Catheter systems for forming a fistula and methods thereof

Abstract

A catheter includes a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends, an electrode including a tip, the electrode positioned within the electrode lumen and movable along a length of the catheter body between a retracted position and an extended position, and a magnet positioned at the tip of the electrode. Moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen.

Description

CATHETER SYSTEMS FOR FORMING A FISTULA AND METHODS THEREOFTECHNICAL FIELD

[0001] The present specification generally relates to catheters for forming fistulas and, more specifically, catheters for forming fistulas at the perforator vein.BACKGROUND

[0002] Fistulas may be formed to redirect blood flow from one body vessel to another, thereby increasing blood flow through the body vessel. The increased blood flow may increase the effectiveness of medical procedures, such as dialysis. In such cases, it may be desirable to increase blood flow through a dialyzer. Blood vessels that include a branched vessel, such as the perforator vein, have high levels of blood flow compared to blood vessels without a branched vessel. Therefore, it may be desirable to form a fistula at a location of the branched vessel. However, traditional fistula-forming catheters are not equipped for forming a fistula at a location of the branched vessel.SUMMARY

[0003] In one aspect, a catheter includes a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends, an electrode including a tip, the electrode positioned within the electrode lumen and movable along a length of the catheter body between a retracted position and an extended position, and a magnet positioned at the tip of the electrode. Moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen.

[0004] In another aspect, a catheter system includes a first catheter and a second catheter. The first catheter includes a first catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends, an electrode including a tip, the electrode positioned within the electrode lumen and movable along a length of the first catheter body between a retracted position and an extended position, and a magnet positioned at the tip of the electrode. Moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen. Thesecond catheter includes a second catheter body and one or more magnets coupled to the second catheter body configured to coapt with the magnet of the first catheter.

[0005] In yet another aspect, a method of operating a catheter system, the method includes providing a first catheter, providing a second catheter, coapting the first catheter with the second catheter, and energizing an electrode. The first catheter body includes an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends, the electrode including a tip, the electrode positioned within the electrode lumen and movable along a length of the first catheter body between a retracted position and an extended position, and a magnet positioned at the tip of the electrode. Moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen. The second catheter includes a second catheter body and one or more magnets coupled to the second catheter body configured to coapt with the magnet of the first catheter.

[0006] These and additional features provided by the embodiments described herein will be more fully understood in view of the following detailed description, in conjunction with the drawings.BRIEF DESCRIPTION OF THE DRAWINGS

[0007] The embodiments set forth in the drawings are illustrative and exemplary in nature and not intended to limit the subject matter defined by the claims. The following detailed description of the illustrative embodiments can be understood when read in conjunction with the following drawings, where like structure is indicated with like reference numerals and in which:

[0008] FIG. 1A schematically depicts a perspective view of a catheter system for forming a fistula including an ablation catheter and a coaptation catheter, according to one or more embodiments shown and described herein;

[0009] FIG. IB schematically depicts a cross sectional view of the catheter system of FIG. 1 A, according to one or more embodiments shown and described herein;

[0010] FIG. 2 schematically depicts a front view of a tip of an electrode of the ablation catheter of FIG. 1A, according to one or more embodiments shown and described herein;

[0011] FIG. 3 schematically depicts a cross sectional view of the ablation catheter of the catheter system in a deployed position, according to one or more embodiments shown and described herein;

[0012] FIG. 4A schematically depicts the catheter system of FIG. 1A traversing body vessels to a treatment site, according to one or more embodiments shown and described herein;

[0013] FIG. 4B schematically depicts the catheter system of FIG. 1 A forming a fistula at the treatment site, according to one or more embodiments shown and described herein;

[0014] FIG. 4C schematically depicts a fistula formed at the treatment site, according to one or more embodiments shown and described herein;

[0015] FIG. 5 A schematically depicts another electrode of the ablation catheter of FIG. 1A in an undeployed position, according to one or more embodiments shown and described herein;

[0016] FIG. 5B schematically depicts the electrode of FIG. 5 A in a deployed position, according to one or more embodiments shown and described herein;

[0017] FIG. 6A schematically depicts yet another electrode of the ablation catheter of FIG. 1A in an undeployed position, according to one or more embodiments shown and described herein;

[0018] FIG. 6B schematically depicts the electrode of FIG. 6 A in a deployed position, according to one or more embodiments shown and described herein;

[0019] FIG. 7A schematically depicts another ablation catheter of the catheter system of FIG. 1 A, according to one or more embodiments shown and described herein;

[0020] FIG. 7B schematically depicts the ablation catheter of FIG. 7A in a deflected position, according to one or more embodiments shown and described herein;

[0021] FIG. 8 schematically depicts the ablation catheter of FIG. 7A positioned at a treatment site, according to one or more embodiments shown and described herein;

[0022] FIG. 9A schematically depicts yet another ablation catheter of the catheter system of FIG. 1 A, according to one or more embodiments shown and described herein;

[0023] FIG. 9B schematically depicts the ablation catheter of FIG. 9A in a deflected position, according to one or more embodiments shown and described herein; and

[0024] FIG. 10 schematically depicts the ablation catheter of FIG. 9 A positioned at a treatment site, according to one or more embodiments shown and described herein.DETAILED DESCRIPTION

[0025] FIGS. 1-10 depict various embodiments of catheter systems for forming fistulas between two body vessels at a treatment site. The treatment site is located in a body vessel including a branched vessel, such as for example, the perforator vein, at or near the intersection between the body vessel and the branched vessel. The catheter system includes an ablation catheter that forms the fistula, and a coaptation catheter. The coaptation catheter is configured to coapt the two body vessels together, and provides a backstop for the ablation catheter. In some embodiments, the ablation catheter includes an electrode that is extendable out of a tip of the ablation catheter. In such embodiments, the ablation catheter may be traversed down the branched vessel toward the treatment site and the electrode may extend out of the tip of the ablation catheter toward the other body vessel to form the fistula. In other embodiments, the ablation catheter may include a pivotable tip so that the ablation catheter may be traversed down the branched vessel and pivoted at the treatment site with a leaf spring electrode extending radially from the pivotable tip to contact the vessel wall and form the fistula. Various embodiments of the catheter system and the operation thereof will be described in more detail herein.

[0026] Referring now to FIGS. 1A and IB, an illustrative catheter system 10 for forming a fistula F (FIG. 4C) is depicted. The catheter system 10 may include a first catheter 12, a second catheter 14, a handle 16, and a radiofrequency generator 18. The handle 16 may be operatively coupled to the first catheter 12 to control operation of various components of the first catheter 12, as will be discussed in further detail herein. The radiofrequency generator 18 may be a traditional radiofrequency generator, such as the BD ESU-1 Electrosurgical Generator, that generates radiofrequency energy to be transferred to an electrode that is capable of ablating tissue in the body vessel, thereby forming a fistula. The radiofrequency generator18 may be provided externally to the handle 16 and selectively coupled to the handle 16 to provide radiofrequency energy to an electrode disposed therein, as will be discussed in further detail herein. Alternatively, the radiofrequency generator 18 may be provided within the handle 16. While the radiofrequency generator 18 provides radiofrequency energy for forming fistulas, it is contemplated and possible that a generator that produces another type of energy, such as thermal, could be used in conjunction with the catheter system 10.

