U.S. patent number 3,837,347 [Application Number 05/245,938] was granted by the patent office on 1974-09-24 for inflatable balloon-type pacing probe.
This patent grant is currently assigned to Electro-Catheter Corporation. Invention is credited to Allen J. Tower.
United States Patent |
3,837,347 |
Tower |
September 24, 1974 |
INFLATABLE BALLOON-TYPE PACING PROBE
Abstract
A catheter device having a tubular assembly with a forward probe
portion including spaced proximal and distal members having
electrodes secured thereto and being provided with inflatable means
comprising a balloon member interconnecting said members; and fluid
receiving means in communication with the probe portion for
dilating said balloon member upon exposure to fluid introduced
under pressure through the fluid-receiving means.
Inventors: |
Tower; Allen J. (Old Bridge,
NJ) |
Assignee: |
Electro-Catheter Corporation
(Rahway, NJ)
|
Family
ID: |
22928705 |
Appl.
No.: |
05/245,938 |
Filed: |
April 20, 1972 |
Current U.S.
Class: |
607/128; 606/192;
604/96.01; 604/21 |
Current CPC
Class: |
A61N
1/056 (20130101) |
Current International
Class: |
A61N
1/05 (20060101); A61n 001/04 () |
Field of
Search: |
;128/404,419P,34B,34D,34E,2.5R,2.6E,2.6R,2M,35R,349R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Lilling & Siegel
Claims
What is claimed is:
1. A pacing and sensing catheter device for use within body
cavities, comprising: an elongated tubular assembly formed at a
forward end thereof with a probe portion adapted to be inserted
into and moved within said body cavities, said tubular assembly
being further formed at a rearward end thereof with means
communicative with said forward end for receiving a fluid; said
probe portion including spaced proximal and distal members and
proximal and distal electrodes secured to said proximal and distal
members, respectively; a first conductor electrically connected to
said proximal electrode, a second conductor electrically connected
to said distal electrode, and said first and second conductors
being electrically insulated from each other; inflatable means
formed of an elastic material secured to and interconnecting each
of said spaced proximal and distal members; and said inflatable
means, comprising a balloon member adapted to be inflated upon
fluid introduced under pressure through said fluid receiving means,
whereby the forward end of said probe portion is resiliently
mounted for inhibiting the transfer of forces between said proximal
and distal members.
2. The device according to claim 1, wherein said first and second
electrical conductors are elongated and extend in spaced
relationship within said tubular assembly.
3. The device according to claim 2 for use with remote heartbeat
pacing apparatus, further comprising first and second electrical
connectors secured to said first and second conductors,
respectively, for electrically interconnecting said proximal and
distal electrodes with said remote apparatus.
4. The device according to claim 3, wherein said proximal and
distal members comprise spaced segments of said elongated tubular
assembly, said proximal member being substantially longer than said
distal member and being formed with a forward end which defines an
opening communicative with interior walls of said balloon member,
said distal member extending between forward and rearward ends
thereof which define foward and rearward openings, respectively,
the forward end of said proximal member and the rearward end of
said distal member being disposed in variably juxtaposed
relationship with respect to one another.
5. The device according to claim 4, wherein said balloon member is
secured to and extends between outer annular surfaces of said
proximal and distal members adjacent the juxtaposed ends
thereof.
6. The device according to claim 5, wherein said proximal electrode
comprises an annular platinum sleeve secured to the outer surface
of said proximal member, said proximal member being formed with an
aperture through which said first electrical conductor extends to
said proximal electrode, said distal electrode comprising a
cup-shaped platinum member surrounding the forward end of said
distal member and being secured to the outer annular surface of
said distal member, said second electrical conductor extending from
within said proximal member through the rearward and forward ends
of said distal member, and being electrically connected to said
cup-shaped distal electrode by a soldered deposit disposed within
and in electrical contact with the inner portion of said cup-shaped
distal electrode.
7. The device according to claim 1, wherein said fluid receiving
means comprises an adaptor formed with an opening which is adapted
to matingly accept an end of a fluid bearing conduit.
8. The device according to claim 7, further including a vented
syringe adapted to be sealingly connected to said fluid bearing
conduit for pressurizing said balloon member to a pre-determined
value.
Description
This invention relates generally to insertion probes and/or
catheters and, more specifically, to an inflatable balloon-type
pacing probe capable of being moved within body cavities and/or
blood vessels of persons and animals.
