U.S. patent application number 11/399865 was filed with the patent office on 2006-08-17 for trans-septal catheter with retention mechanism.
Invention is credited to David E. Francischelli, James R. Skarda, Mark T. Stewart.
Application Number | 20060184221 11/399865 |
Document ID | / |
Family ID | 23124867 |
Filed Date | 2006-08-17 |
United States Patent
Application |
20060184221 |
Kind Code |
A1 |
Stewart; Mark T. ; et
al. |
August 17, 2006 |
Trans-septal catheter with retention mechanism
Abstract
A trans-septal guide catheter for providing access through the
septum separating a first heart chamber from a second heart chamber
that includes an elongated guide catheter body extending between
guide catheter proximal and distal ends. A distal segment of the
guide catheter is adapted to be inserted through the septum to
locate the distal segment of the guide catheter within one of the
first heart chamber and the second heart chamber. The catheter body
encloses a guide catheter lumen adapted to provide access into the
one of the first heart chamber and the second heart chamber through
a guide catheter lumen proximal end opening and a guide catheter
lumen distal end opening. A retention mechanism engages the septum
and maintains the distal segment of the guide catheter extending
into the one of the first heart chamber and the second heart
chamber
Inventors: |
Stewart; Mark T.; (Lino
Lakes, MN) ; Francischelli; David E.; (Anoka, MN)
; Skarda; James R.; (Lake Elmo, MN) |
Correspondence
Address: |
James R. Keogh;MEDTRONIC, INC.
710 Medtronic Parkway
Minneapolis
MN
55432
US
|
Family ID: |
23124867 |
Appl. No.: |
11/399865 |
Filed: |
April 7, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10152553 |
May 21, 2002 |
|
|
|
11399865 |
Apr 7, 2006 |
|
|
|
60292483 |
May 21, 2001 |
|
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Current U.S.
Class: |
607/126 ;
606/129 |
Current CPC
Class: |
A61B 2017/00252
20130101; A61B 17/00234 20130101; A61M 25/10 20130101 |
Class at
Publication: |
607/126 ;
606/129 |
International
Class: |
A61N 1/05 20060101
A61N001/05 |
Claims
1-28. (canceled)
29. An ablation system comprising: a trans-septal guide catheter
for providing access through the septum separating a first heart
chamber from a second heart chamber comprising an elongated guide
catheter body extending between guide catheter proximal and distal
ends, a distal segment of the guide catheter adapted to be inserted
through the septum to locate the distal segment of the guide
catheter within one of the first heart chamber and the second heart
chamber, the catheter body enclosing a guide catheter lumen adapted
to provide access into the one of the first heart chamber and the
second heart chamber through a guide catheter lumen proximal end
opening and a guide catheter lumen distal end opening, the catheter
body enclosing first and second inflation and deflation lumens
fluidly connected to first and second proximal inflation ports and
first and second distal inflatable balloons, the first and second
balloons adapted to engage the septum.
30. The system of claim 29 wherein an inflation medium is
introduced through the first balloon inflation and deflation lumen
to inflate the first balloon.
31. The system of claim 29 wherein the first balloon is adapted to
be inflated in one of the first heart chamber and the second heart
chamber.
32. The system of claim 29 wherein an inflation medium is
introduced through the second balloon inflation and deflation lumen
to inflate the second balloon.
33. The system of claim 29 wherein the second balloon is adapted to
be inflated in one of the first heart chamber and the second heart
chamber.
34. The system of claim 29 wherein the first and second balloons
are adapted to be inflated on opposite sides of the septum.
35. The system of claim 34 wherein the first balloon is inflated in
the right atrial chamber and the second balloon is inflated in the
left atrial chamber.
36. The system of claim 29 wherein the trans-septal guide catheter
is adapted to be advanced through an opening in the septum.
37. The system of claim 36 wherein the opening is a formed via a
puncture.
38. The system of claim 36 wherein the opening is a formed via a
perforation.
39. The system of claim 29 wherein the first heart chamber is an
atrial chamber.
40. The system of claim 39 wherein the atrium is a right atrial
chamber.
41. The system of claim 39 wherein the atrium is a left atrial
chamber.
42. The system of claim 29 wherein the second heart chamber is an
atrial chamber.
43. The system of claim 42 wherein the atrium is a right atrial
chamber.
44. The system of claim 42 wherein the atrium is a left atrial
chamber.
45. The system of claim 29 further comprising an ablation device
for delivering ablating energy to tissue, the ablation device being
adapted to be positioned through the guide catheter lumen, the
ablation device comprising an ablation energy source and an
ablation catheter having an ablation member coupled to the ablation
energy source.
46. The system of claim 45 wherein the ablation member is an
ablation electrode.
47. The system of claim 46 wherein the ablation electrode is a
tubular shaped electrode.
48. The system of claim 46 wherein the ablation electrode is a
ring-shaped shaped electrode.
49. The system of claim 46 wherein the ablation electrode is a coil
electrode.
50. The system of claim 45 wherein the ablating energy is direct
current electrical energy.
51. The system of claim 45 wherein the ablating energy is radio
frequency electrical energy.
52. The system of claim 45 wherein the ablating energy is laser
energy.
53. The system of claim 45 wherein the ablating energy is
ultrasound energy.
54. The system of claim 45 wherein the ablating energy is microwave
energy.
