KR100271780B1 - Abdominal Deflection Catheter for Absorption of Arrhythmia Tissue - Google Patents

Abstract

Vascular catheter has a very flexible end. In the planar control system, the ventricular wall into which the end tip is inserted allows the end catheter and the tip of the tip to be adjusted in an arbitrary direction so as to be accessible to any part. Embodiments of dual-line biplanar control systems include a vertical deflection control line capable of deflecting the catheter end tip to a vertical plane parallel to the longitudinal axis of the tubular catheter and a catheter end to a plane perpendicular to the longitudinal axis of the tubular catheter. Side deflection control lines are included. A single line system capable of both vertical and horizontal adjustment has also been described above.

Description

Abdominal Deflection Catheter for Absorption of Arrhythmia Tissue

1 is a side view of a catheter system showing a flexible tip in various positions.

2 is an enlarged partial view of the tip portion of FIG.

3 is a partially enlarged view of a portion of the tip portion of the catheter cut away.

4 is a partially enlarged view of the side tip deflection adjustment knob which can be operated by hand.

5 (a)-(c) show other embodiments of the electrode catheter of the catheter system of the present invention.

6 is a detailed partial enlarged view of the electrode mapping / cutting tip according to FIGS. 5 (a)-(c).

7 shows a partial side view as an embodiment using a single control wire.

8 (a)-(c) show a rotating side view and a plan view of the piston locking system of the handle of FIG.

9 is a partial side view of another two wire adjustment handle according to the present invention.

* Explanation of symbols for main parts of the drawings

10 handle 12 tube

14: flexible end tip 16: electric jack type plug

18: handle 20: inner tube handle

24: virtual line 28: side tip deflection adjustment knob

30: mounting part 32: tube

34 knob 38 transition part

40: catheter tube 42: platinum catheter tip system

62: vertical tip deflection control line 70: bidirectional adjustment knob

72: internal cylinder 74: thread

76: rotation ring 78: shoulder

80: paper machine 82: spring

84,85: Lock Key

This patent application is a continuation of US patent application 07 / 909,867 filed on July 7, 1992 and a continuation of US patent application 07 / 835,553 filed on February 14, 1992, which is now abandoned.

References to this application are 07 / 840,026 and 07 / 909,869 and 07 / 840,162. Each relates to an improved catheter.

The present invention relates to an improved catheter instrument for use in the field of cardiac arrhythmia. In particular, the present invention relates to the use of a biplanar deflection system that increases the maneuverability of the catheter tip on the side generally perpendicular to the main catheter tube arrangement. This allows the operator to direct and adjust the catheter's tip in various directions by bringing the catheter as close to the arrhythmia tissue as possible for effective removal.

Normal heart rate in a healthy body is controlled by a specific structure known as the SA node. It is a unique space maker of the heart (a device that continues the pain of the heart) that is a specific tissue located in the muscle wall of the right atrium. SA nodes induce a cardiac rhythm by driving genetic or intrinsic regular contractions of the atria and ventricles. It drives or regulates the transmission of ionic pulses through the cardiac conduction pathway in the atria and ventricles, which are contracted and relaxed at the normal rate, driven by the SA node. This series of actions allows blood flow to the circulatory or pulmonary arteries to be maximized with each ventricular contraction. SA nodes have inherent velocities that can be transformed by signals in the nervous system. In response to excitement, physical activity, the sympathetic and parasympathetic nervous system reacts to regulate speed.

The passive heartbeat begins with an electric wave from the SA node in the right atrium and is transmitted to the left atrium and then to the transition between the ventricles and the ventricles, another nodular known as the A-V node. This heartbeat slowly passes through the A-V node to the usual passage known as the inner ventricle between the left and right ventricles, and then to the left and right bundles fed to each ventricle. However, the inner bundle is divided into massive tissues of fine passages of conducting tissues leading from the inside of the heart to the outside. These fibrous tissues provide a passive heartbeat to the myocardial layer of the ventricles.

Unless these systems are compromised, the heart beats normally, maintaining the rhythm of the heart. Natural pulses or current flow in the cardiac conduction system can be hindered or modified by genetic diseases, diseases or injuries that cause scar tissue formation. In case of severe damage to the cardiac conduction pathway or ventricular myocardial layer or genetic disease, electrical propagation is not transmitted normally and confusion such as cardiac arrhythmias occurs. This confusion may be an abnormally slow heart rate (less than 60 pulses per minute) or an abnormally fast pulse rate (more than 100 pulses). All of these conditions threaten the patient's life and, in particular, patients with heart disease are more at risk.

