CA2154773C - Intravascular sensing device - Google Patents
Intravascular sensing device Download PDFInfo
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- CA2154773C CA2154773C CA002154773A CA2154773A CA2154773C CA 2154773 C CA2154773 C CA 2154773C CA 002154773 A CA002154773 A CA 002154773A CA 2154773 A CA2154773 A CA 2154773A CA 2154773 C CA2154773 C CA 2154773C
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- intravascular device
- guidewire
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
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- A—HUMAN NECESSITIES
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- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/1214—Coils or wires
- A61B17/12145—Coils or wires having a pre-set deployed three-dimensional shape
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- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/1214—Coils or wires
- A61B17/1215—Coils or wires comprising additional materials, e.g. thrombogenic, having filaments, having fibers, being coated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12163—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a string of elements connected to each other
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/02007—Evaluating blood vessel condition, e.g. elasticity, compliance
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
- A61B5/287—Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
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- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
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- A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
- A61B17/22012—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
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- A61B2017/00026—Conductivity or impedance, e.g. of tissue
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
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- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
- A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
- A61B2017/12063—Details concerning the detachment of the occluding device from the introduction device electrolytically detachable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/02—Details of sensors specially adapted for in-vivo measurements
- A61B2562/0209—Special features of electrodes classified in A61B5/24, A61B5/25, A61B5/283, A61B5/291, A61B5/296, A61B5/053
- A61B2562/0215—Silver or silver chloride containing
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/04—Arrangements of multiple sensors of the same type
- A61B2562/043—Arrangements of multiple sensors of the same type in a linear array
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- Animal Behavior & Ethology (AREA)
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- Heart & Thoracic Surgery (AREA)
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- Vascular Medicine (AREA)
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- Pathology (AREA)
- Biophysics (AREA)
- Physics & Mathematics (AREA)
- Cardiology (AREA)
- Physiology (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
- Media Introduction/Drainage Providing Device (AREA)
- Surgical Instruments (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
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Abstract
A system for detecting electrical activity within a patient's heart comprising an elongated intravascular device (10), such as a catheter or guidewire, having at least one bipolar electrode pair (17, 18) on a distal section (12) of the elongated device to intravascularly detect electrical activity within the patient's heart. The catheter or guidewire preferably has a tubular shaft (14) formed of braided strands which include a plurality of insulated conductors (15) which are electrically connected to the bipolar electrodes (17, 18).
Description
~NTRAVASCULAR SENSING DEVICE
BACKGROUND OF THE INVENTION
This invention generally relates to the detection of electrical activity or signals within a patient's heart and particularly for determining the source of signals causing arrhythmia.
Prior methods for treating a patient's arrhythmia include the use of antiarrhythmic drugs such as sodium and calcium channel blockers or drugs which reduce the Beta-adrenergic activity. Other methods include the surgically sectioning the origin of the signals causing the arrhythmia or the conducting pathway for such signals. More frequently.
however, to terminate the arrhythmia, the heart tissue which causes the arrhythmia is destroyed by heat, e.g. applying a laser beam or radio frequency (RF) energy to a desired location on the patient's endocardium.
In the tatter instance, the location of the site causing the arrhythmia must be accurately known in order to be able to contact the WO 94/16618 ' PCT/L1594/01054i~
desired location with a tissue destroying device. A major problem of ablating the site of the origin of the signals or a conductive pathway is to accurately determine the site so that an excessive amount of good tissue is not destroyed along with the arrhythmogenic site to ensure that the arrhythmia does not return. For example, the average arrhythmogenic site consists of about 1.4 cm2 of endocardial tissue, whereas a re-entrant site might be much larger. RF ablation techniques produce lesions about 0.5 cm2 in diameter, so several lesions may have to be formed to completely ablate the area of interest. If the arrhythmogenic or re-entrant site is not accurately mapped, much good tissue surrounding the site will be unnecessarily destroyed.
A variety of methods have been used to detect electrical activity within a patient's heart to facilitate the mapping of electrical activity causing the arrhythmia. A number of U.S. Patents describe the use of elongated intravascular signal sensing devices which are advanced through the patient's vasculature until the distal portions of the sensing devices are disposed within one of the heart chambers with one or more electrodes on the distal portion in contact with the endocardial lining.
While this procedure is widely used, it does not always allow the site of arrhythmogenic signals to be accurately determined.
The literature also mentions advancing an intravascular signal sensing device within a patient's coronary artery or coronary sinus or a ' _2_ WO 94/1661 ~ ~ ~ ~ ~ PCTlUS94101054 cardiac vein. However, these methods appear to be experimental and have not been widely used clinically.
What has been needed is a method and system for accurately detecting the source of signals which cause the arrhythmia .
SUMMARY OF THE INVENTION
This invention is directed to an elongated intravascular sensing device for detecting electrical activity of a patient's heart within a vein or artery thereof, and particularly the electrical activity which causes arrhythmia.
The intravascular sensing device of the invention comprises an elongated shaft with a proximal section and a distal section, with the distal section of the shaft being configured so as to be advanceable through the patient's coronary anatomy. The distal section is provided with at least one and preferably a plurality of bipolar electrode pairs spaced along a length of the distal section. Up to 20 or more bipolar electrode pairs may be provided along the distal section of the shaft.
The shaft of the intravascular sensing device is preferably formed of a plurality of insulated electrical conductors braided or wound into an elongated tubular member, although not all of the strands which make up the tubular member need be electrical conductors. The insulation on separate conductors is exposed under each of the sensing electrodes so that an electrical connection can be made. The electrical 2~~~~'~'~~ .
WO 94/16618 ~ PCT/US94/01054 ai connection may be secured by means of a suitable solder or brazing material, and the electrodes may be secured to the underlying tubular member by a suitable means such as an adhesive to ensure maintenance of electrical contact with the exposed conductors. The proximal ends of the electrical conductors are electrically connected to a multi-pin connector on the proximal end of the shaft which is configured to be connected to a receiving member in electrical communication with a display unit.
A plastic jacket, preferably a lubricous polymer such as a thermoplastic fluoropolymer, is applied to the length of the braided tubular member with a slight overlap of the jacket over the edges of the individual electrodes to prevent exposure of a sharp metallic edge which can cause damage when the elongated device is advanced through blood vessels.
The elongated device of the invention may be in the form of a guidewire which has an elongated core member disposed within tubular member formed by the braided electrical conductors. The distal section of the guidewire may have a flexible tip coil which is distal to the length on which the bipolar electrodes are mounted and which is disposed about the distal extremity of the core member. The distal end of the core member may be manually shapable by the physician to facilitate steering the distal portion of the elongated sensing device within the patient's vasculature by torquing the proximal end which extends out of the patient during the procedure. A smooth rounded tip or plug is provided at the 2~.~~'~'~3 distal end of the coil to avoid damage when being advanced through the patient's vasculature. A safety or shaping ribbon may extend from the distal end of the core member to the rounded tip in conventional guidewire fashion.
The elongated device of the invention may also be in the form of a catheter which has an elongated inner lumen extending from the proximal end to a discharge or guidewire port in the distal end of the device. The distal end of the catheter may be provided with a soft tip to minimize traumatic engagement with a blood vessel wall when being advanced therein. In one presently preferred embodiment the inner lumen of the catheter form of the device of the invention is configured to allow the passage therethrough of a conventional guidewire or a guidewire version of the device of the invention which allows signal detection at different locations within the same blood vessel or branch thereof.
When using the intravascufar device of the invention, it is first introduced percutaneously or by means of a cut-down into one of the patient's major peripheral arteries or veins (e.g. the femoral vein or artery) and advanced through the patient's vasculature to one or more desired locations within the veins or arteries of the patient's heart. The distal section of the elongated device of the invention is preferably configured to be advanceable within a blood vessel having a native inner diameter of less than about one millimeter and preferably less than 0.75 mm. A
. ~ ~~ ~ ~ r plurality of such devices may be introduced into the patient's vascular system with one or more devices within the patient's cardiac veins and one or more devices within the patient's coronary arteries.
Electrical signals from the patient's heart are received by the one or more electrode pairs on the distal section in bipolar mode and transmitted through the electrical conductors attached to the individual electrodes to multipin connectors on the proximal ends of the shafts. The position of an elongated sensing device of the invention within the arteries or veins of the patient's heart may be adjusted to optimize signal reception by the electrodes on the distal section of the device and to better detect electrical activity.
It is frequently desirable to provide a device within the patient's heart chambers with electrodes which provide pacing signals.
This greatly facilitates the detection of the arrhythmogenic site or conducting pathways for electrical signals.
The elongated device of the invention provide substantially improved reception of electrical activity within the patient's heart without interference from electrical activity from other regions of the patient's heart. This improved accuracy greatly facilitates the mapping of the elECtrical activity which in turn allows more accurate ablation. These and other advantages will become more apparent from the following detailed description of the invention and the accompanying exemplary drawings.
WO 94/1661ii PCTJUS94/01054 BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is an elevational view of a guidewire embodying features of the invention.
Fig. 2 is an enlarged longitudinal cross-sectional view of a distal portion of the guidewire shown in Fig. 1.
Fig. 3 is an enlarged longitudinal cross-sectional view of the distal portion of a guidewire similar to that shown in Fig. 2 but having a plurality of braided layers.
Fig. 4 is a transverse cross-sectional view of the distal portion of the guidewire shown in Fig. 3 taken along the lines 4-4.
Fig. 5 is a longitudinal cross-sectional view of an intermediate portion of the guidewire shown in Fig. 1 taken along the lines 5-5.
Fig. 6 is a longitudinal cross-sectional view of the an extension of the proximal end of the guidewire shown in Fig. 1 taken along the lines 6-6.
Fig. 7 is an elevational view, partially in section, of a catheter embodying features of the invention.
Fig. 8 is a transverse cross-sectional view of the catheter shown in Fig. 7 taken along the lines 8-8.
Fig. 9 is a schematic view of a patient's coronary arteries with guidewires shown in Fig. 1 disposed within the right coronary artery and the anterior interventricular branch of the left coronary arteries.
WO 94/16618 PCT/US94/01054~
Fig. 10 is a schematic view of a patient's coronary arteries and the great cardiac vein with guidewires as shown in Fig. 1 disposed within the anterior interventricular branch of the left coronary artery and the great cardiac vein.
Fig. 1 1 is a longitudinal cross-sectional view of an alternative ' guidewire construction embodying features of the invention.
Fig. 12 is an efevational view, partially in section, of an alternative guidewire construction.
Fig. 13 is an elevational view, partially in section, of an alternative catheter construction embodying features of the invention.
Fig. 14 is an enlarged eievational view partially in section of the distal portion of the catheter shown in Fig. 13.
Fig. 15 is a schematic representation of responses of bipolar electrodes on separated intravascular devices from an essentially planar wave front.
Fig. 16 is a schematic representation of bipolar electrodes on separated intravascular devices from a circular wave front.
Fig. 17 is an electrocardiogram using a guidewire to detect electrical activity on the bipolar mode.
DETAILED DESCRIPTION OF THE INVENTION
Reference is made to Figs. 1-5 which schematically illustrate an embodiment of the invention wherein the elongated device 10 is the form of a guidewire. The elongated device 10 includes shaft 11 with a ' WO 94/16618 ~ ~ ~ PCTIUS94/01054 distal section 12 and a proximal section 13. The shaft 11 is formed of a braided tubular member 14 formed of a plurality of electrical conductors 15. The distal section 12 of the shaft 11 is provided with a plurality of bipolar electrode pairs 16, each pair of which includes electrodes 1 7 and 18. A core member 19 is disposed within the inner lumen of the braided tubular member 14 and extends beyond the distal end thereof. A distal coil 20 is disposed about and secured by suitable means, such as brazing, soldering or an appropriate adhesive, to the distal extremity of the core member 19 and is provided with a smooth rounded distal tip 21 formed by joining the distal tip of the coil 20 to the distal extremity of the core member 19. The distal extremity of the core member 19 may be flattened into a rectangular cross-section.
Fig. 2 illustrates a single braided layer with sixteen strands.
However, when a higher number of electrode pairs 16 are used, e.g.
sixteen or more, a plurality of braided layers may be required, as depicted in Fig. 3. As shown in this drawing, the outer braided layer 22 terminates at a location proximal to that of the intermediate layer 23 and the intermediate layer terminates at a location proximal to the innermost layer 24 to facilitate securing and electrically connecting the electrodes 17 and 18 to the individual electrical conductors 15 as shown in Fig. 4.
Some of the strands in the layers may not be conductors and be formed of polymer materials such as nylon.
r) 'WO '94/16618 PCT/US94/0105~
The proximal section 13 of the shaft 1 1 as shown in Fig. 1 has two extensions 26 and 27 which have multi-pin connectors 28 and 29 on the proximal ends thereof with each of the electrical conductors 15 being electrically connected to a separate pin. Details of proximal extension 26 is depicted in Fig. 6. A sixteen pin connector is schematically shown in Fig. 6 but connectors having a higher or lower number of pins may be suitable.
Figs. 7 and 8 schematically illustrate another presently preferred embodiment of the invention in the form of a catheter 30. In this embodiment, the catheter shaft 31 has an inner lumen 32 defined by an inner tubular element or lining 33 which is preferably formed of lubricous material such as Teflon~. A tubular member 34 is disposed about tubular lining 33 and is formed of at least one braided layer 35. A
plurality of the strands making up each of the braided Layers are insulated electrical conductors 38 which are electrically connected to individual electrodes 39 and 40 of electrode pairs 41 as in the previously described embodiment. While not shown in the drawing, a plurality of braided layers may be required with more than eight electrode pairs 41. As in the previous embodiment, when a plurality of braided layers are employed, the outer braided layer should terminate at a location proximal to that of the intermediate layer and the intermediate layer should terminate at a location proximal to the inner layer to facilitate securing and electrically connecting the electrodes 39 and 40 to the individual electrical .
conductors 38. Some of the strands in each of the layers may be formed of other materials such as nylon. An outer jacket 42 extends the length of the shaft 31 and the portion of the jacket extending beyond the distal end of the braided tubular member 34 is tapered to provide a nontraumatic flexible distal tip 43. As in the previously described example, the outer jacket 42 overlaps the edges of the electrodes 39 and 40 to avoid exposing a sharp metal edge when advancing the catheter through a patient's blood vessel.
The catheter 30 may be used by itself to detect electrical signals within the patient's coronary veins or arteries with the multiple electrode pairs 41 as in the previous embodiment. Additionally, the catheter may also be used to direct fluids containing cardioplegic materials such as iced saline, solutions of KCI, lidocaine, procaineamide hydrochloride and the like to areas of the patient's heart which are suspected to be the origin of or conduct the aberrant signals. If the arrhythmia stops upon the delivery of such cardioplegic agents, then the operator is assured that the artery or vein through which the agent is delivered leads toward or away from the region of the patient's heart which is to be ablated in order to terminate the arrhythmia. The signal reception by the electrode pairs 41 are essentially the same as in the previously described guidewire embodiment.
The catheter 30 may also be used in conjunction with a guidewire 44 (shown in phantom) as illustrated in Figs. 1-5. The catheter ~~.~~ i ~~
Wo 94/16618 PCT/US94I01054 30 may be positioned at a first location within a coronary artery or cardiac vein of the patient with the guidewire 44, which has a plurality of bipolar electrode pairs 45 as in the previously discussed embodiment, disposed within the inner lumen of the catheter 30 and the distal section thereof extending out the port 46 in the distal end of the catheter into the patient's blood vessel. Adjustments in the relative locations of the guidewire 44 and catheter 30 can be easily made by moving the guidewire 44 through the inner lumen 32 of the catheter 30 or moving the catheter over the guidewire or both.
When using a femoral artery or femoral vein approach to the patient's heart, it is frequently helpful to utilize a guiding catheter to guide the catheter or guidewire of the invention to the coronary artery ostium or the coronary sinus ostium. Such guiding catheters have specially shaped distal tips to facilitating the seating thereof within the desired ostium, thus eliminating the trouble of directing a catheter or guidewire of the invention into the desire ostium.
The bipolar electrodes are circular bands about 0.25 to about 1 mm in width and are preferably made from conducting material which is biocompatible with the body fluids such as gold. The electrodes of the electrode pairs are spaced from each other by about 0.5 to about 2 mm, preferably about 0.75 to about 1.25 mm, and the spacing between the bipolar electrode pairs is about 2 to about 10 mm, preferably about 7 to about 8 mm.
