Patent Application
20160331263
Various embodiments described herein relate to the field of electrophysiological mapping and treatment medical systems, devices, components, and methods.
Non-invasive electrophysiological sensing and mapping of a patient's cardiac or other electrical activity inside the patient typically requires the simultaneous acquisition of numerous surface electrocardiograms (ECGs) using sensing electrodes positioned at many different locations on a patient's torso. The positioning and attachment of such sensing electrodes can be a laborious and time consuming process. In addition, if electrophysiological mapping is to be carried out in combination with other medical procedures, such as navigation of a medical device inside a patient's body, or cardiac or other organ ablation procedures, cardio-version patches, navigation patches (such as Carto3® patches) and ultrasound transducers may also need to be used (in addition to sensing electrodes). Such patches and transducers often must be positioned in between sensing electrodes, which can pose additional difficulties and consume valuable hospital or clinic time.
What is needed are more efficient and quicker means and methods for acquiring ECGs, as well as means and methods for more efficient and quicker acquisition of ECGs in combination with other types of medical procedures.
In one embodiment, there is provided a customizable electrophysiological mapping sensor patch configured for placement on and attachment to a patient's torso, where the patch comprises a first substantially planar layer comprising at least a first flexible material, a second substantially planar electrically insulative layer comprising at least a second flexible material, a plurality of flexible electrical conductors disposed on or within the first layer, or disposed at least partially between the first layer and the second layer, each of the flexible electrical conductors having at least first proximal and second distal ends, a plurality of sensing electrodes, each sensing electrode being operably connected to one of the electrical conductors, a plurality of adhesive members, each adhesive member surrounding at least partially a corresponding one or more of the sensing electrodes, and at least one score line disposed in the mapping sensor patch, the score line defining at least one pre-cut portion of the mapping sensor patch, the score line being configured to permit a user to remove or partially remove the at least one pre-cut portion from the mapping sensor patch by pulling or cutting the mapping sensor patch or pre-cut portion along or near the score line.
In another embodiment, there is provided a system of customizable electrophysiological mapping sensor patches configured for placement on and attachment to a patient's torso, where the system comprises a front mapping sensor patch, a rear mapping sensor patch, and two side mapping sensor patches, each of the patches comprising a first substantially planar layer comprising at least a first flexible material, a second substantially planar electrically insulative layer comprising at least a second flexible material, a plurality of flexible electrical conductors disposed on or within the first layer, or disposed at least partially between the first layer and the second layer, each of the flexible electrical conductors having at least first proximal and second distal ends, a plurality of sensing electrodes, each sensing electrode being operably connected to one of the electrical conductors, a plurality of adhesive members, each adhesive member surrounding at least partially a corresponding one or more of the sensing electrodes, and at least one score line disposed in the mapping sensor patch, the score line being configured to permit a user to remove or partially remove at least one pre-cut portion from the mapping sensor patch by pulling or cutting the mapping sensor patch or pre-cut portion along or near the score line.
In still another embodiment, there is provided a method of configuring a customizable electrophysiological mapping sensor patch for a patient's torso, the mapping sensor patch comprising a first layer comprising at least a first flexible material, a second electrically insulative layer comprising at least a second flexible material, a plurality of flexible electrical conductors disposed on or within the first layer, or disposed at least partially between the first layer and the second layer, each of the flexible electrical conductors having at least first proximal and second distal ends, a plurality of sensing electrodes, each sensing electrode being operably connected to one of the electrical conductors, a plurality of adhesive members, each adhesive member surrounding at least partially a corresponding one or more of the sensing electrodes, at least one score line disposed in the mapping sensor patch, the score line defining at least one pre-cut portion of the mapping sensor patch, the score line being configured to permit a user to remove or partially remove the at least one pre-cut portion from the mapping sensor patch by pulling or cutting the mapping sensor patch or pre-cut portion along or near the score line, where the method comprises removing at least one of the pre-cut portions from the mapping sensor patch on the basis of a procedure that is to be performed on the patient and on the basis of the patient's torso anatomy or torso dimensions.
Further embodiments are disclosed herein or will become apparent to those skilled in the art after having read and understood the specification and drawings hereof.
Different aspects of the various embodiments will become apparent from the following specification, drawings and claims in which:
The drawings are not necessarily to scale. Like numbers refer to like parts or steps throughout the drawings.