55. An ablation method comprising: inserting a distal end of a
trans-septal catheter device into a patient; advancing the distal
end through the patient into a first heart chamber; advancing the
distal end through the septum separating the first heart chamber
from a second heart chamber; inflating a first distal balloon of
the catheter device to engage the septum; inflating a second distal
balloon of the catheter device to engage the septum; advancing an
ablation member through the septum and into the second heart
chamber; positioning the ablation member proximate heart tissue to
be ablated; and delivering ablating energy from an ablation energy
source to the ablation member to ablate heart tissue proximate the
ablation member.
56. The method of claim 55 wherein the trans-septal catheter device
comprises: an elongated catheter body extending between catheter
proximal and distal ends, a distal segment of the catheter adapted
to be inserted through the septum to locate the distal end of the
catheter within the second heart chamber, the catheter body
enclosing a catheter lumen adapted to provide access into the
second heart chamber through a catheter lumen proximal end opening
and a catheter lumen distal end opening, the catheter body
enclosing first and second inflation and deflation lumens fluidly
connected to first and second proximal inflation ports and first
and second distal balloons, the first and second balloons adapted
to engage the septum.
57. The method of claim 56 wherein the ablation member is advanced
through the catheter lumen.
58. The method of claim 55 wherein the distal end of the catheter
is inserted into the neck or groin area of the patient.
59. The method of claim 55 wherein the distal end of the catheter
is inserted into a major artery or vein.
60. The method of claim 55 wherein the first heart chamber is a
right atrial chamber and the second heart chamber is a left atrial
chamber.
61. The method of claim 55 wherein the first heart chamber is a
left atrial chamber and the second heart chamber is a right atrial
chamber.
62. The method of claim 55 wherein the ablation member is an
ablation electrode.
63. The method of claim 62 wherein the ablation electrode is a
tubular shaped electrode.
64. The method of claim 62 wherein the ablation electrode is a
ring-shaped shaped electrode.
65. The method of claim 62 wherein the ablation electrode is a coil
electrode.
66. The method of claim 55 wherein the ablating energy is direct
current electrical energy.
67. The method of claim 55 wherein the ablating energy is radio
frequency electrical energy.
68. The method of claim 55 wherein the ablating energy is laser
energy.
69. The method of claim 55 wherein the ablating energy is
ultrasound energy.
70. The method of claim 55 wherein the ablating energy is microwave
energy.
71. The method of claim 55 wherein the heart tissue to be ablated
is myocardial tissue.
72. The method of claim 55 wherein the distal end of the catheter
is advanced through an opening in the septum.
73. The method of claim 72 wherein the opening is formed via a
puncture.
74. The method of claim 72 wherein the opening is formed via a
perforation.
75. The method of claim 55 wherein the ablation lesions are made
around an orifice.
76. The method of claim 55 further comprising inflating the first
and second balloons on opposite sides of the septum.
77. The method of claim 55 further comprising delivering an
irrigating fluid around the ablation member while delivering
ablating energy to the ablation member.
Description
REFERENCE TO PRIORITY APPLICATION
[0001] This application claims the benefit of U.S. Provisional
Application No. 60/292,483, FILED May 21, 2001, entitled
"TRANS-SEPTAL GUIDE CATHETER WITH RETENTION MECHANISM",
incorporated herein by reference in its entirety.
FIELD OF THE INVENTION
[0002] The present invention relates generally to trans-septal
introducers or guide catheters adapted to introduce an instrument
through the septum between a left and right heart chamber, and more
particularly, the present invention relates to a trans-septal guide
catheter having a retention mechanism for retaining the distal end
of the guide catheter within the left heart chamber particularly to
enable passage therethrough of an electrophysiology (EP)
catheter.
BACKGROUND OF THE INVENTION
[0003] The heart includes a number of pathways through which
electrical signals necessary for normal, electrical and mechanical
synchronous function of the upper and lower heart chambers
propagate. Tachycardia, that is abnormally rapid rhythms of the
heart, are caused by the presence of an arrhythmogenic site or
accessory pathway, which bypasses or short circuits the nodal
pathways in the heart. Tachycardias may be categorized as
ventricular tachycardias (VTs) or supraventricular tachycardias
(SVTs). The most common SVT's include atrioventricular nodal
reentrant tachycardia (AVNRT), Atrioventricular reentrant
tachycardia (AVRT), atrial fibrillation (AF), and atrial flutter
(AFI). Reentrant tachycardias originate in the atria and are
typically caused by an accessory pathway or inappropriate premature
return excitation from the ventricle through the AV node or left
sided accessory pathway. Conditions such as AF and AFI involve
either premature excitation from focal ectopic sites within the
atria or excitations coming through inter-atrial reentry pathways
as well as regions of slow conduction within the atria. VT's
originate from within the ventricles and have their entire circuit
contained within the ventricles. These VT's include bundle branch
reentrant tachycardia (BBR), right ventricular outflow tract
tachycardia (RVOT), and ventricular fibrillation (VF). VT's are
often caused by arrhythmogenic sites associated with a prior
myocardial infarction as well as reentrant pathways between the
ventricles. BBR involves an inappropriate conduction circuit that
uses the right and left bundle branches. RVOT can be described as a
tachycardia originating from the right ventricular outflow tract,
which involves ectopic triggering or reentry mechanisms. VF is a
life threatening condition where the ventricles entertain a
continuous uncoordinated series of contractions that cause a
cessation of blood flow from the heart. If normal sinus rhythm is
not restored, the condition is terminal.
