CN1083694A - 旋转顶端可偏转导管 - Google Patents
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- A61M25/00—Catheters; Hollow probes
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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
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A61N1/00—Electrotherapy; Circuits therefor
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- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
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- A61N1/06—Electrodes for high-frequency therapy
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00577—Ablation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2018/1497—Electrodes covering only part of the probe circumference
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
- A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
Abstract
一种心律失常切除导管,它具有一个特别适于在
心室腔中穿行并探测的高柔性的管状远端部分,该部
分在其长度方向上形成了一个与远端电极携带顶端
相连的管腔,而该顶端配有一个可旋转顶端元件,它
装在远端顶端部分的远端上,并适于与所关心的心室
腔内表面配合并在其上滚动。配备了一个线偏转控
制系统以使远端导管部分的远端顶端系统以受控的
方式偏转,并且配备了一个手动控制装置以控制可旋
转顶端元件的转动。
Description
本发明一般来说涉及用于心律失常手术中的一种改进的导管,具体地说,本发明涉及在侧平面(即,垂直于导管管身)内具有大大增加了的导管端部的可操纵性的旋转顶端可偏转的导管系统的应用,尤其是在心室腔内进行手术时的应用。这就允许操作者在多个方向上引导导管顶端并操纵导管使其尽可能地接近产生心律失常的组织,从而有效地进行定位和切除。
正常的心脏起搏(在一个健康心脏中)是由一个被称作窦房结(SA结)的特殊结构所控制的。这是心脏的自身起搏器,并且是位于右心房心肌壁内的一个特殊的组织。SA结产生控制心房和心室的固有的或自身节律性收缩的脉冲。这种控制和支配作用包括离子脉冲通过心脏传导通路在心房和心室内的传输,从而由窦房结控制心脏按规定的顺序以一定速率收缩和舒张。这一顺序保证了每次心室收缩流向系统循环或者肺循环系统的血液量最大。SA结有其自身固有节律,该节律可由来自神经系统的信号所改变。随着人们情绪激动,体育运动等,交感或副交感神经系统会作出反应以调整节律。
去极化脉冲始于SA结,并以电波的形式从其在右心房的位置传送到左心房,并向下传向心房和心室之间和过滤区域,而被称作房室(A-V)结或接结的另一个结正位于此区域。这一脉冲通过A-V结以一个较慢的方式传导,再通过一个左、右心室之间的被称作希斯束的公共通路,然后进入多个被称为左、右希斯束支的通路,每个希斯束支供应一个心室。然后这些束支分为具有更细的传导组织通路的延伸网络,这些更细的传导组织通路从心脏的内表面延伸至外表面并被称为浦肯野纤维。这些纤维把去极化脉冲送入到心室心肌层的所有部分。
