High-density electrode catheter with magnetic position tracking

Abstract

To provide high-density electrode catheters with magnetic position tracking.SOLUTION: A high-density electrode catheter 13 can include a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis. In some embodiments, the high-density electrode catheter can include a shaft magnetic position sensor disposed along a distal portion of the catheter shaft. In some embodiments, the high-density electrode catheter can include a flexible tip portion located adjacently to the distal end of the catheter shaft, where the flexible tip portion includes a flexible framework. In some embodiments, the high-density electrode catheter can include a plurality of electrodes disposed on the flexible framework. In some embodiments, the high-density electrode catheter can include a tip magnetic position sensor disposed on a portion of the flexible framework.SELECTED DRAWING: Figure 1A

Description

[Technical Field]

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 067,284, filed August 18, 2020, which is incorporated by reference herein as if fully set forth.

[0002] The present disclosure relates to high density electrode catheters with magnetic position tracking. [Background technology]

[0003] Catheters have been used in cardiac medical procedures for many years, for example, to diagnose and treat cardiac arrhythmias, while allowing catheters to be placed in specific locations within the body that would otherwise be inaccessible without more invasive procedures.

[0004] Conventional mapping catheters, for example, may include multiple adjacent ring electrodes surrounding the longitudinal axis of the catheter, which may be constructed of platinum or some other metal. These ring electrodes are relatively rigid. Similarly, conventional ablation catheters have a relatively rigid tip electrode for delivering therapy (e.g., delivering RF ablation energy) and may also include multiple adjacent ring electrodes. When using these conventional catheters and their relatively rigid (or non-compliant) metal electrodes, maintaining good electrical contact with cardiac tissue can be difficult, especially when steep gradients and undulations are present.

[0005] Whether intracardiac mapping or lesion formation, the heartbeat, especially if it is non-uniform or irregular, complicates matters and makes it difficult to maintain sufficient contact between the electrode and the tissue for a sufficient length of time. These problems are exacerbated on sloped or columnar surfaces. If sufficient contact between the electrode and the tissue cannot be maintained, a quality lesion or accurate mapping is unlikely to result.

[0006] The above description is intended only to illustrate the field of the present invention and should not be construed as a disclaimer of the scope of the claims. Summary of the Invention

[0007] Various embodiments of the present disclosure may include a high-density electrode catheter. In some embodiments, the high-density electrode catheter may include a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis. In some embodiments, the high-density electrode catheter may include a shaft magnetic position sensor disposed along a distal portion of the catheter shaft. In some embodiments, the high-density electrode catheter may include a flexible tip section located adjacent the distal end of the catheter shaft, the flexible tip section including a flexible framework. In some embodiments, the high-density electrode catheter may include multiple electrodes disposed on the flexible framework. In some embodiments, the high-density electrode catheter may include a tip magnetic position sensor disposed on a portion of the flexible framework.

[0008] Various embodiments of the present disclosure may include a high-density electrode catheter. In some embodiments, the high-density electrode catheter may include a catheter shaft having a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis. In some embodiments, the high-density electrode catheter may include a flexible tip portion located adjacent the distal end of the catheter shaft, the flexible tip portion including a first outer arm, a second outer arm, and a central arm extending longitudinally. In some embodiments, the high-density electrode catheter may include a plurality of electrodes disposed on each of the first outer arm, the second outer arm, and the central arm. In some embodiments, the high-density electrode catheter may include a tip magnetic position sensor disposed on a distal portion of the central arm.

[0009] Various embodiments of the present disclosure may include a high-density electrode catheter. In some embodiments, the high-density electrode catheter may include a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis. In some embodiments, the high-density electrode catheter may include a flexible tip section located adjacent the distal end of the catheter shaft, the flexible tip section including a flexible framework. In some embodiments, the high-density electrode catheter may include a flexible circuit disposed on the flexible framework, the flexible circuit including a plurality of electrodes disposed thereon. In some embodiments, the high-density electrode catheter may include a tip magnetic position sensor disposed on the distal section of the flexible framework. [Brief explanation of the drawings]

[0010] [Figure 1A] 1 is a schematic overview of a catheter system according to an embodiment of the present disclosure.

[0011] [Figure 1B] FIG. 1 is a schematic block diagram of a system for electroporation therapy according to an embodiment of the present disclosure.

[0012] [Figure 2A] 1A-1C are top views of high-density electrode catheters according to various embodiments of the present disclosure. [Figure 2B] 1 is an isometric side top view of a high-density electrode catheter according to various embodiments of the present disclosure. FIG.

[0013] [Figure 3A] 1 is an isometric side top view of a high-density electrode catheter according to various embodiments of the present disclosure. FIG. [Figure 3B] FIG. 1 is a bottom view of a high-density electrode catheter according to various embodiments of the present disclosure.

[0014] [Figure 3C] FIG. 3C is a side view of the high-density electrode catheter shown in FIGS. 3A and 3B in accordance with an embodiment of the present disclosure.

[0015] [Figure 3D] FIG. 4 is an isometric side bottom view of the high-density electrode catheter shown in FIGS. 3A-3C in accordance with an embodiment of the present disclosure.

[0016] [Figure 3E] FIG. 3D is an isometric top side view of the high-density electrode catheter shown in FIGS. 3A-3D, further showing a manifold portion, according to an embodiment of the present disclosure.

[0017] [Figure 3F] FIG. 3B is an isometric bottom side view of the high-density electrode catheter shown in FIGS. 3A-3E, further showing the manifold portion in FIG. 3E, according to an embodiment of the present disclosure.

[0018] [Figure 3G] FIG. 3C is an isometric top side view of the high-density electrode catheter shown in FIGS. 3A-3F, further illustrating assembly portions, according to an embodiment of the present disclosure.

[0019] [Figure 3H] FIG. 3C is an isometric bottom side view of the high-density electrode catheter shown in FIGS. 3A-3G, further illustrating the assembly portion in FIG. 3G, according to an embodiment of the present disclosure.

[0020] [Figure 3I] FIG. 1 is an isometric top side view of a flexible substructure of a high-density electrode catheter shown herein, in accordance with an embodiment of the present disclosure.

[0021] [Figure 3J] FIG. 3B is an isometric bottom side view of a flexible substructure of the high-density electrode catheter shown in FIGS. 3A-3I, in accordance with an embodiment of the present disclosure.

[0022] [Figure 3K] 1 is a cross-sectional view of a dual lumen tube according to an embodiment of the present disclosure.

[0023] [Figure 3L]FIG. 3H is an isometric bottom side view of the high-density electrode catheter shown in FIG. 3H without the tube covering the flexible substructure, according to an embodiment of the present disclosure.

[0024] [Figure 3M] FIG. 3C is an isometric proximal end view of the assembly portion shown in FIGS. 3G and 3H according to an embodiment of the present disclosure.

[0025] [Figure 3N] FIG. 10 is an isometric bottom side view of the proximal end of the flexible substructure according to an embodiment of the present disclosure.

[0026] [Figure 3O] FIG. 10 is a bottom view of the proximal end of the flexible substructure according to an embodiment of the present disclosure.

[0027] [Figure 3P] FIG. 10 is a bottom view of a proximal end of a flexible substructure disposed within an assembly portion, shown through a cross-section, in accordance with an embodiment of the present disclosure;

[0028] [Figure 3Q] FIG. 10 is an isometric distal end view of a connecting trunk portion according to an embodiment of the present disclosure.

[0029] [Figure 3R] FIG. 3H is an isometric proximal end view of the connecting trunk portion shown in FIG. 3G according to an embodiment of the present disclosure.

[0030] [Figure 3S] FIG. 3J is a bottom view of the distal portion of the flexible substructure shown in FIG. 3J with the addition of electrodes, distal outer substructure tubing, and an atraumatic tip, according to an embodiment of the present disclosure.

[0031] [Figure 3T] FIG. 3J is a bottom isometric view of the distal portion of the flexible substructure shown in FIG. 3J with the addition of electrodes, distal inner substructure tubing, and an atraumatic tip, according to an embodiment of the present disclosure.

[0032] [Figure 3U] FIG. 3J is a bottom isometric view of the distal portion of the flexible substructure shown in FIG. 3J without the distal coupler and magnetic position sensor mount, according to an embodiment of the present disclosure.

