The instant invention is directed toward assessing tissue contact for flexible tip devices which may be implemented for use with catheters, and methods of manufacturing and using the flexible tip devices for assessing tissue contact. In particular, the flexible tip devices of the present invention may comprise one or more piezoelectric sensors for assessing tissue contact for mapping, ablation or other procedures.
Various devices (e.g., electrode sensors, thermal sensors, ablation electrodes, etc.) may be implemented in catheters inserted into the patient's body (e.g., the patient's heart) for use in a wide variety of medical procedures, such as “mapping” the interior of the heart, thermal “mapping,” and tissue ablation, to name only a few examples. It is often desirable to determine the level of tissue contact between the device being used and the tissue the device is being used on.
By way of illustration, sensor output is only meaningful for mapping procedures when the sensors are in sufficient contact with the tissue being mapped. “False” signals received when the sensor is not in good or sufficient contact with the tissue may result in inaccurate mapping of the tissue (e.g., the interior of a patient's heart).
By way of further illustration, it is desirable to control the level of contact to form ablative lesions. In particular, it is desirable to maintain a constant level of contact between the ablation electrode and the cardiac tissue in order to elevate tissue temperature to around 50° C. and form lesions in the cardiac tissue via coagulation necrosis. Such lesions change the electrical properties of the cardiac tissue and may lessen or eliminate undesirable atrial fibrillations when formed at specific locations in cardiac tissue. Insufficient contact during the ablation procedure may result in poor lesion formation and/or damage to surrounding tissue in the heart
Tissue contact is not always readily determined using conventional fluoroscopy techniques. Instead, the physician determines tissue contact based on his/her experience maneuvering the catheter. Such experience only comes with time, and may be quickly lost if the physician does not use the catheter on a regular basis. When used inside the heart, the beating heart further complicates matters by making it difficult to assess and maintain sufficient contact with the tissue for a sufficient length of time. If contact with the tissue cannot be properly maintained, advantages of using the device may not be fully realized.
It is desirable to be able to assess tissue contact for various procedures, including but not limited to mapping and ablation procedures within the heart. Positioning a flexible tip device (e.g., a sensing electrode, thermal sensor, ablation electrode, etc.) against a tissue creates contact stresses, which may be measured by implementing one or more piezoelectric sensors operatively associated with the flexible tip device. The piezoelectric sensor(s) generates a voltage signal corresponding to the contact stresses.
In an exemplary embodiment, one or more piezoelectric sensor is operatively associated with a flexible tip device. Output from the piezoelectric sensor(s) enables a user (e.g., a physician or technician) to position the flexible tip device against a moving tissue with the desired amount of pressure for the procedure.
An exemplary tissue contact sensing system comprises a flexible tip device. At least one piezoelectric sensor is housed within the flexible tip device. The at least one piezoelectric sensor is responsive to contact stress of the flexible tip device by generating electrical signals corresponding to the amount of contact stress. An output device is electrically connected to the at least one piezoelectric sensor. The output device receives the electrical signals for assessing tissue contact by the flexible tip device.
Another exemplary system comprises flexible tip means for practicing a medical procedure. The system also comprises means for generating piezoelectric signals corresponding to contact stress of the flexible tip means. The system also comprises means for assessing tissue contact of the flexible tip means based at least in part on the piezoelectric signals.
An exemplary method of assessing tissue contact comprises: generating piezoelectric signals in response to stress caused by a flexible tip device contacting a tissue, and outputting piezoelectric signals for assessing tissue contact. Output may be conveyed to the user in real-time (e.g., at a display device or other interface) so that the user can properly position the flexible tip device on the tissue with the desired level of contact for the procedure. For example, the user may increase contact pressure if the output indicates insufficient contact for the procedure. Or for example, the user may reduce contact pressure if the output indicates too much contact for the procedure.
An exemplary method for assembling a flexible tip device comprises: positioning a piezoelectric film into a lumen of the flexible tip device, applying a flexible polymer into the lumen of the flexible tip device to maintain a position of the piezoelectric film, and curing the flexible polymer. Optionally, the piezoelectric film may be formed into a substantially J or U (or other desired shape) before applying the flexible polymer. More flexible polymer may be applied to the piezoelectric film after curing to insulate the piezoelectric film.
The foregoing and other aspects, features, details, utilities, and advantages of the present invention will be apparent from reading the following description and claims, and from reviewing the accompanying drawings.
a through
Exemplary embodiments of systems and methods to assess contact between a flexible tip device and a tissue are depicted in the figures. Exemplary systems comprise a flexible tip device (e.g., sensing electrode, thermal sensor, or ablation electrode) which may be inserted into the patient using a catheter. During an exemplary procedure, a user (e.g., the patient's physician or a technician) may insert the catheter into one of the patient's blood vessels, e.g., through the leg or the patient's neck. The user, guided by a real-time fluoroscopy imaging device, moves the catheter to the desired position within the patient's body (e.g., into the patient's heart).