[0027] The second catheter 14 may be a coaptation catheter 14, and will be referred to as such throughout the ensuing description. The coaptation catheter 14 may be configured to coapt the two body vessels together. The coaptation catheter 14 may include a coaptation catheter body 20, and a plurality of alignment elements 22 (FIG. IB). The plurality of alignment elements 22 are configured to coapt with the ablation catheter 12 to draw the ablation catheter 12 toward the coaptation catheter 14. The plurality of alignment elements 22 may be arranged along a length of the coaptation catheter body 20, and positioned within the coaptation catheter body 20 so that the coaptation catheter body 20 completely encloses the plurality of alignment elements 22. The alignment elements 22 may be configured to articulate relative to one another to allow the coaptation catheter 14 to bend throughout and maneuver tortuous anatomy. The alignment elements 22 may be sized and shaped, spaced apart, pivotally coupled to one another, or any combination thereof to allow the alignment elements 22 to articulate relative to one another. For example, as depicted in FIG. IB, the alignment elements 22 are cube shaped, where the coaptation catheter body 20 may be deformable (e.g., made of a deformable material) to stretch around the alignment elements 22 as the alignment elements 22 pivot relative to one another to allow the coaptation catheter 14 to bend and maneuver tortuous anatomy. For further example, the alignment elements 22 may be rounded to allow the coaptation catheter body 20 to bend. As yet another example, the alignment elements 22 may include a spacer coupled between each pair of adjacent alignment elements 22 such that the alignment elements 22 may pivot or move relative to the spacer to allow the coaptation catheter body 20 to bend.

[0028] In embodiments, the alignment elements 22 may be magnets or include magnets. However, it is contemplated and possible that the alignment elements 22 are formed of any material or include a mechanism for coapting with another catheter. For example, the alignment elements 22 may be formed of a ferromagnetic material or an electromagnet configured to be magnetically attracted to another catheter. The coaptation catheter 14 mayinclude any operable number of alignment elements 22 for coapting with another catheter, such as one, two, three, or more than three.

[0029] Referring again to FIGS. 1A and IB, the first catheter 12 may be an ablation catheter 12, and will be referred to as such throughout the ensuing description. The ablation catheter 12 may be configured to ablate tissue in a body vessel BV to form a fistula F between two body vessels. The ablation catheter 12 may be coupled to the handle 16 to allow the handle 16 to control operation of the ablation catheter 12, as will be described in further detail herein. As illustrated in Figs. 1A, 2 and 3, the ablation catheter 12 may include an ablation catheter body 24, an electrode 26, and an alignment element 28. The ablation catheter body 24 may include a proximal end 30, a distal tip 32, a distal portion 34 at the distal tip 32, and a proximal portion 35 at the proximal end 30 with the distal portion 34 positioned distal to the proximal portion 35. The ablation catheter body 24 may define an electrode lumen 36 extending along a length of the ablation catheter body 24, and a second lumen (or rapid exchange lumen) 38 formed therein that extends from the electrode lumen 36. The electrode lumen 36 may extend from the proximal end 30 of the ablation catheter body 24 to the distal tip 32 so that the electrode lumen 36 is open at each of the proximal end 30 and the distal tip 32. The proximal end 30 of the ablation catheter body 24 may be coupled to the handle 16 such that the electrode lumen 36 is open to an interior 17 of the handle 16.

[0030] The second lumen 38 may extend from the electrode lumen 36 to an outer radial surface 40 of the ablation catheter body 24 to be open to the outside of the ablation catheter body 24. However, it is contemplated and possible that the second lumen 38 does not intersect the electrode lumen 36, and is spaced apart from the electrode lumen 36. In such embodiments, the second lumen 38 may at least partially extend in parallel with the electrode lumen 36 and extend out of the distal tip 32 of the ablation catheter body 24 separately from the electrode lumen 36. The second lumen 38 may extend obliquely from the electrode lumen 36 and intersect both the outer radial surface 40 of the ablation catheter body 24 and the electrode lumen 36 at the distal portion 34 of the ablation catheter body 24 to allow a guidewire G to extend through the second lumen 38 and into the electrode lumen 36. The guidewire G may extend out of the electrode lumen 36 at the distal tip 32 of the ablation catheter body 24 to allow the guidewire G to guide the ablation catheter body 24 through a body vessel.

[0031] Referring to FIGS. IB and 2, the electrode 26 may include a proximal end 42, a distal end 44, a tip 46 at the distal end 44 of the electrode 26, and a distal surface 48 at the distal end 44. The electrode 26 may be an elongated body that extends from the proximal end 42 to the distal end 44, and have a length that extends from the proximal end 30 of the ablation catheter body 24 beyond the distal tip 32 of the ablation catheter body 24. The electrode 26 may extend beyond the proximal end 30 of the ablation catheter body 24 such that the proximal end 42 of the electrode 26 is positioned within the interior 17 of the handle 16, and may extend proximally from the handle 16. The proximal end 42 of the electrode 26 may be operatively coupled to the radiofrequency generator 18. The electrode 26 may be configured to transfer energy from the radiofrequency generator 18 to the distal end 44 of the electrode 26. The electrode 26 may be movably positionable within the electrode lumen 36 of the ablation catheter body 24 to be movable along the length of the ablation catheter body 24.

[0032] The alignment element 28 of the ablation catheter 12 may be positioned and coupled to the tip 46 of the electrode 26 and be shaped to define an opening 50 about a center 51 thereof that extends from the tip 46 toward the proximal end 42 of the electrode 26. The alignment element 28 may have a shape of, for example, may be ring-shaped. However, this is a non-limiting example, and the alignment element 28 may have any operable shape for coapting with the alignment elements 22 of the coaptation catheter 14 and defining an opening extending therethrough. The alignment element 28 may be formed of a similar material or mechanism to the alignment elements 22 of the coaptation catheter 14 to enable coaptation between the ablation catheter 12 and the coaptation catheter 14. As a non-limiting example, when the alignment elements 22 of the coaptation catheter 14 are formed of magnets, the alignment element 28 of the ablation catheter 12 may be formed of a magnetic material, such as one or more magnets.

[0033] The electrode 26 may extend through the opening 50 in the alignment element 28 so that the alignment element 28 is positioned proximate the electrode tip 46. As used herein, the term “proximate” should be understood to mean sufficiently proximate such that the magnetic forces between the alignment element 28 and the alignment elements 22 of the coaptation catheter 14 attract the catheters to be able to form a fistula. In embodiments, the alignment element 28 may be positioned at the electrode tip 46. The electrode 26 may be positioned relative to and fixed to the alignment element 28, such as be adhesive, press fitting,or the like, so that the distal surface 48 is coplanar with an outer surface 52 of the alignment element 28. When the outer surface 52 of the alignment element 28 is coplanar with the distal surface 48 of the electrode 26, the magnetic forces between the alignment element 28 and the alignment elements 22 is maximized by limiting the distance between each of the alignment elements 22, 28, while simultaneously limiting the distance between the electrode 26 and the coaptation catheter 14. The outer surface 52 of the alignment element 28 may be a surface that the magnetic flux of the alignment element 28 projects from to magnetically attract the alignment elements 22 of the coaptation catheter 14. This is merely an illustrative example, and the alignment element 28 may be arranged with the electrode 26 in any manner so that the alignment element 28 coapts with the alignment elements 22 of the coaptation catheter 14 while allowing the electrode tip 46 to contact walls of a body vessel B V (FIG. 4A) to ablate the tissue of the body vessel. For example, the alignment element 28 may be positioned adjacent the electrode tip 46 with the outer surface 52 substantially coplanar with the distal surface 48 of the electrode 26. In some embodiments, the outer surface 52 of the alignment element 28 may be non-coplanar with the distal surface 48 of the electrode 26 with the alignment element 28 being spaced apart from the electrode 26. Alternatively or additionally, the alignment element 28 may be coupled to the distal portion 34 of the ablation catheter body 24 instead of the electrode tip 46.