[0033] [Figure 4] FIG. 1 is a top view of a high-density electrode catheter according to an embodiment of the present disclosure, wherein the flexible tip section has a pair of magnetic position sensors disposed on a distal portion of the flexible tip section.

[0034] [Figure 5A] FIG. 1 is an isometric view of a high-density electrode catheter including six longitudinally extending arms, according to an embodiment of the present disclosure.

[0035] [Figure 5B] FIG. 5B is a distally facing isometric view of the high-density electrode catheter shown in FIG. 5A, where the high-density electrode catheter includes six longitudinally extending arms, according to an embodiment of the present disclosure.

[0036] [Figure 5C] 5B is a diagram of the high-density electrode catheter of FIG. 5A further showing the distal end of the proximal coupler and a framework assembly portion in accordance with an embodiment of the present disclosure.

[0037] [Figure 5D] FIG. 5B is a side view of the high-density electrode catheter of FIG. 5A in accordance with an embodiment of the present disclosure.

[0038] [Figure 6A] FIG. 1 is an isometric view of a flexible tip substructure of a high-density electrode catheter according to an embodiment of the present disclosure.

[0039] [Figure 6B] FIG. 6B is a proximal end view of the assembly portion shown in FIG. 6A according to an embodiment of the present disclosure.

[0040] [Figure 7]1A and 1B are diagrams of a distal flexible tip section of a high-density electrode catheter having a particular electrode configuration, according to an embodiment of the present disclosure.

[0041] [Figure 8A] FIG. 1 is a diagram of one electrode spacing configuration in which electrodes are disposed on a distal flexible tip portion of a high-density electrode catheter, according to an embodiment of the present disclosure. [Figure 8B] FIG. 1 is a diagram of one electrode spacing configuration in which electrodes are disposed on a distal flexible tip portion of a high-density electrode catheter, according to an embodiment of the present disclosure. [Figure 8C] FIG. 1 is a diagram of one electrode spacing configuration in which electrodes are disposed on a distal flexible tip portion of a high-density electrode catheter, according to an embodiment of the present disclosure. [Figure 8D] FIG. 1 is a diagram of one electrode spacing configuration in which electrodes are disposed on a distal flexible tip portion of a high-density electrode catheter, according to an embodiment of the present disclosure. [Figure 8E] FIG. 1 is a diagram of one electrode spacing configuration in which electrodes are disposed on a distal flexible tip portion of a high-density electrode catheter, according to an embodiment of the present disclosure.

[0042] [Figure 9] FIG. 1 is an isometric rear view of a distal tip assembly including a magnetic position sensor mount and a distal coupler according to an embodiment of the present disclosure.

[0043] [Figure 10] FIG. 1 is a side view of a distal tip assembly including a magnetic position sensor mount and a distal coupler according to an embodiment of the present disclosure.

[0044] [Figure 11] FIG. 1 is a top view of a high-density electrode catheter with staggered electrodes in accordance with an embodiment of the present disclosure.

[0045] [Figure 12A] FIG. 1 is a top view of a substructure of a flexible tip of a high-density electrode catheter, the substructure including a magnetic position sensor within an outer casing, according to an embodiment of the present disclosure.

[0046] [Figure 12B] 12B is a close-up view of the substructure of the flexible tip of the high-density electrode catheter shown in FIG. 12A, further showing a magnetic position sensor within the outer frame, according to an embodiment of the present disclosure.

[0047] [Figure 13A] FIG. 1 is a top view of a substructure of a flexible tip of a high-density electrode catheter, the substructure including a magnetic position sensor within an outer casing, according to an embodiment of the present disclosure.

[0048] [Figure 13B] FIG. 13B is a close-up view of the substructure of the flexible tip of the high-density electrode catheter shown in FIG. 13A, further showing a magnetic position sensor within the outer frame, according to an embodiment of the present disclosure.

[0049] [Figure 14] FIG. 1 is a top view of a high-density electrode catheter according to an embodiment of the present disclosure, wherein a magnetic position sensor is disposed in an outer arm of the high-density electrode catheter. DETAILED DESCRIPTION OF THE INVENTION

[0050] Referring to the drawings, in which like reference numbers are used to identify identical components in the various views, Figure 1A is a schematic diagram of a catheter system in which the present invention may be implemented. The system may include various visualization, mapping, and navigation components known in the art, including, for example, the EnSite™ Precision™ cardiac mapping and visualization system, commercially available from Abbott Laboratories, Inc., among others, as discussed further herein.

[0051] The system may be used in connection with or for various medical procedures, such as, for example, cardiac mapping and / or cardiac ablation procedures. In one embodiment, the medical positioning system 14 may comprise a magnetic field-based system, such as, for example, the CARTO™ system available from Biosense Webster, Inc., and as generally described with reference to one or more of U.S. Patent Nos. 6,498,944, 6,788,967, and 6,690,963, the entire disclosures of which are incorporated in their entirety as if fully set forth herein. In another embodiment, the magnetic field-based system may comprise, in part, a magnetic field-based system such as the MediGuide™ technology system from Abbott Laboratories, as well as a magnetic field-based system as generally described with reference to one or more of U.S. Patent Nos. 6,233,476, 7,197,354, 7,386,339, U.S. Patent Application No. 14 / 208,120 entitled "Medical Device Navigation System," filed March 13, 2014, U.S. Provisional Patent Application No. 61 / 834,223 entitled "Medical Device Navigation System," filed June 12, 2013, and International Application No. PCT / IB2014 / 059709 entitled "Medical Device Navigation System," filed March 13, 2014 (the disclosures of which are incorporated by reference in their entireties as if fully set forth herein).

[0052] In yet another embodiment, medical positioning system 14 may comprise a combination of magnetic field-based and electric field-based systems, such as, for example, but not limited to, the systems described in pending U.S. patent application Ser. No. 13 / 231,284, filed Sep. 13, 2011, entitled "Catheter Navigation Using Impedance and Magnetic Field Measurements," and U.S. patent application Ser. No. 13 / 087,203, filed Apr. 14, 2011, entitled "System and Method for Registration of Multiple Navigation Systems to a Common Coordinate Frame," each of which is incorporated herein by reference in its entirety as if fully set forth herein, or the CARTO™ 3 system commercially available from Biosense Webster, Inc. In some embodiments, medical positioning system 14 may comprise or be used in conjunction with other commonly available systems, such as, for example, but not limited to, fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI)-based systems. For purposes of clarity and illustration only, the medical positioning system 14 is described below as comprising a hybrid magnetic and impedance tracking system. Although reference is made to cardiac mapping of the heart, one or more aspects of the present disclosure may be applied to other anatomical structures.

[0053] Referring to Figure 1A, a catheter system includes a schematic diagram of a heart 10 of a patient 11. The system includes the capability to receive multiple catheter positions as the distal end of the catheter is moved near and within a chamber of the heart. To this end, Figure 1A illustrates an exemplary catheter location system of the type based on externally applied orthogonal electric fields used to locate one or more catheter position sensors. Such systems may include impedance localization systems and / or hybrid magnetic and impedance tracking systems, such as the EnSite™ NavX™ electroanatomical mapping system, the EnSite™ Velocity™ electroanatomical mapping system, and the EnSite Precision™ electroanatomical mapping system (all commercially available from Abbott Laboratories), or systems generally as found with reference to U.S. Patent No. 7,263,397 (the '397 patent), U.S. Patent Publication No. 2007 / 0060833 A1, U.S. Application No. 11 / 227,580 filed September 15, 2005 (the '580 application), U.S. Publication No. 2018 / 0296111 A1, or U.S. Application No. 15 / 953,155 filed April 13, 2018 (the '155 application). The '397 patent, the '580 application, and the '155 application are all incorporated herein by reference as if fully set forth herein.

[0054] Various EnSite™ systems are based on the principle that when an electric current passes through the rib cage, a voltage drop occurs in internal organs, such as the heart, and this voltage drop can be measured and used to determine the location of a medical device within the body. However, it should be understood that this embodiment is merely exemplary and in no way limiting. Other technologies for locating a catheter in 3D space, such as the MediGuide™ system, may be used in practicing the present invention, including, for example, Biosense Webster's CARTO™ navigation and localization system or Northern Digital's AURORA® system, both of which utilize magnetic fields rather than electric fields. Accordingly, as used herein, a sensor is provided for generating signals indicative of catheter position information and may include one or more position sensors. A position sensor may include one or more electrodes configured to detect one or more characteristics of an electric field, for example, in the case of an impedance-based localization system, or one or more coils (e.g., windings) configured to detect one or more characteristics of a magnetic field, for example, in the case of a magnetic-field-based localization system.

