Catheter for mapping and ablation and method therefor

• US 5,397,339 A
• Filed: 05/07/1993
• Issued: 03/14/1995
• Est. Priority Date: 11/14/1986
• Status: Expired due to Term

• Current Assignee: Catheffects, Inc.
• Original Assignee: Jawahar M. Desai
• Inventors: Desai, Jawahar M.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): LACYK, JOHN P
• Application Number:
  US08/058,427
• Time in Patent Office: 676 Days
• Field of Search: 128/639, 128/642, 128/656, 128/657, 128/658, 128/784, 128/786, 128/772, 128/774, 128/783, 128/419 D, 128/419 S, 604/20, 604/105, 607/115, 607/116, 607/119, 607/122, 607/123, 607/128, 607/148, 607/149
• US Class Current: 607/116
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems

Abstract

A multipolar electrode catheter includes a central and four side electrodes at its distal end. The catheter is actuable from a retracted or collapsed mode wherein the side electrodes are arranged around the tubular catheter outer surface to an expanded mode. A plurality of longitudinal slits in the catheter wall enable radial expansion of the distal end so that the side electrodes are moved to an operative position radially outward from their position in the retracted mode. In the expanded position, the side electrodes lie in the same plane and equally spaced from adjacent electrodes. Electrode leads connected to the electrodes enable the electrodes to be used both for mapping and ablation of endocardial sites.

Claims

1. A method of mapping electrical signals and ablating foci at a patient site using a multipolar electrode catheter having a distal end and an opposite proximal end, a plurality of electrodes mounted adjacent said distal end, said electrodes being movable from a retracted to an expanded position, comprising the steps of:

(a) moving said electrodes to an expanded position from said retracted position;

(b) positioning said distal end of said catheter so that said electrodes are in contacting relation with said site; and

(c) monitoring signals from said electrodes.

2. The method of claim 1 including the steps of:

(a) re-positioning said distal end of said catheter so that said electrodes are in contacting relation with another, different site; and

(b) monitoring signals from said electrodes.

3. The method of claim 2 including the steps of repeating steps of re-positioning and monitoring until the earliest site with respect to a reference point is determined, thereby locating the foci.

4. The method of claim 3, further including the step of discharging energy through at least one of said electrodes so as to ablate said foci.

5. The method of claim 4, further including a contact surface, and wherein said step of discharging includes passing energy from said electrodes to said contact surface through said earliest site.

6. The method of claim 4 wherein said step of discharging includes passing energy from said at least one electrode to at least one other of said electrodes.

7. The method of claim 4 wherein said energy is electrical energy within the range of about 25 to about 300 Joules.

8. The method of claim 2 further including the step of moving said electrodes to a retracted position prior to the step of re-positioning said distal end of said catheter.

9. The method of claim 8 further including the step of moving said electrodes to an expanded position after said distal end of said catheter has been re-positioned.

10. The method of claim 1 further including the steps of:

(a) applying energy to said site through at least one of said electrodes; and

(b) removing said distal end of said catheter from said site if no dysrhythmia occurs.

11. The method of claim 10 wherein said energy is electrical energy within the range of about 25 to about 300 Joules.

12. The method of claim 10 further including the step of moving said electrodes to said retracted position prior to the step of removing said distal end of said catheter.

13. The method of claim 1 further dividing the site into four quadrants, and performing steps (a) through (c), in turn, in successive quadrants.

14. The method of claim 13 including the steps of:

(a) monitoring signals from said electrodes until the earliest site with respect to a reference point is determined, thereby locating the foci; and

(b) discharging energy through at least one of said electrodes so as to ablate the foci.

15. The method of claim 1 wherein the step of positioning said distal end of said catheter is performed before the step of moving said electrodes.

16. The method of claim 1 including the preliminary step of placing the distal end of said catheter within an endocardial chamber.