~ ~. ~ 4'~'~ 3 The overall length of the intravascular devices of the invention may range from about 80 to about 300 cm, typically about 135 to about 175 cm for delivery through the femoral artery or vein and about 90 to about 120 cm for delivery through the brachiocephaiic artery or internal jugular vein. If the guidewire is to be advanced through the inner lumen of the catheter it should be longer than the catheter by about 20 to about 40 cm. The distal section of the catheter is about 10 to about 50 cm in length and is configured to be readily advanceable through a patient's coronary arteries or cardiac veins. The outer diameter of the catheter should be less than about 0.055 inch (1.4 mm) and preferably about 0.035 inch (0.89 mm). The inner lumen 32 is about 0.012 to about 0.022 inch (0.3-0.56 mm) in diameter to facilitate the reception and advancement of a guidewire therethrough. The distal section of the guidewire is about 15 to about 40 cm in length and about 0.008 to about 0.022 inch (0.2-0.56 mm) in outer diameter to facilitate advancement through the coronary arteries and cardiac veins of a human being having natural diameters of less than 0.04 inch (1 mm), preferably less than 0.03 inch (0.75 mm). The distal coil on the guidewire is about 2 to about 10 cm in length and is formed of wire about 0.0003 to about 0.006 inch (0.008-0.153 mm) in diameter. The core member of the guidewire may be tapered along its distal section in a conventional guidewire construction. The flattened distal portion has a rectangular transverse cross section of about 0.002 by about 0.006 inch (0.051-0.15 mm) To the extent not previously described, the materials of construction of the various guidewire and catheter parts may be formed of conventional materials. The electrical conductors may be electrical grade copper wire about 0.005 inch (0.13 mm1 in diameter which are provided with a thin insulated jacket or coating of polyimide or other suitable insulator. The outer jacket may be a thermoplastic fluoropolymer such as THV~' which is available from the 3M Corporation. The distal tip coil on the guidewire form of the invention is preferably formed of platinum to facilitate fluoroscopic observation thereof within the patient, but it may be formed in whole or in part with other material such as stainless steel, titanium, palladium, niobium, iridium, rhodium and alloys thereof. The core wire of the guidewire may be formed of stainless steel or a superelastic NiTi type alloy, with the latter preferably having a stable austenite phase at body temperature and exhibiting a stress induced austenite-to-martensite phase transformation. Proximal and distal sections of the core member may be formed of different materials so as to provide a stronger proximal section for greater pushability and a more flexible distal section to facilitate passage through tortuous coronary anatomy.
One presently preferred method of using the elongated intravascufar devices of the invention as shown in Fig. 9 wherein the distal portion 11 of the guidewires 10 such as shown in Fig. 1 are disposed within the right coronary artery 47 and the anterior WO 94/1661$ PCT/US94/01054 interventricular branch of the left coronary artery 48. As indicated, the electrode pairs 16 on the distal portion 1 1 extend along a major portion of the arteries. The individual intravascular devices may be moved within the arteries as needed to optimize the signals received. While not shown in the drawings, the distal tip with the coil 20 may be shaped to facilitate entry into a side branch of the coronary artery.
Another method is depicted in Fig. 10 wherein one of the elongated intravascular devices 10 of the invention are disposed within the great cardiac vein 49 and another is disposed within the anterior interventricular branch of the left coronary artery 48. A third intravascular device might also be deployed within the right coronary artery 47 as shown to provide a more comprehensive mapping of the patient's heart. As in the prior method the individual guidewires or other intravascular sensing devices may be moved within the artery or vein to -better receive electrical activity.
An alternative embodiment of the invention in the form of a guidewire 50 is shown in Fig. 11 which has a distal portion 51 with bipolar electrodes 52 and 53, an intermediate portion 54 and a proximal portion 55. A core member 56 extends through the inner lumen 57 of the guidewire 50 from the proximal end to at least the distal portion 51. The distal bipolar electrode 52 is electrically secured to the core member 56 by solder 58 and the proximal bipolar electrode 53 is secured by solder 59 to electrical conductor 60 which may be an insulated wire or ribbon.
The proximal end of the electrical conductor 60 is secured by solder 61 to conductive metal tube 62 ( e.g:_ hypotubing) which is electrically isolated from the core member 56. .The exterior surface of the core member 56 and the exterior of the conductive metal tube 62 should be provided with an insulating jacket or coating to maintain the electrical isolation therebetween. The core member 56 and the conductive metal tube 62 are preferably secured together at one or more locations by an insulating adhesive to facilitate the torqueability of the overall guidewire assembly.
Preferably, they are secured at least at the distal end of the metal tube 62.
A coil 63 is disposed about core member 56 proximal to the bipolar electrode pair 52 and 53 and it is secured to the core member by a suitably adhesive 64 or solder or weld. The coil 63 is preferably formed at least in part by a highly radiopaque biocompatible metal, e.g platinum, rhodium, palladium, tungsten, gold, silver or alloys thereof, to facilitate the fluoroscopic observation thereof when disposed within the vasculature of a patient. A palladium-tungsten alloy is preferred. The core member 56 and the coil 63 provide shapeability to the distal portion 51 of the guidewire 50 to facilitate advancement thereof into side branches of a patient's vasculature. An insulating member 65 is disposed between the coil 63 and the proximal bipolar electrode 53 and an insulating member 66 is disposed between electrodes 52 and 53.
~1~4~'~3 WO 94/16618 PCTlLTS94/01054 An inner tubular member 67 may be disposed within the distal section to provide support to the electrodes 52 and 53 and inner tubular member 68 may be disposed within the coil 63 to likewise provide support thereto. A suitable material is thin walled polyimide tubing which is commonly employed in intravascular catheters. A torquing knob 69 is provided on the proximal end of core member 56.
The guidewire 50 may be of conventional intravascular guidewire construction. The overall length is about 150 to about 200 cm, the proximal OD of the core member 56 is typically about 0.013 inch and the distal OD about 0.006 inch which may be further reduced to 0.003 inch. The core member 56 may be ground through one or more transitions to the smaller OD sections. The core member 56 and particularly the distal portion thereof may be formed of a superelastic alloy such as NiTI which has a stable austenite phase at body temperature.
Another alternative guidewire embodiment of the invention is shown in Fig. 12. In this embodiment the guidewire 70 has a shaft 71 formed of woven or braided conductors 72 which are preferably insulated along their length and which extend to the proximal end of the shaft. A
plurality of bipolar electrode pairs 73 with each pair having a proximal electrode 74 and a distal electrode 75. Each of the electrodes are electrically connected to a separate electrical conductor 72 by suitable conductive solder 76. While it is preferable that the conductors are ~Oj9~/~ ~ 8 PCT/LTS94/01054 interwoven into the tube forming the shaft 71, the conductors may be twisted or wound. in the latter case the inner and outer layers of wires would be laid out diagonally but the conductors of one layer would be laid in the opposite direction to than of the conductors in the other layer.
Usually, the wound or twisted conductors are secured together by suitable adhesive, whereas with the interwoven conductors there is sufficient interlocking of the conductors that adhesives are not usually needed. An insulating jacket 78 is provided about the catheter shaft 71.
The core member 77 extends through the interior of the guidewire shaft from the proximal end to the distal end thereof where it is secured to the distal tip or plug 79 of the guidewire 70. A helical coil 80 is disposed about a distal portion of the core member 77 and is secured at its distal end to the distal tip or plug 79 and at its proximal end by adhesive 81. The coil 80 is preferably formed at least in part by a radiopaque material such as those previously discussed. The core member 77 may be configured as in the previous embodiments.
It is within the ambit of this invention that the intravascular sensing device be introduced into a femoral artery or a femoral vein (or other convenient body access site) and be advanced through the patient's vasculature to the coronary veins or arteries. Once the intravascular device is situated in the proper location in the coronary vasculature, electrical activity may be received in any way that is appropriate for the specific situation. The catheter or guidewire may be moved to another location and another set of signals received. It should be apparent that since each electrode mounted on the distal section of the sensing device is individually brought out via the woven wires or filaments to the electrical connection at the proximal end, that each electrode may be used in conjunction with any other electrode in a bipolar anode. The sensing devices may be used in multiples, e.g., a sensing device in each of the major coronary veins and arteries, as shown in Figs. 9 and 10, to provide an overall and complete electrical map of the heart. In this way, arrhythmic foci may be readily located and therapeutic action taken.
Figs. 13 and 14 illustrate a catheter assembly 90 which embodies an additional aspect of the present invention directed to an intravascular catheter 91 for sensing electrical activity within a patient's coronary or cardiac blood vessels. As in the prior embodiments the bipolar electrodes 92 and 93 are electrically connected to individual electrical conductors 94 which are woven or wound to form the tubular shaft 95 of the catheter 91. All of the strands which are wound to form the shaft need not be conductors 94 but may be strands of polymeric materials such as Dacron~",nylon, silk or other natural or synthetic polymeric material. When there are more than 16 electrodes and thus more than 16 electrical conductors, multiple woven layers may be employed. Fig. 14 illustrates in more detail the connection of electrical conductors 94 to the individual electrodes 92 and 93. The electrical conductors 94 are typically electrical grade copper wires of suitable outer 21~4~'~~
WO 94!16618 PCT/US94/01054' diameter such as about 0.004 to about 0.01 inch (0.10-0.25 mm). The conductors 94 may be formed of other conducting materials such as silver, gold and platinum. A suitable insulating material to coat the conductors 94 is polyimide which minimizes cross talk and which can be applied in very thin layers. As in the other embodiments of the invention the conductors 94 may be woven or merely wound, but preferably are woven.
The inner lumen 95 of the catheter 91 is configured to slidabfy receive a guidewire to facilitate the advancement of the catheter over the guidewire and preferably has at least in the distal portion thereof a diameter about 0.002 to about 0.005 inch (0.051-0.127 mm) greater than the guidewire which is to be disposed therein. For guidewire having OD of about 0.016 to about 0.018 inch (0.41-46 mm), the inner lumen 97 would be about 0.018 to about 0.023 inch (0.46-0.58 mm). The OD
of the catheter may range from about 0.03 to about 0.1 inch (0.76-2.54 mm) but preferably is about 0.03 to about 0.05 inch (0.076-1.27 mm), particularly 0.035 to about 0.040 inch (0.89-1.02 mm).
The proximal portion 96 of the catheter 91 makes up about 70 to about 95% of the total length of the catheter with the intermediate portion 97 and the distal portion 98 which has the sensing electrodes 92 and 93 being the remainder. Preferably the catheter 91 has decreasing stiffness from the proximal portion 96 to the intermediate portion 97 and the distal portion 98 to facilitate the advancement of the catheter 91 within the patient's vasculature. The exterior surface of the catheter 91 and the surface defining inner lumen 95 may be formed of lubricous materials or hydrophilic materials which become lubricous when contacting.,pqueous based fluids. Polysulfones and polyfluoroalkanes are examples of suitable lubricous polymers -and polyvinylpyrrolidone, polyethylene oxide and acrylate-based polymers of examples of suitable hydrophilic polymers.
The proximal end of the catheter 91 may be provided with a multiple arm adapter 99 as shown in Fig. 13 with one arm 100 which is configured to receive a syringe for delivering fluid into the inner lumen 95 and a second arm 101 which is provided with an electrical connector 102 which is electrically connected to the electrical conductors 94. The central arm 106 facilitates entry of a guidewire (not shown) into the inner lumen 97. The catheter 91 may be advanced into position within the patient's vascular system, i.e. either the coronary arteries or the _ cardiac veins, over a guidewire which may or may not have electrodes in accordance with the invention to detect electrical activity therein. If the guidewire over which the catheter is advanced into the patient's vasculature does not have sensing electrodes on its distal extremity, it may be withdrawn when the catheter is in its desired position and a guidewire such as shown in Fig. 4 may be advanced through the inner lumen 95 of the catheter 91 and out the port 103 in the distal end of the catheter to a more distal position with the blood vessel.
Once the arrhythmogenlc site or conductive pathway causing an arrhythmia is located, by detecting the electrical activity, means can be advanced through the inner lumen 95 of a catheter of the invention to occlude an arterial passageway which feeds the arrhythmogenic site or conductive pathway so as to terminate the arrhythmia.
Fig. 15 represents an idealized output from a plurality of electrode pairs 110 and 111 on two separate intravascular devices (not shown) disposed in different, generally parallel coronary blood vessels, e.g. a coronary artery and the companion vein, to a nearly planar wave front 112 approaching on end to the intravascular devices. The bipolar response 113 and 114 to the wave front 111 ,from each electrode pair 110 and 111 is shown adjacent thereto, and as indicated, all of the responses are essentially identical, except for the time-of-occurrence, because the wave front reaches all of the electrodes at the same angle.
Changes in tissue properties, e.g. due to an infarct, adjacent the catheters rnay retard the passage of the wave front and as a result distort the shape of the output.
Fig. 16 represents an idealized response from a plurality of electrode pairs 120 and 121 on two separate intravascutar devices (not shown) disposed in different generally parallel coronary blood vessels, as in Fig. 16, but the wave front 122 originates from a site between and in close proximity to the catheters. The idealized wave front 122 is circular and the size and polarity of the responses 123 and 124 to the expanding WO 94/1661i'i PCT/US94101054 wave front varies according to the angle of incidence between the wave front and the electrode pair. An arrhythmogenic site would create a less than ideal wave front which can be readily detected by the plurality of electrodes 120 and 121.
The time of occurrence and directional information obtained from the response from the wave front may be used to determine the origin of the ectopic beat.
EXAMPLE
A guidewire was constructed using a woven tubular braid of sixteen insulated electrical conducting wires, eight woven counterclockwise and eight woven clockwise. Gold metal electrodes 0.01 inch in width were mounted onto the distal end of the shaft about 0.5 inch ( 12.7 mm) apart with each attached to one of the electrical conducting wires. The overall length of the guidewire was about 240 cm. An eight connector DIN plug was installed at the proximal end of the guidewire. The guidewire assembly was 0.018 inch (0.46 mm) in diameter at the distal end, 0.026 inch (0.66 mm) in diameter at the midsection, and 0.032 inch (0.81 mm) at the more proximal end.
The guidewire was introduced into the coronary artery of a live dog using a 7 French coronary guide catheter. A pacer lead having four electrodes was disposed within the heart chamber and was used to pace a ventricular beat so that the electrical activity as a result of that pacing could be monitored intravascularly using the guidewire of the 215 ~'~'~ 3 invention. Fig. 17 is an electrocardiogram produced using the guidewire of the invention which depicts two pulses from that animal test in bipolar mode.
The present invention has been described herein in terms of certain preferred embodiments but various modifications may be made to the present invention without departing from the scope thereof.
BACKGROUND OF THE INVENTION
This invention generally relates to the detection of electrical activity or signals within a patient's heart and particularly for determining the source of signals causing arrhythmia.
Prior methods for treating a patient's arrhythmia include the use of antiarrhythmic drugs such as sodium and calcium channel blockers or drugs which reduce the Beta-adrenergic activity. Other methods include the surgically sectioning the origin of the signals causing the arrhythmia or the conducting pathway for such signals. More frequently.
however, to terminate the arrhythmia, the heart tissue which causes the arrhythmia is destroyed by heat, e.g. applying a laser beam or radio frequency (RF) energy to a desired location on the patient's endocardium.
In the tatter instance, the location of the site causing the arrhythmia must be accurately known in order to be able to contact the WO 94/16618 ' PCT/L1594/01054i~
desired location with a tissue destroying device. A major problem of ablating the site of the origin of the signals or a conductive pathway is to accurately determine the site so that an excessive amount of good tissue is not destroyed along with the arrhythmogenic site to ensure that the arrhythmia does not return. For example, the average arrhythmogenic site consists of about 1.4 cm2 of endocardial tissue, whereas a re-entrant site might be much larger. RF ablation techniques produce lesions about 0.5 cm2 in diameter, so several lesions may have to be formed to completely ablate the area of interest. If the arrhythmogenic or re-entrant site is not accurately mapped, much good tissue surrounding the site will be unnecessarily destroyed.
A variety of methods have been used to detect electrical activity within a patient's heart to facilitate the mapping of electrical activity causing the arrhythmia. A number of U.S. Patents describe the use of elongated intravascular signal sensing devices which are advanced through the patient's vasculature until the distal portions of the sensing devices are disposed within one of the heart chambers with one or more electrodes on the distal portion in contact with the endocardial lining.
While this procedure is widely used, it does not always allow the site of arrhythmogenic signals to be accurately determined.
The literature also mentions advancing an intravascular signal sensing device within a patient's coronary artery or coronary sinus or a ' _2_ WO 94/1661 ~ ~ ~ ~ ~ PCTlUS94101054 cardiac vein. However, these methods appear to be experimental and have not been widely used clinically.
What has been needed is a method and system for accurately detecting the source of signals which cause the arrhythmia .
SUMMARY OF THE INVENTION
This invention is directed to an elongated intravascular sensing device for detecting electrical activity of a patient's heart within a vein or artery thereof, and particularly the electrical activity which causes arrhythmia.
The intravascular sensing device of the invention comprises an elongated shaft with a proximal section and a distal section, with the distal section of the shaft being configured so as to be advanceable through the patient's coronary anatomy. The distal section is provided with at least one and preferably a plurality of bipolar electrode pairs spaced along a length of the distal section. Up to 20 or more bipolar electrode pairs may be provided along the distal section of the shaft.