[0055] It should be further appreciated that in some localization systems, one or more position sensors may collectively define a sensor. The one or more position sensors may be provided at the distal end of the catheter, and the localization system may be configured to obtain position information from the one or more position sensors. The localization system may calculate the distal position of the catheter using not only the received position information but also a geometric relationship between the one or more position sensors providing the position information and the distal position of the catheter (e.g., one piece of geometric information may be the distance from the ring electrodes to the tip). Finally, the localization system may use the calculated position as if it were collected directly. Similarly, in magnetic field-based localization embodiments, there is a geometric relationship between the catheter tip and the magnetic coil, and the localization system is configured to use the calculated tip position (i.e., the tip position calculated based on the magnetic coil signal and prior knowledge of the geometric relationship between the coil and the tip) as if it were collected directly. Of course, other variations are possible.

[0056] With continued reference to FIG. 1A , the illustrated embodiment of the impedance-based localization system shows three sets of surface electrodes (e.g., applied via patches): X-axis electrodes 12, 14, Y-axis electrodes 18, 19, and Z-axis electrodes 16, 22. In some embodiments, an additional surface electrode 21 (e.g., applied via a “belly” patch) may be used. All of the surface electrodes are connected to a switch 24. A representative catheter 13 is shown, having a single distal electrode 17, which may be referred to herein as a “roving” or “measurement” electrode. In some embodiments, the catheter 13 may be a coronary sinus catheter or a right ventricular apex catheter. In this embodiment, the electrode 17 may define a position sensor, although, as alluded to above, many variations are possible, and the catheter 13 may include multiple position sensors, as discussed further herein. FIG. 1A also shows a second, independent catheter 29 having a fixed reference electrode 31 that may be placed on the heart 10 for calibration purposes.

[0057] 1A further shows a computer system 20, a signal generator 25, an analog-to-digital converter 26, and a low-pass filter 27. The computer system 20 may utilize software, hardware, firmware, and / or logic to perform some of the functions described herein. The computer system 20 may be a combination of hardware and instructions for sharing information. The hardware may include, for example, processing resources 32 and / or memory resources 33 (e.g., a non-transitory computer-readable medium (CRM) database, etc.). The processing resources 32 herein may include several processors capable of executing instructions stored by the memory resources 33. The processing resources 32 may be integrated into a single device or distributed across multiple devices. The instructions (e.g., computer-readable instructions (CRI)) may include instructions for adjusting a cardiac model stored in the memory resources 33 and executable by the processing resources 32.

[0058] Computer system 20 is configured to control signal generator 25 according to a predetermined strategy to selectively energize individual surface electrode pairs. In operation, computer system 20 is configured to acquire raw patch data (i.e., voltage measurements) via filter 27 and A / D converter 26 and use this raw patch data to determine raw electrode position coordinates in three-dimensional space (X, Y, Z) of catheter electrodes (e.g., roving electrodes 17 described above) positioned within heart 10 or its chambers. In some embodiments, the phase of the cardiac cycle of patient 11 may be measured or otherwise determined as such electrode position coordinates are received. To this end, in one embodiment, most or all of 12 conventional ECG leads, coupled to body surface electrodes and collectively indicated by reference numeral 15, are provided to assist in obtaining an electrocardiogram (ECG) of patient 11.

[0059] Alternatively, a reference electrode positioned at a fixed location within heart 10 (e.g., placed in the coronary sinus), such as fixed reference electrode 31, may be used to provide a relatively stable signal that can be analyzed to determine the cardiac phase of heart 10 in the cardiac cycle. More generally, a separate catheter having electrodes other than a mobile or roving catheter may be placed and maintained in a constant position relative to heart 10 to obtain a relatively stable signal indicative of cardiac phase. As shown, ECG leads 15 are directly coupled to computer system 20 for acquisition and subsequent processing to obtain the phase of heart 10 in the cardiac cycle. ECG leads 15 may also be provided to other systems (not shown).

[0060] As mentioned above, embodiments of the present disclosure may be used with magnetic field-based systems. Some embodiments may include a main electronic control unit (e.g., one or more processors) with various input / output mechanisms, a display 23, an optional image database, a location system such as a medical positioning system (MPS) (electromagnetic sensor tracking system), an electrocardiogram (ECG) monitor, one or more MPS position sensors (e.g., patient reference sensors), and an MPS-enabled medical device (such as an elongated catheter or introducer) that includes one or more of the above-mentioned MPS position sensors.

[0061] As discussed, in some embodiments, the medical positioning system may comprise a magnetic field-based system, such as, for example, the MediGuide™ technology system from Abbott Laboratories, as well as magnetic field-based systems as generally described with reference to one or more of U.S. Patent Nos. 6,233,476; 7,197,354; 7,386,339; U.S. Patent Application No. 14 / 208,120, entitled "Medical Device Navigation System," filed March 13, 2014; U.S. Provisional Patent Application No. 61 / 834,223, entitled "Medical Device Navigation System," filed June 12, 2013; and International Application No. PCT / IB2014 / 059709, entitled "Medical Device Navigation System," filed March 13, 2014 (the disclosures of which are incorporated by reference in their entireties as if fully set forth herein).

[0062] Embodiments may include input / output mechanisms, which may include conventional devices for interfacing with a computer-based control unit, such as a keyboard, mouse, tablet, foot pedals, switches, etc. Embodiments may also include a display 23, which may also comprise conventional devices.

[0063] Embodiments may find use in navigation applications that use imaging of a region of interest. Accordingly, the magnetic field-based system may optionally include an image database. The image database may be configured to store image information about a patient's body, such as a region of interest surrounding a target location for a medical device and / or multiple regions of interest along a navigation path the device is expected to traverse to reach the target location. The image data in the image database may comprise known image types, including: (1) one or more two-dimensional still images each acquired at a different time in the past; (2) multiple related two-dimensional images acquired in real time from an image acquisition device (e.g., fluoroscopic images from an X-ray imaging device); and / or (3) a sequence of related two-dimensional images defining a cine loop (CL), where in the latter case the image database serves as a buffer (live fluoroscopy); and in the former case each image in the sequence has at least one ECG timing parameter associated with it suitable for enabling playback of the sequence according to a previously acquired real-time ECG signal obtained from an ECG monitor. It should be understood that the foregoing is exemplary only and is in no way limiting. For example, the image database may also include three-dimensional image data. It should be further understood that the images may be acquired using any imaging modality now known or later developed, such as x-ray, ultrasound, computed tomography, nuclear magnetic resonance, etc.

[0064] The MPS may be configured to function as a positioning system and, therefore, may be configured to determine positioning (localization) data for one or more MPS position sensors, one or more medical devices, and / or one or more patient reference sensors (PRSs) and output respective position measurements. Each position measurement may include at least one or both of position and orientation (P&O) relative to a reference coordinate system, which may be the coordinate system of the MPS. For example, P&O may be expressed as the position (i.e., coordinates in three axes: X, Y, and Z) and orientation (i.e., azimuth and elevation) of the magnetic field sensor within the magnetic field relative to the magnetic field generator or transmitter.

[0065] The MPS determines their respective positions (i.e., P&O) within a reference coordinate system based on capturing and processing signals received from magnetic field sensors positioned within a controlled, low-intensity, alternating magnetic field. From an electromagnetic perspective, these sensors produce voltages induced on coils present within the changing magnetic field, as contemplated herein. The sensors are therefore configured to detect one or more characteristics of the magnetic field in which they are positioned and generate indicative signals, which are further processed by the MPS to obtain the sensors' respective P&O. Exemplary design features and manufacturing processes and methods for sensors and medical devices incorporating such sensors can be found in U.S. Pat. No. 8,636,718, the entire contents of which are incorporated herein by reference.

[0066] The MPS sensor, and in further embodiments, optional additional MPS sensors, may be associated with an MPS-enabled medical device. Another MPS sensor, a patient reference sensor (PRS), is configured to provide a position reference for the patient's body to enable motion compensation for overall body movement and / or respiration-induced movement. The PRS may be attached to the manubrium, a stable location on the patient's chest, or another location that is relatively stable. Similar to the MPS position sensor, the PRS is configured to detect one or more characteristics of the magnetic field in which the PRS is located, and the MPS provides position measurements (e.g., P&O measurements) indicative of the position and orientation of the PRS in a reference coordinate system.

