Asymmetric multiple electrode support structures

Multiple electrode support structures have asymmetric geometries, either axially, or radially, or both. The asymmetric support structures are assembled from spline elements that extend between a distal hub and a proximal base. In one embodiment, the spline elements are circumferentially spaced about the distal hub in a radially asymmetric fashion, creating a greater density of spline elements in one region of the structure than in another region. In the same or another embodiment, the spline elements are preformed in an axially asymmetric fashion along their lengths, creating a different geometry in their distal regions than in their proximal regions.

High-resolution mapping of tissue with pacing

According to some embodiments, a method of confirming successful ablation of targeted cardiac tissue of a subject using a high-resolution mapping electrode comprises pacing said cardiac tissue at a predetermined pacing level to increase the heart rate of the subject from a baseline level to an elevated level, the predetermined pacing level being greater than a pre-ablation pacing threshold level but lower than a post-ablation pacing threshold level, delivering ablative energy to the ablation electrode, detecting the heart rate of the subject, wherein the heart rate detected by the high-resolution mapping electrode is at the elevated level before the post-ablation pacing threshold level is achieved, and wherein the heart rate detected by the high-resolution mapping electrode drops below the elevated level once ablation achieves its therapeutic goal or target, and terminating the delivery of ablative energy to the ablation electrode after the heart rate drops below the elevated level.

Surgical system with haptic feedback based upon quantitative three-dimensional imaging

A system is provided to provide haptic feedback during a medical procedure comprising: a quantitative three-dimensional (Q3D); a surgical instrument disposed to deform a tissue structure; a haptic user interface device configured to provide an indication of tissue structure deformation in response to information indicative of the measure of tissue structure deformation; and a processor configured to produce a Q3D model that includes information indicative of a measure of tissue structure deformation and to provide the information indicative of the measure of tissue structure deformation to the haptic user interface device.

Systems and methods for high-resolution mapping of tissue

According to some embodiments, methods and systems of enhancing a map of a targeted anatomical region comprise receiving mapping data from a plurality of mapping electrodes, receiving high-resolution mapping data from a high-resolution roving electrode configured to be moved to locations between the plurality of mapping electrodes, wherein the mapping system is configured to supplement, enhance or refine a map of the targeted anatomical region or to directly create a high-resolution three-dimensional map using the processor receiving the data obtained from the plurality of mapping electrodes and from the high-resolution roving electrode.

Systems and methods for controlling tissue ablation using multiple temperature sensing elements

Systems and associated methods place a temperature sensing element in an "edge regions" between an energy transmitting electrode and a non-electrically conducting support body, where higher temperatures are likely to exist. Reliable temperature sensing, which is sensitive to variations in temperatures along the electrode, results.

High-resolution mapping of tissue with pacing

According to some embodiments, a method of confirming successful ablation of targeted cardiac tissue of a subject using a high-resolution mapping electrode comprises pacing said cardiac tissue at a predetermined pacing level to increase the heart rate of the subject from a baseline level to an elevated level, the predetermined pacing level being greater than a pre-ablation pacing threshold level but lower than a post-ablation pacing threshold level, delivering ablative energy to the ablation electrode, detecting the heart rate of the subject, wherein the heart rate detected by the high-resolution mapping electrode is at the elevated level before the post-ablation pacing threshold level is achieved, and wherein the heart rate detected by the high-resolution mapping electrode drops below the elevated level once ablation achieves its therapeutic goal or target, and terminating the delivery of ablative energy to the ablation electrode after the heart rate drops below the elevated level.

Systems And Methods For Interventional Procedure Planning

A method of planning a procedure to deploy an interventional instrument comprises receiving a model of an anatomic structure. The anatomic structure includes a plurality of passageways. The method further includes identifying a target structure in the model and receiving information about an operational capability of the interventional instrument within the plurality of passageways. The method further comprises identifying a planned deployment location for positioning a distal tip of the interventional instrument to perform the procedure on the target structure based upon the operational capability of the interventional instrument. 1. A method of planning a procedure to deploy an interventional instrument , the method performed by a processing system , the method comprising:receiving a model of an anatomic structure, the anatomic structure including a plurality of passageways;identifying a target structure in the model;receiving information about an operational capability of the interventional instrument within the plurality of passageways; andidentifying a planned deployment location for positioning a distal tip of the interventional instrument to perform the procedure on the target structure based upon the operational capability of the interventional instrument.2. The method of wherein identifying the planned deployment location includes receiving data representing one or more characteristics of the interventional instrument claim 1 , the one or more characteristics including a tool deployment length.3. The method of wherein identifying the planned deployment location includes receiving data representing one or more characteristics of the interventional instrument claim 1 , the one or more characteristics including the bending capability of the interventional instrument.4. The method of wherein identifying the planned deployment location includes receiving data representing one or more characteristics of the interventional instrument and wherein the interventional ...

Thermokeratoplasty system with a guided probe tip

A template that is used with a probe to perform a medical procedure on a cornea. One embodiment of the template includes one or more openings that are used to align the probe with locations of the cornea that are to be denatured with energy transferred by the probe. By way of example, the openings may be located at 6, 7 and 8 millimeters about the center of the cornea. The denatured spots may collectively decrease the radius of curvature of the cornea. The template may have a bottom surface that conforms to the shape of the cornea. The template may have a centering feature that is used to center the template on the cornea and a vacuum channel that maintains the position of the template. The template openings may have stop features that limit a penetration depth of the probe.

Structures for supporting porous electrode elements

A catheter assembly comprising a elongated, flexible support structure having an axis. The assembly also includes an elongated porous electrode assembly carried by the support structure along the axis for contact with tissue. The elongated porous electrode assembly comprises a wall having an exterior peripherally surrounding an interior area, a lumen to convey a medium containing ions into the interior area, and an element coupling the medium within the interior area to a source of electrical energy. At least a portion of the wall comprising a porous material is sized to allow passage of ions contained in the medium to thereby enable ionic transport of electrical energy through the porous material to the exterior of the wall to form a continuous elongated lesion pattern in tissue contacted by the wall. The support structure can have a curvilinear geometry, e.g., a loop shape, and the elongated porous electrode assembly conforms to the curvilinear geometry.

Systems and methods for assessing stability of an operative instrument in a body region

A graphical user interface (GUI) is provided for assisting medical personnel in interpreting data collected by a multiple electrode catheter deployed within the body. The GUI generates and displays an image of the multiple electrode catheter. By manipulating appropriate controls, the medical personnel are able to change the orientation of the displayed image until it matches the orientation of the actual multiple electrode catheter as seen on a fluoroscope. Afterwards, the medical personnel can determine the relative position and orientation of the catheter by reference to the GUI generated image. To aid in interpreting data recovered by the catheter, the individual electrodes and splines are highlighted and labeled. Electrodes recovering particular types of physiological waveforms can be automatically identified and highlighted. Comments and anatomic landmarks can be inserted where desired to further assist in interpreting data. Views from various, virtual fluoroangles can be obtained, ...

Methods of removing heat from an electrode using thermal shunting

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

System and method for estimating cardiac pressure based on cardiac electrical conduction delays using an implantable medical device

Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

Steerable Flexible Needle With Embedded Shape Sensing

A surgical system includes a flexible steerable needle and a shape sensor for measuring the shape of the needle. The surgical system can be manual (e.g., laparoscopic), robotic, or any combination of the two. By directly measuring the shape of the needle, complex and potentially inaccurate modeling of the needle to determine trajectory and insertion depth can be avoided in favor of much more robust direct measurement and modeling of needle shape and/or pose. 1. A flexible needle comprising:a shape sensor anda connector adapted for connecting the shape sensor to a processor for determining the shape of the flexible needle based on data from the shape sensor.2. The flexible needle of wherein the shape sensor comprises at least one of an optical fiber claim 1 , a fiber Bragg grating claim 1 , a nitinol wire claim 1 , and a piezoresistive element.3. The flexible needle of further comprising a wall defining an interior lumen claim 1 , wherein the shape sensor is removably insertable into the interior lumen.4. The flexible needle of further comprising a wall defining an interior lumen claim 1 , wherein the shape sensor is attached to the wall.5. The flexible needle of claim 4 , wherein the shape sensor is attached to an external surface of the wall.6. The flexible needle of claim 4 , wherein the shape sensor is attached to an internal surface of the wall.7. The flexible needle of claim 4 , wherein the wall comprises a groove claim 4 , and wherein the shape sensor is at least partially positioned within the groove.8. The flexible needle of claim 7 , wherein the groove comprises one or more positioning features mated with the shape sensor and wherein the one or more positioning features prevents movement of the shape sensor along the groove.9. The flexible needle of claim 8 , wherein the one or more positioning features comprises at least one of a slot claim 8 , a ridge claim 8 , and a threaded section.10. The flexible needle of further comprising a wall having an interior ...

Multi-Functional Medical Catheter And Methods Of Use

The present invention provides multi-functional medical catheters, systems and methods for their use. In one particular embodiment, a medical catheter (100) includes a flexible elongate body (105) having a proximal end (110) and a distal end (120). A plurality of spaced apart electrodes (130-136) are operably attached to the flexible body near the distal end. At least some of the electrodes are adapted for mapping a tissue and, in some embodiments, at least one of the electrodes is adapted for ablating a desired portion of the tissue. The catheter includes a plurality of tissue orientation detectors (140-146) disposed between at least some of the electrodes. In this manner, the medical catheter is capable of tissue mapping, tissue imaging, tissue orientation, and/or tissue treatment functions.

Systems and methods for robotic medical system integration with external imaging

A medical robotic system and method of operating such comprises taking intraoperative external image data of a patient anatomy, and using that image data to generate a modeling adjustment for a control system of the medical robotic system (e.g., updating anatomic model and/or refining instrument registration), and/or adjust a procedure control aspect (e.g., regulating substance or therapy delivery, improving targeting, and/or tracking performance).

Contact sensing systems and methods

According to some embodiments, a medical instrument comprises an elongate body having a proximal end and a distal end and a pair of electrodes or electrode portions (for example, a split-tip electrode assembly). Systems and methods are described herein that perform contact sensing and/or ablation confirmation based on electrical measurements obtained while energy of different frequencies are applied to the pair of electrodes or electrode portions. The contact sensing systems and methods may calibrate network parameter measurements to compensate for a hardware unit in a network parameter measurement circuit or to account for differences in cables, instrumentation or hardware used.

Ablation devices, systems and methods of using a high-resolution electrode assembly

According to some embodiments, an ablation device comprises an elongate body (e.g., a catheter) having a proximal end and a distal end, a first electrode (e.g., a radiofrequency electrode) positioned at the distal end of the elongate body, at least a second electrode (e.g., a radiofrequency electrode) positioned at a location proximal to the first electrode, the first electrode and the second electrode being configured to contact tissue of a subject and deliver radiofrequency energy sufficient to at least partially ablate the tissue, at least one electrically insulating gap positioned between the first electrode and the second electrode and a filtering element configured to present a low impedance at a frequency used for delivering ablation energy via the first and second electrodes.

ABLATION SYSTEMS WITH MULTIPLE TEMPERATURE SENSORS

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 1. (canceled)2. A cardiac ablation system , comprising:a catheter comprising an electrode assembly, the electrode assembly comprising a proximal electrode and a distal electrode, wherein the proximal electrode is separated from the distal electrode by a gap; andan energy delivery device configured to deliver energy at a frequency within an ablation radiofrequency range to the electrode assembly;wherein the proximal electrode is operatively coupled to the distal electrode using a filtering element at the ablation radiofrequency range such that the proximal electrode and the distal electrode function like a single electrode, and wherein the proximal electrode and the distal electrode function as separate electrodes at high-resolution mapping frequencies;wherein the system is configured to receive signals indicative of temperature from at least one temperature sensor positioned along the proximal electrode or distal electrode;wherein the system is configured to determine, upon execution of instructions stored on a non-transitory storage medium by a hardware processor, temperature measurements from the signals received from the at least one temperature sensor; andwherein the system is configured to adjust one or more treatment parameters of the ablation procedure based, at least in ...

Systems and methods of radiometrically determining a hot-spot temperature of tissue being treated

According to some embodiments, systems for energy delivery to targeted tissue comprise a catheter with an ablation member, a radiometer configured to detect temperature data from the targeted tissue, a processor configured to determine a calculated temperature (e.g., an extreme temperature, such as a peak or trough temperature) within the tissue by applying at least one factor to the temperature data detected by the radiometer, the processor configured to compare the calculated temperature to a setpoint and an energy source configured to energize the ablation member and to regulate delivery of ablative energy to the targeted tissue of the subject based at least in part on the comparison. In some embodiments, the factor depends on at least one characteristic of the targeted tissue. Information regarding a tissue characteristic can be provided using information from an imaging set (e.g., intracardiac echo) or an electrical signal of the subject (e.g., electrocardiogram).

Systems for determining catheter orientation

Systems, devices and methods of determining orientation of a distal end of a medical instrument (e.g., electrode-tissue orientation of an RF ablation catheter) are described herein. One or more processors may be configured to receive temperature measurements from each of a plurality of temperature-measurement devices distributed along a length of the distal end of the medical instrument and determine the orientation from a group of two or more possible orientation options based on whether temperature measurement values or characteristics of temperature response determined from the temperature measurement values satisfy one or more orientation criteria.

Systems and methods for forming large lesions in body tissue using curvilinear electrode elements

Systems and associated methods form larger and deeper lesion patterns by shaping a support body with multiple electrodes in ways that increase the density of the electrodes per given tissue area. The support body can carry either elongated, continuous electrodes or arrays of non-contiguous, segmented electrodes.

Systems and methods for use by an implantable medical device for evaluating ventricular dyssynchrony based on T-wave morphology

Techniques are provided for detecting and evaluating ventricular dyssynchrony based on morphological features of the T-wave and for controlling therapy in response thereto. For example, the number of peaks in the T-wave, the area under the peaks, the number of points of inflection, and the slope of the T-wave can be used to detect ventricular dyssynchrony and evaluate its severity. As ventricular dyssynchrony often arises due to heart failure, the degree of dyssynchrony may also be used as a proxy for tracking the progression of heart failure. Pacing therapy is automatically and adaptively adjusted based on the degree of ventricular dyssynchrony so as to reduce the dyssynchrony and thereby improve cardiac function.

RADIOMETRIC TISSUE CONTACT AND TISSUE TYPE DETECTION

Radiometric systems may comprise a radiometer, an antenna and a processor communicatively coupled together. The processor may provide a contact-focused output based on filtering or other processing of a raw radiometric output signal. The contact-focused output may facilitate determination of whether contact has been achieved and/or assessment of contact. A miniaturized reflectometer may be configured to determine an amount of reflected power from the antenna. The processor may be configured to determine a reflection coefficient of the reflected power determined by the reflectometer and to identify tissue type based on the reflection coefficient. Systems and methods for facilitating deeper temperature measurements of a radiometer are described.

SYSTEMS AND METHODS FOR ROBOTIC MEDICAL SYSTEM INTEGRATION WITH EXTERNAL IMAGING

A medical robotic system and method of operating such comprises taking intraoperative external image data of a patient anatomy, and using that image data to generate a modeling adjustment for a control system of the medical robotic system (e.g., updating anatomic model and/or refining instrument registration), and/or adjust a procedure control aspect (e.g., regulating substance or therapy delivery, improving targeting, and/or tracking performance).

Systems and processes for refining a registered map of a body cavity

A process of refining a map of a body cavity includes positioning a first probe and a second probe within the body cavity. Mapping elements on the first probe are used to gather local information from a plurality of locations along the body cavity. The absolute locations of the mapping elements are registered in a three-dimensional coordinate system, and are associated with the local information to generate the map. A mapping element on the second probe is then used to gather information local to a location between the plurality of locations along the body cavity. The absolute location of the mapping element is registered in the three-dimensional system and associated with the local information to refine the map.

System and method for estimating electrical conduction delays from immittance values measured using an implantable medical device

Techniques are provided for estimating electrical conduction delays with the heart of a patient based on measured immittance values. In one example, impedance or admittance values are measured within the heart of a patient by a pacemaker or other implantable medical device, then used by the device to estimate cardiac electrical conduction delays. A first set of predetermined conversion factors may be used to convert the measured immittance values into conduction delay values. In some examples, the device then uses the estimated conduction delay values to estimate LAP or other cardiac pressure values. A second set of predetermined conversion factors may be used to convert the estimated conduction delays into pressure values. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP.

STEERABLE FLEXIBLE NEEDLE WITH EMBEDDED SHAPE SENSING

A surgical system includes a flexible steerable needle and a shape sensor for measuring the shape of the needle. The surgical system can be manual (e.g., laparoscopic), robotic, or any combination of the two. By directly measuring the shape of the needle, complex and potentially inaccurate modeling of the needle to determine trajectory and insertion depth can be avoided in favor of much more robust direct measurement and modeling of needle shape and/or pose. 1. A flexible needle comprising:a shape sensor anda connector adapted for connecting the shape sensor to a processor for determining the shape of the flexible needle based on data from the shape sensor.2. The flexible needle of wherein the shape sensor comprises at least one of an optical fiber claim 1 , a fiber Bragg grating claim 1 , a nitinol wire claim 1 , and a piezoresistive element.3. The flexible needle of further comprising a wall defining an interior lumen claim 1 , wherein the shape sensor is removably insertable into the interior lumen.4. The flexible needle of further comprising a wall defining an interior lumen claim 1 , wherein the shape sensor is attached to the wall.5. The flexible needle of claim 4 , wherein the shape sensor is attached to an external surface of the wall.6. The flexible needle of claim 4 , wherein the shape sensor is attached to an internal surface of the wall.7. The flexible needle of claim 4 , wherein the wall comprises a groove claim 4 , and wherein the shape sensor is at least partially positioned within the groove.8. The flexible needle of claim 7 , wherein the groove comprises one or more positioning features mated with the shape sensor and wherein the one or more positioning features prevents movement of the shape sensor along the groove.9. The flexible needle of claim 8 , wherein the one or more positioning features comprises at least one of a slot claim 8 , a ridge claim 8 , and a threaded section.10. The flexible needle of further comprising a wall having an interior ...

