The present disclosure pertains to medical devices, and methods for manufacturing medical devices. More particularly, the present disclosure pertains to tissue diagnosis and/or ablation.
A wide variety of intracorporeal medical devices have been developed for medical use, for example, intravascular use. Some of these devices include guidewires, catheters, and the like. These devices are manufactured by any one of a variety of different manufacturing methods and may be used according to any one of a variety of methods. Of the known medical devices and methods, each has certain advantages and disadvantages. There is an ongoing need to provide alternative medical devices as well as alternative methods for manufacturing and using medical devices.
This disclosure provides design, material, manufacturing method, and use alternatives for medical devices. An example electrophysiology medical device may include a catheter shaft including a distal end portion and a sensing assembly having three or more terminals. The sensing assembly includes one or more current-carrying electrodes and one or more sensing electrodes. The one or more current-carrying electrodes, the one or more sensing electrodes, or both includes a mini-electrode. The mini-electrode is disposed on one of the other electrodes. The medical device may also include a controller coupled to the sensing assembly.
Additionally or alternatively to any of the examples above, the sensing assembly includes four terminals.
Additionally or alternatively to any of the examples above, one or more of the three or more terminals are disposed along the distal end portion of the catheter shaft.
Additionally or alternatively to any of the examples above, one or more of the three or more terminals are disposed along a device separate from the catheter shaft.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes at least one mini-electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes at least two mini-electrodes.
Additionally or alternatively to any of the examples above, one or more sensing electrodes includes one mini-electrode.
Additionally or alternatively to any of the examples above, one or more sensing electrodes includes two mini-electrodes.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes a mini-electrode and one or more sensing electrodes includes two mini-electrodes.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes two mini-electrodes and one or more sensing electrodes includes a mini-electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes two mini-electrodes and one or more sensing electrodes includes two mini-electrodes.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes or one or more sensing electrodes includes an ablation electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes an ablation electrode and one or more sensing electrodes includes an electrode disposed on the ablation electrode.
Additionally or alternatively to any of the examples above, one or more sensing electrodes includes an ablation electrode and one or more current-carrying electrodes includes an electrode disposed on the ablation electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes or one or more sensing electrodes includes a ring electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes an ablation electrode and a ring electrode and the one or more sensing electrodes includes at least one mini-electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes at least one mini-electrode and one or more sensing electrodes includes an ablation electrode and a ring electrode.
Additionally or alternatively to any of the examples above, one or more current-carrying electrodes includes an ablation electrode and a mini-electrode and one or more sensing electrodes includes a ring electrode and a mini-electrode.
Additionally or alternatively to any of the examples above, one or more current-injecting electrodes includes a ring electrode and a mini-electrode and one or more sensing electrodes includes an ablation electrode and a mini-electrode.
Another example electrophysiology medical device may include a catheter shaft including a distal end portion. The distal end portion includes a plurality of electrodes. The plurality of electrodes includes at least one current-carrying electrode, a first sensing electrode and a second sensing electrode. Further, at least one of the electrodes is a mini-electrode disposed on another one of the other electrodes. The first sensing electrode is spaced from the current-carrying electrode a first distance. The second sensing electrode is spaced from the current-carrying electrode a second distance and the first distance is different from the second distance.
Additionally or alternatively to any of the examples above, the medical device may include a controller coupled to the plurality of electrodes. The at least one current-carrying electrode and the first and second sensing electrodes are arranged in a four-terminal sensing configuration and the controller is capable of calculating a parameter capable of indicating the proximity of the medical device to tissue.
An example method for diagnosing and/or treating a condition of the heart may include advancing an electrophysiology catheter through a blood vessel to a position adjacent a target site and utilizing the catheter to determine the proximity of the catheter to the target site. The catheter includes a distal end portion and a four-terminal sensing assembly disposed on the distal end portion. The four-terminal sensing assembly includes one or more current-carrying electrodes and one or more sensing electrodes. One or more current-carrying electrodes and/or the one or more sensing electrodes includes a mini-electrode. The method may also include a controller coupled to the four-terminal sensing assembly.
The above summary of some embodiments is not intended to describe each disclosed embodiment or every implementation of the present disclosure. The Figures, and Detailed Description, which follow, more particularly exemplify these embodiments.
While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive.
The disclosure may be more completely understood in consideration of the following detailed description in connection with the accompanying drawings, in which:
While the disclosure is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure.
For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification.
All numeric values are herein assumed to be modified by the term “about”, whether or not explicitly indicated. The term “about” generally refers to a range of numbers that one of skill in the art would consider equivalent to the recited value (e.g., having the same function or result). In many instances, the terms “about” may include numbers that are rounded to the nearest significant figure.
The recitation of numerical ranges by endpoints includes all numbers within that range (e.g. 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5).
As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise.
It is noted that references in the specification to “an embodiment”, “some embodiments”, “other embodiments”, etc., indicate that the embodiment described may include one or more particular features, structures, and/or characteristics. However, such recitations do not necessarily mean that all embodiments include the particular features, structures, and/or characteristics. Additionally, when particular features, structures, and/or characteristics are described in connection with one embodiment, it should be understood that such features, structures, and/or characteristics may also be used connection with other embodiments whether or not explicitly described unless clearly stated to the contrary.
The following detailed description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention.
Cardiac arrhythmia and/or other cardiac pathology contributing to abnormal heart function may originate in cardiac cellular tissue. One technique that may be utilized to treat the arrhythmia and/or cardiac pathology may include ablation of tissue substrates contributing to the arrhythmia and/or cardiac pathology. The tissue in the substrate may be electrically disrupted, or ablated, by heat, chemicals or other means of creating a lesion in the tissue, or otherwise can be electrically isolated from the normal heart circuit. Electrophysiology therapy involves locating the tissue contributing to the arrhythmia and/or cardiac pathology using an ablation, mapping and/or diagnosing catheter and then using the ablation catheter (or another device) to destroy and/or isolate the tissue.
Prior to performing an ablation procedure, a physician and/or clinician may utilize specialized mapping and/or diagnostic catheters to precisely locate tissue contributing and/or causing an arrhythmia or other cardiac pathology. It may, therefore, be desirable to be able to precisely locate the targeted tissue prior to performing the ablation procedure in order to effectively alleviate and/or eliminate the arrhythmia and/or cardiac pathology. Further, precise targeting of the tissue may prevent or reduce the likelihood that healthy tissue (located proximate the targeted tissue) is damaged.
Several methods and/or techniques may be employed to precisely locate targeted tissue where an ablation or other therapeutic procedure may be performed. An example method may include utilizing an ablation, mapping and/or diagnostic catheter to determine how close the catheter is to targeted tissue. Further, the ablation, mapping and/or diagnostic catheter may include one or more sensing electrodes located on a distal portion of the catheter. The electrodes may sense, measure and/or provide a controller with information relating to electrical activity within the cardiac tissue. Using the sensed and/or measured electrical information from cardiac tissue, the controller may be able to correlate the spatial location of the distal portion of the catheter in relation to the cardiac tissue. For example, the electrodes may measure the impedance, resistance, voltage potential, etc. and determine how far a distal portion of a diagnostic and/or ablation catheter is to cardiac tissue.
Electrodes utilized in conjunction with an ablation, mapping and/or diagnostic catheter are often located on the distal portion and/or distal end of the catheter. For example, an ablation catheter may include a distal tip electrode and one or more ring electrodes located proximal the distal tip electrode. The distal tip electrode may be able to sense and/or measure electrical activity in addition to being able to provide ablative therapy as an ablation electrode. The ring electrodes may be used as sensing and/or measuring electrodes in conjunction with one another and/or the ablation electrode.
In general, the size and/or spacing of electrodes may contribute to the accuracy of the electrical information sensed and/or measured by the mapping and/or diagnostic catheter. For example, some methods and/or techniques may emit a current from a first electrode and measure the impedance (or other electrical characteristic) of local tissue using a different pair of electrodes. However, a current emitted from an electrode having a large surface area may not be as concentrated as compared to a current emitted from an electrode having a (proportionally) smaller surface area. A smaller electrode surface area may have a tendency to focus and/or direct current to tissue immediately adjacent the emitting and/or measuring electrodes.
Further, in some circumstances it may be challenging to position an ablation tip and/or ring electrodes precisely adjacent targeted tissue due to the relatively large size of the tip and/or a ring electrode. In particular, it may be challenging to arrange larger electrodes in an optimally-spaced configuration because the size and shape of larger electrodes may limit how close the electrodes can be placed to one another.
In addition, larger electrodes may be more susceptible (as compared to smaller electrodes) to detecting far field electrical activity. Detection of far field electrical activity may negatively affect the detection of local (e.g. targeted) electrical activity.
Therefore, it may be desirable in some instances to utilize, dispose, incorporate and/or couple smaller electrodes (e.g. mini-electrodes) into the distal portion of mapping and/or diagnostic catheters. For example, some of the medical devices and methods disclosed herein may include sensing and measuring electrical activity using mini-electrodes alone or in conjunction with ablation electrodes, ring electrodes, catheters and/or other medical devices. Further, some of the medical devices and methods disclosed herein may utilize electrical information collected from mini-electrodes to assess tissue proximity and/or contact. Other methods and medical devices are also disclosed.
In at least some embodiments, shaft 12 may include a handle 18, which may have an actuator 20 (e.g., a control knob or other actuator). The handle 18 (e.g., a proximal handle) may be positioned at a proximal end of shaft 12, for example. Illustratively, shaft 12 may include a flexible body having a having a distal portion which may include one or more electrodes. For example, the distal portion of shaft 12 may include one or more of a plurality of ring electrodes 22, a distal ablation tip electrode 24, and a plurality of mini-electrodes 26 disposed or otherwise positioned along and/or electrically isolated from distal ablation tip electrode 24.
Shaft 12 may be steerable to facilitate navigating the vasculature of a patient or navigating other lumens. Illustratively, a distal portion 13 of shaft 12 may be deflected by manipulation of actuator 20 to effect steering shaft 12. In some instances, distal portion 13 of shaft 12 may be deflected to position distal ablation tip electrode 24 and/or mini-electrodes 26 adjacent target tissue or to position the distal portion 13 of shaft 12 for another suitable purpose. Additionally, or alternatively, distal portion 13 of shaft 12 may have a pre-formed shape adapted to facilitate positioning distal ablation tip electrode 24 and/or micro-electrode assemblies 26 adjacent a target tissue. Illustratively, the preformed shape of distal portion 13 of shaft 12 may be a radiused shape (e.g., a generally circular shape or a generally semi-circular shape) and/or may be oriented in a plane transverse to a general longitudinal direction of shaft 12. These are just examples.
