The instant disclosure relates generally to force sensing systems capable of determining a force applied at a distal tip of a medical catheter. More specifically, the disclosure relates to a force sensing system with a deformable body.
Exploration and treatment of various organs (or vessels) is possible using catheter-based diagnostic and treatment systems. Catheters may be introduced through a vessel leading to an organ to be explored, or treated, or alternatively may be introduced directly through an incision made in a wall of the organ. Catheter-based surgical systems avoid the trauma and extended recuperation times typically associated with open surgical procedures.
To provide effective diagnosis and/or therapy, it is frequently necessary to first precisely map a zone to be treated. Mapping may be performed, for example, when it is desired to selectively ablate conductive pathways within a heart to treat a cardiac arrhythmia, such as atrial fibrillation. Often, the mapping procedure is complicated by difficulties in locating the zone(s) to be treated due to periodic movement of the heart throughout the cardiac cycle.
Catheter navigation and mapping systems often rely on manual catheter feedback and/or impedance measurements to determine when the catheter is properly positioned. These systems do not measure contact forces with the organ wall, or detect contact forces applied by the catheter against the organ wall that may modify the true wall location. Accordingly, the mapping of the organ may be inaccurate due to artifacts created by excessive contact forces.
To facilitate improved mapping, it is desirable to detect and monitor contact forces between a catheter tip and an organ wall to permit faster and more accurate mapping. Once the topography of the organ is mapped, either the same or a different catheter may be employed to effect treatment. Depending upon the specific treatment to be applied to the organ, the catheter may comprise any of a number of end effectors, such as, for example, RF ablation electrodes, mapping electrodes, etc.
The effectiveness of such end effectors often depends on the end effector contact with the wall tissue, which may be inherently unstable due to the motion of the organ (e.g., pumping motion of the cardiac muscle). Existing catheter-based force sensing systems often do not have the ability to accurately sense the load applied to the distal tip of the catheter associated with either movement of the catheter or the tissue wall in contact therewith. For example, in the case of a cardiac ablation system, at one extreme the creation of a gap between the end effector and the tissue wall may render the treatment ineffective, and inadequately ablate the tissue zone. At the other extreme, if the end effector of the catheter contacts the tissue wall with excessive force, it may inadvertently puncture the tissue.
In view of the foregoing, a catheter-based diagnostic or treatment system that permits sensing of the load applied to the distal extremity of the catheter, including periodic loads arising from movement of the organ, is desirable. It is further desirable to provide diagnostic and treatment apparatus that permit computation of forces applied to a distal tip of a catheter with reduced sensitivity to the location on the catheter tip at which the forces are applied.
The foregoing discussion is intended only to illustrate the present field and should not be taken as a disavowal of claim scope.
Aspects of the present disclosure are directed toward systems and methods for detecting force applied to a distal tip of a medical catheter using a fiber-optic force sensor and processor circuitry. In particular, the instant disclosure relates to a deformable body near a distal tip of a medical catheter that deforms in response to a force applied at the distal tip. The fiber-optic force sensor detects various components of the deformation, and the processor circuitry, based on the detected components of the deformation, determines a force applied to the distal tip of the catheter.
Various embodiments of the present disclosure are directed to force-sensing catheter systems. One such system includes a catheter tip, a tip stem, a deformable body, and a manifold. The tip stem includes an inner and outer diameter, and an aperture that extends through a length of the tip stem. The outer diameter of the tip stem is coupled to the catheter tip. The deformable body is coupled to the outer diameter of the tip stem, and deforms in response to a force exerted on the catheter tip. The deformable body includes a lumen that extends along a longitudinal axis of the force-sensing catheter system. The manifold extends through the lumen of the deformable body and the inner diameter of the tip stem, and is coupled to an inner diameter of the tip stem and a proximal end of the deformable body. The manifold delivers irrigant to the distal tip. In more specific embodiments, the manifold may transmit a portion of the force exerted on the catheter tip, proximally, to the proximal end of the deformable body. Moreover, the manifold and deformable body may emulate a desired lateral-to-axial compliance ratio of the force-sensing catheter system by transmitting more or less of the force exerted on the catheter tip through the manifold.
