Patent Application
20250099167
The present technology relates generally to medical devices, and in particular medical probes with electrodes, and further relates to, but not exclusively, medical probes suitable for use to induce irreversible electroporation (IRE) of cardiac tissues.
Cardiac arrhythmias, such as atrial fibrillation (AF), occur when regions of cardiac tissue abnormally conduct electric 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.
Irrigation, while employing IRE ablation, is required to ensure no thrombosis occurs. However, it is a challenge to ensure even irrigation around the electrodes. Accordingly, there is a need for improved techniques to evenly distribute irrigation fluid flow around each electrode.
There is provided, in accordance with the disclosed technology, an irrigation manifold for a medical device. The irrigation manifold can include a housing extending along a longitudinal axis defining a housing lumen and a housing conduit offset from the housing lumen, the housing conduit being configured to connect with a main line irrigation tube. The irrigation manifold can include a diverter defining a diverter lumen connecting with the housing to define an irrigation chamber. The diverter can include a first shaft nesting within the housing lumen. The diverter can include a diverter ring defining a plurality of diverter conduits disposed radially about the longitudinal axis and connecting with a distal end of the housing. Each diverter conduit is configured to connect with a diverter irrigation tube that routes a fluid to an end effector of the medical device.
There is further provided, in accordance with the disclosed technology, an end effector for a medical device. The end effector can include an irrigation manifold, at least one spine, and an actuator rod. The irrigation manifold extends along a longitudinal axis and can include a housing and a diverter. The housing defines a housing lumen and a housing conduit. The diverter defines a diverter lumen, connects with the housing to define an irrigation chamber, and defines at least one diverter conduit. Fluid is configured to flow into the irrigation chamber via the housing conduit and out of the irrigation chamber via the at least one diverter conduit. The at least one spine is connected to the irrigation manifold at a proximal end of the at least one spine and is configured to bow radially outward from the longitudinal axis and to move between an expanded configuration and a collapsed configuration. The at least one diverter conduit is configured to route the fluid along the at least one spine. The actuator rod passes through the housing lumen and the diverter lumen and is connected to a distal end of the at least one spine. The actuator rod is configured to move the at least one spine between the expanded configuration and the collapsed configuration.
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 present disclosure. The detailed description illustrates by way of example, not by way of limitation, the principles of the disclosed technology. This description will clearly enable one skilled in the art to make and use the disclosed technology, and describes several embodiments, adaptations, variations, alternatives and uses of the disclosed technology, including what is presently believed to be the best mode of carrying out the disclosed technology.
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 technology 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, “operator” can include a doctor, surgeon, technician, scientist, 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 irreversible electroporation (IRE), referred throughout this disclosure interchangeably as pulsed electric field (PEF) and pulsed field ablation (PFA). Ablating or ablation as it relates to the devices and corresponding systems of this disclosure is used throughout this disclosure in reference to 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 “bipolar” and “unipolar” when used to refer to ablation schemes describe ablation schemes which differ with respect to electrical current path and electric field distribution. “Bipolar” refers to ablation scheme utilizing a current path between two electrodes that are both positioned at a treatment site; current density and electric flux density is typically approximately equal at each of the two electrodes. “Unipolar” refers to ablation scheme utilizing a current path between two electrodes where one electrode having a high current density and high electric flux density is positioned at a treatment site, and a second electrode having comparatively lower current density and lower electric flux density is positioned remotely from the treatment site.
As discussed herein, the terms “tubular”, “tube” and “shaft” 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/shaft structures are generally illustrated as a substantially right cylindrical structure. However, the tubular/shaft structures may have a tapered or curved outer surface without departing from the scope of the present disclosure.
The present disclosure is related to systems, method or uses and devices for IRE ablation of cardiac tissue to treat cardiac arrhythmias. Ablative energies are typically provided to cardiac tissue by a tip portion of a catheter which can deliver ablative energy alongside the tissue to be ablated. Some example catheters include three-dimensional structures at the tip portion and are configured to administer ablative energy from various electrodes positioned on the three-dimensional structures. Ablative procedures incorporating such example catheters can be visualized using fluoroscopy.