只要该系统未受到损伤,则脉冲会正常传输并保持心律。然而,心脏传导系统中的自身脉冲或电流可能会由于先天性缺损、疾病或能够造成疤痕组织形成的损伤而被破坏或改变。当在心脏传导通路上或在心室心肌层内存在足够严重的损伤或先天性缺陷时,电脉冲不能正常传输并可能出现被称作心律失常的节律失调。就这种失调而言,使用术语心动过缓来描述心脏收缩的异常减慢,而使用术语心动过速来描述心脏活动的异常加快。虽然这两种情况的任何一种都可能给患者生命造成威胁,但心动过速更严重,特别是在具有潜在心脏病的患者中。
已经可以用多种药物(如利多卡因,奎尼丁和普鲁卡因酰胺)治疗心室心动过速及其它心室节律失常。在交感神经兴奋过度或肾上腺分泌过盛的情况下,可采用β阻滞药物。在药物疗法不能有效地防止心律过速的情况下,可以采用某些手术方法来切除心房或心室中的产生节律失常的组织。这种手术方法包括在产生节律失常的组织部位进行扩大手术,其中通过心胞和心肌作切口,然后冷冻或手术切除,然后被疤痕组织所取代。
由于开心手术是一种极为危险的方法,它需要长期住院和很长时间的复原,因此需要有一种减少外伤的解决办法。为此,设计出了各种类型的导管,用于诊断和治疗多种心脏异常以避免开心手术的创伤。例如,作为消除动脉粥样硬化斑块集合的方法,目前常规地采用气囊血管成形术打开狭窄损伤。在该方法中,载有气囊的导管通过患者血管系统伸入到狭窄部位。气囊由于从导管腔中注入的液体而膨胀,以便对阻塞的血管壁施加压力,进而将其打通。
导管装置还被用于定位和切除心脏传导通路。在美国专利4,785,815中表示了一个这样的装置,其中导管管体在其远端至少载有一个用来感应心脏内的膜电位的电极,还有一个加热装置用来切除由传感装置定位的至少一部分通路。另一种用于心脏内的微小横断面或大横断面传导通路的热切除导管在美国专利4,869,248中进行了说明和描述,其中在导管远端使用了电阻加热元件以进行高度局限的治疗。一旦切除元件正确地定位于所要治疗的局部区域,这些装置一般是有效的。上述类型的导管装置还进行了改进,采用了单柄操作的顶端偏转线,美国专利4,960,134公开了这样的一种装置。
电生理学导管切除方法经常会由于操作者不能操纵导管顶端到达产生节律失常组织的准确部位而受到限制。这个问题在心室腔内极为突出,这是因为构成心室腔内衬形成大量小梁的缘故。定位和切除导管顶端经常塞进小梁的皱褶中。在试图移动导管的过程中,操作者必须重新对导管管身施加转矩,这样做经常会导致顶端从其位置上突然移出到不希望的较远的部位。这一问题导致长时间的且常常令人苦恼的重复性尝试以便操纵和移动导管进入正确位置上。
这种情况主要是由于导管管体本身的可操作性受到限制所造成的结果。导管管体必须具备足够大的强度和硬度,以便将其通过血管系统引入到所关心的组织附近。这种结构不允许在导管顶端包含一定程度的柔性,而这种柔性正是在高度局限的区域内进行复杂的多向操作所必需的。目前可得到的导管的特征在于无法正确地控制细微运动,且顶端只能在平行于主导管管体的平面内偏转。这些导管缺乏在心房或心室内部垂直于主导管管体的平面内控制横向运动的能力,以及缺乏在心室腔内衬(心内膜)的极不平整表面穿行的能力。
目前的大多数心脏组织切除方法包括采用将射频(RF)电流通过导管传送到位于心房或心室内的产生节律失常的部位尽可能接近的组织。射频电流将导管周围的组织加热,造成低密度损伤。为了治疗患者节律失常,必须在产生节律失常的组织中产生损伤。在这种装置的可操纵性方面的改进可以使导管在进行切除之前达到最佳精确定位。
本发明提供了一种使导管顶端具有增强的可操纵性的新型的导管设计。这种增强的可操纵性涉及加入一个可以控制导管顶端的横向运动的旋转顶端的可偏转系统。
本发明的导管系统包括一个细长的柔性管状导管,它具有一个近端、一个远端和一个在这两端之间延伸的中心腔体。导管的外径应满足可将其通过患者血管系统送入到待治疗的心腔部位。主导管一般大小为7~8个French.本发明导管的主导管道部分的远端部分包括一个与主导管管体相连的,由高柔性加强聚合物管形材料(最好是聚乙烯)制成的弹性远端部分。柔性导管部分一直延伸到导管的主管道部分的远端内部。