[0004] Treatment of both SVTs and VTs may be accomplished by a
variety of approaches, including drugs, surgery, implantable
electrical stimulators, and catheter ablation of cardiac tissue of
an effected pathway. While drugs may be the treatment of choice for
many patients, drugs typically only mask the symptoms and do not
cure the underlying cause. Implantable electrical stimulators,
e.g., pacemakers, afferent nerve stimulators and
cardioverter/defibrillators, which have proven to provide
successful treatment, usually can only correct an arrhythmia after
it occurs and is successfully detected. Surgical and catheter-based
treatments, in contrast, will actually cure the problem usually by
ablating the abnormal arrhythmogenic tissue or accessory pathway
responsible for the tachycardia. The catheter-based treatments rely
on the application of various destructive energy sources to the
target tissue including direct current electrical energy, radio
frequency (RF) electrical energy, laser energy, ultrasound,
microwaves, and the like.
[0005] RF ablation protocols have proven to be highly effective in
treatment of many cardiac arrhythmias while exposing the patient to
minimum side effects and risks. RF catheter ablation is generally
performed after an initial electrophysiologic (EP) mapping
procedure is conducted using an EP mapping catheter to locate the
arrhythmogenic sites and accessory pathways. After EP mapping is
completed, an RF ablation catheter having a suitable electrode is
introduced to the appropriate heart chamber and manipulated so that
the electrode lies proximate the target tissue. Such catheters
designed for mapping and ablation, frequently include one or more
cylindrical or band-shaped individual electrodes mounted to the
distal section of the catheter so as to facilitate mapping of a
wider area in less time, or to improve access to target sites for
ablation. RF energy is then applied through the electrode(s) to the
cardiac tissue to ablate a region of the tissue that forms part of
the arrhythmogenic site or the accessory pathway.
[0006] Such mapping and ablation catheters are inserted into a
major vein or artery, usually in the neck or groin area, and guided
into the chambers of the heart by appropriate manipulation through
a venous or arterial route, respectively. The catheter must have a
great deal of flexibility or steerability to be advanced through
the vascular system into a chamber of the heart, and the catheter
must permit user manipulation of the tip even when the catheter
body traverses a curved and twisted vascular access pathway. Such
catheters must facilitate manipulation of the distal tip so that
the distal electrode(s) can be positioned and held against the
tissue region to be mapped or ablated.
[0007] The arrhythmogenic sites or accessory pathways to be mapped
and ablated frequently occur within the left atrial wall,
particularly around pulmonary vein orifices. It is preferable in
such cases to introduce an instrument into the right atrium by a
venous route including the inferior vena cava and to advance it
through the septum separating the right and left atrium. In one
exemplary approach, a guide catheter is inserted in this manner
into the right atrium, and instruments are introduced through the
guide catheter lumen that are manipulated from their proximal end
and advanced through the septal wall first creating a very small
trans-septal perforation, and then enlarging the perforation by
dilation or the like. The guide catheter is then advanced over the
instruments or advanced directly through the perforation in the
septal wall to locate the guide catheter distal end within the left
atrial chamber. The penetrating instruments are retracted from the
guide catheter lumen. The proximal end of the guide catheter is
typically taped to the patient's body or a support to inhibit
retraction back into the right atrial chamber. The mapping and
ablation catheters are then inserted through the guide catheter
lumen to locate their distal segments within the left atrial
chamber.
[0008] The mapping and ablation procedures are undertaken, the
mapping and ablation catheters are retracted, and the guide
catheter is also retracted. The trans-septal perforation tends to
shrink as the dilated myocardial tissue expands across the
perforation.
[0009] It is important that the distal segment of the guide
catheter inserted through the septum remain in place for the entire
procedure and not slip back into the right atrium. The guide
catheter can be inadvertently dislodged by movements of the
proximal segment emerging from the site of incision. The
dislodgement can require withdrawal of the instruments in use,
jeopardizing their sterility, while delay occurs in reestablishing
catheter position and resumption of the procedure.
[0010] In addition, the only way to monitor the location of the
distal segment of the guide catheter is through visualization of a
radiopaque marker of the guide catheter in regard to recognizable
physiologic features of the heart.
[0011] It is sometimes necessary that the distal end segment of the
electrophysiology catheter be directed at an acute angle just as it
exits the guide catheter lumen to be directed toward certain
features of the left atrium. Therefore, only a very short distal
segment of the guide catheter is extended into the left atrium past
the septum so that the electrophysiology catheter can be directed
to the feature of interest. It is more difficult to maintain the
distal segment within the left atrium as the distal segment within
the left atrium is shortened.
[0012] There is therefore a need for a guide catheter that does not
readily retract through the septum once it has been extended
through the septum.
SUMMARY OF THE INVENTION
[0013] The present invention is directed to an improved
trans-septal guide catheter that can be passed through a septum
from one heart chamber to another heart chamber and that possesses
a retention mechanism for maintaining a distal segment thereof in
the other heart chamber. For example, the trans-septal guide
catheter can be introduced into the right atrium, passed through
the atrial septum into the left atrium to locate a distal segment
thereof within the left atrium, and retained within the left atrium
so that the distal segment does not readily retract through the
septum into the right atrium.
[0014] The trans-septal guide catheter provides access through the
septum separating a right heart chamber from a left heart chamber
and preferably includes an elongated guide catheter body extending
between guide catheter proximal and distal ends enclosing a guide
catheter lumen adapted to provide access into the left heart
chamber through a guide catheter lumen proximal end opening and a
guide catheter lumen distal end opening. Retention mechanisms are
provided for engaging the septum and inhibiting retraction through
the septum of the distal segment of the guide catheter extending
into the left heart chamber. The trans-septal guide catheter
particularly enables passage of an EP catheter through the guide
catheter lumen for use in mapping and/or ablation of accessory
pathways in myocardial tissue of the left atrial heart wall.