Ventricular tachycardia and other ventricular arrhythmias can be treated with a number of drugs such as lidocaine, quinidine and procaineamide. In case of excessive sympathetic activity or adrenal secretion, beta-blockers have been used. If medication is ineffective in preventing tachyarrhythmias, special surgical procedures have been used to remove arrhythmia in the atria or ventricles. This process is a massive surgery that is made through the pericardium and heart muscle to find an arrhythmia tissue and then freeze it to replace the scar tissue and remove it.

Cardiac incision is a very dangerous procedure that requires a considerable amount of time for treatment and recovery. Various types of catheter have been devised and used to avoid trauma such as cardiac incision and diagnose and treat many heart diseases. For example, as a method of dissociating atherosclerotic plaques, the narrowing lesion is incised with an instrument used for angioplasty. In this process, the catheterized instrument moves through the patient's vascular system to the location of the stenosis. The instrument is inflated by the liquid injected into the lumen of the catheter, providing pressure to the blocked vessel wall to penetrate the vessel.

Catheter devices are used to find or ablate cardiac electrostatic passages. As one such device shown in US Pat. No. 4,785,815, the catheter tube has at least one electrode at the end that senses membrane potential in the heart and a heating device that can ablate a portion of the passageway found by the sensing device. Heat dissection catheter for small or large incision of the conduction passage in the heart is described in US Pat. No. 4,869,258 for highly topical treatment using a resistive heating element at the end. These devices, which are effective as incisions, are properly placed in restricted locations of requisiteness. Catheter device tips of the type described use a single handle actuated deflection wire. Such a device is described in US Pat. No. 4,960,134.

Electrophysiological catheter dissection procedures are often hampered by the inability of the operator to move the catheter tip to the correct location of the arrhythmia tissue. This is mainly a result of the limited maneuverability of the catheter tube itself. The catheter tube should be of sufficient strength and rigidity to move close to the tissue of interest through the vasculature. This structure limits the flexibility of the catheter tip needed to perform complex multidirectional manipulations at the very confined sites involved. A single deflection wire controlled catheter and available catheter are inadequate for controlling fine movement and are characterized by having a tip that deflects only in a plane parallel to the main catheter tube. This prevents controlled lateral movement in the atrium or in the ventricle perpendicular to the main catheter tube.

Most current cardiac tissue incisions use RF electrical current to deliver tissue to the tissues through catheters as close as possible to the arrhythmia site in the atrium or ventricle. The RF current heats the tissue around the catheter and creates a separate, dense lesion. In order to treat arrhythmias in the patient, the lesion must be created at the location of the arrhythmia. The improved maneuverability of the device allows the catheter to be correctly positioned before incision.

The present invention provides a novel catheter shape with a catheter tip with increased flexibility. Increased flexibility is associated with the coupling of a planar deflection system that can control the lateral motion of the catheter tip.

The catheter system of the present invention comprises an elongated flexible tubular catheter of the top, bottom, and central lumen between them. The outer diameter of the tubla catheter must be able to enter the ventricle of the requirement to be treated and to be transmitted through the patient's vascular system. Typically the size is 7-8 French. The distal end of the main tube of the catheter of the present invention includes a flexible end tip made of a highly flexible reinforced polymer tube such as polyethylene connected to the main tube. This flexible tube runs inside the distal end of the catheter's main tube.

As an example of a flexible end tip, a cylindrical metal tip electrode made of a precious metal such as platinum has a length of 4 mm and a diameter of 3 mm. One or more additional electrodes, preferably two or three ring electrodes, are connected in series with a space of 2 mm in the tip electrode.

In another embodiment, the catheter tip with the electrode has a predetermined fixed “memory” surrounding the periphery of the catheter lumen. This is flexible and can be done using memory materials from metals or plastics such as nickel titanium, also known as nitinol. In this way, specific shapes approaching and conveying specific internal heart regions can be created by mapping / incision electrode tips that can assume typical design shapes when deployed. Mapping / incision tips typically use a series of electrodes that are separated from each other by the shape or number of requirements. These electrodes are typically 4 mm long and 3 mm apart. The tip of the predetermined shape is made to be suitable for operation with the tip deflection system of the present invention while maintaining its shape.