When the catheter reaches the patient's heart, the flexible tip device may be used to perform various procedures, such as, electrically or thermally mapping the myocardium (i.e., muscular tissue in the heart wall), or tissue ablation procedures. Determining contact with the tissue is often critical. In ablation procedures, for example, the amount of contact is critical to form sufficiently deep ablative lesions on the tissue without damaging surrounding tissue in the heart.
As described further below, the system may include one or more piezoelectric sensors which generate electric signals in response to stresses caused by contact with a surface (e.g., tissue within the beating heart). Accordingly, embodiments of the present invention provide a number of advantages, including, for example, facilitating enhanced tissue contact in difficult environments such as a moving surface inside a beating heart.
Optionally, the flexible tip device 10 may be electrically connected via suitable wiring through the catheter shaft 14 to a generator (not shown), such as, e.g., a radio frequency (RF) generator. For example, where the flexible tip device 10 is an electrode, the RF generator is operable to emit electrical energy (e.g., RF radiation) near the distal end of the electrode for mapping operations or forming ablation lesions on the tissue 12.
During use, a user may operate a handle portion (not shown) of the catheter 16 to manually position the catheter 16 inside the patient's body, e.g., so that the flexible tip device 10 is in contact with the tissue 12. In
When the flexible tip device 10 is in sufficient or “good” contact with the tissue 12, the flexible tip device 10 may move or be deflected by movement of the tissue 12 generally in the directions illustrated by arrows 18. Movement of the flexible tip device 10 may be measured in real-time using at least one piezoelectric sensor 20 to assess contact with the tissue 12, as described more fully below.
Before continuing, it is noted that the contact and motion illustrated in
It is also noted that other components typical of systems which are conventionally implemented for various procedures, are not shown or described herein for purposes of brevity. Such components may nevertheless also be provided as part of, or for use with, the flexible tip device 10. For example, these systems commonly include or are used in conjunction with an ECG recording system, and/or various controls for performing the procedure. Such components are well understood in the medical devices arts and therefore further explanation is not necessary for a complete understanding of the invention.
As previously mentioned, one or more piezoelectric sensors 20 may be operatively associated with the flexible tip device 10 to measure stress when the flexible tip device 10 is in contact with the tissue 12.
In an exemplary embodiment, the piezoelectric sensor 20 may include a piezoelectric film 21 laminated on a support structure 22 anchored within the flexible tip device 10. Optionally, piezoelectric film may be laminated to opposite sides of the support structure 22. Signals from the piezoelectric films on opposite sides of the support structure 22 may be combined to improve the sensitivity of the contact sensing. Additionally, because the stress response of piezoelectric materials is anisotropic, the two sides may be oriented differently with respect to each other to either attenuate directional differences in sensitivity or provide directional information of the tissue contact.
Other means for supporting the piezoelectric sensor 20 within the flexible tip device 10 are also contemplated. For example, the piezoelectric sensor 20 may be provided without the support structure 22 and integrally molded within the flexible tip device 10. These and other methods for providing the piezoelectric sensor 20 in the flexible tip device 10 will be readily apparent to those having ordinary skill in the art after becoming familiar with the teachings herein.
The piezoelectric sensor 20 may be provided within a flexible polymer or compliant section 26 of the flexible tip device 10. In addition to housing the piezoelectric sensor 20 in the flexible tip device 10, and protecting the piezoelectric sensor 20 from external damage or corrosion, the compliant section 26 may serve as a low pass mechanical filter. That is, the compliant section 26 attenuates high frequency “noise” signals caused, e.g., by minor vibrations from intermittent contact during positioning of the flexible tip device 10 adjacent the tissue 12. Accordingly, high frequency noise signals are damped, or even non-existent, as output for the user. However, the piezoelectric sensor 20 does not need to be provided in a compliant section. For example, the piezoelectric sensor 20 may instead be provided within an airspace formed in the flexible tip device 10.
Electrical wiring (not shown) may be connected to the piezoelectric sensor 20 and a ground. The electrical wiring may extend through the lumen of the flexible tip device 10 to deliver electrical signals from the piezoelectric sensor 20 to a data acquisition/processing/output device (also not shown), such as, e.g., an echocardiogram (ECG) device. Alternatively, a wireless connection may be implemented, e.g., by providing a transmitter in the catheter and a receiver in association with the data acquisition/processing/output device.