The shaft of the intravascular sensing device is preferably formed of a plurality of insulated electrical conductors braided or wound into an elongated tubular member, although not all of the strands which make up the tubular member need be electrical conductors. The insulation on separate conductors is exposed under each of the sensing electrodes so that an electrical connection can be made. The electrical 2~~~~'~'~~ .
WO 94/16618 ~ PCT/US94/01054 ai connection may be secured by means of a suitable solder or brazing material, and the electrodes may be secured to the underlying tubular member by a suitable means such as an adhesive to ensure maintenance of electrical contact with the exposed conductors. The proximal ends of the electrical conductors are electrically connected to a multi-pin connector on the proximal end of the shaft which is configured to be connected to a receiving member in electrical communication with a display unit.
A plastic jacket, preferably a lubricous polymer such as a thermoplastic fluoropolymer, is applied to the length of the braided tubular member with a slight overlap of the jacket over the edges of the individual electrodes to prevent exposure of a sharp metallic edge which can cause damage when the elongated device is advanced through blood vessels.
The elongated device of the invention may be in the form of a guidewire which has an elongated core member disposed within tubular member formed by the braided electrical conductors. The distal section of the guidewire may have a flexible tip coil which is distal to the length on which the bipolar electrodes are mounted and which is disposed about the distal extremity of the core member. The distal end of the core member may be manually shapable by the physician to facilitate steering the distal portion of the elongated sensing device within the patient's vasculature by torquing the proximal end which extends out of the patient during the procedure. A smooth rounded tip or plug is provided at the 2~.~~'~'~3 distal end of the coil to avoid damage when being advanced through the patient's vasculature. A safety or shaping ribbon may extend from the distal end of the core member to the rounded tip in conventional guidewire fashion.
The elongated device of the invention may also be in the form of a catheter which has an elongated inner lumen extending from the proximal end to a discharge or guidewire port in the distal end of the device. The distal end of the catheter may be provided with a soft tip to minimize traumatic engagement with a blood vessel wall when being advanced therein. In one presently preferred embodiment the inner lumen of the catheter form of the device of the invention is configured to allow the passage therethrough of a conventional guidewire or a guidewire version of the device of the invention which allows signal detection at different locations within the same blood vessel or branch thereof.
When using the intravascufar device of the invention, it is first introduced percutaneously or by means of a cut-down into one of the patient's major peripheral arteries or veins (e.g. the femoral vein or artery) and advanced through the patient's vasculature to one or more desired locations within the veins or arteries of the patient's heart. The distal section of the elongated device of the invention is preferably configured to be advanceable within a blood vessel having a native inner diameter of less than about one millimeter and preferably less than 0.75 mm. A
. ~ ~~ ~ ~ r plurality of such devices may be introduced into the patient's vascular system with one or more devices within the patient's cardiac veins and one or more devices within the patient's coronary arteries.
Electrical signals from the patient's heart are received by the one or more electrode pairs on the distal section in bipolar mode and transmitted through the electrical conductors attached to the individual electrodes to multipin connectors on the proximal ends of the shafts. The position of an elongated sensing device of the invention within the arteries or veins of the patient's heart may be adjusted to optimize signal reception by the electrodes on the distal section of the device and to better detect electrical activity.
It is frequently desirable to provide a device within the patient's heart chambers with electrodes which provide pacing signals.
This greatly facilitates the detection of the arrhythmogenic site or conducting pathways for electrical signals.
The elongated device of the invention provide substantially improved reception of electrical activity within the patient's heart without interference from electrical activity from other regions of the patient's heart. This improved accuracy greatly facilitates the mapping of the elECtrical activity which in turn allows more accurate ablation. These and other advantages will become more apparent from the following detailed description of the invention and the accompanying exemplary drawings.
WO 94/1661ii PCTJUS94/01054 BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is an elevational view of a guidewire embodying features of the invention.
Fig. 2 is an enlarged longitudinal cross-sectional view of a distal portion of the guidewire shown in Fig. 1.
Fig. 3 is an enlarged longitudinal cross-sectional view of the distal portion of a guidewire similar to that shown in Fig. 2 but having a plurality of braided layers.
Fig. 4 is a transverse cross-sectional view of the distal portion of the guidewire shown in Fig. 3 taken along the lines 4-4.
Fig. 5 is a longitudinal cross-sectional view of an intermediate portion of the guidewire shown in Fig. 1 taken along the lines 5-5.
Fig. 6 is a longitudinal cross-sectional view of the an extension of the proximal end of the guidewire shown in Fig. 1 taken along the lines 6-6.
Fig. 7 is an elevational view, partially in section, of a catheter embodying features of the invention.
Fig. 8 is a transverse cross-sectional view of the catheter shown in Fig. 7 taken along the lines 8-8.
Fig. 9 is a schematic view of a patient's coronary arteries with guidewires shown in Fig. 1 disposed within the right coronary artery and the anterior interventricular branch of the left coronary arteries.
WO 94/16618 PCT/US94/01054~
Fig. 10 is a schematic view of a patient's coronary arteries and the great cardiac vein with guidewires as shown in Fig. 1 disposed within the anterior interventricular branch of the left coronary artery and the great cardiac vein.
Fig. 1 1 is a longitudinal cross-sectional view of an alternative ' guidewire construction embodying features of the invention.
Fig. 12 is an efevational view, partially in section, of an alternative guidewire construction.
Fig. 13 is an elevational view, partially in section, of an alternative catheter construction embodying features of the invention.
Fig. 14 is an enlarged eievational view partially in section of the distal portion of the catheter shown in Fig. 13.
Fig. 15 is a schematic representation of responses of bipolar electrodes on separated intravascular devices from an essentially planar wave front.
Fig. 16 is a schematic representation of bipolar electrodes on separated intravascular devices from a circular wave front.
Fig. 17 is an electrocardiogram using a guidewire to detect electrical activity on the bipolar mode.
DETAILED DESCRIPTION OF THE INVENTION
Reference is made to Figs. 1-5 which schematically illustrate an embodiment of the invention wherein the elongated device 10 is the form of a guidewire. The elongated device 10 includes shaft 11 with a ' WO 94/16618 ~ ~ ~ PCTIUS94/01054 distal section 12 and a proximal section 13. The shaft 11 is formed of a braided tubular member 14 formed of a plurality of electrical conductors 15. The distal section 12 of the shaft 11 is provided with a plurality of bipolar electrode pairs 16, each pair of which includes electrodes 1 7 and 18. A core member 19 is disposed within the inner lumen of the braided tubular member 14 and extends beyond the distal end thereof. A distal coil 20 is disposed about and secured by suitable means, such as brazing, soldering or an appropriate adhesive, to the distal extremity of the core member 19 and is provided with a smooth rounded distal tip 21 formed by joining the distal tip of the coil 20 to the distal extremity of the core member 19. The distal extremity of the core member 19 may be flattened into a rectangular cross-section.
Fig. 2 illustrates a single braided layer with sixteen strands.
However, when a higher number of electrode pairs 16 are used, e.g.
sixteen or more, a plurality of braided layers may be required, as depicted in Fig. 3. As shown in this drawing, the outer braided layer 22 terminates at a location proximal to that of the intermediate layer 23 and the intermediate layer terminates at a location proximal to the innermost layer 24 to facilitate securing and electrically connecting the electrodes 17 and 18 to the individual electrical conductors 15 as shown in Fig. 4.
Some of the strands in the layers may not be conductors and be formed of polymer materials such as nylon.
r) 'WO '94/16618 PCT/US94/0105~
The proximal section 13 of the shaft 1 1 as shown in Fig. 1 has two extensions 26 and 27 which have multi-pin connectors 28 and 29 on the proximal ends thereof with each of the electrical conductors 15 being electrically connected to a separate pin. Details of proximal extension 26 is depicted in Fig. 6. A sixteen pin connector is schematically shown in Fig. 6 but connectors having a higher or lower number of pins may be suitable.
Figs. 7 and 8 schematically illustrate another presently preferred embodiment of the invention in the form of a catheter 30. In this embodiment, the catheter shaft 31 has an inner lumen 32 defined by an inner tubular element or lining 33 which is preferably formed of lubricous material such as Teflon~. A tubular member 34 is disposed about tubular lining 33 and is formed of at least one braided layer 35. A
plurality of the strands making up each of the braided Layers are insulated electrical conductors 38 which are electrically connected to individual electrodes 39 and 40 of electrode pairs 41 as in the previously described embodiment. While not shown in the drawing, a plurality of braided layers may be required with more than eight electrode pairs 41. As in the previous embodiment, when a plurality of braided layers are employed, the outer braided layer should terminate at a location proximal to that of the intermediate layer and the intermediate layer should terminate at a location proximal to the inner layer to facilitate securing and electrically connecting the electrodes 39 and 40 to the individual electrical .
conductors 38. Some of the strands in each of the layers may be formed of other materials such as nylon. An outer jacket 42 extends the length of the shaft 31 and the portion of the jacket extending beyond the distal end of the braided tubular member 34 is tapered to provide a nontraumatic flexible distal tip 43. As in the previously described example, the outer jacket 42 overlaps the edges of the electrodes 39 and 40 to avoid exposing a sharp metal edge when advancing the catheter through a patient's blood vessel.
The catheter 30 may be used by itself to detect electrical signals within the patient's coronary veins or arteries with the multiple electrode pairs 41 as in the previous embodiment. Additionally, the catheter may also be used to direct fluids containing cardioplegic materials such as iced saline, solutions of KCI, lidocaine, procaineamide hydrochloride and the like to areas of the patient's heart which are suspected to be the origin of or conduct the aberrant signals. If the arrhythmia stops upon the delivery of such cardioplegic agents, then the operator is assured that the artery or vein through which the agent is delivered leads toward or away from the region of the patient's heart which is to be ablated in order to terminate the arrhythmia. The signal reception by the electrode pairs 41 are essentially the same as in the previously described guidewire embodiment.
The catheter 30 may also be used in conjunction with a guidewire 44 (shown in phantom) as illustrated in Figs. 1-5. The catheter ~~.~~ i ~~
Wo 94/16618 PCT/US94I01054 30 may be positioned at a first location within a coronary artery or cardiac vein of the patient with the guidewire 44, which has a plurality of bipolar electrode pairs 45 as in the previously discussed embodiment, disposed within the inner lumen of the catheter 30 and the distal section thereof extending out the port 46 in the distal end of the catheter into the patient's blood vessel. Adjustments in the relative locations of the guidewire 44 and catheter 30 can be easily made by moving the guidewire 44 through the inner lumen 32 of the catheter 30 or moving the catheter over the guidewire or both.
When using a femoral artery or femoral vein approach to the patient's heart, it is frequently helpful to utilize a guiding catheter to guide the catheter or guidewire of the invention to the coronary artery ostium or the coronary sinus ostium. Such guiding catheters have specially shaped distal tips to facilitating the seating thereof within the desired ostium, thus eliminating the trouble of directing a catheter or guidewire of the invention into the desire ostium.
The bipolar electrodes are circular bands about 0.25 to about 1 mm in width and are preferably made from conducting material which is biocompatible with the body fluids such as gold. The electrodes of the electrode pairs are spaced from each other by about 0.5 to about 2 mm, preferably about 0.75 to about 1.25 mm, and the spacing between the bipolar electrode pairs is about 2 to about 10 mm, preferably about 7 to about 8 mm.
~ ~. ~ 4'~'~ 3 The overall length of the intravascular devices of the invention may range from about 80 to about 300 cm, typically about 135 to about 175 cm for delivery through the femoral artery or vein and about 90 to about 120 cm for delivery through the brachiocephaiic artery or internal jugular vein. If the guidewire is to be advanced through the inner lumen of the catheter it should be longer than the catheter by about 20 to about 40 cm. The distal section of the catheter is about 10 to about 50 cm in length and is configured to be readily advanceable through a patient's coronary arteries or cardiac veins. The outer diameter of the catheter should be less than about 0.055 inch (1.4 mm) and preferably about 0.035 inch (0.89 mm). The inner lumen 32 is about 0.012 to about 0.022 inch (0.3-0.56 mm) in diameter to facilitate the reception and advancement of a guidewire therethrough. The distal section of the guidewire is about 15 to about 40 cm in length and about 0.008 to about 0.022 inch (0.2-0.56 mm) in outer diameter to facilitate advancement through the coronary arteries and cardiac veins of a human being having natural diameters of less than 0.04 inch (1 mm), preferably less than 0.03 inch (0.75 mm). The distal coil on the guidewire is about 2 to about 10 cm in length and is formed of wire about 0.0003 to about 0.006 inch (0.008-0.153 mm) in diameter. The core member of the guidewire may be tapered along its distal section in a conventional guidewire construction. The flattened distal portion has a rectangular transverse cross section of about 0.002 by about 0.006 inch (0.051-0.15 mm) To the extent not previously described, the materials of construction of the various guidewire and catheter parts may be formed of conventional materials. The electrical conductors may be electrical grade copper wire about 0.005 inch (0.13 mm1 in diameter which are provided with a thin insulated jacket or coating of polyimide or other suitable insulator. The outer jacket may be a thermoplastic fluoropolymer such as THV~' which is available from the 3M Corporation. The distal tip coil on the guidewire form of the invention is preferably formed of platinum to facilitate fluoroscopic observation thereof within the patient, but it may be formed in whole or in part with other material such as stainless steel, titanium, palladium, niobium, iridium, rhodium and alloys thereof. The core wire of the guidewire may be formed of stainless steel or a superelastic NiTi type alloy, with the latter preferably having a stable austenite phase at body temperature and exhibiting a stress induced austenite-to-martensite phase transformation. Proximal and distal sections of the core member may be formed of different materials so as to provide a stronger proximal section for greater pushability and a more flexible distal section to facilitate passage through tortuous coronary anatomy.
One presently preferred method of using the elongated intravascufar devices of the invention as shown in Fig. 9 wherein the distal portion 11 of the guidewires 10 such as shown in Fig. 1 are disposed within the right coronary artery 47 and the anterior WO 94/1661$ PCT/US94/01054 interventricular branch of the left coronary artery 48. As indicated, the electrode pairs 16 on the distal portion 1 1 extend along a major portion of the arteries. The individual intravascular devices may be moved within the arteries as needed to optimize the signals received. While not shown in the drawings, the distal tip with the coil 20 may be shaped to facilitate entry into a side branch of the coronary artery.
Another method is depicted in Fig. 10 wherein one of the elongated intravascular devices 10 of the invention are disposed within the great cardiac vein 49 and another is disposed within the anterior interventricular branch of the left coronary artery 48. A third intravascular device might also be deployed within the right coronary artery 47 as shown to provide a more comprehensive mapping of the patient's heart. As in the prior method the individual guidewires or other intravascular sensing devices may be moved within the artery or vein to -better receive electrical activity.
An alternative embodiment of the invention in the form of a guidewire 50 is shown in Fig. 11 which has a distal portion 51 with bipolar electrodes 52 and 53, an intermediate portion 54 and a proximal portion 55. A core member 56 extends through the inner lumen 57 of the guidewire 50 from the proximal end to at least the distal portion 51. The distal bipolar electrode 52 is electrically secured to the core member 56 by solder 58 and the proximal bipolar electrode 53 is secured by solder 59 to electrical conductor 60 which may be an insulated wire or ribbon.
The proximal end of the electrical conductor 60 is secured by solder 61 to conductive metal tube 62 ( e.g:_ hypotubing) which is electrically isolated from the core member 56. .The exterior surface of the core member 56 and the exterior of the conductive metal tube 62 should be provided with an insulating jacket or coating to maintain the electrical isolation therebetween. The core member 56 and the conductive metal tube 62 are preferably secured together at one or more locations by an insulating adhesive to facilitate the torqueability of the overall guidewire assembly.
Preferably, they are secured at least at the distal end of the metal tube 62.
A coil 63 is disposed about core member 56 proximal to the bipolar electrode pair 52 and 53 and it is secured to the core member by a suitably adhesive 64 or solder or weld. The coil 63 is preferably formed at least in part by a highly radiopaque biocompatible metal, e.g platinum, rhodium, palladium, tungsten, gold, silver or alloys thereof, to facilitate the fluoroscopic observation thereof when disposed within the vasculature of a patient. A palladium-tungsten alloy is preferred. The core member 56 and the coil 63 provide shapeability to the distal portion 51 of the guidewire 50 to facilitate advancement thereof into side branches of a patient's vasculature. An insulating member 65 is disposed between the coil 63 and the proximal bipolar electrode 53 and an insulating member 66 is disposed between electrodes 52 and 53.
~1~4~'~3 WO 94/16618 PCTlLTS94/01054 An inner tubular member 67 may be disposed within the distal section to provide support to the electrodes 52 and 53 and inner tubular member 68 may be disposed within the coil 63 to likewise provide support thereto. A suitable material is thin walled polyimide tubing which is commonly employed in intravascular catheters. A torquing knob 69 is provided on the proximal end of core member 56.
