LOCALIZATION OF BODY LUMEN JUNCTIONS

• US 20090182287A1
• Filed: 06/29/2007
• Published: 07/16/2009
• Est. Priority Date: 02/21/2003
• Status: Active Grant

• Current Assignee: 3DT Holdings LLC
• Original Assignee: 3DT Holdings LLC
• Inventors: Kassab, Ghassan S.
• Granted Patent: US 9,974,459 B2
• Time in Patent Office: Days
• US Class Current: 604/264
• 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 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/1467 using more than two electrodes on a single probe
• CPC Class Codes: A61B 5/02007 Evaluating blood vessel condition, e.g. elasticity, compliance
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/1076 for measuring dimensions inside body cavities, e.g. using catheters A61B3/1005 takes precedence
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]

Abstract

Devices, systems, and methods for the localization of body lumen junctions and other intraluminal structure are disclosed. Various embodiments permit clinicians to identify the locations of intraluminal structures and medical devices during non-surgical medical techniques, such as cardiac ablation, by determining the intralumen conductance and/or cross-sectional area at a plurality of locations within the body lumen.

Claims

1. A system, comprising:

a catheter having a proximal end and a distal end, the distal end of the catheter for placement into a body lumen, the catheter comprising a first electrode and a second electrode, each of the first and second electrodes having a proximal end and a distal end, the distal ends of the first and second electrodes located between the proximal and distal ends of the catheter; and

a processor connected to the first and second electrodes of the catheter, the processor capable of collecting conductance data to determine a profile of the body lumen, the conductance data collected at a plurality of locations within the body lumen and determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in a fluid within the body lumen.

2. The system of claim 1, wherein:

the body lumen comprises at least a portion of an atrium.

3. The system of claim 2, wherein:

the body lumen further comprises a pulmonary vein-atrial junction.

4. The system of claim 1, wherein:

the body lumen comprises a blood vessel.

5. The system of claim 1, wherein:

the body lumen comprises a biliary tract.

6. The system of claim 1, wherein:

the body lumen comprises an esophagus.

7. The system of claim 1, wherein:

the fluid comprises blood.

8. The system of claim 1, wherein:

the processor is further capable of calculating a cross-sectional area of the body lumen at each of the plurality of locations within the body lumen using the conductance data.

9. The system of claim 8, wherein:

the catheter further comprises a passageway for passing fluid through the catheter to the location of the distal ends of the first and second electrodes, such that fluid passing through the passageway comes in contact with the distal ends of the first and second electrodes;

the fluid within the body lumen comprises a first fluid having a first conductivity and a second fluid having a second conductivity; and

the conductance data is determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in each of the first fluid and the second fluid.

10. The system of claim 9, wherein:

the conductance data comprises a first conductance value determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in the first fluid and a second conductance value determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in the second fluid.

11. The system of claim 10, wherein:

the profile of the body lumen is determined from the first and second conductance values collected from each of the plurality of locations, the first conductivity of the first fluid, and the second conductivity of the second fluid.

12. The system of claim 1, wherein:

the catheter further comprises a third electrode and a fourth electrode, each of the third and fourth electrodes having a proximal end and a distal end, wherein the first and third electrodes comprise excitation electrodes and the second and fourth electrodes comprise detection electrodes; and

the proximal ends of the third and fourth electrodes are connected to the processor.

13. The system of claim 12, wherein:

the distal ends of the first and third electrodes are located between the proximal and distal ends of the catheter and the distal ends of the second and fourth electrodes are located between the distal ends of the first and third electrodes.

14. The system of claim 1, wherein:

the catheter further comprises at least one ablation contact positioned at the distal end of the catheter, the at least one ablation contact being configured to remove or destroy a targeted tissue within the body lumen.

15. The system of claim 14, wherein:

the targeted tissue comprises tissue located at or adjacent to a pulmonary vein-atrial junction.

16. The system of claim 15, wherein:

the targeted tissue at least partially surrounds the pulmonary vein-atrial junction.

17. The system of claim 16, wherein:

the targeted tissue substantially surrounds the pulmonary vein-atrial junction.

18. The system of claim 14, wherein:

the at least one ablation contact comprises a heating element such that the at least one ablation contact is capable of transferring heat to the targeted tissue.

19. The system of claim 14, wherein:

the at least one ablation contact is positioned circumferentially around a substantially circular portion of the catheter.

20. The system of claim 14, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by cryoablation.

21. The system of claim 14, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by delivering an electrical current to the targeted tissue.

