The present invention relates generally to medical devices, and in particular medical probes with irrigation, and further relates to, but not exclusively, medical probes configured to provide irrigation to electrodes.
Cardiac arrhythmias, such as atrial fibrillation (AF), occur when regions of cardiac tissue abnormally conduct electrical signals to adjacent tissue. This disrupts the normal cardiac cycle and causes asynchronous rhythm. Certain procedures exist for treating arrhythmia, including surgically disrupting the origin of the signals causing the arrhythmia and disrupting the conducting pathway for such signals. By selectively ablating cardiac tissue by application of energy via a catheter, it is sometimes possible to cease or modify the propagation of unwanted electrical signals from one portion of the heart to another.
Many current ablation approaches in the art utilize radiofrequency (RF) electrical energy to heat tissue. RF ablation can have certain risks related to thermal heating which can lead to tissue charring, burning, steam pop, phrenic nerve palsy, pulmonary vein stenosis, and esophageal fistula.
Cryoablation is an alternative approach to RF ablation that generally reduces thermal risks associated with RF ablation. Maneuvering cryoablation devices and selectively applying cryoablation, however, is generally more challenging compared to RF ablation; therefore, cryoablation is not viable in certain anatomical geometries which may be reached by electrical ablation devices.
Some ablation approaches use irreversible electroporation (IRE) to ablate cardiac tissue using nonthermal ablation methods. IRE delivers short pulses of high voltage to tissues and generates an unrecoverable permeabilization of cell membranes. Delivery of IRE energy to tissues using multi-electrode probes was previously proposed in the patent literature. Examples of systems and devices configured for IRE ablation are disclosed in U.S. Patent Pub. No. 2021/0169550A1, 2021/0169567A1, 2021/0169568A1, 2021/0161592A1, 2021/0196372A1, 2021/0177503A1, and 2021/0186604A1, each of which are incorporated herein by reference and attached in the Appendix hereto.
Ablation of tissue can cause localized temperature increases near the electrodes. Therefore, many existing ablation catheters include irrigation elements that are configured deliver irrigation to areas proximate the electrodes. For example, some existing ablation catheters are configured to deliver saline to areas proximate the electrodes. Unfortunately, many existing irrigation elements are designed with sharp turns or otherwise inefficient designs that can reduce the effectiveness of the cooling provided by the irrigation elements. Accordingly, there is a need in the art for irrigation elements that increase the effectiveness of the cooling provided by the irrigation elements.
There is provided, in accordance with an example of the present invention, an irrigation hub for an ablation catheter. The irrigation hub can comprise a cylindrical member extending along a longitudinal axis. The cylindrical member can comprise a proximal end having a first outer diameter and a recess extending inwardly along the longitudinal axis forming an interior portion, a distal end having a second outer diameter, the second outer diameter being less than the first outer diameter, and an irrigation inlet chamber disposed proximate the interior portion and configured to receive fluid from an irrigation supply. The cylindrical member can further comprise a plurality of irrigation openings disposed generally transverse to the longitudinal axis from a distal portion of the irrigation inlet chamber and a flow diverter extending into the distal portion of the irrigation inlet chamber to block fluid flow and redirect fluid flow out of the plurality of irrigation openings in a direction generally transverse relative to the longitudinal axis.
The disclosed technology can include a medical probe comprising a tubular shaft extending along a longitudinal axis of the medical probe, a plurality of spines configured to bow radially outward from the longitudinal axis, and a plurality of electrodes. Each electrode of the plurality of electrodes can be attached to a spine of the plurality of spines. The medical probe can further include an irrigation hub attached to the tubular shaft and configured to receive and support the plurality of spines. The irrigation hub can comprise a cylindrical member extending along the longitudinal axis and comprising a proximal end having a first outer diameter and a recess extending inwardly along the longitudinal axis forming an interior portion and a distal end having a second outer diameter. The second outer diameter can be less than the first outer diameter. The cylindrical member can include an irrigation inlet chamber disposed proximate the interior portion and configured to receive fluid from an irrigation supply line separate from the tubular shaft to prevent fluid immersion into the tubular shaft, a plurality of irrigation openings disposed generally transverse to the longitudinal axis from a distal portion of the irrigation inlet chamber, and a flow diverter extending into the distal portion of the irrigation inlet chamber to block fluid flow and redirect fluid out of the plurality of irrigation openings in a direction generally transverse relative to the longitudinal axis.