The medical professions have enjoyed considerable success over the
years using devices such as catheters and probes, which are
introduced or inserted into body channels and blood vessels.
Catheters are most frequently employed within the urinary tract to
withdraw urine from the bladder, for example, by passing the
catheter through the urethra or passage through which urine is
normally discharged. Probes, on the other hand, which are not
provided with openings to receive body fluids, must also be capable
of insertion into and movement within relatively small body
cavities, such as blood vessels, without injuring vessel and organ
tissues or causing discomfort to the patient or animal being
treated.
While the present invention is principally directed to probes for
use in pacing or regulating the heartbeats of a person or animal,
it is contemplated and within the scope of this invention to
provide medical personnel with insertion apparatus such as probes
and the like equipped with structural safety features which
minimize or eliminate tissue damage and discomfort.
Balloon-type insertion devices are well known to the art. In many
instances a bag or balloon formed of rubber other stretchable
material is provided on catheters, for example, to retain the
catheter within a body channel by inflating the balloon once the
device is properly located. The expanded bag or balloon contacts
the tissue walls defining the body channel and further movement
into or out of the channel is prevented. Such insertion devices
known to the art, however, often cause considerable tissue damage
and patient discomfort both when being inserted as well as when
being inflated. Although such devices are fabricated of relatively
flexible and resilient material, most of these flexibility and
resilience characteristics are exhibited in transverse directions
with respect to the relatively longitudinal axes of these normally
elongated tubes. Thus, while the tube of a catheter will easily
bend to conform to the contour of a body channel, there yet will be
an uncushioned relatively longitudinal transfer of forces to the
forward tip or end of this tube which are required to advance it
upon insertion.
Another problem associated with conventional balloon-type insertion
devices concerns itself with the inflation of the balloon. Here
again, since conventional devices already described are formed with
a balloon extending annularly around a continuous portion of the
tubing near or adjacent its forward tip, the presence of a
continuous length of tubing prevents substantial elongation or
shortening of this tube when body tissue is contacted by either the
forward tip of this tubing or the expanded balloon. Forces are thus
transmitted directly to the tissue without being cushioned and, as
is sometimes the case, tissue walls are damaged or even punctured
or torn.
Accordingly, it is an object of the present invention to provide a
balloon-type, flow-directed insertion device equipped with safety
cushioning means for preventing tissue damage.
Another object of the present invention is to provide a novel
balloon-type pacing probe for use in stimulating the heart's
muscles.
Yet another object of this invention is to provide a segmented
insertion device for use within elongated cavities wherein the
segments are joined by an inflatable balloon adapted to isolate
forces from being transmitted between segments.
A further object of my invention is to provide a segmented
balloon-type pacing probe for use within body blood vessels, and
which is of a predetermined relatively small diameter with respect
to the diameter of said blood vessels, such that the normal flow of
blood is not restricted during its use.
Yet another object of the present invention is to provide a flow
directed, balloon-type pacing probe for use in indicating and/or
evaluating heart block Adams-Stokes seizures, marked bradycardia,
ventricular tachy-arrhythmias and digitalis induced
arrhythmias.
The present invention fulfills the aforementioned objects and
overcomes limitations and disadvantages of prior art solutions to
problems associated with this art. According to one aspect of the
invention, an elongated, relatively flexible tubular assembly is
formed with a hollow resilient insertion tube extending between
forward and rearward ends thereof. The assembly is preferrably
provided at its forward end with a multi-electrode or multi-polar
pacing probe capable of regulating the frequency of heartbeats in
response to signals generated outside the body. This probe is
introduced, for example, into the right shoulder region of the
patient via a 14 gauge cannula or cut-down. The hollow insertion
tube is formed in two spaced segments of different lengths which
are mechanically interconnected by an inflatable balloon which, in
turn, extends annularly about the space between said segments. The
longer or proximal tube segment carries a proximal electrode to
which an electrical conductor is secured. The shorter or distal
tube segment carries a distal electrode to which another electrical
conductor is soldered and which is electrically insulated from the
proximal electrode and its respective conductor. Both the proximal
and distal electrodes serve to stimulate the heart in response to
impulses carried to them from remote signal-generating apparatus
via said conductors.