Described herein are various embodiments of systems, devices, components and methods for conducting electrophysiological studies.
At least portions or components of the EP Solutions 01C System for Non-Invasive Cardiac Electrophysiology Studies (which is based upon and in most aspects the same as the AMYCARD 01 C System for Non-Invasive Cardiac Electrophysiology Studies) may be adapted for use in conjunction with the various embodiments described and disclosed herein. Portions of the EP Solutions 01C System (hereafter “the EP Solutions 01C System”) and other relevant components, devices and methods are described in: (a) U.S. Pat. No. 8,388,547 to Revishvili et al. entitled “Method of Noninvasive Electrophysiological Study of the Heart” (“the '547 patent”); (b) U.S. Pat. No. 8,529,461 to Revishvili et al. entitled “Method of Noninvasive Electrophysiological Study of the Heart” (“the '461 patent”), and (c) U.S. Pat. No. 8,660,639 to Revishvili et al. entitled “Method of Noninvasive Electrophysiological Study of the Heart” (“the '639 patent”). The '547 patent, the '461 patent, and the '639 patent are hereby incorporated by reference herein, each in its respective entirety.
Referring now to
Mapping electrode system 100 comprises a plurality of electrical sensing electrodes positioned on a torso 14 of patient 12 (and in some embodiments on other portions of patient 12's body). Sensing electrodes in MES 100 are configured to sense electrical activity originating in patient 12's body. In addition to electrical sensing electrodes, other types of devices and/or transducers, such as ground electrodes, high intensity focused ultrasound transducers, ultrasound probes, navigation patches, cardioversion patches, and the like (more about which is said below), may be configured to operate in conjunction with, be incorporated into, or form a portion of MES 100 and/or system 10. In one embodiment, and by way of non-limiting illustrative example, MES 100 comprises one or more of an ECG cable with 12 leads and corresponding electrodes, an ECG cable with 4 leads and corresponding electrodes, a patient cable for ECG-mapping with 8 contacts or electrodes, one or more special ECG-mapping cables (each with 56 contacts or electrodes), and special disposable or reusable mapping electrodes, each strip of disposable or reusable mapping electrodes having 8 contacts or electrodes. One example of a disposable ECG electrode suitable for use in CT imaging systems is the Model No. DE-CT electrode manufactured by EP Solutions SA, Rue Galilée 7, CH-1400 Yverdon-les-Bains. Other types and models of electrodes are, of course contemplated, such as electrodes configured for use with MRT/MRI imaging systems or other types of imaging systems 300.
Scanner or imaging system 300 is used to help identify and determine the precise positions of the various electrodes included in MES 100 that have been placed in various positions and locations on patient 12's body.
ECG data are acquired from MES 100 by MMU 200, which in one embodiment comprises an amplifier unit or data acquisition device 210 that filters and amplifies analog signals provided by MES 100, digitizes such analog signals using one or more analog-to-digital converters (“ADCs”), and sends or relays, or otherwise transfers or has transferred, the amplified and digitized signals to first computer workstation 250. In one embodiment, amplifier unit or data acquisition device 210 permits multichannel synchronous EKG/ECG recording from, by way of example, 224 or more surface electrodes positioned on a patient's skin and torso, as well as multichannel synchronous EKG/ECG recording from additional or other electrodes or channels (as described above in connection with MES 100).
In one embodiment, first computer or computer workstation 250 stores or records the amplified and digitized signals provided by data acquisition device 210. Signal digitization and recording functions can also be apportioned or split between data acquisition device 210 and first computer or computer workstation 250, as suitable or desired. Data from scanner 300 and ECG data sensed by MES 100 and acquired and recorded by MMU 200 are then both input into PVM 400. In one embodiment, ECG data from patient 12 are acquired using MES 100 and data acquisition device 210 from unipolar electrodes positioned on patient's torso 14. The precise locations of such electrodes on patient's torso 14 are determined in PVM 400 using data from scanner 300. ECG data recorded by MMU 200 may be stored on a CD, a USB memory stick, in RAM, on an electronic storage device such as a hard or flash drive, or in another memory device or component, and may then be exported or transferred to PVM 400 using such a storage device. Alternatively, ECG data recorded by MMU 200 may be transferred to PVM 400, by way of non-limiting illustrative example, using a local area network (LAN), a wide area network (WAN), wireless communication means (e.g., using Bluetooth or the Medical Implant Communication System or MICS), the internet or the cloud, or by suitable computer communication means known to those skilled in the art. In imaging system 300 and/or in PVM 400 (but typically in imaging system 300), computed tomography or other types of positional/spatial geometry data corresponding to the chest and heart area is carried out, and processing and analysis of multichannel ECG data and computed tomography or other positional/spatial geometry data are executed.