Additional features, functionalities, and applications of the disclosed technology are discussed in more detail herein.
The following detailed description should be read with reference to the drawings, in which like elements in different drawings are identically numbered. The drawings, which are not necessarily to scale, depict selected examples and are not intended to limit the scope of the invention. The detailed description illustrates by way of example, not by way of limitation, the principles of the invention. This description will clearly enable one skilled in the art to make and use the invention, and describes several embodiments, adaptations, variations, alternatives and uses of the invention, including what is presently believed to be the best mode of carrying out the invention.
As used herein, the terms “about” or “approximately” for any numerical values or ranges indicate a suitable dimensional tolerance that allows the part or collection of components to function for its intended purpose as described herein. More specifically, “about” or “approximately” may refer to the range of values±20% of the recited value, e.g. “about 90%” may refer to the range of values from 71% to 110%. In addition, as used herein, the terms “patient,” “host,” “user,” and “subject” refer to any human or animal subject and are not intended to limit the systems or methods to human use, although use of the subject invention in a human patient represents a preferred embodiment. As well, the term “proximal” indicates a location closer to the operator or physician whereas “distal” indicates a location further away to the operator or physician.
As discussed herein, vasculature of a “patient,” “host,” “user,” and “subject” can be vasculature of a human or any animal. It should be appreciated that an animal can be a variety of any applicable type, including, but not limited thereto, mammal, veterinarian animal, livestock animal or pet type animal, etc. As an example, the animal can be a laboratory animal specifically selected to have certain characteristics similar to a human (e.g., rat, dog, pig, monkey, or the like). It should be appreciated that the subject can be any applicable human patient, for example.
As discussed herein, “physician” can include a doctor, surgeon, technician, scientist, operator, or any other individual or delivery instrumentation associated with delivery of a multi-electrode catheter for the treatment of drug refractory atrial fibrillation to a subject.
As discussed herein, the term “ablate” or “ablation”, as it relates to the devices and corresponding systems of this disclosure, refers to components and structural features configured to reduce or prevent the generation of erratic cardiac signals in the cells by utilizing non-thermal energy, such as reversable or irreversible electroporation (IRE), referred throughout this disclosure interchangeably as pulsed electric field (PEF) and pulsed field ablation (PFA), or thermal energy such as radiofrequency (RF) ablation or cryoablation. Ablating or ablation as it relates to the devices and corresponding systems of this disclosure is used throughout this disclosure in reference to thermal or non-thermal ablation of cardiac tissue for certain conditions including, but not limited to, arrhythmias, atrial flutter ablation, pulmonary vein isolation, supraventricular tachycardia ablation, and ventricular tachycardia ablation. The term “ablate” or “ablation” also includes known methods, devices, and systems to achieve various forms of bodily tissue ablation as understood by a person skilled in the relevant art.
As discussed herein, the terms “tubular” and “tube” are to be construed broadly and are not limited to a structure that is a right cylinder or strictly circumferential in cross-section or of a uniform cross-section throughout its length. For example, the tubular structures are generally illustrated as a substantially right cylindrical structure. However, the tubular structures may have a tapered or curved outer surface without departing from the scope of the present disclosure.
Catheter 14 is an exemplary catheter that includes one and preferably multiple electrodes 26 optionally distributed over a plurality of spines 22 at basket catheter 28 and configured to sense the IEGM signals. Catheter 14 may additionally include a position sensor 29 embedded in or near basket catheter 28 for tracking position and orientation of basket catheter 28. Optionally and preferably, position sensor 29 is a magnetic based position sensor including three magnetic coils for sensing three-dimensional (3D) position and orientation.