17. A method of mapping electrical signals at a patient site and ablating foci using a multipolar electrode catheter having a distal end and an opposite proximal end, and a plurality of electrodes mounted adjacent to said distal end, comprising the steps of:

(a) positioning said distal end of said catheter so that said electrodes are in contacting relation with said site;

(b) monitoring signals from said electrodes;

(c) re-positioning said distal end of said catheter so that said electrodes are in contacting relation with another site;

(d) repeating steps (a) through (c) until the earliest site with respect to a reference point is determined, thereby locating the foci;

(e) discharging energy through at least one of said electrodes so as to ablate said foci, wherein said step of discharging includes passing energy from said at least one electrode to at least one other of said electrodes.

18. The method of claim 17 further including a contact surface and wherein said step of discharging includes passing energy from said electrodes to said contact surface through said earliest site.

19. The method of claim 17 wherein said energy is electrical energy within the range of about 25 to about 300 Joules.

20. The method of claim 17 further including the steps of:

(a) applying energy to said site through at least one of said electrodes; and

(b) removing said distal end of said catheter from said site if no dysrhythmia occurs.

21. A method of mapping electrical signals at a patient site and ablating foci using a multipolar electrode catheter having a distal end and an opposite proximal end, and a plurality of electrodes mounted adjacent to said distal end, comprising the steps of:

(a) positioning said distal end of said catheter so that said electrodes are in contacting relation with said site;

(b) monitoring signals from said electrodes;

(c) re-positioning said distal end of said catheter so that said electrodes are in contacting relation with another site; and

(d) repeating steps (a) through (c) until the earliest site with respect to a reference point is determined, thereby locating the foci, further dividing the site into four quadrants, and performing steps (a) through (d) in successive quadrants.

22. The method of claim 21 including the steps of:

(a) monitoring signals from said electrodes until the earliest site with respect to a reference point is determined, thereby locating the foci; and

(b) discharging energy through at least one of said electrodes so as to ablate the foci.

23. A method of mapping electrical signals at a patient site and ablating foci using a multipolar electrode catheter having a distal end and an opposite proximal end, and a plurality of electrodes mounted adjacent to said distal end comprising the steps of:

(a) positioning said distal end of said catheter so that said electrodes are in contacting relation with said site in a first quadrant;

(b) monitoring a plurality of electrograms so as to determine the earliest deflection for use as a reference;

(c) moving said distal end to a second quadrant;

(d) monitoring said plurality of electrograms to determine the earliest deflection;

(e) moving said distal end to a third quadrant;

(f) monitoring said plurality of electrograms to determine the earliest deflection;

(g) moving said distal end to a fourth quadrant;

(h) monitoring said distal end to determine the earliest deflection;

(i) moving the distal end to the quadrant that demonstrated the earliest deflection;

(j) repeating steps (a) through (i) within said quadrant that demonstrated the earliest deflection until the foci is precisely determined.

24. The method of claim 23 further including the step of discharging energy through the cathether to ablate the foci.

25. The method of claim 23 wherein the amount of energy used is between about 25 to about 100 Joules.

26. The method of claim 25 wherein the amount of energy used is up to about 300 Joules.

27. The method of claim 23 including providing a conductive surface contacting the patient and discharging energy from said catheter through said patient to said contact surface.

28. The method of claim 23 including the step of attempting to induce disrhythmia and:

(a) removing the catheter from the patient if no disrhythmia is induced;

or

(b) again discharging energy into the foci if disrhythmia is induced.

29. The method of claim 28 including repeating steps 60(a) and 60(b) until no disrhythmia is induced.

30. The method of claim 23 including the preliminary steps of:

(a) inserting the cathether through an artery; and

(b) advancing said cathether to a heart chamber.

31. The method of claim 30 including the step of using fluoroscopic guidance in advancing said cathether to a heart chamber.

32. The method of claim 23 including the preliminary step of arbitrarily dividing a heart chamber into four quadrants.