Power supply device and ablation system

Abstract

To provide a novel technology related to a catheter ablation method.SOLUTION: A power supply device 8 includes: a power supply part 26 that applies a voltage to a plurality of electrodes, the power supply part 26 being electrically connected to a catheter 4 including a plurality of electrodes; and a control part 28 that controls the power supply part 26 so as to apply a voltage to some electrodes continuously multiple times and then apply a voltage to the other electrodes continuously multiple times.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present disclosure relates to a power supply and an ablation system. [Background technology]

[0002] Patent Document 1 discloses an ablation system including an ablation catheter and a pulse waveform generator that delivers a voltage pulse to the ablation catheter. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Special Publication No. 2019-500170 Summary of the Invention [Problem to be solved by the invention]

[0004] As a result of extensive investigations, the present inventors have come up with a novel technique for catheter ablation.

[0005] The present disclosure has been made in light of these circumstances, and has an object to provide a novel technique related to catheter ablation. [Means for solving the problem]

[0006] One aspect of the present disclosure is a power supply device that includes a power supply unit electrically connected to a catheter having multiple electrodes and that applies a voltage to the multiple electrodes, and a control unit that controls the power supply unit to apply a voltage to some of the electrodes multiple times in succession and then apply a voltage to other electrodes multiple times in succession.

[0007] Another aspect of the present disclosure is an ablation system comprising a catheter having a plurality of electrodes and a power supply device according to the above aspect.

[0008] Any combination of the above components and any conversion of the expression of the present disclosure between a method, an apparatus, a system, etc. are also valid as aspects of the present disclosure. Effect of the Invention

[0009] According to the present disclosure, a novel technique for catheter ablation can be provided. [Brief description of the drawings]

[0010] [Figure 1] 1 is a schematic diagram of an ablation system according to an embodiment. [Diagram 2] FIG. 2 is a perspective view of an electrode assembly. [Diagram 3] FIG. 4 is a diagram showing a first example of the timing of applying voltage to each electrode. [Figure 4] FIG. 11 is a diagram showing a second example of the timing of applying voltages to each electrode. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] The present disclosure will be described below with reference to the drawings based on preferred embodiments. The embodiments are illustrative and do not limit the present disclosure, and all features and combinations thereof described in the embodiments are not necessarily essential to the present disclosure. The same or equivalent components, members, and processes shown in each drawing are given the same reference numerals, and duplicated descriptions are omitted as appropriate. In addition, the scale and shape of each part shown in each drawing are set for convenience to facilitate explanation, and are not to be interpreted as being limiting unless otherwise specified. In addition, when terms such as "first" and "second" are used in this specification or claims, unless otherwise specified, these terms do not represent any order or importance, but are intended to distinguish one configuration from another. In addition, some of the members that are not important in explaining the embodiment in each drawing are omitted.

[0012] Fig. 1 is a schematic diagram of an ablation system 1 according to an embodiment. In Fig. 1, some of the components of the ablation system 1 are depicted as functional blocks. At least some of these functional blocks can be realized as a hardware configuration by elements and circuits such as a computer CPU and memory, and as a software configuration by a computer program or the like. Those skilled in the art will understand that these functional blocks can be realized in various ways by combining hardware and software.

[0013] The ablation system 1 performs a predetermined ablation on an affected area 2 of a patient. An example of the affected area 2 is an organ in which arrhythmia occurs. The ablation system 1 can also be used for ablation on other affected areas 2. The ablation system 1 includes a catheter 4, a return electrode 6, and a power supply unit 8.

[0014] The catheter 4, as an example, has a shaft 10, an electrode assembly 12, and a handle 14. The shaft 10 is made of a flexible tubular body, and at least the tip side is inserted into the patient's body. The shaft 10 is made of a known flexible material including resins such as polyolefin, polytetrafluoroethylene, polyether block amide, and polyamide. The shaft 10 has a multi-lumen structure having, for example, multiple lumens. Various thin wires (not shown) such as conductors and operating wires, an inner tube 22 (see FIG. 2), which will be described later, and the like are inserted into the lumens.

[0015] An electrode assembly 12 is provided at the tip of the shaft 10. Fig. 2 is a perspective view of the electrode assembly 12. The electrode assembly 12 has a plurality of splines 16 and a plurality of electrodes 18. Note that Fig. 1 illustrates the splines 16 in a folded state, and Fig. 2 illustrates the splines 16 in an expanded state.