[0067] An electrocardiogram (ECG) monitor is configured to continuously detect electrical timing signals of the cardiac organ by using a plurality of ECG electrodes (not shown), which may be externally affixed to the outside of a patient's body. The timing signals generally correspond, among other things, to specific phases of the cardiac cycle. Typically, the ECG signals may be used by a control unit for ECG-synchronized playback of a sequence of previously taken images (cineloops) stored in a database. Both the ECG monitor and the ECG electrodes may comprise conventional components.

[0068] The magnetic field-based system is incorporated into or associated with a fluoroscopic imaging system, which may include commercially available fluoroscopic imaging components such as an x-ray source, a C-arm, and / or an x-ray image intensifier or detector (i.e., a "catheter lab"). The MPS (electromagnetic sensor tracking system) includes a magnetic transmitter assembly (MTA) (electromagnetic field generator) and a magnetic processing core for determining position (P&O) measurements. The MTA is configured to generate a magnetic field within and near the patient's thoracic cavity in a predetermined three-dimensional space identified as the motion box.

[0069] The MPS sensors are configured to sense one or more characteristics of the magnetic field when the sensors are within the motion box, as described above, and each of the sensors generates a respective signal that is provided to a magnetic processing core. The processing core is configured to calculate a respective P&O measurement for each MPS sensor within the motion box in response to these detected signals. The processing core can detect when the MPS sensors leave the motion box. Thus, the MPS enables real-time tracking of each sensor in three-dimensional space.

[0070] The actual volume of the motion box may be stored, for example, in a processing core, which may determine the position and orientation of each sensor relative to the boundaries of the motion box. Alternatively, the actual volume of the motion box may be stored, for example, in a main controller, which may be able to determine the position and orientation of each sensor relative to the boundaries of the motion box. Thus, the system may evaluate (e.g., in the processing core or main controller) whether a sensor is within the motion box, on the boundaries of the motion box, or outside the motion box. Based on this information, the motion box and sensors are displayed in relation to each other on the display, as described in more detail elsewhere herein.

[0071] In some alternative embodiments, the MTA may be positioned below the patient couch between the x-ray source and the patient couch. For example, the MTA may be connected to the patient couch. In some embodiments, as discussed herein, the MTA may be a mobile device that is placed on the patient's chest and can be used to generate a magnetic field to track objects.

[0072] The positional relationship between the image coordinate system and the MPS reference coordinate system (electromagnetic tracking coordinate system) may be calculated (e.g., established during setup) based on a known optical-magnetic calibration of the system, since in such embodiments the positioning system and imaging system may be considered fixed relative to one another. However, for other embodiments using other imaging modalities, including embodiments in which image data is first acquired and then imported from an external source (e.g., imaging data stored in a database), a registration step to align the MPS coordinate system with the image coordinate system may need to be performed so that the MPS position measurements are properly aligned with any particular image being used.

[0073] As previously mentioned, embodiments of the present disclosure may be used in connection with or for various procedures, such as cardiac mapping and / or cardiac ablation procedures. In some embodiments, ablation therapy may be used to treat various conditions afflicting the human body. One such condition for which ablation therapy may be used is the treatment of cardiac arrhythmias. When tissue is ablated or subjected to ablation energy, a lesion appears within the tissue. The ablation energy is generated by at least an ablation generator and delivered by an ablation catheter. Electrodes assembled on or within the ablation catheter are used to cause tissue necrosis within cardiac tissue and correct symptoms of atrial arrhythmias, such as, but not limited to, ectopic atrial tachycardia, atrial fibrillation, and atrial flutter. Arrhythmias can result in various dangerous symptoms, including loss of synchronized atrioventricular contractions and blood retention. The primary cause of atrial arrhythmias is believed to be stray electrical signals within the left or right atrium. Ablation catheters deliver ablation energy (e.g., radiofrequency energy, cryoablation, laser, chemical agents, high intensity focused ultrasound, etc.) to cardiac tissue, creating lesions within the cardiac tissue that disrupt undesirable electrical pathways, thereby limiting or preventing stray electrical signals that lead to arrhythmias.

[0074] In some embodiments, ablation can include electroporation. Electroporation is a non-thermal ablation technique that involves applying a strong electric field to induce the formation of pores in cell membranes. The electric field can be induced by applying relatively short pulses, which can last, for example, from one nanosecond to several milliseconds. Such pulses can be repeated to form a pulse train. When such an electric field is applied to tissue in an in vivo environment, cells within the tissue experience a transmembrane potential, thereby opening pores in the cell wall. Electroporation can be reversible (i.e., the temporarily opened pores reseal) or irreversible (i.e., the pores remain open), resulting in cell destruction. For example, in the field of gene therapy, reversible electroporation is used to introduce high-molecular-weight therapeutic vectors into cells. In other therapeutic applications, appropriately configured pulse trains alone can be used to induce cell destruction, for example, by causing irreversible electroporation.

[0075] 1B is a schematic block diagram of a system 40 for electroporation therapy according to embodiments of the present disclosure. Generally, various embodiments include an electrode assembly 42 disposed at the distal end of a catheter 44. The electrode assembly 42 includes one or more individual insulated electrode elements. Each electrode element, also referred to herein as a catheter electrode, is individually connected so that it may be selectively paired or combined with any other electrode element to function as a bipolar or multipolar electrode.

[0076] System 40 can be used for irreversible electroporation to destroy tissue. In particular, system 40 can be used for electroporation-induced primitive necrosis, which refers to the delivery of an electric current that directly causes irreversible loss of cell membrane (cell wall) integrity, resulting in membrane disruption and cell necrosis. This mechanism of cell death can be considered an "outside-in" process, meaning that destruction of the cell's outer wall has a detrimental effect on the inside of the cell. Typically, in classical cell membrane electroporation, current is delivered as a pulsed electric field (i.e., pulsed field ablation (PFA)) between closely spaced electrodes capable of delivering a field strength of approximately 0.1 to 1.0 kV / cm in the form of a brief direct current (DC) pulse (e.g., 0.1 to 20 ms duration).

[0077] System 40 includes a catheter electrode assembly 42 including at least one catheter electrode configured for use as briefly outlined above and described in more detail below. Electrode assembly 42 is incorporated as part of a medical device, such as a catheter 44, for electroporation treatment of tissue 46 within a patient's body 48. In the exemplary embodiment, tissue 46 includes the heart or cardiac tissue. However, it should be understood that embodiments may be used to perform electroporation treatment on a variety of other body tissues.

[0078] 1A further illustrates multiple return electrodes, designated 50, 52, and 54, which are schematic representations of connections to the body and may be used by various subsystems contained within overall system 40, such as an electroporation generator 56, an electrophysiology (EP) monitor 60, such as an ECG monitor, and a localization and guidance system 62 for visualizing, mapping, and guiding internal body structures. In the illustrated embodiment, return electrodes 50, 52, and 54 are patch electrodes. It should be understood that the illustration of a single patch electrode is only schematic (for clarity), and that the subsystems to which these patch electrodes are connected can, and typically will, include two or more patch (body surface) electrodes.

[0079] In some embodiments, return electrodes 50, 52, and 54 may be any other type of electrode suitable for use as a return electrode, including, for example, one or more catheter electrodes. A catheter return electrode may be part of electrode assembly 42 or part of a separate catheter (not shown). System 40 may further include a main computer system 64 (including an electronic control unit 78 and data storage-memory 80), which may be integrated with system 62 in certain embodiments. In some embodiments, main computer system 64 may be integrated with computer system 20 shown in FIG. 1A. System 64 may further include conventional interface components, such as various user input / output mechanisms 66A and a display 66B, among other components. Variable impedance device 58 allows for varying the impedance of the system to limit arcing from the catheter electrodes of catheter 44. In some embodiments, variable impedance device 58 is variable in response to an appropriate control signal from computer system 64.

[0080] In the exemplary embodiment, the catheter 44 includes a cable connector or interface 68, a handle 70, and a shaft 72 having a proximal end 74 and a distal end 76. The catheter 44 may include other conventional components not shown herein, such as a temperature sensor, additional electrodes and corresponding conductors or leads. The connector 68 provides mechanical and electrical connection(s) to a cable 82 extending from the generator 56. The connector 68 may comprise conventional components known in the art and is disposed at the proximal end of the catheter 44, as shown.