[0015] In one embodiment, the retention mechanism further includes
at least one flexible, pliant, tine extending outwardly from a tine
attachment with the distal segment of the guide catheter body to a
tine free end. The tine free end is adapted to deflect inward
toward the guide catheter body when restrained during advancement
of the guide catheter and to extend further outward from the guide
catheter body when restrained against the septal wall when any
retraction force is applied to the guide catheter tending to
retract the distal segment of the guide catheter body back into the
right heart chamber.
[0016] In another embodiment, the retention mechanism includes an
inflatable balloon inflated and deflated through an inflation and
deflation lumen within the guide catheter body extending from a
proximal inflation port at the guide catheter proximal end to a
balloon inflation port within the inflatable balloon. The inflation
medium is introduced through the balloon inflation and deflation
lumen to inflate the balloon after the balloon is advanced through
the septum into the left heart chamber. The inflated balloon bears
against the septal wall and inhibits retraction through the septum
of the distal segment of the guide catheter extending into the left
heart chamber.
[0017] In still another embodiment, the retention mechanism
includes a wire that is extendable through a wire deployment lumen
of the catheter body. A distal wire segment has a non-straight
configuration when extended out of the deployment lumen end opening
and into engagement with the septal wall of the septum within the
left heart chamber that inhibits retraction through the septum of
the distal segment of the guide catheter extending into the left
heart chamber and is straightened when advanced through the wire
deployment lumen.
[0018] The non-straight configuration of the retention wire can
include a wire coil formed of a plurality of wire turns of a coil,
e.g., a planar coil, or an acute bend in the wire. The retention
wire can be formed of a shape memory alloy to possess
superelasticity that enables straightening of the non-straight
configuration within the wire deployment lumen.
[0019] The guide catheters of the present invention solve the
problem of maintaining the distal segment thereof in the heart
chamber that the distal segment is introduced into and enables
shortening of the length of the distal segment to enable maximal
access to features of the heart chamber, particularly the left
atrium. The retention mechanisms ensure that vent ports in the
sidewall of the guide catheter body distal segment are within the
heart chamber that the distal segment is introduced into and are
not obstructed by the septum.
[0020] The retention mechanisms are preferably located to be
deployed or self deploy in the heart chamber that the distal
segment is introduced into to inhibit retraction when retraction
force is applied to the guide catheter proximal end drawing the
retention mechanism against the septal wall. It will be understood
that the deployment mechanisms can be deployed more proximally to
the guide catheter body distal segment to bear against the septal
wall when advancement force is applied to the guide catheter
proximal end. Slight force can then be applied to hold the catheter
in position without advancing the guide catheter further into the
accessed heart chamber. Moreover, it would be possible to duplicate
the retention mechanism to deploy a retention mechanism on either
side of the septum.
[0021] This summary of the invention and the advantages and
features thereof have been presented here simply to point out some
of the ways that the invention overcomes difficulties presented in
the prior art and to distinguish the invention from the prior art
and is not intended to operate in any manner as a limitation on the
interpretation of claims that are presented initially in the patent
application and that are ultimately granted.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] These and other features and advantages of the invention
will become apparent from the following description in which the
preferred embodiments are disclosed in detail in conjunction with
the accompanying drawings in which:
[0023] FIG. 1 is an overall view of one embodiment of an ablation
and/or EP mapping catheter that can be passed through a guide
catheter of the present invention;
[0024] FIG. 2 is a schematic illustration of the introduction of
the ablation and/or EP mapping catheter distal section into the
left atrium through the lumen of a guide catheter extending through
an incision or perforation through the septum between the right and
left atrium;
[0025] FIG. 3 is a simplified schematic illustration of a first
embodiment of a guide catheter of the present invention having a
deployable retention mechanism comprising an expandable balloon
expanded in the left atrium and drawn against the septal wall in
the left atrium to inhibit retraction of the guide catheter distal
segment into the right atrium;
[0026] FIG. 4 is a cross-section view along lines 4-4 of FIG. 3
depicting the guide catheter lumen and balloon inflation/deflation
lumen;
[0027] FIG. 5 is a simplified schematic illustration of a second
embodiment of a guide catheter of the present invention having a
retention mechanism comprising a plurality of pliant tines drawn
against the septal wall in the left atrium to inhibit retraction of
the guide catheter distal segment into the right atrium;
[0028] FIG. 6 is an end view of the distal segment of the guide
catheter of FIG. 5 depicting the guide catheter lumen and outwardly
extending tines;
[0029] FIG. 7 is a simplified schematic illustration of a third
embodiment of a guide catheter of the present invention having a
deployable retention mechanism comprising an extendable wire that
forms a wire coil when extended from a wire deployment lumen into
the left atrium and inhibits retraction of the guide catheter
distal segment into the right atrium;
[0030] FIG. 8 is a simplified schematic illustration of the third
embodiment of a guide catheter of the present invention showing the
extendable wire that forms the wire coil when extended into the
left atrium retracted into the wire deployment lumen during
introduction or withdrawal of the distal segment through the septum
into or from the left atrium;
[0031] FIG. 9 is a simplified schematic illustration of a fourth
embodiment of a guide catheter of the present invention having a
deployable retention mechanism comprising an extendable wire that
bends over at an acute angle when extended from a wire lumen into
the left atrium and inhibits retraction of the guide catheter
distal segment into the right atrium;
[0032] FIG. 10 is a simplified schematic illustration of the fourth
embodiment of a guide catheter of the present invention showing the
extendable wire that bends over when extended into the left atrium
retracted into the wire deployment lumen during introduction or
withdrawal of the distal segment through the septum into or from
the left atrium;
[0033] FIG.11 is an expanded view of the distal end segment of the
extendable wire of FIGS. 9 and 10; and
[0034] FIG. 12 is a cross-section view along lines 12-12 of FIGS.