22. The system of claim 21, further comprising:

a grounding electrode configured to be placed on the body such that the electrical current flows from the targeted tissue to the grounding electrode.

23. The system of claim 22, wherein:

the grounding electrode comprises an adhesive for removably connecting the grounding electrode to the body.

24. A system for ablating a targeted tissue, comprising:

a catheter having a proximal end and a distal end, the distal end of the catheter for placement into a body lumen, the catheter comprising

two excitation electrodes and at least two detection electrodes, each of the two excitation electrodes and at least two detection electrodes having a proximal end and a distal end, the distal ends of the two excitation electrodes and at least two detection electrodes located between the proximal and distal ends of the catheter, and

at least one ablation contact positioned at the distal end of the catheter, the at least one ablation contact being configured to remove or destroy a targeted tissue within the body lumen; and

a processor connected to the two excitation electrodes and the at least two detection electrodes of the catheter, the processor capable of collecting conductance data to determine a profile of the body lumen, the conductance data collected at a plurality of locations within the body lumen and determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in a fluid within the body lumen.

25. The system of claim 24, wherein:

the body lumen comprises at least a portion of an atrium.

26. The system of claim 24, wherein:

the body lumen further comprises a pulmonary vein-atrial junction.

27. The system of claim 24, wherein:

the body lumen comprises a blood vessel.

28. The system of claim 24, wherein:

the body lumen comprises a biliary tract.

29. The system of claim 24, wherein:

the body lumen comprises an esophagus.

30. The system of claim 24, wherein:

the fluid comprises blood.

31. The system of claim 24, wherein:

the processor is further capable of calculating a cross-sectional area of the body lumen at each of the plurality of locations within the body lumen using the conductance data.

32. The system of claim 31, wherein:

the catheter further comprises a passageway for passing fluid through the catheter to the location of the distal ends of the first and second electrodes, such that fluid passing through the passageway comes in contact with the distal ends of the two excitation electrodes and the distal ends of the at least two detection electrodes;

the fluid within the body lumen comprises a first fluid having a first conductivity and a second fluid having a second conductivity; and

the conductance data is determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in each of the first fluid and the second fluid.

33. The system of claim 32, wherein:

the conductance data comprises a first conductance value determined at each of the plurality of locations when the distal ends of the two excitation electrodes and the distal ends of the at least two detection electrodes are immersed in the first fluid and a second conductance value determined at each of the plurality of locations when the distal ends of the two excitation electrodes and the distal ends of the at least two detection electrodes are immersed in the second fluid.

34. The system of claim 33, wherein:

the profile of the body lumen is determined from the first and second conductance values collected from each of the plurality of locations, the first conductivity of the first fluid, and the second conductivity of the second fluid.

35. The system of claim 24, wherein:

the distal ends of the at least two detection electrodes are located between the distal ends of the two excitation electrodes.

36. The system of claim 24, wherein:

the targeted tissue comprises tissue located at or adjacent to a pulmonary vein-atrial junction.

37. The system of claim 36, wherein:

the targeted tissue at least partially surrounds the pulmonary vein-atrial junction.

38. The system of claim 37, wherein:

the targeted tissue substantially surrounds the pulmonary vein-atrial junction.

39. The system of claim 24, wherein:

the at least one ablation contact comprises a heating element such that the at least one ablation contact is capable of transferring heat to the targeted tissue.

40. The system of claim 24, wherein:

the at least one ablation contact is positioned circumferentially around a substantially circular portion of the catheter.

41. The system of claim 40, wherein:

the at least one ablation contact comprises a plurality of ablation contacts positioned circumferentially around a substantially circular portion of the catheter.

42. The system of claim 24, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by cryoablation.

43. The system of claim 24, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by delivering an electrical current to the targeted tissue.

44. The system of claim 43, further comprising:

a grounding electrode configured to be placed on the body such that the electrical current flows from the targeted tissue to the grounding electrode.

45. The system of claim 44, wherein:

the grounding electrode comprises an adhesive for removably connecting the grounding electrode to the body.

52. The system of claim 40, wherein:

the at least one ablation contact comprises a heating element such that the at least one ablation contact is capable of transferring heat to the targeted tissue.

46. A system, comprising:

a catheter having a proximal end and a distal end, the distal end of the catheter for placement into a body lumen, the catheter comprising at least one excitation electrode and at least one detection electrode, each of the excitation and detection electrodes having a proximal end and a distal end, the distal end of each of the excitation and detection electrodes located between the proximal and distal ends of the catheter; and

a processor connected to each of the excitation and detection electrodes of the catheter, the processor capable of collecting conductance data at each of a plurality of locations as the catheter is moved through the body lumen and determining a conductance profile of the body lumen using the conductance data.

