Patent Application
20220054181
This disclosure relates to an esophageal liquid-supply catheter, and an intermediate component for producing the esophageal liquid-supply catheter.
Catheter ablation is a method that treats arrhythmias or the like such as atrial fibrillation in which a catheter is inserted into the body and the tip of the catheter is heated or cooled to destroy and treat the target site in the heart.
Various catheters have been developed as ablation catheters used in the treatment method. Examples thereof include an ablation catheter with a balloon attached at the tip of the catheter and can be heated in the atria, an ablation catheter with a balloon capable of cryoablation and the like.
When ablation of the heart is performed in this way, the effect of ablation (temperature) may be transmitted to the esophagus close to the heart, causing esophageal complications. Therefore, various measures have been taken.
JP 2011-078456 A describes a feeding catheter. Not limited to this catheter, similar catheter tubes may be used to deliver a liquid to the esophagus to reduce the temperature transmission to the esophagus.
JP 2016-067728 A discloses a device that keeps the position of the esophagus away from the ablation site to reduce the temperature transmission to the esophagus.
JP 2017-225791 A describes a device that inserts a balloon into the esophagus and circulates a temperature-controlled liquid in the balloon.
However, when a liquid is delivered to the esophagus using a catheter tube represented by JP '456, it is possible that an efficient liquid delivery cannot be achieved if the esophagus is pressed and compressed from the outside due to the patient's condition, the weight of an organ, or the like.
Further, even if the position of the esophagus is displaced as in JP '728, there is a possibility that the temperature transmission cannot be completely prevented.
In JP '791, the temperature is adjusted by contacting the balloon in which a liquid is circulated with the esophagus, but since the temperature is adjusted only at the contact site of the balloon, it is possible that the reduction of the temperature transmission is less efficient than the method in which the liquid is directly delivered into the esophagus.
It could therefore be helpful to provide a way to reduce the temperature transmission to the esophagus due to heating, cooling or the like by ablation by efficiently delivering a liquid to the esophagus.
We have discovered that, by providing a liquid-supply catheter with a plurality of arms near the distal end thereof in which the arms can be deformed in the esophagus and expanded outward in the radial direction of the catheter, and delivering a liquid when the arms are expanded, it is possible to reduce the temperature transmission to the esophagus due to heating, cooling or the like by ablation.
We thus provide:
(1) An esophageal liquid-supply catheter, comprising a tubular member, a plurality of arms with the proximal ends fixed to the distal end of the tubular member, and a distal end tip fixed to the distal ends of the arms, wherein the plurality of arms can be deformed and expanded outward in the radial direction of the tubular member.
(2) The esophageal liquid-supply catheter according to (1), comprising a shaft which is inserted through the tubular member and which is fixed on the distal end to the distal end tip, wherein the arms are expanded outward in the radial direction when the shaft is slid toward the proximal end relative to the tubular member.
(3) The esophageal liquid-supply catheter according to (2), wherein a space exists between the inner wall of the tubular member and the outer wall of the shaft, and a liquid is flowed in the space.
(4) The esophageal liquid-supply catheter according to (1) or (2), further comprising a liquid-supply tube on the outer wall of the tubular member.
(5) The esophageal liquid-supply catheter according to (2), wherein the shaft is in the form of a catheter, and a liquid to be delivered is flowed through the shaft.
(6) The esophageal liquid-supply catheter according to any one of (1) to (5), wherein the arms or the shaft has a temperature sensor.
(7) The esophageal liquid-supply catheter according to any one of (1) to (6), wherein the tubular member has two or more slits, and the arms are constituted by the tubular member present between the slits.
(8) The esophageal liquid-supply catheter according to any one of (1) to (7), wherein the cross section of the arms has a maximum width of 1 mm or more.
(9) The esophageal liquid-supply catheter according to any one of (2) to (8), wherein the distal end tip and the distal end of the shaft can be fitted with and separated from each other.