[0081] 2A is a top view and FIG. 2B is an isometric side top view of a high-density electrode catheter 101 according to various embodiments of the present disclosure. In some embodiments, the high-density electrode catheter 101 may include a flexible tip section 110 that forms a flexible array of electrodes 102. This flat array (or "paddle" configuration) of electrodes 102 may include four side-by-side, longitudinally extending arms 103, 104, 105, 106, which may form a flexible framework on which the electrodes 102 are disposed. The four electrode-carrying arms may include a first outer arm 103, a second outer arm 106, a first inner arm 104, and a second inner arm 105, which may be joined at their distal ends by a distal connecting portion 109. The arms may be laterally spaced apart from one another.

[0082] Each of the four arms may carry multiple electrodes 102. For example, each of the four arms may carry electrodes 102 spaced along the length of each of the four arms. While each of the high-density-electrode catheters 101 shown in FIGS. 2A and 2B shows four arms, the high-density-electrode catheters 101 may include more or fewer arms. Furthermore, while the high-density-electrode catheters 101 shown in FIGS. 2A and 2B show 18 electrodes (e.g., five electrodes on the first outer arm 103 and the second outer arm 106 and four electrodes on the first inner arm 104 and the second inner arm 105), the catheters may include more or fewer than 18 electrodes. Furthermore, the first outer arm 103 and the second outer arm 106 may include more or fewer than five electrodes, and the first inner arm 104 and the second inner arm 105 may include more or fewer than four electrodes.

[0083] In some embodiments, the electrodes 102 may be used in diagnostic, therapeutic, and / or mapping procedures. For example, without limitation, the electrodes 102 may be used in electrophysiological studies, pacing, cardiac mapping, and ablation. In some embodiments, the electrodes 102 may be used to perform monopolar or bipolar ablation, which may create lesions of specific lines or patterns. In some embodiments, the electrodes 102 may receive electrical signals from the heart and use the electrical signals for electrophysiological studies. In some embodiments, the electrodes 102 may perform location or position sensing functions related to cardiac mapping.

[0084] In some embodiments, the high-density electrode catheter 101 may include a catheter shaft 107. The catheter shaft 107 may include a proximal end and a distal end. The distal end may include a connector 108 that may couple the distal end of the catheter shaft 107 to the proximal end of the planar array. The catheter shaft 107 may define a catheter shaft longitudinal axis aa, as shown in FIG. 2A , along which the first outer arm 103, the first inner arm 104, the second inner arm 105, and the second outer arm 106 may extend generally parallel to the catheter shaft longitudinal axis aa. The catheter shaft 107 may be made of a flexible material so that it can be passed through a patient's tortuous blood vessels. In some embodiments, the catheter shaft 107 may include one or more ring electrodes 111 disposed along the length of the catheter shaft 107. The ring electrodes 111 may be used in one example diagnostic, therapeutic and / or mapping procedures.

[0085] As shown in Figure 2B, the flexible tip section 110 can be adapted to conform to tissue (e.g., cardiac tissue). For example, when the flexible tip section 110 contacts tissue, the flexible tip section 110 can deflect, allowing the flexible framework to conform to the tissue. In some embodiments, at the distal end of the catheter shown in Figures 2A and 2B, the arms (or arm substructures) comprising the paddle structure (or flexible framework having multiple arms and supporting electrodes) are preferably constructed from a flexible or spring-like material, such as nitinol and / or a flexible substrate as described herein. The configuration (e.g., including the length and / or diameter of the arms) and the material of the arms can be adjusted or tailored to provide, for example, desired resilience, flexibility, bendability, conformability, and stiffness characteristics, including one or more characteristics that can vary from the proximal end of a single arm to the distal end of that arm, or between or among multiple arms comprising a single paddle structure.

[0086] The foldability of materials such as nitinol and / or flexible substrates provides the added benefit of facilitating insertion of the paddle structure into a delivery catheter or introducer, whether during delivery of the catheter into the body or during removal of the catheter from the body at the end of the procedure. In some embodiments, a non-conductive shell may be disposed over the material (e.g., nitinol) forming the substructure of the arm. In some embodiments described herein, the non-conductive shell may include a tube defining a longitudinally extending lumen through which the substructure is disposed. In some embodiments, the tube may be formed from a material including a polymer.

[0087] Among other things, the disclosed catheters, together with the catheter's multiple electrodes, are useful for (1) defining a local propagation map of a specific sized area (e.g., a 1-centimeter square area) within the atrial wall of the heart, (2) identifying complexly segmented atrial electrograms for ablation, (3) identifying localized focal potentials between electrodes for higher electrogram resolution, and / or (4) more precisely targeting for ablation. These mapping and ablation catheters are configured to conform to cardiac tissue and remain in contact with the tissue despite potentially irregular cardiac motion. In this way, enhanced stability of the catheter against the heart wall during cardiac motion results in more accurate mapping and ablation due to the maintenance of tissue-electrode contact.

[0088] Additionally, the catheters described herein may be useful for epicardial and / or endocardial use. For example, the planar array embodiments shown herein may be used in epicardial procedures, where the planar electrode array is positioned between the myocardial surface and the pericardium. Alternatively, the planar array embodiments may be used in endocardial procedures to rapidly sweep and / or analyze the inner surface of the myocardium and rapidly generate high-density maps of the electrical properties of cardiac tissue.

[0089] In some embodiments, use of the high-density electrode catheter 101 may be prone to blood clotting at various portions of the high-density electrode catheter 101. For example, blood clotting may occur on the flexible tip portion 110 and / or connector 108 of the high-density electrode catheter 101. While blood clotting is discussed herein, in some instances, other material, such as tissue cells, may collect on the flexible tip portion 110 and / or connector 108. Blood clotting may impair the function of the electrode if blood clots on the electrode. Furthermore, blood clotting on the flexible tip portion 110 and / or connector 108 may cause a thrombus if the clotted blood breaks free. Therefore, it is beneficial to prevent blood clotting and / or the accumulation of other material on the flexible tip portion 110 and / or connector 108, which may be achieved using the embodiments discussed in this disclosure.

[0090] The contents of International Application No. PCT / US2014 / 011940, entitled "Flexible High-Density Mapping Catheter Tips" and "Flexible Ablation Catheter Tips with Onboard High-Density Mapping Electrodes," U.S. Application No. 15 / 331,562, entitled "High Density Electrode Mapping Catheter," and U.S. Application No. 15 / 331,369, entitled "High Density Electrode Mapping Catheter," are incorporated herein by reference as if fully set forth herein. While some embodiments of the present disclosure include a flexible tip portion that includes diagnostic and / or therapeutic electrodes, embodiments of the present disclosure can include flexible and / or rigid tip portions (e.g., distal assemblies) instead of or in addition to flexible tip portions, which can be electrode assemblies or any number of end-use therapeutic and / or diagnostic devices. For example, the tip section may include ultrasound sensors and / or transducers, such as those associated with an intracardiac echocardiography (ICE) catheter, a laser, a balloon, or any number of other therapeutic and / or diagnostic devices.

[0091] In some embodiments, although not shown, a magnetic position sensor may be included within the catheter shaft 107 of the high-density electrode catheter 101. In some embodiments, the position of the magnetic position sensor may be determined as described herein. Based on the position of the magnetic position sensor, the position of the flexible tip section 110 may be determined. However, in some embodiments, depending on the size of the flexible tip section 110, the flexible tip section 110 may extend beyond the range where the position of the flexible tip section 110 can be accurately determined by a magnetic position sensor disposed within the catheter shaft 107. For example, the longitudinal length of the flexible tip section 110 may extend beyond the range where the position of the flexible tip section 110 can be accurately determined by a magnetic position sensor disposed within the catheter shaft 107. Accordingly, embodiments of the present disclosure may include a magnetic position sensor disposed on the flexible tip section 110 of the high-density electrode catheter 101, as discussed further herein. In some embodiments, one or more magnetic position sensors may be disposed on the flexible tip section instead of disposing the magnetic position sensors within the catheter shaft 107.