By way of non-limiting illustrative example, PVM 400 comprises a second computer or computer workstation 450 that comprises a specialized processing and visualization computer or series of interconnected computers or processors, which include pre-installed proprietary software configured to conduct electrophysiological studies. Second computer or computer workstation 450 typically further comprises a keyboard a mouse, a display 414 (such as a 24″ or 25″ LCD monitor), and a printer. PVM 400 and second computer workstation 450 are configured for advanced mathematical processing of computed tomographic study or other positional/spatial geometry data combined with multichannel ECG body surface mapping data, which together make it possible to perform computed non-invasive activation mapping of the patient's heart.
Together, MES 100, MMU 200, scanner 300 and PVM 400 comprise EPM 10 and employ a technique known as NIEM (Non-Invasive Electrophysiological Mapping), which is an electrophysiological method based on non-invasive reconstruction of cardiac activation patterns sensed by a dense network of surface electrodes attached to the patient's torso. NIEM is employed in EPM 10 to permit non-invasive numerical reconstruction of endocardial as well as epicardial and/or pericardial electrograms originating from the patient's ventricles and atria. Mathematical algorithms executed by EPM 10 are applied to the acquired unipolar surface ECG data to permit 3D reconstruction of the patient's heart and thorax.
In one embodiment, EPM 10 reconstructs electrograms using advanced tomographic techniques that eliminate the need to perform invasive mapping studies or procedures on the patient's body. Based on surface electrograms or ECGs acquired on the patient's torso, time-varying electric field potentials of the patient's heart are calculated using electrical field calculation techniques and algorithms. Actual boundaries of the patient's chest and lung surfaces, and of the patient's epicardial and endocardial heart surfaces, are determined by user interaction and image processing algorithms (such as solving differential equation systems). Continuations of electric field potentials throughout the patient's chest surfaces are implemented computationally based on a solution of the Cauchy problem for the Laplace equation in a homogeneous or inhomogeneous medium. When solving the Cauchy problem using the Laplace equation, a model of the chest is employed having tissues that lie within the bounds of large anatomic structures (e.g., the lungs, mediastinum, and/or spine), and that have constant or tissue-specific coefficients of electrical conductivity. Heart electric field potentials are assigned harmonic functions in each region, where each region has a constant coefficient of electrical conductivity and satisfies conjugate conditions at the region's borders for electrical potential and current.
Referring now to
In one embodiment, a plurality of flexible or at least partially flexible, bendable or malleable electrical conductors EC are disposed on or within first layer 112, or are disposed at least partially between first layer 112 and second layer 116. Each of flexible, bendable or malleable electrical conductors EC have at least first proximal and second distal ends (not shown in
Sensing electrodes E and corresponding overlying electrically conductive gel disks CG attached thereto are operably connected to corresponding ones of electrical conductors EC, which are configured to convey electrical signals sensed by sensing electrodes E and corresponding overlying electrically conductive gel disks CG to proximal electrical connections 115 (see, for example,
Adhesive members or disks AD surround at least partially corresponding ones of sensing electrodes E/CG, and are employed to attach or adhere the customizable electrophysiological mapping sensor patch to the patient's torso 14 after protective cover 116 has been removed by the user or health care provider.
Position markers PM have a position overlying and corresponding to that of at least selected ones, if not all, of sensing electrodes E/CG, and permit the precise position of the selected electrodes or each electrode E on the customizable electrophysiological mapping sensor patch to be ascertained quickly and easily using scanner or imaging system 300 in combination with PVM 400 (as described above). Position markers PM may include suitable MRI, CT and/or ultrasound contrast agents to enhance their detection, and increase the accuracy of determining their respective positions on the patient's torso 14.
In another embodiment, sensing electrodes E or portions attached thereto or forming a portion thereof function as position markers, and are configured to include suitable MRI, CT and/or ultrasound contrast agents therein or thereon so they may be detected easily by a suitable imaging system (e.g., an MRI, CT and/or ultrasound system). Fiducial markers may also be included in patches 101, 103 and/or 105, which are configured to operate in conjunction with an external imaging system, such as an MRI, CT and/or ultrasound system 300, and permit the precise spatial positions or locations of the fiducial markers to be determined using such imaging systems 300.