[0034] Referring to FIGS. 1 A-3, the electrode 26 may be movable along the length of the electrode lumen 36 between a retracted position (FIG. IB) and an extended position (FIG. 3). Referring to FIG. IB, in the retracted position, the tip 46 of the electrode 26 may be positioned in the electrode lumen 36 proximal to the second lumen 38 to allow the guidewire G to be inserted into the second lumen 38 and extend distally out of the electrode lumen 36.

[0035] Referring to FIGS. 1 A-3, in the extended position, the tip 46 of the electrode 26 is spaced apart from and positioned distally to the ablation catheter body 24. The electrode 26 may move in a proximal-to-distal direction from the retracted position to the extended position. The electrode 26 may be moved via physical manipulation of the electrode 26 by a user, or via an actuator 54 (FIG. 1A). The actuator 54 may be an automatic, or electronically controlled, actuator, such as a linear actuator, or a manual actuator, such as a slider or dial. The actuator 54 may be positioned within and / or coupled to the handle 16, and operatively coupled to the electrode 26 at or near the proximal end 30 of the electrode 26 to be configured to move theelectrode 26 between the retracted position and the extended position. In embodiments where the actuator 54 is an automatic actuator, the handle 16 may include one or more inputs 56 positioned on an exterior of the handle 16 and communicatively coupled to the actuator 54 to be configured to actuate the actuator 54. In such embodiments, operation of the one or more inputs 56 may move the electrode 26 from the retracted position to the extended position or from the extended position to the retracted position. In embodiments where the actuator 54 is a manual actuator, the manual actuator 54 may be partially positioned on the exterior of the handle 16 to be physically attached to the inputs 56 such that physical manipulation of the inputs 56 move the actuator 54. The manual actuator 54 may extend into the handle 16 to be operatively coupled to the electrode 26. In such embodiments, the actuator 54 may be operated by physical manipulation of the inputs 56 or the actuator 54, such as rotating or linear movement or the actuator 54 to move the electrode 26 between the retracted position and the extended position. In embodiments where the actuator 54 is an electronic actuator, the inputs 56 may be electronic inputs communicatively coupled to the actuator 54 such that actuation of the inputs 56 causes the actuator 54 to automatically actuate.

[0036] Operation of the catheter system 10 will now be described with reference to FIGS. 1-4C. Referring initially to FIG. 4A, each of the ablation catheter 12 and the coaptation catheter 14 may be inserted into separate body vessels. Particularly, the ablation catheter 12 may be inserted into a first blood vessel VI that includes a main vessel MV and a branched vessel BV extending from the main vessel MV, and the coaptation catheter 14 may be inserted into a second blood vessel V2. When inserted into the first blood vessel VI, the electrode 26 may be in the retracted position to be positioned within the ablation catheter body 24, and the guidewire G may be inserted into the second lumen 38 of the ablation catheter 12 to extend out of the electrode lumen 36 distally from the ablation catheter body 24 and guide the ablation catheter 12 during movement through the first blood vessel VI. Once positioned in the body vessels, each of the ablation catheter 12 and the coaptation catheter 14 may be moved through the respective body vessels until positioned at the treatment site T. As illustrated in FIG. 4A, the treatment site T may be at an intersection of the branched vessel BV and the main vessel MV of the first blood vessel VI.

[0037] Referring now to FIG. 4B, when positioned at the treatment site T, the guidewire G may be removed from the electrode lumen 36 and the second lumen 38 so that the electrode26 may be moved from the retracted position to the extended position. With the electrode 26 in the extended position, the electrode 26 may contact a vessel wall of the main vessel MV across from the branched vessel BV. When the coaptation catheter 14 is positioned in the second blood vessel V2 adjacent the treatment site T, the ablation catheter 12 may extend across the area where the fistula F is to be formed so that the alignment elements 22 extend across the treatment site T and allow for coaptation with the ablation catheter 12. When each of the ablation catheter 12 and the coaptation catheter 14 are positioned at the treatment site T, the magnetic force between the alignment element 28 of the electrode 26 and the one or more of the alignment elements 22 of the coaptation catheter 14 draws the ablation catheter 12 and the coaptation catheter 14 together with the vessel walls of each of the first blood vessel VI and the second blood vessel V2. Once the ablation catheter 12 and the coaptation catheter 14 are coapted, the radiofrequency generator 18 (FIG. 1A) may be activated to energize the electrode 26, thereby ablating tissue of the body vessels positioned between the ablation catheter 12 and the coaptation catheter 14 and forming the fistula. The coaptation catheter body 20 and the alignment elements 22 may act as a backstop for preventing the energy from the electrode 26 from passing through the coaptation catheter 14. For example, the coaptation catheter body 20 and / or the alignment elements 22 may be at least partially formed of, or further include, an electrically insulating coating to prevent energy from passing through the coaptation catheter 14.

[0038] Referring now to FIG. 4C, once the fistula F is formed at the treatment site T, each of the ablation catheter 12 and the coaptation catheter 14 may be retracted out of the body vessels, and blood may flow through the fistula F from one of the body vessels to the other.

[0039] Referring now to FIGS. 5A and 5B, an alternative ablation catheter 60 is depicted. The alternative ablation catheter 60 is substantially similar to that of the ablation catheter 12 described above, and like structure will not be described again for brevity. The alternative ablation catheter 60 differs in that it includes an alternative electrode 62 that includes a proximal end 64, a distal end 66, an expandable tip 68 at the distal end 66 of the electrode 62. The electrode 62 includes an elongated body extending from the proximal end 64 to the distal end 66 to extend into the handle 16 and distal to the ablation catheter body 24, similar to the electrode 26 described above.

[0040] The expandable tip 68 may include an ablation surface 69 configured to ablate tissue when the radiofrequency generator 18 is activated. The expandable tip 68 may expand and contract between a compressed position and an expanded position, respectively. Referring to FIG. 5 A, in the compressed position, the tip 68 may include a width W1 that is less than a width W2, or radius, of the electrode lumen 36 so that the tip 68 may be positionable within the electrode lumen 36. The expandable tip 68 may be in the compressed position when the electrode 62 is in the retracted position. The contact between the expandable tip 68 and the electrode lumen 36 may maintain the expandable tip 68 in the compressed position, thereby preventing the expandable tip 68 from expanding to the expanded position.