7-10 depicting the guide catheter lumen and one embodiment of the
extendable wire lumen and extendable wire cross-section.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0035] FIG. 1 schematically illustrates an anatomically-conforming,
multi-curve ablation and/or EP mapping catheter 10 that can be
introduced through a guide catheter of the present invention for
orienting a distal tip electrode 12 (or electrodes) with respect to
the heart wall for RF ablation and/or EP mapping. The multi-curve
catheter 10 can incorporate a porous tip and catheter lumen for
emitting irrigating fluid around the distal tip electrode 12, but
those features are not illustrated in FIG. 1 to simplify
illustration. Moreover, the distal segment 32 is simplified in FIG.
1 to show an elongated tubular shaped ablation electrode 12 and a
pair of mapping electrodes 13 and 15 in the illustration of FIG. 1,
but the distal segment 32 may include a plurality of ring-shaped
electrodes, one or more coil electrode or the like having other
shapes that are presently used or may come into use and including
several variations described below in reference to other figures
including visible or invisible light, infrared, and electrical
energy from or along the distal tip.
[0036] The catheter 10 includes a catheter shaft or body 20 and a
handle 40. The catheter shaft or body 20 has a shaft axis 24 and
extends between a distal end 26 and a proximal end 28 and is
separated into a proximal section 22 and a distal section 30.
Catheter body 20 may be of any suitable diameter and length and may
be straight or pre-curved along its length, but preferably is
straight when unrestrained. The distal section 30 or the distal
segment thereof can be tapered from the diameter of the proximal
section 22. Preferably, the catheter body 20 has a uniform outside
diameter of about 0.052 inch (1.32 mm) to 0.1040 inch (2.64 mm) and
a length of about 50 cm to 110 cm.
[0037] The proximal section 22 has sufficient column strength and
is capable of good torque transmission to permit controlled
placement of the distal section 30 at a target site in the heart
including a selected cardiac valve or vessel in the manners
discussed below. The distal section 30 is deflectable away from
shaft axis 24 and includes a distal segment 32, a curvable proximal
segment 36 having a proximal segment length, and a bendable
intermediate segment 34 having an intermediate segment length
disposed between the distal segment 32 and the curvable proximal
segment 36. The illustrative tip electrode 12 is positioned along
the distal segment 32, preferably extending proximally from the
catheter body distal end 26 through all or part of the length of
the distal segment 32. The distal segment 32 can include an
elongated ablation electrode 12 that may be solid or irrigated and
can include one or more proximal ring electrodes 13,15 for use in
mapping that are either located proximally as shown or distally
from ablation electrode 12. Each electrode is separately connected
to insulated conductors extending proximally through the catheter
body 20 to terminals of a cable connector in or on the handle 40
that is connected via a cable to the ablation energy source and/or
mapping signal amplifiers. As described further below, a
thermocouple is also typically included in the distal segment 32 of
such ablation catheters, and separately insulated thermocouple
conductors extending proximally through the catheter body 20 to
terminals of the cable connector in or on the handle 40 that are
coupled via a cable to the temperature display and ablation energy
control apparatus known in the art.
[0038] The handle 40 can take any of the forms known in the art for
making electrical connections with the conductors within the
catheter body 20, for delivering irrigation fluid to an irrigation
lumen (if present) of the catheter body 20. The handle 40 also
includes a mechanism for deflecting the distal tip section 30 into
the shapes provided by the present invention. The mechanism can
take any form for pulling, pushing and/or twisting the deflection
or push/pull wires within the catheter body 20 as described further
below. In the illustrated embodiment, the handle 40 is attached to
the catheter body proximal end 28 and supports axially slidable
manipulators comprising push-pull rings 44 and 46 and a rotatable
lateral deflection ring 42 that are coupled to the proximal ends of
a curve deflection push-pull wire, a knuckle deflection push-pull
wire, and a lateral deflection wire identified and described
further below. The lateral deflection ring 42 can be rotated to
impart a torque in a lateral deflection wire coupled thereto to
laterally rotate the distal section 30 with respect to axis 24
within the proximal section 22.
[0039] As shown in FIG. 1, when the push-pull wires are relaxed,
the distal segment 32, the bendable intermediate segment 34, and
the curvable proximal segment 36 are aligned with the shaft axis 24
that is referenced as 0.degree.. The knuckle deflection push-pull
wire can be retracted or pulled by sliding ring 46 proximally to
impart a small radius bend from substantially 0.degree., wherein
the distal and proximal segments 32 and 36 are axially aligned, to
substantially 180.degree., whereby the distal and proximal segments
32 and 36 are substantially in side-by-side alignment. The knuckle
deflection push-pull wire can be extended or pushed by sliding
push-pull ring 46 distally to impart a small radius bend from
substantially 0.degree. to about -90.degree., that is in a bend
direction opposite to the bend direction imparted when the knuckle
deflection push-pull wire is retracted or pulled by sliding ring 46
proximally. The intermediate segment 34 is bent in a bending radius
of between 2.0 mm and 7.0 mm, and preferably less than about 5.0 mm
within the bending angle range. The abrupt knuckle bend angle range
can be restricted further by positioning of the slide end stops for
the push-pull ring 46 during assembly.