The invention will be more clearly understood from the following
description of a specific embodiment of the invention, together
with the accompanying drawings, wherein similar reference
characters denote similar elements throughout the several views,
and in which:
FIG. 1 is a fragmentary view of the entire probe assembly according
to one embodiment of the invention;
FIG. 2 is an enlarged fragmentary view of the insertion
balloon-type tip or probe portion of the invention shown in FIG.
1;
FIG. 3 is a cross-sectional elevational view of the insertion tip
or probe portion of FIG. 2, illustrating the balloon in its
inflated condition; and
FIG. 4 is an enlarged cross-sectional elevational view looking
along line 4--4 of FIG. 3.
Referring now in more detail to the drawing, in FIG. 1 a
balloon-type bi-polar pacing insertion assembly, generally
designated numeral 10, is shown to include elongated hollow tubing
12 which extends between a valved adaptor assembly 14 and a probe
assembly 16.
Tubing 12, is a preferred embodiment of the invention, consists of
a chemically and organically non-porous material such as Corolan
which is manufactured by the Electro-Catheter Corporation of
Rahway, New Jersey, and which is capable of being sterilized by
heat or chemical action, and which further has a substantially
smooth, low-friction surface so as to be capable of easy insertion
into and through a body cavity, such as a vein. Other suitable
materials may be substituted for tubing 12 and are contemplated by
this invention, including, without limitation, radio opaque
vinyl-type tubing which is visible by X-ray. Tubing 12 is
relatively flexible to permit its passage through irregular body
channels such as the veins leading to the heart.
Valved adaptor assembly 14, as shown in FIG. 1, consists of a
Y-shaped plastic or rubber housing 18 formed with a leg or end 20
which receives and is secured air-tightly to the rearward end of
tubing 12, such as by potting or cementing. Another leg or end 22
of housing 18 holds two insulated electrical wires or conductors 24
and 26, which extend from housing end 22 at their most rearward
ends to male electrical connector pins 28 and 30, respectively.
Connector pins 28 and 30 are of a conventional type which will
matingly engage electrical sockets (not shown) of remote apparatus,
described in more detail below. Housing legs or ends 20 and 22
serve as strain-reliefs in receiving tubing 12 and conductors 24
and 26 such that the possibility of breakage or fracture is
minimized. Legs or ends 20 and 22 further serve as air-tight
junctions, thereby preventing the undesirable flow of air between
the interior of adaptor assembly housing 18 and the
environment.
Larger leg or end 32 of housing 18 is formed with a tapered opening
34 which is adapted to receive the forward end of a vented-type
syringe, or air duct, designated reference numeral 34 in FIG. 1.
Thus, air or another pre-selected fluid may be introduced under
pressure through opening 34, such as by moving the plunger of a
vented syringe 36 forward within its barrel, and thereafter through
hollow tubing 12 toward probe assembly 16. Vented syringe 36 is
preferably a 21/2 cubic centimeter (cc) syringe formed with a hole
through its barrel at a location corresponding to 11/2 cc, thereby
preventing the possibility of bursting balloon 70, described below.
No more than 11/2 cc of fluid is thus introduced. Adaptor assembly
14 is preferable equipped with a valve of a type known to the art,
for preventing undesirable fluid or air flow through the housing
18, as well as to enable personnel to control the fluid pressure
within tubing 12.
Looking now at probe assembly 16 in FIGS. 2 and 3, it is seen that
assembly 16 comprises two forward segments of tubing 12 which, for
convenience, are designated proximal tubing segment 38 and distal
tubing segment 40 in FIG. 3. The adjectives proximal and distal are
hereinafter used merely to denote locations with respect to valved
adaptor assembly 14. Distal segment 40 is substantially shorter
than proximal segment 38 and is preferable formed by severing a
predetermined length of tubing from the forward end of tubing
12.
Proximal tubing segment 38 terminates at a forward end 42 which
defines an opening 44. Distal tubing segment 40 extends between its
rearward end 46 and a forward end 48, both ends defining openings
50 and 52, respectively. Forward end 42 and rearward end 46 are
spaced from one another a predetermined distance which, in a
preferred embodiment of the invention, is three (3) millimeters. It
is within the scope of this invention for this distance to vary,
preferably between two (2) and five (5) millimeters, although my
invention contemplates a spacing of from one (1) to ten (10 )
millimeters.