In an exemplary embodiment, the flexible tip device 10 may be assembled as follows. A strip of piezoelectric film 21 is laminated to the support structure 22 and then formed (e.g., bent) into the desired shape (e.g., the substantially U-shape shown in
It is noted that the configuration with the piezoelectric sensor 20 housed within the flexible tip device 10 enable manufacturing of relatively small sizes and therefore are particularly suitable for use, e.g., in so-called brush electrodes. However, these embodiments are not limited to any particular size or use. It is also noted that other shapes and arrangements of the piezoelectric sensor(s) 20 are also contemplated, as will be readily apparent to those having ordinary skill in the art after becoming familiar with the teachings herein.
In use, the piezoelectric sensor 20 responds to electrode-tissue contact stresses by generating electrical energy (e.g., a voltage). Accordingly, when the flexible tip device 10 is positioned in contact with the tissue 12, piezoelectric sensor 20 generates an electrical signal corresponding to stress caused by this contact. The resulting electrical signal may be processed and/or otherwise output for the user so that the user is able to determine when the flexible tip device 10 contacts the tissue 12.
Piezoelectric sensors which generate electrical energy in response to applied mechanical stress are well-understood in the electro-mechanical arts. In general, piezoelectric sensors comprise a piezoelectric material which contains positive and negative electrical charges. In a neutral or “non-stressed” state, these electrical charges are symmetrically distributed in the piezoelectric material such that the material exhibits an overall neutral electrical charge. However, subjecting the piezoelectric material to a mechanical stress (e.g., flexure, pressure, and/or tension) disturbs the symmetrical distribution of electrical charges, thereby generating electrical energy across the material. Even minor deformation of some piezoelectric materials (e.g., on the order of nanometers) may generate a measurable voltage signal. Operation of piezoelectric material may be better understood with brief reference to
In an exemplary embodiment, the piezoelectric sensor 20 may be a laminated sensor or film having a plurality of laminated layers. Although not required, laminating the sensor increases its sensitivity. Piezoelectric films are flexible, lightweight, and tough engineered plastic that is available in a wide variety of thicknesses and large areas. Among other advantages, piezoelectric film has a low acoustic impedance which is close to that of water, human tissue, and other organic materials. For example, the acoustic impedance of piezoelectric film is only about 2.6 times the acoustic impedance of water. Piezoelectric film also has a low density and excellent sensitivity, and is mechanically tough. When extruded into a thin film, piezoelectric polymers can be directly attached to a support structure without distributing its mechanical range of motion. Piezoelectric film is therefore well suited to strain-sensing applications requiring very wide bandwidth and high sensitivity.
In
It is noted that the laminated layers of piezoelectric sensor 20 are not limited to any particular material and/or configuration. For example, the piezoelectric sensor 20 is not limited to use with separate metal layers 32a and 32b. Nor is the piezoelectric sensor 20 limited to the generally rectangular configuration shown in
In an exemplary embodiment, the piezoelectric material 30 may comprise a thin, flexible, polymer-based material. One such piezoelectric film is a polyvinylidene fluoride (PVDF) film commercially available from the Sensor Products Division of Measurement Specialties, Inc. (Norristown, Pa.). This PVDF film is approximately 28 μm thick, enabling the PVDF film to be readily housed within the catheter shaft 14.
In addition, this PVDF film has a wide frequency range of about 0.001 Hz to 109 Hz and a high dynamic stress constant (g31=216×10−3 Vm/N). For purposes of illustration, other common piezoelectric materials, such as lead zirconate titanate (PZT) has a dynamic stress constant (g31) of 10×10−3 Vm/N, and barium titanium oxide (BaTiO3) has a dynamic stress constant (g31) of 5×10−3 Vm/N. Accordingly, the PVDF film is very sensitive, exhibiting a relatively high voltage response to relatively small mechanical stresses, and is therefore well-suited for measuring dynamic stresses and strains.
Of course the piezoelectric sensor 20 described above with reference to
Piezoelectric sensor 20 is shown in
The most widely used coefficients, d3n (for charge) and g3n (for voltage), possess two subscripts. The first refers to the electrical axis, while the second subscript refers to the mechanical axis. Because piezoelectric film is thin, the electrodes are only applied to the top and bottom film surfaces. Accordingly, the electrical axis is always referred to as “3”, as the charge or voltage is always transferred through the thickness (n=3) of the film. The mechanical axis can be either 1, 2, or 3, because the stress can be applied to any of these axes. Typically, piezoelectric film is used in the mechanical 1 direction for low frequency sensing and actuation (<100 KHz) and in the mechanical 3 direction for high ultrasound sensing and actuation (>100 KHz). These stresses can be better understood with reference to
In each case, these stresses disturb the symmetrical distribution of electrical charges, and electrical energy is generated across the piezoelectric material 30. In operation, this electrical energy may be collected by metal layers 32a, 32b, e.g., for delivery as an electrical signal via electrical wiring through the catheter shaft 14 to a data acquisition/processing/output device (not shown).