柔性远端部分包括一个金属顶端电极,它最好是由一种金属如不锈钢或铂制成的,且在一个成功的实施例中,该电极长16毫米,直径4毫米。顶端电极包括一个旋转顶端系统,并与柔性远端导管管体的远端相连,以便使近端保持在管体内,而旋转顶端从管体伸出。旋转顶端最好制成三角形,带有三个由弧形有波纹的侧表面分隔开的纵齿,以便能够使导管顶端在心内膜表面上的运行具有更大的可操纵性。这些齿提供了更好的摩擦拖动以及与心内膜表面的更好的电接触。在一个实施例中,10毫米远端含有三个这样的彼此对称设置(间隔120°)的齿。这些齿是弧形的以便在顶端旋转过程中进一步改善摩擦拖动。
在柔性管体内的旋转顶端的近端部分具有一个有两个安全环的微轴承系统,这两个安全环将旋转顶端固定在轴承上,在旋转顶端和导管之间还有一个固定和密封装置。位于柔性管体内部的旋转顶部部分有两个(~1毫米宽)环,它们可在旋转顶端和导管之间提供固定和密封。顶端的近端部分有一个插入轴承系统内的带一个圆盘的轴。轴承套在顶端的轴上并含有两个环用作导管顶端机构固定器。除轴承系统、固定环,和旋转线以外,将两条保护线最好固定在轴承系统上并连在一个T形销钉上,销钉埋入顶端约10毫米并起到辅助保护作用以防止顶端从导管轴中移出。
顶端的可旋转扭矩是通过一个固定在顶端的高扭矩不锈钢线(一般为0.358毫米)传送的。该线包含于一个由摩擦力较小的材料[如聚四氟乙烯(PTFE)]制成的管状外罩内以使其能够以最小的或较小的摩擦力旋转。
可旋转的扭矩传送线和低摩擦管体穿过导管柔性和坚硬部分的中心轴,并通过远离手柄处的一个径向开口伸出导管管体,并与一个固定在距导管手柄一定距离上的手动可旋转横向调节控制棒相连。棒的左旋和右旋传送和施加可旋转扭矩以转动导管顶端。该可旋转棒被设计为当向下推时可任意转动,而松开时则锁定在一定位置上。
高扭矩线可用于旋转控制,将射频电流传送到旋转顶端以便进行切除,以及作为接收心肌组织电活动的远端记录电极来记录和定位。向高扭矩旋转线的电传导是通过位于旋转控制棒上的一个类似刷子的拾取机构来完成的。
可以在顶端电极附近顺序地排列几个辅助电极(最好2或3个环状电极),一般起始于顶端电极之后2毫米,并间隔约2毫米。所有电极都通过一个细的低阻抗导线与输入/输出装置(一般是一个电音频插座型连接器)相连。音频插座或其它输入/输出连接器与手柄相连。电极可连在一个记录系统上,该系统测量和显示在所涉及的心腔内感应到的心脏去极化电位。能够用该系统确定最早的早搏时间,该时间代表组织切除的最合乎要求的位置。当与记录设备相连时,顶端电极用于测定,而当与电源相连时,它又可用于传导切割能量。
该系统还包括一个垂直偏转控制线,该线控制顶端在平行于主导管管体的平面内的偏转(垂直偏转)。它包括一条线,最好是不锈钢的,它在偏离中心位置上插入到导管的可偏转部分中并用一个就在顶端电极系统下面的T型不锈钢销钉固定在导管侧壁上。
垂直偏转控制线穿过导管到达手柄并固定在手柄的可纵向(滑动)移动的部分上。在轴部分上移动手柄件造成柔性导管顶端的垂直偏转变化。垂直偏转线张紧本身就使顶端偏转,因为该线的插入位置是偏心的并在导管的柔性部分一侧。
导管顶端的旋转是通过仅在端部是柔性的并插入到导管的柔性可偏转远端部分中的高度可扭转线获得的。该线的近端部分是非常坚硬的。
在附图中,其所有相同的部件全部标注相同的符号:
图1是导管系统的一个侧视图,其中部分部件被分部断开;
图2A是图1中导管旋转顶端部分的放大的部件分解图;
图2B是图2A中的旋转顶端的端视图;
图3是图1中的顶端系统旋转部分的极度放大的侧视图;以及
图4是图1中控制棒的部分剖开的放大示意图。
图1表示了一个旋转顶端组织切除导管系统,该系统包括一般用10来表示的手柄部分,一个中间的、相对较硬的管状部分12,以及一个柔性远端可操纵的远端导管部分14。在描绘导管较长的主体时,中间部分12被断开来表示。