[0016] Each spline 16 is a linear body extending in the axial direction of the shaft 10, and is made of the same flexible material as the shaft 10. The electrode assembly 12 shown in FIG. 2 has a first spline 16a, a second spline 16b, a third spline 16c, a fourth spline 16d, a fifth spline 16e, and a sixth spline 16f as an example, but the number of splines 16 is not limited to six and may be any number. In the present disclosure, when it is not necessary to distinguish the first spline 16a to the sixth spline 16f from one another, they may be simply referred to as "splines 16."

[0017] The splines 16 are arranged at intervals around the axis of the shaft 10. The distal end of each spline 16 is connected to a distal tip 20. The proximal end of each spline 16 is inserted into the shaft 10 from its distal end and fixed to the shaft 10. The distal tip 20 is connected to the distal tip 20 with the distal end of an inner tube 22 connected to the distal tip 20. The inner tube 22 is passed through the lumen of the shaft 10 and has a proximal end connected to the handle 14. The inner tube 22 can be advanced and retreated toward the distal end and proximal end of the shaft 10 by operating the handle 14.

[0018] When the inner tube 22 is pulled toward the base end of the shaft 10 with each spline 16 extending linearly, the distal tip 20 is displaced toward the base end of the shaft 10. This causes each spline 16 to curve and bulge outward, and the electrode assembly 12 assumes a basket shape. When the inner tube 22 is pushed toward the distal end of the shaft 10 with each spline 16 curved, the distal tip 20 is displaced toward the distal end of the shaft 10. This causes each spline 16 to become linear, and the electrode assembly 12 is folded. The term "basket shape" comes from the fact that the shape of the multiple splines 16 resembles the curved pattern on the surface of a basketball.

[0019] A plurality of electrodes 18 are provided on each spline 16. The plurality of electrodes 18 are arranged at a predetermined interval from each other in the longitudinal direction of the spline 16. Each electrode 18 is ring-shaped and made of a metal having good electrical conductivity, such as platinum, gold, silver, copper, aluminum, stainless steel, or an alloy thereof. The electrode assembly 12 shown in FIG. 2 has a first electrode 18a, a second electrode 18b, a third electrode 18c, and a fourth electrode 18d on each spline 16 as an example, but the number of electrodes 18 is not limited to four and may be at least one. In the present disclosure, when it is not necessary to distinguish the first electrode 18a to the fourth electrode 18d from each other, they may be simply referred to as "electrodes 18".

[0020] The tip of a conductor wire (not shown) is connected to each electrode 18. The conductor wire is passed through the lumen of the shaft 10, and the base end is connected to a connector (not shown) of the handle 14 shown in FIG. 1. A power supply unit 8 is electrically connected to each conductor wire via the connector of the handle 14. A voltage is applied to the multiple electrodes 18 by the power supply unit 8, as will be described in detail later.

[0021] The handle 14 is provided at the base end of the shaft 10, and is disposed outside the body when the catheter 4 is used, and is grasped or operated by an operator. The handle 14 has a main body portion grasped by the operator and an operation portion for advancing and retracting the inner tube 22. By operating the operation portion, the inner tube 22 can be displaced toward the base end side relative to the shaft 10. As a result, the electrode assembly 12 in the folded state unfolds in a direction intersecting with the axis of the shaft 10. Also, by operating the operation portion, the inner tube 22 can be displaced toward the tip side relative to the shaft 10. As a result, the electrode assembly 12 in the unfolded state is folded. The connector is provided in the main body portion. The catheter 4 may have an irrigation mechanism that sprays an irrigation fluid, such as saline, from the tip during ablation.

[0022] The return electrode 6 is attached to the body surface of the patient during ablation. The return electrode 6 is also electrically connected to a power supply 8. During ablation, a voltage is applied to each electrode 18 and the return electrode 6, thereby performing ablation.

[0023] The power supply device 8 includes an input unit 24, a power supply unit 26, a control unit 28, and a display unit 30. The input unit 24 is composed of, for example, a dial, a button, a touch panel, etc., and is operated by an operator of the ablation system 1. The operator can input various setting values ​​and signals instructing operations to the power supply device 8 via the input unit 24. Note that the various setting values ​​may be preset at the time of product shipment, etc., and held in the power supply device 8. A signal indicating the setting values, etc. is sent from the input unit 24 to the control unit 28.