In some instances, system 10 may be utilized in ablation procedures on a patient. Illustratively, shaft 12 may be configured to be introduced into or through vasculature of a patient and/or into or through any other lumen or cavity. In one example, shaft 12 may be inserted through the vasculature of the patient and into one or more chambers of the patient's heart (e.g., a target area). When in the patient's vasculature or heart, shaft 12 may be used to map and/or ablate myocardial tissue using the ring electrodes 22, mini-electrodes 26, and/or distal ablation tip electrode 24. In some instances, distal ablation tip electrode 24 may be configured to apply ablation energy to myocardial tissue of the heart of a patient.
Distal ablation tip electrode 24 may be a suitable length and include a suitable surface area. In some instances, distal ablation tip electrode 24 may have a length of between one (1) mm and twenty (20) mm, three (3) mm and seventeen (17) mm, or six (6) mm and fourteen (14) mm. In one illustrative example, distal ablation tip electrode 24 may have an axial length of about eight (8) mm. Further, distal ablation tip electrode may have a suitable surface area of between five (5) mm2 and one hundred (100) mm2, ten (10) mm2 and eighty (80) mm2, or twenty (20) mm2 and seventy (70) mm2. In one illustrative example, distal ablation tip electrode 24 may have a surface area of about twenty-nine (29) mm2. Distal ablation tip electrode 24 may be formed from or otherwise include platinum and/or other suitable materials. These are just examples.
As stated, mini-electrodes 26 may be circumferentially distributed about a distal ablation tip electrode 24. Mini-electrodes 26 may be capable of operating, or configured to operate, in unipolar or bipolar sensing modes. Mini-electrodes 26 may be capable of sensing, or may be configured to sense, electrical characteristics (e.g. impedance) corresponding to myocardial tissue proximate thereto.
For example, in some instances system 10 may be capable of utilizing impedance measurements to sense contact between the catheter tip (e.g. distal ablation tip electrode 24) and tissue. In general, the impedance of a given medium may be measured by applying a known voltage or current to a given medium and measuring the resulting voltage or current. In other words, impedance measurements of a given medium can be obtained by injecting current between two electrodes and measuring the resulting voltage between the same electrodes through which the current was injected. The ratio of the voltage potential to the applied current provides an indication of the impedance of the medium through which the current traveled.
For example,
In some instances, contact system 10 may utilize different impedance measurements of a local medium to determine whether the distal ablation tip electrode 24 is contacting tissue. For example, the impedance of cardiac tissue is different than that of blood. Therefore, by knowing the relative difference in the impedance of tissue versus blood, system 10 may be able to determine whether the medium through which a current is being applied is either blood or cardiac tissue, for example.
In some examples, mini-electrodes 26 may be operatively coupled to controller 16. Further, generated output from mini-electrodes 26 may be sent to controller 16 of system 10 for processing in one or more manners discussed herein and/or for processing in other manners. As stated, an electrical characteristic (e.g. impedance) and/or an output signal from a mini-electrode pair may at least partially form the basis of a contact assessment, ablation area assessment (e.g., tissue viability assessment), and/or an ablation progress assessment (e.g., a lesion formation/maturation analysis), as discussed below.
Further, system 10 may be capable of processing or may be configured to process the electrical signals from mini-electrodes 26, ring electrodes 22, and/or distal ablation tip electrode 24. Based, at least in part, on the processed output from mini-electrodes 26, ring electrodes 22, and/or distal ablation tip electrode 24, controller 16 may generate an output to a display (not shown) for use by a physician or other user. In instances where an output is generated to a display and/or other instances, controller 16 may be operatively coupled to or otherwise in communication with the display. Illustratively, the display may include various static and/or dynamic information related to the use of system 10. In one example, the display may include one or more of an image of the target area, an image of shaft 12, and/or indicators conveying information corresponding to tissue proximity, which may be analyzed by the user and/or by a processor of system 10 to determine the existence and/or location of arrhythmia substrates within the heart, to determine the location of shaft 12 within the heart, and/or to make other determinations relating to use of shaft 12 and/or other elongated members.
System 10 may include an indicator in communication with controller 16. The indicator may be capable of providing an indication related to a feature of the output signals received from one or more of the electrodes of shaft 12. In one example, an indication to the clinician about a characteristic of shaft 12 and/or the myocardial tissue interacted with and/or being mapped may be provided on the display. In some cases, the indicator may provide a visual and/or audible indication to provide information concerning the characteristic of shaft 12 and/or the myocardial tissue interacted with and/or being mapped. For example, system 10 may determine that a measured impedance corresponds to an impedance value of cardiac tissue and therefore may output a color indicator (e.g. green) to a display. The color indicator may allow a physician to more easily determine whether to apply ablative therapy to a given cardiac location. This is just an example. It is contemplated that a variety of indicators may be utilized by system 10.
In the above disclosure, the ability for system 10 to accurately measure impedance values may depend on the relative distribution of current density being applied to a given medium. For example, the size of the electrode from which current is emitted may lead to current diffusion through non-targeted, surrounding tissue. When comparing the current density of two electrodes, one of which is proportionally larger than the other, the electrode with less surface area may concentrate an electrical current to localized tissue to a greater extent than the larger electrode. Therefore, it may be challenging to get accurate current delivery at discrete spatial points in cardiac tissue when utilizing proportionally larger electrodes.
Additional details regarding mini-electrodes 26, distal ablation tip electrode 24 and ring electrode 22 are shown in
As shown in
It is contemplated that mini-electrodes 26 may have a suitable exposed surface area of between 0.20 mm2 and 1 mm2, 0.30 mm2 and 0.80 mm2, or 0.40 mm2 and 0.70 mm2. In one embodiment, mini-electrodes 26 may have a suitable exposed surface area of 0.50 mm2. Comparison of the ratio of the suitable exposed surface are of mini-electrodes 26 to that of distal ablation tip electrode 24 shows that the suitable exposed surface area of distal ablation tip electrode 24 may be at least ten (10) times larger, fifteen (15) times, or twenty (20) times larger than the suitable surface are of mini-electrodes 26. These are just examples. The ratio of the suitable exposed surface area of distal tip electrode 24 to the suitable exposed surface area of mini-electrode 26 may be less than or greater than twenty (20). For example, the ratio of the suitable exposed surface area of distal tip electrode 24 to the suitable exposed surface area of mini-electrode 26 may be 30, 50, or 100. Further, the ratio of the suitable exposed surface area of distal tip electrode 24 to the suitable exposed surface area of mini-electrode 26 may be less than one hundred seventy five (175).
Alternatively, mini-electrodes 26 may be used in conjunction with distal ablation tip electrode 24, with ring electrode 22, or alone. Additionally, because mini-electrodes 26 may be proportionally smaller than either distal ablation tip electrode 24 and/or ring electrode 22, mini-electrodes 26 may be positioned in many different spatial configurations with respect to distal ablation tip electrode 24 and/or ring electrode 22. For example, as shown in
Even though much of the discussion herein has been directed to embodiments in which mini-electrodes 26 have been positioned “on” distal ablation tip electrode 24, it is further contemplated that one or more mini-electrodes may be positioned along the catheter shaft at a position that is away from distal ablation tip electrode 24 and continue to function substantially equivalent to those embodiments in which mini-electrodes are positioned “on” distal tip ablation electrode 24.
For example,
Further, the size of mini-electrodes 26 may allow mini-electrodes 26 to be placed directly adjacent to tissue for which an ablation, diagnostic and/or therapeutic procedure may be performed. For example, as discussed above, in order to determine tissue contact through impedance measurements, the current for which a voltage ratio (and hence, impedance) is measured must pass through the medium (e.g. tissue) for which the targeted impedance value is sought. If the current is diffused and/or passes primarily through a non-targeted medium (e.g. blood), the observed impedance value may not accurately represent whether the catheter is in contact with the desired medium (e.g. tissue).
Due to their relatively small size, mini-electrodes 26 may be placed precisely at a discrete point in space. Further, it may be desirable to inject current between mini-electrodes 26 positioned at a discrete point in space. It can be appreciated that measurements (e.g. impedance) derived from mini-electrodes 26 may reflect the medium adjacent to a discrete point in space. For example, positioning and driving current through closely positioned mini-electrodes 26 may provide greater confidence that impedance measurements derived therefrom are accurate.
Further, it may be desirable to position mini-electrodes 26 close to distal ablation tip electrode 24 and/or ring electrode 22. For example, disposing closely-positioned mini-electrodes 26 directly on distal ablation tip 24 may provide confidence that distal ablation tip 24 is, in fact, in contact with a given medium reflected by a particular impedance measurement.
As stated above, injecting current through mini-electrodes 26 (versus a larger distal ablation tip electrode 24 and/or ring electrode 22) may improve measurements by concentrating the current path precisely through a localized medium. Diffusion of current through surrounding tissue may be reduced by injecting current through the smaller surface area of mini-electrode 26 verses a larger surface area electrode.
Additionally or alternatively, improvement in the measurement of impedance may be accomplished by using a four-terminal sensing configuration. In general, a four-terminal sensing configuration drives current through a pair of electrodes (similar to that discussed above) and measures the voltage across a different pair of electrodes. For ease of understanding the foregoing discussion, the electrode pair between which current is injected in a four-terminal sensing configuration will be hereafter referred to as the “current-carrying” electrode pair. The electrode pair across which voltage is measured will be referred to as the “sensing” electrode pair.
One advantage of a four-terminal sensing configuration is that the measured impedance may not be sensitive to the impedance of the electrodes. In a two-terminal sensing configuration, the measured impedance includes the surrounding medium and both electrodes. In contrast, a four-terminal sensing configuration measures voltage across electrodes through which the current is negligible. As a result, the measured impedance is that of the surrounding medium and is largely independent of the impedance of the electrode and its interface with the surrounding medium.
