42C, 43b / 43c, 44b / 44c and the direction formed by the two catheter tips (catheter tip 32 and catheter tip 33 / catheter tip 34 and catheter tip 31) is bisected (arrow) And a deflection mechanism that bends the distal end portion of the catheter body 10 in the A direction / the arrow B direction.

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). 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. 4) constituting a deflection mechanism of the catheter tip portion are passed through the lumen of the tube member 11. 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. 3, the distal end member 12 constituting the catheter body 10 includes a cylindrical portion 121 inserted into the lumen of the tube member 11 and each of the four catheter distal end portions (31, 32, 33, 34). And a holding portion 122 having four pores into which the base end portion of each is inserted.
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 (holding portion 122) is preferably the same as the outer diameter of the tube member 11.
The length of the tip member 12 (holding portion 122) 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 four catheter tip portions (first catheter tip portion 31, second catheter tip portion 32, third catheter tip portion 33, and fourth catheter tip portion 34). ing.
As shown in FIG. 2, the four catheter tip portions are spaced equidistantly from the tip of the catheter body 10 (tip member 12) along the circumferential direction of the axis of the catheter body 10 (in the side view shown in FIG. It extends at an interval of °.
Each of the four catheter tip portions extends in the tip direction while being bent radially outward of the axis of the catheter body 10.

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 5 to 50 mm, and more preferably 10 to 30 mm.

  As shown in FIGS. 3 and 5, the catheter tip portions 31, 32, 33, 34 are composed of elongated plate-like core members 311, 321, 331, 341 and covered tubes 312, 322, 332, 342. ing.

As shown in FIG. 3, the core member 311 constituting the first catheter tip 31 extends along the inner hole of the covering tube 312 and the tip is fixed in a state of being embedded in the tip electrode 41a. .
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 structures of the second catheter tip 32 and the fourth catheter tip 34 are the same as those of the first catheter tip 31 and the third catheter tip 33.

The core member stores the shape of the distal end portion of the catheter, and is deformed (for example, deformed linearly) by applying force. However, when the force is removed, the stored shape (as shown in FIGS. 1 to 4) is stored. Return to the unfolded shape.
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 four catheter distal end portions 31, 32, 33, and 34 are inserted into the pores formed in the distal end member 12 (holding portion 122), respectively, and the covered tubes 312 322, and 332 at the proximal end portions. 342 and the holding portion 122 are heat-sealed, whereby each of the catheter tip portions 31, 32, 33, 34 is fixed to the catheter body 10 (tip member 12).

On the catheter tip (first catheter tip 31, second catheter tip 32, third catheter tip 33, fourth catheter tip 34), tip electrodes 41a, 42a, 43a, 44a are respectively provided. And two ring-shaped electrodes 41B and 41c, 42b and 42C, 43b and 43c, and 44b and 44c, respectively.
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 FIG. 2, among the eight ring-shaped electrodes 41B and 41c, 42b and 42C, 43b and 43c, and 44b and 44c that constitute the electrode catheter 1, the ring shape that is attached to the distal end portion 31 of the first catheter The electrode 41B and the ring-shaped electrode 42C attached to the second catheter tip 32 have an electrode width (length in the tube axis direction) longer than the electrode width of the other ring-shaped electrodes. Is 1.5 to 2.0 times.
Here, the electrode width of the ring electrodes other than the ring electrode 41B and the ring electrode 42C is preferably 0.5 to 4.0 mm, and more preferably 0.6 to 1.2 mm.

According to the electrode catheter 1 having such a configuration, by finding the ring-shaped electrode 41B having a wide electrode width among the ring-shaped electrodes 41B, 42b, 43b, and 44b that are first from the distal end side on the X-ray image. It can be recognized that the distal end portion of the catheter to which the ring-shaped electrode 41B is attached is the first distal end portion 31 of the catheter.
If the first catheter tip 31 can be recognized on the X-ray image, the tip electrode and the ring electrode attached to the first catheter tip 31 are recognized as the tip electrode 41a and the ring electrodes 41B and 41c, respectively. Can do.