Ablation of cardiac tissue using application of a thermal technique, such as radio frequency (RF) energy and cryoablation, to correct a malfunctioning heart is a well-known procedure. Typically, to successfully ablate using a thermal technique, cardiac electropotentials need to be measured at various locations of the myocardium. In addition, temperature measurements during ablation provide data enabling the efficacy of the ablation. Typically, for an ablation procedure using a thermal technique, the electropotentials and the temperatures are measured before, during, and after the actual ablation. RF approaches can have risks that 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 can reduce some thermal risks associated with RF ablation. However maneuvering cryoablation devices and selectively applying cryoablation 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.
The present disclosure can include electrodes configured for irreversible electroporation (IRE), RF ablation, and/or cryoablation. IRE can be referred to throughout this disclosure interchangeably as pulsed electric field (PEF) ablation and pulsed field ablation (PFA). IRE as discussed in this disclosure is a non-thermal cell death technology that can be used for ablation of atrial arrhythmias. To ablate using IRE/PEF, biphasic voltage pulses are applied to disrupt cellular structures of myocardium. The biphasic pulses are non-sinusoidal and can be tuned to target cells based on electrophysiology of the cells. In contrast, to ablate using RF, a sinusoidal voltage waveform is applied to produce heat at the treatment area, indiscriminately heating all cells in the treatment area. IRE therefore has the capability to spare adjacent heat sensitive structures or tissues which would be of benefit in the reduction of possible complications known with ablation or isolation modalities. Additionally, or alternatively, monophasic pulses can be utilized.
Electroporation can be induced by applying a pulsed electric field across biological cells to cause reversable (temporary) or irreversible (permanent) creation of pores in the cell membrane. The cells have a transmembrane electrostatic potential that is increased above a resting potential upon application of the pulsed electric field. While the transmembrane electrostatic potential remains below a threshold potential, the electroporation is reversable, meaning the pores can close when the applied pulse electric field is removed, and the cells can self-repair and survive. If the transmembrane electrostatic potential increases beyond the threshold potential, the electroporation is irreversible, and the cells become permanently permeable. As a result, the cells die due to a loss of homeostasis and typically die by apoptosis. Generally, cells of differing types have differing threshold potential. For instance, heart cells have a threshold potential of approximately 500 V/cm, whereas for bone it is 3000 V/cm. These differences in threshold potential allow IRE to selectively target tissue based on threshold potential.
The technology of this disclosure includes systems and methods for applying electrical signals from catheter electrodes positioned in the vicinity of myocardial tissue to generate a generate ablative energy to ablate the myocardial tissue. In some examples, the systems and methods can be effective to ablate targeted tissue by inducing irreversible electroporation. In some examples, the systems and methods can be effective to induce reversible electroporation as part of a diagnostic procedure. Reversible electroporation occurs when the electricity applied with the electrodes is below the electric field threshold of the target tissue allowing cells to repair. Reversible electroporation does not kill the cells but allows a physician to see the effect of reversible electroporation on electrical activation signals in the vicinity of the target location. Example systems and methods for reversible electroporation is disclosed in U.S. Patent Publication 2021/0162210, the entirety of which is incorporated herein by reference.
The pulsed electric field, and its effectiveness to induce reversible and/or irreversible electroporation, can be affected by physical parameters of the system and biphasic pulse parameters of the electrical signal. Physical parameters can include electrode contact area, electrode spacing, electrode geometry, etc. Examples presented herein generally include physical parameters adapted to effectively induce reversible and/or irreversible electroporation. Biphasic pulse parameters of the electrical signal can include voltage amplitude, pulse duration, pulse interphase delay, inter-pulse delay, total application time, delivered energy, etc. In some examples, parameters of the electrical signal can be adjusted to induce both reversible and irreversible electroporation given the same physical parameters. Examples of various systems and methods of ablation including IRE are presented in U.S. Patent Publications 2021/0169550A1, 2021/0169567A1, 2021/0169568A1, 2021/0161592A1, 2021/0196372A1, 2021/0177503A1, and 2021/0186604A1, the entireties of each of which are incorporated herein by reference.