Ultrasound-guided ablation catheter and methods of use

The present invention provides ultrasound-guided ablation catheters and methods for their use. In one embodiment, a tissue ablation apparatus (2) includes a flexible elongate body (12) having proximal (14) and distal (12) ends. A plurality of spaced-apart electrodes (24) are operably attached to the flexible body near the distal end. A plurality of transducer elements (28) are disposed between at least some of the electrodes. Transducers assist the physician in determining whether or not the ablation elements are in contact with the tissue to be ablated.

Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface, used in association with an electrode structure deployed in contact with heart tissue, generates a display comprising an image of the electrode structure at least partially while performing a therapeutic or diagnostic procedure. The interface annotates the image in response to procedure events.

SYSTEMS AND METHODS FOR ROBOTIC MEDICAL SYSTEM INTEGRATION WITH EXTERNAL IMAGING

A medical system comprises a memory for receiving intraoperative external image data for at least a portion of a patient anatomy. The memory further receives intraoperative pose data for a medical instrument of the medical system. The medical system further comprises a processor configured for generating a first model of the patient anatomy. The processor is further configured for, based on the intraoperative external image data, intraoperatively generating an updated model of the patient anatomy that is different from the first model. The updated model includes an anatomical structure that is not present in the first model.

Tissue characterization using intracardiac impedances with an implantable lead system

An implantable system acquires intracardiac impedance with an implantable lead system. In one implementation, the system generates frequency-rich, low energy, multi-phasic waveforms that provide a net-zero charge and a net-zero voltage. When applied to bodily tissues, current pulses or voltage pulses having the multi-phasic waveform provide increased specificity and sensitivity in probing tissue. The effects of the applied pulses are sensed as a corresponding waveform. The waveforms of the applied and sensed pulses can be integrated to obtain corresponding area values that represent the current and voltage across a spectrum of frequencies. These areas can be compared to obtain a reliable impedance value for the tissue. Frequency response, phase delay, and response to modulated pulse width can also be measured to determine a relative capacitance of the tissue, indicative of infarcted tissue, blood to tissue ratio, degree of edema, and other physiological parameters.

ALIGNMENT OF Q3D MODELS WITH 3D IMAGES

A method is provided to align a quantitative three-dimensional (Q3D) model of a three dimensional (3D) structure with a 3D visual representation of a sub-surface target object internal to the anatomical structure, the method comprising: identifying fiducial points within the external surface of the 3D structure represented in the 3D visual representation; identifying the same fiducial points within the Q3D model; aligning the identified fiducial points in the 3D visual representation with the identified fiducial points in the Q3D model; and producing a visual image representation of the 3D structure that includes a view of an external surface and a view of the internal sub-surface target structure. 1. A system for producing an image of a surgical scene comprising:a quantitative three-dimensional (Q3D) endoscope disposed to image a scene within a surgical field of view;at least one processor configured to:determine a Q3D model of a tissue structure imaged by the Q3D endoscope;input a 3D visual representation of the tissue structure;determine a geometric transformation to align an outer surface of the tissue structure of the 3D visual representation of the tissue structure with the Q3D model of said tissue structure; andproduce, based at least in part upon said geometric transformation, a visual output representing the combined Q3D model of the tissue structure and the 3D visual representation of the tissue structure.2. The system of claim 1 ,wherein the 3D visual representation can be one of the following: MRI, CT, PET, ultrasound or fluorescent images.3. The system of claim 1 ,identifying multiple fiducial points on an outer surface of the tissue structure represented in the 3D visual representation;identifying substantially the same multiple fiducial points of the tissue structure represented within the Q3D model;wherein the at least one processor is further configured to:apply a geometric transformation to the 3D visual representation of the tissue structure to ...

Catheter with sensor tip and method of use of same

An apparatus and method for catheter-based sensing and injection at a target site within a patient's body. An injection catheter is equipped with electrodes at its distal end which contact the surface of a target site, such as an AV node of the heart. Electrical signals detected at the target site by the electrodes are fed via leads to the proximal end of the catheter, where they are received by a monitor, such as an EKG monitor. If the electrical signals satisfy predetermined criteria, a needle within the catheter is extended into the target site, and a therapeutic agent is injected into the target site.

Systems and methods for guiding catheters using registered images

Systems and methods for imaging a body cavity and for guiding a treatment element within a body cavity are provided. A system may include an imaging subsystem having an imaging device and an image processor that gather image data for the body cavity. A mapping subsystem may be provided, including a mapping device and a map processor, to identify target sites within the body cavity, and provide location data for the sites. The system may also include a location processor coupled to a location element on a treatment device to track the location of the location element. The location of a treatment element is determined by reference to the location element. A treatment subsystem including a treatment device having a treatment element and a treatment delivery source may also be provided. A registration subsystem receives and registers data from the other subsystems, and displays the data.

Steerable flexible needle with embedded shape sensing

A minimally invasive system comprises an elongate medical instrument including a flexible body. The flexible body includes a wall including a channel, and the channel includes a groove. The flexible body further includes a lumen defined by an interior surface of the wall and a curved distal tip portion. The elongate medical instrument further includes a shape sensor coupled to the flexible body. The shape sensor is at least partially positioned within the groove, and the shape sensor is configured to detect shape characteristics of at least a portion of the flexible body. The system further includes an actuator for manipulating the elongate medical instrument.

Systems and methods for forming elongated lesion patterns in body tissue using straight or curvilinear electrode elements

Systems and associated methods position arrays of multiple emitters of ablating energy in straight or curvilinear positions in contact with tissue to form elongated lesion patterns. The elongated lesion patterns can continuous or interrupted, depending upon the orientation of the energy emitters.

Use of cardiogenic impedance waveform morphology to analyze cardiac conditions and to adjust treatment therapy

In specific embodiments, one or more cardiogenic impedance signal template is stored, where each template has a corresponding morphology. Additionally, one or more cardiogenic impedance signal is obtained using electrodes implanted within a patient, where each signal has a corresponding morphology. The morphology of one or more obtained cardiogenic impedance signal is compared to the morphology of one or more stored template, to determine one or more metric indicative of similarity between the compared morphologies. The one or more metric indicative of similarity is used to analyze the patient's cardiac condition, to discriminate among arrhythmias and/or to adjust a cardiac pacing parameter.

Steerable flexible needle with embedded shape sensing

A minimally invasive system comprises an elongate medical instrument including a lumen; an elongate, flexible stylet removably receivable within the lumen; a sensor system coupled to the stylet, the sensor system configured to detect characteristics of at least a portion of the elongate medical instrument; and a processor. The processor comprises an error detection module configured to receive the detected characteristics from the sensor system; compare the detected characteristics with expected characteristics of at least the portion of the elongate medical instrument; and notify a user of a deviation between the detected characteristics and the expected characteristics. The processor further comprises a path planning module configured to intraoperatively generate, based on a shape of at least the portion of the elongate medical instrument detected by the sensor system, a target trajectory for continuing advancement of the elongate medical instrument within a patient anatomy.

Medical instruments with multiple temperature sensors

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

Multi-functional medical catheter and methods of use

The present invention provides multi-functional medical catheters, systems and methods for their use. In one particular embodiment, a medical catheter ( 100 ) includes a flexible elongate body ( 105 ) having a proximal end ( 110 ) and a distal end ( 120 ). A plurality of spaced apart electrodes ( 130 - 136 ) are operably attached to the flexible body near the distal end. At least some of the electrodes are adapted for mapping a tissue and, in some embodiments, at least one of the electrodes is adapted for ablating a desired portion of the tissue. The catheter includes a plurality of tissue orientation detectors ( 140 - 146 ) disposed between at least some of the electrodes. In this manner, the medical catheter is capable of tissue mapping, tissue imaging, tissue orientation, and/or tissue treatment functions.

ABLATION CATHETER WITH HIGH-RESOLUTION ELECTRODE ASSEMBLY

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 120-. (canceled)21. A method of operating an ablation system , comprising:delivering energy at a frequency within an ablation radiofrequency range to at least one of a proximal electrode and a distal electrode, the proximal and distal electrodes positioned along a distal end of an intraluminal device, wherein the proximal electrode is separated from the distal electrode by a gap;wherein the proximal electrode is operatively coupled to the distal electrode using a filtering element at the ablation radiofrequency range such that the proximal electrode and the distal electrode function like a single electrode, and wherein the proximal electrode and the distal electrode function as separate electrodes at high-resolution mapping frequencies;receiving signals indicative of temperature from at least one temperature sensor positioned along the proximal or distal electrode;determining, upon execution of instructions stored on a non-transitory storage medium by a hardware processor, determined temperature measurements from the signals received from the at least one temperature sensor; andadjusting one or more treatment parameters of the ablation procedure based, at least in part, on the determined temperature measurements.22. The method of claim 21 ,wherein the ablation radiofrequency range ...

Systems and methods for guiding and locating functional elements on medical devices positioned in a body

A system for performing an invasive diagnostic or therapeutic medical procedure includes a first probe having a distal portion carrying a plurality of functional elements and a second probe having a distal portion carrying a functional element and a location sensor. The system includes a proximity processing subsystem in communication with the functional elements carried by each of the first and second probes and configured to determine a proximity of the functional element carried by the second probe relative to a first functional element carried by the first probe. The systems further includes a location processing subsystem configured to determine an absolute position and orientation of the location sensor carried by the second probe with respect to a three-dimensional reference coordinate system that can be internal or external to the three-dimensional space in which the first and second probes are positioned.

Systems and methods for interventional procedure planning

A method includes registering a distal segment of a guide catheter with a patient coordinate system; tracking a position of the distal segment; determining an insertion length based on the tracked position, wherein the imaging probe is disposed within the guide catheter; receiving an image of an anatomic structure from the imaging probe, the image having an image frame of reference, the distal segment having a catheter frame of reference; receiving location data associated with a target structure identified in the image, wherein the received location data is in the image frame of reference; and transforming the location data from the image frame of reference to the catheter frame of reference based on the determined insertion length and the tracked position of the distal segment, wherein transforming the location data further includes determining a roll angle for the image frame of reference with respect to the catheter frame of reference.

System and method for calibrating cardiac pressure measurements derived from signals detected by an implantable medical device

Various techniques are provided for calibrating and estimating left atrial pressure (LAP) using an implantable medical device, based on impedance, admittance or conductance parameters measured within a patient. In one example, default conversion factors are exploited for converting the measured parameters to estimates of LAP. The default conversion factors are derived from populations of patients. In another example, a correlation between individual conversion factors is exploited to allow for more efficient calibration. In yet another example, differences in thoracic fluid states are exploited during calibration. In still yet another example, a multiple stage calibration procedure is described, wherein both invasive and noninvasive calibration techniques are exploited. In a still further example, a therapy control procedure is provided, which exploits day time and night time impedance/admittance measurements.

Systems and methods for interventional procedure planning

A system for planning a procedure to be performed using an interventional instrument may comprise a sensor system that generates sensor data and a control system that may receive information about an operational capability of the interventional instrument within a plurality of passageways in a model of an anatomic structure. The control system may also identify a plurality of optional deployment locations for positioning a distal tip of the interventional instrument to perform the procedure on a target structure in the model based on at least one of the sensor data or the information about the operational capability of the interventional instrument. A display system may display the model of the anatomic structure having the plurality of passageways and display the plurality of optional deployment locations in the model. A code may be displayed that provides information about a relative quality of each of the plurality of optional deployment locations.

CONTACT SENSING SYSTEMS AND METHODS

According to some embodiments, a medical instrument comprises an elongate body having a proximal end and a distal end and a pair of electrodes or electrode portions (for example, a split-tip electrode assembly). Systems and methods are described herein that perform contact sensing and/or ablation confirmation based on electrical measurements obtained while energy of different frequencies are applied to the pair of electrodes or electrode portions. The contact sensing systems and methods may calibrate network parameter measurements to compensate for a hardware unit in a network parameter measurement circuit or to account for differences in cables, instrumentation or hardware used. 1. A system for determining a contact state of a distal end portion of a medical instrument with a target region based , at least in part , on electrical measurements , the system comprising:a signal source configured to generate at least one signal having a first frequency and a second frequency to be applied to a pair of electrode members of a combination electrode assembly; and process a resulting waveform that formulates across the pair of electrode members to obtain a first electrical measurement at the first frequency;', 'process a resulting waveform that formulates across the pair of electrode members to obtain a second electrical measurement at the second frequency;', 'determine a bipolar contact impedance magnitude based on the first electrical measurement;', 'determine a bipolar contact impedance magnitude and a phase angle based on the second electrical measurement; and', 'calculate a contact indication value indicative of a state of contact between a distal end portion of a medical instrument and a target region based on a criterion combining: (i) the impedance magnitude based on the first electrical measurement, (ii) a ratio of the impedance magnitudes based on the first electrical measurement and the second electrical measurement, and (iii) the phase angle based on the second ...

Interactive systems and methods for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface is associated with a structure which, in use, is deployed in an interior body region of a patient. The structure includes an operative element coupled to a controller, which establishes an operating condition for the operative element to perform a diagnostic or therapeutic procedure in the interior body region. The interface generates a first display comprising an image of the structure at least partially while the operative element performs the procedure. The interface also generates a second display comprising one or more data fields reflecting the operating condition of the controller. The interface enables selection of the first display or the second display for viewing on a display screen.

Ultrasound-guided ablation catheter and methods of use

The present invention provides ultrasound-guided ablation catheters and methods for their use. In one embodiment, a tissue ablation apparatus (2) includes a flexible elongate body (12) having proximal (14) and distal (12) ends. A plurality of spaced-apart electrodes (24) are operably attached to the flexible body near the distal end. A plurality of transducer elements (28) are disposed between at least some of the electrodes. Transducers assist the physician in determining whether or not the ablation elements are in contact with the tissue to be ablated.

Adaptive staged wake-up for implantable medical device communication

A communication wake-up scheme for an implantable medical device may involve repeatedly activating a receiver to determine whether an external device is attempting to establish communication with the implantable device. To reduce the amount of power consumed by the implantable device in conjunction with the wake-up scheme, the scheme may involve conducting preliminary radio frequency signal detections as a precursor to conducting a full scan. In this way, power may be conserved since the more power intensive full scans may be performed less frequently. This preliminary detection of radio frequency signals also may be adapted to reduce the number of full scans performed by the implantable device that do not result in communication with the external device. In some embodiments the adaptation involves adjusting one or more thresholds that are used in conjunction with the preliminary detection of radio frequency signals.

ELECTRODE ASSEMBLY WITH THERMAL SHUNT MEMBER

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 1. (canceled)2. An electrode assembly for an ablation catheter with thermal shunting , the electrode assembly comprising:a proximal electrode portion;a distal electrode portion;a filtering element electrically coupling the proximal electrode portion to the distal electrode portion and configured to present a low impedance at a frequency used for delivering ablative energy via the proximal and distal electrode portions; andat least one thermal shunt member in thermal communication with the proximal electrode portion and the distal electrode portion to selectively remove heat from at least one of the electrode assembly and tissue being treated by the electrode assembly when the electrode assembly is activated;wherein the at least one thermal shunt member extends at least partially through an interior of the electrode assembly to transfer heat from the electrode assembly during use;wherein the at least one thermal shunt member is configured to receive at least one fluid conduit extending at least partially through an interior of the at least one thermal shunt member, wherein the at least one thermal shunt member is in thermal communication with the at least one fluid conduit; andwherein the at least one fluid conduit is configured to place the electrode assembly in fluid ...

IMPLANTABLE CARDIAC DEVICE WITH SATELLITE REFRESH

In one embodiment an implantable cardiac device is provided that includes an implantable cardiac stimulation device with an implantable satellite device coupled to it. The implantable satellite device has a charge storage device. The implantable stimulation device having a refresh generator configured to generate a charge and voltage balanced multi-phasic refresh signal with a duration less than a capacitive time constant of an electro-electrolyte interface of the implantable cardiac device and transmit the charge and voltage balanced multi-phasic refresh signal to the implantable satellite device for charging the charge storage device. In various embodiments, the charge and voltage balanced multi-phasic refresh signal having alternating phase signs and null durations between the alternating phases. In some embodiments, the refresh generator is configured to modulate the multi-phasic waveform refresh signal. The multi-phasic waveform refresh signal may be modulated to contain configuration ...

Method and apparatus to align a probe with a cornea

A system and method for denaturing corneal tissue of a cornea. The system may include an optical recognition system that-can recognize a feature of the corneal. The recognized feature is used to register a desired probe location relative to the cornea. The desired probe location is displayed by a monitor. The system further includes a probe that is coupled to an arm. The arm contains position sensors that provide position information of the probe. The position information is used to map and display the actual position of the probe. By watching the monitor the user can move the probe into the desired probe location relative to the cornea. Once the probe is properly positioned energy is delivered to denature corneal tissue.

SYSTEM AND METHOD FOR CALIBRATING CARDIAC PRESSURE MEASUREMENTS DERIVED FROM SIGNALS DETECTED BY AN IMPLANTABLE MEDICAL DEVICE

Various techniques are provided for calibrating and estimating left atrial pressure (LAP) using an implantable medical device, based on impedance, admittance or conductance parameters measured within a patient. In one example, default conversion factors are exploited for converting the measured parameters to estimates of LAP. The default conversion factors are derived from populations of patients. In another example, a correlation between individual conversion factors is exploited to allow for more efficient calibration. In yet another example, differences in thoracic fluid states are exploited during calibration. In still yet another example, a multiple stage calibration procedure is described, wherein both invasive and noninvasive calibration techniques are exploited. In a still further example, a therapy control procedure is provided, which exploits day time and night time impedance/admittance measurements.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Systems and methods for guiding catheters using registered images

Systems and methods for imaging a body cavity and for guiding a treatment element within a body cavity are provided. A system may include an imaging subsystem having an imaging device and an image processor that gather image data for the body cavity. A mapping subsystem may be provided, including a mapping device and a map processor, to identify target sites within the body cavity, and provide location data for the sites. The system may also include a location processor coupled to a location element on a treatment device to track the location of the location element. The location of a treatment element is determined by reference to the location element. A treatment subsystem including a treatment device having a treatment element and a treatment delivery source may also be provided. A registration subsystem receives and registers data from the other subsystems, and displays the data.