For example,
Referring to
Additionally or alternatively, a variety of combinations, arrangements and/or configurations may incorporate a variety of electrodes (e.g. distal ablation tip electrode, ring electrode, mini-electrode, remote reference electrode, etc.) in a four-terminal sensing configuration. In some combinations (e.g. the combinations illustrated in
For example,
Similar to that discussed above with respect to
Additionally or alternatively, a four-terminal sensing configuration may be implemented and/or configured using only three electrodes. In some instances, a single electrode (e.g. distal ablation tip electrode, ring electrode, mini-electrode, remote electrode, etc.) may operate as both a current-carrying and sensing electrode. In this case, the measured impedance may include the impedance of the electrode used for both purposes (e.g., current-carrying and sensing) as well as the impedance of the electrode's interface with the surrounding medium. This configuration may approximate the four-terminal configuration if the impedance of the electrode is low or is not expected to vary significantly. Including the impedance of one of the electrodes (and its interface) may be desirable in some cases, particularly if that impedance varies significantly with tissue contact.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include one or more mini-electrodes 126, while the sensing electrode pair may include the distal tip ablation electrode 124 and/or ring electrode 122.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include a distal tip ablation electrode 124 and a mini-electrode 126, while the sensing electrode pair may include one or more mini-electrodes 126.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include one or more mini-electrodes 126, while the sensing electrode pair may include a distal tip ablation electrode 124 and one or more mini-electrodes 126.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include one or more mini-electrodes 126, while the sensing electrode pair may include a ring electrode 122 and one or more mini-electrodes 126.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include a ring electrode 122 and one or more mini-electrodes 126, while the sensing electrode pair may include one or more mini-electrodes 126.
In another example of a four-terminal sensing configuration, all the electrodes in the four-terminal sensing configuration may be mini-electrodes 126.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include one mini-electrode 126 and distal tip ablation electrode 124, while the sensing electrode pair may include one or more mini-electrode 126 and ring electrode 122.
In another example of a four-terminal sensing configuration, the sensing electrode pair may include one mini-electrode 126 and distal tip ablation electrode 124, while the current-carrying electrode pair may include one or more mini-electrode 126 and ring electrode 122.
In another example of a four-terminal sensing configuration, the current-carrying electrode pair may include one mini-electrode 126, while the sensing electrode pair may include the distal tip ablation electrode 124.
In another example of a four-terminal sensing configuration, the sensing electrode pair may include one mini-electrode 126, while the current-carrying electrode pair may include the distal tip ablation electrode 124.
It is contemplated that the controller 16 may incorporate an algorithm that controls the various electrodes in the desired manner in order to assess contact. This might include powering the electrodes in the manner disclosed herein. This may also include more than one sensing configuration, with the sensing configurations multiplexed in time, frequency, or both.
While the above discussion indicates that mini-electrodes may be used for tissue contact sensing, this is not intended to be limiting. Rather, the mini-electrodes may be used for a variety of functions including ablation, mapping, sensing, or the like.
As stated, the impedance, resistance, voltage and/or other output obtained from any of the above described four-terminal sensing configurations may be displayed for diagnostic use by a physician or clinician. For example, a four-terminal sensing configuration may measure and/or sense the impedance of tissue, and output a corresponding indicator (as described above) to a display. The display may be connected to controller 16, RF generator 14 and/or to any other component of system 10.
In addition or alternatively to that disclosed above, another method for assessing tissue contact may include determining a parameter of a model and observing changes in the parameter as the distal end portion 13 of catheter 12 moves between different mediums (e.g. as between blood and tissue).
For example, a scaling factor may be a parameter in a model used for this purpose. The model may relate to one or more potential differences between one or more sensing electrodes and a reference electrode. A reference electrode may be an electrode placed a distance away from the potential measuring electrodes. For example, a reference electrode may be placed on the back of a patient.
Sensing electrodes may be disposed on the tip and/or end of distal portion 13 of a catheter. In some examples, sensing electrodes may include mini-electrodes as described herein.
Additionally or alternatively, the model may also relate to the distance in space between a current-carrying electrode and one or more sensing electrodes. The current-carrying electrode may take a variety of forms. For example, the current-carrying electrode may be a distal ablation tip electrode 24 as shown in
In some configurations, the potential measurement between a sensing electrode and a reference electrode may be modeled as being inversely proportional to the distance between a current-carrying electrode and a sensing electrode. For example, the relationship may be modeled as:
In this example, the parameter K may be used to assess tissue contact. The above equation is just an example. Other models and parameters are contemplated.
As stated above, the model may relate to both the potential differences between one or more sensing electrodes and the distance between a current-carrying electrode and sensing electrodes. For example,
In some instances, the relationship between the above electrodes and potential values may be represented by the following equation:
It can be appreciated that the variables
represent the measured potential difference between the four sensing electrodes and a reference electrode. Additionally, the potential differences may be determined by system 10. Further, it can be appreciated that ∥rCCE1−rSE1∥, ∥rCCE1−rSE2∥, ∥rCCE1−rSE3∥ and ∥rCCE1−rSE4∥ represent the absolute value of the distance (in space) between the current-carrying electrode and the four sensing electrodes, respectively. It is further understood that these distances may be determined as the position (and distance) for every sensing electrode in relation to the current-carrying electrode is known.
The parameters K and C in the above system of linear equations can be estimated using a number of well-known techniques for optimization or linear regression. For example, least squares can be used to estimate K and C. Other methods are contemplated.
Scaling factor K may be inversely proportional to the conductivity of a given medium. In other words, the scaling factor K will be different for two mediums having different conductivities. For example, the conductivity of blood is greater than that of cardiac tissue, and therefore, the scaling factor K will be lower for blood as compared to cardiac tissue.
Knowing the potential differences and absolute distance values, it may be possible to solve the linear equation set (above) for the scaling factor, K. Is should be noted that in order to solve the disclosed linear equation set, sensing electrodes must be located at different distances away from the current injecting electrode. If, for example, the distances were all identical, then the matrix on the right-hand side of the equation would be singular and result in an infinite number of equally valid solutions. Referring to