Some embodiments of the present disclosure are directed to an ablation catheter tip assembly. The ablation catheter tip assembly includes an ablation catheter tip, a deformable body, and a manifold. The ablation catheter tip delivers energy to contacted tissue to induce necrosis of the contacted tissue. The deformable body is mechanically coupled to a proximal end of the ablation catheter tip, and deforms in response to a force exerted on the catheter tip. The deformable body may include a lumen that extends along a longitudinal axis of the force-sensing catheter system, through which the manifold extends. The manifold is mechanically coupled to the proximal end of the ablation catheter tip, and delivers irrigant to the ablation catheter tip. To limit deformation of the deformable body, in response to the force exerted on the catheter tip, the manifold may absorb a portion of the force. In more specific embodiments, the catheter tip assembly includes a thermocouple coupled near a distal end of the catheter tip and a wire or flexible electronic circuit communicatively coupled with the thermocouple. The wire or flexible electronic circuit extends proximally through the force-sensing catheter system and an aperture of the tip stem. The aperture of the tip stem facilitates hermetically sealing the aperture with the wire or flexible electronic circuit extending therethrough.
The foregoing and other aspects, features, details, utilities, and advantages of the present disclosure will be apparent from reading the following description and claims, and from reviewing the accompanying drawings.
While various embodiments discussed herein are amenable to modifications and alternative forms, aspects thereof have been shown by way of example in the drawings and will be described in further detail. It should be understood, however, that the intention is not to limit the disclosure to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the scope of the disclosure including aspects defined in the claims.
Aspects of the present disclosure are directed toward systems and methods for detecting force applied to a distal tip of an intravascular medical catheter. In particular, the instant disclosure relates to a deformable body (also referred to as a structural member) near a distal tip of a medical catheter that deforms in response to a force applied at the distal tip. Force sensors, such as fiber-optic force sensors, detect various components of the deformation, and processor circuitry, based on the detected components of the deformation, determines a force applied to the distal tip of the catheter. Importantly, various aspects of the present disclosure are directed to withstanding high load forces exerted on the deformable body without plastically deforming.
Various embodiments of the present disclosure are directed to a deformable body for a catheter force sensing system. The force sensing system may be modular to facilitate application of the force sensing system on various types of catheters, and for various applications. Force sensing systems as disclosed herein may be calibrated to measure forces exerted on a distal tip of a medical catheter via fiber optic measurement of a cavity gap, for example. Such a force sensing system may be particularly useful for cardiovascular ablation catheters, where a distal tip of the catheter is positioned in contact with myocardial tissue that is to receive an ablation therapy and necrose in response to the treatment. Ablation therapy can be a useful treatment for patients with a cardiac arrhythmia (e.g., atrial fibrillation). The necrosed tissue facilitates electrical isolation of unwanted electrical impulses often emanating from pulmonary veins (and arrhythmic foci). By electrically isolating the foci from the left atrium of the cardiac muscle, for example, the symptoms of atrial fibrillation can be reduced or eliminated. To the extent that arrhythmic foci are located within a tissue ablation zone, the arrhythmic foci are destroyed.
In a typical ablation therapy for atrial fibrillation, pulmonary veins are treated in accordance to their likelihood of having arrhythmic foci. Often, all pulmonary veins are treated. A distal tip of the catheter may include electrophysiology electrodes (also referred to as spot electrodes) which help to expedite diagnosis and treatment of a source of a cardiac arrhythmia, and may also be used to confirm a successful ablation therapy by determining the isolation of the arrhythmic foci from the left atrium, for example, or the destruction of the arrhythmic foci entirely.
During an ablation therapy, a distal end of an ablation catheter tip contacts ablation targeted myocardial tissue in order to conductively transfer energy (e.g., radio-frequency, thermal, etc.) thereto. It has been discovered that consistent force, during a series of tissue ablations, forms a more uniform and transmural lesion line. Uniform lesion lines have been found to better isolate the electrical impulses produced by arrhythmic foci, thereby improving the overall efficacy of the ablation therapy. To achieve consistent force, aspects of the present disclosure utilize a deformable body in the ablation catheter tip. The deformable body deforms in response to forces being exerted upon a distal end of the ablation catheter tip. The deformation of the deformable body may then be measured by a measurement device (e.g., ultrasonic, magnetic, optical, interferometry, etc.). Based on the tuning of the deformable body and/or the calibration of the measurement device, the deformation can then be associated with a force exerted on the distal end of the ablation catheter tip (e.g., via a lookup table, formula(s), calibration matrix, etc.). The measurement device and/or processor circuitry may be used to determine the exerted force, and output a signal indicative of the force exerted on the catheter tip. The calculated force can then be displayed to a clinician or otherwise communicated. In some specific embodiments, the processor circuitry may intervene in the ablation therapy where the force exerted on the tissue by the catheter tip is too low or too high.