(10) The esophageal liquid-supply catheter according to any one of (2), (5) to (9), wherein the shaft is a catheter having a diameter of 1.667 mm to 5 mm.
(11) An intermediate component for producing the esophageal liquid-supply catheter according to any one of (2) to (9), wherein the shaft is excluded from the esophageal liquid-supply catheter comprising the shaft according to any one of (2) to (9).
The arms can be expanded in the esophagus, and by delivering a liquid in this state, it is possible to reduce the temperature transmission to the esophagus due to heating, cooling or the like by ablation.
Examples of our catheters and components will be described in detail with reference to the Figures, but this disclosure is not limited to the examples. The same elements are denoted by the same reference numerals and redundant description will be omitted. Also, the proportions in the Figures do not always match what is described. The term “length” refers to the length in the longitudinal direction.
An esophageal liquid-supply catheter 1 of the first example will be described with reference to
The esophageal liquid-supply catheter 1 has a tubular member 2 and a shaft 4 inserted into the lumen (space) of the tubular member 2, and the tubular member 2 and the shaft 4 can slide with each other. A space exists between the inner wall of the tubular member 2 and the outer wall of the shaft 4, and a liquid is flowed in the space during the operation.
The examples of the shape of the shaft 4 include, but are not limited to, a tube having a lumen, a wire, a stranded wire and the like.
The length of the tubular member 2 and the shaft 4 are preferably 200 mm to 1000 mm, respectively. The material of the tubular member 2 and the shaft 4 is preferably a flexible material having excellent antithrombotic properties, and examples thereof include, but are not limited to, fluoropolymers, polyamides, polyurethane polymers, polyimides, metals and the like.
The tubular member 2 has on its distal end a plurality of arms 3 connected to the tubular member 2, and the distal end side of the arms 3 and the distal end side of the shaft 4 are fixed to a distal end tip 5. When the shaft 4 is slid toward the proximal end relative to the tubular member 2, that is, in the direction in which the distal end tip 5 approaches the tubular member 2, the distal end tip 5 and the distal end side of the arms 3 are pulled by the shaft 4 towards the proximal end side. On the other hand, the proximal end side of the arms 3 is fixed to the tubular member 2 and thus does not move. Therefore, as shown in
The length of the arms 3 is preferably 20 mm to 100 mm. The cross-sectional shape of the arms 3 may be any shape such as a circle shown in
The material of the arms 3 and the distal end tip 5 is preferably a flexible material having excellent antithrombotic properties, and examples thereof include, but are not limited to, fluoropolymers, polyamides, polyurethane polymers, polyimides, metals and the like.
Examples of the shape of the esophageal liquid-supply catheter 1 on the handle side include, but are not limited to, a Y-shaped connector 6 having a valve structure 7, which allows the tubular member 2 and the shaft 4 to be slid and fixed.
The handle side of the esophageal liquid-supply catheter 1 is connected to an extension tube 10 which is capable of delivering and sucking a liquid into the lumen of the tubular member 2. When a liquid is delivered from a syringe 11 connected to the extension tube 10, the liquid passes through a space (gap) between the inner wall of the tubular member 2 and the outer wall of the shaft 4, and then discharged from a fluid hole 13 formed by the gap between the distal end of the tubular member 2 and the shaft 4. The liquid delivered to the esophagus is preferably a temperature-controlled liquid. For example, when used in combination with an ablation catheter which is heated, the temperature is preferably 5° C. or lower. When used in combination with an ablation catheter which is cooled, the temperature is preferably 25° C. or higher and 40° C. or lower. In addition to the syringe 11, a known device used for an esophageal liquid-supply catheter can be used as a device to deliver and suck a liquid to the esophageal liquid-supply catheter 1, which is provided outside the esophageal liquid-supply catheter 1.