It can be appreciated from the above discussion that it may be possible to utilize known variables to solve the disclosed linear equation for the scaling factor K. Therefore, system 10 may determine and compare different scaling factor values as the distal end portion 13 of catheter 12 is moved between different mediums (e.g. blood, tissue).
The following documents are herein incorporated by reference: U.S. Patent Application Pub. US2008/0243214, U.S. Patent Application Pub. US2014/0058375, U.S. Patent Application Pub. US2013/0190747, U.S. Patent Application Pub. US2013/0060245, and U.S. Patent Application Pub. US2009/0171345.
Various modifications and additions can be made to the exemplary embodiments discussed without departing from the scope of the present invention. For example, while the embodiments described above refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications, and variations as fall within the scope of the claims, together with all equivalents thereof.
This application is a continuation application of U.S. patent application Ser. No. 14/881,112, filed Oct. 12, 2015, which claims priority to Provisional Application No. 62/063,296, filed Oct. 13, 2014, which is herein incorporated by reference in its entirety.
Number | Name | Date | Kind |
---|---|---|---|
3391845 | Bessett | Jul 1968 | A |
3773401 | Douklias et al. | Nov 1973 | A |
4466443 | Utsugi | Aug 1984 | A |
4602624 | Naples et al. | Jul 1986 | A |
4633882 | Matsuo et al. | Jan 1987 | A |
4732149 | Sutter | Mar 1988 | A |
4745928 | Webler et al. | May 1988 | A |
4763660 | Kroll et al. | Aug 1988 | A |
4945912 | Langberg | Aug 1990 | A |
4966145 | Kikumoto et al. | Oct 1990 | A |
5019076 | Yamanashi et al. | May 1991 | A |
5029588 | Yock et al. | Jul 1991 | A |
5114423 | Kasprzyk et al. | May 1992 | A |
5151100 | Abele et al. | Sep 1992 | A |
5178150 | Silverstein et al. | Jan 1993 | A |
5217460 | Knoepfler | Jun 1993 | A |
5230349 | Langberg | Jul 1993 | A |
5238004 | Sahatjian et al. | Aug 1993 | A |
5240003 | Lancee et al. | Aug 1993 | A |
5242441 | Avitall | Sep 1993 | A |
5254088 | Lundquist et al. | Oct 1993 | A |
5277201 | Stern | Jan 1994 | A |
5295482 | Clare et al. | Mar 1994 | A |
5318589 | Lichtman | Jun 1994 | A |
5324284 | Imran | Jun 1994 | A |
5331966 | Bennett et al. | Jul 1994 | A |
5334193 | Nardella | Aug 1994 | A |
5341807 | Nardella | Aug 1994 | A |
5377685 | Kazi et al. | Jan 1995 | A |
5383874 | Jackson et al. | Jan 1995 | A |
5385146 | Goldreyer | Jan 1995 | A |
5385148 | Lesh et al. | Jan 1995 | A |
5391199 | Ben-Haim | Feb 1995 | A |
5398683 | Edwards et al. | Mar 1995 | A |
5415654 | Daikuzono | May 1995 | A |
5417689 | Fine | May 1995 | A |
5423811 | Imran et al. | Jun 1995 | A |
5447529 | Marchlinski et al. | Sep 1995 | A |
5456682 | Edwards et al. | Oct 1995 | A |
5462521 | Brucker et al. | Oct 1995 | A |
5482054 | Slater et al. | Jan 1996 | A |
5485849 | Panescu et al. | Jan 1996 | A |
5494042 | Panescu et al. | Feb 1996 | A |
5500012 | Brucker et al. | Mar 1996 | A |
5520683 | Subramaniam et al. | May 1996 | A |
5545161 | Imran | Aug 1996 | A |
5571088 | Lennox et al. | Nov 1996 | A |
5573535 | Viklund | Nov 1996 | A |
5575772 | Lennox | Nov 1996 | A |
5579764 | Goldreyer | Dec 1996 | A |
5582609 | Swanson et al. | Dec 1996 | A |
5643197 | Brucker et al. | Jul 1997 | A |
5647870 | Kordis et al. | Jul 1997 | A |
5676693 | LaFontaine | Oct 1997 | A |
5688267 | Panescu et al. | Nov 1997 | A |
5718701 | Shai et al. | Feb 1998 | A |
5722402 | Swanson et al. | Mar 1998 | A |
5735846 | Panescu et al. | Apr 1998 | A |
5762067 | Dunham et al. | Jun 1998 | A |
5788636 | Curley | Aug 1998 | A |
5792064 | Panescu et al. | Aug 1998 | A |
5800482 | Pomeranz et al. | Sep 1998 | A |
5810802 | Panescu et al. | Sep 1998 | A |
5820568 | Willis | Oct 1998 | A |
5830213 | Panescu et al. | Nov 1998 | A |
5833621 | Panescu et al. | Nov 1998 | A |
5836875 | Webster, Jr. | Nov 1998 | A |
5836990 | Li | Nov 1998 | A |
5868735 | Lafontaine | Feb 1999 | A |
5871483 | Jackson et al. | Feb 1999 | A |
5871526 | Gibbs et al. | Feb 1999 | A |
5876336 | Swanson et al. | Mar 1999 | A |
5885278 | Fleischman | Mar 1999 | A |
5893847 | Kordis | Apr 1999 | A |
5913854 | Maguire et al. | Jun 1999 | A |
5913856 | Chia et al. | Jun 1999 | A |
5916213 | Haissaguerre et al. | Jun 1999 | A |
5919188 | Shearon et al. | Jul 1999 | A |
5957850 | Marian et al. | Sep 1999 | A |
6002968 | Edwards | Dec 1999 | A |
6004269 | Crowley et al. | Dec 1999 | A |
6006755 | Edwards | Dec 1999 | A |
6027500 | Buckles et al. | Feb 2000 | A |
6030379 | Panescu et al. | Feb 2000 | A |
6042559 | Dobak, III | Mar 2000 | A |
6050267 | Nardella et al. | Apr 2000 | A |
6050994 | Sherman | Apr 2000 | A |
6059778 | Sherman | May 2000 | A |
6063078 | Wittkampf | May 2000 | A |
6064905 | Webster et al. | May 2000 | A |
6068629 | Haissaguerre et al. | May 2000 | A |
6070094 | Swanson et al. | May 2000 | A |
6071281 | Burnside et al. | Jun 2000 | A |
6083170 | Ben-Haim | Jul 2000 | A |
6083222 | Klein et al. | Jul 2000 | A |
6099524 | Lipson et al. | Aug 2000 | A |
6101409 | Swanson et al. | Aug 2000 | A |
6116027 | Smith et al. | Sep 2000 | A |
6120476 | Fung et al. | Sep 2000 | A |
6162184 | Swanson et al. | Dec 2000 | A |
6165123 | Thompson | Dec 2000 | A |
6171275 | Webster, Jr. | Jan 2001 | B1 |
6171305 | Sherman | Jan 2001 | B1 |
6200314 | Sherman | Mar 2001 | B1 |
6206831 | Suorsa et al. | Mar 2001 | B1 |
6210337 | Dunham et al. | Apr 2001 | B1 |
6216027 | Willis et al. | Apr 2001 | B1 |
6224557 | Ziel et al. | May 2001 | B1 |
6233491 | Kordis et al. | May 2001 | B1 |
6241724 | Fleischman et al. | Jun 2001 | B1 |
6241754 | Swanson et al. | Jun 2001 | B1 |
6258087 | Edwards et al. | Jul 2001 | B1 |
6270493 | Lalonde et al. | Aug 2001 | B1 |
6290697 | Tu et al. | Sep 2001 | B1 |
6352534 | Paddock et al. | Mar 2002 | B1 |
6395325 | Hedge et al. | May 2002 | B1 |
6400981 | Govari | Jun 2002 | B1 |
6423002 | Hossack | Jul 2002 | B1 |
6475213 | Swanson et al. | Nov 2002 | B1 |
6488678 | Sherman | Dec 2002 | B2 |
6491710 | Satake | Dec 2002 | B2 |
6500174 | Maguire et al. | Dec 2002 | B1 |
6508767 | Burns et al. | Jan 2003 | B2 |
6508769 | Bonnefous | Jan 2003 | B2 |
6508803 | Horikawa et al. | Jan 2003 | B1 |
6514249 | Maguire et al. | Feb 2003 | B1 |
6516667 | Broad et al. | Feb 2003 | B1 |
6517533 | Swaminathan | Feb 2003 | B1 |
6517534 | McGovern et al. | Feb 2003 | B1 |
6537271 | Murray et al. | Mar 2003 | B1 |
6544175 | Newman | Apr 2003 | B1 |
6546270 | Goldin et al. | Apr 2003 | B1 |
6547788 | Maguire et al. | Apr 2003 | B1 |
6569160 | Goldin et al. | May 2003 | B1 |
6569162 | He | May 2003 | B2 |
6572547 | Miller et al. | Jun 2003 | B2 |
6575966 | Lane et al. | Jun 2003 | B2 |
6575969 | Rittman et al. | Jun 2003 | B1 |
6579278 | Bencini | Jun 2003 | B1 |
6582372 | Poland | Jun 2003 | B2 |
6584345 | Govari | Jun 2003 | B2 |
6589182 | Loftman et al. | Jul 2003 | B1 |
6589238 | Edwards et al. | Jul 2003 | B2 |
6592525 | Miller et al. | Jul 2003 | B2 |
6602242 | Fung et al. | Aug 2003 | B1 |
6620103 | Bruce et al. | Sep 2003 | B1 |
6632179 | Wilson et al. | Oct 2003 | B2 |
6638222 | Chandrasekaran et al. | Oct 2003 | B2 |
6640120 | Swanson et al. | Oct 2003 | B1 |
6647281 | Morency | Nov 2003 | B2 |
6656174 | Hegde et al. | Dec 2003 | B1 |
6658279 | Swanson et al. | Dec 2003 | B2 |
6663573 | Goldin | Dec 2003 | B2 |
6663622 | Foley et al. | Dec 2003 | B1 |
6666862 | Jain et al. | Dec 2003 | B2 |
6673067 | Peyman | Jan 2004 | B1 |
6676606 | Simpson et al. | Jan 2004 | B2 |
6692441 | Poland et al. | Feb 2004 | B1 |
6705992 | Gatzke | Mar 2004 | B2 |
6709396 | Flesch et al. | Mar 2004 | B2 |
6711429 | Gilboa et al. | Mar 2004 | B1 |
6719756 | Muntermann | Apr 2004 | B1 |
6723094 | Desinger | Apr 2004 | B1 |