Further, by finding the ring-shaped electrode 42C having a wide electrode width among the ring-shaped electrodes 41c, 42C, 43c, and 44c that are second from the tip side on the X-ray image, the ring-shaped electrode 42C is attached. It can be recognized that the catheter tip portion is the second catheter tip portion 32.
If the second catheter tip 32 can be recognized on the X-ray image, the tip electrode and the ring electrode attached thereto are recognized as the tip electrode 42a and the ring electrodes 42b and 42C, respectively. Can do.

In addition, if the first catheter tip 31 and the second catheter tip 32 can be recognized on the X-ray image, they are next to the second catheter tip 32 (opposite to the first catheter tip 31). The catheter tip can be recognized as the third catheter tip 33.
If the third catheter tip 33 can be recognized on the X-ray image, the tip electrode and the ring electrode attached thereto are recognized as the tip electrode 43a and the ring electrodes 43b and 43c, respectively. Can do.

In addition, if the first catheter tip 31, the second catheter tip 32, and the third catheter tip 33 can be recognized on the X-ray image, they are next to the third catheter tip 33 (the third catheter tip 33). The catheter tip (between the catheter tip 33 and the first catheter tip 31) can be recognized as the fourth catheter tip 34.
If the fourth catheter tip 34 can be recognized on the X-ray image, the tip electrode and the ring-shaped electrode attached thereto are recognized as the tip electrode 44a and the ring-shaped electrodes 44b and 44c, respectively. Can do.

As a result, it is possible to easily grasp which catheter tip is attached to all the tip electrodes 41a, 42a, 43a, 44a on the X-ray image.
In addition, regarding all the ring electrodes 41B and 41c, 42b and 42C, 43b and 43c, and 44b and 44c on the X-ray image, it is determined at which arrangement position at which catheter tip portion. It can be easily grasped.

The electrode catheter 1 of this embodiment includes a deflection mechanism that bends the distal end portion of the catheter main body 10 in a direction that bisects the angle formed by two adjacent catheter distal end portions.
That is, a direction in which the distal end portion of the catheter main body 10 is bent by the deflection mechanism (a plane including the locus of the bent distal end portion) and an angle formed by the two catheter distal end portions as the distal end portion of the catheter main body 10 is bent. The direction in which the bisector moves is the same (the plane including the locus of the bisector).

By such a deflection mechanism, the direction in which the distal end portion of the catheter body 10 bisects the angle formed by the catheter distal end portion 32 and the catheter distal end portion 33 (the direction indicated by the arrow A in FIGS. 1 and 2), and The angle formed by the catheter distal end portion 34 and the catheter distal end portion 31 can be bent in a bisecting direction (direction indicated by arrow B in FIGS. 1 and 2).
Then, the distal end portion of the catheter body 10 is bent in the direction indicated by the arrow A or the arrow B, so that the four catheter distal end portions 31, 32, 33, and 34 are integrated in the direction indicated by the arrow A or the arrow B. Move to.

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 pulling wires (indicated by 51 and 52 in FIG. 4) to be drawn and a rotating plate 22 to which the proximal ends of the two pulling 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 a direction (arrow A direction) that bisects the angle formed by the catheter distal end portion 32 and the catheter distal end portion 33, whereby the four catheter distal end portions are Moves 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 a direction (arrow B direction) that bisects the angle formed by the catheter distal end portion 34 and the catheter distal end portion 31, whereby the four catheter distal end portions are Moves integrally in the direction of arrow B.

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 four catheter tip portions are linearly deformed (closed state), and a target site (for example, ablation line formation site) in the heart chamber. The electrode catheter 1 is moved to the vicinity of and the four catheter tip portions are pushed out of the sheath in the vicinity of the target site, so that the memory shape of the catheter tip portion (deployed shape as shown in FIGS. 1 to 4) Restore it.

  Next, while observing the X-ray image, the catheter body 10 is arranged along (in parallel with) the ablation line, and the catheter body 10 is rotated around the axis so that two adjacent X-ray images can be seen on the X-ray image. Stop at the position where the angle formed by the catheter tip becomes maximum.