One or more temperature sensors 8 are arranged on the shaft 4. Lead wire(s) of the temperature sensor(s) (not shown) extend inside the shaft 4 or inside the lumen of the tubular member 2 to the rear end of the esophageal liquid-supply catheter 1, from which the lead wire(s) are connected to a connector 9 arranged on the handle side. The connector 9 is connected to a temperature display device, and thus, it is possible to measure the temperature inside the esophagus.
In
In
As described above, the fluid hole(s) 13 may be arranged anywhere on the esophageal liquid-supply catheter 1, and may be a combination of
The attachment mechanism 16 is, for example, a columnar silicon rubber having a slit or a hole of about 5 Fr (French catheter scale)=1.667 mm. By fixing the attachment mechanism 16 to the distal end tip 5, various catheters including commercially available products can be used as a shaft 4 and fitted and detached from the distal end tip 5. The attachment mechanism 16 is not limited to this and may be any mechanism as long as it can fix various catheters to the distal end tip 5. Further, a catheter having a function for measuring the temperature and having a diameter of 1.667 mm to 5 mm is preferably used as a shaft because the temperature inside the esophagus can be measured.
As described above, a commercially available catheter can be used as a shaft. When the above-mentioned attachment mechanism 16 is fixed to the distal end tip 5, the user (doctor) can use any desired catheter as the shaft and assemble our esophageal liquid-supply catheter before use. That is, our above-mentioned esophageal liquid-supply catheter excluding the shaft can be used as an intermediate component for manufacturing our esophageal liquid-supply catheter, and thus, we provide such an intermediate component as well.
Specific examples of our esophageal liquid-supply catheters will be described below. The term “length” refers to the length in the longitudinal direction.
A polyvinyl chloride tube having an outer diameter of 4.7 mm, an inner diameter of 3.8 mm, and a length of 550 mm was formed to use as a tubular member 2.
A polyurethane tube having an outer diameter of 2.3 mm, an inner diameter of 1.2 mm, and a length of 580 mm was formed to use as a shaft 4. A copper wire with a diameter of 0.1 mm and a length of 650 mm coated with an electrically insulating polytetrafluoroethylene protective coating and a constantan wire with a diameter of 0.1 mm and a length of 650 mm coated with an electrically insulating polytetrafluoroethylene protective coating were welded together only at the tips of the two metal wires to form a thermocouple. This welded thermocouple was fixed by soldering inside a SUS304 pipe having an outer diameter of 2.5 mm, an inner diameter of 2.3 mm, and a length of 4.4 mm. Thus, a temperature sensor 8 was formed. Three temperature sensors 8 were fixed by swaging at positions of 30 mm, 40 mm, and 50 mm from the distal end side of the shaft 4, and the copper wires and the constantan wires were all connected to the metal pins of the connector 9 via the lumen of the shaft 4.
A Y-shaped connector 6 was fixed to the rear end of the tubular member 2 with an adhesive, and the shaft 4 was inserted from the rear end side of the Y-shaped connector 6 to form a double-tube shaft. The Y-shaped connector 6 has a valve structure 7 and, thus, the shaft 4 can be slid, and liquid can be prevented from leaking from the gap between the tubular member 2 and the shaft 4. An extension tube 10 having a length of 20 mm and a syringe 11 having a capacity of 30 mL were connected to the Y-shaped connector 6 so that a liquid could be delivered into the tubular member 2.
A polyvinyl chloride tube having an outer diameter of 4.7 mm, an inner diameter of 3.8 mm, and a length of 20 mm was formed to use as a distal end tip 5. A silicon tube having an outer diameter of 3.8 mm, an inner diameter of 1.7 mm, and a length of 20 mm was used as an attachment mechanism 16 and fixed inside the distal end tip 5 with an adhesive. The distal end side of the shaft 4 was inserted into the attachment mechanism 16 and, thus, the distal end tip 5 and the shaft 4 were fixed.