In one embodiment, electrical conductors EC are formed by printing or inking an electrically conductive and bendable or flexible material onto first layer 112, second layer 114, both layers, or other layers disposed therebetween. In one embodiment, first or top layer 112 comprises a flexible and/or stretchable layer comprising a woven textile comprising one or more elastomeric fiber yarns. Electrical conductors EC may be formed, by way of non-limiting example, by screen printing with a thickness of about 0.02 mm and a width of about 1 mm, by integrating electrically conductive yarns into layers 112, 114 or other layers, where the yarn has a diameter of about 0.05 mm Electrically conductive materials such as gold, silver, copper, carbon or metals or metal alloys may also be attached (for example by gluing or looming) to layer 112 or 114. Other embodiments of electrical conductors EC include electrical conductors comprising wires, cables, ribbon conductors, flexible electronic circuits, flex circuits, and flexible plastic substrates with electrical conductors disposed thereon or therein. Further embodiments of electrical conductors EC include electrical conductors comprising polyimide, PEEK or transparent conductive polyester film, and printed or screen printed flexible silver or other metal or metal alloy circuits disposed on polyester.
In one embodiment, the distal end of each electrical conductor EC is electrically and operably connected or attached to an electrode E having, by way of example, a diameter of about 14 mm. In one embodiment, electrical conductors EC and/or electrodes E have a thickness of about 0.1 mm and are formed by screen printing or printing on a PET substrate having a thickness, for example, of 0.05 mm. PET is polyethylene terephthalate, a thermoplastic polymer resin of the polyester family suitable for use in fibers for clothing layers. The PET layer or substrate may be glued or otherwise bonded to layer 112 or 114. The proximal end of each electrical conductor EC forms or is attached to proximal electrical connection or tab 115, which is configured for an external electrical connector such as a connector 107 of a mapping cable 102 to be connected thereto, for example by crimping. When formed by screen printing, electrically insulating or second layer 114 may have a thickness of about 0.02 mm, and be formed, by way of example, from a material designated ELECTRODAG 452SS™ MANUFACTURED BY Henkel®, which in one embodiment is applied on a lower or bottom surface of layer 112 after electrical conductors EC have been printed or otherwise formed thereon so as to cover all electrically conductive components except electrodes E and electrical connections or tabs 115.
In some embodiments, adhesive members or rings AD have an internal diameter of about 14 mm, an outside diameter of about 24 mm, and a thickness of about 1 mm. By way of example, adhesive members AD may be formed of polyethylene foam impregnated or coated with a synthetic rubber adhesive (for example, VANCIVE® MED5696R), and are glued or otherwise attached to electrically insulative layer 114 near each electrode E. The inner diameter of each adhesive member AD may be filled with a solid or compressible electrically conductive gel disc CG having, for example, an outer diameter of about 14 mm, a thickness of about 0.8 mm, where the gel comprises CONFORT® M807 manufactured by R&D Medical. In one embodiment, each electrically conductive gel disk or member CG is attached to underlying electrically conductive electrode E (as shown in
Referring now to
Continuing to refer to
Each pre-cut is configured and shaped for a specific purpose and application. For example, row and column pre-cuts are shaped and configured to permit the health care provider or user to customize the width or height of a patch 101, 103 or 105 to match the requirements set by the dimensions and configurations of a particular patient's torso 14.
Column pre-cuts CPC in patches 101, 103 and 105 may be employed to customize the width of such patches according to a patient's torso and other dimensions. Smaller patients may require reduced widths for such patches.
Row pre-cuts RPC in patches 101, 103 and 105 may be employed to customize the height of such patches according to a patient's torso and other dimensions. Smaller patients may require reduced heights for such patches. In rear patch 105 shown in
Female anatomy pre-cut FAPC is shaped and configured to permit the health care provider or user to customize a front patch 101 to permit a female patient's breasts to fit over or along the upper edge of patch 101; female anatomy electrodes EF1-EF8 are configured to replace the electrodes lost by removing pre-cut FAPC, and are attached directly to the patient's breasts. Other separate patches and electrodes, located apart from patches 101, 103 and 105 may also be included in MES 100.