[0041] Referring to FIG. 5B, when moving from the compressed position to the expanded position, the tip 68 may expand so that in the expanded position, the expandable tip 68 has a width W1 that is greater than the width W1 of the tip 68 in the compressed position. Additionally, the width W1 of the tip 68 in the expanded position may be greater than the width W2 of the electrode lumen 36. As used herein, the “width Wl” is directed to a width W1 of the ablation surface 69, where the increased width W of the expandable tip 68 allows for increasing a width, or surface area, of the fistula F formed by ablating tissue with the electrode 62. The expandable tip 68 may move from the compressed position to the expanded position when the electrode 62 moves from the retracted position to the extended position. When the electrode 62 is in the extended position, the expandable tip 68 may automatically expand to the expanded position, e.g., the relaxed configuration of the expandable tip 68 may be the expanded position.

[0042] The expandable tip 68 may be formed of a material that may compress and expand to a desired shape, such as a shape memory alloy (e.g., nitinol) to allow the expandable tip 68 to move from the compressed position to the expanded position. In embodiments where the expandable tip 68 is formed of a shape memory alloy, in the compressed position the expandable tip 68 may be folded to be compressed to fit within the electrode lumen 36, and unfolded when in the expanded position. However, it is contemplated and possible that the expandable tip 68 is formed of any material capable of expanding to have an increased width Wl of the ablation surface 69. In the embodiments where the expandable tip 68 is formed of a shape memory alloy, the expandable tip 68 may be biased toward a predetermined shape such that compression from the electrode lumen 36 on the expandable tip 68 when the electrode 62 is in the retracted position deforms the expandable tip 68 to the compressed shape and removalof the expandable tip 68 from the electrode lumen 36 when the electrode 62 is in the extended position allows the expandable tip 68 to return to the predetermined shape. The predetermined shape may be any shape that allows the ablation surface 69 to have a greater width W 1 that the width W2 of the electrode lumen 36, such as, for example, a cone or frustoconical shape.

[0043] Referring now to FIGS. 6A and 6B, another alternative ablation catheter 70 is depicted. The alternative ablation catheter 70 is substantially similar to that of the ablation catheter 12 and the ablation catheter 60 described above, and like structure will not be described again for brevity. The alternative ablation catheter 70 includes a pivotable electrode 72 configured to pivot to increase the surface area of the electrode that is in contact with the wall of the body vessel. The pivotable electrode 72 may be positionable within an electrode lumen 96 of an ablation catheter body 98. The alternative ablation catheter 70 may further include a first actuator 54a and a second actuator 54b each positioned within the handle 16 that are configured to move and pivot the pivotable electrode 72.

[0044] The pivotable electrode 72 may include a guiding rod 74, a deployment wire 76, and an electrode body 78. The guiding rod 74 is part of the pivotable electrode 72 and may include a proximal end 80, and a distal end 82 opposite the proximal end 80. The proximal end 80 of the guiding rod 74 may extend proximally from the ablation catheter body 98 to be positioned within the handle 16 so that the first actuator 54a may be used to move the guiding rod 74. The guiding rod 74 may be movable along the length of the electrode lumen 96 and the electrode body 78 may be pivotally connected to the guiding rod 74. Movement of the guiding rod 74 along the electrode lumen 96 moves the electrode body 78 longitudinally along the electrode lumen 96. The guiding rod 74 may extend into the handle 16 (FIG. 1A) so that the proximal end 80 is operatively coupled to the radiofrequency generator 18. The guiding rod 74 is configured to transfer energy from the radiofrequency generator 18 to the electrode body 78. The guiding rod 74 may additionally be configured to facilitate rotation of the electrode body 78 relative to the guiding rod 74. The guiding rod 74 may be formed of any material capable of transferring energy from the radiofrequency generator 18, such as a metal. The guiding rod 74 may be shaped so that the guiding rod 74 is either flexible, such as shaped as a wire, or rigid, such as shaped as a cylinder.

[0045] The deployment wire 76 is also part of the pivotable electrode 72 and may include a proximal end 86 and a distal end 88 opposite the proximal end 86. The deploymentwire 76 may be positionable in the electrode lumen 96 such that the deployment wire 76 is movable along the length of the electrode lumen 96. However, it is contemplated and possible that the deployment wire 76 is positionable in a lumen separate from the electrode lumen 96 to be separate from the guiding rod 74. The deployment wire 76 may be movable relative to the guiding rod 74 in the electrode lumen 96. The deployment wire 76 may extend along a length of the electrode lumen 36 such that the proximal end 86 of the deployment wire 76 is positioned within the handle 16 (FIG. 1A) and the distal end 88 may extend distally out of the electrode lumen 96. The proximal end 86 of the deployment wire 76 may extend proximally from the ablation catheter body 98 to be positioned within the handle 16 so that the second actuator 54b may be used to move the deployment wire 76. The distal end 88 of the deployment wire 76 may be pivotally coupled to the electrode body 78 so that the deployment wire 76 is configured to facilitate rotation of the electrode body 78.

[0046] The electrode body 78 may include a center portion 90 between a pair of ends 92, and an ablation surface 94 extending between the pair of ends 92. The electrode body 78 may be formed of any material capable of transferring radiofrequency energy, such as a metal. The electrode body 78 may be a rigid body or, in embodiments, the electrode body 78 may be a wire, such as a braided steel, that is flexible. The electrode body 78 may be shaped to have an elongated body extending between the pair of ends 92 or may have any other suitable shape. The electrode body 78 may have a width W3 extending between the pair of ends 92 that is greater than the width W2 of the electrode lumen 96. A thickness of the electrode body 78 that is measured transversely to the width W3 may be less than the width W2 of the electrode lumen 96 so that the electrode body 78 may be oriented to be positioned within the electrode lumen 96, as shown in FIG. 6A.

[0047] The deployment wire 76 and the guiding rod 74 may each be pivotally coupled to the electrode body 78. The guiding rod 74 may be pivotally coupled to the electrode body 78 proximate the center of the electrode body 78 with the deployment wire 76 pivotally coupled to the electrode body 78 at or near one of the pair of ends 92 of the electrode body 78. In such embodiments, the deployment wire 76 may be advanced or retracted along the electrode lumen 96 to pivot the electrode body 78 relative to the guiding rod 74. Additional embodiments of coupling the guiding rod 74 and the deployment wire 76 to the electrode body 78 are contemplated and possible. For example, the guiding rod 74 may be pivotally coupled to theelectrode body 78 at the center of the electrode body 78. For further example, the guiding rod 74 may be pivotally coupled to the electrode body 78 anywhere along the electrode body 78 between the pair of ends 92 with the deployment wire 76 pivotally coupled to the electrode body 78 between the guiding rod 74 and one of the pair of ends 92. For further example, the guiding rod 74 may be pivotally coupled to the electrode body 78 at one of the pair of ends 92 of the electrode body 78, and the deployment wire 76 may be pivotally coupled to the electrode body 78 at the other of the pair of ends 92.