The guidewire 50 may be of conventional intravascular guidewire construction. The overall length is about 150 to about 200 cm, the proximal OD of the core member 56 is typically about 0.013 inch and the distal OD about 0.006 inch which may be further reduced to 0.003 inch. The core member 56 may be ground through one or more transitions to the smaller OD sections. The core member 56 and particularly the distal portion thereof may be formed of a superelastic alloy such as NiTI which has a stable austenite phase at body temperature.
Another alternative guidewire embodiment of the invention is shown in Fig. 12. In this embodiment the guidewire 70 has a shaft 71 formed of woven or braided conductors 72 which are preferably insulated along their length and which extend to the proximal end of the shaft. A
plurality of bipolar electrode pairs 73 with each pair having a proximal electrode 74 and a distal electrode 75. Each of the electrodes are electrically connected to a separate electrical conductor 72 by suitable conductive solder 76. While it is preferable that the conductors are ~Oj9~/~ ~ 8 PCT/LTS94/01054 interwoven into the tube forming the shaft 71, the conductors may be twisted or wound. in the latter case the inner and outer layers of wires would be laid out diagonally but the conductors of one layer would be laid in the opposite direction to than of the conductors in the other layer.
Usually, the wound or twisted conductors are secured together by suitable adhesive, whereas with the interwoven conductors there is sufficient interlocking of the conductors that adhesives are not usually needed. An insulating jacket 78 is provided about the catheter shaft 71.
The core member 77 extends through the interior of the guidewire shaft from the proximal end to the distal end thereof where it is secured to the distal tip or plug 79 of the guidewire 70. A helical coil 80 is disposed about a distal portion of the core member 77 and is secured at its distal end to the distal tip or plug 79 and at its proximal end by adhesive 81. The coil 80 is preferably formed at least in part by a radiopaque material such as those previously discussed. The core member 77 may be configured as in the previous embodiments.
It is within the ambit of this invention that the intravascular sensing device be introduced into a femoral artery or a femoral vein (or other convenient body access site) and be advanced through the patient's vasculature to the coronary veins or arteries. Once the intravascular device is situated in the proper location in the coronary vasculature, electrical activity may be received in any way that is appropriate for the specific situation. The catheter or guidewire may be moved to another location and another set of signals received. It should be apparent that since each electrode mounted on the distal section of the sensing device is individually brought out via the woven wires or filaments to the electrical connection at the proximal end, that each electrode may be used in conjunction with any other electrode in a bipolar anode. The sensing devices may be used in multiples, e.g., a sensing device in each of the major coronary veins and arteries, as shown in Figs. 9 and 10, to provide an overall and complete electrical map of the heart. In this way, arrhythmic foci may be readily located and therapeutic action taken.
Figs. 13 and 14 illustrate a catheter assembly 90 which embodies an additional aspect of the present invention directed to an intravascular catheter 91 for sensing electrical activity within a patient's coronary or cardiac blood vessels. As in the prior embodiments the bipolar electrodes 92 and 93 are electrically connected to individual electrical conductors 94 which are woven or wound to form the tubular shaft 95 of the catheter 91. All of the strands which are wound to form the shaft need not be conductors 94 but may be strands of polymeric materials such as Dacron~",nylon, silk or other natural or synthetic polymeric material. When there are more than 16 electrodes and thus more than 16 electrical conductors, multiple woven layers may be employed. Fig. 14 illustrates in more detail the connection of electrical conductors 94 to the individual electrodes 92 and 93. The electrical conductors 94 are typically electrical grade copper wires of suitable outer 21~4~'~~
WO 94!16618 PCT/US94/01054' diameter such as about 0.004 to about 0.01 inch (0.10-0.25 mm). The conductors 94 may be formed of other conducting materials such as silver, gold and platinum. A suitable insulating material to coat the conductors 94 is polyimide which minimizes cross talk and which can be applied in very thin layers. As in the other embodiments of the invention the conductors 94 may be woven or merely wound, but preferably are woven.
The inner lumen 95 of the catheter 91 is configured to slidabfy receive a guidewire to facilitate the advancement of the catheter over the guidewire and preferably has at least in the distal portion thereof a diameter about 0.002 to about 0.005 inch (0.051-0.127 mm) greater than the guidewire which is to be disposed therein. For guidewire having OD of about 0.016 to about 0.018 inch (0.41-46 mm), the inner lumen 97 would be about 0.018 to about 0.023 inch (0.46-0.58 mm). The OD
of the catheter may range from about 0.03 to about 0.1 inch (0.76-2.54 mm) but preferably is about 0.03 to about 0.05 inch (0.076-1.27 mm), particularly 0.035 to about 0.040 inch (0.89-1.02 mm).
The proximal portion 96 of the catheter 91 makes up about 70 to about 95% of the total length of the catheter with the intermediate portion 97 and the distal portion 98 which has the sensing electrodes 92 and 93 being the remainder. Preferably the catheter 91 has decreasing stiffness from the proximal portion 96 to the intermediate portion 97 and the distal portion 98 to facilitate the advancement of the catheter 91 within the patient's vasculature. The exterior surface of the catheter 91 and the surface defining inner lumen 95 may be formed of lubricous materials or hydrophilic materials which become lubricous when contacting.,pqueous based fluids. Polysulfones and polyfluoroalkanes are examples of suitable lubricous polymers -and polyvinylpyrrolidone, polyethylene oxide and acrylate-based polymers of examples of suitable hydrophilic polymers.
The proximal end of the catheter 91 may be provided with a multiple arm adapter 99 as shown in Fig. 13 with one arm 100 which is configured to receive a syringe for delivering fluid into the inner lumen 95 and a second arm 101 which is provided with an electrical connector 102 which is electrically connected to the electrical conductors 94. The central arm 106 facilitates entry of a guidewire (not shown) into the inner lumen 97. The catheter 91 may be advanced into position within the patient's vascular system, i.e. either the coronary arteries or the _ cardiac veins, over a guidewire which may or may not have electrodes in accordance with the invention to detect electrical activity therein. If the guidewire over which the catheter is advanced into the patient's vasculature does not have sensing electrodes on its distal extremity, it may be withdrawn when the catheter is in its desired position and a guidewire such as shown in Fig. 4 may be advanced through the inner lumen 95 of the catheter 91 and out the port 103 in the distal end of the catheter to a more distal position with the blood vessel.
Once the arrhythmogenlc site or conductive pathway causing an arrhythmia is located, by detecting the electrical activity, means can be advanced through the inner lumen 95 of a catheter of the invention to occlude an arterial passageway which feeds the arrhythmogenic site or conductive pathway so as to terminate the arrhythmia.
Fig. 15 represents an idealized output from a plurality of electrode pairs 110 and 111 on two separate intravascular devices (not shown) disposed in different, generally parallel coronary blood vessels, e.g. a coronary artery and the companion vein, to a nearly planar wave front 112 approaching on end to the intravascular devices. The bipolar response 113 and 114 to the wave front 111 ,from each electrode pair 110 and 111 is shown adjacent thereto, and as indicated, all of the responses are essentially identical, except for the time-of-occurrence, because the wave front reaches all of the electrodes at the same angle.
Changes in tissue properties, e.g. due to an infarct, adjacent the catheters rnay retard the passage of the wave front and as a result distort the shape of the output.
Fig. 16 represents an idealized response from a plurality of electrode pairs 120 and 121 on two separate intravascutar devices (not shown) disposed in different generally parallel coronary blood vessels, as in Fig. 16, but the wave front 122 originates from a site between and in close proximity to the catheters. The idealized wave front 122 is circular and the size and polarity of the responses 123 and 124 to the expanding WO 94/1661i'i PCT/US94101054 wave front varies according to the angle of incidence between the wave front and the electrode pair. An arrhythmogenic site would create a less than ideal wave front which can be readily detected by the plurality of electrodes 120 and 121.
The time of occurrence and directional information obtained from the response from the wave front may be used to determine the origin of the ectopic beat.
EXAMPLE
A guidewire was constructed using a woven tubular braid of sixteen insulated electrical conducting wires, eight woven counterclockwise and eight woven clockwise. Gold metal electrodes 0.01 inch in width were mounted onto the distal end of the shaft about 0.5 inch ( 12.7 mm) apart with each attached to one of the electrical conducting wires. The overall length of the guidewire was about 240 cm. An eight connector DIN plug was installed at the proximal end of the guidewire. The guidewire assembly was 0.018 inch (0.46 mm) in diameter at the distal end, 0.026 inch (0.66 mm) in diameter at the midsection, and 0.032 inch (0.81 mm) at the more proximal end.
The guidewire was introduced into the coronary artery of a live dog using a 7 French coronary guide catheter. A pacer lead having four electrodes was disposed within the heart chamber and was used to pace a ventricular beat so that the electrical activity as a result of that pacing could be monitored intravascularly using the guidewire of the 215 ~'~'~ 3 invention. Fig. 17 is an electrocardiogram produced using the guidewire of the invention which depicts two pulses from that animal test in bipolar mode.
The present invention has been described herein in terms of certain preferred embodiments but various modifications may be made to the present invention without departing from the scope thereof.
Claims (15)
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. An elongated intravascular device for detecting electrical activity within a blood vessel of a patient's heart, comprising:
an elongated shaft having a proximal section and a distal section with said distal section being configured to be advanceable through a coronary artery or a cardiac vein of a patient's heart;
at least one pair of sensing electrodes mounted on said distal section with said electrodes being electrically connected to separate electrical conductors extending to said proximal section of the elongated shaft; and a flexible guiding tip which has an elongated manually shapeable core member and including a coil member disposed about said core member, extending distally from said sensing electrodes on said distal section configured for advancement through a blood vessel of the patient's heart.
an elongated shaft having a proximal section and a distal section with said distal section being configured to be advanceable through a coronary artery or a cardiac vein of a patient's heart;
at least one pair of sensing electrodes mounted on said distal section with said electrodes being electrically connected to separate electrical conductors extending to said proximal section of the elongated shaft; and a flexible guiding tip which has an elongated manually shapeable core member and including a coil member disposed about said core member, extending distally from said sensing electrodes on said distal section configured for advancement through a blood vessel of the patient's heart.
2. The intravascular device of claim 1, wherein said elongated shaft is a tubular member formed by strands which include a plurality of insulated electrical conductors.
3. The intravascular device of claim 2, wherein the strands are braided into said tubular member.
4. The intravascular device of any one of claims 1 through 3, wherein a plurality of electrode pairs are mounted on said distal shaft section.
5. The intravascular device of claim 4, wherein there is a spacing of about 2 to about 10 mm between adjacent electrode pairs.
6. The intravascular device of claim 4, wherein there is a spacing of about 5 to about 8 mm between adjacent electrode pairs.
7. The intravascular device of any one of claims 1 through 6, wherein there is a spacing of about 0.25 to about 2 mm between said electrodes of said at least one electrode pair.
8. The intravascular device of any one of claims 1 through 7, wherein there is a spacing of about 0.5 to about 1.25 mm between said electrodes of said at least one electrode pair.
9. The intravascular device of any one of claims 1 through 8, wherein said electrodes are circular bands of electrical conducting materials having widths of about 0.25 to about 1 mm.
10. The intravascular device of any one of claims 1 through 9, wherein said shaft has an inner lumen extending therein and said elongated core member is disposed within the inner lumen of the shaft.
11. The intravascular device of claim 2, wherein said tubular member has an inner lumen extending therein configured to slidably receive a guidewire.
12. The intravascular device of claim 11, wherein said inner lumen has a diameter of less than about 0.022 inch.
13. The intravascular device of claim 2, wherein said tubular member has a tubular lining which defines an inner lumen extending therein.
14. The intravascular device of claim 13, wherein said tubular lining is formed of a lubricous material.
15. The intravascular device of claim 14, wherein said lubricous material is a fluoropolymer.
Applications Claiming Priority (9)
Application Number | Priority Date | Filing Date | Title |
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US1081893A | 1993-01-29 | 1993-01-29 | |
US4344993A | 1993-04-05 | 1993-04-05 | |
US5729493A | 1993-05-05 | 1993-05-05 | |
US08/043,449 | 1993-05-05 | ||
US08/010,818 | 1993-05-05 | ||
US08/057,294 | 1993-05-05 | ||
US08/188,619 US5509411A (en) | 1993-01-29 | 1994-01-27 | Intravascular sensing device |
US08/188,619 | 1994-01-27 | ||
PCT/US1994/001054 WO1994016618A1 (en) | 1993-01-29 | 1994-01-28 | Intravascular sensing device |
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CA2154773A1 CA2154773A1 (en) | 1994-08-04 |
CA2154773C true CA2154773C (en) | 2004-10-12 |
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CA002154773A Expired - Fee Related CA2154773C (en) | 1993-01-29 | 1994-01-28 | Intravascular sensing device |