6 (1) and 6 (2) are a plan view and a side view showing the state at this time, and are forms that can be grasped on an X-ray image. In the plan view shown in FIG. 6A, the ablation line AL extends in a direction (on the bisector) that bisects the angle formed by the catheter tip 32 and the catheter tip 33.
That is, in the plan view shown in FIG. 6 (1), the catheter tip 32 and the catheter tip 33 are symmetrical with respect to the ablation line AL (the state where these catheter tips cross the ablation line). Yes, the tip electrode 42a and the tip electrode 43a are in symmetrical positions with the ablation line AL as an axis.

  In addition, as shown in FIG. 6 (2), the catheter tip 31 and the catheter tip 34 are in a state of straddling the ablation line AL, and the tip electrode 41a and the tip electrode 44a are connected to the ablation line AL. It is in a symmetrical position with respect to the axis.

Next, the distal end portion of the catheter body 10 is bent along the ablation line AL (to the inner wall side of the heart) by the deflection mechanism. As a result, while maintaining the state where the catheter main body 32 (31) and the catheter main body 33 (34) straddle the ablation line AL, the tip electrode mounted on each of them is brought into contact with the inner wall of the heart. be able to.
For example, by rotating the rotating plate 22 in the direction of the arrow B1 shown in FIG. 1 and pulling the pulling wire 51, the angle between the distal end portion of the catheter body 10 and the distal end portion 34 of the catheter and the distal end portion 31 of the catheter is increased. Bend 90 ° in the direction of arrow B to be equally divided.
As a result, the four catheter tip portions 31, 32, 33, 34 move integrally in the direction of arrow B, and as shown in FIGS. 7 (1) and (2), The attached tip electrodes 41a, 42a, 43a, 44a can be brought into contact with the inner wall of the heart.

According to the electrode catheter 1 of this embodiment, the direction of the arrow A and the direction of the arrow B, which are the bending direction of the distal end portion of the catheter body 10 (the moving direction of the distal end portion of the catheter), are made to coincide with the direction in which the ablation line is formed. In this state, the distal end portion of the catheter body 10 is bent by 90 ° so that the catheter body 32 (31) and the catheter body 33 (34) straddle the ablation line AL [tip electrode 42a (41a). And the tip electrode 43a (44a) in a symmetrical position about the ablation line AL], and the four catheter tip portions 31, 32, 33, 34 are moved integrally. Each of the four tip electrodes 41a, 42a, 43a, 44a attached to each of them is brought into contact with the inner wall of the heart, Or it can be moved along the Activation line.
Note that the ablation line AL shown in FIGS. 6 and 7 does not normally appear on the X-ray image, but is normally grasped by the operator.

As shown in FIG. 7 (1), after the distal end portion of the catheter body 10 is bent, the four distal end electrodes 41a, 42a, 43a, 44a are arranged at an equal distance from the ablation line AL.
By applying electrical stimulation (pacing) from any one of the tip electrodes arranged in this way (pacing), measure the potential at the other tip electrode, and compare the transmission speed (time when the potential was detected), thereby ablation The line AL can be evaluated.
It is also possible to place another electrode catheter around the catheter body 10, apply electrical stimulation from the other electrode catheter (pacing), measure the potential at each tip electrode, and compare the transmission speed. is there.
By arranging the four tip electrodes equidistant from the ablation line AL, if the intended cauterization is made along the ablation line AL, the tip electrode 41a and the tip electrode 41a The potential transmission speed between the tip electrodes 44a (potential transmission speed between the electrodes straddling the ablation line AL) is between the tip electrode 42a and the tip electrode 41a, and between the tip electrode 43a and the tip electrode 44a. It becomes slower than the transmission speed of the potential (potential transmission speed between the electrodes not crossing the ablation line AL).
If uniform cauterization is performed along the ablation line AL, the transmission speed of the potential between the tip electrode 42a and the tip electrode 43a is equal to the transmission speed of the potential between the tip electrode 41a and the tip electrode 44a. Become.