SYSTEMS AND METHODS FOR INTERVENTIONAL PROCEDURE PLANNING

A method of deploying an interventional instrument is performed by a processing system. The method comprises receiving an image of an anatomic structure from an imaging probe. The image has an image frame of reference. The imaging probe is extendable distally beyond a distal end of a guide catheter. The distal end of the guide catheter has a catheter frame of reference. The method further includes receiving location data associated with a target structure identified in the image. The received location data is in the image frame of reference. The method further comprises transforming the location data associated with the target structure from the image frame of reference to the catheter frame of reference. 120-. (canceled)21. A method of deploying an interventional instrument , the method comprising:identifying a target structure in an anatomic frame of reference;determining a target region in the anatomic frame of reference with respect to a current location of the interventional instrument wherein determining the target region includes determining a probability of a location of the target structure relative to the current location of the interventional instrument; andrecording a first engagement location of the interventional instrument within the target region.22. The method of wherein at least a portion of the target structure is located within the target region.23. The method of wherein the anatomic frame of reference is a three-dimensional anatomic frame of reference and wherein identifying the target structure includes identifying a model target structure in a three-dimensional model frame of reference and registering the three-dimensional model frame of reference to the three-dimensional anatomic frame of reference.24. The method of wherein determining the target region includes at least one of determining a change in a patient anatomical pose between a preoperative imaging time and an interventional procedure time claim 21 , determining an uncertainty value ...

Quantitative three-dimensional imaging of surgical scenes from multiport perspectives

A system is provided that includes a quantitative three-dimensional (Q3D) endoscope that is inserted through a first port providing access to a body cavity to a first position at which a first 3D image of a first portion of an anatomical structure is captured from a perspective of said endoscope. A first Q3D model is produced based upon the captured first image. The endoscope is inserted through a second port providing access to the body cavity to a second position at which a second image of a second portion of the anatomical structure is captured. A second quantitative Q3D model is produced based upon the captured second image. The first Q3D model and the second Q3D model are combined together to produce an expanded Q3D model of the anatomical structure. The expanded Q3D model can be stored for further manipulation or can be displayed in 3D.

Surgical system with haptic feedback based upon quantitative three-dimensional imaging

A system is provided to provide haptic feedback during a medical procedure comprising: a quantitative three-dimensional (Q3D) endoscope; a surgical instrument disposed to deform a tissue structure; a haptic user interface device configured to provide an indication of tissue structure deformation in response to information indicative of the measure of tissue structure deformation; and a processor configured to produce a Q3D model that includes information indicative of a measure of tissue structure deformation and to provide the information indicative of the measure of tissue structure deformation to the haptic user interface device.

ATRIAL FIBRILLATION DETECTION BASED ON ABSENCE OF CONSISTENT P-LOOPS IN AVERAGED VECTORCARDIOGRAM

A method for determining the presence of atrial fibrillation includes obtaining data from at least three orthogonal leads indicative of electrical activity of a heart over multiple heart beats, averaging the data to obtain an average heart beat, generating, from the averaged data, an average heart beat vectorcardiogram (VCG) that is a function of voltage level, comparing, over a segment of the average heart beat, the average heart beat VCG with a threshold value, and indicating whether the average heart beat VCG exceeds or does not exceed the threshold value.

Thermokeratoplasty system with a regulated power generator

An apparatus that provides energy to a probe in contact with a cornea to perform a medical procedure. The apparatus includes a circuit that supplies energy to the probe and a regulator that regulates the delivery of energy during the medical procedure. The apparatus may include a sensing circuit that senses a change in a physiology of the cornea. The regulator can vary the energy delivered to the cornea in accordance with changes in the cornea physiology. For example, a waveform of tissue impedance may be determined and compared to a desired waveform. Deviations from the desired waveform may cause the regulator to increase or decrease the power applied to the cornea.

Interactive systems and methods for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface is associated with a structure which, in use, is deployed in an interior body region of a patient. The structure includes an operative element coupled to a controller, which establishes an operating condition for the operative element to perform a diagnostic or therapeutic procedure in the interior body region. The interface generates a first display comprising an image of the structure at least partially while the operative element performs the procedure. The interface also generates a second display comprising one or more data fields reflecting the operating condition of the controller. The interface enables selection of the first display or the second display for viewing on a display screen.

ADAPTIVE STAGED WAKE-UP FOR IMPLANTABLE MEDICAL DEVICE COMMUNICATION

A communication wake-up scheme for an implantable medical device may involve repeatedly activating a receiver to determine whether an external device is attempting to establish communication with the implantable device. To reduce the amount of power consumed by the implantable device in conjunction with the wake-up scheme, the scheme may involve conducting preliminary RF signal detections as a precursor to conducting a full scan. In this way, power may be conserved since the more power intensive full scans may be performed less frequently. This preliminary detection of RF signals also may be adapted to reduce the number of full scans performed by the implantable device that do not result in communication with the external device. In some embodiments the adaptation involves adjusting one or more thresholds that are used in conjunction with the preliminary detection of RF signals. In some embodiments a wake-up scheme may involve scanning for signals using an initial RF band that is relatively ...

Orientation determination based on temperature measurements

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

SYSTEMS, DEVICES AND METHODS FOR TREATING LUNG TUMOR

A method to treat a human patient including: advancing a catheter through a natural airway of the patient and positioning a distal portion of the catheter in the natural airway of a lung of the patient to a target region in the lung, injecting a conductive hypertonic saline solution having a concentration of at least 5% of sodium chloride by weight/volume from the distal portion of the catheter into the target region; delivering energy from the distal portion into the hypertonic saline solution in the target region, wherein the energy heats the hypertonic saline solution in the target region; ablating the target region with the heated conductive hypertonic saline solution, sensing electric impedance or electric conductivity of the target region during the delivery of the energy, and controlling the rate or a bolus of the hypertonic saline solution injected into the target region based on the electric impedance or the electric conductivity.

Methods of determining catheter orientation

Systems, devices and methods of determining orientation of a distal end of a medical instrument (e.g., electrode-tissue orientation of an RF ablation catheter) are described herein. One or more processors may be configured to receive temperature measurements from each of a plurality of temperature-measurement devices distributed along a length of the distal end of the medical instrument and determine the orientation from a group of two or more possible orientation options based on whether temperature measurement values or characteristics of temperature response determined from the temperature measurement values satisfy one or more orientation criteria.

Systems and methods for navigation based on ordered sensor records

A method of tracking a medical instrument comprises receiving a model of an anatomical passageway formation and receiving a set of ordered sensor records for the medical instrument. The set of ordered sensor records provide a path history of the medical instrument. The method further comprises registering the medical instrument with the model of the anatomical passageway formation based on the path history.

STEERABLE FLEXIBLE NEEDLE WITH EMBEDDED SHAPE SENSING

A minimally invasive system comprises an elongate medical instrument including a flexible body. The flexible body includes a wall including a channel, and the channel includes a groove. The flexible body further includes a lumen defined by an interior surface of the wall and a curved distal tip portion. The elongate medical instrument further includes a shape sensor coupled to the flexible body. The shape sensor is at least partially positioned within the groove, and the shape sensor is configured to detect shape characteristics of at least a portion of the flexible body. The system further includes an actuator for manipulating the elongate medical instrument.

Catheter with sensor tip and method of use of same

An apparatus and method for catheter-based sensing and injection at a target site within a patient's body. An injection catheter is equipped with electrodes at its distal end which contact the surface of a target site, such as an AV node of the heart. Electrical signals detected at the target site by the electrodes are fed via leads to the proximal end of the catheter, where they are received by a monitor, such as an EKG monitor. If the electrical signals satisfy predetermined criteria, a needle within the catheter is extended into the target site, and a therapeutic agent is injected into the target site.

Devices and methods for treating lung tumors

An ablation catheter configured to ablate tissue in a lung of a patient including: a flexible shaft that advances endobronchially into an airway of the lung and has an outer diameter of 2.0 mm or less; an ablation electrode attached to a distal portion of the flexible shaft and to deliver radiofrequency (RF) electrical current to the tissue and conductively connectable to an RF electrical energy source external to the patient; wherein an outer diameter of an assembly of the flexible shaft and the ablation electrode is no greater than 2.0 mm; a liquid outlet on the distal portion and configured to be in fluid communication with a source of hypertonic saline solution; and a first occluder attached to the flexible shaft proximal to the ablation electrode and proximal to the liquid outlet, wherein the first occluder is configured to expand to occlude the airway.

Interactive systems and methods for controlling the use of diagnostic or therapeutic instruments in interior body regions

An interface is associated with a structure which, in use, is deployed in an interior body region of a patient. The structure includes an operative element coupled to a controller, which establishes an operating condition for the operative element to perform a diagnostic or therapeutic procedure in the interior body region. The interface generates a first display comprising an image of the structure at least partially while the operative element performs the procedure. The interface also generates a second display comprising one or more data fields reflecting the operating condition of the controller. The interface enables selection of the first display or the second display for viewing on a display screen.

METHODS AND SYSTEMS FOR ENHANCED MAPPING OF TISSUE

According to some embodiments, methods and systems of enhancing a map of a targeted anatomical region comprise receiving mapping data from a plurality of mapping electrodes, receiving high-resolution mapping data from a high-resolution roving electrode configured to be moved to locations between the plurality of mapping electrodes, wherein the mapping system is configured to supplement, enhance or refine a map of the targeted anatomical region or to directly create a high-resolution three-dimensional map using the processor receiving the data obtained from the plurality of mapping electrodes and from the high-resolution roving electrode.

System for recording use of structures deployed in association with heart tissue

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.

METHODS OF DETERMINING CATHETER ORIENTATION

Systems, devices and methods of determining orientation of a distal end of a medical instrument (e.g., electrode-tissue orientation of an RF ablation catheter) are described herein. One or more processors may be configured to receive temperature measurements from each of a plurality of temperature-measurement devices distributed along a length of the distal end of the medical instrument and determine the orientation from a group of two or more possible orientation options based on whether temperature measurement values or characteristics of temperature response determined from the temperature measurement values satisfy one or more orientation criteria. 1. A method of determining an orientation of a distal end of an ablation catheter with respect to a target region , the method comprising:receiving signals indicative of temperature from a plurality of temperature sensors distributed along a distal end of an ablation catheter at a first plurality of time points in a first period of time;determining temperature measurement values at each of the first plurality of time points for each of the plurality of temperature sensors;calculating a starting temperature value for each of the plurality of temperature sensors based on the determined temperature measurement values;receiving signals indicative of temperature from the plurality of temperature sensors at a second plurality of time points in a second period of time after the first period of time;determining temperature measurement values at each of the second plurality of time points for each of the plurality of temperature sensors;calculating a rate of change between the determined temperature values at each of the second plurality of time points and a starting temperature value for each of the plurality of temperature sensors; andat each time point of the second plurality of time points, determining an orientation of the distal end of the ablation catheter relative to a target surface based on a comparison of the ...

Ultrasound-guided ablation catheter and methods of use

The present invention provides ultrasound-guided ablation catheters and methods for their use. In one embodiment, a tissue ablation apparatus (2) includes a flexible elongate body (12) having proximal (14) and distal (12) ends. A plurality of spaced-apart electrodes (24) are operably attached to the flexible body near the distal end. A plurality of transducer elements (28) are disposed between at least some of the electrodes. Transducers assist the physician in determining whether or not the ablation elements are in contact with the tissue to be ablated.

Analyzing circadian variations of a hemodynamic parameter to determine an adverse cardiac condition

A system and method of determining the status of an adverse cardiac condition of a medical patient based on circadian variation of one or more hemodynamic parameters are provided. In some embodiments, the system and method calculate a first average value of a series of first values during a first time period, a second average value of a series of second values during a second time period, and a difference between the first average value and the second average value. The method provides an indication of an adverse cardiac condition when the difference is less than a predetermined threshold.

Methods and devices for endovascular ablation of a splanchnic nerve

Systems, devices, and methods for transvascular ablation of target tissue are disclosed herein. The devices and methods may, in some examples, be used for splanchnic nerve ablation to increase splanchnic venous blood capacitance to treat at least one of heart failure and hypertension. For example, the devices disclosed herein may be advanced endovascularly to a target vessel in the region of a thoracic splanchnic nerve (TSN), such as a greater splanchnic nerve (GSN) or a TSN nerve root. Also disclosed are method of treating heart failure, such as HFpEF, by endovascularly ablating a thoracic splanchnic nerve to increase venous capacitance and reduce pulmonary blood pressure.

3-D catheter localization using permanent magnets with asymmetrical properties about their longitudinal axis

The present invention provides systems and methods for localizing a catheter. One or more permanent magnets are mounted to a catheter. The permanent magnet(s) generate a magnetic field that is asymmetrical about the longitudinal axis of the catheter. One or more magnetic sensors are used to sense the magnetic field. Processing circuitry is configured for determining the roll of the catheter based on the sensed magnetic field. The processing circuitry can also determine the positional coordinates and/or the pitch and yaw of the catheter based on this sensed magnetic field.

Systems and methods for acquiring making time-sequential measurements of biopotentials sensed in myocardial tissue

Systems and methods for generating a composite signal derived from biopotentials sensed in myocardial tissue are disclosed and described. One such method includes inputting a first set of signals comprising biopotentials sensed at a first group of tissue sites during a first time interval; inputting a second set of signals comprising biopotentials sensed at a second group of tissue sites during a second time interval sequentially after the first time interval, wherein at least one of the biopotentials sensed as part of the first set of signals is not sensed as part of the second set of signals, and at least one of the biopotentials sensed as part of the second set of signals is not sensed as part of the first set of signals; and time aligning the first and second sets of signals using biopotentials sensed at the same site as part of both the first and second sets of signals, thereby generating the composite signal arranged for analysis as if all biopotentials were sensed during a common ...

Ablation and imaging catheter

A catheter for ablating and imaging tissue includes a porous electrode structure comprising an interior region for receiving a conductive medium, an elongate tube having a distal tube end that extends within the interior region, and an ultrasonic transducer assembly housed within the distal tube end.

Ablation systems with multiple temperature sensors

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

METHODS OF DETERMINING CATHETER ORIENTATION

Systems, devices and methods of determining orientation of a distal end of a medical instrument (e.g., electrode-tissue orientation of an RF ablation catheter) are described herein. One or more processors may be configured to receive temperature measurements from each of a plurality of temperature-measurement devices distributed along a length of the distal end of the medical instrument and determine the orientation from a group of two or more possible orientation options based on whether temperature measurement values or characteristics of temperature response determined from the temperature measurement values satisfy one or more orientation criteria. 1. A method of determining an orientation of a distal end of an ablation catheter with respect to a target region , the method comprising:receiving signals indicative of temperature from a plurality of temperature sensors distributed along a distal end of an ablation catheter at a plurality of time points over a period of time;determining temperature measurement values at each of the plurality of time points for each of the plurality of temperature sensors;calculating a rate of change between the determined temperature values at each of the plurality of time points and a starting temperature value for each of the plurality of temperature sensors;at each time point of the plurality of time points, determining an orientation of the distal end of the ablation catheter relative to a target surface based on a comparison of the calculated rate of change of at least two of the plurality of temperature sensors.2. The method of claim 1 , wherein determining temperature measurement values at each of the plurality of time points for each of the plurality of temperature sensors comprises calculating a moving average value at each of the plurality of time points based on a current temperature measurement value and one or more previous temperature measurement values.3. The method of claim 2 , wherein calculating the rate of change ...

Method and apparatus to automatically insert a probe into a cornea

An apparatus that is used to perform a medical procedure on a cornea. The apparatus may include a ring that can be placed on a cornea and a probe that can deliver energy to denature corneal tissue. The probe can be moved about the ring and cornea by a first actuator. A second actuator may move the probe into contact with the cornea to deliver energy and denature tissue. The process of moving the probe and delivering energy can be repeated to create a circular pattern of denatured areas. The circular pattern of denatured areas may correct for hyperopia. The actuators may be controlled by a controller that operates in accordance with a program to move the probe and create the circular pattern of denatured areas in an automated process.

Expandable-collapsible electrode structures made of electrically conductive material

Electrode assemblies and associated systems employ a nonporous wall having an exterior for contacting tissue. The exterior peripherally surrounds an interior area. The wall is essentially free of electrically conductive material. The wall is adapted to assume an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. The assemblies and systems include a lumen that conveys a medium containing ions into the interior area. An element free of physical contact with the wall couples the medium within the interior area to a source of electrical energy to enable ionic transport of electrical energy from the source through the medium to the wall for capacitive coupling to tissue contacting the exterior of the wall.

Adaptable communication sensitivity for an implantable medical device

A wireless communication threshold for an implantable medical device is automatically adapted in an attempt to maintain optimum signal detection sensitivity. In some aspects, a threshold level may be adapted to account for current environmental conditions, implant conditions, device conditions, or other conditions that may affect the reception of wireless signals at the device. In some aspects, the determination of an optimum level for the threshold involves a tradeoff relating to effectively detecting target signals while avoiding detection of noise and/or interference. In some aspects, adaptation of a threshold may be based on maximum energy levels associated with one or more sets of RF energy sample data. In some aspects, adaptation of a threshold may be based on the number of false wakeups that occur during a period of time.

Multi-functional medical catheter and methods of use

The present invention provides multi-functional medical catheters, systems and methods for their use. In one particular embodiment, a medical catheter ( 100 ) includes a flexible elongate body ( 105 ) having a proximal end ( 110 ) and a distal end ( 120 ). A plurality of spaced apart electrodes ( 130-136 ) are operably attached to the flexible body near the distal end. At least some of the electrodes are adapted for mapping a tissue and, in some embodiments, at least one of the electrodes is adapted for ablating a desired portion of the tissue. The catheter includes a plurality of tissue orientation detectors ( 140-146 ) disposed between at least some of the electrodes. In this manner, the medical catheter is capable of tissue mapping, tissue imaging, tissue orientation, and/or tissue treatment functions.