6735465 | Panescu | May 2004 | B2 |
6736814 | Manna et al. | May 2004 | B2 |
6743174 | Ng et al. | Jun 2004 | B2 |
6773402 | Govari et al. | Aug 2004 | B2 |
6776758 | Peszynski et al. | Aug 2004 | B2 |
6796979 | Lentz | Sep 2004 | B2 |
6796980 | Hall | Sep 2004 | B2 |
6804545 | Fuimaono et al. | Oct 2004 | B2 |
6811550 | Holland et al. | Nov 2004 | B2 |
6824517 | Salgo et al. | Nov 2004 | B2 |
6837884 | Woloszko | Jan 2005 | B2 |
6845257 | Fuimaono et al. | Jan 2005 | B2 |
6845264 | Skladnev et al. | Jan 2005 | B1 |
6917834 | Koblish et al. | Jul 2005 | B2 |
6922579 | Taimisto et al. | Jul 2005 | B2 |
6923808 | Taimisto | Aug 2005 | B2 |
6932811 | Hooven et al. | Aug 2005 | B2 |
6945938 | Grunwald | Sep 2005 | B2 |
6950689 | Willis et al. | Sep 2005 | B1 |
6952615 | Satake | Oct 2005 | B2 |
6958040 | Oliver et al. | Oct 2005 | B2 |
6972016 | Hill et al. | Dec 2005 | B2 |
7001383 | Keidar | Feb 2006 | B2 |
7037264 | Poland | May 2006 | B2 |
7047068 | Haissaguerre | May 2006 | B2 |
7097643 | Cornelius et al. | Aug 2006 | B2 |
7099711 | Fuimaono et al. | Aug 2006 | B2 |
7105122 | Karason | Sep 2006 | B2 |
7112198 | Satake | Sep 2006 | B2 |
7115122 | Swanson et al. | Oct 2006 | B1 |
7123951 | Fuimaono et al. | Oct 2006 | B2 |
7125409 | Truckai et al. | Oct 2006 | B2 |
7131947 | Demers | Nov 2006 | B2 |
7166075 | Varghese et al. | Jan 2007 | B2 |
7181262 | Fuimaono et al. | Feb 2007 | B2 |
7198625 | Hui et al. | Apr 2007 | B1 |
7220233 | Nita et al. | May 2007 | B2 |
7232433 | Schlesinger et al. | Jun 2007 | B1 |
7247155 | Hoey et al. | Jul 2007 | B2 |
7270634 | Scampini et al. | Sep 2007 | B2 |
7288088 | Swanson | Oct 2007 | B2 |
7291142 | Eberl et al. | Nov 2007 | B2 |
7306561 | Sathyanarayana | Dec 2007 | B2 |
7335052 | D Sa | Feb 2008 | B2 |
7347820 | Bonnefous | Mar 2008 | B2 |
7347821 | Skyba et al. | Mar 2008 | B2 |
7347857 | Anderson et al. | Mar 2008 | B2 |
7361144 | Levrier et al. | Apr 2008 | B2 |
7422591 | Phan | Sep 2008 | B2 |
7438714 | Phan | Oct 2008 | B2 |
7455669 | Swanson | Nov 2008 | B2 |
7488289 | Suorsa et al. | Feb 2009 | B2 |
7507205 | Borovsky et al. | Mar 2009 | B2 |
7507237 | Geistert | Mar 2009 | B2 |
7519410 | Taimisto et al. | Apr 2009 | B2 |
7529393 | Peszynski et al. | May 2009 | B2 |
7534207 | Shehada et al. | May 2009 | B2 |
7544164 | Knowles et al. | Jun 2009 | B2 |
7549988 | Eberl et al. | Jun 2009 | B2 |
7569052 | Phan et al. | Aug 2009 | B2 |
7578791 | Rafter | Aug 2009 | B2 |
7582083 | Swanson | Sep 2009 | B2 |
7585310 | Phan et al. | Sep 2009 | B2 |
7610073 | Fuimaono et al. | Oct 2009 | B2 |
7648462 | Jenkins et al. | Jan 2010 | B2 |
7697972 | Verard et al. | Apr 2010 | B2 |
7704208 | Thiele | Apr 2010 | B2 |
7720420 | Kajita | May 2010 | B2 |
7727231 | Swanson | Jun 2010 | B2 |
7736362 | Eberl et al. | Jun 2010 | B2 |
7740629 | Anderson et al. | Jun 2010 | B2 |
7758508 | Thiele et al. | Jul 2010 | B1 |
7766833 | Lee et al. | Aug 2010 | B2 |
7776033 | Swanson | Aug 2010 | B2 |
7785324 | Eberl | Aug 2010 | B2 |
7794398 | Salgo | Sep 2010 | B2 |
7796789 | Salgo et al. | Sep 2010 | B2 |
7799025 | Wellman | Sep 2010 | B2 |
7815572 | Loupas | Oct 2010 | B2 |
7819863 | Eggers et al. | Oct 2010 | B2 |
7837624 | Hossack et al. | Nov 2010 | B1 |
7859170 | Knowles et al. | Dec 2010 | B2 |
7862561 | Swanson et al. | Jan 2011 | B2 |
7862562 | Eberl | Jan 2011 | B2 |
7879029 | Jimenez | Feb 2011 | B2 |
7892228 | Landis et al. | Feb 2011 | B2 |
7894871 | Wittkampf et al. | Feb 2011 | B2 |
7918850 | Govari et al. | Apr 2011 | B2 |
7957817 | Gillespie et al. | Jun 2011 | B1 |
7996085 | Levin | Aug 2011 | B2 |
8016822 | Swanson | Sep 2011 | B2 |
8048028 | Horn et al. | Nov 2011 | B2 |
8103327 | Harlev et al. | Jan 2012 | B2 |
8128617 | Bencini et al. | Mar 2012 | B2 |
8160690 | Wilfley et al. | Apr 2012 | B2 |
8162935 | Paul et al. | Apr 2012 | B2 |
8183441 | Cukadar | May 2012 | B2 |
8265745 | Hauck et al. | Sep 2012 | B2 |
8267926 | Paul et al. | Sep 2012 | B2 |
8290578 | Schneider | Oct 2012 | B2 |
8317783 | Cao et al. | Nov 2012 | B2 |
8369922 | Paul et al. | Feb 2013 | B2 |
8400164 | Osadchy et al. | Mar 2013 | B2 |
8403925 | Miller et al. | Mar 2013 | B2 |
8406866 | Deno et al. | Mar 2013 | B2 |
8414579 | Kim et al. | Apr 2013 | B2 |
8449535 | Deno et al. | May 2013 | B2 |
8454538 | Wittkampf et al. | Jun 2013 | B2 |
8454589 | Deno et al. | Jun 2013 | B2 |
8489184 | Wilfley et al. | Jul 2013 | B2 |
8579889 | Bencini | Nov 2013 | B2 |
8583215 | Lichtenstein | Nov 2013 | B2 |
8603084 | Fish et al. | Dec 2013 | B2 |
8603085 | Jimenez | Dec 2013 | B2 |
8644950 | Hauck | Feb 2014 | B2 |
8657814 | Werneth et al. | Feb 2014 | B2 |
8672936 | Thao et al. | Mar 2014 | B2 |
8679109 | Paul et al. | Mar 2014 | B2 |
8728077 | Paul et al. | May 2014 | B2 |
8740900 | Kim et al. | Jun 2014 | B2 |
8755860 | Paul et al. | Jun 2014 | B2 |
8771343 | Weber et al. | Jul 2014 | B2 |
8876817 | Avitall et al. | Nov 2014 | B2 |
8894643 | Watson et al. | Nov 2014 | B2 |
8906011 | Gelbart et al. | Dec 2014 | B2 |
8945015 | Rankin et al. | Feb 2015 | B2 |
8945117 | Bencini | Feb 2015 | B2 |
8998890 | Paul et al. | Apr 2015 | B2 |
9044300 | Belhe et al. | Jun 2015 | B2 |
9089340 | Hastings et al. | Jul 2015 | B2 |
9125565 | Hauck | Sep 2015 | B2 |
9125668 | Subramaniam et al. | Sep 2015 | B2 |
9168004 | Gliner et al. | Oct 2015 | B2 |
9173586 | Deno et al. | Nov 2015 | B2 |
9211156 | Kim et al. | Dec 2015 | B2 |
9241687 | McGee | Jan 2016 | B2 |
9241761 | Rankin et al. | Jan 2016 | B2 |
9254163 | Paul et al. | Feb 2016 | B2 |
9265434 | Merschon et al. | Feb 2016 | B2 |
9271782 | Paul et al. | Mar 2016 | B2 |
9283026 | Paul et al. | Mar 2016 | B2 |
9370329 | Tun et al. | Jun 2016 | B2 |
9393072 | Kim et al. | Jul 2016 | B2 |
9463064 | Subramaniam et al. | Oct 2016 | B2 |
9603659 | Subramaniam et al. | Mar 2017 | B2 |
9622897 | Stangenes et al. | Apr 2017 | B1 |
9743854 | Stewart et al. | Aug 2017 | B2 |
9757191 | Avitall et al. | Sep 2017 | B2 |
9956035 | Govari et al. | May 2018 | B2 |
10524684 | Fay et al. | Jan 2020 | B2 |
20010008967 | Sherman | Jul 2001 | A1 |
20010029371 | Kordis | Oct 2001 | A1 |
20010031921 | Bonnefous | Oct 2001 | A1 |
20010034518 | Edwards et al. | Oct 2001 | A1 |
20010039381 | Burns et al. | Nov 2001 | A1 |
20020007180 | Wittenberger et al. | Jan 2002 | A1 |
20020045893 | Lane et al. | Apr 2002 | A1 |
20020065512 | Fjield et al. | May 2002 | A1 |
20020072663 | Fuimaono et al. | Jun 2002 | A1 |
20020082503 | Chandrasekaran et al. | Jun 2002 | A1 |
20020087208 | Koblish et al. | Jul 2002 | A1 |
20020091384 | Hooven et al. | Jul 2002 | A1 |
20020107447 | Suorsa et al. | Aug 2002 | A1 |
20020111548 | Swanson et al. | Aug 2002 | A1 |
20020147391 | Morency | Oct 2002 | A1 |
20020151807 | Goldin | Oct 2002 | A1 |
20020161306 | Govari | Oct 2002 | A1 |
20020165448 | Ben-Haim et al. | Nov 2002 | A1 |
20020169445 | Jain et al. | Nov 2002 | A1 |
20020183731 | Holland et al. | Dec 2002 | A1 |
20020183735 | Edwards et al. | Dec 2002 | A1 |
20020198521 | Maguire | Dec 2002 | A1 |
20030004505 | Bencini et al. | Jan 2003 | A1 |
20030004506 | Messing | Jan 2003 | A1 |
20030013955 | Poland | Jan 2003 | A1 |
20030013958 | Govari et al. | Jan 2003 | A1 |
20030014051 | Woloszko | Jan 2003 | A1 |
20030014095 | Kramer et al. | Jan 2003 | A1 |
20030028103 | Miller et al. | Feb 2003 | A1 |
20030028104 | Wilson et al. | Feb 2003 | A1 |
20030040804 | Stack et al. | Feb 2003 | A1 |
20030065371 | Satake | Apr 2003 | A1 |
20030078509 | Panescu | Apr 2003 | A1 |
20030088240 | Saadat | May 2003 | A1 |
20030092993 | Grunwald | May 2003 | A1 |
20030097125 | Hall | May 2003 | A1 |
20030158548 | Phan et al. | Aug 2003 | A1 |
20030158549 | Swanson | Aug 2003 | A1 |
20030163045 | Gatzke | Aug 2003 | A1 |
20030163130 | Manna et al. | Aug 2003 | A1 |
20030171672 | Varghese et al. | Sep 2003 | A1 |
20030187353 | Ng et al. | Oct 2003 | A1 |
20030191380 | Fuimaono et al. | Oct 2003 | A1 |
20030195407 | Fuimaono et al. | Oct 2003 | A1 |
20030208124 | Poland | Nov 2003 | A1 |