All electrodes are connected to the input / output device, which is generally an electrical negative jack type connector by a flake low resistance wire conductor. The handle can also be connected to a phono jack or other connector. The electrode can be connected to a recorder that measures and represents the cardiac pulsatile potential sensed within the associated ventricle. This system is used to show the fastest activity, indicating the most appropriate location for tissue dissection. The tip electrode (or other electrode) can be used for electrical mapping which is connected to the recorder and connected to transport the cutting energy following the energy source.

In one embodiment, the system includes a pair of wires of vertical deflection control wire and horizontal deflection control wire. The vertical deflection wire regulates the deflection of the tip in a plane parallel to the main catheter tube. (Vertical deflection) The system also includes a stainless steel wire connected to a T-shaped pin, such as stainless steel. The T-shaped pin is fixed to the flexible end about 3-4 mm away from the tip electrode and becomes the axis of the vertical deflection wire.

Tip deflection can be achieved by actuating the longitudinally movable portion of the handle, which provides the pulling and loosening of the wire. Pulling the vertical deflection wire off center from the insertion position of the wire to the side of the flexible portion of the catheter causes the tip to deflect. The wire runs from the central lumen through the main body of the catheter to the handle.

Lateral deflection and adjustment are possible using highly torsional wires that are flexible only at the ends and can be inserted into the flexible deflection ends of the catheter. The upper end of this wire is quite rigid. It is connected to a hand-operated rotary lateral adjustment knob, which is threaded to the rigid part of the catheter and exits the catheter tube through a radial opening some distance from the handle and mounted a distance away from the catheter handle. The distal end of this wire is typically fixed by soldering to the tip electrode. Rotation of the knob transmits a rotatable torsion to the catheter tip. When the distal catheter tip is deflected vertically, the torsion through this wire causes the distal tip to deflect laterally. The knob system is designed to rotate freely when pressed down and lock in position when released. The rotary knob system is designed to allow only a limited number of revolutions, possibly 5 to 6 revolutions, to prevent the wires from over-rotating and breaking by the operator.

Vertical deflection of the catheter tube is made possible by the longitudinal movement of the handle. Lateral motion adjustment is carried out by turning the rotary knob in the direction required. The knob and handle of the rotary knob allow you to position the tip exactly on the heart.

Continuous recording of electroactivity while the catheter tip is deflected or rotated is possible because the tip electrode is connected to a conducting wire connected to the phono connector. The tip is connected to an RF electrical current source for incision.

Another embodiment using a single wire capable of deflecting the catheter in both the vertical and horizontal directions by using a high torsion material that is designed to rotate simultaneously with the pull is described and a separate dual-wire control system.

1 illustrates a planar tissue incision catheter system, which includes a handle 10, a relatively rigid tube 12 in the center and a flexible distal tip 14. The 12th part in the middle has an interruption section to explain the main body of the catheter.

The handle includes an electric jack type plug 16 having a plurality of input / output points connected to a conductor, which will be described below. The handle 18 is free to adjust the distance along the longitudinal axis of the handle in relation to the inner tubular handle 20. Distance adjustment is explained by an imaginary line (24). The handle generally includes a manually actuated side rotating tip deflection adjustment knob, which is connected to the center tube by a tube 32 and fixed at a distance from the handle by the mounting portion 30. Knob 34 is rotatable in the longitudinal axis and is described in more detail in FIG. The relatively small tube 32 is joined by a transitional end 38, which is narrowed down and has a flexible end tip 14. The flexible tip includes an upper end of the flexible catheter tube 40 that is connected to the main catheter tube 12 and the end of the platinum catheter tip system 42 with electrodes. Tube 40 is generally 4 to 8 cm, depending on the intended use. The tube becomes a biologically adaptable material and is made of relatively inert polymers that can be combined with other catheter materials and have strength and flexibility in order to obtain the characteristics required. Thin, flexible tubes typically have an ID of less than 3mm.

As shown in FIG. 2 and FIG. 3, the catheter tip system 42 has a plurality of electrodes electrically connected to the external environment of the tip, each of which is connected to the insulated electrical conductors 50, 52, 54. 44,46,48). The lead is connected to the handle through the catheter tubes 40 and 42 and separated from the jack 16. The ablation electrode 42 can be connected via a wire to operate as an output at high frequency electric force or to a recorder in a mapping mode when operated in ablation mode.