A combination magnetic based position sensor and force sensor 68 may be operated together with a location pad 25 including a plurality of magnetic coils 32 configured to generate magnetic fields in a predefined working volume. Real time position of basket catheter 28 of catheter 14 may be tracked based on magnetic fields generated with location pad 25 and sensed by magnetic based position sensor 29. Details of the magnetic based position sensing technology are described in U.S. Pat. Nos. 5,391,199; 5,443,489; 5,558,091; 6,172,499; 6,239,724; 6,332,089; 6,484,118; 6,618,612; 6,690,963; 6,788,967; 6,892,091, each of which are incorporated herein by reference and attached in the Appendix hereto.
System 10 includes one or more electrode patches 38 positioned for skin contact on patient 23 to establish location reference for location pad 25 as well as impedance-based tracking of electrodes 26. For impedance-based tracking, electrical current is directed toward electrodes 26 and sensed at electrode skin patches 38 so that the location of each electrode can be triangulated via the electrode patches 38. Details of the impedance-based location tracking technology are described in U.S. Pat. Nos. 7,536,218; 7,756,576; 7,848,787; 7,869,865; and 8,456,182, each of which are incorporated herein by reference and attached in the Appendix hereto.
A recorder 11 displays electrograms 21 captured with body surface ECG electrodes 18 and intracardiac electrograms (IEGM) captured with electrodes 26 of catheter 14. Recorder 11 may include pacing capability for pacing the heart rhythm and/or may be electrically connected to a standalone pacer.
System 10 may include an ablation energy generator 50 that is adapted to conduct ablative energy to one or more of electrodes at a distal tip of a catheter configured for ablating. Energy produced by ablation energy generator 50 may include, but is not limited to, radiofrequency (RF) energy or pulsed-field ablation (PFA) energy, including monopolar or bipolar high-voltage DC pulses as may be used to effect irreversible electroporation (IRE), or combinations thereof.
Patient interface unit (PIU) 30 is an interface configured to establish electrical communication between catheters, electrophysiological equipment, power supply and a workstation 55 for controlling operation of system 10. Electrophysiological equipment of system 10 may include for example, multiple catheters, location pad 25, body surface ECG electrodes 18, electrode patches 38, ablation energy generator 50, and recorder 11. Optionally and preferably, PIU 30 additionally includes processing capability for implementing real-time computations of location of the catheters and for performing ECG calculations.
Workstation 55 includes memory, processor unit with memory or storage with appropriate operating software loaded therein, and user interface capability. Workstation 55 may provide multiple functions, optionally including (1) modeling the endocardial anatomy in three-dimensions (3D) and rendering the model or anatomical map 20 for display on a display device 27, (2) displaying on display device 27 activation sequences (or other data) compiled from recorded electrograms 21 in representative visual indicia or imagery superimposed on the rendered anatomical map 20, (3) displaying real-time location and orientation of multiple catheters within the heart chamber, and (5) displaying on display device 27 sites of interest such as places where ablation energy has been applied. One commercial product embodying elements of the system 10 is available as the CARTO™ 3 System, available from Biosense Webster, Inc., 31 Technology Drive, Suite 200, Irvine, CA 92618, USA.
The physician 24 can bring the basket catheter 28 into contact with tissue to perform the ablation procedure. As ablative energy is output by the electrodes 26, the electrodes 26 and nearby tissue may begin to be heated. To help dissipate the heat generated by the electrodes 26, the disclosed technology can include an irrigation hub 100 that can be configured to deliver a fluid proximate the electrodes 26 to cool the electrodes 26 and prevent thrombosis, as will be described in greater detail herein.