Four vinyl chloride flat plates, each having a width of 4.5 mm, a thickness of 0.5 mm, and a length of 50 mm, were formed as arms 3. That is, the maximum width of the cross section of the arms 3 was 4.5 mm. The four arms 3 were heat-welded and fixed to the tubular member 2 and the distal end tip 5 such that the angle of each with the central axis of the shaft 4 was 90° (that is, at equal intervals around the shaft 4). An esophageal liquid-supply catheter of Example 1 was thus prepared.
An esophageal liquid-supply catheter of Example 2 was prepared in the same manner as in Example 1 except that the width of the vinyl chloride flat plates used as the arms 3 was changed to 0.9 mm. The maximum width of the cross section of the arms 3 was 1.0 mm.
An esophageal liquid-supply catheter of Example 3 was prepared in the same manner as in Example 1 except that the width of the vinyl chloride flat plates used as the arms 3 was changed to 0.5 mm. The maximum width of the cross section of the arms 3 was 0.7 mm.
The method and results of the comparative evaluation of Example 1, Example 2, Comparative Example 1 and Example 3 will now be described.
The shaft 4 of Example 1, Example 2 and Example 3 was slid by 20 mm toward the proximal end side relative to the tubular member 2. A force in the longitudinal direction was applied to the arms 3, and the arms 3 were deformed and expanded outward in the radial direction. The esophageal temperature was measured with the temperature sensors 8 of Example 1, Example 2, Comparative Example 1 and Example 3. When the esophageal temperature reached 40° C., a liquid having a temperature of 5° C. was delivered at the delivery amount of 10 mL/time by the syringe 11 at a rate of 10 mL/sec.
To confirm the reduction effect of the temperature transmission when the esophagus was compressed from the outside, the heat source 18 was pressed against the pig esophagus 17 with a load of 0 N, 3 N and 5 N.
The liquid delivery operation as mentioned above was carried out three times using Example 1, Example 2, Comparative Example 1 and Example 3.
In any of the above examples, the esophageal temperature measured by the temperature sensors 8 was about 50° C. when the liquid was not delivered. Table 1 shows the measurement results (numerical values are in ° C.) of the decrease in the esophageal temperature due to the liquid delivery in each Example.
A comparison of Example 1, Example 2 and Comparative Example 1 confirmed that, in Comparative Example 1, the esophageal temperature decreased at a load of 0 N and a load of 3 N but not at a load of 5 N because the liquid was no longer able to be delivered, and that in Examples 1 and 2, the esophageal temperature decreased by about 15° C. even at a load of 5 N.
That is, when a liquid is delivered to the esophagus using a tubular member 2 not having arms 3, the liquid cannot be delivered efficiently if the esophagus is pressed and compressed from the outside due to the patient's condition, the weight of an organ or the like. However, Example 1 and Example 2 demonstrated that the liquid could be efficiently delivered because the esophagus was supported from the inside.
A comparison of Example 1, Example 2 and Example 3 showed that the esophageal temperature decreased even at a load of 5 N in Example 3, but the decrease in the esophageal temperature was smaller than in Example 1 and Example 2.
The maximum width of the cross section of the arms 3 of Example 1 is 4.5 mm, the maximum width of the cross section of the arms 3 of Example 2 is 1.0 mm, and the maximum width of the cross section of the arms 3 of Example 3 is 0.7 mm. That is, we confirmed that the maximum width of the cross section of the arms 3 is preferably 1.0 mm or more to efficiently deliver the liquid. In Examples 1, 2 and 3, the polyvinyl chloride arms 3 which did not have the sufficient rigidity for the expansion of the pig esophagus 17 in the direction of the heat source 18 were used. However, as long as the maximum width of the cross section of the arms 3 was 1.0 mm or more, particularly efficient liquid delivery was possible. It is clear that the arms 3 with higher rigidity may be used in consideration of the patient's condition, the weight of an organ, and the like.
Our esophageal liquid-supply catheters can be used in combination with catheter ablation to treat arrhythmias such as atrial fibrillation.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2018-238594 | Dec 2018 | JP | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/JP2019/049815 | 12/19/2019 | WO | 00 |