Lateral tip deflection is achieved by connecting the high torsion line 64 through the central core of the catheter tube and through the tube to the side control knob 28. The vertical tip deflection control line 62 is inserted into the deflection portion of the catheter at an off-center position and has a terminal axis on the side wall of the catheter by a T-shaped stainless steel pin 66 directly below the tip electrode. The vertical deflection control line 62 is connected to the handle 10 through the central lumen of the catheter, and the upper end thereof forms an axis on the handle of the handle 18. Handle handles result in vertical deflection of the flexible catheter tip.

A hand operated rotatable side tip deflection adjustment knob system has been described in detail in FIG. 4. The hand operated knob system 28 includes an outer cylinder 34, a bidirectional adjustment knob 70 which is operated by a finger connected to an inner cylinder 72 having a plurality of threads 74 and a rotating ring 76. . The ring 76 is on the main shaft and is limited in speed by the lower shoulder 78 and the upper paper machine 30. The spring 82 pushes the knob upwards relative to the handle 70 to which the locking keys 84 and 85 are connected. The adjusting line 64 traverses the knob system and is axised to the knob at 86 so that the rotational force following the adjusting line 64 is directly controlled by the rotation of the knob 70.

Any mechanism may be used to carry out the manual operation of the rotary knob adjustment system 28 and what is presented in FIG. 4 operates as follows. The knob 70 attached to the inner cylinder 72 can be mutually adjusted longitudinally relative to the spring 82. When the handle 70 is pushed, the locking keys 84 and 85 dissociate and the cylinder 72 rotates. Allow it to rotate about the ring. The end of the line 64 is fixed to the knob 70 in the 86 position and the rotation of the knob 70 provides a rotational force to the control line 64 in the direction of the desired to transfer to the tip 42. The spring 82 maintains the round end socket in the normally engaged position and the relative rotation is interrupted by maintaining the rotational force on the line 64. Rotation of the knob 70 is limited by paper machines 80, 84, 85 and the dislocation force by the catheter tip 42 is maintained below the level at which the catheter tip can shear the line.

In operation, the catheter system is introduced by incision into the femoral aorta and delivered through the vascular system to the room of the patient's heart. When the desired atrium is reached, the reciprocal movement of the handle 18 and the compression and rotation of the knob 70 allow for complex vertical and lateral adjustment of the tip so that the electrode can be accessed at any point in the atrium.

The electrodes 44, 46 and 48 are used to draw the cardiac pulsatile potential through the atrium and thereby map to the location of the initial active site. Tip electrodes are used to deliver energy for tissue incisions and also in mapping mode.

In addition, as shown in FIGS. 5 (a)-(c) and 6, the catheter tip may be made in a shape of a desired shape according to a specific site or an internal heart site. This can be done by varying the tip of the electrode catheter to a predetermined shape using memory elements such as metal alloys and plastics. As an example of this, in Figs. 5 (a) and 5 (b), the shape of the incision tip and the plate mapping is designed to fit the atrial side of the A-V ring. The shape of Figure 5 (c) is made to fit the ventricular surface of the A-V ring. In general, catheter tips at 100 include fragments of several shapes, as seen at 102, 104, and 106, about 4.2 cm in length (tips with 64 mm ring electrodes at 3 mm intervals). The wire tail 108 having a length of 0.2 cm shown in FIGS. 5 (a) and 5 (b) helps the electrode to stably settle in the correct position. The catheter tip includes a very flexible top 110 about 8.5 cm in length to help move it to its intended location. Ring electrodes 112 separated by spaces 114 are connected to the electrodes, respectively. The electrode may be any shape or size.

In FIG. 5 (c), the side arm 106 shows a control shape suitable for the straight tip 100. This shape is suitable for intracellular mapping and incisions in the ventricles of the A-V ring and for accessing the posterior side passage. The remainder of the flexible tip at 118 is similar to the flexible tip portion 110 of FIGS. 40 and 5 (a) and 5 (b) of FIG. 2 attached to the main catheter tube 120 as in the transition region 122. Do.