Probe assembly 16 further includes an annular proximal electrode 54
which is bonded to tubing segment 38 a small distance from forward
end 42. Proximal electrode 54 is formed of an electrically
conductive metal, preferably platinum. Similarly, a cup-shaped
distal electrode 56 is bonded to distal tubing segment 40 such that
the interior of distal electrode 56 annularly surrounds and
encloses forward end 48 of segment 40. Distal electrode 56 is
preferably made of platinum or other suitable electrically
conductive material, and is formed with a hollow nose portion 58
which constitutes the forwardmost tip of insertion assembly 10. The
outer surfaces of nose portion 58 are smooth and frictionless, and
are rounded to provide a blunt convex surface designed not to
irritate, puncture or damage body tissue.
A predetermined quantity of solder 60 located within the hollow
nose portion 58 of distal electrode 56 firmly, both mechanically
and electrically, secures distal electrode 56 to a central cabe
assembly 62 which, in turn, extends relatively longitudinally
through the confines of tubing from adaptor assembly 14 to segments
38 and 40 and thereafter to solder 60. It is important here to
emphasize the importance of the strong mechanical locking of distal
electrode 56 to the remainder of the insertion assembly 10 since,
as it should be apparent, separation of the distal electrode and/or
tubing segment 40 within the circulatory system of a patient could
result in substantial injury, or possibly death. The firm bonding
of distal electrode 56 to tubing segment 40, coupled with the firm
soldered bond of distal electrode 56 to cable assembly 62
effectively precludes this danger. The presence of an inflatable
bag or balloon 70, shown in FIGS. 2 and 3 are described in more
detail below, serves to yet further eliminate this danger of
separation.
Cable assembly 62 preferably comprises a Teflon coated, brass
plated electrical conductor 64, such as copper (Teflon is a
registered trademark of the E. I. duPont de Nemours, Inc. of
Wilmington, Delaware). Assembly 62 is relatively flexible and
easily bends such that forces applied directly to the nose portion
58 of distal electrode 56 will result in a lessening of the
distance between tubing segment ends 42 and 46. A conductive wire
68 extends through proximal tubing segment 38 of elongated tubing
12 to and through an aperture 66 formed through the wall of
proximal tubing segment 38, and thereafter to and in mechanical and
electrical contact with proximal electrode 54, such as by soldering
or brazing. Conductor 64 and wire 68 are electrically insulated
from one another by virtue of the presence of the Teflon coating
around the length of conductor 64. Conductor 64 and wire 68 are
mechanically and electrically connected within adaptor assembly 14
to conductors 24 and 26, respectively, and thus, also to connector
pins 28 and 30, respectively. It is contemplated by and within the
scope of the present invention to substitute a single conductor or
wire in the place of conductors 64 and 24; and similarly, to
substitute a single conductor or wire in the place of wire 68 and
conductor 26.
An inflatable bag or balloon 70 is shown relaxed in FIG. 2 and
inflated in FIGS. 3 and 4. Balloon 70, in a preferred embodiment of
this invention, comprises a latex tube which extends annularly over
and in firm air-tight, bonded contact with the outer surfaces of
both forward end 42 of tubing segment 38 and rearward end 46 of
tubing segment 40. Bonding of the inner extremities of balloon 70
to tubing segments 38 and 40 may be accomplished by cementing,
heat-induced welding or fusion, or other suitable conventional
means. Balloon 70 may be fabricated from suitable stretchable
materials other than latex, which are inert and which are capable
of being sterilized by heat or chemical action.
It should now be apparent that fluid, preferably air, introduced
under predetermined pressures into elongated tubing 12 by syringe
36, for example, will cause balloon 70 to gradually stretch or
expand both radially outwardly to a diameter approximately
one-quarter to one-half the diameter of the blood vessel within
which it is situated, as well as longitudinally from the relaxed
position shown in FIG. 2 to that shown in FIG. 3. The longitudinal
expansion of balloon 70, in turn, causes distal electrode 56 to be
biased away from proximal electrode 54, such that the spacing or
distance between ends 42 and 46 of tubing segments 38 and 40 is
increased. Upon deflation of balloon 70, segment 40 will once again
return to its original spacing from segment 38.