[0024] The power supply unit 26 supplies the ablation voltage V to the electrode 18 and the return electrode 6 in accordance with a control signal CTL sent from the control unit 28. out The power supply unit 26 is composed of a predetermined power supply circuit such as a switching regulator. The control unit 28 controls the operation of the entire power supply device 8 and executes predetermined arithmetic processing. The control unit 28 is composed of a microcomputer, for example. The control unit 28 controls the application of the voltage Vout to the electrode 18 and the counter electrode 6 by sending a control signal CTL to the power supply unit 26. The display unit 30 displays various information to the outside. The display unit 30 is composed of a liquid crystal display, a CRT display, an organic EL display, etc.

[0025] Next, the contents of the control executed by the control unit 28 will be described. The ablation system 1 of this embodiment performs ablation on the affected area 2 by irreversible electroporation (IRE). Since IRE is non-thermal, it is possible to suppress damage to tissues and nerves located around the affected area 2. For example, when performing pulmonary vein dissection to treat atrial fibrillation, it is possible to suppress damage to the esophagus and phrenic nerve around the affected area, and to suppress the occurrence of esophageal fistula and phrenic nerve paralysis.

[0026] In IRE, pulsed electric field ablation (PFA) is performed. PFA is an ablation technique that kills cells by applying a pulsed electric field generated by applying a high voltage to each electrode 18 and the return electrode 6, that is, forms a lesion in the affected area 2. The electric field tends to be reflected at the boundary between tissues. Therefore, it is possible to suppress damage to adjacent tissues when the affected area is cauterized.

[0027] When the electrode assembly 12 is inserted into the patient's body via a blood vessel or the like and placed at the affected area 2, the control unit 28 controls the power supply unit 26 to apply a voltage to each electrode 18 in sequence according to the rules described below. That is, the control unit 28 controls the power supply unit 26 to apply a voltage to some of the electrodes 18 multiple times in succession, and then apply a voltage to other electrodes 18 multiple times in succession. The "some electrodes 18" and the "other electrodes 18" may each be one electrode 18 or two or more electrodes 18. In addition, "applying a voltage multiple times in succession" means applying a biphasic pulse to the same electrode 18 multiple times without applying a voltage to other electrodes 18 in between. Hereinafter, the application of a voltage multiple times in succession to the same electrode 18 will be referred to simply as "successive application" as appropriate. The fact that a voltage is applied continuously to each electrode 18 in sequence can be confirmed, for example, by connecting an oscilloscope to each electrode 18.

[0028] FIG. 3 is a diagram showing a first example of the timing of applying a voltage to each electrode 18. As an example, the control unit 28 applies a voltage continuously in sequence to the first electrode 18a to the third electrode 18c provided on one spline 16. Then, the control unit 28 applies a voltage continuously in sequence to the first electrode 18a to the third electrode 18c provided on another spline 16. The control unit 28 repeats this sequential application, and finally applies a voltage to all the first electrodes 18a to the third electrodes 18c of the electrode assembly 12. In this embodiment, the fourth electrode 18d on each spline 16 is excluded from the target to which the voltage is applied. The fourth electrode 18d is provided for potential measurement or as a spare when the ablation range is wide. The fourth electrode 18d can be omitted.

[0029] Specifically, first, a voltage is applied continuously a number of times to the first electrode 18a on the first spline 16a. Next, a voltage is applied continuously a number of times to the second electrode 18b on the first spline 16a. Next, a voltage is applied continuously a number of times to the third electrode 18c on the first spline 16a. Next, the voltage application target is shifted to the second spline 16b, and a voltage is applied continuously a number of times in sequence to the first electrode 18a to the third electrode 18c on the second spline 16b. Thereafter, a voltage is also applied continuously a number of times in sequence to each of the electrodes 18 on the third spline 16c to the sixth spline 16f.

[0030] The power supply unit 26 of this embodiment applies a voltage to each electrode 18 to generate a biphasic pulse (bipolar pulse). Thus, a positive voltage phase pulse and a negative voltage phase pulse are applied to each electrode 18, and the polarity of each electrode 18 alternates. The voltage amplitude value Am is, for example, 1000V or more and 4000V or less. The pulse width Δp is, for example, 0.1μs or more and 100μs or less.