20030229285 | Simpson et al. | Dec 2003 | A1 |
20030229286 | Lenker | Dec 2003 | A1 |
20030236462 | Salgo et al. | Dec 2003 | A1 |
20040006268 | Gilboa et al. | Jan 2004 | A1 |
20040010200 | Sweeney | Jan 2004 | A1 |
20040015084 | Flesch et al. | Jan 2004 | A1 |
20040073114 | Oliver et al. | Apr 2004 | A1 |
20040073118 | Peszynski et al. | Apr 2004 | A1 |
20040078036 | Keidar | Apr 2004 | A1 |
20040082860 | Haissaguerre | Apr 2004 | A1 |
20040092806 | Sagon et al. | May 2004 | A1 |
20040097805 | Verard et al. | May 2004 | A1 |
20040116793 | Taimisto et al. | Jun 2004 | A1 |
20040116916 | Lentz | Jun 2004 | A1 |
20040137098 | Karason | Jul 2004 | A1 |
20040147920 | Keidar | Jul 2004 | A1 |
20040158139 | Fuimaono et al. | Aug 2004 | A1 |
20040158140 | Fuimaono et al. | Aug 2004 | A1 |
20040158238 | Lalonde et al. | Aug 2004 | A1 |
20040158270 | Wyzgala et al. | Aug 2004 | A1 |
20040162556 | Swanson | Aug 2004 | A1 |
20040167509 | Taimisto | Aug 2004 | A1 |
20040172110 | Satake | Sep 2004 | A1 |
20040186467 | Swanson et al. | Sep 2004 | A1 |
20040193042 | Scampini et al. | Sep 2004 | A1 |
20040204670 | Nita et al. | Oct 2004 | A1 |
20040210136 | Varghese et al. | Oct 2004 | A1 |
20040215177 | Swanson | Oct 2004 | A1 |
20040215183 | Hoey et al. | Oct 2004 | A1 |
20040215186 | Cornelius et al. | Oct 2004 | A1 |
20040225219 | Demers | Nov 2004 | A1 |
20040236192 | Necola et al. | Nov 2004 | A1 |
20040267125 | Skyba et al. | Dec 2004 | A1 |
20050033331 | Burnett et al. | Feb 2005 | A1 |
20050059862 | Phan | Mar 2005 | A1 |
20050059962 | Phan et al. | Mar 2005 | A1 |
20050059963 | Phan et al. | Mar 2005 | A1 |
20050059965 | Eberl et al. | Mar 2005 | A1 |
20050065506 | Phan | Mar 2005 | A1 |
20050065508 | Johnson et al. | Mar 2005 | A1 |
20050070894 | McClurken | Mar 2005 | A1 |
20050090817 | Phan | Apr 2005 | A1 |
20050119545 | Swanson | Jun 2005 | A1 |
20050119648 | Swanson | Jun 2005 | A1 |
20050119649 | Swanson | Jun 2005 | A1 |
20050119653 | Swanson | Jun 2005 | A1 |
20050119654 | Swanson et al. | Jun 2005 | A1 |
20050124881 | Kanai et al. | Jun 2005 | A1 |
20050124899 | Byrd et al. | Jun 2005 | A1 |
20050125020 | Meade et al. | Jun 2005 | A1 |
20050165391 | Maguire et al. | Jul 2005 | A1 |
20050187544 | Swanson et al. | Aug 2005 | A1 |
20050203505 | Megerman et al. | Sep 2005 | A1 |
20050203597 | Yamazaki et al. | Sep 2005 | A1 |
20050215993 | Phan | Sep 2005 | A1 |
20050228286 | Messerly et al. | Oct 2005 | A1 |
20050228290 | Borovsky et al. | Oct 2005 | A1 |
20050228504 | Demarais | Oct 2005 | A1 |
20050251121 | Swanson | Nov 2005 | A1 |
20050251122 | Swanson | Nov 2005 | A1 |
20050251123 | Eberl et al. | Nov 2005 | A1 |
20050273060 | Levy et al. | Dec 2005 | A1 |
20050288667 | Thompson et al. | Dec 2005 | A1 |
20060030919 | Mrva et al. | Feb 2006 | A1 |
20060047277 | Eberl et al. | Mar 2006 | A1 |
20060052698 | Loupas | Mar 2006 | A1 |
20060058657 | Sathyanarayana | Mar 2006 | A1 |
20060058668 | Levrier et al. | Mar 2006 | A1 |
20060074309 | Bonnefous | Apr 2006 | A1 |
20060089634 | Anderson et al. | Apr 2006 | A1 |
20060100522 | Yuan et al. | May 2006 | A1 |
20060155272 | Swanson | Jul 2006 | A1 |
20060155273 | Swanson | Jul 2006 | A1 |
20060155274 | Swanson et al. | Jul 2006 | A1 |
20060161146 | Cornelius et al. | Jul 2006 | A1 |
20060161201 | Phan et al. | Jul 2006 | A1 |
20060182320 | Peszynski et al. | Aug 2006 | A1 |
20060184112 | Horn et al. | Aug 2006 | A1 |
20060193504 | Salgo et al. | Aug 2006 | A1 |
20060195079 | Eberl | Aug 2006 | A1 |
20060195080 | Ebert | Aug 2006 | A1 |
20060195081 | Landis et al. | Aug 2006 | A1 |
20060206109 | Swanson | Sep 2006 | A1 |
20060224153 | Fischell et al. | Oct 2006 | A1 |
20060247607 | Cornelius et al. | Nov 2006 | A1 |
20060247683 | Danek et al. | Nov 2006 | A1 |
20060253028 | Lam et al. | Nov 2006 | A1 |
20060253116 | Avitall et al. | Nov 2006 | A1 |
20060258940 | D Sa | Nov 2006 | A1 |
20060271032 | Chin et al. | Nov 2006 | A1 |
20060271034 | Swanson | Nov 2006 | A1 |
20070003811 | Zerfass et al. | Jan 2007 | A1 |
20070016019 | Salgo | Jan 2007 | A1 |
20070016054 | Cao et al. | Jan 2007 | A1 |
20070016059 | Morimoto et al. | Jan 2007 | A1 |
20070016228 | Salas | Jan 2007 | A1 |
20070021744 | Creighton, IV | Jan 2007 | A1 |
20070032724 | Thiele | Feb 2007 | A1 |
20070049925 | Phan et al. | Mar 2007 | A1 |
20070055225 | Dodd et al. | Mar 2007 | A1 |
20070073135 | Lee et al. | Mar 2007 | A1 |
20070083193 | Werneth et al. | Apr 2007 | A1 |
20070088345 | Larson et al. | Apr 2007 | A1 |
20070123764 | Thao et al. | May 2007 | A1 |
20070129633 | Lee et al. | Jun 2007 | A1 |
20070135700 | Taimisto et al. | Jun 2007 | A1 |
20070156128 | Jimenez | Jul 2007 | A1 |
20070165916 | Cloutier et al. | Jul 2007 | A1 |
20070167813 | Lee et al. | Jul 2007 | A1 |
20070179375 | Fuimaono et al. | Aug 2007 | A1 |
20070181139 | Hauck | Aug 2007 | A1 |
20070198007 | Govari et al. | Aug 2007 | A1 |
20070225610 | Mickley et al. | Sep 2007 | A1 |
20070238997 | Camus | Oct 2007 | A1 |
20070239017 | Knowles et al. | Oct 2007 | A1 |
20070270791 | Wang et al. | Nov 2007 | A1 |
20070270794 | Anderson et al. | Nov 2007 | A1 |
20070276239 | Rafter | Nov 2007 | A1 |
20080004691 | Weber et al. | Jan 2008 | A1 |
20080009733 | Saksena | Jan 2008 | A1 |
20080015568 | Paul et al. | Jan 2008 | A1 |
20080025145 | Peszynski et al. | Jan 2008 | A1 |
20080051841 | Swerdlow et al. | Feb 2008 | A1 |
20080056750 | Kajita | Mar 2008 | A1 |
20080058836 | Moll et al. | Mar 2008 | A1 |
20080086073 | McDaniel | Apr 2008 | A1 |
20080091109 | Abraham | Apr 2008 | A1 |
20080140065 | Rioux et al. | Jun 2008 | A1 |
20080147060 | Choi | Jun 2008 | A1 |
20080161668 | Wittkampf et al. | Jul 2008 | A1 |
20080161705 | Podmore et al. | Jul 2008 | A1 |
20080161795 | Wang et al. | Jul 2008 | A1 |
20080161796 | Cao et al. | Jul 2008 | A1 |
20080195089 | Thiagalingam et al. | Aug 2008 | A1 |
20080228111 | Nita | Sep 2008 | A1 |
20080243214 | Koblish | Oct 2008 | A1 |
20080249518 | Warnking et al. | Oct 2008 | A1 |
20080255470 | Hauck et al. | Oct 2008 | A1 |
20080275428 | Tegg et al. | Nov 2008 | A1 |
20080275442 | Paul et al. | Nov 2008 | A1 |
20080275465 | Paul et al. | Nov 2008 | A1 |
20080281319 | Paul et al. | Nov 2008 | A1 |
20080281322 | Sherman et al. | Nov 2008 | A1 |
20080287803 | Li et al. | Nov 2008 | A1 |
20080288038 | Paul et al. | Nov 2008 | A1 |
20080300454 | Goto | Dec 2008 | A1 |
20080300589 | Paul et al. | Dec 2008 | A1 |
20080312521 | Solomon | Dec 2008 | A1 |
20080312713 | Wilfley et al. | Dec 2008 | A1 |
20090000383 | Knowles et al. | Jan 2009 | A1 |
20090005771 | Lieber et al. | Jan 2009 | A1 |
20090024119 | Wellman | Jan 2009 | A1 |
20090030312 | Hadjicostis | Jan 2009 | A1 |
20090048591 | Ibrahim et al. | Feb 2009 | A1 |
20090056344 | Poch | Mar 2009 | A1 |
20090062790 | Malchano et al. | Mar 2009 | A1 |
20090062795 | Vakharia et al. | Mar 2009 | A1 |
20090069807 | Eggers et al. | Mar 2009 | A1 |
20090076390 | Lee et al. | Mar 2009 | A1 |
20090088631 | Dietz et al. | Apr 2009 | A1 |
20090093810 | Subramaniam et al. | Apr 2009 | A1 |
20090093811 | Koblish et al. | Apr 2009 | A1 |
20090099472 | Remmert et al. | Apr 2009 | A1 |
20090131930 | Gelbart et al. | May 2009 | A1 |
20090131932 | Vakharia et al. | May 2009 | A1 |
20090163904 | Miller et al. | Jun 2009 | A1 |
20090171235 | Schneider et al. | Jul 2009 | A1 |
20090171274 | Harlev et al. | Jul 2009 | A1 |
20090171341 | Pope et al. | Jul 2009 | A1 |
20090171345 | Miller et al. | Jul 2009 | A1 |
20090177069 | Razavi | Jul 2009 | A1 |
20090177111 | Miller et al. | Jul 2009 | A1 |
20090182316 | Bencini | Jul 2009 | A1 |
20090209950 | Starksen | Aug 2009 | A1 |
20090216125 | Lenker | Aug 2009 | A1 |
20090240247 | Rioux et al. | Sep 2009 | A1 |
20090259274 | Simon et al. | Oct 2009 | A1 |
20090275827 | Aiken et al. | Nov 2009 | A1 |
20090281541 | Ibrahim et al. | Nov 2009 | A1 |
20090287202 | Ingle et al. | Nov 2009 | A1 |
20090292209 | Hadjicostis | Nov 2009 | A1 |
20090299355 | Bencini et al. | Dec 2009 | A1 |
20090299360 | Ormsby | Dec 2009 | A1 |