Precise placement of the catheter system of the present invention allows tissue to be dissected with a catheter to more easily and accurately treat cardiac arrhythmias. This is less time consuming and more practical than previous systems.

6 illustrates a general electrode catheter tip having a plurality of ring electrodes 112 having a predetermined space 114. Each electrode is connected by a separate insulator wire 130 as in 132. There is a bundle of wires that can be controlled outside the catheter in a known manner. The adjusting pin 136 and adjusting line 135 provide a flexible end 110 for moving the device as described above.

The lines used to deflect the catheter in the vertical direction in the deflection catheter system of the present invention can also be used for lateral deflection of the catheter tip using a single control line. In an embodiment, the lead is made of a high torsion material capable of reacting by the kidneys and transferring torsion to the tip. Thus, when the line is stretched, the tip deflects vertically by the required amount, and when the line rotates, the tip transmits rotational force to the catheter tip and moves to the side deflection. 7 and 8A-8C illustrate embodiments of catheter control handles obtained using a single control wire.

Figure 7 shows another handle system with a bent portion just below the attachment of the distal end of the main incision catheter system tube 12, which is an electrical jack or plug at the top of the handle with a number of irregularities as in 145. It leads. Multiple unevenness 145 is located in a flexible conduit housing that is connected with a plurality of wires 145 to adjust the entire catheter system connected to the tip electrode in a known manner. It is usually made of nylon tubing to protect the wire so that the center of the catheter system can be adjusted and can be easily twisted and untwisted so as to be unaffected by rotation and bilateral movement in the middle.

The handle 140 includes a piston 152 that can move in both directions, and includes an outer housing 148 including a cylinder hole 150 connected thereto. The piston 152 has an enlarged piston handle 154 that can be gripped by the operator and the housing 143 is rotatable relative to the piston portion 152.

157 is a multi-function adjusting wire, through the bore 155, the distal end being wound on the rotating wall 156 between the two bores in the protected handle, which can be rotated relative to the bore by using the screw head at 158. have. As such, when the handle is assembled, or repaired, or adjusted by friction, the tension of the adjusting wire 157 is first adjusted, and then the tension is controlled by the interaction of the piston handle 154.

The piston 152 has a plurality of grooves 160 and ridges 162 opposite the pistons, which are connected to the ring 164 and the wire 166 and in FIGS. 8 (a)-8 (c) It makes the piston mentioned above move. The ring 168 is connected to the ear 170 that is the lock of the ring 164. The rubber o-ring 172 blocks the top axle of the piston 174 and provides the necessary friction to prevent unlimited movement of the piston.

A rotation limiter is in the handle to limit the number of rotations of the housing 148 relative to the piston handle 154. The upper end of the cylinder with a piston 152 of about 6 cm has one or more grooves of about 5 mm deep and 3 mm wide which leads to the nut 180 of the extension shaft of the piston 152 with the stop 184. It becomes the passage of. Rotation of the handle housing 148 relative to the piston 152/154 causes the nut 180 to move toward the groove 182 along the pitch and the rotation of the nut is caused by the pin 178 in contact with the groove 176. Is blocked. This substitution is limited by the stop 184 and the top piston 174.

The nuts 180 are positioned in the middle of the thin groove 182 so that the left or right rotation may be the same. As such, the relative rotation of the control line 157 on the shaft 158 is limited to 8-10 times to prevent breakage by torsion. Relative rotation of handles 148 and 154 also causes twist of line 147 relative to wire 157. Allow the flexible tube 147 to loosen to allow sufficient rotation. The tension is adjusted by the piston movement relative to the cylinder when the piston wraps the wire 157 in the longitudinal direction.

8 (a) to 8 (c) illustrating the locking mechanism of the piston 152 illustrate the control of the mutual movement of the piston system. On the other hand, a parallel line 166 of a certain space is in the groove 186 disposed on the opposite side of the pair. The wire 166 is connected to the barb 162 and serves to lock the piston when the piston 152 rotates and mutually moves so that the ridge is not connected to the wire when the 152 rotates by 90 °.