Aspects of the present disclosure are also directed to a deformable body for a force sensing system that facilitates the routing of wires, thermocouples, irrigation lumens, and flexible circuitry, for example, through an inner diameter of the deformable body to a distal tip of the catheter. The ability to extend thermocouples distal of the deformable body is particularly advantageous for ablation catheter applications as the temperature readings from the thermocouples will be far more accurate and instantaneous. Further, in some embodiments, the deformable body may also be stiffened to withstand high load forces. During insertion of the catheter through an introducer, and/or while traveling through the vasculature of a patient, the distal tip of the catheter (and therefore the deformable body by virtue of the mechanical coupling of the two components) may experience large forces. In some applications, the deformable body may experience forces up to 1,000 grams. In various embodiments, a pivot point of a flexure portion of the deformable body is extended radially outwards to facilitate stiffening of the deformable body to withstand large forces without plastically deforming. This also facilitates a larger inner diameter for routing wires and other components through the deformable body. Plastic deformation is particularly problematic for catheter-based force sensing applications as the new set of the deformable body renders the factory calibration of the force sensing system inaccurate. Due to such plastic deformation, when the catheter is in a non-contact position with the cardiovascular system of a patient, the force sensing system may return a force indicative of contact between the distal tip and tissue. To prevent such plastic deformation, pivot points of flexure portions within the deformable body may be radially extended, increasing the stiffness and limiting total deflection to less than 3,000 nanometers. Yet further embodiments of the deformable body may extend an outer diameter to decrease the effect of a bending moment applied along a longitudinal axis of the deformable body. This outer diameter further increases the stiffness of the deformable body. Moreover, by extending the outer diameter the fulcrum arm created by the flexure portions will deflect a greater distance for the same lateral deflection of the deformable body facilitating improved measurement resolution of the measurement device.
The deformable body disclosed herein may further be manufactured on a modular platform which facilitates the use of a single force sensor assembly on a number of different medical catheters.
Details of the various embodiments of the present disclosure are described below with specific reference to the figures.
Referring now to the drawings wherein like reference numerals are used to identify identical components in the various views,
In the illustrative embodiment of
The handle 21 provides a portion for a user to grasp or hold the elongated medical device 19 and may further provide a mechanism for steering or guiding the shaft 22 within the patient's body 14. For example, the handle 21 may include a mechanism configured to change the tension on a pull-wire extending through the elongated medical device 19 to the distal end 24 of the shaft 22 or some other mechanism to steer the shaft 22. The handle 21 may be conventional in the art, and it will be understood that the configuration of the handle 21 may vary. In an embodiment, the handle 21 may be configured to provide visual, auditory, tactile and/or other feedback to a user based on information received from the fiber optic force sensor assembly 11. For example, if contact to tissue 13 is made by distal tip 24, the fiber optic force sensor assembly 11 will transmit data to the computer system 15 indicative of the contact. In response to the computer system 15 determining that the data received from the fiber optic force sensor assembly 11 is indicative of a contact between the distal tip 24 and a patient's body 14, the computer system 15 may operate a light-emitting-diode on the handle 21, a tone generator, a vibrating mechanical transducer, and/or other indicator(s), the outputs of which could vary in proportion to the signal sensed by the fiber optic force sensor assembly 11.
The computer system 15 can utilize software, hardware, firmware, and/or logic to perform a number of functions described herein. The computer system 15 can be a combination of hardware and instructions to share information. The hardware, for example can include processing resource 16 and/or a memory 17 (e.g., non-transitory computer-readable medium (CRM) database, etc.). A processing resource 16, as used herein, can include a number of processors capable of executing instructions stored by the memory resource 17. Processing resource 16 can be integrated in a single device or distributed across multiple devices. The instructions (e.g., computer-readable instructions (CRI)) can include instructions stored on the memory 17 and executable by the processing resource 16 for force detection.
The memory resource 17 can be in communication with the processing resource 16. A memory 17, as used herein, can include a number of memory components capable of storing instructions that can be executed by processing resource 16. Such a memory 17 can be a non-transitory computer readable storage medium, for example. The memory 17 can be integrated in a single device or distributed across multiple devices. Further, the memory 17 can be fully or partially integrated in the same device as the processing resource 16 or it can be separate but accessible to that device and the processing resource 16. Thus, it is noted that the computer system 15 can be implemented on a user device and/or a collection of user devices, on a mobile device and/or a collection of mobile devices, and/or on a combination of the user devices and the mobile devices.