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US (5) | US5706809A (en) |
EP (1) | EP0681450B1 (en) |
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DE (1) | DE69430192T2 (en) |
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Families Citing this family (390)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5699796A (en) * | 1993-01-29 | 1997-12-23 | Cardima, Inc. | High resolution intravascular signal detection |
DE69428188T2 (en) * | 1993-01-29 | 2002-03-21 | Medtronic Inc | MULTIPLE SENSOR FOR DISPLAYING ELECTRICAL SIGNALS IN BLOOD VESSELS |
US5706809A (en) * | 1993-01-29 | 1998-01-13 | Cardima, Inc. | Method and system for using multiple intravascular sensing devices to detect electrical activity |
US5645082A (en) * | 1993-01-29 | 1997-07-08 | Cardima, Inc. | Intravascular method and system for treating arrhythmia |
AU7924694A (en) * | 1993-10-01 | 1995-05-01 | Target Therapeutics, Inc. | Sheathed multipolar catheter and multipolar guidewire for sensing cardiac electrical activity |
US5517989A (en) * | 1994-04-01 | 1996-05-21 | Cardiometrics, Inc. | Guidewire assembly |
US6245068B1 (en) | 1994-08-08 | 2001-06-12 | Scimed Life Systems, Inc. | Resilient radiopaque electrophysiology electrodes and probes including the same |
US6296632B1 (en) | 1994-08-17 | 2001-10-02 | Boston Scientific Corporation | Ball-shaped fiber implant, and method and device for inserting the implant |
IL116561A0 (en) * | 1994-12-30 | 1996-03-31 | Target Therapeutics Inc | Severable joint for detachable devices placed within the body |
US6101409A (en) * | 1995-02-17 | 2000-08-08 | Ep Technologies, Inc. | Systems and methods for analyzing biopotential morphologies in body tissue |
US5711305A (en) * | 1995-02-17 | 1998-01-27 | Ep Technologies, Inc. | Systems and methods for acquiring endocardially or epicardially paced electrocardiograms |
US5605157A (en) * | 1995-02-17 | 1997-02-25 | Ep Technologies, Inc. | Systems and methods for filtering signals derived from biological events |
US5722416A (en) * | 1995-02-17 | 1998-03-03 | Ep Technologies, Inc. | Systems and methods for analyzing biopotential morphologies in heart tissue to locate potential ablation sites |
US5630425A (en) * | 1995-02-17 | 1997-05-20 | Ep Technologies, Inc. | Systems and methods for adaptive filtering artifacts from composite signals |
US5595183A (en) * | 1995-02-17 | 1997-01-21 | Ep Technologies, Inc. | Systems and methods for examining heart tissue employing multiple electrode structures and roving electrodes |
US5601088A (en) * | 1995-02-17 | 1997-02-11 | Ep Technologies, Inc. | Systems and methods for filtering artifacts from composite signals |
EP0809463B1 (en) * | 1995-02-17 | 2002-07-10 | Boston Scientific Limited | Systems for making time-sequential measurements of biological events |
US5609157A (en) * | 1995-02-17 | 1997-03-11 | Ep Technologies, Inc. | Systems and methods for analyzing biopotential morphologies in body tissue using iterative techniques |
US6059779A (en) * | 1995-04-28 | 2000-05-09 | Target Therapeutics, Inc. | Delivery catheter for electrolytically detachable implant |
US6002956A (en) * | 1995-05-23 | 1999-12-14 | Cardima, Inc. | Method of treating using an over-the-wire EP catheter |
US5782760A (en) * | 1995-05-23 | 1998-07-21 | Cardima, Inc. | Over-the-wire EP catheter |
US5895355A (en) | 1995-05-23 | 1999-04-20 | Cardima, Inc. | Over-the-wire EP catheter |
CA2223990C (en) * | 1995-06-07 | 2007-01-30 | Cardima, Inc. | Guiding catheter for coronary sinus |
JP3529537B2 (en) * | 1996-03-25 | 2004-05-24 | テルモ株式会社 | Electrode catheter |
US6063077A (en) * | 1996-04-08 | 2000-05-16 | Cardima, Inc. | Linear ablation device and assembly |
US6302880B1 (en) | 1996-04-08 | 2001-10-16 | Cardima, Inc. | Linear ablation assembly |
US5863291A (en) * | 1996-04-08 | 1999-01-26 | Cardima, Inc. | Linear ablation assembly |
US5755718A (en) * | 1996-06-04 | 1998-05-26 | Sklar; Joseph H. | Apparatus and method for reconstructing ligaments |
US5824026A (en) * | 1996-06-12 | 1998-10-20 | The Spectranetics Corporation | Catheter for delivery of electric energy and a process for manufacturing same |
US5964793A (en) * | 1996-06-20 | 1999-10-12 | Rutten; Jean | Lead introducer with defibrillation electrode and method of atrial defibrillation |
US5766152A (en) | 1996-08-15 | 1998-06-16 | Cardima, Inc. | Intraluminal delivery of tissue lysing medium |
US5964797A (en) * | 1996-08-30 | 1999-10-12 | Target Therapeutics, Inc. | Electrolytically deployable braided vaso-occlusion device |
DE69739342D1 (en) * | 1996-09-23 | 2009-05-14 | Best Vascular Inc | |
US5690667A (en) * | 1996-09-26 | 1997-11-25 | Target Therapeutics | Vasoocclusion coil having a polymer tip |
US6002955A (en) * | 1996-11-08 | 1999-12-14 | Medtronic, Inc. | Stabilized electrophysiology catheter and method for use |
USH1905H (en) * | 1997-03-21 | 2000-10-03 | Medtronic, Inc. | Mechanism for adjusting the exposed surface area and position of an electrode along a lead body |
US5971983A (en) * | 1997-05-09 | 1999-10-26 | The Regents Of The University Of California | Tissue ablation device and method of use |
US6024740A (en) | 1997-07-08 | 2000-02-15 | The Regents Of The University Of California | Circumferential ablation device assembly |
US6012457A (en) | 1997-07-08 | 2000-01-11 | The Regents Of The University Of California | Device and method for forming a circumferential conduction block in a pulmonary vein |
EP0893093A1 (en) * | 1997-07-25 | 1999-01-27 | Sulzer Osypka GmbH | Catheter for the endocardial detection of heart potentials |
US6589199B1 (en) | 1997-08-28 | 2003-07-08 | Boston Scientific Corporation | System for implanting a cross-linked polysaccharide fiber and methods of forming and inserting the fiber |
AU8913998A (en) | 1997-08-28 | 1999-03-22 | Boston Scientific Corporation | System for implanting a cross-linked polysaccharide fiber and methods of formingand inserting the fiber |
US5938624A (en) | 1997-09-10 | 1999-08-17 | Radi Medical Systems Ab | Male connector with a continous surface for a guide wire and method therefor |
US6159165A (en) * | 1997-12-05 | 2000-12-12 | Micrus Corporation | Three dimensional spherical micro-coils manufactured from radiopaque nickel-titanium microstrand |
US6168570B1 (en) | 1997-12-05 | 2001-01-02 | Micrus Corporation | Micro-strand cable with enhanced radiopacity |
US6136015A (en) * | 1998-08-25 | 2000-10-24 | Micrus Corporation | Vasoocclusive coil |
US6241691B1 (en) | 1997-12-05 | 2001-06-05 | Micrus Corporation | Coated superelastic stent |
US6251092B1 (en) | 1997-12-30 | 2001-06-26 | Medtronic, Inc. | Deflectable guiding catheter |
US6344037B1 (en) * | 1998-02-03 | 2002-02-05 | Scimed Life Systems, Inc. | Integrated coaxial transmission line and flexible drive cable |
US6714823B1 (en) * | 1998-04-29 | 2004-03-30 | Emory University | Cardiac pacing lead and delivery system |
US6327505B1 (en) * | 1998-05-07 | 2001-12-04 | Medtronic, Inc. | Method and apparatus for rf intraluminal reduction and occlusion |
US6231572B1 (en) * | 1998-05-29 | 2001-05-15 | Applied Medical Resources Corporation | Electrosurgical catheter apparatus and method |
CA2345921C (en) | 1998-06-12 | 2005-01-25 | Cardiac Pacemakers, Inc. | Modified guidewire for left ventricular access lead |
US6251107B1 (en) * | 1998-06-25 | 2001-06-26 | Cardima, Inc. | Ep catheter |
US6240321B1 (en) * | 1998-08-12 | 2001-05-29 | Cardiac Pacemakers, Inc. | Expandable seal for use with medical device and system |
US6634364B2 (en) | 2000-12-15 | 2003-10-21 | Cardiac Pacemakers, Inc. | Method of deploying a ventricular lead containing a hemostasis mechanism |
US6241665B1 (en) | 1998-10-21 | 2001-06-05 | Plc Medical System, Inc. | Percutaneous mapping system |
US6332881B1 (en) | 1999-09-01 | 2001-12-25 | Cardima, Inc. | Surgical ablation tool |
US6980958B1 (en) * | 2000-01-11 | 2005-12-27 | Zycare, Inc. | Apparatus and methods for monitoring and modifying anticoagulation therapy of remotely located patients |
US6532378B2 (en) * | 2000-01-14 | 2003-03-11 | Ep Medsystems, Inc. | Pulmonary artery catheter for left and right atrial recording |
US7570982B2 (en) * | 2000-01-27 | 2009-08-04 | Biosense Webster, Inc. | Catheter having mapping assembly |
US6711428B2 (en) * | 2000-01-27 | 2004-03-23 | Biosense Webster, Inc. | Catheter having mapping assembly |
US6795721B2 (en) | 2000-01-27 | 2004-09-21 | Biosense Webster, Inc. | Bidirectional catheter having mapping assembly |
US6628976B1 (en) | 2000-01-27 | 2003-09-30 | Biosense Webster, Inc. | Catheter having mapping assembly |
US20040246551A1 (en) * | 2000-02-18 | 2004-12-09 | Reijnen Herman Hubertus Jacobus | Window |
US7811282B2 (en) | 2000-03-06 | 2010-10-12 | Salient Surgical Technologies, Inc. | Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof |
US6689131B2 (en) | 2001-03-08 | 2004-02-10 | Tissuelink Medical, Inc. | Electrosurgical device having a tissue reduction sensor |
US6558385B1 (en) | 2000-09-22 | 2003-05-06 | Tissuelink Medical, Inc. | Fluid-assisted medical device |
WO2003024349A1 (en) | 2001-09-05 | 2003-03-27 | Tissuelink Medical, Inc. | Fluid-assisted medical devices, systems and methods |
US8048070B2 (en) | 2000-03-06 | 2011-11-01 | Salient Surgical Technologies, Inc. | Fluid-assisted medical devices, systems and methods |
ES2643763T3 (en) | 2000-03-06 | 2017-11-24 | Salient Surgical Technologies, Inc. | Fluid supply system and controller for electrosurgical devices |
US6733500B2 (en) | 2000-03-31 | 2004-05-11 | Medtronic, Inc. | Method and system for delivering a medical electrical lead within a venous system |
US6836687B2 (en) | 2000-03-31 | 2004-12-28 | Medtronic, Inc. | Method and system for delivery of a medical electrical lead within a venous system |
US6743227B2 (en) | 2000-03-31 | 2004-06-01 | Medtronic, Inc. | Intraluminal visualization system with deflectable mechanism |
US7497844B2 (en) * | 2000-03-31 | 2009-03-03 | Medtronic, Inc. | System and method for positioning implantable medical devices within coronary veins |
JP4926359B2 (en) | 2000-05-03 | 2012-05-09 | シー・アール・バード・インコーポレーテッド | Apparatus and method for mapping and cauterization in electrophysiological procedures |
US6746446B1 (en) | 2000-08-04 | 2004-06-08 | Cardima, Inc. | Electrophysiological device for the isthmus |
US20030149368A1 (en) * | 2000-10-24 | 2003-08-07 | Hennemann Willard W. | Method and apparatus for locating and detecting vascular plaque via impedence and conductivity measurements, and for cryogenically passivating vascular plaque and inhibiting vascular plaque progression and rupture |
US20020072737A1 (en) * | 2000-12-08 | 2002-06-13 | Medtronic, Inc. | System and method for placing a medical electrical lead |
ATE418287T1 (en) * | 2001-04-27 | 2009-01-15 | Bard Inc C R | CATHETER FOR THREE-DIMENSIONAL IMAGING OF ELECTRICAL ACTIVITY IN BLOOD VESSELS |
US6972016B2 (en) * | 2001-05-01 | 2005-12-06 | Cardima, Inc. | Helically shaped electrophysiology catheter |
US7727229B2 (en) | 2001-05-01 | 2010-06-01 | C.R. Bard, Inc. | Method and apparatus for altering conduction properties in the heart and in adjacent vessels |
US7329223B1 (en) | 2001-05-31 | 2008-02-12 | Abbott Cardiovascular Systems Inc. | Catheter with optical fiber sensor |
US6697667B1 (en) | 2001-05-31 | 2004-02-24 | Advanced Cardiovascular Systems, Inc. | Apparatus and method for locating coronary sinus |
US7532920B1 (en) | 2001-05-31 | 2009-05-12 | Advanced Cardiovascular Systems, Inc. | Guidewire with optical fiber |
US6716178B1 (en) | 2001-05-31 | 2004-04-06 | Advanced Cardiovascular Systems, Inc. | Apparatus and method for performing thermal and laser doppler velocimetry measurements |
US20030065374A1 (en) * | 2001-10-01 | 2003-04-03 | Medtronic, Inc. | Active fixation lead with helix extension indicator |
DE10153842A1 (en) | 2001-10-24 | 2003-05-08 | Biotronik Mess & Therapieg | electrode assembly |
US7065394B2 (en) * | 2001-12-12 | 2006-06-20 | Medtronic, Inc | Guide catheter |
US20040073158A1 (en) * | 2001-12-12 | 2004-04-15 | Medtronic, Inc. | Guide catheter |
US7653438B2 (en) | 2002-04-08 | 2010-01-26 | Ardian, Inc. | Methods and apparatus for renal neuromodulation |
US7783365B2 (en) * | 2002-04-11 | 2010-08-24 | Medtronic, Inc. | Implantable medical device conductor insulation and process for forming |
US20030216800A1 (en) * | 2002-04-11 | 2003-11-20 | Medtronic, Inc. | Implantable medical device conductor insulation and process for forming |
AU2002312708A1 (en) * | 2002-06-26 | 2004-01-19 | Endosense S.A. | Catheterization method and system |
US20040024425A1 (en) * | 2002-07-31 | 2004-02-05 | Worley Seth J. | Method and apparatus for using a cardiac stimulating, sensing and guidewire combination |
US7313445B2 (en) * | 2002-09-26 | 2007-12-25 | Medtronic, Inc. | Medical lead with flexible distal guidewire extension |
US20040082947A1 (en) * | 2002-10-25 | 2004-04-29 | The Regents Of The University Of Michigan | Ablation catheters |
US20050033137A1 (en) * | 2002-10-25 | 2005-02-10 | The Regents Of The University Of Michigan | Ablation catheters and methods for their use |
JP2006504472A (en) | 2002-10-29 | 2006-02-09 | ティシューリンク・メディカル・インコーポレーテッド | Fluid-assisted electrosurgical scissors and method |
CA2508800A1 (en) | 2002-12-11 | 2004-06-24 | Proteus Biomedical, Inc. | Method and system for monitoring and treating hemodynamic parameters |
WO2004067081A2 (en) * | 2003-01-24 | 2004-08-12 | Proteus Biomedical Inc. | Methods and apparatus for enhancing cardiac pacing |
WO2004066814A2 (en) * | 2003-01-24 | 2004-08-12 | Proteus Biomedical Inc. | Method and system for remote hemodynamic monitoring |
WO2004066817A2 (en) * | 2003-01-24 | 2004-08-12 | Proteus Biomedical Inc. | Methods and systems for measuring cardiac parameters |
US7142903B2 (en) | 2003-03-12 | 2006-11-28 | Biosense Webster, Inc. | Catheter with contractable mapping assembly |
US8103358B2 (en) * | 2003-04-04 | 2012-01-24 | Medtronic, Inc. | Mapping guidelet |
US7082336B2 (en) * | 2003-06-04 | 2006-07-25 | Synecor, Llc | Implantable intravascular device for defibrillation and/or pacing |
US7617007B2 (en) * | 2003-06-04 | 2009-11-10 | Synecor Llc | Method and apparatus for retaining medical implants within body vessels |
US7529589B2 (en) | 2003-06-04 | 2009-05-05 | Synecor Llc | Intravascular electrophysiological system and methods |
US8239045B2 (en) * | 2003-06-04 | 2012-08-07 | Synecor Llc | Device and method for retaining a medical device within a vessel |
EP3045136B1 (en) | 2003-09-12 | 2021-02-24 | Vessix Vascular, Inc. | Selectable eccentric remodeling and/or ablation of atherosclerotic material |
US7142919B2 (en) * | 2003-10-24 | 2006-11-28 | Medtronic, Inc. | Reconfigurable, fault tolerant multiple-electrode cardiac lead systems |
WO2005058415A2 (en) * | 2003-12-12 | 2005-06-30 | Synecor, Llc | Implantable medical device having pre-implant exoskeleton |
US7220127B2 (en) * | 2003-12-15 | 2007-05-22 | Medtronic, Inc. | Heart model |
US20050137646A1 (en) * | 2003-12-22 | 2005-06-23 | Scimed Life Systems, Inc. | Method of intravascularly delivering stimulation leads into brain |
US8060207B2 (en) | 2003-12-22 | 2011-11-15 | Boston Scientific Scimed, Inc. | Method of intravascularly delivering stimulation leads into direct contact with tissue |
US7727232B1 (en) | 2004-02-04 | 2010-06-01 | Salient Surgical Technologies, Inc. | Fluid-assisted medical devices and methods |