[0048] Referring still to FIGS. 6 A and 6B, the pivotable electrode 72 may be movable between a retracted configuration (FIG. 6A) and an extended configuration (FIG. 6B). Referring to FIG. 6A, when the pivotable electrode 72 is in the retracted configuration, the guiding rod 74 is in a retracted position, and the deployment wire 76 is in a retracted position. When the guiding rod 74 is in the retracted position, the guiding rod 74 and the electrode body 78 are positioned in the electrode lumen 96. When the guiding rod 74 is in the retracted position, the deployment wire 76 is in the retracted position with the electrode body 78 positioned in a stowable position. In the stowable position, the distal end 88 of the deployment wire 76 is positioned proximal to the distal end 82 of the guiding rod 74. In the stowable position, the width W3 of the electrode body 78 may extend along the length of the electrode lumen 96 so that the electrode body 78 is positionable within the electrode lumen 96 with the guiding rod 74 and the deployment wire 76.

[0049] Referring to FIG. 6B, when the pivotable electrode 72 is in the extended configuration, the guiding rod 74 is in an extended position, and the deployment wire 76 is in an extended position. When the guiding rod 74 is in the extended position, the guiding rod 74 and the electrode body 78 are extended through the electrode lumen 96 and out of the distal tip 32 to be positioned distal to the ablation catheter body 98. When the guiding rod 74 is in the extended position, the deployment wire 76 is movable from the retracted position to the extended position. When the deployment wire 76 is in the extended position, the distal end 88 of the deployment wire 76 is positioned a distance from the distal tip 32 of the ablation catheter 70 about equal to a distance between the distal tip 32 of the ablation catheter 70 and the distal end 82 of the guiding rod 74. With the distal tip 32 of the ablation catheter 70 about equal to the distance between the distal tip 32 of the ablation catheter 70 and the distal end 82 of the guiding rod 74, the electrode body 78 is in a deployed position. In the deployed position, theelectrode body 78 is pivoted from the stowable position so that the width W3 of the electrode body 78 extends perpendicularly to the length of the electrode lumen 96 so that the width W3 of the electrode body 78 extends in the same direction as the width W2 of the electrode lumen 96 and is greater than the width W2 of the electrode lumen 96. In the deployed position, the ablation surface 94 of the electrode body 78 extends obliquely or perpendicularly to the guiding rod 74 to orient the ablation surface 94 relative to the body vessel B V.

[0050] Referring now to FIGS. 7A-8, another alternative ablation catheter 100 is depicted. The alternative ablation catheter 100 is similar to the ablation catheters 12, 60 and 70 described above, and like structure will not be described again for brevity. The ablation catheter 100 includes a pivot mechanism 102 configured to pivot a distal portion 104 of an ablation catheter body 101 relative to a proximal portion 106 of the ablation catheter body 101.

[0051] The pivot mechanism 102 may include a hinge 110 positioned between and pivotally coupling the distal portion 104 of the ablation catheter body 101 to the proximal portion 106, and a pair of tension wires 112. The hinge 110 may be configured to pivot the distal portion 104 relative to the proximal portion 106 such that the distal portion 104 may extend obliquely or perpendicularly to the proximal portion 106. The hinge 110 may be coupled at a proximal end 113 of the distal portion 104 and a distal end 114 of the proximal portion 106. However, in embodiments, the hinge 110 may be coupled to the distal portion 104 anywhere along the length of the distal portion 104. In some embodiments, the hinge 110 may be pivotally coupled to the distal portion 104 near a center of the distal portion 104 to allow the distal portion 104 to be pivoted to form a T-shape with the proximal portion 106.

[0052] The ablation catheter body 101 may define a pair of wire lumens 116 configured to receive the pair of tension wires 112. The pair of wire lumens 116 may extend from a proximal end 107 of the ablation catheter body 101 to the distal tip 105. The pair of tension wires 112 may extend along the length of the ablation catheter body 101 through the pair of wire lumens 116 to be fixedly coupled to the distal portion 104. The pair of tension wires 112 may be coupled to the distal portion 104 at the distal tip 105 of the ablation catheter body 101. However, it is contemplated and possible that the tension wires 112 are coupled anywhere along the length of the distal portion 104, such as the proximal end 113 of the distal portion 104. The tension wires 112 may each include a distal end 120 connected to the distal portion 104, and a proximal end 122 opposite the distal end 120 that extends into the handle 16. Thetension wires 112 are attached to the distal portion 104 at a location that is axially spaced apart from hinge 110 at a position between the outer radial surface 103 and the hinge 110. The tension wires 112 may be configured to pivot the distal portion 104 about the hinge 110 via pulling on one of the pair of tension wires 112. One of the tension wires 112 may be pulled toward the handle 16 to move the distal end 120 of the tension wire 112 toward the handle 16, thereby pulling the distal portion 104 of the ablation catheter body 101 to pivot the distal portion 104 relative to the hinge 110 in a first direction Al toward the one of the tension wires 112. The other one of the tension wires 112 may be pulled toward the handle 16 after releasing the one of the tension wires 112 to pivot the distal portion 104 of the ablation catheter body 101 in a second direction A2 opposite the first direction Al toward the other one of the tension wires 112. The pivot mechanism 102 may include any number of tension wires 112, such as one, two, three, or more than three. In embodiments, the pivot mechanism 102 may include three tension wires 112 coupled to the distal end of the distal portion 104 and spaced apart from the hinge 110 in a radial direction so that the distal portion 104 may be pivoted about the hinge 110 in three directions. In such embodiments, the hinge 110 may be a bearing positioned between the distal portion 104 and the proximal portion 106 to allow the distal portion 104 to pivot about the hinge 110 in three directions. Additionally, in such embodiments, more than one wire may be pulled at a time to pivot the distal portion 104 in a direction between two of the tension wires 112 to allow for the distal portion 104 to pivot about the hinge 110 in 360 degrees.

[0053] An actuator 123 may be operatively coupled at or near the proximal end 122 of the tension wires 112 to be configured to pivot the distal portion 104 via the pair of tension wires 112. When the actuator 123 operates the tension wires 112, the actuator 123 may pull one of the tension wires 112 to move the distal end 120 of the tension wire 112 toward the handle 16, thereby pulling the distal portion 104 of the ablation catheter body 101 to pivot the distal portion 104 relative to the hinge 110 in the first direction Al. The actuator 123 may pull the other one of the tension wires 112 after releasing the one tension wire 112 to pivot the distal portion 104 of the ablation catheter body 101 in the second direction A2. The actuator 123 may be an automatic actuator, such as a linear actuator, or a manual actuator, such as a dial. The actuator 123 may be positioned at least partially within the handle 16. In embodiments including an automatic actuator, the actuator 123 may be positioned in the handle 16 and be communicatively coupled to an input 124 on an exterior of the handle 16, the input 124 beingconfigured to be operated by a user to actuate the actuator 123. In embodiments including a manual actuator, the actuator 123 may be partially positioned on the exterior of the handle 16 to be physically manipulatable by a user, and extend into the handle 16 to be operatively coupled to the tension wires 112 to operate the tension wires 112.

[0054] The actuator 123 may pivot the distal portion 104 via the pivot mechanism 102 between an undeflected position (FIG. 7A) and a deflected position (FIG. 7B). Referring to FIG. 7A, in the undeflected position, the distal portion 104 of the ablation catheter body 101 may extend substantially in the same direction as the proximal portion 106. When moving from the undeflected position to the deflected position, one of the tension wires 112 may be retracted by the actuator 123 to pivot the distal portion 104 relative to the proximal portion 106 about the hinge 110. In the deflected position, the distal portion 104 of the ablation catheter body 101 extends obliquely or perpendicularly to the proximal portion 106.