手柄部分还包括一个电插入式插座装置16,其上有多个与下述导体相连的输入/输出拾取点。手柄部分中的外部手握部分18被做成使手柄在沿着相对于内部管状手柄部分20的纵轴方向的一定距离内是任意可调的。在虚线22中进一步表示了这一可调距离。手柄包括一个通常以28表示的手动可旋转侧向顶端偏转控制棒,它通过一个固定元件30与手柄彼此隔开地固定就位,并通过管状元件32与中心管形部分相连。棒本身是纵向旋转可调的,下面将做更全面地描述。而主导管管体12则又通过一个过渡部分34与柔性可操纵的远端顶端部分14相连,顶端部分可以具有与管体12相同或稍小些的直径。柔性顶端部分进一步包括柔性增强聚合物导管管体36的近端部分,该部分将主导管管体12的远端与含有电极和旋转顶端系统的导管顶端系统38连接起来。按照使用要求,管体部分36可以具有任何便利的长度,一般约为4~8厘米。管体部分可以是任何具有必要的强度和柔性并具有与其它导管材料混合能力的生物相容的、相对惰性的聚合物材料,它们可以用某些材料进行增强以获得所需特性,管体部分通常具有3毫米或更小的内径。
如图所示,为了更加清楚起见,图2A、2B和图3作了放大,导管顶端系统包括多个电极带40,42和44,它们与顶端的外部环境保持电联系,并具有彼此绝缘的电导体50,52和54。导体穿过导管管体36和12以及手柄以便在插入部分16上分开拾取点。
切除电极系统38中的旋转顶端60按需要可以在定位状态中用作记录系统的输入端,而在切除状态下操作时,可以作为通过一个或多个导体56的高频电源的输出端。如将要在下面作更详细描述的,顶端部件60的旋转是通过高扭矩导线56获得的,导线在远端与顶端电极相连,并穿过导管管体的中间芯部,在近端穿过管体32与侧向控制棒28相连。
将一个垂直的顶端偏转控制线58在偏离中线的位置上插入导管的可偏转部分,并具有一个刚好在顶端电极系统38下面用T型不锈钢销钉59(图3)固定在导管侧壁上的远端。垂直偏转控制线58穿过导管的中心腔体到达手柄10及固定在手柄18的可移动部分的近端上。在管体部分上移动手柄元件18就可以使柔性导管顶端在垂直方向上产生偏转变化。
在图4中详细表示的手动可旋转侧向顶端旋转控制棒系统也示于图1中。手动棒系统32包括一个外圆筒形元件62,一个手指操作的双向可调棒元件64,它们均与内圆柱体66相连。弹簧68顶住一个止动件70,该止动件又作用于圆柱体66上以迫使棒元件相对于手柄22向上与锁定球和承窝形花轴72和74配合。控制线56穿过棒系统并在76处固定在棒上,从而使施加在控制线56上的旋转扭矩直接由棒64的旋转来控制。提供一个功率输出系统以便利用线56穿过的传输导体80来连接导体78和控制线56、从位于音频插座16上的一个接点提供电功率,从而以电刷或类似方式保持恒定接触。
在包括图2A和2B以及图3在内的分解图和端视图中具体描绘了旋转顶端系统。如图3所示,顶端系统38包括从柔性远端导管管体36的远端伸出的旋转顶端元件60,埋在柔性偏转导管管体36内的旋转顶端的其余部分或近端部分。在图2A和图2B所示的分解视图中可更清楚地看出,暴露部分包括旋转顶端头部,它含有三个与中心轴线对称的(约间隔120°)齿状元件84。各齿之间的区域(以85表示)是弧形或曲线型的以进一步加强齿对顶端产生牵引力的能力。旋转头与一个整体式的长度约为5毫米量级或更长的轴86相连,更小直径(约1毫米)的轴88上装有一个与高扭矩旋转导线56直接相连的环形元件90。用银锝料将该环固定在轴上以防止顶端与轴承系统92脱离。
将轴86设计成位于轴承系统92(图2A)内的轴颈,该系统含有一个永久性润滑的圆柱形中心开孔94和一对环件96,当系统的近端插入到柔性导管管体内部时,由于端部夹在导管侧壁,则这对环件适于保持轴承组件92相对于导管36的静止关系。轴86和圆柱形开孔94的内配合表面最好由自动润滑材料(如PTFE)或类似材料制作。
将旋转顶端和轴承系统插入柔性远端管状导管系统36并由支承环96固定就位。如图3所示,可以将另一束导线98连在轴承装置92上,并进一步固定在导管管体36的侧壁上,如用100和102表示的,以起到安全固定装置的作用并进一步防止在使用过程中轴承装置从导管管体的远端移出。