9, another two wire adjustment handle is shown in the handle housing 190, which has a cylinder recess 192 for receiving an interlocking piston 194 surrounded by an O-ring 195 and an electrical adjustment wire ( 198 is connected to the rotational side deflection control ring 196 and the vertical deflection wire 200 is connected to the center of the main catheter tube. The electrical connector is 204. Torsion is applied to the lateral deflection wire 204 mounted in the tube 206 branched from the main catheter tube 202 by the inner ring gear 208 and pinion to which the wire 204 is fixed. A single rotation of the ring gear enables up to eight revolutions of the pinion gear 210 and gives multiple rotational forces of the side deflection control wire 204. The interaction of the piston 192 regulates the elongation of the side (vertical) deflection wires, and the rotation of the ring gear 208 controls the torsion in the side control wires 204.

The present invention has been described above so that the novel principles can be applied using the embodiments described above. However, it will be appreciated that various changes and unusually different arrangements without departing from the scope of the present invention are within the scope of the present invention.

Claims (36)

A cardiac arrhythmia catheter comprising: a highly flexible tubular catheter portion having a distal tip that can be inserted and moved through a ventricle; An electrode device moved near the distal tip by a catheter system; A dual element biplane system capable of regulating the insertion and movement of the distal catheter so that any portion of the intraventricular wall to which the distal tip is inserted can be accessed in any direction; The dual element biplanar system consists of a vertical deflection control element that can tilt the distal tip of the catheter in a plane parallel to the longitudinal axis of the tubular catheter and a distal tip of the catheter in a plane perpendicular to the longitudinal axis of the tubular catheter. Cardiac arrhythmia resection catheter, characterized in that the side deflection control element is included. In the construction of a catheter tip control system: a lateral deflection control element leading into the end catheter lumen in the configuration of a catheter with a highly flexible tubular end catheter portion leading to the main catheter and an acting end tip that is precisely controlled There is an end axially near the distal tip of the ter such that for lateral deflection control the rotational force is created such that the distal end is oriented in a plane parallel to the direction of the rotational force; And a device providing rotational force with respect to the side deflection control element. 3. The device of claim 2, wherein the side deflection control device is a torsion transmission control line, and the device for providing rotational force to the side deflection control line is an auto-locking, manually rotatable knob. 4. The device according to claim 3, wherein in the configuration of the self-locking, manually rotatable knob, the device is attached to the side deflection control line so that the rotation of the rotary knob can provide a considerable amount of rotational force to the side deflection control line. Locking wedge device is spring-loaded to maintain the rotational position of the knob when the; And a rotation limiting device of the rotary knob for limiting rotation of the knob in a direction for limiting rotational force provided to the side deflection control line. 5. The device of claim 4, wherein the lateral deflection control line is more flexible in cross section of the distal catheter lumen. A configuration of a double catheter tip control system comprising: a catheter with a highly flexible tubular terminal catheter portion that is precisely controlled end tips and end catheter lumens; The vertical deflection control component inserted into the distal catheter lumen, which is fixed at the end of the flexible distal catheter portion, so that the movement of the vertical deflection control component along the distal catheter lumen is parallel to the direction of line movement. A device for deflecting the distal tip of the ter, displaced by a vertical deflection control line and longitudinal axis along the flexible distal catheter lumen, and a lateral deflection control fitted within the distal catheter lumen with the distal end fixed to the distal tip of the flexible distal catheter The component is a double-structured catheter tip, characterized in that the rotational force acting on the side deflection control component is configured to cause the end tip to deflect on a plane parallel to the direction of the applied rotational force, and to provide a rotational force to the side deflection control component. Regulation system. 7. A device according to claim 6, wherein in the arrangement of the device which is substituted with the vertical deflection control component and the longitudinal axis along the flexible terminal catheter lumen, the manual control handle with the longitudinal displacement portion attached to the vertical deflection control component and its longitudinal movement The longitudinal displacement of the vertical deflection control component and the vertical deflection of the distal tip are adjusted, and the configuration of the device for providing rotational force to the side deflection control component is an automatic lock mounted to the control handle and attached to the side deflection control component, A structurally rotatable side adjustment knob and left and right rotation of the knob provide a rotational force to the side deflection control component, which is transmitted to induce a lateral deflection of the disturbance at the distal tip. In the construction of a deflection catheter system