SYSTEMS AND METHODS FOR NAVIGATION BASED ON ORDERED SENSOR RECORDS

A method performed by a computing system comprises receiving a first set of spatial information from an instrument positioned within an anatomic passageway. The first set of spatial information includes a plurality of spatial data records including position information for a distal end of the instrument at a plurality of time periods. The method further comprises ordering the plurality of spatial data records in a time-gathered order. The method further comprises evaluating a spatial relationship between first and second consecutive spatial data records of the plurality of spatial data records. The method further comprises filtering the first set of spatial information based upon the evaluated spatial relationship.

Systems and methods for interventional procedure planning

A system for performing an interventional procedure includes an interventional instrument and a control system. The instrument includes a catheter and an interventional tool extendable from the catheter. The control system includes a processor and a memory comprising machine-readable instructions that cause the control system to: receive a model of an anatomic structure, the anatomic structure including a plurality of passageways; identify a target structure in the model; receive information about a maximum extension length the interventional tool can be extended relative to a distal tip of the catheter; based upon the received information about the maximum extension length, identify a planned deployment location for positioning the distal tip of the catheter to perform the interventional procedure on the target structure; determine a navigational path for the catheter to the target structure; and navigate the catheter to the identified planned deployment location via computer control or ...

SYSTEMS AND METHODS FOR FACILITATING CONSISTENT RADIOMETRIC TISSUE CONTACT DETECTION INDEPENDENT OF ORIENTATION

According to some embodiments, systems for facilitating consistent radiometric tissue contact detection independent of orientation comprise a medical instrument having an antenna positioned at a distal end, an energy delivery element positioned at a distal end of the medical instrument, a radiometer, an impedance transformation network positioned between the antenna and the radiometer, and a processor configured to receive an input signal from the radiometer and provide an output indicative of an amount of tissue contact based upon the input signal. The impedance transformation network may be tuned to provide a substantially uniform radiometric response independent of an orientation of the antenna with respect to the tissue as the antenna is brought into contact with the tissue of a subject. 112.-. (canceled)13. A system for facilitating determination of contact of a distal tip of a medical instrument with tissue of a subject comprising:a connector configured to couple to a medical instrument having an antenna, a radiometer and an impedance transformation network positioned between the antenna and the radiometer, wherein the impedance transformation network is tuned to provide a substantially uniform radiometric response independent of an orientation of the antenna with respect to the tissue as the antenna is brought into contact with the tissue of a subject; anda processor configured to receive an input signal from the radiometer and provide an output indicative of an amount of tissue contact based upon said input signal.14. The system of claim 13 , wherein the output comprises an apparent temperature change.15. The system of claim 13 , wherein the processor is configured to operate in (i) a contact sensing phase to determine whether an ablation element is in contact with the tissue prior to delivery of ablative energy and (ii) an energy delivery phase upon determination of contact during the contact sensing phase claim 13 , and wherein a gain of the radiometer ...

System and Method for Estimating Cardiac Pressure Based on Cardiac Electrical Conduction Delays Using an Implantable Medical Device

Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom.

Systems and Methods of Radiometrically Determining a Hot-Spot Temperature of Tissue Being Treated

According to some embodiments, systems for energy delivery to targeted tissue comprise a catheter with an ablation member, a radiometer configured to detect temperature data from the targeted tissue, a processor configured to determine a calculated temperature (e.g., an extreme temperature, such as a peak or trough temperature) within the tissue by applying at least one factor to the temperature data detected by the radiometer, the processor configured to compare the calculated temperature to a setpoint and an energy source configured to energize the ablation member and to regulate delivery of ablative energy to the targeted tissue of the subject based at least in part on the comparison. In some embodiments, the factor depends on at least one characteristic of the targeted tissue. Information regarding a tissue characteristic can be provided using information from an imaging set (e.g., intracardiac echo) or an electrical signal of the subject (e.g., electrocardiogram). 1. A system for energy delivery to a targeted tissue of a subject , comprising:a catheter comprising a radiofrequency electrode;a radiometer configured to detect temperature data from the targeted tissue;a processor configured to determine a calculated temperature within the targeted tissue by applying at least one scaling factor to the temperature data detected by the radiometer, the processor being configured to compare the calculated temperature to a setpoint temperature; andan energy source configured to energize the radiofrequency electrode and regulate delivery of ablative energy to the targeted tissue of the subject based at least in part on a comparison between the calculated temperature and the setpoint temperature.2. The system of claim 1 , wherein the calculated temperature relates to a peak temperature within the targeted tissue.3. The system of claim 1 , wherein the at least one scaling factor comprises an estimation factor claim 1 , the estimation factor depending on claim 1 , at least ...

Tissue characterization using intracardiac impedances with an implantable lead system

An implantable system acquires intracardiac impedance with an implantable lead system. In one implementation, the system generates frequency-rich, low energy, multi-phasic waveforms that provide a net-zero charge and a net-zero voltage. When applied to bodily tissues, current pulses or voltage pulses having the multi-phasic waveform provide increased specificity and sensitivity in probing tissue. The effects of the applied pulses are sensed as a corresponding waveform. The waveforms of the applied and sensed pulses can be integrated to obtain corresponding area values that represent the current and voltage across a spectrum of frequencies. These areas can be compared to obtain a reliable impedance value for the tissue. Frequency response, phase delay, and response to modulated pulse width can also be measured to determine a relative capacitance of the tissue, indicative of infarcted tissue, blood to tissue ratio, degree of edema, and other physiological parameters.

Electrode assembly with thermal shunt member

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

Tissue heating and ablation systems and methods which predict maximum tissue temperature

Systems and methods heat or ablate body tissue by positioning an electrode to transmit heat or ablation energy to a tissue region. The systems and methods measure a first temperature using a temperature sensing element associated with the electrode. The systems and methods also measure a second temperature using a temperature sensing element associated with the electrode. The systems and methods process at least one of the first and second temperatures to derive a prediction of maximum temperature of the tissue region. The systems and methods generate an output that controls the transmission of the heating or ablation energy based, at least in part, upon the maximum tissue temperature prediction.

Expandable-collapsible electrode structures made of electrically conductive material

Electrode assemblies and associated systems employ a nonporous wall having an exterior for contacting tissue. The exterior peripherally surrounds an interior area. The wall is essentially free of electrically conductive material. The wall is adapted to assume an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. The assemblies and systems include a lumen that conveys a medium containing ions into the interior area. An element free of physical contact with the wall couples the medium within the interior area to a source of electrical energy to enable ionic transport of electrical energy from the source through the medium to the wall for capacitive coupling to tissue contacting the exterior of the wall.

Ablation systems and methods using heat shunt networks

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

Systems and methods for examining the electrical characteristic of cardiac tissue

Systems and methods examine heart tissue morphology using three or more spaced apart electrodes, at least two of which are located within the heart in contact with endocardial tissue. The systems and methods transmit electrical current through a region of heart tissue lying between selected pairs of the electrodes, at least one of the electrodes in each pair being located within the heart. The systems and methods derive the electrical characteristic of tissue lying between the electrode pairs based, at least in part, upon sensing tissue impedances. The systems and methods make possible the use of multiple endocardial electrodes for taking multiple measurements of the electrical characteristics of heart tissue. Multiplexing can be used to facilitate data processing. The systems and methods also make possible the identification of regions of low relative electrical characteristics, indicative of infarcted tissue, without invasive surgical techniques.

SYSTEMS AND METHODS FOR HIGH-RESOLUTION MAPPING OF TISSUE

According to some embodiments, methods and systems of enhancing a map of a targeted anatomical region comprise receiving mapping data from a plurality of mapping electrodes, receiving high-resolution mapping data from a high-resolution roving electrode configured to be moved to locations between the plurality of mapping electrodes, wherein the mapping system is configured to supplement, enhance or refine a map of the targeted anatomical region or to directly create a high-resolution three-dimensional map using the processor receiving the data obtained from the plurality of mapping electrodes and from the high-resolution roving electrode. 1. A device for high-resolution mapping and ablating targeted tissue of subject , comprising:an elongate body comprising a proximal end and a distal end;a first high-resolution electrode portion positioned on the elongate body;at least a second electrode portion positioned adjacent the first electrode portion, the first and second electrode portions being configured to contact tissue of a subject and deliver radiofrequency energy sufficient to at least partially ablate the tissue; andat least one electrically insulating gap positioned between the first electrode portion and the second electrode portion, the at least one electrically insulating gap comprising a gap width separating the first and second electrode portions;wherein the device is configured to be positioned within targeted tissue of the subject to obtain high-resolution mapping data related to said tissue when ablative energy is not being delivered via the first and second electrode portions; andwherein the device is used as a roving device in conjunction with a separate mapping device or system to provide mapping data in tissue regions not adequately covered by said separate mapping device or system, wherein the separate mapping device or system comprises a plurality of mapping electrodes.2. The device of :wherein the first electrode portion is configured to ...

System and method for estimating cardiac pressure using parameters derived from impedance signals detected by an implantable medical device

Techniques are provided for estimating left atrial pressure (LAP) or other cardiac pressure parameters based on various parameters derived from impedance signals. In particular, effective LAP is estimated based on one or more of: electrical conductance values, cardiogenic pulse amplitudes, circadian rhythm pulse amplitudes, or signal morphology fractionation values, each derived from the impedance signals detected by the implantable device. Predetermined conversion factors stored within the device are used to convert the various parameters derived from the electrical impedance signal into LAP values or other appropriate cardiac pressure values. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself.

Catheter with sensor tips, tool and device and methods of use of same

An apparatus and method for catheter-based sensing and injection at a target site within a patient's body. An injection catheter is equipped with a electrodes at its distal end which contact the surface of a target site, such as an AV node of the heart. Electrical signals detected at the target site by the electrodes are fed via leads to the proximal end of the catheter, where they are received by a monitor, such as an EKG monitor. If the electrical signals satisfy predetermined criteria, a needle within the catheter is extended into the target site, and a therapeutic agent is injected into the target site.

Tissue characterization using intracardiac impedances with an implantable lead system

An implantable system acquires intracardiac impedance with an implantable lead system. In one implementation, the system generates frequency-rich, low energy, multi-phasic waveforms that provide a net-zero charge and a net-zero voltage. When applied to bodily tissues, current pulses or voltage pulses having the multi-phasic waveform provide increased specificity and sensitivity in probing tissue. The effects of the applied pulses are sensed as a corresponding waveform. The waveforms of the applied and sensed pulses can be integrated to obtain corresponding area values that represent the current and voltage across a spectrum of frequencies. These areas can be compared to obtain a reliable impedance value for the tissue. Frequency response, phase delay, and response to modulated pulse width can also be measured to determine a relative capacitance of the tissue, indicative of infarcted tissue, blood to tissue ratio, degree of edema, and other physiological parameters.

SYSTEMS AND METHODS FOR GUIDING CATHETERS USING REGISTERED IMAGES

Systems and methods for imaging a body cavity and for guiding a treatment element within a body cavity are provided. A system may include an imaging subsystem having an imaging device and an image processor that gather image data for the body cavity. A mapping subsystem may be provided, including a mapping device and a map processor, to identify target sites within the body cavity, and provide location data for the sites. The system may also include a location processor coupled to a location element on a treatment device to track the location of the location element. The location of a treatment element is determined by reference to the location element. A treatment subsystem including a treatment device having a treatment element and a treatment delivery source may also be provided. A registration subsystem receives and registers data from the other subsystems, and displays the data. 1111.-. (canceled)112. A system for navigating within a body cavity of a patient , comprising:an imaging subsystem comprising an imaging device configured for generating image data of the body cavity;a probe configured to be moved within the body cavity; anda three-dimensional coordinate registration subsystem configured for registering the image data and the location of the probe within a three-dimensional coordinate system.113. The system of claim 112 , wherein the probe comprises a treatment device having a treatment element claim 112 , the system further comprising a treatment delivery subsystem comprising the treatment device and a treatment delivery source coupled to the treatment element.114. The system of claim 112 , wherein the probe comprises a mapping device configured for generating mapping data claim 112 , the system further comprising a mapping subsystem comprising the mapping device claim 112 , wherein the registration subsystem is further configured for registering the mapping data within the three-dimensional coordinate system.115. The system of claim 112 , further ...

System and methods for serial analysis of electrocardiograms

Systems and methods for serial analysis of electrocardiograms are presented, wherein serial electrocardiographic (ECG) assessment is incorporated with three-dimensional vectorial analysis of the cardiac electrical signal, using changes in novel 3D-based vectorial markers over time to improve diagnostic sensitivity for acute coronary syndromes (ACS), and improve differentiation of ACS from the broad range of heart diseases that resemble ACS on ECG. 1. A method for detecting a first cardiac condition , comprising:a. providing a first quantity of 12-lead ECG data, and at least a second quantity of 12-lead ECG data from a patient;b. constructing a 3-D representation of cardiac activity from the first and second quantities of ECG data;c. computing values for one or more parameters based upon at least one of said 3-D representation of cardiac activity from the first quantity of ECG data;c. computing values for said one or more parameters based upon at least one of said 3-D representation of cardiac activity from the second quantity of ECG data;d. calculating a difference in said one or more parameters between the first quantity of ECG data and the second quantity of ECG data;e. conducting an analysis of said calculated differences in said one or more parameters;f. forming one or more conclusions regarding the cardiac condition of a patient based upon the analysis of said calculated differences in one or more parameters;g. providing feedback to a healthcare provider regarding said conclusions2. The method of claim 1 , wherein said differences in one or more parameters are calculated as absolute values of said differences.3. The method of claim 1 , further comprising applying a multifactorial analysis protocol utilizing at least one of the values of the one or more parameters; and automatically drawing one or more conclusions regarding a first cardiac condition of the patient based at least in part upon the output of the multifactorial analysis protocol.4. The method of ...

SYSTEM AND METHOD FOR ESTIMATING ELECTRICAL CONDUCTION DELAYS FROM IMMITTANCE VALUES MEASURED USING AN IMPLANTABLE MEDICAL DEVICE

Techniques are provided for estimating electrical conduction delays with the heart of a patient based on measured immittance values. In one example, impedance or admittance values are measured within the heart of a patient by a pacemaker or other implantable medical device, then used by the device to estimate cardiac electrical conduction delays. A first set of predetermined conversion factors may be used to convert the measured immittance values into conduction delay values. In some examples, the device then uses the estimated conduction delay values to estimate LAP or other cardiac pressure values. A second set of predetermined conversion factors may be used to convert the estimated conduction delays into pressure values. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP. 1. A system for estimating cardiac pressure within a patient using an implantable medical device , the system comprising:an immittance detection system operative to detect a value representative of electrical immittance within the heart of the patient; andan immittance-based electrical conduction delay estimation unit operative to estimate an electrical conduction delay in the heart of the patient from the value representative of immittance.2. The system of further including a conduction delay-based cardiac pressure estimation unit operative to estimate cardiac pressure within the patient from the estimated electrical conduction delay. This application is a Divisional application of and claims priority and other benefits from U.S. patent application Ser. No. 12/127,963 (Attorney Docket No. A08P3008), filed May 28, 2008, entitled “SYSTEM AND METHOD FOR ESTIMATING ELECTRICAL CONDUCTION DELAYS FROM IMMITTANCE VALUES MEASURED USING AN IMPLANTABLE MEDICAL DEVICE”, incorporated herein by reference in its entirety.This application claims priority on U.S. patent application Ser. No. 11/779,350, of Wenzel et al., filed Jul. 18, 2007, entitled, “System and ...

Systems and Methods for Navigation Based on Ordered Sensor Records

A method of tracking a medical instrument comprises receiving a model of an anatomical passageway formation and receiving a set of ordered sensor records for the medical instrument. The set of ordered sensor records provide a path history of the medical instrument. The method further comprises registering the medical instrument with the model of the anatomical passageway formation based on the path history. 1. A method of tracking a medical instrument , the method comprising:receiving a model of an anatomical passageway formation;receiving a set of ordered sensor records for the medical instrument, the set providing a path history of the medical instrument; andregistering the medical instrument with the model of the anatomical passageway formation based on the path history.2. The method of further comprising determining a relationship between a first sensor record of the set of ordered sensor records claim 1 , a second sensor record of the set of ordered sensor records claim 1 , a first candidate match point defined within the model of the anatomical passageway claim 1 , and a second candidate match point defined within the model of the anatomical passageway.3. The method of wherein determining the relationship includes determining a transition probability between the first and second candidate match points.4. The method of further comprising tracking the movement of the medical instrument relative to the model of the anatomical passageway formation.5. The method of wherein the set of ordered sensor records include a set of temporally ordered sensor records.6. The method of wherein the set of ordered sensor records include a set of spatially ordered sensor records.7. The method of wherein receiving the model of the anatomical passageway formation includes receiving the model formed from a set of three-dimensional volumetric images.8. The method of wherein receiving a set of ordered sensor records includes receiving the set from an electromagnetic sensor coupled to ...

ELECTROMAGNETIC TIP SENSOR

A medical instrument having a distal tip through which a lumen extends can employ an electromagnetic sensor including a coil that is in the distal tip and winds around the lumen or a coil that is in the distal tip and defines an area having a normal direction that is perpendicular to an instrument axis that extends along the lumen. Three coils can be oriented so that normal directions of the areas defined by the coils are along three orthogonal axes. 1. A medical instrument comprising:a main tube having a distal tip through which a lumen of the main tube extends; andan electromagnetic sensor including a first coil that is in the distal tip and defines a first area through which the lumen passes.2. The instrument of claim 1 , wherein the first area has a first normal direction that is parallel to a central axis of the lumen.3. The instrument of claim 1 , wherein the first area has a first normal direction that is at a non-zero angle to a central axis of the lumen.4. The instrument of claim 1 , wherein the electromagnetic sensor further comprises a second coil that is in the distal tip and defines a second area through which the lumen passes.5. The instrument of claim 4 , wherein the first area has a first normal direction claim 4 , and the second area has a second normal direction that is at a non-zero angle to the first normal direction.6. The instrument of claim 5 , wherein the first normal direction is perpendicular to the second normal direction.7. The instrument of claim 1 , wherein the electromagnetic sensor further comprises a second coil that is in the distal tip and defines a second area through which a first radial axis of the instrument extends.8. The instrument of claim 7 , wherein the second area has a normal direction that is perpendicular to an instrument axis that extends along the lumen.9. The instrument of claim 7 , wherein the electromagnetic sensor further comprises a third coil that is in the distal tip and defines a third area through which a ...