[0055] The ablation catheter 100 may further include an alternative electrode 108 that at least partially extends out of an outer radial surface 103 of the ablation catheter body 101. The electrode 108 may include an elongated portion 109 that is positioned in and extends along one of the wire lumens 116, or another lumen, in the ablation catheter body 101, and an exposed portion 111 that extends out of the ablation catheter body 101 to be configured to ablate tissue. The elongated portion 109 may extend into the handle 16 to be operatively coupled to the radiofrequency generator 18 to transfer radiofrequency energy to the exposed portion 111 of the electrode 108. The exposed portion 111 may extend out of an opening 115 formed in the outer radial surface 103 of the ablation catheter body 101. In embodiments, the alternative electrode 108 may be a leaf spring electrode that is radially spaced apart from the ablation catheter body 101. However, this is merely illustrative, and the alternative electrode 108 may be any electrode capable of extending radially from the ablation catheter body 101. Alternatively, the alternative ablation catheter 100 may include an electrode similar to the electrode 26 described above or any of the electrodes described herein.

[0056] Referring to FIG. 8, the alternative ablation catheter 100 may be inserted into the first blood vessel V 1 and moved to the treatment site T. When positioned near the treatment site T, the distal portion 104 of the ablation catheter body 101 may be moved to the deflected position to extend obliquely to the proximal portion 106 and be substantially parallel to one of the body vessels where the fistula F is to be formed. The distal portion 104 may be pivoted ina direction to position the electrode between the distal portion 104 and the coaptation catheter 14 so that the electrode is positioned to form a fistula between the two body vessels.

[0057] Referring now to FIGS. 9A-10, another alternative ablation catheter 130 is depicted. The alternative ablation catheter 130 is similar to the ablation catheters 12, 60, 70, 100 described above, and like structure will not be described again for brevity. The ablation catheter 130 includes a pivot mechanism 132 configured to pivot a distal portion 134 of an ablation catheter body 131 relative to a proximal portion 136 of the ablation catheter body 131 about a plurality of articulating joints 138. The pivot mechanism 132 may include the plurality of articulating joints 138, and a pair of tension wires 140. The pair of tension wires 140 are substantially similar to the pair of tension wires 112 discussed above, and will not be described again for brevity.

[0058] The plurality of articulating joints 138 may be positioned between the distal portion 134 and the proximal portion 136, and may be arranged sequentially so that the articulating joints 138 are stacked in a proximal to distal direction. The plurality of articulating joints 138 may be configured to pivot the distal portion 134 relative to the proximal portion 136 such that the distal portion 134 may extend perpendicularly or obliquely to the proximal portion 136. Each of the articulating joints 138 may include a concave surface 141, and a convex surface 142 spaced apart from the concave surface 141, the convex surface 142 configured to nest in the concave surface 141 of the adjacent articulating joint so that the adjacent articulating joint may pivot relative to the other articulating joint about the convex surface 142. In embodiments, the distal portion 134 and / or the proximal portion 136 may include a surface adjacent the plurality of articulating joints 138 that complements the respective convex surface 142 and concave surface 141 of the adjacent articulating joint so that the distal portion 134 may pivot about the convex surface 142 of the adjacent articulating joint and one of the articulating joints 138 positioned adjacent the proximal portion 136 may pivot relative to the proximal portion 136. Particularly, in such embodiments, the distal portion 134 may include a contact surface 144 shaped similarly to the concave surface 141 to complement the convex surface 142 of the adjacent articulating joint 138 in contact with the contact surface 144 of the distal portion 134. Further, in such embodiments, the proximal portion 136 may include a contact surface 146 shaped similarly to the convex surface 142 to complement theconcave surface 141 of the adjacent articulating joint 138 in contact with the contact surface 146 of the proximal portion 136.

[0059] The plurality of articulating joints 138 may include any operable number of articulating joints 138 to allow the distal portion 134 to be pivoted relative to the proximal portion 136, such as one, two, three, four, or more than four. As the articulating joints 138 pivot relative to one another, a larger number of articulating joints 138 allows the distal portion 134 to be further pivoted relative to the proximal portion 136 when compared to a lesser number of articulating joints 138.

[0060] The ablation catheter body 131 and the plurality of articulating joints 138 may define a pair of wire lumens 148 configured to receive the pair of tension wires 140, a first side 150, and an opposite second side 152. The articulating joints 138 may be spaced apart from each other on the first side 150 and the second side 152 while contacting one another between the first side 150 and the second side 152 at the concave surface 141 and the adjacent convex surface 142. One of the tension wires 140 may be pulled to pivot the plurality of articulating joints 138 in a first direction Bl toward the first side 150, thereby compressing the articulating joints 138 along the first side 150 and expanding the articulating joints 138 along the second side 152. The plurality of articulating joints 138 may pivot in the first direction Bl so that the concave surface 141 at the first side 150 contacts the convex surface 142 of the adjacent articulating joint at the first side 150. The other of the tension wires 140 may be pulled to pivot the plurality of articulating joints 138 in a second direction B2 toward the second side 152, thereby compressing the articulating joints 138 along the second side 152 and expanding the articulating joints 138 along the first side 150. The plurality of articulating joints 138 may pivot in the second direction B2 so that the concave surface 141 at the second side 152 contacts the convex surface 142 of the adjacent articulating joint at the second side 152.

[0061] The pair of tension wires 140 may be pulled in a similar manner to the pair of tension wires 112 discussed above, and will not be described again for brevity. The pair of tension wires 140 may be pulled to pivot the distal portion 134 via the pivot mechanism 132 between an undeflected position (FIG. 9A) and a deflected position (FIG. 9B). Referring to FIG. 9A, in the undeflected position, the distal portion 134 of the ablation catheter body 131 may extend substantially in the same direction as the proximal portion 136. When moving from the undeflected position to the deflected position, one of the tension wires 140 may be retractedby an actuator 133 to pivot the articulating joints 138 toward the first side 150 or the second side 152. In the deflected position, the articulating joints 138 may be pivoted so that the distal portion 134 extends obliquely or perpendicularly to the proximal portion 136.

[0062] The ablation catheter 130 may further include an electrode 154 having an elongated portion 156 and an exposed portion 158 similar to the electrode 108 described above, and will not be described again for brevity.

[0063] Referring to FIG. 10, the alternative ablation catheter 130 may be inserted into the first blood vessel V 1 and moved to the treatment site T. When positioned near the treatment site T, the distal portion 134 of the ablation catheter body 131 may be moved to the deflected position to extend obliquely to the proximal portion 136 and be substantially parallel to one of the body vessels where the fistula is to be formed. The distal portion 134 may be pivoted in a direction to position the electrode 154 between the distal portion 134 and the coaptation catheter 14 so that the electrode 154 is positioned to form a fistula between the two body vessels.

[0064] Embodiments may be further described with reference to the following numbered clauses:

[0065] 1. A catheter including: a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; an electrode including a tip, the electrode positionable within the electrode lumen and movable along a length of the catheter body between a retracted position and an extended position, wherein in the retracted position the electrode tip is proximal to the distal tip and moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen; and a magnetic material positioned proximal the tip of the electrode.