used for arrhythmia tissue ablation, a central catheter consisting of an elongated flexible plastic tube having a base and an end and a small external diameter that can move through the arterial vasculature at the inlet is formed at the base end. The relatively short end catheter, which consists of a relatively long luminal lumen leading to and which provides the necessary transfer force for transmitting the catheter through the arterial blood system, is connected to the end of the central catheter. Flexible tube consisting of a flexible plastic tube connected to the end of the central catheter with a diameter less than or equal to the outer diameter of the ter and can pass through the ventricles, and the inner tube steel extending from the base to the end has a relatively large control force. Consists of walls and connected to the catheter system An electrode device consisting of at least one electrode implemented by an electrode of the distal catheter portion, which is connected to the outer surface of the distal catheter, and a vertical deflection control line fitted within the distal tip lumen is fixed to the flexible tip to secure the end catheter The movement of the vertical deflection control line to the longitudinal axis deflects the end tip of the catheter in a plane parallel to the direction of line movement; A device that is displaced by a vertical deflection control line and a longitudinal axis along the flexible lumen, and the side deflection control line fitted in the end tip lumen is fixed to the flexible catheter end and parallel to the direction of rotational force adapted to the rotational force applied to the side deflection control line. And a device for generating deflection of the end tip of the catheter relative to one side and for providing rotational force to the lateral deflection control line. 9. The device of claim 8, wherein the arrangement of the device is replaced with a vertical deflection control line and a longitudinal axis along the flexible terminal catheter lumen: A manually operated control handle having a longitudinal displacement portion attached to the vertical deflection control line and the longitudinal movement of the handle A device for inducing longitudinal displacement of the vertical deflection control line, adjusting the vertical deflection of the end tip, and providing rotational force to the side deflection control line; The self-locking manual rotational side adjustment knob attached to the side deflection adjustment line and away from the adjustment handle provides rotational force to the side deflection adjustment line by left and right rotation of the knob, which is transmitted to the end tip. A device characterized in that the end tip induces lateral deflection as required. 10. The device of claim 8, wherein the end tip of the end catheter comprises: a mapping electrode device for receiving a stimulus of electroactivity of the intracardiac tissue contacted by the tip of the end anode, and a high frequency current in the contact tissue and excision energy. An ablation electrode device for providing; An input / output device that receives and delivers electrical stimulation coupled to the mapping and ablation electrode device; Mechanism characterized by consisting of a control device for adjusting the input and output. 11. The instrument of claim 10 wherein the mapping and ablation functions are performed by the same tip electrode. 9. The instrument of claim 8 wherein the end tip portion of the end catheter consists of a plurality of electrodes suitable for both mapping and ablation. 9. The apparatus of claim 8, wherein the configuration of the end tip of the end catheter comprises: a plurality of mapping electrode devices spaced at intervals to accommodate direct stimulation of the electrical activity of the cardiac tissue contacted by the ends of the flexible tip; A plurality of ablation electrode devices arranged at regular intervals for receiving a high frequency current and supplying ablation energy to the contacted tissue; And an input / output device for receiving and transmitting an electrical stimulus connected to each of the mapping and ablation electrode devices, and an adjusting device for separately controlling the input / output of each electrode device. 15. The instrument of claim 14 wherein the mapping and ablation functions are performed by the same electrode. 9. The instrument of claim 8 wherein the electrode portion of the end catheter is made to a certain size using a memory material. 14. The instrument of claim 13 wherein the electrode portion of the end catheter is made to a certain size using a memory material. 15. The instrument of claim 14 wherein the electrode portion of the end catheter is made to a certain size using a memory material. 14. The instrument of claim 13 wherein the tail portion, which is continuous or connected to the end of the electrode, helps to position or stabilize the electrode. 17. The instrument of claim 16 wherein the tail portion continuous or connected to the end of the electrode helps to position or stabilize the electrode. 18. The instrument of claim 17, wherein a tail portion continuous or connected to an end of the electrode helps to position or stabilize the electrode. In a device for mapping electrical cardiac negative potential and excision of cardiac tissue, a highly flexible tubular end catheter with biased cardiac mapping and ablation catheter is introduced and moved through the ventricle and has an end tip with a mapping and ablation tip electrode system. Tere moieties; The end tip consists of a double line biplanar control system capable of regulating the movement of the end catheter in any direction to access any portion of the ventricular wall introduced, wherein the double line biplanar control system is adapted to the longitudinal axis of the tubular catheter. A vertical deflection control line for deflecting the end tip of the catheter in a parallel plane; A lateral deflection control line for deflecting the end tip of the catheter in a plane perpendicular to the longitudinal axis of the tubular catheter; Tension is adjustable in the vertical deflection control line and in the side deflection control line for deflecting and adjusting the tip electrode system that approaches and maps the tissue of the ventricle; Apparatus characterized in that the tip electrode system is adjustable to allow for early ablation of designated areas. 