ELECTROCARDIOGRAM PATCH DEVICES AND METHODS

Methods and apparatuses, including devices and systems, for remote and detection and/or diagnosis of acute myocardial infarction (AMI). In particular, described herein are handheld and adhesive devices having an electrode configuration capable of recording three orthogonal ECG lead signals in an orientation-specific manner, and transmitting these signals to a processor. The processor may be remote or local, and it may automatically or semi-automatically detect AMI, atrial fibrillation or other heart disorders based on the analyses of the deviation of the recorded 3 cardiac signals with respect to previously stored baseline recordings. 1. A method , the method comprising:adhesively attaching a patch on a patient's chest so that a first electrode and a second electrode integrated on a back of the patch measure bioelectric signals from the patient's chest, wherein the first and second electrodes are positioned a distance of at least 5 cm apart;acquiring a baseline electrocardiogram (ECG) shortly after adhesively attaching the patch to the patient's chest when the patient contacts a third electrode on the patch with a finger of a first hand and a fourth electrode on the patch with a finger of a second hand, wherein the baseline ECG comprises three orthogonal, or quasi-orthogonal, leads generated from the first, second third and fourth electrodes; andupdating the baseline ECG over one or more subsequent days when the patient contacts the third electrode on the patch with the finger of the first hand and the fourth electrode on the patch with the finger of a second hand when the patient indicates, on the patch, that symptoms are not present, wherein the baseline ECG recording comprises three orthogonal, or quasi-orthogonal, leads generated from the first, second third and fourth electrodes.2. The method of claim 1 , further comprising storing the baseline ECG.3. The method of claim 1 , further comprising recording a symptomatic ECG when the patient indicates claim 1 , on ...

SYSTEMS, DEVICES AND METHODS FOR TREATING LUNG TUMORS

A system for treatment of a target region of lung tissue including: a flow regulator configured to be interposed between a conductive fluid source and a conductive fluid outlet positionable at or in proximity of the target region of lung tissue, the flow regulator being further configured for controlling a flow rate or a bolus quantity of conductive fluid coming from the fluid source and delivered to the conductive fluid outlet; and a controller communicatively connectable with said flow regulator and with at least one sensor, with the at least one sensor being configured for detecting values taken by at least one control parameter representative of a physical property, wherein the physical property is one of temperature (T), pressure (p), electric impedance (Z), or electric conductivity (C) of material present at or in proximity of the target region of lung tissue. 1. A system for treatment of a target region of lung tissue , the system comprising:a flow regulator configured to be interposed between a conductive fluid source and a conductive fluid outlet positionable at or in proximity of the target region of lung tissue, the flow regulator being further configured to control a flow rate or a bolus quantity of the conductive fluid coming from the fluid source and delivered to the conductive fluid outlet;a controller configured to control the flow regulator and configured to receive values detected by a sensor, wherein the sensor detects values of a control parameter representative of a physical property which is at least one of: temperature (T), pressure (P), electric impedance (Z), and electric conductivity (C) of material present at or in proximity of the target region of lung tissue;wherein the controller is configured to:receive one or more of the values of the control parameter; controlling the flow regulator in a high delivery mode in which the flow rate of the conductive fluid delivered to the conductive-fluid outlet is no less than a set high flow rate, or ...

SYSTEM AND METHOD FOR ESTIMATING CARDIAC PRESSURE BASED ON CARDIAC ELECTRICAL CONDUCTION DELAYS USING AN IMPLANTABLE MEDICAL DEVICE

Techniques are provided for estimating left atrial pressure (LAP) or other cardiac performance parameters based on measured conduction delays. In particular, LAP is estimated based interventricular conduction delays. Predetermined conversion factors stored within the device are used to convert the various the conduction delays into LAP values or other appropriate cardiac performance parameters. The conversion factors may be, for example, slope and baseline values derived during an initial calibration procedure performed by an external system, such as an external programmer. In some examples, the slope and baseline values may be periodically re-calibrated by the implantable device itself. Techniques are also described for adaptively adjusting pacing parameters based on estimated LAP or other cardiac performance parameters. Still further, techniques are described for estimating conduction delays based on impedance or admittance values and for tracking heart failure therefrom. 1. A method for calibrating a cardiac pressure estimation system of an implantable medical device for implant within a patient , the method comprising:{'sub': 1', '1, 'detecting a first cardiac pressure value (Pressure) and a first calibration value (D) while the patient is at rest, the first calibration value being a detected conduction delay within the heart of the patient;'}{'sub': 2', '2, 'detecting a second cardiac pressure value (Pressure) and a second calibration value (D) while the patient is subject to a condition significantly affecting cardiac pressure within the patient, the second calibration value also being a detected conduction delay within the heart of the patient;'}{'sub': 1', '2', '1', '2, 'determining conversion factors for converting additional detected conduction delays into cardiac pressure estimates based on the first and second cardiac pressure values (Pressure, Pressure) and the first and second calibration values (D, D); and'}transmitting the conversion factors to the ...

SURGICAL SYSTEM WITH HAPTIC FEEDBACK BASED UPON QUANTITATIVE THREE-DIMENSIONAL IMAGING

A system is provided to provide haptic feedback during a medical procedure comprising: a quantitative three-dimensional (Q3D); a surgical instrument disposed to deform a tissue structure; a haptic user interface device configured to provide an indication of tissue structure deformation in response to information indicative of the measure of tissue structure deformation; and a processor configured to produce a Q3D model that includes information indicative of a measure of tissue structure deformation and to provide the information indicative of the measure of tissue structure deformation to the haptic user interface device. 1. A method to provide haptic feedback during a medical procedure comprising:moving a surgical instrument across a surface of a tissue structure to impart a force to deform different tissue surface locations of the tissue structure;capturing image information indicative of deformation distances of the different tissue surface locations of the tissue structure;producing in a non-transitory memory device a quantitative three dimensional (Q3D) model that provides a map of measures of tissue structure deformation for the contact between the surgical instrument and the tissue surface at the different locations of the tissue structure, based upon the captured image information; andproducing haptic feedback indicative of the map of the measures of tissue structure deformation at the contact locations of the surface of the tissue structure.2. The method of claim 1 ,wherein capturing the image information includes positioning a Q3D endoscope, having an imaging sensor array comprising at least three coplanar imaging sensors having coplanar overlapping fields of view, to capture the different tissue surface locations of the tissue structure within the overlapping fields of view.3. The method of claim 1 ,wherein producing the haptic feedback includes producing a shape display indicative of the map of the measures of tissue structure deformation at the contact ...

METHODS OF REMOVING HEAT FROM AN ELECTRODE USING THERMAL SHUNTING

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 1. (canceled)2. A method of heat removal from an electrode assembly during a tissue treatment procedure , the method comprising:delivering energy to an electrode assembly of an ablation system, the ablation system comprising a catheter comprising a distal end, the electrode assembly positioned along the distal end of the catheter;wherein the catheter of the ablation system comprises at least one thermal shunt member along its distal end,wherein the at least one thermal shunt member extends at least partially through an interior of the electrode assembly; andwherein the catheter further comprises at least one fluid passage extending at least partially through the interior of the electrode assembly and an interior of the at least one thermal shunt member;delivering a fluid through the at least one fluid passage; andtransferring heat from the electrode assembly to the fluid via the at least one thermal shunt member to reduce the likelihood of localized hot spots along the distal end of the catheter.3. The method of claim 2 ,{'sup': '2', 'wherein the at least one thermal shunt member is configured to transfer heat while not retaining heat, and wherein the at least one thermal shunt member comprises a thermal diffusivity greater than 1.5 cm/sec;'}wherein the electrode assembly ...

SYSTEMS FOR DETERMINING CATHETER ORIENTATION

Systems, devices and methods of determining orientation of a distal end of a medical instrument (e.g., electrode-tissue orientation of an RF ablation catheter) are described herein. One or more processors may be configured to receive temperature measurements from each of a plurality of temperature-measurement devices distributed along a length of the distal end of the medical instrument and determine the orientation from a group of two or more possible orientation options based on whether temperature measurement values or characteristics of temperature response determined from the temperature measurement values satisfy one or more orientation criteria. 1. A system for continuously determining an orientation of an ablation catheter with respect to a target region while energy is being applied during an ablation procedure , the system comprising:an ablation catheter comprising an elongate body having a first plurality of temperature-measurement devices positioned at a distal end of the elongate body and a second plurality of temperature-measurement devices spaced proximal to the first plurality of temperature-measurement devices and at least one electrode member positioned at the distal end of the elongate body;an energy source configured to apply ablative energy sufficient to ablate target tissue to the at least one electrode member of the ablation catheter; and obtain temperature measurements from each of the first plurality of temperature-measurement devices and each of the second plurality of temperature-measurement devices at a plurality of time points while the ablative energy is being applied by the energy source;', 'at each time point of the plurality of time points, determine a rate of change in temperature measurement values from a previous time point to a current time point for each of the first plurality of temperature-measurement devices and each of the second plurality of temperature-measurement devices from the obtained temperature measurements; and', ' ...

Ablation systems and methods using heat shunt networks

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

METHODS OF DETERMINING CATHETER ORIENTATION

Systems, devices and methods of determining orientation of a distal end of a medical instrument (e.g., electrode-tissue orientation of an RF ablation catheter) are described herein. One or more processors may be configured to receive temperature measurements from each of a plurality of temperature-measurement devices distributed along a length of the distal end of the medical instrument and determine the orientation from a group of two or more possible orientation options based on whether temperature measurement values or characteristics of temperature response determined from the temperature measurement values satisfy one or more orientation criteria. 1. A method of determining an orientation of a medical device configured to deliver energy with respect to a target region , the method comprising:a medical device having a plurality of temperature sensors;determining an initial temperature measurement value for each of the plurality of temperature sensors at a first plurality of time points during a first period of time;determining a temperature measurement value for each of the plurality of temperature sensors at a second plurality of time points during a second period of time; andcalculating a rate of change between the determined temperature values at each of the second plurality of time points and the initial temperature measurement value for each of the plurality of temperature sensors.2. The method of claim 1 , wherein calculating the rate of change between the determined temperature values at each of the second plurality of time points and the initial temperature measurement value for each of the plurality of temperature sensors includes:subtracting the initial temperature measurement values from a moving average value; anddividing by a time elapsed from the first period of time to the second period of time.3. The method of claim 2 , wherein the moving average value is determined based on the initial temperature measurement values and the determined ...

DEVICES AND METHODS FOR TREATING LUNG TUMORS

An ablation catheter configured to ablate tissue in a lung of a patient including: a flexible shaft that advances endobronchially into an airway of the lung and has an outer diameter of 2.0 mm or less; an ablation electrode attached to a distal portion of the flexible shaft and to deliver radiofrequency (RF) electrical current to the tissue and conductively connectable to an RF electrical energy source external to the patient; wherein an outer diameter of an assembly of the flexible shaft and the ablation electrode is no greater than 2.0 mm; a liquid outlet on the distal portion and configured to be in fluid communication with a source of hypertonic saline solution; and a first occluder attached to the flexible shaft proximal to the ablation electrode and proximal to the liquid outlet, wherein the first occluder is configured to expand to occlude the airway. 1. An ablation catheter configured to ablate tissue in a lung of a patient , the ablation catheter comprising:a flexible shaft configured to advance endobronchially into an airway of the lung;an ablation electrode attached to a distal portion of the flexible shaft and configured to deliver radiofrequency (RF) electrical current to the tissue, wherein the ablation electrode is conductively connectable to an RF electrical energy source external to the patient;a liquid outlet on the distal portion and configured to be in fluid communication with a source of a conductive liquid; anda first occluder attached to the flexible shaft proximal to the ablation electrode and proximal to the liquid outlet.2. The ablation catheter of claim 1 , wherein the occluder is a deployable balloon claim 1 , a deployable valve and/or a deployable stent.3. The ablation catheter of claim 1 , wherein the first occluder comprises a deployable balloon having a first cross section width of 1.5 to 30 mm claim 1 , and wherein the balloon is configured to expand to occlude the airway.4. The ablation catheter of claim 1 , wherein a distance along ...

METHODS AND SYSTEMS FOR ENHANCED MAPPING OF TISSUE

According to some embodiments, methods and systems of enhancing a map of a targeted anatomical region comprise receiving mapping data from a plurality of mapping electrodes, receiving high-resolution mapping data from a high-resolution roving electrode configured to be moved to locations between the plurality of mapping electrodes, wherein the mapping system is configured to supplement, enhance or refine a map of the targeted anatomical region or to directly create a high-resolution three-dimensional map using the processor receiving the data obtained from the plurality of mapping electrodes and from the high-resolution roving electrode. 1. A system for obtaining mapping data for a targeted anatomical tissue of a subject , the system comprising:a catheter comprising at least one high-resolution electrode configured to map tissue along the targeted anatomical tissue; anda data acquisition device configured to receive mapping data from the catheter;wherein the data acquisition device is configured to couple to a separate mapping device, the data acquisition device being configured to receive mapping data from the separate mapping device, wherein the separate mapping device comprises a plurality of mapping electrodes; anda processor configured to generate a three-dimensional map from the mapping data received from the catheter and the separate mapping device by the data acquisition device.2. The system of claim 1 , wherein the separate mapping system comprises at least one expandable member claim 1 , wherein at least some of the plurality of mapping electrodes are positioned along the at least one expandable member.3. The system of claim 1 , wherein the mapping data received from the separate mapping device comprise unipolar or bipolar signals.4. The system of claim 1 , wherein the processor is configured to align or synchronize mapping data obtained from the catheter and the separate mapping device.5. The system of claim 1 , wherein the processor is configured to ...

Systems and Methods For Interventional Procedure Planning

A method of deploying an interventional instrument is performed by a processing system. The method comprises receiving an image of an anatomic structure from an imaging probe. The image has an image frame of reference. The imaging probe is extendable distally beyond a distal end of a guide catheter. The distal end of the guide catheter has a catheter frame of reference. The method further includes receiving location data associated with a target structure identified in the image. The received location data is in the image frame of reference. The method further comprises transforming the location data associated with the target structure from the image frame of reference to the catheter frame of reference. 1. A method of deploying an interventional instrument , the method performed by a processing system , the method comprising:receiving an image of an anatomic structure from an imaging probe, the image having an image frame of reference, wherein the imaging probe is extendable distally beyond a distal end of a guide catheter, the distal end of the guide catheter having a catheter frame of reference;receiving location data associated with a target structure identified in the image, wherein the received location data is in the image frame of reference;transforming the location data associated with the target structure from the image frame of reference to the catheter frame of reference.2. The method of further comprising:registering the catheter frame of reference to a patient frame of reference andtransforming the location data associated with the target structure from the catheter frame of reference to the image frame of reference.3. The method of further comprising:receiving location data associated with the target structure identified in a patient model anddetermining an offset correction vector between the location data associated with the target structure identified in the image and the location data associated with the target structure identified in a patient ...

HIGH-RESOLUTION MAPPING OF TISSUE WITH PACING

According to some embodiments, a method of confirming successful ablation of targeted cardiac tissue of a subject using a high-resolution mapping electrode comprises pacing said cardiac tissue at a predetermined pacing level to increase the heart rate of the subject from a baseline level to an elevated level, the predetermined pacing level being greater than a pre-ablation pacing threshold level but lower than a post-ablation pacing threshold level, delivering ablative energy to the ablation electrode, detecting the heart rate of the subject, wherein the heart rate detected by the high-resolution mapping electrode is at the elevated level before the post-ablation pacing threshold level is achieved, and wherein the heart rate detected by the high-resolution mapping electrode drops below the elevated level once ablation achieves its therapeutic goal or target, and terminating the delivery of ablative energy to the ablation electrode after the heart rate drops below the elevated level. 1. An energy delivery module configured to deliver ablative energy to targeted cardiac tissue of a subject and for confirming successful ablation of said targeted cardiac tissue , comprising:a processor for regulating the delivery of ablative energy;wherein the energy delivery module is configured to operatively couple to a catheter, wherein the energy delivery module is configured to energize an electrode positioned along a distal end of the catheter to selectively ablate targeted cardiac tissue adjacent the electrode;wherein the energy delivery module is configured to couple to a pacemaker for selectively pacing cardiac tissue in order to attain capture of the heart of the subject;wherein the processor is configured, via a predetermined pacing signal provided to the catheter by a pacemaker, to increase the heart rate of the subject from a baseline level to an elevated level, the predetermined pacing signal comprising a pacing level greater than a pre-ablation pacing threshold level; ...

SYSTEMS AND METHODS TO MONITOR AND TREAT HEART FAILURE CONDITIONS

An implantable device monitors and treats heart failure, pulmonary edema, and hemodynamic conditions and in some cases applies therapy. In one implementation, the implantable device applies a high-frequency multi-phasic pulse waveform over multiple-vectors through tissue. The waveform has a duration less than the charging time constant of electrode-electrolyte interfaces in vivo to reduce intrusiveness while increasing sensitivity and specificity for trending parameters. The waveform can be multiplexed over multiple vectors and the results cross-correlated or subjected to probabilistic analysis or thresholding schemata to stage heart failure or pulmonary edema. In one implementation, a fractionation morphology of a sensed impedance waveform is used to trend intracardiac pressure to stage heart failure and to regulate cardiac resynchronization therapy. The waveform also provides unintrusive electrode integrity checks and 3-D impedancegrams. 1. An implantable device , comprising:a waveform generator to create a waveform for application along each of multiple vectors through a bodily tissue of a patient via electrodes, wherein the duration of each waveform is less than a charging time constant of an electrode-electrolyte interface between each electrode and the bodily tissue and wherein at least one of the vectors is confined to within the patient's heart tissue or pericardium;a multiplexor to apply and process the waveform over the multiple vectors;an impedance measurement module to obtain multiple impedance measurements at least in part via the multiplexor such that one of the multiple impedance measurements is obtained for each of the multiple vectors; andan evaluator to interpret the multiple impedance measurements in order to estimate a bodily parameter of the patient.2. The implantable device as recited in claim 1 , wherein the multiplexor uses time multiplexation to apply and process the waveform over the multiple vectors.3. The implantable device as recited in ...