ATE534426T1 (en) * | 2004-02-10 | 2011-12-15 | Synecor Llc | INTRAVASCULAR DELIVERY SYSTEM FOR THERAPEUTIC AGENTS |
EP1715788B1 (en) | 2004-02-17 | 2011-09-07 | Philips Electronics LTD | Method and apparatus for registration, verification, and referencing of internal organs |
US7295875B2 (en) | 2004-02-20 | 2007-11-13 | Boston Scientific Scimed, Inc. | Method of stimulating/sensing brain with combination of intravascularly and non-vascularly delivered leads |
US20050203600A1 (en) | 2004-03-12 | 2005-09-15 | Scimed Life Systems, Inc. | Collapsible/expandable tubular electrode leads |
US7177702B2 (en) | 2004-03-12 | 2007-02-13 | Scimed Life Systems, Inc. | Collapsible/expandable electrode leads |
US7590454B2 (en) * | 2004-03-12 | 2009-09-15 | Boston Scientific Neuromodulation Corporation | Modular stimulation lead network |
US7174220B1 (en) * | 2004-03-16 | 2007-02-06 | Pacesetter, Inc. | Construction of a medical electrical lead |
US7231260B2 (en) | 2004-05-06 | 2007-06-12 | Boston Scientific Scimed, Inc. | Intravascular self-anchoring electrode body with arcuate springs, spring loops, or arms |
US7286879B2 (en) | 2004-07-16 | 2007-10-23 | Boston Scientific Scimed, Inc. | Method of stimulating fastigium nucleus to treat neurological disorders |
EP1799101A4 (en) * | 2004-09-02 | 2008-11-19 | Proteus Biomedical Inc | Methods and apparatus for tissue activation and monitoring |
US8920414B2 (en) | 2004-09-10 | 2014-12-30 | Vessix Vascular, Inc. | Tuned RF energy and electrical tissue characterization for selective treatment of target tissues |
US9713730B2 (en) | 2004-09-10 | 2017-07-25 | Boston Scientific Scimed, Inc. | Apparatus and method for treatment of in-stent restenosis |
US8396548B2 (en) | 2008-11-14 | 2013-03-12 | Vessix Vascular, Inc. | Selective drug delivery in a lumen |
WO2006105474A2 (en) * | 2005-03-31 | 2006-10-05 | Proteus Biomedical, Inc. | Automated optimization of multi-electrode pacing for cardiac resynchronization |
US20060089637A1 (en) | 2004-10-14 | 2006-04-27 | Werneth Randell L | Ablation catheter |
US7949407B2 (en) | 2004-11-05 | 2011-05-24 | Asthmatx, Inc. | Energy delivery devices and methods |
US7722565B2 (en) | 2004-11-05 | 2010-05-25 | Traxtal, Inc. | Access system |
WO2006052940A2 (en) | 2004-11-05 | 2006-05-18 | Asthmatx, Inc. | Medical device with procedure improvement features |
US7751868B2 (en) | 2004-11-12 | 2010-07-06 | Philips Electronics Ltd | Integrated skin-mounted multifunction device for use in image-guided surgery |
US20070093802A1 (en) * | 2005-10-21 | 2007-04-26 | Danek Christopher J | Energy delivery devices and methods |
US7805269B2 (en) | 2004-11-12 | 2010-09-28 | Philips Electronics Ltd | Device and method for ensuring the accuracy of a tracking device in a volume |
US8617152B2 (en) * | 2004-11-15 | 2013-12-31 | Medtronic Ablation Frontiers Llc | Ablation system with feedback |
US7412273B2 (en) | 2004-11-15 | 2008-08-12 | Biosense Webster, Inc. | Soft linear mapping catheter with stabilizing tip |
US7468062B2 (en) * | 2004-11-24 | 2008-12-23 | Ablation Frontiers, Inc. | Atrial ablation catheter adapted for treatment of septal wall arrhythmogenic foci and method of use |
US7429261B2 (en) * | 2004-11-24 | 2008-09-30 | Ablation Frontiers, Inc. | Atrial ablation catheter and method of use |
US7937160B2 (en) * | 2004-12-10 | 2011-05-03 | Boston Scientific Neuromodulation Corporation | Methods for delivering cortical electrode leads into patient's head |
US20060135953A1 (en) * | 2004-12-22 | 2006-06-22 | Wlodzimierz Kania | Tissue ablation system including guidewire with sensing element |
CA2587986A1 (en) | 2005-01-18 | 2006-07-27 | Traxtal Inc. | Electromagnetically tracked k-wire device |
CA2588002A1 (en) | 2005-01-18 | 2006-07-27 | Traxtal Inc. | Method and apparatus for guiding an instrument to a target in the lung |
US8182433B2 (en) | 2005-03-04 | 2012-05-22 | Endosense Sa | Medical apparatus system having optical fiber load sensing capability |
US8075498B2 (en) | 2005-03-04 | 2011-12-13 | Endosense Sa | Medical apparatus system having optical fiber load sensing capability |
US20090118612A1 (en) | 2005-05-06 | 2009-05-07 | Sorin Grunwald | Apparatus and Method for Vascular Access |
CA2612679A1 (en) | 2005-06-20 | 2007-01-04 | Richardo D. Roman | Ablation catheter |
DE602006019117D1 (en) | 2005-06-21 | 2011-02-03 | Us Government | DEVICE AND METHOD FOR A TRACKABLE ULTRASOUND |
CA2613360A1 (en) | 2005-06-21 | 2007-01-04 | Traxtal Inc. | System, method and apparatus for navigated therapy and diagnosis |
WO2007005641A2 (en) * | 2005-07-01 | 2007-01-11 | Proteus Biomedical, Inc. | Deployable epicardial electrode and sensor array |
AU2006268238A1 (en) * | 2005-07-11 | 2007-01-18 | Medtronic Ablation Frontiers Llc | Low power tissue ablation system |
US8894589B2 (en) | 2005-08-01 | 2014-11-25 | Endosense Sa | Medical apparatus system having optical fiber load sensing capability |
US7983751B2 (en) * | 2005-08-12 | 2011-07-19 | Proteus Biomedical, Inc. | Measuring conduction velocity using one or more satellite devices |
US8657814B2 (en) | 2005-08-22 | 2014-02-25 | Medtronic Ablation Frontiers Llc | User interface for tissue ablation system |
US9661991B2 (en) | 2005-08-24 | 2017-05-30 | Koninklijke Philips N.V. | System, method and devices for navigated flexible endoscopy |
US8784336B2 (en) | 2005-08-24 | 2014-07-22 | C. R. Bard, Inc. | Stylet apparatuses and methods of manufacture |
US7842031B2 (en) * | 2005-11-18 | 2010-11-30 | Medtronic Cryocath Lp | Bioimpedance measurement system and method |
US8696656B2 (en) | 2005-11-18 | 2014-04-15 | Medtronic Cryocath Lp | System and method for monitoring bioimpedance and respiration |
US20100204766A1 (en) * | 2005-12-22 | 2010-08-12 | Mark Zdeblick | Implantable integrated circuit |
US11234761B2 (en) * | 2006-01-27 | 2022-02-01 | Baylis Medical Company Inc. | Electrosurgical device for creating a channel through a region of tissue and methods of use thereof |
US20070265673A1 (en) * | 2006-04-03 | 2007-11-15 | Terrance Ransbury | Flexible interconnect assembly for implantable medical devices |
US8019435B2 (en) | 2006-05-02 | 2011-09-13 | Boston Scientific Scimed, Inc. | Control of arterial smooth muscle tone |
US8048063B2 (en) | 2006-06-09 | 2011-11-01 | Endosense Sa | Catheter having tri-axial force sensor |
US8567265B2 (en) | 2006-06-09 | 2013-10-29 | Endosense, SA | Triaxial fiber optic force sensing catheter |
US7774039B2 (en) | 2006-09-05 | 2010-08-10 | Boston Scientific Scimed, Inc. | Multi-bend steerable mapping catheter |
US20210121227A1 (en) | 2006-09-29 | 2021-04-29 | Baylis Medical Company Inc. | Connector system for electrosurgical device |
US11666377B2 (en) | 2006-09-29 | 2023-06-06 | Boston Scientific Medical Device Limited | Electrosurgical device |
WO2008045925A2 (en) * | 2006-10-10 | 2008-04-17 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ablation electrode assembly with insulated distal outlet |
ES2560006T3 (en) | 2006-10-18 | 2016-02-17 | Vessix Vascular, Inc. | Induction of desirable temperature effects on body tissue |
AU2007310991B2 (en) | 2006-10-18 | 2013-06-20 | Boston Scientific Scimed, Inc. | System for inducing desirable temperature effects on body tissue |
US7931647B2 (en) * | 2006-10-20 | 2011-04-26 | Asthmatx, Inc. | Method of delivering energy to a lung airway using markers |
US8388546B2 (en) | 2006-10-23 | 2013-03-05 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
US7794407B2 (en) | 2006-10-23 | 2010-09-14 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
US7881806B2 (en) * | 2006-10-31 | 2011-02-01 | Medtronic, Inc. | Medical lead delivery device |
US8311633B2 (en) * | 2006-12-04 | 2012-11-13 | Synecor Llc | Intravascular implantable device having superior anchoring arrangement |
US20080147168A1 (en) * | 2006-12-04 | 2008-06-19 | Terrance Ransbury | Intravascular implantable device having detachable tether arrangement |
CA2676119C (en) | 2007-01-29 | 2021-01-19 | Simon Fraser University | Transvascular nerve stimulation apparatus and methods |
US8641704B2 (en) * | 2007-05-11 | 2014-02-04 | Medtronic Ablation Frontiers Llc | Ablation therapy system and method for treating continuous atrial fibrillation |
US8157789B2 (en) | 2007-05-24 | 2012-04-17 | Endosense Sa | Touch sensing catheter |
US8622935B1 (en) | 2007-05-25 | 2014-01-07 | Endosense Sa | Elongated surgical manipulator with body position and distal force sensing |
EP2170162B1 (en) | 2007-06-26 | 2017-08-23 | Vasonova, Inc. | Apparatus for endovascular device guiding and positioning using physiological parameters |
US8235983B2 (en) | 2007-07-12 | 2012-08-07 | Asthmatx, Inc. | Systems and methods for delivering energy to passageways in a patient |
US20090043301A1 (en) * | 2007-08-09 | 2009-02-12 | Asthmatx, Inc. | Monopolar energy delivery devices and methods for controlling current density in tissue |
US8360995B2 (en) * | 2007-09-18 | 2013-01-29 | Cook Medical Technologies Llc | Wire guide |
US10524691B2 (en) | 2007-11-26 | 2020-01-07 | C. R. Bard, Inc. | Needle assembly including an aligned magnetic element |
US10449330B2 (en) | 2007-11-26 | 2019-10-22 | C. R. Bard, Inc. | Magnetic element-equipped needle assemblies |
US10751509B2 (en) | 2007-11-26 | 2020-08-25 | C. R. Bard, Inc. | Iconic representations for guidance of an indwelling medical device |
US8849382B2 (en) | 2007-11-26 | 2014-09-30 | C. R. Bard, Inc. | Apparatus and display methods relating to intravascular placement of a catheter |
ES2651898T3 (en) | 2007-11-26 | 2018-01-30 | C.R. Bard Inc. | Integrated system for intravascular catheter placement |
US9521961B2 (en) | 2007-11-26 | 2016-12-20 | C. R. Bard, Inc. | Systems and methods for guiding a medical instrument |
US9649048B2 (en) | 2007-11-26 | 2017-05-16 | C. R. Bard, Inc. | Systems and methods for breaching a sterile field for intravascular placement of a catheter |
US9636031B2 (en) | 2007-11-26 | 2017-05-02 | C.R. Bard, Inc. | Stylets for use with apparatus for intravascular placement of a catheter |
US8781555B2 (en) | 2007-11-26 | 2014-07-15 | C. R. Bard, Inc. | System for placement of a catheter including a signal-generating stylet |
EP2227174B1 (en) | 2007-12-28 | 2019-05-01 | Salient Surgical Technologies, Inc. | Fluid-assisted electrosurgical device |
US8478382B2 (en) | 2008-02-11 | 2013-07-02 | C. R. Bard, Inc. | Systems and methods for positioning a catheter |
US8473069B2 (en) * | 2008-02-28 | 2013-06-25 | Proteus Digital Health, Inc. | Integrated circuit implementation and fault control system, device, and method |
US20100069781A1 (en) * | 2008-04-15 | 2010-03-18 | Johansen Jerald A | Device and method for accessing and treating ducts of mammary glands |
WO2009128968A1 (en) | 2008-04-17 | 2009-10-22 | Medtronic, Inc. | Extensible implantable medical lead with braided conductors |
US8298227B2 (en) | 2008-05-14 | 2012-10-30 | Endosense Sa | Temperature compensated strain sensing catheter |
US20090287189A1 (en) * | 2008-05-14 | 2009-11-19 | Becton, Dickinson And Company | Optimal radiopaque catheter |
ES2525525T3 (en) | 2008-08-22 | 2014-12-26 | C.R. Bard, Inc. | Catheter assembly that includes ECG and magnetic sensor assemblies |
US8437833B2 (en) | 2008-10-07 | 2013-05-07 | Bard Access Systems, Inc. | Percutaneous magnetic gastrostomy |
WO2010056745A1 (en) | 2008-11-17 | 2010-05-20 | Minnow Medical, Inc. | Selective accumulation of energy with or without knowledge of tissue topography |
EP2358429A4 (en) * | 2008-12-02 | 2013-05-29 | Proteus Digital Health Inc | Analyzer compatible communication protocol |
US9254168B2 (en) | 2009-02-02 | 2016-02-09 | Medtronic Advanced Energy Llc | Electro-thermotherapy of tissue using penetrating microelectrode array |
WO2010096579A1 (en) * | 2009-02-20 | 2010-08-26 | Boston Scientific Scimed, Inc. | Steerable catheter having intermediate stiffness transition zone |
EP2398416B1 (en) | 2009-02-23 | 2015-10-28 | Medtronic Advanced Energy LLC | Fluid-assisted electrosurgical device |
WO2010115139A2 (en) * | 2009-04-02 | 2010-10-07 | Proteus Biomedical, Inc. | Method and apparatus for implantable lead |
US8412347B2 (en) | 2009-04-29 | 2013-04-02 | Proteus Digital Health, Inc. | Methods and apparatus for leads for implantable devices |
US9445734B2 (en) | 2009-06-12 | 2016-09-20 | Bard Access Systems, Inc. | Devices and methods for endovascular electrography |
WO2010144916A2 (en) * | 2009-06-12 | 2010-12-16 | Innerpulse, Inc. | Methods and systems for anti-thrombotic intravascular implantable devices |
ES2745861T3 (en) | 2009-06-12 | 2020-03-03 | Bard Access Systems Inc | Apparatus, computer-aided data-processing algorithm, and computer storage medium for positioning an endovascular device in or near the heart |
US20110004288A1 (en) * | 2009-06-12 | 2011-01-06 | Terrance Ransbury | Intravascular implantable device having integrated anchor mechanism |
US9532724B2 (en) | 2009-06-12 | 2017-01-03 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation using endovascular energy mapping |
US8786049B2 (en) | 2009-07-23 | 2014-07-22 | Proteus Digital Health, Inc. | Solid-state thin-film capacitor |
CN102497832B (en) | 2009-09-08 | 2015-09-09 | 显著外科技术公司 | For case assembly and the using method thereof of electro-surgical device, electrosurgical unit |
WO2011044421A1 (en) | 2009-10-08 | 2011-04-14 | C. R. Bard, Inc. | Spacers for use with an ultrasound probe |
US10639008B2 (en) | 2009-10-08 | 2020-05-05 | C. R. Bard, Inc. | Support and cover structures for an ultrasound probe head |
US8469953B2 (en) | 2009-11-16 | 2013-06-25 | Covidien Lp | Twin sealing chamber hub |
CN102821679B (en) | 2010-02-02 | 2016-04-27 | C·R·巴德股份有限公司 | For the apparatus and method that catheter navigation and end are located |
US9592090B2 (en) | 2010-03-11 | 2017-03-14 | Medtronic Advanced Energy Llc | Bipolar electrosurgical cutter with position insensitive return electrode contact |
US9795765B2 (en) | 2010-04-09 | 2017-10-24 | St. Jude Medical International Holding S.À R.L. | Variable stiffness steering mechanism for catheters |
CA2795229A1 (en) | 2010-04-09 | 2011-10-13 | Vessix Vascular, Inc. | Power generating and control apparatus for the treatment of tissue |
US9192790B2 (en) | 2010-04-14 | 2015-11-24 | Boston Scientific Scimed, Inc. | Focused ultrasonic renal denervation |
ES2778041T3 (en) | 2010-05-28 | 2020-08-07 | Bard Inc C R | Apparatus for use with needle insertion guidance system |
US20110295249A1 (en) * | 2010-05-28 | 2011-12-01 | Salient Surgical Technologies, Inc. | Fluid-Assisted Electrosurgical Devices, and Methods of Manufacture Thereof |
EP2912999B1 (en) | 2010-05-28 | 2022-06-29 | C. R. Bard, Inc. | Apparatus for use with needle insertion guidance system |
US8473067B2 (en) | 2010-06-11 | 2013-06-25 | Boston Scientific Scimed, Inc. | Renal denervation and stimulation employing wireless vascular energy transfer arrangement |
US9138289B2 (en) | 2010-06-28 | 2015-09-22 | Medtronic Advanced Energy Llc | Electrode sheath for electrosurgical device |
US8906012B2 (en) | 2010-06-30 | 2014-12-09 | Medtronic Advanced Energy Llc | Electrosurgical devices with wire electrode |
US8920417B2 (en) | 2010-06-30 | 2014-12-30 | Medtronic Advanced Energy Llc | Electrosurgical devices and methods of use thereof |