[0040] The manipulator push-pull ring 44 can be moved proximally or
distally to move the curve deflection push-pull wire coupled
thereto proximally or distally to form a curve in the proximal
segment 36 that is opposed to or in the same direction as the bend
imparted in the intermediate segment 34. The bend or curve of the
proximal segment 36 that can be induced relative to the catheter
body axis 24 as depicted in the figures can be between -90.degree.
to +270.degree. relative to the proximal section 22. The curvature
range of the proximal segment 36 can be restricted further by
position of the slide end stops for the push-pull ring 44 during
assembly.
[0041] Many possible co-planar curves induced in the segments of
the distal section 30 in relation to the catheter body axis 24
accomplished by selective movement of the axially slidable
manipulator rings 46 and 44 coupled to the knuckle deflection
push-pull wire 56 and the curve deflection push-pull wire 54,
respectively. The distal end of the knuckle deflection push-pull
wire 56 terminates at the junction of the intermediate segment 34
with the distal segment 32, and the curve deflection push-pull wire
54 terminates at the junction of the intermediate segment 34 with
the proximal segment 36. The knuckle deflection push-pull wire 56
and the curve deflection push-pull wire 54 extend in parallel with
and are radially aligned to the catheter body axis 24 along a
common radius extending from the catheter body axis 24 through the
proximal section 22 and the proximal segment 36. The knuckle
deflection push-pull wire 56 is spaced further away from the axis
24 than the curve deflection push-pull wire 54 through the proximal
section 22 and proximal segment 36. The distal section of the
knuckle deflection push-pull wire 56 traversing the intermediate
segment 34 is axially aligned with the axis of the curve deflection
push-pull wire 54 in the proximal segment 36.
[0042] When the ring 42 is rotated clockwise or counterclockwise,
the lateral deflection wire is twisted, causing the junction of the
proximal and intermediate segments 36 and 34 to rotate. It will be
understood from the construction of the lateral deflection wire
described below that a lateral deflection of the tip segment 32 and
the intermediate segment 34 in the range of -90.degree. to
+90.degree. with respect to catheter body straight axis 24 can be
achieved by such rotation.
[0043] The structure of the catheter body 20 that achieves these
angular tip section deflections and the lateral deflection is
illustrated in commonly assigned U.S. patent application Ser. No.
(P-9288.00), filed Oct. 10, 2000, in the names of Mark T. Stewart
et al. for HEART WALL ABLATION/MAPPING CATHETER AND METHOD. The
guide catheter of the present invention is advantageously employed
with this and other ablation and/or EP mapping catheters that are
introduced into through the guide catheter lumen that is itself
extended from the right atrium through the septum to locate a
distal segment of the guide catheter therein as shown in FIG. 2,
for example.
[0044] FIG. 2 is a schematic illustration of the introduction of
the ablation and/or EP mapping catheter distal section into the
left atrium through the lumen 64 of a guide sheath or catheter 60
extending through an incision or perforation through the septum to
locate a guide catheter distal segment 62 within the left atrium.
FIG. 2 illustrates, in simplified form, a sectioned heart 100 and
the major vessels bringing venous blood into the right atrium RA,
oxygenated blood into the left atrium (LA) and the aorta and aortic
arch (FIG. 20) receiving oxygenated blood from the left ventricle
(LV). The venous blood is delivered to the RA through the superior
vena cava (SVC), the inferior vena cava (IVC) and the coronary
sinus (CS) which all open into the right atrium (RA) superior to
the annulus of the tricuspid valve leading into the right
ventricle. Oxygenated blood from the two lungs is delivered into
the left atrium by the left and right, inferior and superior,
pulmonary veins (LIPV, LSPV, RIPV and RSPV) which are superior to
the mitral valve. The RA and LA are separated by an inter-atrial
septum 68, and the RV and LV are separated by a ventricular septum.
The tricuspid valve and mitral valve are not shown completely to
simplify the figures.
[0045] Accessory pathways develop in several parts of the RA and LA
that are reached by the catheter 10 to be mapped and/or ablated in
accordance with methods of use thereof. Premature activations that
cause atrial fibrillation occur frequently in the LA wall,
particularly from pulmonary venous foci around the annular orifices
of certain or all of the pulmonary veins RIPV, RSPV, LIPV, LSPV
shown in FIG. 2. The LA can be accessed in a retrograde manner
through the aorta. However, another convenient approach to the LA
is via a puncture or perforation made through the inter-atrial
septum from the RA. The transseptal guide sheath or catheter 60
depicted in FIG. 2 is inserted through the septum 68 via the
perforation 66.
[0046] The EP mapping/ablation catheter 20 is introduced through
the guide catheter lumen 64, and the handle is manipulated to form
the distal section 30 with about a +90.degree. knuckle bend made in
the intermediate segment and slight positive, neutral or negative
curvatures in the range of about -45.degree. to +45.degree. in the
proximal segment 36 to align the distal tip to locations 2A, 2B or
2C. Continuous lesions can be made around the selected pulmonary
valve orifice by successively moving the distal electrode to the
next location and applying RF ablation energy. The movement can be
effected by twisting the distal segment about the catheter body
axis using the deflection wire and manipulator.