[0092] 3A is an isometric side top view of a high-density-electrode catheter 120, and FIG. 3B is a bottom view of a high-density-electrode catheter 120, according to various embodiments of the present disclosure. In some embodiments, the high-density-electrode catheter 120 can include a flexible tip section 122 that forms a flexible array of electrodes 124. The flexible tip section 122 can be disposed adjacent the distal end of a catheter shaft (not shown). In some embodiments, the flexible tip section 122 can connect to the catheter shaft via a proximal coupler 128, which will be discussed further herein. This flat array (or "paddle" configuration) of electrodes 124 includes five side-by-side, longitudinally extending arms 126-1, 126-2, 126-3, 126-4, and 126-5, which may form a flexible framework on which the electrodes 124 are disposed. As shown, seven electrodes 124 may be disposed along each of the longitudinally extending arms 126-1, 126-2, 126-3, 126-4, and 126-5, for a total of 35 electrodes. In some embodiments, a greater or lesser number of electrodes 124 may be disposed on the flexible tip portion 122. In some embodiments, one or more additional electrodes 130 may be disposed along the central arm 126-5 or along another portion of the flexible tip portion 122, as discussed further herein.

[0093] Although five side-by-side arms 126-1, 126-2, 126-3, 126-4, 126-5 are shown, embodiments of the present disclosure may include fewer or more than five arms. In some embodiments, the five electrode-carrying arms may comprise a first outer arm 126-1, a second outer arm 126-4, a first inner arm 126-2, a second inner arm 126-3, and a central arm 126-5, which may be joined at their distal ends by a distal coupler 136. In some embodiments, the distal coupler 136 may extend longitudinally and define one or more transverse lumens 138-1, 138-2 extending therethrough. In some embodiments, the first outer arm 126-1, the second outer arm 126-4, the first inner arm 126-2, and the second inner arm 126-3 may extend through crossing lumens 138-1, 138-2, thereby coupling the arms 126-1, 126-2, 126-3, 126-4 together. However, as discussed further herein, in some embodiments, the arms 126-1, 126-2, 126-3, 126-4, 126-5 may not be coupled together at their distal ends.

[0094] In some embodiments, the flexible tip portion 122 can include a magnetic position sensor 209, as further shown in Figure 3J. In some embodiments, the magnetic position sensor 209 can be disposed along a distal portion of the flexible framework that forms the flexible tip portion 122. Although hidden from view in Figure 3A, the magnetic position sensor 209 can be disposed within the central electrode 130. For example, as further shown in Figure 3J, the central electrode 130 can define a lumen in which the magnetic position sensor 209 is disposed.

[0095] In some embodiments, magnetic position sensor 209 may be disposed on and / or in a portion of flexible tip portion 122. In some embodiments, a distal portion of flexible tip portion 122 may define a mounting feature for magnetic position sensor 209. In some embodiments, the mounting feature may include a notch in a portion of flexible tip portion 122, a groove in a portion of the flexible tip portion, a lumen in a portion of the flexible tip portion, etc. In some embodiments, the notch may be defined in one of arms 126-1, 126-2, ..., 126-5, distal coupler 136, a framework forming one of arms 126-1, 126-2, ..., 126-5, or elsewhere in flexible tip portion 122.

[0096] In some embodiments, the groove may be defined in one of the arms 126-1, 126-2, ..., 126-5, the distal coupler 136, a framework forming one of the arms 126-1, 126-2, ..., 126-5, or elsewhere within the flexible tip section 122. In some embodiments, the central electrode 130 may define a lumen within which the magnetic position sensor 209 may be disposed, as described herein. In some embodiments, the lumen may be formed by other structure contained within the flexible tip section 122. For example, the lumen may be defined in one of the arms 126-1, 126-2, ..., 126-5, the distal coupler 136, a framework forming one of the arms 126-1, 126-2, ..., 126-5, or elsewhere within the flexible tip section 122. Although some examples have been provided for mounting features, the examples are not so limited and may include other types of mounting features.

[0097] In some embodiments, the magnetic position sensor 209 may be disposed at the distal end of the central arm 126-5. In some embodiments, the magnetic position sensor 209 may sense position and / or orientation in five degrees of freedom (5DOF) or six degrees of freedom (6DOF). As discussed further herein, one or more magnetic position sensors 134-1, 134-2 (FIG. 3B) may be disposed within the proximal coupler 128 and / or along a catheter shaft coupled to the proximal coupler 128 and electrically coupled to the computer system 20 via wires 154-1, 154-2 (e.g., twisted pair wires). The magnetic position sensors 209, 134-1, 134-2 are disposed within a magnetic field and may generate one or more signals that may indicate the position and / or orientation of the magnetic position sensors 209, 134-1, 134-2.

[0098] In some embodiments, the longitudinal length of the flexible tip section 122 may be such that the position of the distal end of the flexible tip section 122 cannot be determined by a magnetic position sensor disposed at the distal end of the catheter shaft. For example, the distal section of the flexible tip section 122 may extend beyond the realm of magnetically accurate position information and software used to determine the position of the flexible tip section. Thus, the position and / or orientation of the flexible tip section 122 may not be able to be accurately determined. Accordingly, the position and / or orientation of the magnetic position sensor 209 disposed within the distal end of the flexible tip section 122 can be determined, and the position of the magnetic position sensor 209 can be used to determine the position and / or orientation of the distal end of the flexible tip section 122, which may extend beyond the realm of magnetically accurate position information.

[0099] In some embodiments, the magnetic position sensor 209 can be disposed on a portion of the flexible tip section 122 beyond the area of ​​magnetically accurate position information provided by the one or more magnetic position sensors 134-1, 134-2 disposed on the proximal coupler 128 and / or on the distal end of the catheter shaft from which the flexible tip section 122 extends. Although the location of the magnetic position sensor 209 is generally described as being disposed on the central arm 126-5, the magnetic position sensor 209 can be located at other locations along the flexible tip section 122 to allow for the location of the flexible tip section 122 to be determined.

[0100] In some embodiments, the central electrode 130 may be cylindrical and extend distally from the central arm 126-5. The central electrode 130 may house a magnetic position sensor 209 (FIG. 3J) while also providing the functionality of an electrode that may be used for diagnostic and / or therapeutic purposes as described herein. The central electrode 130 may connect to a distal coupler 136 at its distal end. The distal coupler 136 may couple the distal end of the central arm 126-5, the distal ends of the first and second outer arms 126-1 and 126-4, and the distal ends of the first and second inner arms 126-2 and 126-3. As mentioned above, although the distal coupler 136 is shown with respect to FIG. 3A, the distal coupler 136 is not required. For example, the framework forming the flexible tip section 122 of the high-density electrode catheter 120 may not be coupled together at a location distal to the distal end of the proximal coupler 128 and / or the catheter shaft from which the flexible tip section 122 extends. In some embodiments, although not shown, a magnetic position sensor may be disposed on one or more portions of the uncoupled framework to enable determination of the location of the uncoupled framework and / or one or more portions of the uncoupled framework.

[0101] In some embodiments, although not shown, the central electrode 130 may include one or more electrodes disposed outside the magnetic position sensor 209. For example, in some embodiments, the central electrode 130 may be divided into multiple portions (e.g., a top half, a bottom half) disposed around the periphery of the central electrode 130. In some embodiments, one or more spot electrodes may be disposed on the magnetic position sensor 209. In some embodiments, the central electrode 130 may be formed from a flexible circuit having one or more electrodes formed thereon, and the one or more electrodes may be disposed over the magnetic position sensor 209.

[0102] In some embodiments, the central arm 126-5 can include an extension feature 140. As shown in FIG. 3A, the extension feature 140 can include a nonlinear extension feature 140. The nonlinear extension feature 140 includes a bend within a portion of the central arm 126-5 that can be straightened, allowing the longitudinal length of the central arm 126-5 to be increased when the bend is in the straightened configuration. In some embodiments, for example, the high-density electrode catheter 120 can be introduced into the body through a sheath. The high-density electrode catheter 120 can be in a storage state while disposed within the sheath, and in the storage state, the distance between each of the longitudinally extending arms is reduced. This can increase the stored longitudinal length of the flexible tip portion 122 compared to the device's deployed length, as shown in FIG. 3A.