47. The system of claim 46, wherein:

the processor is further capable of using the conductance data to calculate a cross-sectional area of the body lumen at each of the plurality of locations within the body lumen.

48. The system of claim 46, wherein:

the catheter further comprises at least one ablation contact positioned at the distal end of the catheter, the at least one ablation contact being configured to remove or destroy a targeted tissue within the body lumen.

49. The system of claim 48, wherein:

the targeted tissue comprises tissue located at or adjacent to a pulmonary vein-atrial junction.

50. The system of claim 49, wherein:

the targeted tissue at least partially surrounds the pulmonary vein-atrial junction.

51. The system of claim 50, wherein:

the targeted tissue substantially surrounds the pulmonary vein-atrial junction.

53. The system of claim 48, wherein:

the at least one ablation contact is positioned circumferentially around a substantially circular portion of the catheter.

54. The system of claim 48, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by cryoablation.

55. The system of claim 48, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by delivering an electrical current to the targeted tissue.

56. The system of claim 55, further comprising:

a grounding electrode configured to be placed on the body such that the electrical current flows from the targeted tissue to the grounding electrode.

57. The system of claim 56, wherein:

the grounding electrode comprises an adhesive for removably connecting the grounding electrode to the body.

58. A system for ablation of a targeted tissue, comprising:

a catheter having a proximal end and a distal end, the distal end of the catheter for placement into a body lumen, the catheter comprising

at least one excitation electrode and at least one detection electrode, each of the at least one excitation electrodes and each of the at least one detection electrodes having a proximal end and a distal end, the distal ends of the at least one excitation electrode and the at least one detection electrode located between the proximal and distal ends of the catheter, and

at least one ablation contact positioned at the distal end of the catheter, the at least one ablation contact being configured to remove or destroy a targeted tissue within the body lumen; and

a processor connected to the at least one excitation electrode and at least one detection electrode, the processor capable of collecting conductance data to determine a profile of the body lumen, the conductance data collected at a plurality of locations within the body lumen and determined at each of the plurality of locations when the distal ends of the at least one excitation electrode and the at least one detection electrode are immersed in a fluid within the body lumen.

59. The system of claim 58, wherein:

the processor is further capable of calculating the cross-sectional area at each of the plurality of locations in the body lumen using the conductance data.

60. The system of claim 58, wherein:

the targeted tissue comprises tissue located at or adjacent to a pulmonary vein-atrial junction.

61. The system of claim 60, wherein:

the targeted tissue at least partially surrounds the pulmonary vein-atrial junction.

62. The system of claim 61, wherein:

the targeted tissue substantially surrounds the pulmonary vein-atrial junction.

63. The system of claim 58, wherein:

the at least one ablation contact comprises a heating element such that the at least one ablation contact is capable of transferring heat to the targeted tissue.

64. The system of claim 58, wherein:

the at least one ablation contact is positioned circumferentially around a substantially circular portion of the catheter.

65. The system of claim 58, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by cryoablation.

66. The system of claim 58, wherein:

the at least one ablation contact is configured to remove or destroy the targeted tissue by delivering an electrical current to the targeted tissue.

67. The system of claim 66, further comprising:

a grounding electrode configured to be placed externally on the body such that the electrical current flows from the targeted tissue to the grounding electrode.

68. The system of claim 67, wherein:

the grounding electrode comprises an adhesive for removably connecting the grounding electrode to the body.

69. The system of claim 58, wherein:

the at least one excitation electrode comprises a first excitation electrode and a second excitation electrode; and

the at least one detection electrode comprises a first detection electrode and a second detection electrode.

70. The system of claim 69, wherein:

the distal ends of the first and second detection electrodes are positioned on the catheter between the distal end of the first excitation electrode and the distal end of the second excitation electrode.

71. A method for localizing a junction or other structure within a body lumen, comprising the steps of:

providing a system, comprising

a catheter having a proximal end and a distal end, the distal end of the catheter for placement into a body lumen, the catheter comprising a first electrode and a second electrode, each of the first and second electrodes having a proximal end and a distal end, the distal ends of the first and second electrodes located between the proximal and distal ends of the catheter; and

a processor connected to the first and second electrodes of the catheter, the processor capable of collecting conductance data to determine a profile of the body lumen, the conductance data collected at a plurality of locations within the body lumen and determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in a fluid within the body lumen;

introducing the catheter into the body lumen;

providing constant electrical current flow to the body lumen through the catheter;

measuring a first conductance value at a first location in the body lumen;

moving the catheter to a second location in the body lumen;

measuring a second conductance value at a second location in the body lumen; and

determining a profile of the body lumen based on the first conductance value of the first location and the second conductance value of the second location.

