WO2007067943A2 - Assessment of electrode coupling for tissue ablation - Google Patents

Assessment of electrode coupling for tissue ablation Download PDF

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Publication number
WO2007067943A2
WO2007067943A2 PCT/US2006/061716 US2006061716W WO2007067943A2 WO 2007067943 A2 WO2007067943 A2 WO 2007067943A2 US 2006061716 W US2006061716 W US 2006061716W WO 2007067943 A2 WO2007067943 A2 WO 2007067943A2
Authority
WO
WIPO (PCT)
Prior art keywords
electrode
coupling
tissue
electrical
ablation
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2006/061716
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English (en)
French (fr)
Other versions
WO2007067943A3 (en
Inventor
Saurav Paul
Hong Cao
Kedar Ravindra Behle
Chou Thao
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
St Jude Medical Atrial Fibrillation Division Inc
Original Assignee
St Jude Medical Atrial Fibrillation Division Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by St Jude Medical Atrial Fibrillation Division Inc filed Critical St Jude Medical Atrial Fibrillation Division Inc
Priority to US12/096,071 priority Critical patent/US8267926B2/en
Publication of WO2007067943A2 publication Critical patent/WO2007067943A2/en
Publication of WO2007067943A3 publication Critical patent/WO2007067943A3/en
Anticipated expiration legal-status Critical
Priority to US13/593,676 priority patent/US9254163B2/en
Priority to US15/013,065 priority patent/US10182860B2/en
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • 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
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00297—Means for providing haptic feedback
    • A61B2018/00303—Means for providing haptic feedback active, e.g. with a motor creating vibrations
    • 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
    • A61B2018/00315—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
    • 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
    • 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
    • A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
    • 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
    • A61B2018/00666—Sensing and controlling the application of energy using a threshold value
    • 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
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00702—Power or energy
    • 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
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/0075—Phase
    • 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
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00755—Resistance or impedance
    • 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
    • A61B2018/00869—Phase
    • 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
    • A61B2018/00875—Resistance or impedance
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body

Definitions

  • An exemplary method of assessing electrode-tissue contact for tissue ablation may comprise: measuring impedance between an electrode and ground as the electrode approaches a target tissue, separating a reactance component from the measured impedance, and indicating a contact condition for the target tissue based at least in part on the reactance component.
  • first, second, and third ranges could be used individually to compare with a phase angle value associated with the first electrical signal, or may be used in any appropriate combination with each other. It should be appreciated that what is "insufficient,” “sufficient,” “elevated/excessive” may be dependent upon the tissue being coupled with the first electrode, as well as one or more other factors.
  • a phase angle associated with the first electrical signal at a certain point in time of a medical procedure may be determined in any appropriate manner and for purposes of assessing the electrode coupling at this certain point in time in accordance with the first aspect. It of course may be desirable to assess the electrode coupling on some predetermined temporal basis or otherwise in accordance with some predefined function (e.g., assess a phase angle associated with the first electrical signal every "x" W
  • One or more parameters may be monitored/assessed for purposes of identifying the existence of an elevated or excessive coupling condition between the first electrode and tissue in the case of the fourth aspect, including without limitation impedance, phase angle (e.g., in accordance with the first aspect), reactance (e.g., in accordance with the second aspect), and target frequency (e.g., in accordance with the seventh aspect discussed below).
  • a reactance e.g., of a portion of an electrical circuit that extends from the first electrode, through a patient's body, and to a return electrode
  • first, second, and third ranges could be used individually to compare with a target frequency, or may be used in any appropriate combination with each other. It should be appreciated that what is "insufficient,” “sufficient,” or “elevated/excessive” may be dependent upon the tissue being coupled with the first electrode, as well as one or more other factors.
  • Fig. 12b illustrates one embodiment of a protocol that may be used to assess a coupling between an electrode and tissue based upon identifying a baseline coupling condition.
  • Exemplary catheter system 10 may include a generator 40, such as, e.g., a radio frequency (RF) generator, and a measurement circuit 42 electrically connected to the electrode catheter 14 (as illustrated by wires 44 to the electrode catheter).
  • the electrode catheter 14 may also be electrically grounded, e.g., through grounding patch 46 affixed to the patient's arm or chest (as shown in Fig. 1).
  • generator 40 emits a so-called “pinging” (e.g., low) frequency as the electrode catheter 14 approaches the target tissue 24.
  • the "pinging" frequency may be emitted by the same electrode catheter that is used to apply ablative energy for lesion formation.
  • a separate electrode catheter may be used for applying the "pinging" frequency.
  • the separate electrode may be in close contact with (or affixed to) the electrode for applying ablative energy so that a contact or coupling condition can be determined for the electrode which will be applying the ablative energy.
  • measurement circuit 42 and/or processor 50 and memory 52 may be provided in a handle portion of the electrode catheter 14. In another example, at least part of the measurement circuit 42 may be provided elsewhere in the electrode catheter 14 (e.g., in the tip portion). In still other Docket No. 0B-047809US
  • X is reactance from both capacitance and inductance.
  • comparator 86 provides a direct current (DC) output voltage proportional to the difference in phase between the voltage and current measurements.
  • phase detection circuit 80 shown in Fig. 5 is provided as one example, and is not intended to be limiting. Other implementations may also be readily provided by those having ordinary skill in the electronics arts after becoming familiar with the teachings herein without departing from the scope of the invention.
  • Step 402' of the assessment protocol 400' of Fig. 9b is directed to sending an electrical signal. Only a single frequency is required for the protocol 400' to provide its assessment. That is, the electrode coupling assessment may be provided using a single frequency in the case of the assessment protocol 400'. Typically this will be after the electrode has been positioned at least in the general vicinity of the target tissue (e.g., within a heart chamber). A reactance of the electrical circuit that includes the electrode and the target tissue is thereafter determined at step 404'. This reactance may be determined in any appropriate manner.
  • the frequency at which the reactance or phase matches the preset value is the "target frequency.” Any appropriate value may be used for the preset value for purposes of step 628, including a positive value, zero, or a negative value (e.g., a zero phase angle, such that the target frequency may be referred to as a 0° phase frequency; or a zero inductance, such that the target condition frequency may be referred to as a 0 inductance frequency).