20090306643 | Pappone et al. | Dec 2009 | A1 |
20100010487 | Phan et al. | Jan 2010 | A1 |
20100030204 | Stein et al. | Feb 2010 | A1 |
20100057072 | Roman et al. | Mar 2010 | A1 |
20100069921 | Miller et al. | Mar 2010 | A1 |
20100076402 | Mazzone et al. | Mar 2010 | A1 |
20100076426 | De et al. | Mar 2010 | A1 |
20100094274 | Narayan et al. | Apr 2010 | A1 |
20100106155 | Anderson et al. | Apr 2010 | A1 |
20100113938 | Park et al. | May 2010 | A1 |
20100114092 | Eisele et al. | May 2010 | A1 |
20100117659 | Osadchy et al. | May 2010 | A1 |
20100121393 | Levin | May 2010 | A1 |
20100137944 | Zhu | Jun 2010 | A1 |
20100145221 | Brunnett et al. | Jun 2010 | A1 |
20100152728 | Park et al. | Jun 2010 | A1 |
20100168557 | Deno et al. | Jul 2010 | A1 |
20100168568 | Sliwa | Jul 2010 | A1 |
20100168570 | Sliwa et al. | Jul 2010 | A1 |
20100168735 | Deno et al. | Jul 2010 | A1 |
20100168831 | Korivi et al. | Jul 2010 | A1 |
20100228247 | Paul et al. | Sep 2010 | A1 |
20100241117 | Paul et al. | Sep 2010 | A1 |
20100249599 | Hastings et al. | Sep 2010 | A1 |
20100249603 | Hastings et al. | Sep 2010 | A1 |
20100249604 | Hastings et al. | Sep 2010 | A1 |
20100262140 | Watson et al. | Oct 2010 | A1 |
20100268217 | Habib | Oct 2010 | A1 |
20100286690 | Paul et al. | Nov 2010 | A1 |
20100298823 | Cao et al. | Nov 2010 | A1 |
20100298826 | Leo et al. | Nov 2010 | A1 |
20100331658 | Kim et al. | Dec 2010 | A1 |
20110028820 | Lau et al. | Feb 2011 | A1 |
20110034915 | Ibrahim et al. | Feb 2011 | A1 |
20110071400 | Hastings et al. | Mar 2011 | A1 |
20110071401 | Hastings et al. | Mar 2011 | A1 |
20110106075 | Jimenez | May 2011 | A1 |
20110112569 | Friedman et al. | May 2011 | A1 |
20110118727 | Fish et al. | May 2011 | A1 |
20110125008 | Wittkampf et al. | May 2011 | A1 |
20110125143 | Gross et al. | May 2011 | A1 |
20110125150 | Deno et al. | May 2011 | A1 |
20110130648 | Beeckler et al. | Jun 2011 | A1 |
20110137151 | Lichtenstein | Jun 2011 | A1 |
20110137153 | Govari et al. | Jun 2011 | A1 |
20110144491 | Sliwa et al. | Jun 2011 | A1 |
20110144524 | Fish et al. | Jun 2011 | A1 |
20110160584 | Paul et al. | Jun 2011 | A1 |
20110237933 | Cohen | Sep 2011 | A1 |
20110282249 | Tsoref et al. | Nov 2011 | A1 |
20110319782 | Sweeney et al. | Dec 2011 | A1 |
20120004547 | Harks et al. | Jan 2012 | A1 |
20120004621 | Shaw et al. | Jan 2012 | A1 |
20120029504 | Afonso et al. | Feb 2012 | A1 |
20120071870 | Salahieh et al. | Mar 2012 | A1 |
20120095347 | Adam et al. | Apr 2012 | A1 |
20120101398 | Ramanathan et al. | Apr 2012 | A1 |
20120116537 | Liebetanz | May 2012 | A1 |
20120136346 | Condie et al. | May 2012 | A1 |
20120136348 | Condie et al. | May 2012 | A1 |
20120136351 | Weekamp et al. | May 2012 | A1 |
20120165702 | Hauck | Jun 2012 | A1 |
20120172698 | Teo et al. | Jul 2012 | A1 |
20120172727 | Hastings et al. | Jul 2012 | A1 |
20120172871 | Hastings et al. | Jul 2012 | A1 |
20120232460 | Raven et al. | Sep 2012 | A1 |
20120238897 | Wilfley et al. | Sep 2012 | A1 |
20120310064 | McGee | Dec 2012 | A1 |
20120323237 | Paul et al. | Dec 2012 | A1 |
20120330304 | Vegesna et al. | Dec 2012 | A1 |
20130023784 | Schneider et al. | Jan 2013 | A1 |
20130023897 | Wallace | Jan 2013 | A1 |
20130060245 | Grunewald et al. | Mar 2013 | A1 |
20130066312 | Subramaniam et al. | Mar 2013 | A1 |
20130066315 | Subramaniam et al. | Mar 2013 | A1 |
20130079763 | Heckel et al. | Mar 2013 | A1 |
20130085416 | Mest | Apr 2013 | A1 |
20130138099 | Paul et al. | May 2013 | A1 |
20130165926 | Mathur et al. | Jun 2013 | A1 |
20130172715 | Just et al. | Jul 2013 | A1 |
20130172742 | Rankin et al. | Jul 2013 | A1 |
20130172875 | Govari et al. | Jul 2013 | A1 |
20130184706 | Gelbart et al. | Jul 2013 | A1 |
20130190747 | Koblish et al. | Jul 2013 | A1 |
20130197363 | Rankin et al. | Aug 2013 | A1 |
20130197507 | Kim et al. | Aug 2013 | A1 |
20130226169 | Miller et al. | Aug 2013 | A1 |
20130274582 | Afonso et al. | Oct 2013 | A1 |
20130331739 | Gertner | Dec 2013 | A1 |
20130345537 | Thakur et al. | Dec 2013 | A1 |
20140012251 | Himmelstein et al. | Jan 2014 | A1 |
20140051959 | Gliner et al. | Feb 2014 | A1 |
20140058375 | Koblish | Feb 2014 | A1 |
20140066764 | Subramaniam et al. | Mar 2014 | A1 |
20140073893 | Bencini | Mar 2014 | A1 |
20140075753 | Haarer et al. | Mar 2014 | A1 |
20140081111 | Tun et al. | Mar 2014 | A1 |
20140081112 | Kim et al. | Mar 2014 | A1 |
20140081113 | Cohen et al. | Mar 2014 | A1 |
20140081262 | Koblish et al. | Mar 2014 | A1 |
20140100563 | Govari et al. | Apr 2014 | A1 |
20140107430 | Deno et al. | Apr 2014 | A1 |
20140107453 | Maskara et al. | Apr 2014 | A1 |
20140107636 | Bencini | Apr 2014 | A1 |
20140121660 | Hauck | May 2014 | A1 |
20140128757 | Banet et al. | May 2014 | A1 |
20140142393 | Piskun et al. | May 2014 | A1 |
20140194867 | Fish et al. | Jul 2014 | A1 |
20140200429 | Spector et al. | Jul 2014 | A1 |
20140200430 | Spector | Jul 2014 | A1 |
20140214028 | Gelbart et al. | Jul 2014 | A1 |
20140228713 | Thao et al. | Aug 2014 | A1 |
20140243917 | Morley et al. | Aug 2014 | A1 |
20140261985 | Selkee | Sep 2014 | A1 |
20140275916 | Nabutovsky et al. | Sep 2014 | A1 |
20140276052 | Rankin et al. | Sep 2014 | A1 |
20140276811 | Koblish et al. | Sep 2014 | A1 |
20140288548 | Kim et al. | Sep 2014 | A1 |
20140330150 | Thakur et al. | Nov 2014 | A1 |
20140336518 | Shuros et al. | Nov 2014 | A1 |
20140350694 | Behan | Nov 2014 | A1 |
20140358137 | Hu | Dec 2014 | A1 |
20140364715 | Hauck | Dec 2014 | A1 |
20140364843 | Paul et al. | Dec 2014 | A1 |
20140364848 | Heimbecher et al. | Dec 2014 | A1 |
20140379093 | Durgin | Dec 2014 | A1 |
20150005624 | Hauck et al. | Jan 2015 | A1 |
20150011995 | Avitall et al. | Jan 2015 | A1 |
20150018813 | Gliner | Jan 2015 | A1 |
20150133914 | Koblish | May 2015 | A1 |
20150133920 | Rankin et al. | May 2015 | A1 |
20150148796 | Bencini | May 2015 | A1 |
20150164356 | Merschon et al. | Jun 2015 | A1 |
20150224326 | Toth et al. | Aug 2015 | A1 |
20150254419 | Laughner et al. | Sep 2015 | A1 |
20150265341 | Koblish | Sep 2015 | A1 |
20150265348 | Avitall et al. | Sep 2015 | A1 |
20150342672 | Bencini et al. | Dec 2015 | A1 |
20150374252 | De et al. | Dec 2015 | A1 |
20150374436 | Subramaniam et al. | Dec 2015 | A1 |
20160008065 | Gliner et al. | Jan 2016 | A1 |
20160089256 | Belhe et al. | Mar 2016 | A1 |
20160100884 | Fay et al. | Apr 2016 | A1 |
20160113582 | Altmann et al. | Apr 2016 | A1 |
20160113712 | Cheung et al. | Apr 2016 | A1 |
20160174865 | Stewart et al. | Jun 2016 | A1 |
20190223951 | Bencini | Jul 2019 | A1 |
20200222115 | Cheung et al. | Jul 2020 | A1 |
Number | Date | Country |
---|---|---|
2014200766 | Jun 2015 | AU |
2682055 | Oct 2008 | CA |
2847846 | Mar 2013 | CA |
2848053 | Mar 2013 | CA |
1269708 | Oct 2000 | CN |
1455655 | Nov 2003 | CN |
1674836 | Sep 2005 | CN |
1942145 | Apr 2007 | CN |
101045016 | Oct 2007 | CN |
101879060 | Nov 2010 | CN |
102271607 | Dec 2011 | CN |
102573966 | Jul 2012 | CN |
102573986 | Jul 2012 | CN |
103251451 | Aug 2013 | CN |
103917185 | Jul 2014 | CN |
103987336 | Aug 2014 | CN |
104039257 | Sep 2014 | CN |
104244810 | Dec 2014 | CN |
104254368 | Dec 2014 | CN |
104619259 | May 2015 | CN |
104640513 | May 2015 | CN |
104661609 | May 2015 | CN |
1502542 | Feb 2005 | EP |
1547537 | Jun 2005 | EP |
0985423 | Apr 2006 | EP |
1343427 | Jul 2006 | EP |
1717601 | Nov 2006 | EP |
1935332 | Jun 2008 | EP |
1009303 | Jun 2009 | EP |
1343426 | Oct 2012 | EP |
2574278 | Apr 2013 | EP |
2755587 | Jul 2014 | EP |
2755588 | Jul 2014 | EP |
2136702 | Jul 2015 | EP |
2897545 | Jul 2015 | EP |
06-507797 | Sep 1994 | JP |
07-100214 | Apr 1995 | JP |
08-038501 | Feb 1996 | JP |
09-140803 | Jun 1997 | JP |
2000-000242 | Jan 2000 | JP |
2000-083918 | Mar 2000 | JP |
2000-504242 | Apr 2000 | JP |
2002-528039 | Aug 2002 | JP |
2003-504090 | Feb 2003 | JP |
2004-503335 | Feb 2004 | JP |
2005-500127 | Jan 2005 | JP |
2006-239414 | Sep 2006 | JP |
2007-513684 | May 2007 | JP |