SYSTEMS AND METHODS FOR INTERVENTIONAL PROCEDURE PLANNING

A method of planning a procedure to deploy an interventional instrument comprises receiving a model of an anatomic structure. The anatomic structure includes a plurality of passageways. The method further includes identifying a target structure in the model and receiving information about an operational capability of the interventional instrument within the plurality of passageways. The method further comprises identifying a planned deployment location for positioning a distal tip of the interventional instrument to perform the procedure on the target structure based upon the operational capability of the interventional instrument. 1. A system for planning a procedure to be performed using an interventional instrument , the system comprising:a control system that receives information about an operational capability of the interventional instrument within a plurality of passageways in a model of an anatomic structure and identifies a plurality of optional deployment locations for positioning a distal tip of the interventional instrument to perform the procedure on a target structure in the model based on the information about the operational capability of the interventional instrument; and 'wherein each of the plurality of optional deployment locations is displayed using a code that provides information about a relative quality of each of the plurality of optional deployment locations for deploying the interventional instrument to perform the procedure, the relative quality of each of the plurality of optional deployment locations based on the information received about the operational capability of the interventional instrument.', 'a display system that displays the model of the anatomic structure having the plurality of passageways and displays the plurality of optional deployment locations in the model,'}2. The system of claim 1 , wherein the control system identifies a planned deployment location from the plurality of optional deployment locations claim 1 , the ...

Systems and Methods for Robotic Medical System Integration With External Imaging

A medical robotic system and method of operating such comprises taking intraoperative external image data of a patient anatomy, and using that image data to generate a modeling adjustment for a control system of the medical robotic system (e.g., updating anatomic model and/or refining instrument registration), and/or adjust a procedure control aspect (e.g., regulating substance or therapy delivery, improving targeting, and/or tracking performance). 127-. (canceled)28. A medical robotic system comprising:a memory for receiving intraoperative external image data for at least a portion of a patient anatomy, the intraoperative external image data including image data for a target location in the patient anatomy; anda processor configured for at least semi-automatically controlling a medical instrument of the medical robotic system based on the intraoperative external image data to deliver a substance to the target location through the medical instrument.29. The medical robotic system of claim 28 , wherein the processor is further configured to provide pose data for a distal end region of the medical robotic system claim 28 , andwherein the intraoperative external image data comprises data of the patient anatomy only within a predetermined region based on the pose data.30. (canceled)31. The medical robotic system of claim 28 , wherein the processor is further configured to identify image data for the substance in the intraoperative external image data.32. The medical robotic system of claim 31 , wherein the processor is further configured to adjust a control parameter for delivering the substance based on the image data for the substance.33. The medical robotic system of claim 28 ,wherein controlling the medical robotic system comprises applying a treatment modality to the target location using the medical robotic system.34. The medical robotic system of claim 33 , wherein the processor is further configured to identify an effect of the treatment modality in the ...

SYSTEMS AND METHODS FOR INTERVENTIONAL PROCEDURE PLANNING

A system for performing an interventional procedure comprises an interventional instrument and a control system. The control system comprises a processor and a memory comprising machine-readable instructions that, when executed by the processor, cause the control system to receive a model of an anatomic structure record a target location for a target structure identified in the model, determine a planned deployment location for the interventional instrument to perform the interventional procedure on the target structure, receive sensor data including an operative image of the target structure from a sensor system, and identify, based on the operative image of the target structure, a revised deployment location for the interventional instrument to perform the interventional procedure on the target structure. 120-. (canceled)21. A system for performing an interventional procedure , the system comprising:an interventional instrument anda control system comprising a processor and a memory comprising machine-readable instructions that, when executed by the processor, cause the control system to:receive a model of an anatomic structure;record a target location for a target structure identified in the model;determine a planned deployment location for the interventional instrument to perform the interventional procedure on the target structure;receive sensor data including an operative image of the target structure from a sensor system; andidentify, based on the operative image of the target structure, a revised deployment location for the interventional instrument to perform the interventional procedure on the target structure.22. The system of claim 21 , wherein the model is generated from images recorded at least one of preoperatively or intra-operatively.23. The system of claim 21 , wherein the machine-readable instructions claim 21 , when executed by the processor further cause the control system to:identify a revised target location for the target structure based on ...

QUANTITATIVE THREE-DIMENSIONAL VISUALIZATION OF INSTRUMENTS IN A FIELD OF VIEW

A system is provided that includes a Q3D endoscope disposed to image a field of view and a processor that produces a Q3D model of a scene and identifies target instruments and structures. The processor is configured to display the scene from a virtual field of view of an instrument, to determine a no fly zone around targets, to determine a predicted path for said instruments or to provide 3D tracking of said instruments. 112-. (canceled)13. A system for maneuvering a surgical instrument , comprising:a quantitative three-dimensional (Q3D) endoscope disposed to image a scene within its field of view;at least one processor configured to,determine a Q3D model of a scene imaged by the Q3D endoscope;identify at least one instrument within the imaged scene; anddetermine a predicted path of the identified instrument based at least in part upon at least one of extrapolation from a previous path followed by the identified instrument and a virtual extension of the identified instrument.14. The system of claim 13 , wherein the system comprises an input allowing the user to select said at least one instrument from a set of instruments.15. The system of claim 13 ,wherein the processor is further configured to determine said previous path from one or more 3D poses of the identified instrument within said Q3D model at each of one or more different time points.16. The system of claim 13 ,wherein the processor is further configured to determine a Q3D model of a scene imaged by the Q3D endoscope at each of multiple times;determine a position of the at least one instrument within the imaged scene at each of the multiple times;determine the previous path based upon the determined positions of the at least one instrument within the imaged scene at each of the multiple times.17. The system of claim 13 ,wherein determining a predicted path of the identified instrument based upon a virtual extension of the identified instrument further includes:determining a 3D poses of the identified ...

QUANTITATIVE THREE-DIMENSIONAL IMAGING OF SURGICAL SCENES FROM MULTIPORT PERSPECTIVES

A system is provided that includes a quantitative three-dimensional (Q3D) endoscope that is inserted through a first port providing access to a body cavity to a first position at which a first 3D image of a first portion of an anatomical structure is captured from a perspective of said endoscope. A first Q3D model is produced based upon the captured first image. The endoscope is inserted through a second port providing access to the body cavity to a second position at which a second image of a second portion of the anatomical structure is captured. A second quantitative Q3D model is produced based upon the captured second image. The first Q3D model and the second Q3D model are combined together to produce an expanded Q3D model of the anatomical structure. The expanded Q3D model can be stored for further manipulation or can be displayed in 3D. 1. A system for 3D imaging of a surgical scene comprising:a quantitative three-dimensional (Q3D) endoscope operable to image an anatomical structure within a body cavity;at least one manipulator configured to insert the Q3D endoscope through a first port and later through at least a second port, the first port and the second port each providing access to the body cavity; andat least one processor configured to:produce a first Q3D model based upon a first image captured with the endoscope in the first port;produce a second Q3D model based upon a second image captured with the endoscope in the second port; andcombine together the first Q3D model and the second Q3D model.2. The system of claim 1 ,wherein the combining together includes:determining a first position of the endoscope relative to a first coordinate system when the endoscope is in the first port;determining a second position of the endoscope relative to a second coordinate system when the endoscope is in the second port;using a kinematic relationship between the first position of the endoscope and the second position of the endoscope to align the first Q3D model and ...

QUANTITATIVE THREE-DIMENSIONAL IMAGING AND PRINTING OF SURGICAL IMPLANTS

A system to produce a replacement anatomical structure, comprising: a quantitative three-dimensional (Q3D) endoscope disposed to image a structure within a field of view that includes target tissue; at least one processor configured to: produce a first Q3D model of an anatomical structure that includes target tissue; produce a second Q3D model of the anatomical structure that includes remainder tissue in a location from which the target has been tissue removed; and produce a third Q3D model of a replacement structure based at least in part upon the first Q3D model and the second Q3D model. 1. A system to produce a replacement anatomical structure , comprising:a quantitative three-dimensional (Q3D) endoscope disposed to image an anatomical structure within a field of view that includes target tissue;at least one processor configured to:produce a first Q3D model based upon image information captured from the anatomical structure that represents an external surface of bone tissue including the target bone tissue;produce a second Q3D model based upon image information captured from the anatomical structure that represents remainder tissue structure, which defines an empty region in a location of the anatomical structure from which the target tissue has been tissue removed; andproduce a third Q3D model of a replacement structure based at least in part upon the first Q3D model and the second Q3D model.2. The system of claim 1 ,wherein producing the third Q3D model includes determining one or more differences between the first Q3D model and the second Q3D model.3. The system of claim 1 ,wherein producing the third Q3D model includes determining 3D digital subtraction between the first Q3D model and the second Q3D model.4. The system of claim 1 ,wherein the at least one processor is configured to:convert the third Q3D model to a three dimensional (3D) model of the replacement structure in a format that is suitable for use by a 3D printing machine.5. The system of claim 1 , ...

SURGICAL SYSTEM WITH HAPTIC FEEDBACK BASED UPON QUANTITATIVE THREE-DIMENSIONAL IMAGING

A system is provided to provide haptic feedback during a medical procedure comprising: a quantitative three-dimensional (Q3D); a surgical instrument disposed to deform a tissue structure; a haptic user interface device configured to provide an indication of tissue structure deformation in response to information indicative of the measure of tissue structure deformation; and a processor configured to produce a Q3D model that includes information indicative of a measure of tissue structure deformation and to provide the information indicative of the measure of tissue structure deformation to the haptic user interface device. 1. A system to provide haptic feedback during a medical procedure comprising:a quantitative three-dimensional (Q3D) endoscope having a field of view and operable to measure deformation of different locations of a tissue structure placed within its field of view;a surgical instrument operable to deform different locations of the tissue structure placed within the Q3D endoscope field of view;at least one processor configured to produce a Q3D model that provides a map of measures of tissue structure deformation at different locations of the tissue structure; anda haptic user interface device configured to produce haptic feedback indicative of the map of measures of tissue structure deformation at least first and second various locations of the tissue structure.2. The system of claim 1 ,wherein the haptic user interface device includes a shape display.3. The system of claim 1 ,wherein the haptic user interface device includes an array of axially aligned pins.4. The system of claim 1 ,wherein the haptic user interface device includes an source of variable electrotactile stimulation.5. The system of claim 1 ,wherein the haptic user interface device includes a surgical instrument manipulation control device.6. The system of further including:an alarm source configured to produce an alarm in response to the processor providing information indicative of a ...

QUANTITATIVE THREE-DIMENSIONAL IMAGING OF SURGICAL SCENES

A device is provided that includes an endoscope; an image sensor array is disposed to image a field of view adjacent to the endoscope, each sensor includes a pixel array that is separate from the pixel arrays of other sensors; and a light source is disposed to illuminate the field of view. 1. A device comprising:an endoscope;an image sensor array disposed to image a field of view adjacent to the endoscope, each sensor including a pixel array that is separate from the pixel arrays of other sensors; anda light source disposed to illuminate the field of view;wherein the endoscope includes an elongated portion having a first end portion and a second end portion opposite the first end portion;wherein the image sensor array is disposed displaced from the first end portion;the device further including:a light pipe disposed to transmit an image from a field of view adjacent the first end portion to the image sensor array displaced from the first end portion.2. The device of claim 1 ,wherein the light source produces only non-structured light.3. The device of claim 1 ,wherein the light source produces white light.4. (canceled)5. The device of claim 1 ,wherein the light source produces white light.6. (canceled)7. The device of claim 1 ,wherein an end of the endoscope opposite the first end portion of the elongated portion is configured for mechanical coupling with a mechanical surgical arm.8. (canceled)9. A device comprising:an endoscope;an image sensor array disposed to image a field of view adjacent to the endoscope, each sensor including a pixel array that is separate from the pixel arrays of other sensors; anda light source disposed to illuminate the field of view; anda controller configured to, determine a three-dimensional location of a target object based upon image information captured by the image sensor array.10. The device of claim 9 ,wherein the three-dimensional location of the target object is determined based at least in part upon a pixel-distance relationship ...

METHODS AND DEVICES FOR ENDOVASCULAR ABLATION OF A SPLANCHNIC NERVE

Systems, devices, and methods for transvascular ablation of target tissue. The devices and methods may, in some examples, be used for splanchnic nerve ablation to increase splanchnic venous blood capacitance to treat at least one of heart failure and hypertension. For example, the devices disclosed herein may be advanced endovascularly to a target vessel in the region of a thoracic splanchnic nerve (TSN), such as a greater splanchnic nerve (GSN) or a TSN nerve root. Also disclosed are method of treating heart failure, such as HFpEF, by endovascularly ablating a thoracic splanchnic nerve to increase venous capacitance and reduce pulmonary blood pressure. 1. A method of ablating a great splanchnic nerve or a greater splanchnic nerve root to increase splanchnic venous blood capacitance , comprising:advancing an elongate medical device into an azygous vein, the elongate medical device including a distal region, a flexible shaft with a fluid lumen therein, and an ablation element disposed at the distal region, the ablation element comprising a membrane in fluid communication with the fluid lumen, the ablation element at least partially defining a fluid chamber,advancing the ablation element from the azygous vein into a T9, T10, or T11 intercostal vein;when the ablation element is disposed in the intercostal vein, delivering a fluid through the fluid lumen and into the fluid chamber to expand the membrane into an expanded configuration that has a cylindrically shaped active ablation region, the active ablation region having a length from 5 mm to 20 mm and an outer diameter from 2 mm to 4 mm; anddelivering ablation energy from the ablation member to create a continuous circumferential lesion having a length in a range of 5 to 20 mm, and thereby ablate a portion of a thoracic splanchnic nerve or a thoracic splanchnic nerve root.2. The method of claim 1 , wherein delivering the ablation energy creates the continuous lesion that also has a depth of at least 5 mm around the ...

DEVICES, SYSTEMS, AND METHODS FOR TREATMENT OF HEART FAILURE BY SPLANCHNIC NERVE ABLATION

Apparatuses and methods for treating a heart failure patient by ablating a nerve of the thoracic splanchnic sympathetic nervous system to increase venous capacitance and reduce pulmonary blood pressure. A method comprising: inserting a catheter into a vein adjacent the nerve, applying stimulation energy and observing hemodynamic effects, applying ablation energy and observing hemodynamic effects, applying stimulation energy after the ablation and observing hemodynamic effects and monitoring for presence of the lung in the ablation zone. An alternative method comprising: inserting a catheter into a vein adjacent the nerve, detecting that lung tissue is a safe distance from an ablation zone, and delivering ablation energy to the target nerve when lung tissue is a safe distance from the ablation zone. 1. An apparatus for transvascular ablation of a target nerve , comprising: causing a decrease of at least one of the size of the lumen at a location along the blood vessel or the blood flow at a location along the blood vessel, and', 'delivering ablation energy adapted for the ablation of said target nerve., 'a delivery device configured to connect to an elongated shaft configured to be inserted into a blood vessel lumen, wherein the delivery device is configured for2. An apparatus according to claim 1 , wherein the delivery device is configured to operate at least in a lumen reducing energy mode and an ablation energy mode claim 1 ,wherein in lumen reducing energy mode the delivery device is adapted to cause a first energy to be generated and delivered from an energy delivery element, andwherein in the ablation energy mode, the delivery device is adapted to cause a second energy, different from the first energy, to be generated and delivered from said or a further energy delivery element.3. An apparatus according to claim 2 , wherein the elongated shaft comprises:a number of electrodes carried by a portion of the elongated shaft; and the delivery device comprises:a power ...

METHODS AND DEVICES FOR ENDOVASCULAR ABLATION OF A SPLANCHNIC NERVE

Systems, devices, and methods for transvascular ablation of target tissue. The devices and methods may, in some examples, be used for splanchnic nerve ablation to increase splanchnic venous blood capacitance to treat at least one of heart failure and hypertension. For example, the devices disclosed herein may be advanced endovascularly to a target vessel in the region of a thoracic splanchnic nerve (TSN), such as a greater splanchnic nerve (GSN) or a TSN nerve root. Also disclosed are method of treating heart failure, such as HFpEF, by endovascularly ablating a thoracic splanchnic nerve to increase venous capacitance and reduce pulmonary blood pressure. 1. A method of ablating a greater splanchnic nerve or a greater splanchnic nerve root to increase splanchnic venous blood capacitance , comprising:advancing an elongate medical device into an azygous vein, the elongate medical device including a distal region and an ablation element disposed at the distal region;advancing the ablation element from the azygous vein into a T9, T10, or T11 intercostal vein;when the ablation element is disposed in the T9, T10, or T11 intercostal vein, delivering energy from the ablation element; andcreating a lesion having a length in a range of 5 to 20 mm, whereby creating the lesion ablates a portion of a greater splanchnic nerve or a greater splanchnic nerve root.2. The method of claim 1 , wherein the flexible shaft comprises a fluid lumen and the distal region includes an inflatable membrane claim 1 , the method further comprising delivering a fluid through the fluid lumen and into inflatable membrane to thereby inflate the inflatable membrane to an expanded configuration.3. The method of claim 1 , wherein creating the lesion having a length in a range of 5 to 20 mm comprises creating a continuous circumferential range having a length in a range of 5 to 20 mm.4. The method of claim 1 , wherein creating the lesion comprises creating a lesion that has a depth of at least 5 mm.5. The ...