As shown in
The irrigation hub 100 can include a plurality of irrigation openings 104 that can be configured to permit fluid to flow therethrough and to help direct the fluid outwardly from the irrigation hub 100. The irrigation openings 104 can be dispersed radially around the distal end 103b and be generally transverse to the longitudinal axis 60. The irrigation openings 104 can each form an aperture having an inlet area 105a that is smaller than an outlet area 105b such that the fluid is permitted to disperse outwardly when directed out of the irrigation openings 104. In other words, as fluid flows through the irrigation hub 100 and out of the irrigation openings 104, the inlet area 105a through which the fluid first flows through the irrigation openings will be smaller than the outlet area 105b through which the fluid flows just prior to leaving the irrigation hub 100. In this way, the irrigation hub 100 can help to guide or direct the irrigation fluid toward the electrodes 26 or otherwise outwardly from the irrigation hub 100.
The irrigation hub 100 can further include a plurality of relief lands 106 that can be configured to receive and help retain the spines 22. As shown in
The irrigation hub 100 can further include a sensor mount 108 that can be disposed at the distal end 103b of the cylindrical member 102. The sensor mount 108 can be configured to receive and support one or more sensors 70, 608 (see
As shown in
The irrigation hub 100 can further include a plurality of attachment mechanisms 114 that can be configured for attaching the irrigation hub 100 to the combination sensor 68 and/or the tubular shaft 62. The attachment mechanisms 114 can be, for example and not limited to, bayonet mounts, snap connectors, a threaded fitting, or other suitable types of attachment mechanisms 114 for the particular application.
As will be appreciated, the irrigation openings 104 can extend outwardly from the irrigation inlet chamber 112 through the irrigation hub 100. As described previously, the irrigation openings 104 can include an inlet area 105a that is smaller than an outlet area 105b. the inlet area 105a can be near the irrigation inlet chamber 112 and the outlet area 105b can be disposed a distance away from the irrigation inlet chamber 112. A surface 122 of the irrigation openings 104 can extend between the inlet are 105a and the outlet are 105b. The surface 122 can be configured such that the surface is disposed at the angle θ or an angle that is substantially similar to the angle θ such that the fluid can be directed outwardly through the irrigation openings 104 without generating significant turbulence.
With the configuration of electrodes 826a, 826b disposed on the spines 822 as shown in
As shown in
Each electrode retention region 860 can include one or more cutouts 864 that can permit the spine 822 to be bent or pinched inwardly. Each electrode retention region 860 can further include one or more retention members 862 that protrude outwardly and can be configured to prevent the electrode 826 from sliding proximally or distally along the spine 822. During manufacture, proximal ends of the frame of the basket catheter 828 are inserted into lumens of the electrodes 826a, 826b, and the electrodes 826a, 826b are slid distally along the spines 822 to their respective final position. The cutouts 864 permit the electrodes 826a, 826b to slide over a retention members 862a-c. Because of the one or more cutouts 864 in the spines 822, the retention members 862a-c can be configured to move inwardly when the spine 822 is pinched inwardly to permit an electrode 826a, 826b to slide over the retention member 862a-c. Once the electrode 826a, 826b is slid past the retention member 862, the retention member 862 can resiliently bend back to its previous position, thereby preventing the electrode 826a, 826b from sliding proximally or distally along the spine 822.
The proximal electrode retention region 860b includes a proximal retention member 862c and a distal retention member 862b. The proximal electrode retention region 860b need not be configured to permit the proximal electrodes 826b to pass over the distal retention member 862b. The distal electrode retention region 860a utilizes the central spine intersection 850 to prevent the distal electrodes 826a from moving distally once the distal electrodes 826a are in their respective final position.
Although the basket catheter 828 is shown as having two electrodes 826 disposed near each other on a given spine 822 and having alternating groupings of electrodes 826 on adjacent spines 822, the disclosed technology can include other configurations of electrodes 826 and spines 822 not shown. For example, the disclosed technology can include groupings of three or more electrodes 826 and/or multiple groupings of electrodes 826 disposed on spines 822. Thus, the disclosed technology is not limited to the particular configuration of electrodes 826 and spines 822 shown and described herein.