The memory 17 can be in communication with the processing resource 16 via a communication link (e.g., path). The communication link can be local or remote to a computing device associated with the processing resource 16. Examples of a local communication link can include an electronic bus internal to a computing device where the memory 17 is one of a volatile, non-volatile, fixed, and/or removable storage medium in communication with the processing resource 16 via the electronic bus.
In various embodiments of the present disclosure, the computer system 15 may receive optical signals from a fiber optic force sensor assembly 11 via one or more optical fibers extending a length of the catheter shaft 22. A processing resource 16 of the computer system 15 may execute an algorithm stored in memory 17 to compute a force exerted on catheter tip 24, based on the received optical signals.
U.S. Pat. No. 8,567,265 discloses various optical force sensors for use in medical catheter applications, such optical force sensors are hereby incorporated by reference as though fully disclosed herein.
The catheter assembly 87 may have a width and a length suitable for insertion into a bodily vessel or organ. In one embodiment, the catheter assembly 87 comprises a proximal portion 87a, a middle portion 87b and a distal portion 87c. The distal portion 87c may include an end effector which may house the fiber optic force sensor assembly 11 and the one or more fiber optic force sensing element(s) 90. The catheter assembly may be of a hollow construction (i.e. having a lumen) or of a non-hollow construction (i.e. no lumen), depending on the application.
In response to a deformation of a deformable body, due to a force being exerted on a distal tip of a catheter, one or more fiber optic elements 83 (as shown in
A fiber optic force sensing element 90, for detecting a deformation of a deformable body, may be an interferometric fiber optic strain sensor, a fiber Bragg grating strain sensor, or other fiber optic sensor well known in the art.
Referring to
Referring to
The reflected radiation 89, be it the modulated waveform 89a (as in
Referring to
In various embodiments of the present disclosure, to limit the deformation of a structural member, partial ablation catheter tip assembly 200 may be designed to transmit approximately 50% of a force exerted on flex tip 205 through a manifold 215. The manifold 215 transmits the force to a catheter shaft that is coupled to a proximal end of the tip assembly 200. To facilitate large force loads on the manifold 215, the manifold may include a strain relief 221 which limits lateral deflection of the manifold 215 in response to a force exerted on the tip assembly 200 transverse to a longitudinal axis.
Manifold 215 includes an irrigant lumen 216 that delivers irrigant from a distal end of the catheter shaft to a dispersion chamber 214 within the flex tip 205 via manifold apertures 2171-N. The placement of the manifold apertures 2171-N both along a length and circumference of a distal tip of the manifold 215 help facilitate even distribution of irrigant throughout the dispersion chamber 214. Once inside the dispersion chamber 214, the irrigant exits the flex tip 205 via irrigant apertures 2081-N, by virtue of positive pressure therein.
To measure real-time temperature of tissue in contact with a distal tip 206 of the tip assembly 200, it is desirable to position a thermocouple 220 as proximal to the tissue as possible. In the present embodiment, the thermocouple 220 is positioned so that a surface of the thermocouple 220 may be directly, thermally coupled to the tissue. To facilitate desired positioning of the thermocouple, while preventing irrigant from within dispersion chamber 214 from flowing proximally into a structural member 430 (see, e.g.,
In some embodiments, a flexible member 207 of flex tip 205 may comprise a composition including a titanium alloy (or other metal alloy with characteristics including a high tensile strength, e.g., titanium).
The segments 341, 342, 343 are bridged by flexure portions 3311-2, each flexure portion defining a neutral axes 344 and 345. Each of the neutral axes constitute a location within the respective flexure portions where the stress is zero when subjected to a pure bending moment in any direction.
In some embodiments, adjacent members of the segments may define a plurality of gaps 346 and 347 at the flexure portions 3311-2, each having a separation dimension. It is noted that while the longitudinal separation dimensions of the gaps are depicted as being uniform, the separation dimensions may vary across a given gap, or between gaps. Moreover, the radial dimension of the gaps may also vary (e.g., to compensate for the effects of a moment exerted along a length of the structural member 330).
The structural member 330 may include a plurality of grooves 3331-3 that are formed within an outer surface 348 of the structural member. The grooves 3331-3 may be spaced rotationally equidistant (i.e. spaced 90° apart where there are three grooves) about the longitudinal axis 340 and may be oriented parallel with a longitudinal axis 340 of the structural member 330. Each of the grooves may terminate at a respective one of the gaps 346 and 347 of the flexure portions 3311-2. For example, groove 3331 may extend along the proximal segment 343 and intermediate segment 342 terminating at the gap 346 at flexure portion 3311. Other grooves, such as groove 3332 may extend along the proximal segment 343 terminating at the gap 347 at flexure portion 3312.