Pre-cuts NPCC (navigation pre-cut), CPCC (cardioversion pre-cut), and GPPC (ground patch pre-cut—see
In one embodiment, and when removed from front patch 101, anatomical reference mark pre-cut APC is a hole through which a health care provider or user may place his or her finger to locate a patient's xiphoid process (a bony landmark and protrusion from a patient's sternum), and then to appropriately position front patch 101 with APC located directly over the patient's xiphoid process. Such a patch registration process on the patient's torso 14 can help position all of patches 101, 103 and 105 in optimum and appropriate positions on the patient's body.
Any of the pre-cut types described above may be included in any of the patch types (i.e., front, side or rear patches). In addition, patch types may be combined into a single unitary patch (e.g., combined front and side patches, combined side and rear patches, etc.). Other specific types of pre-cuts are also contemplated, such as pre-cuts for ultrasonic transducers and sensors, diagnostic sensors or transducers, and the like, which may be configured and shaped according to the particular function a given pre-cut is to serve, and/or the device with which it is intended to be used.
In addition, any of patches 101, 103 and 105 may further comprise an anchor, an attachment or another device or devices attached or secured thereto such as adhesive patches, VELCRO® patches, plastic or metal hooks, loops, substrates, sockets, snaps, snap caps, zippers, posts, studs, which, by way of non-limiting example, may be employed to hold sensors or transducers in a desired position, route cables or wires, or otherwise hold or anchor assorted devices, components or materials in place. Such sensors and transducers may include ultrasound sensors and transducers, such as HIFU transducers and HIFU imaging probes, and may also include transmitters and/or receivers configured to permit the position of a catheter or portion(s) of a catheter within the patient's body to be determined, where the catheter includes electrode(s), sensor(s) or antennae configured to receive and/or transmit electromagnetic signals having frequencies outside the range of natural heart electrical signals, and which are received and/or transmitted from predetermined or known location(s) on the catheter body (e.g., near or at the distal tip of the catheter). In some embodiments, pre-cuts and/or anchors, attachments or other devices attached or secured to patches 101, 103 and 105 are labelled, marked, or colored-coded according to function or type so as to facilitate ease of use and reduce user or operator error.
In one embodiment, score lines SL in front patch 101, side patch 103 and rear patch 105 are configured to permit a user to remove or partially remove desired pre-cut portions from the patch by the user pulling or cutting the patch and/or the desired pre-cut portion along or near the corresponding score line SL. In one embodiment, score lines SL are formed in one or more of layers 112, 114, and 116, as well as in portions of the electrical conductors EC that are traversed by the score lines SL. In one embodiment, score lines SL comprise adjoining through-spaces or perforations that penetrate through the top, middle and/or bottom layers of an electrophysiological mapping sensor patch so that the cut-out defined thereby may be easily torn or cut along the score line SL, and thus be removed from the surrounding or adjoining patch by a user or health care provider. Score lines SL and their corresponding perforations are configured according to the thickness and composition of the material or materials through which they are formed so they may be torn reasonably uniformly along the score line SL (or tear line) by a user or health care provider once the tear has been initiated. Where a score line SL traverses an electrical conductor EC, more closely spaced perforations may be required in the traversed electrical conductor EC to permit the score line SL to be torn through the electrical conductor EC without undue effort. Score lines SL need not be straight, but may be curved, waved or otherwise shaped. Score lines SL may be formed using a cutting knife, blade or roller, a laser, a laser scoring machine, a die and punch, or any other suitable apparatus or method.
In one alternative embodiment, one or more removable pre-cuts included in patches 101, 103 and 105 may be adhered to patch 101, 103 and/or 105 by means of a suitable adhesive disposed, for example, around the periphery of each pre-cut, thereby eliminating or reducing the need for perforations or score lines SL. Such an adhesive has sufficient strength to hold each pre-cut in place, but is also weak enough to permit each pre-cut to be peeled away and removed from the patch by a user or health care provider. Zippers or other types of separable or separating devices may also be used to form the boundaries of removable pre-cuts.
Thus, in some embodiments patches 101, 103 and/or 105 are configured such that with respect to electrodes E that are disposed distally from and above, but not within, the boundaries of a pre-cut, electrical conductors EC corresponding thereto are routed around or outside the boundaries of such pre-cuts such that when the pre-cut is removed an electrical connection is maintained between the distally located electrode E and its corresponding proximal electrical connection or tab 115. In such embodiments, electrical conductors EC corresponding to electrodes E located distally from and directly above the pre-cuts may be routed around the pre-cuts, and in being so configured may even cross over adjoining or other electrical conductors EC (provided they are electrically insulated therefrom at the crossover points).