ELECTROCARDIOGRAM PATCH DEVICES AND METHODS

Methods and apparatuses, including devices and systems, for remote and detection and/or diagnosis of acute myocardial infarction (AMI). In particular, described herein are handheld and adhesive devices having an electrode configuration capable of recording three orthogonal ECG lead signals in an orientation-specific manner, and transmitting these signals to a processor. The processor may be remote or local, and it may automatically or semi-automatically detect AMI, atrial fibrillation or other heart disorders based on the analyses of the deviation of the recorded 3 cardiac signals with respect to previously stored baseline recordings. 1. An adhesive patch device for synthesizing a 12-lead electrocardiogram , the device comprising:a patch of adhesive material having a back and a front, wherein the back is configured to be adhesively secured to a patient's chest;a first electrode and a second electrode integrated on the back of the patch configured to measure bioelectric signals from the patient's chest, wherein the first and second electrodes are positioned a distance of at least 5 cm apart;a third electrode on the front of the patch and configured to measure bioelectric signals from the patient's right hand;a fourth electrode on the front of the patch and configured to measure bioelectric signals from the patient's left hand;a processing network forming a central point in a sagittal plane through the patient's chest passing between the third and fourth electrodes when the housing is held adhesively secured against the patient's chest, wherein three orthogonal cardiac leads are formed from said electrodes and the central point; anda processor within a housing on the patch configured to process the three orthogonal cardiac leads derived from the first, second, third and fourth electrodes.2. The device of claim 1 , further comprising a communication circuit within the housing configured to transmit the processed three orthogonal cardiac leads to a remote processor.3. ...

Systems and methods for robotic medical system integration with external imaging

A medical robotic system and method of operating such comprises taking intraoperative external image data of a patient anatomy, and using that image data to generate a modeling adjustment for a control system of the medical robotic system (e.g., updating anatomic model and/or refining instrument registration), and/or adjust a procedure control aspect (e.g., regulating substance or therapy delivery, improving targeting, and/or tracking performance).

HIGH-RESOLUTION MAPPING OF TISSUE WITH PACING

According to some embodiments, a method of confirming successful ablation of targeted cardiac tissue of a subject using a high-resolution mapping electrode comprises pacing said cardiac tissue at a predetermined pacing level to increase the heart rate of the subject from a baseline level to an elevated level, the predetermined pacing level being greater than a pre-ablation pacing threshold level but lower than a post-ablation pacing threshold level, delivering ablative energy to the ablation electrode, detecting the heart rate of the subject, wherein the heart rate detected by the high-resolution mapping electrode is at the elevated level before the post-ablation pacing threshold level is achieved, and wherein the heart rate detected by the high-resolution mapping electrode drops below the elevated level once ablation achieves its therapeutic goal or target, and terminating the delivery of ablative energy to the ablation electrode after the heart rate drops below the elevated level. 1. A system for delivering energy to targeted cardiac tissue of a subject and for confirming successful ablation of said targeted cardiac tissue , comprising:a catheter comprising a high-resolution electrode along a distal end of the catheter;an energy delivery module comprising a processor, the energy delivery module being configured to operatively couple to the catheter, wherein the energy delivery module is configured to energize the electrode to selectively ablate targeted cardiac tissue adjacent the electrode; anda pacemaker, wherein the pacemaker is integral to the energy delivery module;wherein the system is configured to detect a signal relating to a localized heart rate at the high-resolution electrode via the high-resolution electrode;wherein the energy delivery module is configured to selectively pace cardiac tissue in order to attain capture of the heart of the subject;wherein the system is configured, via a predetermined pacing signal provided to the catheter by the ...

MEDICAL INSTRUMENTS WITH MULTIPLE TEMPERATURE SENSORS

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 1. A medical instrument comprising:an elongate body comprising a proximal end and a distal end;a combination electrode assembly comprising a tip electrode portion positioned at the distal end of the elongate body and a proximal ring electrode portion spaced apart from the tip electrode portion by an electrically-insulating gap;a first plurality of thermocouples positioned along the tip electrode portion, wherein the first plurality of thermocouples are thermally insulated from the tip electrode portion; anda second plurality of thermocouples positioned along the proximal ring electrode portion,wherein the combination electrode assembly is configured to contact tissue and to deliver energy sufficient to generate a lesion at a depth from a surface of the tissue, andwherein temperature measurements determined from the first plurality of thermocouples and the second plurality of thermocouples are indicative of temperature of the tissue.2. The medical instrument of claim 1 ,wherein the first plurality of thermocouples comprises at least three thermocouples, and wherein the second plurality of thermocouples comprises at least three thermocouples,wherein the first plurality of thermocouples are spaced apart circumferentially around the elongate body,wherein the second plurality of ...

CONTACT SENSING SYSTEMS AND METHODS

According to some embodiments, a medical instrument comprises an elongate body having a proximal end and a distal end and a pair of electrodes or electrode portions (for example, a split-tip electrode assembly). Systems and methods are described herein that perform contact sensing and/or ablation confirmation based on electrical measurements obtained while energy of different frequencies are applied to the pair of electrodes or electrode portions. The contact sensing systems and methods may calibrate network parameter measurements to compensate for a hardware unit in a network parameter measurement circuit or to account for differences in cables, instrumentation or hardware used. 120-. (canceled)21. A system for determining whether a medical instrument is in contact with tissue based , at least in part , on impedance measurements , the system comprising:a signal source configured to deliver signals having different frequencies to a pair of electrodes of a medical instrument; anda processing device configured to:apply a transform to a resulting waveform that formulates across the pair of electrodes to obtain impedance measurements at a first frequency and a second frequency;determine a ratio between the magnitude of the impedance at the second frequency and the first frequency; andgenerate an output indicative of contact based on the ratio.22. The system of claim 21 , wherein the signal source comprises a radiofrequency energy source and wherein the first and second frequencies are between 5 kHz and 1000 kHz.23. The system of claim 21 , wherein the signal source is configured to generate signals having a frequency adapted for tissue ablation.24. The system of claim 21 , further comprising a second signal source configured to generate signals having a frequency adapted for tissue ablation.25. The system of claim 24 , wherein the frequency adapted for tissue ablation is between 400 kHz and 600 kHz.26. A method of determining whether a medical instrument is in contact ...

Ablation devices, systems and methods of using a high-resolution electrode assembly

According to some embodiments, an ablation device comprises an elongate body (e.g., a catheter) having a proximal end and a distal end, a first electrode (e.g., a radiofrequency electrode) positioned at the distal end of the elongate body, at least a second electrode (e.g., a radiofrequency electrode) positioned at a location proximal to the first electrode, the first electrode and the second electrode being configured to contact tissue of a subject and deliver radiofrequency energy sufficient to at least partially ablate the tissue, at least one electrically insulating gap positioned between the first electrode and the second electrode and a filtering element configured to present a low impedance at a frequency used for delivering ablation energy via the first and second electrodes.

Methods of removing heat from an electrode using thermal shunting

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

ELECTRODE ASSEMBLY WITH THERMAL SHUNT MEMBER

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 120-. (canceled)21. An electrode assembly for an ablation catheter with thermal shunting , the electrode assembly comprising:a discrete proximal electrode portion;a discrete distal electrode portion;a filtering element electrically coupling the proximal electrode portion to the distal electrode portion and configured to present a low impedance at a frequency used for delivering ablative energy via the proximal and distal electrode portions, the filtering element being a capacitor; anda plurality of thermal shunt members in thermal communication with the proximal electrode portion and the distal electrode portion to selectively remove heat from at least one of the electrode assembly and tissue being treated by the electrode assembly when the electrode assembly is activated;a first one of the plurality of thermal shunt members extends at least partially through an interior of the electrode assembly to transfer heat from the electrode assembly during use; anda second one of the plurality of thermal shunt members being differently sized than the first one of the plurality of thermal shunt members and a third one of the plurality of thermal shunt members being separated from the second one of the plurality of thermal shunt members by a portion of the electrode assembly.22. The assembly ...

METHODS OF RADIOMETRICALLY DETERMINING AN EXTREME TEMPERATURE DURING A TREATMENT PROCEDURE

According to some embodiments, systems for energy delivery to targeted tissue comprise a catheter with an ablation member, a radiometer configured to detect temperature data from the targeted tissue, a processor configured to determine a calculated temperature (e.g., an extreme temperature, such as a peak or trough temperature) within the tissue by applying at least one factor to the temperature data detected by the radiometer, the processor configured to compare the calculated temperature to a setpoint and an energy source configured to energize the ablation member and to regulate delivery of ablative energy to the targeted tissue of the subject based at least in part on the comparison. In some embodiments, the factor depends on at least one characteristic of the targeted tissue. Information regarding a tissue characteristic can be provided using information from an imaging set (e.g., intracardiac echo) or an electrical signal of the subject (e.g., electrocardiogram). 110-. (canceled)11. A system for energy delivery to a targeted tissue of a subject , comprising.a processor configured to determine a calculated temperature within the targeted tissue by adjusting temperature data received by a radiometer using at least one factor; andan ablation energy source configured to energize an ablation member to deliver energy to the targeted tissue of the subject based on, at least in part, the calculated temperature.12. The system of claim 11 , wherein the calculated temperature relates to an extreme temperature within the targeted tissue.13. The system of claim 11 , further comprising an input device configured to receive a setpoint claim 11 , the setpoint comprising a target ablation temperature of the targeted tissue or a set curve claim 11 , wherein the energy source is configured to regulate delivery of energy to targeted tissue by comparing the calculated temperature to the setpoint.14. The system of claim 11 , wherein the at least one factor comprises an estimation ...

ORIENTATION DETERMINATION BASED ON TEMPERATURE MEASUREMENTS

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member. 1. A system for determining orientation of a distal tip of an ablation device with respect to tissue , the system comprising: receive signals indicative of temperature from a first plurality of temperature sensors positioned along and isolated from contact with a distal member of a combination electrode assembly of an ablation device while energy is being delivered by the combination electrode assembly, the combination electrode assembly comprising the distal member and a proximal member spaced apart from the distal member by an electrically-insulating gap;', 'receive signals indicative of temperature from a second plurality of temperature sensors positioned along and isolated from contact with the proximal member of the combination electrode assembly while energy is being delivered by the combination electrode assembly;', 'determine temperature measurements from the signals received from the first plurality of temperature sensors and the second plurality of temperature sensors;', 'determine an orientation of a distal tip of the ablation device with respect to tissue based on processing of the temperature measurements; and', 'generate an output indicative of the orientation to be output to a display., 'a hardware processor configured to, upon execution of instructions stored on a ...

Treatment adjustment based on temperatures from multiple temperature sensors

According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

RADIOMETRIC TISSUE CONTACT AND TISSUE TYPE DETECTION

Radiometric systems may comprise a radiometer, an antenna and a processor communicatively coupled together. The processor may provide a contact-focused output based on filtering or other processing of a raw radiometric output signal. The contact-focused output may facilitate determination of whether contact has been achieved and/or assessment of contact. A miniaturized reflectometer may be configured to determine an amount of reflected power from the antenna. The processor may be configured to determine a reflection coefficient of the reflected power determined by the reflectometer and to identify tissue type based on the reflection coefficient. Systems and methods for facilitating deeper temperature measurements of a radiometer are described. 1. A system for facilitating determination of quality of contact between an energy delivery device and tissue prior to and during energy delivery , the system comprising:a radiofrequency energy generator;a radiofrequency energy delivery device comprising a radiofrequency electrode configured to deliver ablative energy provided by the radiofrequency energy generator;a radiometer; anda processor configured to:extract variability information from a signal received from the radiometer;determine a level of tissue contact between a distal tip of the energy delivery device and tissue to be ablated based, at least in part, upon said variability information; andgenerate an output indicative of the level of tissue contact.2. The system of claim 1 , wherein the variability information is based on a moving average of the signal received from the radiometer.3. The system of claim 1 , wherein the level of tissue contact is determined based upon a comparison to at least one threshold.4. The system of claim 3 , wherein the at least one threshold comprises a piecewise linear threshold.5. The system of claim 3 , wherein the at least one threshold is configured to be automatically adjusted based on historical variability information data.6. The ...

SYSTEMS AND METHODS FOR NAVIGATION BASED ON ORDERED SENSOR RECORDS

A method of tracking a medical instrument comprises receiving a model of an anatomical passageway formation and receiving a set of ordered sensor records for the medical instrument. The set of ordered sensor records provide a path history of the medical instrument. The method further comprises registering the medical instrument with the model of the anatomical passageway formation based on the path history. The method further includes displaying a virtual visualization image in a display system, the virtual visualization image being based on the registering of the medical instrument with the model of the anatomical passageway and depicting a rendered view of the model of the anatomical passageway from a perspective of the medical instrument within the model of the anatomical passageway. 144-. (canceled)45. A method of tracking a medical instrument , the method comprising:receiving a model of an anatomical passageway formation;receiving a set of ordered sensor records for the medical instrument, the set providing a path history of the medical instrument;registering the medical instrument with the model of the anatomical passageway formation based on the path history; anddisplaying a virtual visualization image in a display system, the virtual visualization image being based on the registering of the medical instrument with the model of the anatomical passageway and depicting a rendered view of the model of the anatomical passageway from a perspective of the medical instrument within the model of the anatomical passageway.46. The method of further comprising determining a relationship between a first sensor record of the set of ordered sensor records claim 45 , a second sensor record of the set of ordered sensor records claim 45 , a first candidate match point defined within the model of the anatomical passageway claim 45 , and a second candidate match point defined within the model of the anatomical passageway.47. The method of wherein determining the relationship ...

Contact sensing systems and methods

According to some embodiments, a medical instrument comprises an elongate body having a proximal end and a distal end and a pair of electrodes or electrode portions (for example, a split-tip electrode assembly). Systems and methods are described herein that perform contact sensing and/or ablation confirmation based on electrical measurements obtained while energy of different frequencies are applied to the pair of electrodes or electrode portions. The contact sensing systems and methods may calibrate network parameter measurements to compensate for a hardware unit in a network parameter measurement circuit or to account for differences in cables, instrumentation or hardware used.

DEVICES AND METHODS FOR TREATING LUNG TUMORS

An ablation catheter configured to ablate tissue in a lung of a patient including: a flexible shaft that advances endobronchially into an airway of the lung and has an outer diameter of 2.0 mm or less; an ablation electrode attached to a distal portion of the flexible shaft and to deliver radiofrequency (RF) electrical current to the tissue and conductively connectable to an RF electrical energy source external to the patient; wherein an outer diameter of an assembly of the flexible shaft and the ablation electrode is no greater than 2.0 mm; a liquid outlet on the distal portion and configured to be in fluid communication with a source of hypertonic saline solution; and a first occluder attached to the flexible shaft proximal to the ablation electrode and proximal to the liquid outlet, wherein the first occluder is configured to expand to occlude the airway. 1. An ablation catheter configured to ablate tissue in a lung of a patient , the ablation catheter comprising:a flexible shaft configured to advance endobronchially into an airway of the lung, wherein the flexible shaft has an outer diameter no greater than 2.0 mm;an ablation electrode attached to a distal portion of the flexible shaft and configured to deliver radiofrequency (RF) electrical current to the tissue, wherein the ablation electrode is conductively connectable to an RF electrical energy source external to the patient;wherein an outer diameter of an assembly of the flexible shaft and the ablation electrode is no greater than 2.0 mm;a liquid outlet on the distal portion and configured to be in fluid communication with a source of hypertonic saline solution; anda first occluder attached to the flexible shaft proximal to the ablation electrode and proximal to the liquid outlet, wherein the first occluder is configured to expand to occlude the airway.2. The ablation catheter of claim 1 , wherein the occluder is a deployable balloon claim 1 , a deployable valve and/or a deployable stent.3. The ablation ...

DEVICES FOR TREATING LUNG TUMORS

An apparatus () for ablating a tumor in a lung including: an elongate shaft (); an obturator () positioned at a distal region of the elongate shaft, a suction lumen () extending through the elongate shaft and exiting the shaft distal to the obturator, wherein the suction lumen is configured to remove air or fluid from the portion of the lung, an ablation catheter delivery lumen () extending through the elongate shaft and exiting the shaft distal to the obturator, and an ablation catheter () comprising an RF electrode (). 1. An apparatus for ablating a tumor in a lung comprising:an elongate shaft;an obturator positioned at a distal region of the elongate shaft,a suction lumen extending through the elongate shaft and exiting the shaft distal to the obturator, wherein the suction lumen is configured to remove air or fluid from the portion of the lung,an ablation catheter delivery lumen extending through the elongate shaft and exiting the shaft distal to the obturator, andan ablation catheter comprising an RF electrode.2. The apparatus of wherein the ablation catheter comprises a plurality of ablation catheters.3. The apparatus of wherein each of the plurality of ablation catheters are configured to be deployed simultaneously from the ablation catheter delivery lumen.4. (canceled)5. (canceled)6. The apparatus of claim 1 , further comprising an RF ablation console configured to deliver RF ablation energy to the RF electrode.7. (canceled)8. The apparatus of wherein the RF ablation electrode(s) is configured to be delivered to a bronchiole and is at least one of a flexible electrode claim 1 , a tightly wound wire coil claim 1 , and a hydrophilic electrode.9. (canceled)10. The apparatus of claim 1 , wherein the ablation catheter includes a three dimensional navigation sensor.1126.-. (canceled)27. A method of treating a patient with lung cancer comprising:delivering a catheter through an airway of the patient to a target region in the patient's lung,positioning the thermal ...

Systems and methods for visualizing tissue during diagnostic or therapeutic procedures

A catheter tube carries an imaging element for visualizing tissue. The catheter tube also carries a support structure, which extends beyond the imaging element for contacting surrounding tissue away from the imaging element. The support element stabilizes the imaging element, while the imaging element visualizes tissue in the interior body region. The support structure also carries a diagnostic or therapeutic component to contact surrounding tissue.