虽然应该理解,可以使用任何机械上等同的装置来完成手动可旋转棒控制系统28的任务,但图4这一个图基本上是按下列方式操作的。棒64和与其相连的内圆筒66一起在纵向上对着回动弹簧68是反复可调的,以便当手柄64推进时,多个球体和球窝(以72和74表示)相互脱开,使圆筒66可以相对于外壳元件62旋转。导线56的末端在元件64的74处固定就位,以便使棒64的旋转在所需方向上给控制线56施加一个扭矩,然后,控制线56再按需要将扭矩传给旋转顶端60使其旋转。弹簧68通常将球体和球窝保持在相互啮合的位置上以防止其它的相对转动,从而保持顶端60的旋转位置恒定。
在操作中,通过一个切口将导管系统引入股动脉并穿过血管系统进入所关心的患者心脏的腔体内。一旦到达正确的腔室,手柄18的反复移动,以及棒64的压缩与转动就可对顶端元件60的复杂的垂直和横向移动进行精确控制,以使得腔体壁上的任何一点对于电极来说都是容易接近的。电极元件40、42、44和60可被用来测定整个腔体内的心脏去极化电位,进而探测和测定早搏点。顶端电极60被用于传输组织切除能量,并在某些情况下,也可被用于定位状态。
采用本发明的导管系统可以使旋转顶端60沿着腔壁的横向运动更加精确,特别是在心室腔内,这是因为在心室腔内旋转顶端60的弧形齿84便于沿室壁定位和移动。就治疗心律失常而言,这就使得由导管进行的组织切除更加容易且更加准确。该方法比以前的系统更加实用。
在此已经遵循专利法规相当详细地描述了本发明,并为本领域内的技术人员提供了实施这一新的原理以及按要求构成和应用实施例所需要的信息。但是应该理解,本发明可以采用有极大不同的一些装置实施,并可以进行多种变化而不会偏离本发明自身的范畴。
Claims (20)
1、一种心律失常的定位和切除导管,其特征在于包括:
一个用来进入和有选择地通过任何心脏腔室内表面的,相对较短的,高柔性的管状远端导管部分,其中在其长度方向上有一个管腔并具有一个携带电极的远端顶端系统;
一个用来使远端顶端系统偏转的偏转线系统;
用于控制偏转线系统的偏转导线控制装置;
一个装在远端顶端部分的远端顶端处并适于与目标心腔内表面相互配合并在其上滚动的可旋转顶端电极元件;
产生和控制可旋转顶端元件的转动的旋转控制装置;以及
用于接收来自可旋转顶端电极元件的电脉冲并将电切割脉冲从导管外部传送到旋转顶端电极元件的电导体装置。
2、如权利要求1所述的心律失常的定位和切除导管,其特征在于进一步包括:
在与远端顶端电极间隔约一定距离的远端导管部分上携带的多个外界传导环形电极;以及
用来接收来自传导环形电极的电脉冲并将电切割脉冲传到环形电极的导体装置。
3、如权利要求1所述心律失常的定位和切除导管,其特征在于其中用于产生和控制可旋转顶端元件的转动的旋转控制装置进一步包括:
一个在远端导管腔体内穿过且远端固定在可旋转顶端元件上的可扭转旋转控制线,使得在控制线上施加可旋转扭矩即可产生可旋转远端顶端的相应的转动;
用于给旋转控制线施加扭转,进而转动可旋转顶端的装置。
4、如权利要求3所述心律失常的定位和切除导管,其特征在于进一步包括:
与可旋转顶端元件的近端相连的轴件;以及
固定在柔性管状远端导管部分的远端的轴承件,它与连在可旋转顶端元件近端的轴件相联系,轴件与轴承件为轴颈配合。
5、如权利要求1所述心律失常的切除导管,其特征在于可旋转电极顶端元件进一步包括多个适合于与心腔内表面配合的纵向牵引齿。
6、如权利要求3所述的心律失常的定位和切除导管,其特征在于可旋转电极顶端元件进一步包括多个适合于与心腔内表面配合的纵向牵引齿。
7、如权利要求4所述心律失常的定位和切除导管,其特征在于可旋转电极顶端元件进一步包括多个适合于与心腔内表面配合的纵向摩擦齿。
8、如权利要求7所述心律失常的定位和切除导管,其特征在于多个齿包括三个对称间隔开的齿,其间具有弧形凹陷。
9、如权利要求4所述心律失常的定位和切除导管,其特征在于用来对旋转控制线施加扭矩的装置是一个与旋转控制线的近端相连的,自锁的,手动释放的和手动可旋转的棒系统。