The disclosed technology described herein can be further understood according to the following clauses:
Clause 1: An irrigation hub for an ablation catheter, the irrigation hub comprising: a cylindrical member extending along a longitudinal axis, the cylindrical member comprising: a proximal end having a first outer diameter and a recess extending inwardly along the longitudinal axis forming an interior portion; a distal end having a second outer diameter, the second outer diameter being less than the first outer diameter; an irrigation inlet chamber disposed proximate the interior portion and configured to receive fluid from an irrigation supply; a plurality of irrigation openings disposed generally transverse to the longitudinal axis from a distal portion of the irrigation inlet chamber; and a flow diverter extending into the distal portion of the irrigation inlet chamber to block fluid flow and redirect fluid flow out of the plurality of irrigation openings in a direction generally transverse relative to the longitudinal axis.
Clause 2: The irrigation hub of Clause 1, wherein the plurality of irrigation openings are disposed radially around the cylindrical member and are configured to direct the fluid toward electrodes of a basket catheter.
Clause 3: The irrigation hub of Clauses 1 or 2, wherein each irrigation opening of the plurality of irrigation openings comprises an aperture having an outlet area greater than an inlet area.
Clause 4: The irrigation hub of any of Clauses 1-3, wherein the flow diverter comprises a conical member extending proximally along the longitudinal axis into the irrigation inlet chamber.
Clause 5: The irrigation hub of any of Clauses 1-4, wherein at least a portion of each irrigation opening extends outwardly at an angle.
Clause 6: The irrigation hub of Clause 5, wherein the angle of each irrigation opening relative to the longitudinal axis is approximately equal to an angle formed by an outer surface of the conical member relative to the longitudinal axis.
Clause 7: The irrigation hub of any of Clauses 1-6, wherein the proximal end comprises one or more attachment mechanisms configured to releasably attach the proximal end to a catheter shaft.
Clause 8: The irrigation hub of any of Clauses 1-6, wherein the proximal end comprises one or more attachment mechanisms configured to releasably attach the proximal end to a force sensor.
Clause 9: The irrigation hub of Clauses 7 or 8, wherein the one or more attachment mechanisms comprises one or more bayonet mounts.
Clause 10: The irrigation hub of any of the preceding Clauses, wherein the proximal end further comprises a plurality of relief lands disposed radially around an outer surface of the proximal end, each relief land of the plurality of relief lands configured to receive a spine of a basket catheter.
Clause 11: The irrigation hub of any of the preceding Clauses, wherein the distal end further comprises a sensor mount configured to receive and support a sensor.
Clause 12: The irrigation hub of Clause 11, wherein the sensor comprises a reference electrode.
Clause 13: The irrigation hub of Clause 11, wherein the sensor comprises a position sensor.
Clause 14: A medical probe, comprising: a tubular shaft extending along a longitudinal axis of the medical probe; a plurality of spines configured to bow radially outward from the longitudinal axis; a plurality of electrodes, each electrode of the plurality of electrodes attached to a spine of the plurality of spines; and an irrigation hub attached to the tubular shaft and configured to receive and support the plurality of spines, the irrigation hub comprising a cylindrical member extending along the longitudinal axis and comprising: a proximal end having a first outer diameter and a recess extending inwardly along the longitudinal axis forming an interior portion; a distal end having a second outer diameter, the second outer diameter being less than the first outer diameter; an irrigation inlet chamber disposed proximate the interior portion and configured to receive fluid from an irrigation supply line separate from the tubular shaft to prevent fluid immersion into the tubular shaft; a plurality of irrigation openings disposed generally transverse to the longitudinal axis from a distal portion of the irrigation inlet chamber; and a flow diverter extending into the distal portion of the irrigation inlet chamber to block fluid flow and redirect fluid out of the plurality of irrigation openings in a direction generally transverse relative to the longitudinal axis.
Clause 15: The medical probe of Clause 14, wherein the plurality of spines are configured to transition between an expanded state and a collapsed state.
Clause 16: The medical probe of Clauses 14 or 15, wherein the flow diverter is disposed at least partially in the irrigation inlet chamber.
Clause 17: The medical probe of any of Clauses 14-16, wherein the plurality of irrigation openings are disposed radially around the cylindrical member and are configured to direct the fluid toward the plurality of electrodes.