[0047] These manipulations can require that the length of the guide
catheter distal segment 62 be minimized and can cause inadvertent
retraction of the distal segment 62 through the perforation 66 in
the septal wall 68 and into the RA. The guide catheters of the
present invention are formed with a retention mechanism that is
deployed to bear against the LA wall around or alongside the
perforation 66. The perforation 66 is first formed through the
septal wall of the septum 68, a distal segment of the guide
catheter is advanced into the right heart chamber. In this
particular case, the guide catheter is advanced through the IVC
into the RA and then through the perforation 66 to locate the
distal segment in the LA. Then, the retention mechanism is deployed
or self deploys into engagement with the septum 68 to inhibit
retraction of the distal segment of the guide catheter through the
perforation 66 back into RA when any retraction force is applied to
the guide catheter. In this way, access is provided to introduce
instruments or materials into the LA. The preferred use of the
guide catheter of the present invention is to introduce a
mapping/ablation EP catheter of the type depicted in FIGs.1 and 2,
for example, into the LA. Then, the deployment mechanism is
withdrawn or retracted or overcome by applied retraction force to
enable withdrawal of the guide catheter through the perforation
66.
[0048] FIG. 3 is a simplified schematic illustration of a first
embodiment of a guide catheter 70 of the present invention having a
deployable retention mechanism comprising an expandable balloon 78
expanded in the LA and drawn against the septal wall in the LA of
the septum 66 to inhibit retraction of the guide catheter distal
segment 76 into the RA. FIG. 4 is a cross-section view along lines
4-4 of FIG. 3 depicting the guide catheter lumen 72 and balloon
inflation/deflation lumen 82 within the guide catheter body 80.
[0049] The inflatable balloon 78 is inflated and deflated through
the inflation/deflation lumen 82 that extends within the guide
catheter body 80 from a proximal inflation port 86 at the guide
catheter proximal end 74 to a balloon inflation port 84 within the
inflatable balloon 78. The inflation medium (preferably a fluid,
e.g., saline or a radiopaque solution) is introduced through the
balloon inflation/deflation lumen 82 to inflate the balloon 78
after the deflated balloon 78 is advanced through the septum 68
into the LA. The inflated balloon 78 bears against the septal wall
and resists or inhibits retraction through the septum 66 of the
distal segment 76 of the guide catheter 70 extending into the LA.
The mapping/ablation EP catheter can then be introduced through the
guide catheter lumen 72 as depicted in FIG. 2 to map or ablate
cardiac tissue.
[0050] It may be noted that guide catheter 70 may include a second
expandable balloon 78a (shown dashed) that is adapted to be
expanded in the RA and drawn against the septal wall. This is
discussed further below.
[0051] FIG. 5 illustrates a second embodiment of a guide catheter
90 of the present invention having a self deployed retention
mechanism that includes a plurality of pliant tines 98,100 drawn
against the septum in the LA to inhibit retraction of the guide
catheter distal segment 96 through the perforation 66 into the RA.
FIG. 6 is an end view of the distal segment 96 of the guide
catheter of FIG. 5 depicting the guide catheter lumen 92 and
outwardly extending tines 98 and 100.
[0052] Each such flexible, pliant, tine 98,100 extends outwardly
from a tine attachment 102,104 with the distal segment of the guide
catheter body to a respective tine free end 106,108. Preferably,
the flexible, pliant, tines 98, 100 extend proximally and outwardly
from the respective tine attachments 102,104 with the guide
catheter body 94 at an acute angle to the guide catheter body 94.
The tines 98,100 can be rectangular or circular in cross-section
and can be thinner or thicker than depicted and longer or shorter
than depicted. The tines 98, 100 can be formed of a plastic
material, polyurethane or silicone rubber.
[0053] The tine free ends 106 and 108 are able to deflect inward
toward the guide catheter body 94 by contact against the septum 68
when the guide catheter 90 is advanced through the perforation 66.
The tines 98,100 extend or spread further outward from the guide
catheter body 94 against the septal wall as shown in FIG. 5 when
any retraction force is applied to the guide catheter 90 tending to
retract the distal segment 96 of the guide catheter body back into
the RA. While the tines 98,100 resist bending to extend distally,
they can be inverted if sufficient retraction force is applied to
the guide catheter body 94 at its proximal end in order to retract
the distal segment 96 through the perforation 66.
[0054] It will be understood that more than one tine can be
employed arrayed around the circumference of the catheter body 94.
Two additional tines 98' and 100' are illustrated in broken lines
in FIG. 6 to illustrate four tines in this instance. The additional
tines 98', 100' are formed and function in the same manner as tines
98,100 as described above.
[0055] FIG. 7 illustrates a third embodiment of a guide catheter
110 of the present invention having a deployable retention
mechanism that includes an extendable wire 112 that forms a wire
coil 114 when extended from a wire deployment lumen 118 (shown in
FIG. 12) into the LA and inhibits retraction of the guide catheter
distal segment 116 into the RA. The catheter body 122 encloses a
guide catheter lumen 124 (FIG. 12) adapted to receive a
mapping/ablation EP catheter and the wire deployment lumen 118
extending between a deployment lumen proximal end opening and a
deployment lumen distal end opening in the distal segment 120. FIG.
8 shows the extendable wire 112 that forms a wire coil 114 when
extended into the LA retracted into the wire lumen 118 during
introduction into or withdrawal from the RA of the distal segment
116 through the perforation 66 in the septum 68.