[0031] In this embodiment, the voltage is applied to all the electrodes 18 to be applied with the voltage in the electrode assembly 12, that is, the first electrode 18a to the third electrode 18c in the first spline 16a to the sixth spline 16f, in sequence, to complete the ablation. Note that the application of the voltage to all the electrodes 18 to be applied with the voltage is regarded as one cycle, and the ablation may be completed by applying the voltage multiple times. The number of consecutive voltage applications and the number of cycles can be appropriately set based on experiments or the like by the designer. For example, the number of consecutive applications is set in the range of 2 to 100 times. Also, the number of consecutive applications may differ for each electrode. The number of cycles is, for example, 1 to 1000 cycles. Also, the control unit 28 may control the power supply unit 26 to repeat the sequential application of the voltage multiple sets, with multiple cycles of voltage application regarded as one set. The number of sets can be appropriately set based on experiments or the like by the designer, and is, for example, 1 to 100 sets.

[0032] By sequentially applying a voltage to each electrode 18, it is possible to increase the region that can be formed by each electrode 18 compared to the case where a voltage is simultaneously applied to all of the multiple electrodes 18. This is believed to be because, when a voltage is applied to all of the multiple electrodes 18 at once, the current flows dispersedly among the multiple electrodes 18, decreasing the current density, whereas, when a voltage is applied sequentially to each electrode 18, the current is concentrated in one electrode 18, increasing the current density. In addition, by sequentially applying a voltage to the multiple electrodes 18 at intervals, it is possible to suppress the occurrence of body movements of the patient due to PFA.

[0033] Furthermore, by continuously applying a voltage to the same electrode 18, the number of times the power supply target is switched can be reduced compared to the case where the power supply target is switched every time a voltage is applied, and therefore the control executed by the control unit 28 can be simplified.

[0034] Furthermore, the control unit 28 may control the power supply unit 26 as follows. Fig. 4 is a diagram showing a second example of the timing of applying a voltage to each electrode 18. That is, the control unit 28 controls the power supply unit 26 to apply a voltage multiple times in succession to all electrodes 18 to which a voltage is applied and which are provided on some of the splines 16, and then to apply a voltage multiple times in succession to all electrodes 18 to which a voltage is applied and which are provided on other splines 16. The "some splines 16" and the "other splines 16" may each be one spline 16 or two or more splines 16.

[0035] As an example, the control unit 28 continuously applies a voltage simultaneously to the first electrode 18a to the third electrode 18c provided on one spline 16. Then, the control unit 28 continuously applies a voltage simultaneously to the first electrode 18a to the third electrode 18c provided on another spline 16. The control unit 28 repeats this sequential application, and finally applies a voltage to all of the first electrodes 18a to the third electrodes 18c of the electrode assembly 12. In this disclosure, "simultaneously applied" means that the states in which the voltages are applied to the electrodes 18 overlap at least temporarily.

[0036] Specifically, first, a voltage is applied to the first electrode 18a to the third electrode 18c on the first spline 16a in succession multiple times. Next, the target of voltage application is shifted to the second spline 16b, and the voltage is applied to the first electrode 18a to the third electrode 18c on the second spline 16b in succession multiple times. Thereafter, the target of voltage application is shifted to the third spline 16c to the sixth spline 16f in order, and the voltage is applied to the first spline 16a to the third electrode 18c of each spline 16 in succession multiple times. Note that the application of voltage to all splines 16 is regarded as one revolution, and ablation may be completed by applying voltage multiple revolutions. Furthermore, multiple revolutions of voltage application may be regarded as one set, and multiple sets of voltage application may be performed. The number of consecutive voltage applications, the number of revolutions, and the number of sets are as described above.

[0037] In this way, by switching the target to which the voltage is applied in units of splines, the region that can be formed by each electrode 18 can be enlarged, as in the first example in which the target to which the voltage is applied is switched in units of electrodes. Moreover, compared to the first example, the control can be further simplified. Moreover, the power supply circuit for switching the target to which the voltage is applied can be easily simplified. This allows the power supply device 8 to be made smaller. Moreover, it is possible to easily add electrodes 18. Moreover, compared to the first example, the time required for ablation can be shortened. Or, if the time until ablation is completed is the same, the number of times the voltage is applied can be increased, so that the region can be made larger.

[0038] Note that the order of power supply is not limited as long as voltage is ultimately applied to all of the electrodes 18 to be powered in the electrode assembly 12. For example, after a voltage is continuously applied to some of the electrodes 18 to be powered on one spline 16, the power supply target may shift to the electrodes 18 on the next spline 16. As one example, after a voltage is continuously applied in sequence to the first electrodes 18a on each spline 16, a voltage may be continuously applied in sequence to the second splines 16b on each spline 16, and finally a voltage may be continuously applied in sequence to the third splines 16c on each spline 16.