Catheter with sensor tips, tool and device and methods of use of same

An apparatus and method for catheter-based sensing and injection at a target site within a patient's body. An injection catheter is equipped with electrodes at its distal end which contact the surface of a target site, such as an AV node of the heart. Electrical signals detected at the target site by the electrodes are fed via leads to the proximal end of the catheter, where they are received by a monitor, such as an EKG monitor. If the electrical signals satisfy predetermined criteria, a needle within the catheter is extended into the target site, and a therapeutic agent is injected into the target site.

Ablation and imaging catheter

A catheter tube carries an imaging element for visualizing tissue. The catheter tube also carries a support structure, which extends beyond the imaging element for contacting surrounding tissue away from the imaging element. The support element stabilizes the imaging element, while the imaging element visualizes tissue in the interior body region. The support structure also carries a diagnostic or therapeutic component to contact surrounding tissue.

Systems and methods for visualizing interior regions of the body

An imaging system for visualizing an interior body region comprises a catheter tube having a proximal end and a distal end adapted for introduction into the interior body region. The distal end carries an element that forms a three-dimensional support structure for contacting peripheral tissue in the interior body region. The three-dimensional support structure has an open interior. The distal end also carries an imaging element for visualizing the interior body region. The three-dimensional support structure peripherally surrounds the imaging element, thereby keeping peripheral tissue from contacting the imaging element. A steering mechanism on the proximal end of the catheter tube moves the imaging element within the open interior of the three-dimensional support structure. The system provides a stable platform through which accurate displays of interior body images can be created for viewing and analysis by the physician, so the appropriate treatment or therapy can be prescribed.

SYSTEMS AND METHODS FOR INTERVENTIONAL PROCEDURE PLANNING

A method of planning a procedure to deploy an interventional instrument comprises receiving a model of an anatomic structure. The anatomic structure includes a plurality of passageways. The method further includes identifying a target structure in the model and receiving information about an operational capability of the interventional instrument within the plurality of passageways. The method further comprises identifying a planned deployment location for positioning a distal tip of the interventional instrument to perform the procedure on the target structure based upon the operational capability of the interventional instrument. 120-. (canceled)21. A system for performing an interventional procedure , the system comprising:an interventional instrument comprising a catheter and an interventional tool extendable from the catheter; and receive a model of an anatomic structure, the anatomic structure including a plurality of passageways;', 'identify a target structure in the model;', 'receive information about a maximum extension length the interventional tool can be extended relative to a distal tip of the catheter; and', 'based upon the received information about the maximum extension length, identify a planned deployment location for positioning the distal tip of the catheter to perform the interventional procedure on the target structure., 'a control system comprising a processor and a memory comprising machine-readable instructions that, when executed by the processor, cause the control system to22. The system of claim 21 , wherein the interventional tool comprises an imaging probe.23. The system of claim 22 , wherein the imaging probe comprises an ultrasound probe.24. The system of claim 22 , wherein the imaging probe comprises an optical coherence tomography probe.25. The system of claim 21 , wherein the machine-readable instructions claim 21 , when executed by the processor claim 21 , further cause the control system to track movement of the interventional ...

Systems and methods for deriving and displaying the propagation velocities of electrical events in the heart

Systems and methods examine heart tissue morphology by locating electrodes in contact with a region of heart tissue to sense the timing of a local depolarization events. From this, the systems and methods derive the propagation velocities of the depolarization events and create an output that displays the derived propagation velocities in spatial relation to sensing electrode. The systems and methods can arrange the derived propagation velocities into groups of equal propagation velocities and generate in three dimensions an output of the groups of equal propagation velocities in spatial relation to the location of the sensing electrodes. The iso-conduction display more rapidly identifies the regions of slow conduction which are candidate ablation sites, than an iso-chronal or iso-delay display.

Matching electrical characteristics and propagation velocities to locate ablation sites

Systems (10) and methods examine heart tissue morphology for the purpose of locating a potential ablation site. The systems and methods derive the electrical characteristic of tissue lying between the electrode pairs (38) based, at least in part, upon sensing tissue impedances. The systems and methods also sense the timing of local depolarization events in the tissue in which impedance is sensed and derive therefrom the propagation velocities of the sensed depolarization events. The systems and methods match the derived tissue electrical characteristics with the derived propagation velocities in spatial relation to the electrodes to characterize the morphology of the contacted heart tissue to identify a potential ablation site.

System and methods for matching electrical characteristics and propagation velocities in cardiac tissue

Systems and methods examine heart tissue morphology using three or more spaced apart electrodes, at least two of which are located within the heart in contact with endocardial tissue. The systems and methods transmit electrical current through a region of heart tissue lying between selected pairs of the electrodes, at least one of the electrodes in each pair being located within the heart. The systems and methods derive the electrical characteristic of tissue lying between the electrode pairs based, at least in part, upon sensing tissue impedances. The systems and methods also sense the timing of local depolarization events in the tissue in which impedance is sensed and derive therefrom the propagation velocities of the sensed depolarization events. The systems and methods match the derived tissue electrical characteristics with the derived propagation velocities in spatial relation to the electrodes to characterize the morphology of the contacted heart tissue. This matching provides precise differentiation between regions of infarcted heart tissue and healthy heart tissue.

System and method for matching electrical characteristics and propagation velocities in cardiac tissue to locate potential ablation sites

Systems and methods examine heart tissue morphology for the purpose of locating a potential ablation site. The systems and methods derive the electrical characteristic of tissue lying between the electrode pairs based, at least in part, upon sensing tissue impedances. The systems and methods also sense the timing of local depolarization events in the tissue in which impedance is sensed and derive therefrom the propagation velocities of the sensed depolarization events. The systems and methods match the derived tissue electrical characteristics with the derived propagation velocities in spatial relation to the electrodes to characterize the morphology of the contacted heart tissue to identify a potential ablation site.

Systems for locating and guiding operative elements within interior body regions

Systems and methods for locating an operative element within an interior body space use a locating probe, which includes at least one transmitting element to transmit an electric waveform output within at least a portion of the space. The systems and methods also use a sensing element, which is adapted to be carried by the operative element to sense a local electric waveform within the space. A processing element coupled to the sensing element generates a processed output that locates the sensing element relative to the locating probe based, at least in part, upon a differential comparison of the waveform output and the sensed local waveform.

Systems and methods for guiding and locating functional elements on medical devices positioned in a body

A system for performing an invasive diagnostic or therapeutic medical procedure includes a first probe having a distal portion carrying a plurality of functional elements and a second probe having a distal portion carrying a functional element and a location sensor. The system includes a proximity processing subsystem in communication with the functional elements carried by each of the first and second probes and configured to determine a proximity of the functional element carried by the second probe relative to a first functional element carried by the first probe. The systems further includes a location processing subsystem configured to determine an absolute position and orientation of the location sensor carried by the second probe with respect to a three-dimensional reference coordinate system that can be internal or external to the three-dimensional space in which the first and second probes are positioned.

High-resolution mapping of tissue with pacing

Systems and methods for high-resolution mapping of tissue

According to some embodiments, methods and systems of enhancing a map of a targeted anatomical region comprise receiving mapping data from a plurality of mapping electrodes, receiving high-resolution mapping data from a high-resolution roving electrode configured to be moved to locations between the plurality of mapping electrodes, wherein the mapping system is configured to supplement, enhance or refine a map of the targeted anatomical region or to directly create a high-resolution three-dimensional map using the processor receiving the data obtained from the plurality of mapping electrodes and from the high-resolution roving electrode.

Ablation devices, systems and methods of using a high-resolution electrode assembly

According to some embodiments, an ablation device comprises an elongate body (e.g., a catheter) having a proximal end and a distal end, a first electrode (e.g., a radiofrequency electrode) positioned at the distal end of the elongate body, at least a second electrode (e.g., a radiofrequency electrode) positioned at a location proximal to the first electrode, the first electrode and the second electrode being configured to contact tissue of a subject and deliver radiofrequency energy sufficient to at least partially ablate the tissue, at least one electrically insulating gap positioned between the first electrode and the second electrode and a filtering element configured to present a low impedance at a frequency used for delivering ablation energy via the first and second electrodes.

Contact sensing systems and methods

According to some embodiments, a medical instrument comprises an elongate body having a proximal end and a distal end and a pair of electrodes or electrode portions (for example, a split-tip electrode assembly). Systems and methods are described herein that perform contact sensing and/or ablation confirmation based on electrical measurements obtained while energy of different frequencies are applied to the pair of electrodes or electrode portions. The contact sensing systems and methods may calibrate network parameter measurements to compensate for a hardware unit in a network parameter measurement circuit or to account for differences in cables, instrumentation or hardware used.

Interface for performing a diagnostic or therapeutic procedure on heart tissue with an electrode structure

An interface for performing a diagnostic or therapeutic procedure on heart tissue with an electrode structure includes a controller which operates to establish an operating condition for the electrode structure, a processing unit coupled to the controller, a memory storage device including process software adapted to be executed by the processing unit and a graphical user interface including a display screen coupled to the processing unit. The process software performs a first control application and a second control application, each control application prescribing procedures for carrying out a given task using the electrode structure, at least one of the control applications prescribing a clinical procedure affecting heart tissue. The process software further performs a first function to create on the display screen separate first and second display regions, a second function to show in the first display region a selection menu display comprising a first field for selecting the first control application for execution and a second field for selecting the second control application for execution, and a third function to show in the second display region a first graphical display during execution of the first control application and a second graphical display during execution of the second control application.

Tissue heating and ablation systems and methods using self-heated electrodes

Systems and methods using an electrode able to transmit heating or ablation energy into tissue include first and second sensing elements associated with the electrode for measuring first and second temperatures. The electrode also includes a heating element in thermal conductive contact with the electrode for heating the electrode. The systems and methods sequentially activate the heating element and sense temperatures without transmitting tissue heating or ablation energy, and then transmit heating or ablation energy and sense temperatures without activating the heating element, to derive from the sensed temperatures a prediction of maximum tissue temperature.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Tissue heating and ablation systems and methods using predicted temperature for monitoring and control

Systems and methods employ an energy emitting electrode to heat tissue. The systems and methods derive a temperature prediction for a future time period. The systems and methods control the application of energy to the energy emitting electrode based, at least in part, upon the temperature prediction.

Systems and methods for identifying the physical, mechanical, and functional attributes of multiple electrode arrays

Systems and methods identify the physical, mechanical, and functional attributes of multiple electrode arrays. The systems and methods provide a structure adapted for contact with tissue in an interior body region. The structure possesses a physical property affecting tissue contact. The systems and methods include an identification code that uniquely identifies the physical property of the structure, such as size of the structure, or shape of the structure, or symmetry or lack of symmetry of the structure, or a stiffness value of the structure, or combinations thereof. The systems and methods also include an identification element attached in association with the structure to retain the identification code. The identification element is adapted to provide an output representative of the identification code. The structure also carries at least one electrode. The electrode possesses-a physical property, or both. The identification code uniquely identifies both the physical property of the structure and the physical or functional property of the electrode. The identification element retains one or more of these physical or functional properties for output and consideration prior to use of the structure.

Systems and methods for sensing sub-surface temperatures in body tissue

Systems and methods supply ablation energy to an electrode in contact with tissue to form a tissue-electrode interface. The system and methods sense, simultaneously with ablation, at least two tissue temperature conditions using at least two tissue temperature sensing elements which are held within a carrier that is substantially isolated from thermal conductive contact with the electrode. The carrier holds the tissue temperature sensing elements in a spaced apart relationship in thermal conductive contact with tissue at different depths beneath the tissue-electrode interface. The systems and methods control the supply of ablation energy to the electrode based, at least in part, upon temperatures sensed by the tissue temperature sensing elements.

Systems and apparatus for sensing temperature in body tissue

An apparatus for ablating body tissue has an electrode for contacting tissue to transmit ablation energy. A tissue temperature sensing element is held in a thermally conducting carrier on the electrode. The carrier holds the tissue temperature sensing element in thermal conductive contact with tissue, while keeping the temperature sensing element in isolation from thermal conductive contact with the electrode. The carrier has prescribed thermal conductive characteristics that significantly improve the sensitivity of the temperature sensing element to tissue temperature and not the temperature of the electrode.

Systems and methods for sensing temperature within the body

Systems and methods well suited for use in catheter based tissue ablation systems employ thermocouples (80) for temperature sensing at an energy emitter site (30). The sensed temperature is used to control the energy output from the energy source to maintain tissue temperature within desired parameters. The systems combine accuracy with compact, low profile construction.

Systems and methods for ablating body tissue using predicted maximum tissue temperature

Systems and methods ablate body tissue using an electrode for contacting tissue at a tissue-electrode interface to transmit ablation energy at a determinable power level. The systems and methods include an element to remove heat from the electrode at a determinable rate. The systems and methods employ a processing element to derive a prediction of the maximum tissue temperature condition occurring beneath the tissue-electrode interface. The processing element controls the power level of ablation energy transmitted by the electrode, or the rate at which the electrode is cooled, or both, based, at least in part, upon the maximum tissue temperature prediction.

System for controlling tissue ablation using temperature sensors

This invention is a system and associated method to ablate body tissue using multiple emitters (30) of ablating energy. The system and method convey ablating energy individually to each emitter (30) in a sequence of power pulses. The system and method periodically sense the temperature of each emitter (30) and compare the sensed temperatures to a desired temperature established for all emitters (30) to generate a signal individually for each emitter (30) based upon the comparison. The system and method individually vary the power pulse to each emitter (30) based upon the signal for that emitter to maintain the temperatures of all emitters essentially at the desired temperature during tissue ablation.

Systems and methods for sensing multiple temperature conditions during tissue ablation

Systems and methods for ablating body tissue use an electrode for contacting tissue to form a tissue-electrode interface. The electrode is adapted to be connected to a source of ablation energy to conduct ablation energy for transmission by the electrode into tissue at the tissue-electrode interface. The electrode is preferably cooled. The systems and methods include multiple temperature sensing elements. One element senses tissue temperature. A second element senses electrode temperature. A third element senses the rate at which the electrode is cooled. The systems and methods control the supply of ablation energy to the electrode based, at least in part, upon the multiple temperatures sensed by the different temperature sensing elements.

Systems and methods for obtaining desired lesion characteristics while ablating body tissue

This invention is systems and methods for ablating body tissue use, and electrode (16) for contacting tissue. The electrode (16) is coupled to a source of ablation energy (12) for transmitting ablation energy at a prescribed ablation power level into tissue to form, over a prescribed time period, a therapeutic result. The systems and methods include an element (50) to cool the electrode (16). An input element (100) inputs a desired result, and a processing element (98) retains a function correlating an observed relationship among lesion boundary depth, ablation power level, ablation time and temperature. The processing element (98) compares the desired result to the function and selects an operating condition based upon the comparison to achieve the desired result.

Systems and methods for sensing sub-surface temperatures in body tissue during ablation with actively cooled electrodes

Systems and associated methods for ablating body tissue employ an electrode for contacting tissue to form a tissue-electrode interface. The electrode is adapted to be connected to a source of ablation energy to conduct ablation energy for transmission by the electrode into tissue at the tissue-electrode interface. The systems and methods also include an element to cool the electrode. The systems and methods hold a tissue temperature sensing element in a carrier in thermal conductive contact with tissue beneath the tissue-electrode interface. The systems and methods include a controller that is coupled to the tissue temperature sensing element to control either the supply of ablation energy, or the rate at which the electrode is cooled, or both based, at least in part, upon temperature sensed by the temperature sensing element.

Tissue heating and ablation systems and methods which predict maximum tissue temperature

Systems and methods heat or ablate body tissue by positioning an electrode to transmit heat or ablation energy to a tissue region. The systems and methods measure a first temperature using a temperature sensing element associated with the electrode. The systems and methods also measure a second temperature using a temperature sensing element associated with the electrode. The systems and methods process at least one of the first and second temperatures to derive a prediction of maximum temperature of the tissue region. The systems and methods generate an output that controls the transmission of the heating or ablation energy based, at least in part, upon the maximum tissue temperature prediction.

Systems and methods for controlling power in an electrosurgical probe

Systems and methods for controlling the power supplied to an electrosurgical probe. The systems and methods may be used to monitor electrode-tissue contact, adjust power in response to a loss of contact, and apply power in such a manner that charring, coagulum formation and tissue popping are less likely to occur.

Compensation for power variation along patient cables

A method and system for delivering power over a patient cable to a therapeutic device, in which a variable that depends on the delivered power is sensed or measured near a distal end of the patient cable, and a feedback signal is generated based on the sensed or measured value. The delivered power is adjusted based at least in part on the feedback signal to compensate for power variance along the patient cable.

Expandable-collapsible electrode structures for capacitive coupling to tissue

Electrode assemblies and associated systems employ a nonporous wall having an exterior for contacting tissue. The exterior peripherally surrounds an interior area. The wall is essentially free of electrically conductive material. The wall is adapted to assume an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. The assemblies and systems include a lumen that conveys a medium containing ions into the interior area. An element free of physical contact with the wall couples the medium within the interior area to a source of electrical energy to enable ionic transport of electrical energy from the source through the medium to the wall for capacitive coupling to tissue contacting the exterior of the wall.

Folding electrode structures

Improved folding electrode assemblies and associated methods employ a structure comprising a wall peripherally enclosing an interior. The structure is adapted to selectively assume a geometry that changes between an expanded geometry having a first maximum diameter and a collapsed geometry having a second maximum diameter less than the first maximum diameter. At least one folding region in the wall is adapted to fold upon itself along a predefined fold line as the structure geometry changes. The folding region is formed when a portion of the wall is coated with an electrically conductive material for the purpose of transmitting electrical ablating energy, while another portion of the wall is left free of the electrically conductive material. Alternatively, the folding region is formed by forming an array of apertures in the wall.

Quantitative three-dimensional imaging and 3d modeling of surgical implants

Systems for recording use of structures deployed in association with heart tissue

A system records use of a structure deployed in operative association with heart tissue in a patient. An image controller generates an image of the structure while in use in the patient. An input receives data including information identifying the patient. An output processes the image in association with the data as a patient-specific, data base record for storage, retrieval, or manipulation.