In a fiber optic force sensing assembly, fiber optics may be disposed in the grooves 3331-3, respectively, such that the distal ends of the fiber optics terminate at the gaps 346 and 347 of either flexure portion 3311-2. For example, a fiber optic may extend along groove 3331, terminating proximate or within the gap 346 at flexure portion 3311. Likewise, a second fiber optic may extend along the groove 3332 and terminate proximate or within the gap 347 at flexure portion 3312. Surfaces 349 of the flexure portions 3311-2, opposite the distal ends of first and second fiber optics, may be coated with a highly reflective material, or third and fourth fiber optics with mirrored surfaces positioned opposite the first and second fiber optics, relative to the gaps 346 and 347. Alternatively, a fiber Bragg grating strain sensor may be implemented.
The gaps 346 and 347 at the flexure portions 3311-2 may be formed so that they extend laterally through a major portion of the structural member 330. Also, the gaps may be oriented to extend substantially normal to a longitudinal axis 340 of the structural member 330, or at an acute angle with respect to the longitudinal axis. In the depicted embodiment, the structural member 330 comprises a hollow cylindrical tube with the flexure portions comprising slots that extend transverse to the longitudinal axis 340 through one side of the hollow cylindrical tube. In many embodiments, the slots extend into an inner diameter 334 of the structural member, and in some cases through the longitudinal axis.
As shown in
When a fiber optic force sensor consistent with the above is assembled, one or more fiber optics are mechanically coupled to structural member 330 via grooves 3331-3. In some embodiments, each of the fiber optics may be communicatively coupled to a Fabry-Perot strain sensor within one of the slots which form the flexure portions 3311-2. The Fabry-Perot strain sensor includes transmitting and reflecting elements on either side of the slots to define an interferometric gap. The free end of the transmitting element may be faced with a semi-reflecting surface, and the free end of the reflecting element may be faced with a reflecting surface.
In some assemblies of a fiber optic force sensor assembly, the fiber optics may be positioned along the grooves 3331-3 (as shown in
In some embodiments, structural member 330 may comprise a composition including a stainless steel alloy (or other metal alloy with characteristics including a high tensile strength, e.g., titanium).
Referring to
As shown in
As discussed in more detail in reference to
In various catheter applications, it may be desirable to place a thermocouple (or other temperature monitoring sensor) as far distal on the catheter as possible to facilitate near real-time temperature measurements; this may be particularly valuable for ablation catheters. Accordingly, the partial ablation catheter tip assembly 400 of
As shown in
In some specific embodiments, as shown in
While various embodiments of the present disclosure are discussed in reference to an ablation catheter, it is to be understood that a catheter consistent with the present disclosure may implement various different types of end effectors—e.g., mapping electrodes or ablation electrodes, such as are known in the art for diagnosis or treatment of a vessel or organ may be utilized with the present invention. For example, the catheter tip assembly 400 may be configured as an electrophysiology catheter for performing cardiac mapping and ablation. In other embodiments, the catheter tip assembly 400 may be configured to deliver drugs or bioactive agents to a vessel or organ wall or to perform minimally invasive procedures such as, for example, cryo-ablation.
Fiber optic channels 6511-3 extend longitudinally along an outer diameter of the coupler body 650, and align with grooves (see, e.g.,
U.S. provisional application No. 62/331,292, filed 3 May 2016, U.S. application Ser. No. 15/585,859, filed 3 May 2017, and international application no. PCT/US17/30828, filed 3 May 2017, are hereby incorporated by reference as though fully set forth herein.
Although several embodiments have been described above with a certain degree of particularity, those skilled in the art could make numerous alterations to the disclosed embodiments without departing from the spirit of the present disclosure. It is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative only and not limiting. Changes in detail or structure may be made without departing from the present teachings. The foregoing description and following claims are intended to cover all such modifications and variations.
Various embodiments are described herein of various apparatuses, systems, and methods. Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” “an embodiment,” or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” “in an embodiment,” or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation.
It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
This application claims the benefit of U.S. provisional application No. 62/540,409, filed 2 Aug. 2017, which is hereby incorporated by reference as though fully set forth herein.
Number | Date | Country | |
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62540409 | Aug 2017 | US |