[0066] 2 The catheter according to the previous clause, wherein the magnetic material is ring-shaped, and the electrode extends through a center of the magnet.

[0067] 3. The catheter according to clause 2, wherein the electrode further comprises a distal end and a distal surface at the distal end, and the magnetic material comprises an outer surface that is coplanar with the distal surface of the electrode.

[0068] 4. The catheter according to any of the preceding clauses, further including a second lumen formed in the catheter body that extends obliquely from the electrode lumen.

[0069] 5. The catheter according to clause 4, wherein the second lumen extends from the electrode lumen to an outer radial surface of the catheter body.

[0070] 6. The catheter according to any of the preceding clauses, further comprising an actuator operatively coupled to the electrode, the actuator being configured to move the electrode between the retracted position and the extended position.

[0071] 7. The catheter according to clause 6, further comprising an input communicatively coupled to the actuator, the input is configured to actuate the actuator.

[0072] 8. The catheter according to clause 7, further comprising a handle, wherein: a proximal end of the catheter body is coupled to the handle with the electrode lumen open to an interior of the handle, and a proximal end of the electrode opposite the distal end is positioned in the interior of the handle to be operatively coupled to the actuator.

[0073] 9. A catheter system including: a first catheter including: a first catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; an electrode including a tip, the electrode positionable within the electrode lumen and movable along a length of the first catheter body between a retracted position and an extended position, wherein in the retracted position the electrode tip is proximal to the distal tip and moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen; a magnetic material positioned proximal the tip of the electrode; a second catheter including: a second catheter body; and one or more magnets coupled to the second catheter body configured to coapt with the magnet of the first catheter.

[0074] 10. The catheter according to the previous clause, wherein the magnetic material of the first catheter is ring-shaped, and the electrode extends through a center of the magnetic material of the first catheter.

[0075] 11. The catheter system according to clause 10, wherein the electrode further comprises a distal end and a distal surface at the distal end, and the magnetic material comprises an outer surface that is coplanar with the distal surface of the electrode.

[0076] 12. The catheter according to any of clauses 9-11, further including a second lumen formed in the first catheter body that extends obliquely from the electrode lumen.

[0077] 13. The catheter system according to clause 12, wherein the second lumen extends from the electrode lumen to an outer radial surface of the catheter body.

[0078] 14. The catheter system according to any of clauses 9-13, further comprising an actuator operatively coupled to the electrode, the actuator being configured to move the electrode between the retracted position and the extended position.

[0079] 15. The catheter system according to clause 14, further comprising an input communicatively coupled to the actuator, the input is configured to actuate the actuator.

[0080] 16. The catheter system according to clause 15, further comprising a handle, wherein: a proximal end of the catheter body is coupled to the handle with the electrode lumen open to an interior of the handle, and a proximal end of the electrode opposite the distal end is positioned in the interior of the handle to be operatively coupled to the actuator.

[0081] 17. A method of operating a catheter system, the method including: providing a first catheter including: a first catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; an electrode including a tip, the electrode positionable within the electrode lumen and movable along a length of the first catheter body between a retracted position and an extended position, wherein in the retracted position the electrode tip is proximal to the distal tip and moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen; a magnetic material positioned proximal the tip of the electrode; providing a second catheter including: a second catheter body; and one or more magnets coupled to the second catheter body configured to coapt with the magnet of the first catheter; coapting the first catheter with the second catheter; and energizing the electrode.

[0082] 18. The method according to clause 17, further comprising: actuating an actuator operatively coupled to the electrode to move the electrode from the retracted position to the extended position.

[0083] 19. The method according to either of clauses 17 and 18, further comprising: activating a radiofrequency generator operatively coupled to the electrode to energize the electrode.

[0084] 20. The method according to any of clauses 17-19, further comprising: removing a guidewire from a rapid exchange lumen formed in the first catheter body that extends obliquely from the electrode lumen.

[0085] 21. A catheter comprising: a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; and a pivotable electrode positionable within the electrode lumen, the pivotable electrode comprising a guiding rod, an electrode body, and a deployment wire, the guiding rod and the deployment wire being independently movable in the electrode lumen of the catheter body and each pivotally coupled to the electrode body, the guiding rod being movable between a retracted position and an extended position, wherein in the retracted position the electrode body is proximal to the distal tip and moving the guiding rod from the retracted position to the extended position extends the electrode body out of the distal tip, and the deployment wire being movable between a retracted position and an extended position, moving the deployment wire from the retracted position to the extended position pivots the electrode body.

[0086] 22. The catheter according to clause 21, wherein the electrode body comprises a center portion between a pair of ends, the guiding rod is pivotally coupled to the electrode body proximate the center portion, and the deployment wire is pivotally coupled to the electrode body between the guiding rod and one of the pair of ends.

[0087] 23. The catheter according to clause 22, wherein: the electrode body has a width extending between the pair of ends that is greater than a width of the electrode lumen, when the deployment wire is in the retracted position, the width of the electrode body extends along a length of the electrode lumen, and when the deployment wire is in the extended position, the width of the electrode body extends perpendicularly to the length of the electrode lumen.

[0088] 24. The catheter according to either of clauses 22 and 23, wherein the guiding rod is operatively coupled to a radiofrequency generator to transfer radiofrequency energy to the electrode body.

[0089] 25. A catheter comprising: a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; and an electrode positionable within the electrode lumen and movable along a length of the catheter body between a retracted position and an extended position, moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen, the electrode comprising an expandable tip comprising an ablation surface, the expandable tip being configured to expand and contract between a compressed position and an expanded position, wherein: in the retracted position the expandable tip is proximal to the distal tip, and in the expanded position, the ablation surface has a width that is greater than the width of the ablation surface in the compressed position.

[0090] 26. The catheter according to clause 25, wherein the width of the ablation surface in the expanded position is greater than a width of the electrode lumen.

[0091] 27. The catheter according to either of clauses 25 and 26, wherein: when the electrode is in the retracted position, the expandable tip is in the compressed position, and when the electrode is in the extended position, the expandable tip is in the expanded position.

[0092] 28. A catheter comprising: a catheter body including an electrode lumen formed therein, a proximal portion, and a distal portion positioned distal to the proximal portion, the distal portion being configured to pivot relative to the proximal portion such that the distal portion extends obliquely to the proximal portion; and an electrode extending from the distal portion of the catheter body.

[0093] 29. The catheter according to clause 28, further comprising: a pair of tension wires each having a distal end and a proximal end, the distal end connected to the distal portion; and an actuator coupled to the proximal end of the pair of tension wires, the actuator configured to pivot the distal portion by actuating the pair of tension wires.

[0094] 30. The catheter according to clause 29, further comprising a hinge positioned between the proximal portion and the distal portion configured to pivot the distal portion relative to the proximal portion.

[0095] 31. The catheter according to clause 29, further comprising a plurality of articulating joints positioned between the proximal portion and the distal portion configured to pivot the distal portion relative to the proximal portion.

[0096] It is noted that the terms "substantially" and "about" may be utilized herein to represent the inherent degree of uncertainty that may be attributed to any quantitative comparison, value, measurement, or other representation. These terms are also utilized herein to represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue.