Clause 18: The medical probe of Clause 17, each electrode of the plurality of electrodes having a tissue-facing surface and an inwardly-facing surface, the plurality of irrigation openings configured to direct the fluid toward the inwardly-facing surface of each electrode of the plurality of electrodes.
Clause 19: The medical probe of any of Clauses 14-18, wherein each irrigation opening of the plurality of irrigation openings comprises an aperture having an outlet area greater than an inlet area.
Clause 20: The medical probe of any of Clauses 14-19, wherein the flow diverter comprises a conical member extending proximally along the longitudinal axis into the irrigation inlet chamber.
Clause 21: The medical probe of any of Clauses 14-19, wherein at least a portion of each irrigation opening extends outwardly at an angle.
Clause 22: The medical probe of Clause 21, wherein the angle of each irrigation opening relative to the longitudinal axis is approximately equal to an angle formed by an outer surface of the conical member relative to the longitudinal axis.
Clause 23: The medical probe of any of Clauses 14-22, wherein the proximal end comprises one or more attachment mechanisms configured to releasably attach the proximal end to the tubular shaft.
Clause 24: The medical probe of any of Clauses 14-22 further comprising a force sensor disposed between the irrigation hub and the tubular shaft.
Clause 25: The medical probe of Clause 24, wherein the proximal end comprises one or more attachment mechanisms configured to releasably attach the proximal end to the force sensor.
Clause 26: The medical probe of Clauses 23 or 25, wherein the one or more attachment mechanisms comprises one or more bayonet mounts.
Clause 27: The medical probe of any of Clauses 14-26, wherein the proximal end further comprises a plurality of relief lands disposed radially around an outer surface of the proximal end, each relief land of the plurality of relief lands configured to receive a respective spine of the plurality of spines.
Clause 28: The medical probe of any of Clauses 14-27, wherein the distal end further comprises a sensor mount configured to receive and support a sensor.
Clause 29: The medical probe of Clause 28, wherein the sensor comprises a reference electrode.
Clause 30: The medical probe of Clause 28, wherein the sensor comprises a position sensor.
Clause 31: A medical probe, comprising: a tubular shaft extending along a longitudinal axis of the medical probe; a plurality of spines configured to bow radially outward from the longitudinal axis, each spine of the plurality of spines comprising a retention member; a plurality of electrodes, each electrode of the plurality of electrodes attached to a spine of the plurality of spines and prevented from sliding proximally or distally along the spine by the retention member, the plurality of electrodes being disposed on the plurality of spines in groupings, the groupings being disposed in alternating proximal and distal positions along adjacent spines; and an irrigation hub attached to the tubular shaft and configured to receive and support the plurality of spines, the irrigation hub comprising a cylindrical member extending along the longitudinal axis and comprising: a plurality of irrigation openings disposed generally transverse to the longitudinal axis from a distal portion of an irrigation inlet chamber of the irrigation hub; and a flow diverter configured to block fluid flow and redirect fluid out of the plurality of irrigation openings in a direction generally transverse relative to the longitudinal axis.
The embodiments described above are cited by way of example, and the present invention is not limited by what has been particularly shown and described hereinabove. Rather, the scope of the invention includes both combinations and sub combinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
This application claims the benefit of priority under 35 U.S.C. § 119 to prior filed U.S. Provisional Patent Application No. 63/336,023 (Attorney Docket No.: BIO6675USPSP1) filed on Apr. 28, 2022, prior filed U.S. Provisional Patent Application No. 63/336,094 (Attorney Docket No.: BIO6693USPSP1) filed on Apr. 28, 2023, and prior filed U.S. Provisional Patent Application No. 63/477,819 (BIO6794USPSP1) filed on Dec. 29, 2022, the entire contents of each of which is hereby incorporated by reference as if set forth in full herein.
Number | Date | Country | |
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63477819 | Dec 2022 | US | |
63336094 | Apr 2022 | US | |
63336023 | Apr 2022 | US |