US9358365B2 (en) | 2010-07-30 | 2016-06-07 | Boston Scientific Scimed, Inc. | Precision electrode movement control for renal nerve ablation |
US9463062B2 (en) | 2010-07-30 | 2016-10-11 | Boston Scientific Scimed, Inc. | Cooled conductive balloon RF catheter for renal nerve ablation |
US9408661B2 (en) | 2010-07-30 | 2016-08-09 | Patrick A. Haverkost | RF electrodes on multiple flexible wires for renal nerve ablation |
US9084609B2 (en) | 2010-07-30 | 2015-07-21 | Boston Scientific Scime, Inc. | Spiral balloon catheter for renal nerve ablation |
US9155589B2 (en) | 2010-07-30 | 2015-10-13 | Boston Scientific Scimed, Inc. | Sequential activation RF electrode set for renal nerve ablation |
JP2012034852A (en) * | 2010-08-06 | 2012-02-23 | Japan Lifeline Co Ltd | Electrode catheter |
WO2012024577A2 (en) | 2010-08-20 | 2012-02-23 | C.R. Bard, Inc. | Reconfirmation of ecg-assisted catheter tip placement |
TWI556849B (en) | 2010-10-21 | 2016-11-11 | 美敦力阿福盧森堡公司 | Catheter apparatus for renal neuromodulation |
US8718770B2 (en) | 2010-10-21 | 2014-05-06 | Medtronic, Inc. | Capture threshold measurement for selection of pacing vector |
US8974451B2 (en) | 2010-10-25 | 2015-03-10 | Boston Scientific Scimed, Inc. | Renal nerve ablation using conductive fluid jet and RF energy |
US9023040B2 (en) | 2010-10-26 | 2015-05-05 | Medtronic Advanced Energy Llc | Electrosurgical cutting devices |
US9220558B2 (en) | 2010-10-27 | 2015-12-29 | Boston Scientific Scimed, Inc. | RF renal denervation catheter with multiple independent electrodes |
US8801693B2 (en) | 2010-10-29 | 2014-08-12 | C. R. Bard, Inc. | Bioimpedance-assisted placement of a medical device |
US9028485B2 (en) | 2010-11-15 | 2015-05-12 | Boston Scientific Scimed, Inc. | Self-expanding cooling electrode for renal nerve ablation |
US9089350B2 (en) | 2010-11-16 | 2015-07-28 | Boston Scientific Scimed, Inc. | Renal denervation catheter with RF electrode and integral contrast dye injection arrangement |
US9668811B2 (en) | 2010-11-16 | 2017-06-06 | Boston Scientific Scimed, Inc. | Minimally invasive access for renal nerve ablation |
US9326751B2 (en) | 2010-11-17 | 2016-05-03 | Boston Scientific Scimed, Inc. | Catheter guidance of external energy for renal denervation |
US9060761B2 (en) | 2010-11-18 | 2015-06-23 | Boston Scientific Scime, Inc. | Catheter-focused magnetic field induced renal nerve ablation |
US9192435B2 (en) | 2010-11-22 | 2015-11-24 | Boston Scientific Scimed, Inc. | Renal denervation catheter with cooled RF electrode |
US9023034B2 (en) | 2010-11-22 | 2015-05-05 | Boston Scientific Scimed, Inc. | Renal ablation electrode with force-activatable conduction apparatus |
US20120157993A1 (en) | 2010-12-15 | 2012-06-21 | Jenson Mark L | Bipolar Off-Wall Electrode Device for Renal Nerve Ablation |
WO2012100095A1 (en) | 2011-01-19 | 2012-07-26 | Boston Scientific Scimed, Inc. | Guide-compatible large-electrode catheter for renal nerve ablation with reduced arterial injury |
US9427281B2 (en) | 2011-03-11 | 2016-08-30 | Medtronic Advanced Energy Llc | Bronchoscope-compatible catheter provided with electrosurgical device |
US9358066B2 (en) | 2011-04-08 | 2016-06-07 | Covidien Lp | Flexible microwave catheters for natural or artificial lumens |
WO2012142588A1 (en) | 2011-04-14 | 2012-10-18 | Endosense S.A. | Compact force sensor for catheters |
US8355784B2 (en) | 2011-05-13 | 2013-01-15 | Medtronic, Inc. | Dynamic representation of multipolar leads in a programmer interface |
AU2012278809B2 (en) | 2011-07-06 | 2016-09-29 | C.R. Bard, Inc. | Needle length determination and calibration for insertion guidance system |
US9492113B2 (en) | 2011-07-15 | 2016-11-15 | Boston Scientific Scimed, Inc. | Systems and methods for monitoring organ activity |
CN103813745B (en) | 2011-07-20 | 2016-06-29 | 波士顿科学西美德公司 | In order to visualize, be directed at and to melt transcutaneous device and the method for nerve |
WO2013016203A1 (en) | 2011-07-22 | 2013-01-31 | Boston Scientific Scimed, Inc. | Nerve modulation system with a nerve modulation element positionable in a helical guide |
CN103874524B (en) * | 2011-08-04 | 2016-08-17 | 伦敦国王学院 | Manipulator continuously |
USD724745S1 (en) | 2011-08-09 | 2015-03-17 | C. R. Bard, Inc. | Cap for an ultrasound probe |
USD699359S1 (en) | 2011-08-09 | 2014-02-11 | C. R. Bard, Inc. | Ultrasound probe head |
US9750565B2 (en) | 2011-09-30 | 2017-09-05 | Medtronic Advanced Energy Llc | Electrosurgical balloons |
US9446219B2 (en) | 2011-10-04 | 2016-09-20 | Lake Region Manufacturing, Inc. | Multiconductor or multipolar guidewire |
WO2013052848A1 (en) * | 2011-10-07 | 2013-04-11 | Boston Scientific Scimed, Inc. | Methods for detection and thermal treatment of lower urinary tract conditions |
US9265459B2 (en) | 2011-10-07 | 2016-02-23 | Boston Scientific Scimed, Inc. | Methods and systems for detection and thermal treatment of lower urinary tract conditions |
WO2013055826A1 (en) | 2011-10-10 | 2013-04-18 | Boston Scientific Scimed, Inc. | Medical devices including ablation electrodes |
EP2765940B1 (en) | 2011-10-11 | 2015-08-26 | Boston Scientific Scimed, Inc. | Off-wall electrode device for nerve modulation |
US9420955B2 (en) | 2011-10-11 | 2016-08-23 | Boston Scientific Scimed, Inc. | Intravascular temperature monitoring system and method |
US9364284B2 (en) | 2011-10-12 | 2016-06-14 | Boston Scientific Scimed, Inc. | Method of making an off-wall spacer cage |
WO2013059202A1 (en) | 2011-10-18 | 2013-04-25 | Boston Scientific Scimed, Inc. | Integrated crossing balloon catheter |
US9162046B2 (en) | 2011-10-18 | 2015-10-20 | Boston Scientific Scimed, Inc. | Deflectable medical devices |
US8870864B2 (en) | 2011-10-28 | 2014-10-28 | Medtronic Advanced Energy Llc | Single instrument electrosurgery apparatus and its method of use |
US9211107B2 (en) | 2011-11-07 | 2015-12-15 | C. R. Bard, Inc. | Ruggedized ultrasound hydrogel insert |
CN104023662B (en) | 2011-11-08 | 2018-02-09 | 波士顿科学西美德公司 | Hole portion renal nerve melts |
WO2013074813A1 (en) | 2011-11-15 | 2013-05-23 | Boston Scientific Scimed, Inc. | Device and methods for renal nerve modulation monitoring |
US9119632B2 (en) | 2011-11-21 | 2015-09-01 | Boston Scientific Scimed, Inc. | Deflectable renal nerve ablation catheter |
US9265969B2 (en) | 2011-12-21 | 2016-02-23 | Cardiac Pacemakers, Inc. | Methods for modulating cell function |
US9174050B2 (en) | 2011-12-23 | 2015-11-03 | Vessix Vascular, Inc. | Methods and apparatuses for remodeling tissue of or adjacent to a body passage |
EP2797534A1 (en) | 2011-12-28 | 2014-11-05 | Boston Scientific Scimed, Inc. | Device and methods for nerve modulation using a novel ablation catheter with polymeric ablative elements |
US9050106B2 (en) | 2011-12-29 | 2015-06-09 | Boston Scientific Scimed, Inc. | Off-wall electrode device and methods for nerve modulation |
CN107126622A (en) | 2012-03-05 | 2017-09-05 | 西蒙·弗雷瑟大学 | neural stimulation system |
WO2013169927A1 (en) | 2012-05-08 | 2013-11-14 | Boston Scientific Scimed, Inc. | Renal nerve modulation devices |
BR112014030643A8 (en) | 2012-05-31 | 2018-05-15 | Baylis Medical Co Inc | radiofrequency drilling rig. |
CA2875516C (en) * | 2012-06-05 | 2020-11-03 | Muffin Incorporated | Catheter systems and methods useful for cell therapy |
EP2861153A4 (en) | 2012-06-15 | 2016-10-19 | Bard Inc C R | Apparatus and methods for detection of a removable cap on an ultrasound probe |
EP2863987B1 (en) | 2012-06-21 | 2023-08-02 | Lungpacer Medical Inc. | Transvascular diaphragm pacing systems |
JP6236441B2 (en) | 2012-06-22 | 2017-11-22 | コビディエン エルピー | Microwave temperature measurement for microwave ablation system |
US20140005573A1 (en) * | 2012-06-28 | 2014-01-02 | Volcano Corporation | Side-Loading Connectors for Use With Intravascular Devices and Associated Systems and Methods |
US9808342B2 (en) * | 2012-07-03 | 2017-11-07 | St. Jude Medical, Cardiology Division, Inc. | Balloon sizing device and method of positioning a prosthetic heart valve |
US9259269B2 (en) | 2012-08-07 | 2016-02-16 | Covidien Lp | Microwave ablation catheter and method of utilizing the same |
CN104540465A (en) | 2012-08-24 | 2015-04-22 | 波士顿科学西美德公司 | Intravascular catheter with a balloon comprising separate microporous regions |
WO2014043687A2 (en) | 2012-09-17 | 2014-03-20 | Boston Scientific Scimed, Inc. | Self-positioning electrode system and method for renal nerve modulation |
US10398464B2 (en) | 2012-09-21 | 2019-09-03 | Boston Scientific Scimed, Inc. | System for nerve modulation and innocuous thermal gradient nerve block |
WO2014047454A2 (en) | 2012-09-21 | 2014-03-27 | Boston Scientific Scimed, Inc. | Self-cooling ultrasound ablation catheter |
US10835305B2 (en) | 2012-10-10 | 2020-11-17 | Boston Scientific Scimed, Inc. | Renal nerve modulation devices and methods |
US9044575B2 (en) | 2012-10-22 | 2015-06-02 | Medtronic Adrian Luxembourg S.a.r.l. | Catheters with enhanced flexibility and associated devices, systems, and methods |
US9693821B2 (en) | 2013-03-11 | 2017-07-04 | Boston Scientific Scimed, Inc. | Medical devices for modulating nerves |
US9956033B2 (en) | 2013-03-11 | 2018-05-01 | Boston Scientific Scimed, Inc. | Medical devices for modulating nerves |
US11937873B2 (en) | 2013-03-12 | 2024-03-26 | Boston Scientific Medical Device Limited | Electrosurgical device having a lumen |
US9808311B2 (en) | 2013-03-13 | 2017-11-07 | Boston Scientific Scimed, Inc. | Deflectable medical devices |
JP6220044B2 (en) | 2013-03-15 | 2017-10-25 | ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. | Medical device for renal nerve ablation |
US10265122B2 (en) | 2013-03-15 | 2019-04-23 | Boston Scientific Scimed, Inc. | Nerve ablation devices and related methods of use |
JP6139772B2 (en) | 2013-03-15 | 2017-05-31 | ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. | Control unit for use with electrode pads and method for estimating leakage |
US9610122B2 (en) | 2013-03-29 | 2017-04-04 | Covidien Lp | Step-down coaxial microwave ablation applicators and methods for manufacturing same |
US9855404B2 (en) | 2013-05-03 | 2018-01-02 | St. Jude Medical International Holding S.À R.L. | Dual bend radii steering catheter |
WO2014189794A1 (en) | 2013-05-18 | 2014-11-27 | Medtronic Ardian Luxembourg S.A.R.L. | Neuromodulation catheters with shafts for enhanced flexibility and control and associated devices, systems, and methods |
US9814618B2 (en) | 2013-06-06 | 2017-11-14 | Boston Scientific Scimed, Inc. | Devices for delivering energy and related methods of use |
WO2014205399A1 (en) | 2013-06-21 | 2014-12-24 | Boston Scientific Scimed, Inc. | Medical devices for renal nerve ablation having rotatable shafts |
CN105473091B (en) | 2013-06-21 | 2020-01-21 | 波士顿科学国际有限公司 | Renal denervation balloon catheter with co-movable electrode supports |
US9707036B2 (en) | 2013-06-25 | 2017-07-18 | Boston Scientific Scimed, Inc. | Devices and methods for nerve modulation using localized indifferent electrodes |
JP6204579B2 (en) | 2013-07-01 | 2017-09-27 | ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. | Renal nerve ablation medical device |
KR101697908B1 (en) | 2013-07-01 | 2017-01-18 | 쥬어리크 메디컬 코퍼레이션 | Apparatus and method for intravascular measurements |
US10835183B2 (en) | 2013-07-01 | 2020-11-17 | Zurich Medical Corporation | Apparatus and method for intravascular measurements |
EP3019106A1 (en) | 2013-07-11 | 2016-05-18 | Boston Scientific Scimed, Inc. | Medical device with stretchable electrode assemblies |
CN105377169B (en) | 2013-07-11 | 2019-04-19 | 波士顿科学国际有限公司 | Device and method for neuromodulation |
WO2015010074A1 (en) | 2013-07-19 | 2015-01-22 | Boston Scientific Scimed, Inc. | Spiral bipolar electrode renal denervation balloon |
CN105392435B (en) | 2013-07-22 | 2018-11-09 | 波士顿科学国际有限公司 | Renal nerve ablation catheter with twisting sacculus |
US10342609B2 (en) | 2013-07-22 | 2019-07-09 | Boston Scientific Scimed, Inc. | Medical devices for renal nerve ablation |
CN105473093B (en) | 2013-08-22 | 2019-02-05 | 波士顿科学国际有限公司 | Flexible circuit with the improved adhesion strength to renal nerve modulation sacculus |
CN105555218B (en) | 2013-09-04 | 2019-01-15 | 波士顿科学国际有限公司 | With radio frequency (RF) foley's tube rinsed with cooling capacity |
EP3043733A1 (en) | 2013-09-13 | 2016-07-20 | Boston Scientific Scimed, Inc. | Ablation balloon with vapor deposited cover layer |
US10631914B2 (en) | 2013-09-30 | 2020-04-28 | Covidien Lp | Bipolar electrosurgical instrument with movable electrode and related systems and methods |
US11246654B2 (en) | 2013-10-14 | 2022-02-15 | Boston Scientific Scimed, Inc. | Flexible renal nerve ablation devices and related methods of use and manufacture |
WO2015057521A1 (en) | 2013-10-14 | 2015-04-23 | Boston Scientific Scimed, Inc. | High resolution cardiac mapping electrode array catheter |
US9770606B2 (en) | 2013-10-15 | 2017-09-26 | Boston Scientific Scimed, Inc. | Ultrasound ablation catheter with cooling infusion and centering basket |
JP6259098B2 (en) | 2013-10-15 | 2018-01-10 | ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. | Medical device and method for manufacturing the medical device |
EP3057521B1 (en) | 2013-10-18 | 2020-03-25 | Boston Scientific Scimed, Inc. | Balloon catheters with flexible conducting wires |
WO2015061457A1 (en) | 2013-10-25 | 2015-04-30 | Boston Scientific Scimed, Inc. | Embedded thermocouple in denervation flex circuit |
US9242088B2 (en) | 2013-11-22 | 2016-01-26 | Simon Fraser University | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
CN105899157B (en) | 2014-01-06 | 2019-08-09 | 波士顿科学国际有限公司 | Tear-proof flexible circuit assembly |
EP3096835B1 (en) | 2014-01-21 | 2019-08-07 | Lungpacer Medical Inc. | Systems for optimization of multi-electrode nerve pacing |
WO2015113034A1 (en) | 2014-01-27 | 2015-07-30 | Medtronic Ardian Luxembourg S.A.R.L. | Neuromodulation catheters having jacketed neuromodulation elements and related devices, systems, and methods |
US11000679B2 (en) | 2014-02-04 | 2021-05-11 | Boston Scientific Scimed, Inc. | Balloon protection and rewrapping devices and related methods of use |
WO2015119890A1 (en) | 2014-02-04 | 2015-08-13 | Boston Scientific Scimed, Inc. | Alternative placement of thermal sensors on bipolar electrode |
CN105979868B (en) | 2014-02-06 | 2020-03-10 | C·R·巴德股份有限公司 | Systems and methods for guidance and placement of intravascular devices |
JP2017513600A (en) | 2014-04-24 | 2017-06-01 | メドトロニック アーディアン ルクセンブルク ソシエテ ア レスポンサビリテ リミテ | Nerve adjustment catheter with braided shaft and related systems and methods |
US9974599B2 (en) | 2014-08-15 | 2018-05-22 | Medtronic Ps Medical, Inc. | Multipurpose electrosurgical device |
US10624697B2 (en) | 2014-08-26 | 2020-04-21 | Covidien Lp | Microwave ablation system |
US10813691B2 (en) | 2014-10-01 | 2020-10-27 | Covidien Lp | Miniaturized microwave ablation assembly |
US9956029B2 (en) | 2014-10-31 | 2018-05-01 | Medtronic Advanced Energy Llc | Telescoping device with saline irrigation line |
US10973584B2 (en) | 2015-01-19 | 2021-04-13 | Bard Access Systems, Inc. | Device and method for vascular access |
US9717503B2 (en) | 2015-05-11 | 2017-08-01 | Covidien Lp | Electrolytic detachment for implant delivery systems |
JP6812422B2 (en) * | 2015-05-29 | 2021-01-13 | マイクロベンション インコーポレイテッドMicrovention, Inc. | Catheter circuit |