10、如权利要求7所述装置,其特征在于自锁、手动可旋转棒系统进一步包括一个自锁的,手动可旋转的控制棒,它与控制手柄间隔开,并以这样的方式连在侧向偏转控制线上,即棒向左或向右旋转给侧向偏转控制线施加了一个相应的可旋转扭矩,而控制线将该扭矩传给远端顶端,从而使可旋转顶端元件在相应方向上产生转动。
11、如权利要求1所述装置,其特征在于用来接收来自可旋转顶端元件的电脉冲并将电脉冲从导管外部传入旋转顶端元件的电导体装置是旋转控制线。
12、如权利要求4所述装置,其特征在于用来接收来自可旋转顶端元件的电脉冲并将电脉冲从导管外部传到旋转顶端元件的电导体装置是旋转控制线。
13、如权利要求10所述装置,其特征在于用来接收来自可旋转顶端元件的电脉冲并将电脉冲从导管外部传到旋转顶端元件的电导体装置是旋转控制线。
14、如权利要求3所述装置,其特征在于手动棒还包括用来将电压传入和传出旋转控制线的电压拾取装置。
15、如权利要求12所述装置,其特征在于手动棒还包括用来将电压传入和传出旋转控制线的电压拾取装置。
16、如权利要求14所述心律失常的切除导管,其特征在于可旋转电极顶端元件还包括多个适合于与心腔内表面配合的纵向牵引齿。
17、如权利要求15所述心律失常的切除导管,其特征在于该齿包括三个间隔约120°的平缓曲线形齿。
18、如权利要求4所述心律失常的切除导管,其特征在于轴承装置与远端导管部分中的一个安全固定件相连。
19、一种用于定位和对产生心律失常组织施行切除的导管系统,其特征在于包括:
一个中心导管,包括一个具有一个近端和一个远端的细长柔性塑料管体,中心导管外径要足够小以使其能够由一个引入点通过动脉血管系统到达所关心的冠状腔,并进一步包括一个从近端向远端延伸的具有相对较大尺寸的内管腔,并具有一个管壁,它提供了能够使导管通过血管系统运行所必需的必要的扭矩传输;
一个与中心导管的远端相连的相对较短的远端导管部分,包括一个与中心导管远端相连的柔性塑料管体,它具有比中心导管更小的并能够通入任何腔体的外径,它有一个近端和一个远端,且还包括一个从近端向远端延伸的内管腔,并具有一个携带电极的远端顶端系统;
一个偏转线系统,用来以受控的方式使远端顶端系统发生偏转;
用于控制远端顶端系统偏转的偏转控制装置;
固定于远端顶端系统的远端上,并适于与所关心的心腔内表面配合并在其上滚动的可旋转的导电顶端电极系统;
一个旋转控制装置,包括穿过远端导管腔体内的一个可扭转的旋转控制线,并具有一个固定在可旋转顶端元件上的远端,以使得在控制线上施加可旋转扭矩,则会产生可旋转远端顶端元件上的相应旋转;
轴承装置,其中可旋转顶端元件以轴颈连接的方式置于远端导管部分中;
其中,旋转控制线还提供了一个导电体装置,它用来接收来自可旋转顶端元件的电脉冲,并将电切割脉冲从导管外部传入旋转顶端元件。
20、一种采用导管对心脏组织进行电定位和电切除的方法,其特征在于该方法包括以下步骤:
提供一个电定位和电切除心脏导管,包括:
一个进入所关心的心脏内表面并在其上运行的相对短的,柔性的管状远端导管部分,沿其长度方向上有一个管腔,并有一个远端携带电极的顶端系统;
一个能够驱使并控制远端顶端系统偏转的偏转线和手动偏转线控制系统;
一个可旋转顶端电极元件和手动旋转控制系统,顶端电极固定在远端顶端部分的远端上,并适合于与所关心的心脏内表面配合并在其上滚动;
一个导体装置,用来接收来自外界的电脉冲,并将电切割脉冲从导管外部送入旋转顶端电极元件;
将导管系统引入并通过血管系统使其送入所希望达到的患者心腔中;
利用偏转线控制系统和旋转控制系统以及旋转电极顶端,随着旋转顶端的垂直和横向的移动来探测所关心的腔壁,以便确定腔体内壁的电活动;
在顶端电极上施加射频切割电流以切除显示出早搏的组织。
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US07/840,026 US5242441A (en) | 1992-02-24 | 1992-02-24 | Deflectable catheter with rotatable tip electrode |