Returning to the piezoelectric sensor 20 shown mounted to the flexible tip device 10 in
In an exemplary embodiment, the signal strength (e.g., amplitude) from the piezoelectric sensor 20 is proportional to the amount of stress due to the contact of the flexible tip device 10 with tissue 12 (e.g., the myocardium), and therefore can be used to determine if the flexible tip device 10 is in good contact with the tissue 12. If the contact is insufficient for the procedure, then there are no peaks in the resulting waveform 42 (or the peaks are intermittent). On the other hand, a strong correlation between the heartbeat and output by the piezoelectric sensor indicates sufficient or good contact with the moving tissue.
Signal periodicity is also a strong indicator of dynamic contact assessment. For example, if the period between heartbeats corresponds well with the period output by the piezoelectric sensor 20, stresses on the piezoelectric sensor 20 are being caused by the heartbeat (and not some other reason). Accordingly, the user may use this feedback to move the flexible tip device 10 to achieve the desired tissue contact.
Before continuing, it is noted that any suitable analog and/or digital device may be implemented for indicating tissue contact to a user. In another exemplary embodiment, the electrical signals generated by piezoelectric sensor 20 may be further characterized using a suitable processing device such as, but not limited to, a desktop or laptop computer. Such processing device may be implemented to receive the voltage signal generated by the piezoelectric sensor 20 and convert it to a corresponding contact condition and output for the user, e.g., at a display device.
It is also noted that the output device is not limited to a display device. For example, the tissue contact may be output to the user as an audio signal or tactile feedback (e.g., vibrations) on the handle of the catheter 16. In any event, circuitry for conveying output of the piezoelectric sensor to a user in one form or another may be readily provided by those having ordinary skill in the electronics arts after becoming familiar with the teachings herein.
Although the flexible tip device 10 shown in
To receive a signal from other directions of movement, a twisted (e.g., quarter-twisted) piezoelectric sensor may be implemented within the flexible tip device. Alternatively, multiple piezoelectric sensors 20 (or strips of piezoelectric film) may be provided within the flexible tip device 10 to receive signals in bi-planar and full-arc multi-planar orientations, as discussed in the following embodiments.
a through
In use, the piezoelectric sensors 120a-b respond to mechanical stresses by generating electrical energy (e.g., a voltage) which may be output to a user (e.g., as illustrated in
In use, the piezoelectric sensors 220a-c respond to mechanical stresses by generating electrical energy (e.g., a voltage) which may be output to a user (e.g., as illustrated in
In use, the piezoelectric sensors 320a-c respond to mechanical stresses by generating electrical energy (e.g., a voltage) which may be output to a user (e.g., as illustrated in
In use, the piezoelectric sensors 420a-f respond to mechanical stresses by generating electrical energy (e.g., a voltage) which may be output to a user (e.g., as illustrated in
In each of the embodiments shown in
It is noted that still more piezoelectric sensors in addition to those shown in
Although several embodiments of this invention 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 or scope of this invention. References are only used for identification purposes to aid the reader's understanding of the present invention, and do not create limitations as to the position, orientation, or use of the invention. In addition, various combinations of the embodiments shown are also contemplated even if not particularly described. Changes in detail or structure, such as but not limited to combinations of various aspects of the disclosed embodiments, may be made without departing from the spirit of the invention as defined in the appended claims.
This application is a continuation of U.S. application Ser. No. 11/617,364, filed 28 Dec. 2006, now U.S. Pat. No. 8,672,936 (the '364 application) which is a continuation-in-part of U.S. application Ser. No. 11/553,965, filed 27 Oct. 2006, now U.S. Pat. No. 8,021,361 (the '965 application), which claims the benefit of U.S. provisional application No. 60/730,634, filed 27 Oct. 2005 (the '634 application). This application is also a continuation-in-part of U.S. application Ser. No. 11/549,100, filed 12 Oct. 2006, now U.S. Pat. No. 8,679,109 (the '100 application), which claims the benefit of U.S. provisional application No. 60/727,164, filed 13 Oct. 2005 (the '164 application), all of which are hereby incorporated by reference as though fully set forth herein.
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