US10349890B2 (en) | 2015-06-26 | 2019-07-16 | C. R. Bard, Inc. | Connector interface for ECG-based catheter positioning system |
US11389227B2 (en) | 2015-08-20 | 2022-07-19 | Medtronic Advanced Energy Llc | Electrosurgical device with multivariate control |
US11051875B2 (en) | 2015-08-24 | 2021-07-06 | Medtronic Advanced Energy Llc | Multipurpose electrosurgical device |
US10779883B2 (en) | 2015-09-09 | 2020-09-22 | Baylis Medical Company Inc. | Epicardial access system and methods |
JP6785301B2 (en) | 2015-11-04 | 2020-11-18 | ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. | Medical devices and related methods |
US10321915B2 (en) * | 2015-12-18 | 2019-06-18 | Stryker Corporation | Vaso-occlusive device and delivery assembly |
US10716612B2 (en) | 2015-12-18 | 2020-07-21 | Medtronic Advanced Energy Llc | Electrosurgical device with multiple monopolar electrode assembly |
EP3677206B1 (en) | 2016-01-07 | 2022-02-23 | St. Jude Medical International Holding S.à r.l. | Medical device with multi-core fiber for optical sensing |
US11000207B2 (en) | 2016-01-29 | 2021-05-11 | C. R. Bard, Inc. | Multiple coil system for tracking a medical device |
US10813692B2 (en) | 2016-02-29 | 2020-10-27 | Covidien Lp | 90-degree interlocking geometry for introducer for facilitating deployment of microwave radiating catheter |
US20170332918A1 (en) * | 2016-05-19 | 2017-11-23 | Dragon Medical Development Limited | Guidewire apparatus and method for multiple parameter analysis of coronary stenosis |
US10828037B2 (en) | 2016-06-27 | 2020-11-10 | Covidien Lp | Electrolytic detachment with fluid electrical connection |
US10828039B2 (en) | 2016-06-27 | 2020-11-10 | Covidien Lp | Electrolytic detachment for implantable devices |
US11051822B2 (en) | 2016-06-28 | 2021-07-06 | Covidien Lp | Implant detachment with thermal activation |
US11065053B2 (en) | 2016-08-02 | 2021-07-20 | Covidien Lp | Ablation cable assemblies and a method of manufacturing the same |
US10376309B2 (en) | 2016-08-02 | 2019-08-13 | Covidien Lp | Ablation cable assemblies and a method of manufacturing the same |
US11197715B2 (en) | 2016-08-02 | 2021-12-14 | Covidien Lp | Ablation cable assemblies and a method of manufacturing the same |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US20190001126A1 (en) | 2017-06-30 | 2019-01-03 | Lungpacer Medical Inc. | Devices and methods for prevention, moderation, and/or treatment of cognitive injury |
US10195429B1 (en) | 2017-08-02 | 2019-02-05 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10940308B2 (en) | 2017-08-04 | 2021-03-09 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
CA3082622C (en) | 2017-12-05 | 2021-02-02 | Wesley Robert PEDERSEN | Transseptal guide wire puncture system |
WO2019217317A1 (en) * | 2018-05-07 | 2019-11-14 | Farapulse, Inc. | Systems, apparatuses, and methods for filtering high voltage noise induced by pulsed electric field ablation |
GB2577472A (en) * | 2018-07-16 | 2020-04-01 | Medsolve Ltd | An intracoronary wire, system and method for evaluating intracoronary flow |
GB2610076A (en) * | 2018-07-16 | 2023-02-22 | Cerebria Ltd | An intracoronary wire, system and method for evaluating intracoronary flow |
WO2020081373A1 (en) | 2018-10-16 | 2020-04-23 | Bard Access Systems, Inc. | Safety-equipped connection systems and methods thereof for establishing electrical connections |
EP3877043A4 (en) | 2018-11-08 | 2022-08-24 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
GB2580076A (en) * | 2018-12-20 | 2020-07-15 | Cook Medical Technologies Llc | Energy delivery device for endovascular occlusion |
WO2020232333A1 (en) | 2019-05-16 | 2020-11-19 | Lungpacer Medical Inc. | Systems and methods for sensing and stimulation |
US11771900B2 (en) | 2019-06-12 | 2023-10-03 | Lungpacer Medical Inc. | Circuitry for medical stimulation systems |
US11759190B2 (en) | 2019-10-18 | 2023-09-19 | Boston Scientific Medical Device Limited | Lock for medical devices, and related systems and methods |
US11801087B2 (en) | 2019-11-13 | 2023-10-31 | Boston Scientific Medical Device Limited | Apparatus and methods for puncturing tissue |
US11724070B2 (en) | 2019-12-19 | 2023-08-15 | Boston Scientific Medical Device Limited | Methods for determining a position of a first medical device with respect to a second medical device, and related systems and medical devices |
US11931098B2 (en) | 2020-02-19 | 2024-03-19 | Boston Scientific Medical Device Limited | System and method for carrying out a medical procedure |
US11819243B2 (en) | 2020-03-19 | 2023-11-21 | Boston Scientific Medical Device Limited | Medical sheath and related systems and methods |
US11826075B2 (en) | 2020-04-07 | 2023-11-28 | Boston Scientific Medical Device Limited | Elongated medical assembly |
US11793446B2 (en) | 2020-06-17 | 2023-10-24 | Boston Scientific Medical Device Limited | Electroanatomical mapping system with visualization of energy-delivery and elongated needle assemblies |
US11938285B2 (en) | 2020-06-17 | 2024-03-26 | Boston Scientific Medical Device Limited | Stop-movement device for elongated medical assembly |
WO2021255604A1 (en) * | 2020-06-17 | 2021-12-23 | Baylis Medical Company Inc. | Perforation device and system |
US11937796B2 (en) | 2020-06-18 | 2024-03-26 | Boston Scientific Medical Device Limited | Tissue-spreader assembly |
WO2022187161A1 (en) * | 2021-03-03 | 2022-09-09 | St. Jude Medical, Cardiology Division, Inc. | Electrode with protected impedance reduction coating |
US20230101016A1 (en) | 2021-09-27 | 2023-03-30 | Medtronic, Inc. | Intra-body electrode with a poly(3,4-ethylenedioxythiophene)-based coating |
Family Cites Families (56)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US452220A (en) * | 1891-05-12 | gunning | ||
US33925A (en) * | 1861-12-17 | Improvement in fastenings for shoulder-straps | ||
US3060923A (en) * | 1959-01-07 | 1962-10-30 | Teca Corp | Coaxial electrode structure and a method of fabricating same |
FR1557087A (en) * | 1967-12-15 | 1969-02-14 | ||
US3773037A (en) * | 1972-11-27 | 1973-11-20 | Univ California | Simplified external field electromagnetic catheter flow meter |
DE2605590A1 (en) * | 1976-02-12 | 1977-08-18 | Heinz Dr Med Praeuer | Pacemaker electrode with flexible electrode catheter - with flexible projecting base for abutment against wall of heart |
SE434460B (en) * | 1979-06-14 | 1984-07-30 | Bertil Reenstierna | ENDOCARDIAL, IMPLANTABLE CORD FOR THE HEART STIMULATOR |
US4271847A (en) * | 1979-06-28 | 1981-06-09 | Medtronic, Inc. | Temporary adjustable bipolar lead |
US4458677A (en) * | 1979-09-19 | 1984-07-10 | Mccorkle Jr Charles E | Intravenous channel cardiac electrode and lead assembly and method |
US4402330A (en) * | 1979-09-24 | 1983-09-06 | Medtronic, Inc. | Body implantable lead |
US4467817A (en) * | 1981-04-20 | 1984-08-28 | Cordis Corporation | Small diameter lead with introducing assembly |
US4481953A (en) * | 1981-11-12 | 1984-11-13 | Cordis Corporation | Endocardial lead having helically wound ribbon electrode |
US4437474A (en) * | 1982-07-16 | 1984-03-20 | Cordis Corporation | Method for making multiconductor coil and the coil made thereby |
US4759378A (en) * | 1982-10-14 | 1988-07-26 | American Hospital Supply Corporation | Flexible tip cardiac pacing catheter |
US4559951A (en) * | 1982-11-29 | 1985-12-24 | Cardiac Pacemakers, Inc. | Catheter assembly |
US4979510A (en) * | 1984-03-06 | 1990-12-25 | Ep Technologies, Inc. | Apparatus and method for recording monophasic action potentials from an in vivo heart |
USRE33925E (en) * | 1984-05-22 | 1992-05-12 | Cordis Corporation | Electrosurgical catheter aned method for vascular applications |
US4587975A (en) * | 1984-07-02 | 1986-05-13 | Cardiac Pacemakers, Inc. | Dimension sensitive angioplasty catheter |
US5095916A (en) * | 1985-06-20 | 1992-03-17 | Medtronic, Inc. | Cardioversion and defibrillation lead system |
US4690155A (en) * | 1985-07-03 | 1987-09-01 | Cordis Corporation | Monophasic action potential recording lead |
US4785815A (en) * | 1985-10-23 | 1988-11-22 | Cordis Corporation | Apparatus for locating and ablating cardiac conduction pathways |
EP0249338A3 (en) * | 1986-06-12 | 1988-12-14 | C.R. Bard, Inc. | Retroperfusion catheter |
US4867173A (en) * | 1986-06-30 | 1989-09-19 | Meadox Surgimed A/S | Steerable guidewire |
US5163445A (en) * | 1987-04-10 | 1992-11-17 | Cardiometrics, Inc. | Apparatus, system and method for measuring spatial average velocity and/or volumetric flow of blood in a vessel and screw joint for use therewith |
US4869248A (en) * | 1987-04-17 | 1989-09-26 | Narula Onkar S | Method and apparatus for localized thermal ablation |
DE3718139C1 (en) * | 1987-05-29 | 1988-12-08 | Strahlen Umweltforsch Gmbh | Cardiac catheter |
EP0293499B1 (en) * | 1987-06-01 | 1993-09-01 | Siemens-Elema AB | Implantable multi-pole coaxial lead |
US5159937A (en) * | 1987-09-30 | 1992-11-03 | Advanced Cardiovascular Systems, Inc. | Steerable dilatation catheter |
US4777955A (en) * | 1987-11-02 | 1988-10-18 | Cordis Corporation | Left ventricle mapping probe |
US4951682A (en) * | 1988-06-22 | 1990-08-28 | The Cleveland Clinic Foundation | Continuous cardiac output by impedance measurements in the heart |
US5147355A (en) * | 1988-09-23 | 1992-09-15 | Brigham And Womens Hospital | Cryoablation catheter and method of performing cryoablation |
US4966597A (en) * | 1988-11-04 | 1990-10-30 | Cosman Eric R | Thermometric cardiac tissue ablation electrode with ultra-sensitive temperature detection |
EP0369044A1 (en) * | 1988-11-14 | 1990-05-23 | Siemens-Elema AB | Electrode arrangement |
US4945912A (en) * | 1988-11-25 | 1990-08-07 | Sensor Electronics, Inc. | Catheter with radiofrequency heating applicator |
US5099838A (en) * | 1988-12-15 | 1992-03-31 | Medtronic, Inc. | Endocardial defibrillation electrode system |
US4957110A (en) * | 1989-03-17 | 1990-09-18 | C. R. Bard, Inc. | Steerable guidewire having electrodes for measuring vessel cross-section and blood flow |
US5140987A (en) * | 1989-03-17 | 1992-08-25 | Wayne State University | Method for transvenous ablation of cardiac electrically conductive tissue by laser photocoagulation |
US5029585A (en) * | 1989-07-14 | 1991-07-09 | Baxter International Inc. | Comformable intralumen electrodes |
US5056517A (en) * | 1989-07-24 | 1991-10-15 | Consiglio Nazionale Delle Ricerche | Biomagnetically localizable multipurpose catheter and method for magnetocardiographic guided intracardiac mapping, biopsy and ablation of cardiac arrhythmias |
US5044375A (en) * | 1989-12-08 | 1991-09-03 | Cardiac Pacemakers, Inc. | Unitary intravascular defibrillating catheter with separate bipolar sensing |
US5095917A (en) * | 1990-01-19 | 1992-03-17 | Vancaillie Thierry G | Transuterine sterilization apparatus and method |
US5122136A (en) * | 1990-03-13 | 1992-06-16 | The Regents Of The University Of California | Endovascular electrolytically detachable guidewire tip for the electroformation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas |
US5083565A (en) * | 1990-08-03 | 1992-01-28 | Everest Medical Corporation | Electrosurgical instrument for ablating endocardial tissue |
US5125896A (en) * | 1990-10-10 | 1992-06-30 | C. R. Bard, Inc. | Steerable electrode catheter |
US5193550A (en) * | 1990-11-30 | 1993-03-16 | Medtronic, Inc. | Method and apparatus for discriminating among normal and pathological tachyarrhythmias |
US5174288A (en) * | 1990-11-30 | 1992-12-29 | Medtronic, Inc. | Method and apparatus for cardiac defibrillation |
US5170802A (en) * | 1991-01-07 | 1992-12-15 | Medtronic, Inc. | Implantable electrode for location within a blood vessel |
US5165403A (en) * | 1991-02-26 | 1992-11-24 | Medtronic, Inc. | Difibrillation lead system and method of use |
US5193546A (en) * | 1991-05-15 | 1993-03-16 | Alexander Shaknovich | Coronary intravascular ultrasound imaging method and apparatus |
CA2109793A1 (en) * | 1991-05-24 | 1992-12-10 | Stuart D. Edwards | Combination monophasic action potential/ablation catheter and high-performance filter system |
US5184621A (en) * | 1991-05-29 | 1993-02-09 | C. R. Bard, Inc. | Steerable guidewire having electrodes for measuring vessel cross-section and blood flow |
EP0661948B1 (en) * | 1992-09-23 | 1997-11-19 | Endocardial Solutions, Inc. | Endocardial mapping system |
US5330522A (en) * | 1992-12-29 | 1994-07-19 | Siemens Pacesetter, Inc. | Ring electrode for a multilumen lead and method of constructing a multilumen lead |
US5706809A (en) * | 1993-01-29 | 1998-01-13 | Cardima, Inc. | Method and system for using multiple intravascular sensing devices to detect electrical activity |
US5364352A (en) * | 1993-03-12 | 1994-11-15 | Heart Rhythm Technologies, Inc. | Catheter for electrophysiological procedures |
AU7924694A (en) * | 1993-10-01 | 1995-05-01 | Target Therapeutics, Inc. | Sheathed multipolar catheter and multipolar guidewire for sensing cardiac electrical activity |
-
1994
- 1994-01-27 US US08/188,298 patent/US5706809A/en not_active Expired - Lifetime
- 1994-01-27 US US08/188,619 patent/US5509411A/en not_active Expired - Lifetime
- 1994-01-28 AU AU62336/94A patent/AU6233694A/en not_active Abandoned
- 1994-01-28 DE DE69430192T patent/DE69430192T2/en not_active Expired - Lifetime
- 1994-01-28 AT AT94909512T patent/ATE214569T1/en not_active IP Right Cessation
- 1994-01-28 JP JP51736794A patent/JP3370093B2/en not_active Expired - Fee Related
- 1994-01-28 WO PCT/US1994/001054 patent/WO1994016618A1/en active IP Right Grant
- 1994-01-28 CA CA002154773A patent/CA2154773C/en not_active Expired - Fee Related
- 1994-01-28 AU AU62330/94A patent/AU692762B2/en not_active Ceased
- 1994-01-28 EP EP94909512A patent/EP0681450B1/en not_active Expired - Lifetime
- 1994-01-28 ES ES94909512T patent/ES2173913T3/en not_active Expired - Lifetime
- 1994-01-28 JP JP51736694A patent/JP3488716B2/en not_active Expired - Lifetime
- 1994-01-28 WO PCT/US1994/001055 patent/WO1994016619A1/en active IP Right Grant
- 1994-01-28 JP JP6517348A patent/JPH08506034A/en not_active Ceased
- 1994-01-28 WO PCT/US1994/001018 patent/WO1994016632A1/en active IP Right Grant
- 1994-01-28 AU AU62335/94A patent/AU6233594A/en not_active Abandoned
-
1996
- 1996-04-19 US US08/636,509 patent/US5682885A/en not_active Expired - Lifetime
- 1996-12-11 US US08/763,202 patent/US6141576A/en not_active Expired - Lifetime
-
1997
- 1997-11-04 US US08/963,771 patent/US5967978A/en not_active Expired - Lifetime
Also Published As
Publication number | Publication date |
---|---|
ES2173913T3 (en) | 2002-11-01 |
AU6233594A (en) | 1994-08-15 |
US6141576A (en) | 2000-10-31 |
US5706809A (en) | 1998-01-13 |
WO1994016618A1 (en) | 1994-08-04 |
EP0681450B1 (en) | 2002-03-20 |
JPH08506252A (en) | 1996-07-09 |
AU692762B2 (en) | 1998-06-18 |
ATE214569T1 (en) | 2002-04-15 |
JPH08506034A (en) | 1996-07-02 |
WO1994016619A1 (en) | 1994-08-04 |
US5967978A (en) | 1999-10-19 |
CA2154773A1 (en) | 1994-08-04 |
JP3370093B2 (en) | 2003-01-27 |
US5682885A (en) | 1997-11-04 |
US5509411A (en) | 1996-04-23 |
JP3488716B2 (en) | 2004-01-19 |
DE69430192D1 (en) | 2002-04-25 |
WO1994016632A1 (en) | 1994-08-04 |
AU6233094A (en) | 1994-08-15 |
JPH08506251A (en) | 1996-07-09 |
DE69430192T2 (en) | 2002-11-07 |
AU6233694A (en) | 1994-08-15 |
EP0681450A1 (en) | 1995-11-15 |
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