2007-513685 | May 2007 | JP |
2007-163559 | Jun 2007 | JP |
2007-244857 | Sep 2007 | JP |
2008-080152 | Apr 2008 | JP |
2009-518150 | May 2009 | JP |
2009-142653 | Jul 2009 | JP |
2010-522623 | Jul 2010 | JP |
2011-142995 | Jul 2011 | JP |
2011-525842 | Sep 2011 | JP |
2012-531967 | Dec 2012 | JP |
5336465 | Nov 2013 | JP |
2014-012174 | Jan 2014 | JP |
2014-531244 | Nov 2014 | JP |
2015-501162 | Jan 2015 | JP |
2015-509027 | Mar 2015 | JP |
10-2010-0021401 | Feb 2010 | KR |
10-1490374 | Feb 2015 | KR |
9221278 | Dec 1992 | WO |
9413358 | Jun 1994 | WO |
9604860 | Feb 1996 | WO |
9725916 | Jul 1997 | WO |
9725917 | Jul 1997 | WO |
9736541 | Oct 1997 | WO |
9745156 | Dec 1997 | WO |
9902096 | Jan 1999 | WO |
9858681 | Mar 1999 | WO |
9909879 | Mar 1999 | WO |
9927862 | Jun 1999 | WO |
9953853 | Oct 1999 | WO |
0029062 | May 2000 | WO |
0141664 | Jun 2001 | WO |
0158372 | Aug 2001 | WO |
0164145 | Sep 2001 | WO |
0168173 | Sep 2001 | WO |
0174252 | Oct 2001 | WO |
0180755 | Nov 2001 | WO |
0202234 | Jan 2002 | WO |
0205868 | Jan 2002 | WO |
0209599 | Feb 2002 | WO |
0219934 | Mar 2002 | WO |
0247569 | Jun 2002 | WO |
2002102234 | Dec 2002 | WO |
0339338 | May 2003 | WO |
2004093703 | Nov 2004 | WO |
2007079278 | Jul 2007 | WO |
2008003058 | Jan 2008 | WO |
2008046031 | Apr 2008 | WO |
2008118992 | Oct 2008 | WO |
2009032421 | Mar 2009 | WO |
2009048824 | Apr 2009 | WO |
2009048943 | Apr 2009 | WO |
2010001595 | Jan 2010 | WO |
2010054409 | May 2010 | WO |
2010056771 | May 2010 | WO |
2010082146 | Jul 2010 | WO |
2011008444 | Jan 2011 | WO |
2011024133 | Mar 2011 | WO |
2011033421 | Mar 2011 | WO |
2011089537 | Jul 2011 | WO |
2011095937 | Aug 2011 | WO |
2011101778 | Aug 2011 | WO |
2012001595 | Jan 2012 | WO |
2012049621 | Apr 2012 | WO |
2012066430 | May 2012 | WO |
2012135703 | Oct 2012 | WO |
2012151301 | Nov 2012 | WO |
2012161880 | Nov 2012 | WO |
2012166239 | Dec 2012 | WO |
2013040201 | Mar 2013 | WO |
2013040297 | Mar 2013 | WO |
2013101923 | Jul 2013 | WO |
2014036439 | Mar 2014 | WO |
2014047281 | Mar 2014 | WO |
2014058375 | Apr 2014 | WO |
2014072879 | May 2014 | WO |
2014152575 | Sep 2014 | WO |
2015138465 | Sep 2015 | WO |
2015143061 | Sep 2015 | WO |
2015183635 | Dec 2015 | WO |
Entry |
---|
Extended European Search Report issued in EP Application 16182627.6, dated Nov. 8, 2016, 5 pages. |
Extended European Search Report issued in EP Application No. 15174537.9, dated Mar. 2, 2016, 7 pages. |
Extended European Search Report issued in EP18177491.0, dated Oct. 26, 2018, 10 pages. |
Goldbert, S. Nahum et al., “Variables Affecting Proper System Grounding for Radiofrequency Ablation in an Animal Model”, JVIR, vol. 11, No. 8, Sep. 2000, pp. 1069-1075. |
Hayerkamp, W., et. al. Coagulation of Ventricular Myocardium Using Radiofrequency Alternating Current: Bio-Physical Aspects and Experimental Findings. PACE, 12:187-195, Jan. 1989, Part II. |
International Search Report and Written Opinion issued in PCT/US2008/058324, dated Aug. 18, 2008, 11 pages. |
International Search Report and Written Opinion issued in PCT/US2012/031819, dated Sep. 27, 2012, 16 pages. |
International Search Report and Written Opinion issued in PCT/US2012/055155, dated Mar. 11, 2013, 19 pages. |
International Search Report and Written Opinion issued in PCT/US2012/055309, dated Nov. 19, 2012, 13 pages. |
International Search Report and Written Opinion issued in PCT/US2012/072061, dated Mar. 21, 2013, 9 pages. |
International Search Report and Written Opinion issued in PCT/US2013/020503, dated Mar. 20, 2013, 10 pages. |
International Search Report and Written Opinion issued in PCT/US2013/021013, dated Apr. 5, 2013, 14 pages. |
International Search Report and Written Opinion issued in PCT/US2013/056211, dated Jan. 20, 2014. |
International Search Report and Written Opinion issued in PCT/US2013/058105, dated Nov. 22, 2013, 16 pages. |
International Search Report and Written Opinion issued in PCT/US2013/060183, dated Jan. 27, 2014, 10 pages. |
International Search Report and Written Opinion issued in PCT/US2013/060194, dated Jan. 29, 2014, 10 pages. |
International Search Report and Written Opinion issued in PCT/US2013/060612, dated Feb. 28, 2014, 16 pages. |
International Search Report and Written Opinion issued in PCT/US2014/027491, dated Sep. 23, 2014, 17 pages. |
International Search Report and Written Opinion issued in PCT/US2015/021300, dated Jun. 9, 2015, 11 pages. |
International Search Report and Written Opinion issued in PCT/US2015/031591, dated Aug. 17, 2015, 11 pages. |
International Search Report and Written Opinion issued in PCT/US2015/055173, dated Jan. 18, 2016, 11 pages. |
International Search Report and Written Opinion issued in PCT/US2015/057242, dated Jan. 15, 2016, 11 pages. |
International Search Report and Written Opinion issued in PCT/US2015/066874, dated Apr. 1, 2016, 11 pages. |
International Search Report and Written Opinion issued in PCT/US2016/028006 dated Jul. 12, 2016, 12 pages. |
International Search Report and Written Opinion received for PCT Patent Application No. PCT/US2010/023574, dated Jun. 18, 2010, 11 pages. |
Invitation to Pay Additional Fees and Partial International Search Report issued in PCT/US2014/027491, dated Jul. 28, 2014, 5 pages. |
IPO First Examination Report issued in Patent Application No. 201717007706, dated Mar. 11, 2020, 7 pages. |
Machi MD, Junji, “Prevention of Dispersive Pad Skin Burns During RFA by a Simple Method”, Editorial Comment, Surg Laparosc Endosc Percutan Tech , vol. 13, No. 6, Dec. 2003, pp. 372-373. |
Neufeid, Gordon R, et al., “Electrical Impedance Properties of the Body and the Problem of Aiternate-site Burns During Electrosurgery”, Medical Instrumentation, vol. 19, No. 2, Mar.-Apr. 1985, pp. 83-87. |
Partial European Search Report issued in EP Application 18177491.0, dated Jul. 16, 2018, 11 pages. |
Partial International Search Report issued in PCT/US2012/055155, dated Dec. 20, 2012, 7 pages. |
Patriciu, A. et al., “Detecting Skin Burns Induced by Surface Electrodes”, published in Engineering in Medicine and Biology Society, 2001, Proceedings of the 23rd Annual International Conference of the IEEE, vol. 3, pp. 3129-3131. |
Piorkowski, Christopher et al., “First in Human Validation of Impedance-Based Catheter Tip-to-Tissue Contact Assessment in the Left Atrium”, Journal of Cardiovascular Electrophysiology, vol. 20, No. 12, Dec. 1, 2009, pp. 1366-1373. |
Pires, L. A. et al. Temperature-guided Radiofrequency Catheter Ablation of Closed-Chest Ventricular Myocardium with a Novel Thermistor-Tipped Catheter American Heart Journal, 127(6): 1614-1618, Jun. 1994. |
Price, Adam et al., “Novel Abalation Catheter Technology that Improves Mapping Resolution and Monitoring of Lesion Maturation”, The Journal of Innovations in Cardiac Rhythm Management, vol. 3, 2002, pp. 599-609. |
Price, Adam et al., “PO3-39 Pin Electrodes Improve Resolution: Enhanced Monitoring of Radioirequency Lesions in the Voltage and Frequency Domains”, Heart Rhythm 2010, 31st Annual Scientific Sessions, May 12-15 in Denver Colorado. |
Ring, E.R., et. Al. Catheter Ablation of the Ventricular Septum with Radiofrequency Energy. American Heart Journal, 117 (6): 1233-1240, Jun. 1989. |
Steinke, Karin et al., “Dispersive Pad Site burns With Modern Radiofrequency Ablation Equipment”, Surg Laparosc Endosc Percutan Tech, vol. 13, No. 6, Dec. 2003, pp. 366-371. |
Zachary, J.M. et al., “PO4-86 Pin Electrodes Provide Enhanced Resolution Enabling titration of Radiofrequency Duration to Lesion Maturation”, Heart Rhythm 2011, 32 Annual Scientific Sessions, May 4-7, San Francisco, CA. |
Woodard et al., Probiotics Improve Outcomes After Roux-en-Y Gastric Bypass Surgery: A Prospective Randomized Trial, J Gastrointest Surg (2009) 13:1198-1204. |
Number | Date | Country | |
---|---|---|---|
20200138331 A1 | May 2020 | US |
Number | Date | Country | |
---|---|---|---|
62063296 | Oct 2014 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 14881112 | Oct 2015 | US |
Child | 16733748 | US |