According to one embodiment, there is provided a method of configuring a customizable electrophysiological mapping sensor patch for a patient's torso, the mapping sensor patch comprising a first layer comprising at least a first flexible material, a second electrically insulative layer comprising at least a second flexible material, a plurality of flexible electrical conductors disposed on or within the first layer, or disposed at least partially between the first layer and the second layer, each of the flexible electrical conductors having at least first proximal and second distal ends, a plurality of sensing electrodes, each sensing electrode being operably connected to one of the electrical conductors, a plurality of adhesive members, each adhesive member surrounding at least partially a corresponding one or more of the sensing electrodes, at least one score line disposed in the mapping sensor patch, the score line defining at least one pre-cut portion of the mapping sensor patch, the score line being configured to permit a user to remove the at least one pre-cut portion from the mapping sensor patch by pulling or cutting the mapping sensor patch or pre-cut portion along or near the score line, where the method comprises removing at least one of the pre-cut portions from the mapping sensor patch on the basis of a procedure that is to be performed on the patient and on the basis of the patient's torso anatomy or torso dimensions.
According to another method and embodiment, and by way of illustrative example, customizable patches 101, 103 and 105 are employed in combination with an Amycard 01C electrophysiological mapping system using the following steps:
Note that the above method is merely illustrative, that some steps may not be included, and that other steps may be added.
According to some embodiments, and by way of example, the maximum physical dimensions of patches 101, 103 and 105 (without removing any pre-cuts), and the minimum physical dimensions of patches 101, 103 and 105 (after removing all pre-cuts) may be defined using the dimensions set forth in Table 1 below, where the maximum chest circumference is ensured by combining front patch 101, rear patch 105 and side patches 103a and 103b without any pre-cuts removed, and where maximum chest length is ensured by not removing any pre-cuts or electrodes from front patch 101. Customization of front patch 101 for patient sex is provided by the female anatomy pre-cut and corresponding separate electrodes EF.
With respect to the prior art electrode configurations shown in
In addition to the systems, devices, and components described above, it will now become clear to those skilled in the art that various methods associated therewith are also contemplated, such as methods of manufacturing and using customizable patches in accordance with the teachings of the present disclosure.
The foregoing outlines features of several embodiments so that those skilled in the art may better understand the detailed description set forth herein. Those skilled in the art will now understand that many different permutations, combinations and variations of patches 101, 103 and 105, and the various components, devices, systems and methods associated therewith, fall within the scope of the various embodiments. Those skilled in the art should appreciate that they may readily use the present disclosure as a basis for designing or modifying other processes and structures for carrying out the same purposes and/or achieving the same advantages of the embodiments introduced herein. Those skilled in the art should also realize that such equivalent constructions do not depart from the spirit and scope of the present disclosure, and that they may make various changes, substitutions and alterations herein without departing from the spirit and scope of the present disclosure.
After having read and understood the present specification, those skilled in the art will now understand and appreciate that the various embodiments described herein provide solutions to long-standing problems in the use of electrophysiological mapping electrodes and systems, such as increasing the positional accuracy of electrodes and decreasing the amount of time required to deploy such electrodes on a patient in a clinical or hospital setting.
This application claims priority and other benefits from U.S. Provisional Patent Application Ser. No. 62/161,065 entitled “Adaptive ECG Smart Acquisition Patch” to Cailler et al. filed May 13, 2015, which is hereby incorporated by reference in its entirety. This application also incorporates by reference in their respective entireties: (a) U.S. patent application Ser. No. 15/143,599 filed on May 1, 2016 entitled “Systems, Components, Devices and Methods for Cardiac Mapping Using Numerical Reconstruction of Cardiac Action Potentials” to Kalinin et al. (hereafter “the '599 application to Kalinin”), and (b) U.S. patent application Ser. No. 15/143,603 filed on May 1, 2016 entitled “Combined Electrophysiological Mapping and Cardiac Ablation Methods, Systems, Components and Devices” to Stroebel et al. (hereafter “the '______ application to Stroebel”).
| Number | Date | Country | |
|---|---|---|---|
| 62161065 | May 2015 | US |