[0103] As shown, the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3 have bends (e.g., elbows) along their longitudinal lengths, causing the arms to flare out laterally. For example, with respect to the second outer arm 126-4, this arm includes a proximal bend 142-1 and a distal bend 142-2. When the flexible tip portion 122 is folded into a storage state, these bends 142-1, 142-2 straighten, thereby increasing the longitudinal length of the second outer arm 126-4. In this embodiment, the inclusion of extension features 140 on the central arm 125-5, including nonlinear extension features 140, allows the central arm 125-5 to extend along with the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3, thereby preventing the central arm 126-5 from pulling on the flexible tip portion 122 and causing it to become misaligned during storage. Without the extension features 140, during storage, the lengths of the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3 would increase, while the length of the central arm 126-5 would remain the same, causing a portion of the flexible tip portion 122 to fold over on itself.

[0104] As shown, the proximal coupler 128 can include a distal coupler head 144. In some embodiments, the distal coupler head 144 can be an irrigated distal coupler head 144. In some embodiments, the distal coupler head 144 can include one or more irrigation ports 146-1, 146-2 configured to eject a fluid (e.g., an irrigation fluid). For example, in some embodiments, the irrigation ports 146-1, 146-2 can be positioned to distribute a fluid in a manner that substantially covers the flexible tip portion 122. In some embodiments, the irrigation ports 146-1, 146-2 can be configured to distribute a fluid over the flexible tip portion 122 to help prevent the accumulation of blood clotting or other substances on the flexible tip portion 122. In some embodiments, one or more portions of the flexible tip portion 122 can be susceptible to blood clotting. Accordingly, embodiments of the present disclosure may be configured to distribute fluid over one or more of these portions of flexible tip portion 122 to prevent blood clotting. In some embodiments, irrigation features associated with proximal coupler 128 and distal coupler head 144 of proximal coupler 128 may include one or more features described with respect to U.S. Patent No. 15 / 585,859, which is incorporated by reference herein as if fully set forth herein.

[0105] 3A , the proximal coupler 128 can include a connecting stem section 150 that can be inserted into a lumen defined by the catheter shaft. In some embodiments, the connecting stem section 150 can define a first sensor groove 148-1 and a second sensor groove 148-2 defined in an outer surface 152 of the connecting stem section 150. In some embodiments, the first sensor groove 148-1 and the second sensor groove 148-2 can be angled relative to each other and / or relative to the longitudinal axis of the high-density electrode catheter 120. In some embodiments, the first sensor groove 148-1 and the second sensor groove 148-2 and the magnetic position sensors 134-1, 134-2 can include features described with respect to U.S. Patent No. 15 / 585,859, which is incorporated herein by reference as if fully set forth herein. The configuration of magnetic position sensors 134-1, 134-2 may allow the position and / or orientation of proximal coupler 128, and therefore high-density electrode catheter 120, to be determined in six degrees of freedom.

[0106] In some embodiments, although not shown, additional electrodes may be disposed along distal portions of arms 126-1, 126-2, 126-3, and 126-4, as indicated by arrows 156-1 and 156-2. For example, while FIG. 3A shows electrodes 124 linearly aligned with one another along linear portions of arms 126-1, 126-2, 126-3, and 126-4, embodiments of the present disclosure may benefit from additional electrodes disposed along the regions of arms 126-1, 126-2, 126-3, and 126-4 indicated by arrows 156-1 and 156-2.

[0107] In some embodiments, the electrodes (e.g., one or more of electrodes 124, 130) disposed on high-density-electrode catheter 120 may be used for various diagnostic and / or therapeutic purposes, including, but not limited to, cardiac mapping and / or ablation. In some embodiments, the ablation performed by the electrodes may include multiple different types of ablation. For example, the ablation performed by the electrodes may include monopolar and / or bipolar radiofrequency ablation and / or electroporation, as previously described herein.

[0108] In some embodiments, the flexible tip portion 122 may be an electrode assembly configured as a bipolar electrode assembly for use in bipolar electrode-based electroporation therapy. Specifically, as described above, one or more of the electrodes 124 and / or the central electrode 130 disposed on the flexible framework may be individually electrically coupled to the generator 56 shown in FIG. 1B (e.g., via suitable electrical wires or other suitable electrical conductors extending through the catheter shaft 44) and configured to be selectively energized with opposite polarities (e.g., by the electroporation generator 56 and / or the computer system 64) to generate corresponding electric fields therebetween that are capable of IRE therapy. That is, one or more of the electrodes 124, 130 is configured to function as a cathode, and the other is configured to function as an anode. One or more of the electrodes 124, 130 may be any suitable electroporation electrode. In an exemplary embodiment, one or more of the electrodes 124, 130 may be a ring electrode. One or more of the electrodes 124, 130 may have any other shape or configuration.

[0109] It will be appreciated that the shape, size, and / or configuration of one or more of the electrodes 124, 130 can affect various parameters of the applied electroporation treatment. For example, increasing the surface area of ​​one or more of the electrodes 124, 130 can reduce the applied voltage required to produce the same level of tissue destruction. While the description refers only to electrode 124, the description herein may apply to any one of the electrodes shown on the flexible tip section 122 of the high-density-electrode catheter 120. While the electrodes 124, 130 disposed on the flexible tip section 122 are described as a bipolar electrode assembly, it will be understood that in some embodiments, the electrodes 124, 130 disposed on the flexible tip section 122 can be configured as a monopolar electrode assembly and use a patch electrode (e.g., return electrode 50) as the return or indifferent electrode.

[0110] 3C is a side view of the high-density electrode catheter 120 shown in FIGS. 3A and 3B in accordance with an embodiment of the present disclosure. As shown, the flexible tip section 122 can extend distally from the proximal coupler 128. In some embodiments, the distal end of the distal coupler head 144 can include a cross-longitudinal slot 157 into which the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3 can extend. As further shown, the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3 can extend distally from the distal coupler head 144 from a plane that bisects the longitudinal axis aa of the distal coupler head 144 and the connecting trunk section 150.

[0111] In some embodiments, the central arm 126-5 may extend from the distal coupler head 144 below the longitudinal axis aa and below where the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3 extend from the distal coupler head 144. In some embodiments, the central arm 126-5 may include an extension feature 140. For example, the central arm 126-5 may exit the distal end of the distal coupler head 144 and extend distally and upward, rising through a plane defined by the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3. 3C , the longitudinal axis aa may extend through a plane defined by the first and second outer arms 126-1 and 126-4 and the first and second inner arms 126-2 and 126-3. After reaching the apex 158, the central arm 126-5 may extend downward toward the plane defined by the arms 126-1, 126-2, 126-3, and 126-4. As previously described, when the flexible framework is in the storage configuration, the longitudinal lengths of the arms 126-1, 126-2, ..., 126-5 may extend, flattening the curve in the extension feature 140 and allowing the central arm 126-5 to extend.

[0112] 3D is an isometric side bottom view of the high-density electrode catheter 120 shown in FIGS. 3A-3C in accordance with an embodiment of the present disclosure. FIG. 3D illustrates a third irrigation port 146-3 and a fourth irrigation port 146-4 defined in the distal face of the distal coupler head 144. In some embodiments, the distal coupler head 144 can define a lumen 160 into which adhesive can be injected to fill the interior cavity housing the proximal connecting portions of the substructures of the arms 126-1, 126-2, . . . , 126-5, as further illustrated herein. In some embodiments, the lumen 160 can allow for insertion of a sixth arm in one embodiment in which the flexible tip portion includes six arms, as shown and described with respect to FIG. 5A.

[0113] Figure 3E is an isometric top side view of the high-density electrode catheter 120' shown in Figures 3A-3D in accordance with an embodiment of the present disclosure, further showing the manifold portion 162. Figure 3F is an isometric bottom side view of the high-density electrode catheter 120' shown in Figures 3A-3E in accordance with an embodiment of the present disclosure, further showing the manifold portion 162. In some embodiments, the manifold portion 162 can direct fluid to each of the irrigation ports defined in the distal face of the distal coupler head 144. In some embodiments, the manifold portion 162 can be a hollow cylindrical tube that extends over the distal end of the connecting trunk portion 150 and / or the assembly portion 176 (Figure 3G).

[0114] The manifold portion 162 may define a circumferential manifold 164 defined within an outer surface of the manifold portion 162. As shown, the circumferential manifold 164 may extend circumferentially around the manifold portion 162 and be defined by the recessed manifold portion 170, the inner surface of the distal coupler head 144, and the manifold walls 166-1, 166-2. As shown in FIG. 3F , the manifold walls 166-1, 166-2 define proximal and distal ends of the circumferential manifold 164 and may be fluid-sealed with the inner surface of the distal coupler head 144.