Reference is made to
Catheter 14 is an exemplary catheter that includes one and preferably multiple electrodes 26 optionally distributed over a plurality of spines 104 at basket assembly 28 and configured to sense the IEGM signals. Catheter 14 may additionally include a position sensor embedded in or near basket assembly 28 for tracking position and orientation of basket assembly 28. Optionally and preferably, position sensor is a magnetic based position sensor including three magnetic coils for sensing three-dimensional (3D) position and orientation.
Magnetic based position sensor 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 assembly 28 of catheter 14 may be tracked based on magnetic fields generated with location pad 25 and sensed by magnetic based position sensor. 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.
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.
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 end effector 100 is connected to the rest of the medical probe 14 via an elongated shaft 200. The elongated shaft 200 can be tubular in form and flexible, with certain portions being more flexible than others. For example, a tip portion can be made more flexible than the rest to allow the end effector 100 to be easily deflected. The elongated shaft 200 can be formed from a flexible, biocompatible electrically insulative material such as polyamide-polyether (Pebax) copolymers, polyethylene terephthalate (PET), urethanes, polyimide, parylene, silicone, etc. In some examples, insulative material can include biocompatible polymers including, without limitation, polyetheretherketone (PEEK), polyglycolic acid (PGA), poly(lactic-co-glycolic acid) copolymer (PLGA), polycaprolactive (PCL), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly-L-lactide, polydioxanone, polycarbonates, and polyanhydrides with the ratio of certain polymers being selected to control the degree of inflammatory response.
In some examples, the spines 104 may be formed integrally with a distal hub (referred to herein as crown 108), as seen in
An atraumatic annulus 114 and coil 116 are connected to the crown 108. In some examples, the coil 116 can comprise a single axis sensor (SAS). In other examples, the coil 116 can comprise a dual axis sensor (DAS) or a triple axis sensor (TAS). The coil 116 can comprise a conductive material wound in a coil or a coil formed into a flexible circuit. The coil 116 can comprise electrical leads for conduction of current induced on the coil to the patient interface unit 30. As will be appreciated, by attaching a coil 116 to the distal end of the end effector 100, it is possible to detect a position thereof. In this way, a physician 24 can more accurately determine the position of the distal end of the end effector 100 before applying ablative energy to tissue.
An insulative material, referred to herein as a jacket 106, is provided over each spine. Each jacket 106 serves to enhance the atraumaticity of the end effector 100 to protect the subject from sharp edges and for irrigation purposes described in greater detail below. The jacket 106 can include a polymer. For example, the jacket 106 can be formed from a flexible, biocompatible electrically insulative material such as polyamide-polyether (Pebax) copolymers, polyethylene terephthalate (PET), urethanes, polyimide, parylene, silicone, etc. In some examples, insulative material can include biocompatible polymers including, without limitation, polyetheretherketone (PEEK), polyglycolic acid (PGA), poly(lactic-co-glycolic acid) copolymer (PLGA), polycaprolactive (PCL), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly-L-lactide, polydioxanone, polycarbonates, and polyanhydrides with the ratio of certain polymers being selected to control the degree of inflammatory response. Furthermore, while the jacket 106 is shown to be tubular in these figures, the jacket 106 can be shaped, scalloped, ribbed, ridged, concaved, convexed, or otherwise configured such that the overall profile of jacket 106 yields physical and/or mechanical properties, such as rigidity and flexion along multiple axes, required by the end effector 100, mentioned above. Moreover, a flexible sleeve 146 is provided over proximal end of the end effector 100 and an irrigation manifold 120 (
The spine(s) 104 are movable between an expanded configuration and a collapsed configuration. The elongated shaft 200 connects the end effector 100 to a handle that, in use, the operator 24 can manipulate. An actuator rod 202 is connected to the crown 108 to facilitate the expanding and collapsing of the spines 104. For example, the rod 202 can be translated along a longitudinal axis A1 to expand/collapse the spines 104. In the expanded configuration (
With continued reference to
Making reference to
Further to the above, the irrigation diverter 128 is generally cylindrical in form. The irrigation diverter 128 includes a first diverter shaft 130, a diverter ring 132, and a second diverter shaft 136 that are all axially aligned along the longitudinal axis A1, with a diverter lumen 138 being defined therethrough. The first diverter shaft 130 and second diverter shaft 136 are disposed on opposing sides of the diverter ring 132 along the longitudinal axis A1. As particularly shown in
As shown particularly in
A lip 132A is also formed in an outer surface of the diverter ring 132. As seen particularly in
With reference now primarily to
With continued reference to
As shown particularly in
In examples described herein, electrodes 26 can be configured to deliver ablation energy (IRE and/or RF) to tissue in heart 12. In addition to using electrodes 26 to deliver ablation energy, the electrodes 26 can also be used to determine the location of the end effector 100 and/or to measure a physiological property such as local surface electrical potentials at respective locations on tissue in heart 12. The electrodes 26 can be biased such that a greater portion of the electrode 26 faces outwardly from the end effector 100 such that the electrodes 26 deliver a greater amount of electrical energy outwardly away from the end effector 100 (i.e., toward the heart 12 tissue) than inwardly toward the end effector 100.