72. The method of claim 71, wherein:

the body lumen comprises a blood vessel; and

the fluid comprises blood.

73. The method of claim 71, wherein:

the body lumen comprises at least a portion of an atrium.

74. The method of claim 71, wherein:

the body lumen comprises a biliary tract.

75. The method of claim 71, wherein:

the body lumen comprises an esophagus.

76. The method of claim 71, wherein:

the profile of the body lumen comprises relative conductances.

77. The method of claim 71, wherein the:

profile of the body lumen comprises relative cross-sectional areas.

78. The method of claim 71, wherein:

the catheter further comprises a passageway for passing fluid through the catheter to the location of the distal ends of the first and second electrodes, such that fluid passing through the passageway comes in contact with the distal ends of the first and second electrodes;

the fluid within the body lumen comprises a first fluid having a first conductivity and a second fluid having a second conductivity; and

the conductance data is determined at each of the plurality of locations when the distal ends of the first and second electrodes are immersed in each of the first fluid and the second fluid.

79. The method of claim 78, further comprising:

injecting a known volume of a first solution having a first conductivity into the body lumen;

injecting a second solution having a second conductivity into the body lumen, wherein the second solution has a second volume and wherein the second conductivity does not equal the first conductivity;

measuring a second conductance value at the first location in the body lumen;

calculating the conductance at the first location in the body lumen;

measuring a first conductance value at a second location in the body lumen; and

calculating the conductance at the second location in the body lumen.

80. The method of claim 79, wherein:

the step of determining a profile of the body lumen comprises determining a profile of the body lumen based on the conductance of the first location, the conductance of the second location, and the conductivities of the first and second solutions.

81. The method of claim 80, wherein:

the profile of the body lumen comprises cross-sectional areas of the plurality of locations.

82. The method of claim 71, wherein:

the catheter further comprises a third electrode and a fourth electrode, each of the third and fourth electrodes having a proximal end and a distal end, the distal ends of the third and fourth electrodes located between the proximal and distal ends of the catheter;

the proximal ends of the third and fourth electrodes are connected to the processor;

the first and the third electrodes comprise excitation electrodes and the second and fourth electrodes comprise detection electrodes; and

the distal ends of the second and fourth electrodes are located between the distal ends of the first and third electrodes.

83. A method for ablating a targeted tissue, comprising the steps of:

providing a system, comprising

a catheter having a proximal end and a distal end, the distal end of the catheter for placement into a body lumen, the catheter comprising

at least one excitation electrode and at least one detection electrode, each of the at least one excitation electrode and the at least one detection electrode having a proximal end and a distal end, the distal ends of the at least one excitation electrode and the at least one detection electrode located between the proximal and distal ends of the catheter, and

at least one ablation contact positioned at the distal end of the catheter, the at least one ablation contact being configured to remove or destroy a targeted tissue within the body lumen; and

a processor connected to the at least one excitation electrode and the at least one detection electrode of the catheter, the processor capable of collecting conductance data to determine a profile of the body lumen, the conductance data collected at a plurality of locations within the body lumen and determined at each of the plurality of locations when the distal ends of the at least one excitation electrode and the at least one detection electrode are immersed in a fluid within the body lumen;

introducing the catheter into the body lumen;

providing electrical current flow to the body lumen through the catheter;

measuring a first conductance value at a first location in the body lumen;

moving the catheter to a second location in the body lumen;

measuring a second conductance value at a second location in the body lumen;

determining a profile of the body lumen based on the first conductance value of the first location and the second conductance value of the second location;

using the profile to locate the catheter in the body lumen in relation to the targeted tissue; and

ablating the targeted tissue using the catheter.

84. The method of claim 83, wherein the profile comprises conductances.

85. The method of claim 83, wherein the profile comprises cross-sectional areas.

86. The method of claim 83, wherein:

the at least one excitation electrode comprises two excitation electrodes; and

the at least one detection electrode comprises at least two detection electrodes.

87. The method of claim 86, wherein:

the distal ends of the at least two detection electrodes are located between the distal ends of the two excitation electrodes.

88. The method of claim 87, wherein:

the at least two detection electrodes consist of two detection electrodes.