In use, the probe assembly 16 of insertion assembly 10 is caused to
enter a blood vessel through a placement or percutaneous needle
inserted through an incision made in the skin of a patient, and
probe assembly 16 together with portions of tubing 12 are
manipulated through the blood vessel toward the heart. This is
accomplished with the balloon 70 completely relaxed and without the
presence of pressures greater than atmospheric pressure within
tubing 12. Either by noting the length of tubing 12 inserted, or by
monitoring of the location of probe assembly 16 in a conventional
manner known to the medical arts, a relatively precise positioning
of the proximal and distal electrodes is accomplished. Once
positioned within the superior vena cava balloon 70 is inflated in
the manner heretofore described and the inflated probe assembly is
advanced to the right ventricle of the heart, whereupon the balloon
is deflated and the probe assembly is stabilized in the apex of the
ventricle. The position of the probe can be verified by X-ray of
the patient's chest, or fluoroscopy.
Connector pins 28 and 30 can be mechanically and electrically
connected to an electrocardiograph apparatus, so that monitoring of
the position of the distal electrode has been enabled, and
thereafter connected to an impulse generator, such as a Pacemaker,
a registered trademark of the Electro-Catheter Corporation of
Rahway, New Jersey. Electrical impulses generated by the Pacemaker
are carried to proximal and distal electrodes 54 and 56, thereby
stimulating the rhythmic contractions within the heart commonly
known as heartbeats.
During the insertion of the probe, nose portion 58 may come into
contact with body tissue on its journey towards the heart, due to
the irregular path defined by the blood vessel. This contact with
body tissue will impede the progress of the probe and will both
result in displacement of the tissue, and will create forces on the
probe tip or nose. The result will be movement of distal tubing
segment 40 and proximal tubing segment 38 towards one another. This
safety feature of relative movement as between these segments
prevents the puncturing of body tissue and is facilitated by both
the presence of the space between the segments, as well as the
resilient compressibility of the relaxed balloon 70.
Thus, forces existing in proximal tubing segment 38 necessary to
advance the probe will not be transmitted directly to body tissue,
but will be absorbed by the cushioning effect of the collapsible
balloon 70.
Yet another novel safety feature of this invention resides in the
characteristics exhibited by probe assembly 16 once it has been
properly positioned and it is desired to inflate balloon 70. Upon
inflation of balloon 70 in the manner described, should the outer
walls of the balloon gradually contact and come to bear against the
inner body tissue walls defining the cavity within which the probe
assembly has been positioned, increases in pressure within tubing
12 will result in corresponding increases in bearing forces against
this wall tissue as a result of the balloon's attempts to expand
under this pressure. The present invention prevents these bearing
forces from becoming dangerously excessive by permitting elongation
of balloon 70 when restrained by body tissue from expanding
outwardly or transversely from the axis of tubing 12, and by
permitting a separation of tubing segments 38 and 40 from one
another by virtue of their resilient interconnection with balloon
70. It is also significant that once balloon 70 has been inflated,
movement of either of segments 38 or 40 will not be carried
directly to the body tissue, but will result in a flexing of the
resilient pressurized balloon.
Both in the case just described where balloon 70 is relaxed, as
well as in the case where the balloon is being inflated, probe
assembly 16 and its elements exhibit a greater flexibility and
resilience than heretofore made possible in the art. Greater
angular displacements of distal electrode 56 from its normal
longitudinal axis are possible with this electrode than are
possible with known, more rigid continuous tubings. Furthermore,
FIG. 3 clearly illustrates the fact that less angular and shear
stresses will be present at the points of securement of balloon 70
to tubing segments 38 and 40 than in prior art-type balloon
devices, due to the break or gap between these segments. The
ability of segments 38 and 40 to move away from one another greatly
relieves any stress concentrations at the points at which the
annular balloon joins these segments.
While the invention has been described for a single pole or
bi-polar pacing probe for use in persons, it is contemplated that
the safety features of the invention have considerable advantageous
use in veterinary medicine. A single pole device may be employed
wherein a second electrode is positioned on the patient's skin. It
is also contemplated and within the scope of this invention that a
balloon-type probe strucure of the type described may be used in
non-pacing medical applications, such as the curing of an embolemia
within a person or animal, by utilizing the inflatable balloon 70
to remove a clot from the circulatory system.
The embodiment of the invention particularly disclosed is presented
merely as an example of the invention. Other embodiments, forms and
modifications of the invention coming within the proper scope of
the appended claims will, of course, readily suggest themselves to
those skilled in the art.
* * * * *