[0056] In use, the elongated retention wire 112 is extended at
guide catheter proximal end 126 through the wire deployment lumen
118 to dispose the distal wire segment 114 within the LA as shown
in FIG. 7. The distal wire segment 114 is straightened when
advanced through the wire deployment lumen 118 but forms a
non-straight configuration when extended out of the deployment
lumen end opening and into engagement with the septal wall of the
septum 68 within the LA that inhibits retraction through the septum
of the distal segment 120 extending into the LA. The
mapping/ablation EP catheter can then be introduced through the
guide catheter lumen 124 as depicted in FIG. 2 to map or ablate
cardiac tissue. When the procedure is completed, the elongated
retention wire 112 is retracted as shown in FIG. 8 to enable
retraction of the guide catheter distal segment 120 back into the
RA.
[0057] The retention wire 112 and wire lumen 118 can have a
circular or rectangular cross-section, and the wire coil 114 can be
any desired non-straight configuration, e.g., a wire coil formed of
a plurality of wire turns wound in a common plane as shown or into
any other coil shape. The retention wire 112 can be formed of a
shape memory alloy that possesses superelasticity that enables
straightening of the non-straight configuration within the wire
deployment lumen 118.
[0058] FIGS. 9-11 illustrate a fourth embodiment of a guide
catheter 130 of the present invention having a deployable retention
mechanism that includes a distal section 134 of extendable wire
132. The distal section 134 bends over at an acute angle at bend
146 when extended from a wire lumen 138 (FIG. 12) into the LA and
inhibits retraction of the guide catheter distal segment 140 into
the RA by bearing against the septal wall of septum 68. The acute
bend 146 in the wire 132 is straightened during advancement through
the wire deployment lumen 132 as shown in FIG. 10 and by the broken
lines of FIG. 11.
[0059] The retention wire 132 and wire lumen 138 can have a
circular or rectangular cross-section. The retention wire 132 can
be formed of a shape memory alloy and possesses superelasticity
that enables straightening of the non-straight configuration within
the wire deployment lumen 138.
[0060] Each of the retention wires 112 and 132 can also be formed
of a non-conductive plastic material having shape memory of the
non-straight configuration when released and capable of being
straightened to traverse a wire deployment lumen.
[0061] It will be seen that the particular embodiments of the guide
catheter can be used to guide ablation/mapping EP catheters like
catheter 10 of FIGS. 1 and 2 or can be used to access the LA from
the RA to introduce any other instrument or material into the LA
from outside the patient's body in performance of any suitable
medical procedure. It will also be understood that the guide
catheters of the present invention can be employed to access the LV
from the RV to introduce any other instrument or material into the
LV from outside the patient's body in performance of any suitable
medical procedure. Moreover, it will be apparent that such a guide
catheters of the present invention can be employed to access a
right heart chamber from a left heart chamber.
[0062] Each of the above-described embodiments and alternatives and
equivalents thereof are used in a method of providing access
through the septum separating a right heart chamber from a left
heart chamber and deploying the retention mechanism into engagement
with the septum to maintain the distal segment of the guide
catheter extending into the heart chamber accessed by the
perforation in place. The retention mechanisms are preferably
located along the catheter body to be deployed or self deploy into
the heart chamber that the distal segment is introduced into to
inhibit retraction when retraction force is applied to the guide
catheter proximal end drawing the retention mechanism against the
septal wall. It will be understood that the deployment mechanisms
can be deployed more proximally to the guide catheter body distal
segment to bear against the septal wall when advancement force is
applied to the guide catheter proximal end. Slight force can then
be applied to hold the catheter in position without advancing the
guide catheter further into the accessed heart chamber. Moreover,
it would be possible to duplicate the retention mechanism to deploy
a retention mechanism on either side of the septum.
[0063] For example, referring back to FIG. 3, the balloon 78 and
port 84 can be located along the catheter body to be expanded in
the RA. An exemplary balloon of this nature is shown as balloon 78a
(shown dashed). In one embodiment, duplicate balloon 78a and port
can be located along the catheter body to be expanded in the RA
along with balloon 78 and port 84. Referring to FlGs. 5 and 6, the
tines 98,100 (and 98', 100') can be located along the catheter body
to extend outward in the RA and bear against the septal wall. Or, a
duplicate set of tines can be located along the catheter body to
extend outward in the RA along with the depicted tines 98,100 (and
98', 100'). Referring to FIG. 8, the wire coil 114 can be deployed
from the wire deployment lumen 118 from a lumen distal end opening
along the catheter body to extend outward in the RA and bear
against the septal wall. Or, a duplicate wire coil can be deployed
along the catheter body to extend outward in the RA along with the
depicted wire coil 114. Referring to FIG. 9, the bent wire distal
section 134 can be deployed from the wire deployment lumen 138 from
a lumen distal end opening along the catheter body to extend
outward in the RA and bear against the septal wall. Or, a duplicate
bent wire distal section can be deployed along the catheter body to
extend outward in the RA along with the depicted bent wire distal
section 134.
[0064] Although particular embodiments of the invention have been
described herein in some detail, this has been done for the purpose
of providing a written description of the invention in an enabling
manner and to form a basis for establishing equivalents to
structure and method steps not specifically described or listed. It
is contemplated by the inventors that the scope of the limitations
of the following claims encompasses the described embodiments and
equivalents thereto now known and coming into existence during the
term of the patent. Thus, it is expected that various changes,
alterations, or modifications may be made to the invention as
described herein without departing from the spirit and scope of the
invention as defined by the appended claims.
* * * * *