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US4920980A (en) * | 1987-09-14 | 1990-05-01 | Cordis Corporation | Catheter with controllable tip |
US4960134A (en) * | 1988-11-18 | 1990-10-02 | Webster Wilton W Jr | Steerable catheter |
-
1992
- 1992-02-24 US US07/840,026 patent/US5242441A/en not_active Expired - Lifetime
-
1993
- 1993-02-23 CN CN93103187A patent/CN1083694A/zh active Pending
- 1993-02-23 WO PCT/US1993/001561 patent/WO1993016755A1/en active Application Filing
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CN102316794A (zh) * | 2009-01-15 | 2012-01-11 | 皇家飞利浦电子股份有限公司 | 电生理学导管 |
CN103189009B (zh) * | 2010-10-29 | 2016-09-07 | C·R·巴德股份有限公司 | 医疗设备的生物阻抗辅助放置 |
CN103189009A (zh) * | 2010-10-29 | 2013-07-03 | C·R·巴德股份有限公司 | 医疗设备的生物阻抗辅助放置 |
CN104427950A (zh) * | 2012-03-02 | 2015-03-18 | 韦伯斯特生物官能(以色列)有限公司 | 用于治疗心房扑动的具有单动作双偏转机构的导管 |
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CN105828867B (zh) * | 2013-12-20 | 2019-02-01 | 圣犹达医疗用品心脏病学部门有限公司 | 用于医疗装置的致动器抑制组件 |
CN113558754A (zh) * | 2015-09-09 | 2021-10-29 | 贝利斯医疗公司 | 心外膜的进入系统和方法 |
CN105286991A (zh) * | 2015-10-13 | 2016-02-03 | 南方医科大学 | 一种电圈套器 |
CN110505850A (zh) * | 2017-02-01 | 2019-11-26 | 因特斯高普公司 | 用于内窥镜工具的外套管的旋转控制机构 |
CN110505850B (zh) * | 2017-02-01 | 2022-10-28 | 因特斯高普公司 | 用于内窥镜工具的外套管的旋转控制机构 |
CN107185097A (zh) * | 2017-07-05 | 2017-09-22 | 常州市第人民医院 | 一种尖端控制型神经介入微导管 |
CN107185097B (zh) * | 2017-07-05 | 2023-03-07 | 常州市第一人民医院 | 一种尖端控制型神经介入微导管 |
CN115337520A (zh) * | 2022-08-15 | 2022-11-15 | 上海鹏冠生物医药科技有限公司 | 一种端部可任意转向的人体腔道介入装置 |
Also Published As
Publication number | Publication date |
---|---|
US5242441A (en) | 1993-09-07 |
WO1993016755A1 (en) | 1993-09-02 |
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