Examples of materials ideally suited for forming electrodes 26 include gold, platinum, and palladium (and their respective alloys). These materials also have high thermal conductivity which allows the minimal heat generated on the tissue (i.e., by the ablation energy delivered to the tissue) to be conducted through the electrodes to the back side of the electrodes (i.e., the portions of the electrodes on the inner sides of the spines), and then to the blood pool in heart 12.
The electrodes 26 may be provided with one or more outlets 26A (
With specific reference now being made to
As illustrated by the foregoing, the irrigation manifold 120 and diverter tubes 142, along with the irrigation conduits 106B formed in the jackets 106, enable even distribution of irrigation around the electrodes 26 while simultaneously providing a way to provide irrigation directly within a patient 23. As will be appreciated, the presently disclosed technology can be modified in various ways without departing from the spirit and scope of the present disclosure.
The disclosed technology described herein can be further understood according to the following clauses:
Clause 1. An irrigation manifold for a medical device, the irrigation manifold comprising: a housing extending along a longitudinal axis defining a housing lumen and a housing conduit offset from the housing lumen, the housing conduit being configured to connect with a main line irrigation tube; and a diverter defining a diverter lumen connecting with the housing to define an irrigation chamber, and comprising: a first shaft nesting within the housing lumen; a diverter ring defining a plurality of diverter conduits disposed radially about the longitudinal axis and connecting with a distal end of the housing, each diverter conduit being configured to connect with a diverter irrigation tube that routes a fluid to an end effector of the medical device.
Clause 2. The irrigation manifold of clause 1, the irrigation chamber being annular in form.
Clause 3. The irrigation manifold of any one of clauses 1-2, the diverter ring defining a lip that nests with an inner annular surface of the housing.
Clause 4. The irrigation manifold of any one of clauses 1-3, the plurality of diverter conduits being spaced about a circumferential periphery of the diverter ring.
Clause 5. The irrigation manifold of any one of clauses 1-4, the diverter further comprising a second shaft, the first shaft and the second shaft being disposed on opposing sides of the diverter ring.
Clause 6. An irrigation system for a medical device, the irrigation system comprising: an irrigation manifold comprising: a housing defining a housing conduit and extending along a longitudinal axis; and a diverter connecting with the housing to define an annular irrigation chamber and defining a plurality of diverter conduits; a main line irrigation tube connected to the housing conduit and configured to connect with a fluid source; and a plurality of diverter irrigation tubes, each connected to a respective diverter conduit, the plurality of diverter irrigation tubes being configured to route a fluid to an end effector of the medical device.
Clause 7. The irrigation system of clause 6, further comprising the end effector, the end effector comprising a plurality of spines disposed about the longitudinal axis, each spine comprising a proximal end connected to the irrigation manifold.
Clause 8. The irrigation system of clause 7, the end effector further comprising a plurality of jackets, each jacket defining: a spine channel receiving a respective spine of the plurality of spines; and an irrigation conduit that receives a respective diverter irrigation tube of the plurality of the plurality of diverter irrigation tubes.