[0039] The order of power supply to the first electrode 18a to the third electrode 18c on each spline 16 is not limited. The order of power supply to the first electrode 18a to the third electrode 18c may be different for each spline 16. The order of power supply to the first spline 16a to the sixth spline 16f is not limited. Some splines 16 may be excluded from the power supply targets. The electrodes 18 may be divided into a number of electrode groups less than the number of the electrodes 18, and a voltage may be applied to each electrode group in sequence. The above-mentioned second example is an example of such grouping. The electrodes 18 belonging to each electrode group may be arranged on different splines 16. The electrodes 18 on one spline 16 may belong to different electrode groups. The same electrode 18 may be assigned to two or more different electrode groups.

[0040] Furthermore, the shape and number of the splines 16 and the electrodes 18 are not limited. Furthermore, the catheter 4 may not have the splines 16 at the tip of the shaft 10, and the electrodes 18 may be disposed on the shaft 10. Furthermore, the power supply unit 26 may apply a voltage to each electrode 18 to generate a monophasic pulse.

[0041] The configurations of the catheter 4 and the power supply device 8 can be changed as appropriate. For example, the distal end side of the shaft 10 of the catheter 4 may be bent in one direction or in multiple directions by operating the handle 14. The control of the power supply unit 26 by the control unit 28 may be realized by hardware (circuit) or software (program). When realized by software, the software is composed of a group of programs for causing a computer to execute each function. Each program may be, for example, built into the computer in advance, or may be installed into the computer from a network or a recording medium.

[0042] The above describes the embodiments of the present disclosure in detail. The above-mentioned embodiments merely show specific examples of implementing the present disclosure. The contents of the embodiments do not limit the technical scope of the present disclosure, and many design changes such as changes, additions, and deletions of components are possible within the scope of the idea of ​​the present disclosure defined in the claims. A new embodiment with a design change has the effects of each of the combined embodiments and modifications. In the above-mentioned embodiments, the contents for which such design changes are possible are emphasized by adding notations such as "in this embodiment" and "in this embodiment", but design changes are permitted even in contents without such notations. Any combination of components included in each embodiment is also valid as an aspect of the present disclosure. The hatching on the cross section of the drawing does not limit the material of the object to which the hatching is added.

[0043] The embodiment may be specified by the items described below. [1st item] a power supply unit (26) electrically connected to the catheter (4) having a plurality of electrodes (18) and configured to apply a voltage to the plurality of electrodes (18); and a control unit (28) that controls the power supply unit (26) to apply a voltage to some of the electrodes (18) multiple times in succession, and then apply a voltage to other electrodes (18) multiple times in succession. Power supply (8). [Second item] The catheter (4) has a shaft (10) and a plurality of splines (16) arranged in a circumferential direction of the shaft (10), Each spline (16) is provided with at least one electrode (18); the control unit (28) controls the power supply unit (26) to apply a voltage multiple times in succession to all of the electrodes (18) to be supplied with power and provided on some of the splines (16), and then to apply a voltage multiple times in succession to all of the electrodes (18) to be supplied with power and provided on another of the splines (16); The power supply device (8) as described in item 1. [3rd item] a catheter (4) having a plurality of electrodes (18); The power supply device (8) according to the first or second item, Ablation system (1). [Explanation of symbols]

[0044] 1 ablation system, 4 catheter, 8 power supply, 10 shaft, 16 spline, 18 electrode, 26 power supply unit, 28 control unit.

Claims

1. a power supply unit electrically connected to the catheter having a plurality of electrodes and configured to apply a voltage to the plurality of electrodes; and a control unit that controls the power supply unit to apply a voltage to some of the electrodes multiple times in succession and then apply a voltage to other of the electrodes multiple times in succession. power supply.

2. The catheter includes a shaft and a plurality of splines arranged in a circumferential direction of the shaft, At least one of said electrodes is provided on each spline; the control unit controls the power supply unit to apply a voltage multiple times in succession to all of the electrodes to which a voltage is applied that are provided on some of the splines, and then to apply a voltage multiple times in succession to all of the electrodes to which a voltage is applied that are provided on another of the splines.

2. The power supply device of claim 1.

3. A catheter having a plurality of electrodes; The power supply device according to claim 1 or 2, Ablation system.

Images