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Plasma & Fusion (AREA)
  • General Health & Medical Sciences (AREA)
  • Otolaryngology (AREA)
  • Physics & Mathematics (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Public Health (AREA)
  • Cardiology (AREA)
  • Surgical Instruments (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
PCT/US2006/061716 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation Ceased WO2007067943A2 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US12/096,071 US8267926B2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
US13/593,676 US9254163B2 (en) 2005-12-06 2012-08-24 Assessment of electrode coupling for tissue ablation
US15/013,065 US10182860B2 (en) 2005-12-06 2016-02-02 Assessment of electrode coupling for tissue ablation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US74823405P 2005-12-06 2005-12-06
US60/748,234 2005-12-06

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US12/096,071 A-371-Of-International US8267926B2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
US13/593,676 Division US9254163B2 (en) 2005-12-06 2012-08-24 Assessment of electrode coupling for tissue ablation

Publications (2)

Publication Number Publication Date
WO2007067943A2 true WO2007067943A2 (en) 2007-06-14
WO2007067943A3 WO2007067943A3 (en) 2007-12-06

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Family Applications (6)

Application Number Title Priority Date Filing Date
PCT/US2006/061716 Ceased WO2007067943A2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
PCT/US2006/061710 Ceased WO2007067937A2 (en) 2005-12-06 2006-12-06 Design of handle set for ablation catheter with indicators of catheter and tissue parameters
PCT/US2006/061712 Ceased WO2007067939A2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
PCT/US2006/061714 Ceased WO2007067941A2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
PCT/US2006/061711 Ceased WO2007067938A2 (en) 2005-12-06 2006-12-06 Method for displaying catheter electrode-tissue contact in electro-anatomic mapping and navigation system
PCT/US2006/046565 Ceased WO2007067628A1 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation

Family Applications After (5)

Application Number Title Priority Date Filing Date
PCT/US2006/061710 Ceased WO2007067937A2 (en) 2005-12-06 2006-12-06 Design of handle set for ablation catheter with indicators of catheter and tissue parameters
PCT/US2006/061712 Ceased WO2007067939A2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
PCT/US2006/061714 Ceased WO2007067941A2 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation
PCT/US2006/061711 Ceased WO2007067938A2 (en) 2005-12-06 2006-12-06 Method for displaying catheter electrode-tissue contact in electro-anatomic mapping and navigation system
PCT/US2006/046565 Ceased WO2007067628A1 (en) 2005-12-06 2006-12-06 Assessment of electrode coupling for tissue ablation

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US (9) US9283026B2 (enExample)
EP (3) EP1962710B1 (enExample)
JP (3) JP5312948B2 (enExample)
CN (2) CN103251451B (enExample)
AU (3) AU2006321918B2 (enExample)
BR (3) BRPI0621018A2 (enExample)
CA (3) CA2631946C (enExample)
IL (3) IL191733A (enExample)
WO (6) WO2007067943A2 (enExample)

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