Clause 9. The irrigation system of clause 8, the plurality of diverter irrigation tubes comprising first diverter irrigation tubes and second diverter irrigation tubes, each first diverter irrigation tube being received by the irrigation conduit of a respective jacket of the plurality of jackets, and each second diverter irrigation tube comprising a distal end disposed outside the plurality of jackets.
Clause 10. The irrigation system of clause 9, each second diverter irrigation tube being sandwiched by adjacent first diverter irrigation tubes.
Clause 11. The irrigation system of any one of clauses 8-10, each spine channel and each irrigation conduit spanning an entire length of each jacket.
Clause 12. The irrigation system of clause 11, further comprising an annulus connected to a distal end of the plurality of spines, the annulus occluding a distal end of each irrigation conduit.
Clause 13. The irrigation system of clause 11, further comprising an annulus connected to a distal end of the plurality of spines, the annulus being configured to permit the fluid to exit a distal end of each irrigation conduit.
Clause 14. The irrigation system of any one of clauses 7-13, further comprising at least one electrode connected to each spine, at least a portion of the plurality of diverter irrigation tubes being configured to route the fluid through at least one outlet defined in or proximal the at least one electrode.
Clause 15. The irrigation system of any one of clauses 9-11, further comprising at least one electrode connected to each jacket, each first diverter irrigation tube being configured to route the fluid through respective irrigation conduits of the jackets to the at least one electrode.
Clause 16. The irrigation system of clause 15, further comprising an outlet defined in or disposed proximal each electrode of the at least one electrode.
Clause 17. An end effector for a medical device, the end effector comprising: an irrigation manifold extending along a longitudinal axis and comprising: a housing defining a housing lumen and a housing conduit; and a diverter defining a diverter lumen, connecting with the housing to define an irrigation chamber, and defining at least one diverter conduit, with fluid being configured to flow into the irrigation chamber via the housing conduit and out of the irrigation chamber via the at least one diverter conduit; at least one spine connected to the irrigation manifold at a proximal end of the at least one spine and configured to bow radially outward from the longitudinal axis and to move between an expanded configuration and a collapsed configuration, the at least one diverter conduit being configured to route the fluid along the at least one spine; an actuator rod passing through the housing lumen and the diverter lumen and connected to a distal end of the at least one spine, the actuator rod being configured to move the at least one spine between the expanded configuration and the collapsed configuration.
Clause 18. The end effector of clause 17, the at least one spine being integrally formed from a tube stock.
Clause 19. The end effector of any one of clauses 17-18, further comprising a distal hub integral with the at least one spine, the actuator rod being connected to the distal hub.
Clause 20. The end effector of any one of clauses 17-19, further comprising a spine coupler that is shaped to couple the proximal end of the at least one spine to the diverter.
Clause 21. The end effector of clause 20, the spine coupler encircling at least a portion of the diverter.
Clause 22. The end effector of any one of clauses 20-21, further comprising at least one diverter irrigation tube that is connected to the at least one diverter conduit and is disposed beyond the spine coupler in a radial direction.
Clause 23. The end effector of any one of clauses 17-22, further comprising at least one electrode connected to the at least one spine, the at least one electrode comprising an outlet configured to permit the fluid to exit therethrough.
Clause 24. The end effector of any one of clauses 17-23 further comprising at least one jacket, the at least one jacket defining: a spine channel receiving the at least one spine; and an irrigation conduit that connects with the at least one diverter conduit.
Clause 25. The end effector of clause 24, the at least one jacket comprising a wall separating the spine channel and the irrigation conduit.
Clause 26. The end effector of any one of clauses 17-25, the actuator rod defining an actuator rod lumen coaxial with the longitudinal axis.
Clause 27. The end effector of any one of clauses 17-26, the actuator rod being configured to translate along the longitudinal axis configured to move the at least one spine between the expanded configuration and the collapsed configuration.
Clause 28. The end effector of any one of clauses 17-27, the housing conduit and the at least one diverter conduit being laterally offset from the longitudinal axis and extending parallel to the longitudinal axis.
The examples described above are cited by way of example, and the disclosed technology is not limited by what has been particularly shown and described hereinabove. Rather, the scope of the disclosed technology 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.