19. The instrument of claim 18, wherein the end tip of the highly flexible tubular end catheter portion is of a predetermined predetermined shape using a memory material and the predetermined shape is adjustable to map a tissue surface of a specially designated heart region. The device of claim 6, wherein: the longitudinal deflection control component is a control line, the lateral deflection component is a control line, the configuration of the device being replaced with the vertical deflection control component and the longitudinal axis along the flexible end catheter lumen; The manually actuated adjustment handle has a cylindrical concave portion in which the longitudinally displaceable piston portion can be reciprocated, the reciprocating motion adjusting the vertical deflection of the end tip corresponding to the longitudinal displacement of the vertical deflection control line, and In the configuration of the device for supplying rotational force to the side deflection control line; The rotary ring gear unit associated with the inner pinion gear is connected to the side deflection control line so that the rotation of the ring gear causes the opposite rotation of the pinion gear, which in turn supplies a considerable amount of rotational force to the side deflection control line. And the rotational force adjusts the end tip for deflection of the disturbance. 24. The mechanism of claim 23 wherein rotation of the ring gear induces multiple rotations of the pinion gear. 24. The instrument of claim 23 wherein a closure device is included between the piston portion and the cylindrical recess. In the construction of a flat planar catheter tip deflection control system: a side catheter end catheter with a highly flexible tubular end catheter, which is an end catheter lumen, with an end tip that is precisely adjusted and The vertical deflection control device has a fixed tip at the end of the flexible end catheter and the reciprocating motion of the control longitudinally along the end catheter lumen deflects the end tip of the catheter in a vertical plane parallel to the direction of motion of the control device. The end tip of the catheter is deflected in the side plane in a direction parallel to the rotational force by feeding the rotational force to the adjusting device; A device for displacing the deflector and longitudinal axis along the flexible end catheter lumen; And a device for supplying rotational force to the deflection control device. 27. The device of claim 26, wherein the control device is a control line. The apparatus of claim 27, further comprising: a device for displacing the control line with a longitudinal axis along the flexible end catheter lumen and for supplying rotational force to the deflection control device; The regulating handle device includes a cylinder-shaped recess in the longitudinal axis, and a reciprocating piston is disposed therein for reciprocating movement in the cylindrical recess, and the adjustment line is attached so that the longitudinal movement of the piston Inducing to adjust the vertical deflection of the end tip; And the piston in the handle is such that the rotation of the piston relative to the handle provides rotational force to the control line, the control line transmitting rotational force to the end tip, causing a lateral deflection of the distal end tip. 29. The device of claim 28, wherein the piston device is configured with an external, hand-operable piston handle device for adjusting the movement of the piston device. 30. The device of claim 29, further comprising a locking device to prevent undesired longitudinal movement of the piston device. 31. The piston lock device of claim 30, wherein the piston lock includes a plurality of small arcuate concave ridges arranged on the outer surface of the piston device in a longitudinal axis, which are secured to the handle, which extends to the cylindrical inlet and the piston Has a flat sector that can rotate on the ridge, and the piston device can be freely reciprocated in a cylindrical recess. When rotated, the flat sector has a side locking device in the piston, Apparatus characterized in that included in the side closure device. 32. A device according to claim 31, comprising a flat sector arranged opposite and a pair of ridges arranged opposite to each other separated by a side closure device. 29. The device of claim 28, comprising a rotation limiter associated with the handle and the piston device. 29. The device of claim 28, wherein the control line includes a device for adjusting the initial longitudinal tension. 34. The rotational device of claim 33, wherein the rotational limiter includes a rotational obstruction device for adjusting the ride between a predetermined range on an axis fixed to the end of the piston to prevent rotation on the axis, wherein the rotation of the axis is a relative displacement of the rider device. And a stopper for causing the movement and limiting the movement of the rider device such as rotation between the rider device and the shaft to limit the rotational force applied to the control line. 35. The device of claim 34, wherein the rider anti-rotation device includes at least one protrusion and the protrusion has one or more longitudinal grooves.