  As shown in FIG. 8, instead of the deflection mechanism constituting the electrode catheter of the present invention, the catheter body 110 extends in the direction in which the catheter tip portion 133 and the catheter tip portion 131 extend (directions indicated by arrows a and b). When a deflection mechanism that bends the distal end portion of the catheter is employed, as shown in FIG. 1A, the catheter distal end portion 132 (131) and the catheter distal end portion 133 (134) are arranged with the ablation line AL as an axis. Even if it arrange | positions so that it may become line symmetry (the state which these catheter front-end | tip parts straddled the ablation line), the front-end | tip part of the catheter main body 110 is bent in the b direction, for example (2) As shown in Fig. 4, the catheter tip 132 (131) and the catheter tip 133 (134) cross the ablation line. It can not be maintained Ide and state (positional relationship prior to bending), the inner wall to the tip electrode 141a which is brought close to the heart, 142a, 143a, 144a may deviate significantly from the ablation line AL.

  Further, according to the deflection mechanism as described above, when the distal end portion of the catheter main body 110 is bent along the ablation line AL, the catheter distal end portions 133 and 131 move along the ablation line AL and are attached thereto. Since the tip electrodes 143a and 141a move on the ablation line AL, these tip electrodes cannot be used for potential measurement.

In the above description, the tip electrodes 41a, 42a, 43a, and 44a are described as examples of the corresponding electrodes. However, the same applies to the corresponding ring electrodes (eight ring electrodes shown in FIG. 2). It is.
That is, according to the electrode catheter 1 of this embodiment, while maintaining the positional relationship that the ring-shaped electrode 42b (41B) and the ring-shaped electrode 43b (44b) are in a symmetric position about the ablation line AL, The ring-shaped electrodes 41B, 42b, 43b, and 44b can be brought close to (in contact with) the inner wall of the heart or moved along the ablation line.
And after bending the front-end | tip part of the catheter main body 10, the four ring-shaped electrodes 41B, 42b, 43b, 44b which are corresponding electrodes can be arrange | positioned at equal distance from the ablation line AL.

Moreover, according to the electrode catheter 1 of this embodiment, while maintaining the positional relationship that the ring-shaped electrode 42C (41c) and the ring-shaped electrode 43c (44c) are in symmetrical positions with the ablation line AL as an axis, The ring-shaped electrodes 41c, 42C, 43c, and 44c can be moved closer to (in contact with) the inner wall of the heart or moved along the ablation line.
And after bending the front-end | tip part of the catheter main body 10, the four ring-shaped electrodes 41c, 42C, 43c, and 44c which are corresponding electrodes can be arrange | positioned at equal distance from the ablation line AL.

  Furthermore, according to the electrode catheter 1 of this embodiment, the bending direction of the distal end portion of the catheter main body 10 by the deflection mechanism is a direction that bisects the angle formed by the two catheter distal end portions. The force when bending the distal end portion does not concentrate on any one catheter tip, and the force pressing the inner wall of the heart by the tip electrode attached to the catheter tip is extremely small. There is no risk of hurting.

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

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

  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 34 Fourth catheter tip 311, 321, 331, 341 Core member 312, 322, 332, 342 Covered tube 41a, 42a, 43a, 44a Tip electrode 41B / 41c, 42b / 42C, 43b / 43c, 44b / 44c Ring shape electrode

Claims (3)

A catheter body having at least one inner bore;
A control handle connected to the proximal end of the catheter body;
Four catheter tips extending from the tip of the catheter body at equiangular intervals along the circumferential direction of the axis of the catheter body;
An electrode attached to each of the catheter tips;
An electrode catheter comprising: a deflection mechanism that bends the distal end portion of the catheter main body in a direction that bisects an angle formed by two adjacent catheter distal end portions.   2. The electrode catheter according to claim 1, wherein the deflection mechanism bends the distal end portion of the catheter body in both directions around the axis of the catheter body.   The electrode catheter according to claim 1 or 2, wherein a tip electrode and at least one ring-shaped electrode are attached to each of the catheter tip portions.

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