[0097] While particular embodiments have been illustrated and described herein, it should be understood that various other changes and modifications may be made without departing from the spirit and scope of the claimed subject matter. Moreover, although various aspects of the claimed subject matter have been described herein, such aspects need not be utilized in combination. It is therefore intended that the appended claims cover all such changes and modifications that are within the scope of the claimed subject matter.

Claims

1. A catheter comprising: a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; an electrode including a tip, the electrode positionable within the electrode lumen and movable along a length of the catheter body between a retracted position and an extended position, wherein in the retracted position the electrode tip is proximal to the distal tip and moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen; and a magnetic material positioned proximate the tip of the electrode.

2. The catheter of claim 1, wherein the magnetic material is ring-shaped, and the electrode extends through a center of the magnetic material.

3. The catheter of claim 2, wherein the electrode further comprises a distal end and a distal surface at the distal end, and the magnetic material comprises an outer surface that is coplanar with the distal surface of the electrode.

4. The catheter of claim 1, further comprising a second lumen formed in the catheter body that extends obliquely from the electrode lumen.

5. The catheter of claim 4, wherein the second lumen extends from the electrode lumen to an outer radial surface of the catheter body.

6. The catheter of claim 1, further comprising an actuator operatively coupled to the electrode, the actuator being configured to move the electrode between the retracted position and the extended position.

7. The catheter of claim 6, further comprising an input communicatively coupled to the actuator, the input is configured to actuate the actuator.

8. The catheter of claim 6, further comprising a handle, wherein: a proximal end of the catheter body is coupled to the handle with the electrode lumen open to an interior of the handle, anda proximal end of the electrode opposite a distal end of the electrode is positioned in the interior of the handle to be operatively coupled to the actuator.

9. A catheter system comprising: a first catheter comprising: a first catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; an electrode including a tip, the electrode positionable within the electrode lumen and movable along a length of the first catheter body between a retracted position and an extended position, wherein in the retracted position the electrode tip is proximal to the distal tip and moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen; a magnetic material positioned proximate the tip of the electrode; a second catheter comprising: a second catheter body; and one or more magnets coupled to the second catheter body configured to coapt with the magnet of the first catheter.

10. The catheter system of claim 9, wherein the magnetic material of the first catheter is ring-shaped, and the electrode extends through a center of the magnetic material of the first catheter.

11. The catheter system of claim 10, wherein the electrode further comprises a distal end and a distal surface at the distal end, and the magnetic material comprises an outer surface that is coplanar with the distal surface of the electrode.

12. The catheter system of claim 9, further comprising a second lumen formed in the first catheter body that extends obliquely from the electrode lumen.

13. The catheter system of claim 12, wherein the second lumen extends from the electrode lumen to an outer radial surface of the first catheter body.

14. The catheter system of claim 9, further comprising an actuator operatively coupled to the electrode, the actuator being configured to move the electrode between the retracted position and the extended position.

15. The catheter system of claim 14, further comprising an input communicatively coupled to the actuator, the input is configured to actuate the actuator.

16. The catheter system of claim 14, further comprising a handle, wherein: a proximal end of the first catheter body is coupled to the handle with the electrode lumen open to an interior of the handle, and a proximal end of the electrode opposite the distal end is positioned in the interior of the handle to be operatively coupled to the actuator.

17. A method of operating a catheter system, the method comprising: providing a first catheter comprising: a first catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; an electrode including a tip, the electrode positionable within the electrode lumen and movable along a length of the first catheter body between a retracted position and an extended position, wherein in the retracted position the electrode tip is proximal to the distal tip and moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen; a magnetic material positioned proximate the tip of the electrode; providing a second catheter comprising: a second catheter body; and one or more magnets coupled to the second catheter body configured to coapt with the magnet of the first catheter; coapting the first catheter with the second catheter; and energizing the electrode.

18. The method of claim 17, further comprising: actuating an actuator operatively coupled to the electrode to move the electrode from the retracted position to the extended position.

19. The method of claim 17, further comprising: activating a radiofrequency generator operatively coupled to the electrode to energize the electrode.

20. The method of claim 17, further comprising: removing a guidewire from a rapid exchange lumen formed in the first catheter body that extends obliquely from the electrode lumen.

21. A catheter compri sing : a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; and a pivotable electrode positionable within the electrode lumen, the pivotable electrode comprising a guiding rod, an electrode body, and a deployment wire, the guiding rod and the deployment wire being independently movable in the electrode lumen of the catheter body and each pivotally coupled to the electrode body, the guiding rod being movable between a retracted position and an extended position, wherein in the retracted position the electrode body is proximal to the distal tip and moving the guiding rod from the retracted position to the extended position extends the electrode body out of the distal tip, and the deployment wire being movable between a retracted position and an extended position, moving the deployment wire from the retracted position to the extended position pivots the electrode body.

22. The catheter of claim 21, wherein the electrode body comprises a center portion between a pair of ends, the guiding rod is pivotally coupled to the electrode body proximate the center portion, and the deployment wire is pivotally coupled to the electrode body between the guiding rod and one of the pair of ends.

23. The catheter of claim 22, wherein: the electrode body has a width extending between the pair of ends that is greater than a width of the electrode lumen,when the deployment wire is in the retracted position, the width of the electrode body extends along a length of the electrode lumen, and when the deployment wire is in the extended position, the width of the electrode body extends perpendicularly to the length of the electrode lumen.

24. The catheter of claim 22, wherein the guiding rod is operatively coupled to a radiofrequency generator to transfer radiofrequency energy to the electrode body.

25. A catheter comprising: a catheter body including an electrode lumen formed therein and a distal tip through which the electrode lumen axially extends; and an electrode positionable within the electrode lumen and movable along a length of the catheter body between a retracted position and an extended position, moving the electrode from the retracted position to the extended position extends the electrode out of the distal tip from the electrode lumen, the electrode comprising an expandable tip comprising an ablation surface, the expandable tip being configured to expand and contract between a compressed position and an expanded position, wherein: in the retracted position the expandable tip is proximal to the distal tip, and in the expanded position, the ablation surface has a width that is greater than the width of the ablation surface in the compressed position.

26. The catheter of claim 25, wherein the width of the ablation surface in the expanded position is greater than a width of the electrode lumen.

27. The catheter of claim 25, wherein: when the electrode is in the retracted position, the expandable tip is in the compressed position, and when the electrode is in the extended position, the expandable tip is in the expanded position.

28. A catheter comprising: a catheter body including an electrode lumen formed therein, a proximal portion, and a distal portion positioned distal to the proximal portion, the distal portion being configured topivot relative to the proximal portion such that the distal portion extends obliquely to the proximal portion; and an electrode extending from the distal portion of the catheter body.

29. The catheter of claim 28, further comprising: a pair of tension wires each having a distal end and a proximal end, the distal end connected to the distal portion; and an actuator coupled to the proximal end of the pair of tension wires, the actuator configured to pivot the distal portion by actuating the pair of tension wires.

30. The catheter of claim 29, further comprising a hinge positioned between the proximal portion and the distal portion configured to pivot the distal portion relative to the proximal portion.

31. The catheter of claim 29, further comprising a plurality of articulating j oints positioned between the proximal portion and the distal portion configured to pivot the distal portion relative to the proximal portion.

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