[0115] In some embodiments, a fluid lumen may be defined within connecting trunk portion 150, as further shown and described herein. The fluid lumen may be in fluid communication with a fluid input 168, which may be defined within recessed manifold portion 170 and extend between an inner surface of manifold portion 162 and an outer surface of recessed manifold portion 170. In one example, fluid may be input to circumferential manifold 164 by fluid input 168, filling circumferential manifold 164 with fluid. Recessed manifold portion 170 may further define fluid outlets 172-1, 172-2, 172-3, 172-4 (fluid outlet 172-4 is hidden from view). Each of the fluid outlets 172-1, 172-2, 172-3, 172-4 may be fluidly coupled to a fluid conduit 174-1, 174-2, 174-3, 174-4, respectively.

[0116] Fluid conduits 174-1, 174-2, 174-3, 174-4 may be defined within assembly portion 176, which will be further described with respect to FIG. 3G. As shown in FIG. 3F, each of conduits 174-1, 174-2, 174-3, 174-4 may be defined within a distal surface of assembly portion 176. FIG. 3G is an isometric top side view of high-density electrode catheter 120″ shown in FIGS. 3A-3F in accordance with an embodiment of the present disclosure, further illustrating assembly portion 176. FIG. 3H is an isometric bottom side view of high-density electrode catheter 120″ shown in FIGS. 3A-3G in accordance with an embodiment of the present disclosure, further illustrating assembly portion 176. Assembly portion 176 may, in some embodiments, be disposed on the distal end of connecting trunk section 150. As shown, the assembly portion 176 is cylindrically shaped and can define conduits 174-1, 174-2, 174-3, 174-4 through which irrigation fluid can flow and be directed from the irrigation ports 146-1, 146-2, 146-3, 146-4 (FIGS. 3A and 3D).

[0117] In some embodiments, assembly portion 176 can define a receiving lumen that can receive connecting trunk portion 150 therein. In some embodiments, multiple adhesive holes 180-1, 180-2, 180-3, 180-4 can be defined in the outer surface of assembly portion 176 (180-4 is hidden from view). Adhesive can be injected into adhesive lumen 178 and flow through the interior portion of assembly portion 176 to adhesive holes 180-1, 180-2, 180-3, 180-4, thereby securing assembly portion 176 to connecting trunk portion 150 and manifold portion 162 ( FIG. 3F ). As further shown, the proximal ends of arms 126-1, 126-2, . . . , 126-5 can be disposed within the distal end of assembly portion 176 such that the proximal ends are disposed in a predetermined position relative to assembly portion 176.

[0118] In some embodiments, the assembly portion 176 may include an irrigation through-hole 182, as further shown in FIG. 3M. The irrigation through-hole 182 may be fluidly coupled to an irrigation lumen 280 (FIG. 3Q) defined in the connecting trunk portion 150. For example, the irrigation lumen 280 may be defined in and extend longitudinally through the connecting trunk portion 150. The irrigation lumen 280 may supply irrigation fluid to the through-hole 182 and, therefore, to the fluid input 168.

[0119] Figure 3I is an isometric top side view of the flexible substructure 190 of the high-density electrode catheter 120 shown herein, in accordance with an embodiment of the present disclosure. Figure 3J is an isometric bottom side view of the flexible substructure 190 of the high-density electrode catheter shown in Figures 3A-3I, in accordance with an embodiment of the present disclosure. The flexible substructure 190 may include a first outer frame 192-1, a first inner frame 192-2, a central frame 192-5, a second inner frame 192-3, and a second outer frame 192-4. The first outer frame 192-1 and the first inner frame 192-2 are shown covered by respective tubes 194-1, 194-2 through which the first outer frame 192-1 and the first inner frame 192-2 pass. In some embodiments, tubes 194-1, 194-2 may be dual-lumen tubes, as further shown in FIG. 3K, with frame 192-1 passing through a first lumen 198 of the dual-lumen tube and multiple wires 196 passing through a second lumen 200 of the dual-lumen tube that separates from the first lumen 198 via a flat cross member 202.

[0120] 3I, the central frame 192-5 may include the previously described nonlinear extension feature 204 that allows the central frame 192-5 to extend as the outer frames 192-1, 192-4 and inner frames 192-2, 192-3 extend in the storage configuration. As shown, one nonlinear extension feature 204 is shown, but two or more nonlinear extension features may be included along the central arm 192-5. For example, in some embodiments, a series of undulations may be included along the central arm 192-5, each of which flattens as the central arm 192-5 extends with the outer frames 192-1, 192-4 and inner frames 192-2, 192-3.

[0121] In some embodiments, the proximal end of each of the frames 192-1, 192-2, ..., 192-5 includes a frame mounting portion 206-1, 206-2, ..., 206-5 that can engage the mounting portion 176, as described herein. The frames 192-1, 192-2, ..., 192-5 can be formed from a flexible material, which in some embodiments can include a metal (e.g., Nitinol). As further shown, the frames 192-1, 192-2, ..., 192-5 can include a flat cross-section as further described with respect to U.S. Application No. 15 / 331,369, entitled "High Density Electrode Mapping Catheter," which is incorporated herein by reference as if fully set forth herein. In some embodiments, framework mounting portions 206-1, 206-2, ..., 206-5 may be disposed within corresponding openings and / or lumens defined within mounting portion 176, as further described herein with respect to Figure 3M.

[0122] FIG. 3L is an isometric bottom side view of the high-density electrode catheter 120''' shown in FIG. 3H, without the tube 194 covering the flexible substructure 190, according to an embodiment of the present disclosure. As shown, the proximal end of each of the frames 192-1, 192-2, ..., 192-5 may be disposed within the mounting portion 176. For example, as shown, the side of the frame mounting portion 206-1 is seen to protrude into a mounting cutout 210 defined in the proximal end of the mounting portion 176. As shown, the mounting cutout 210 may be an opening (e.g., a slot) extending distally from the proximal end of the mounting portion 176 having a circumferential width at least as large as the thickness of the frame mounting portion 206-1. As shown in FIG. 3M, the opposite side of the mounting portion 176 may include a mounting cutout 225.

[0123] 3M is an isometric proximal end view of assembly portion 176, according to an embodiment of the present disclosure. As shown, assembly portion 176 defines adhesive holes 180-1, 180-2, 180-3, 180-4, through which adhesive may be disposed to secure assembly portion 176, as described herein. As further shown, assembly portion 176 may include irrigation through-hole 182 through which irrigation fluid may flow and be distributed by manifold portion 162 (FIG. 3F). Further aspects of the assembly portion are described with respect to FIG. 3P.

[0124] 3N is an isometric bottom side view of the proximal end of flexible substructure 190 according to an embodiment of the present disclosure. FIG. 3M is a bottom view of the proximal end of flexible substructure 190 according to an embodiment of the present disclosure. As shown, the proximal end of each of frames 192-1, 192-2,..., 192-5 may include a frame mounting portion 206-1, 206-2,..., 206-5. Frame mounting portions 206-1, 206-2,..., 206-5 may be configured to engage mounting portion 176 to lock frame mounting portions 206-1, 206-2,..., 206-5, and thus frames 192-1, 192-2,..., 192-5, in place relative to mounting portion 176. In some embodiments, frame mounting portions 206-1, 206-2, ..., 206-5 can include clip portions that utilize spring tension provided by frames 192-1, 192-2, ..., 192-5 to engage corresponding clip portions defined in mounting portion 176. In some embodiments, the spring tension can be provided by flexibility associated with frames 192-1, 192-2, ..., 192-5.

[0125] In some embodiments, relative to the central frame mounting portion 192-5, the central frame mounting portion 206-5 can include a spring clip 228. As shown, a spring post 230 can extend proximally relative to the central frame 192-5 and connect at its proximal end to the spring clip 228 via a spring connector. In some embodiments, a spring gap 234 can be defined between the spring post 230 and the spring clip 228. In operation, the spring gap 234 can provide space for the spring clip 228 to be compressed toward the spring post 230 when the central frame mounting portion 206-5 is pushed through the assembly lumen 269 ( FIG. 3M ), as described further herein. As described further, the assembly lumen 269 can have a shape complementary to the cross-section of the central frame 192-5, allowing the central frame mounting portion 206-5 to be pushed through the assembly lumen 269.

[0126] 3O, the spring clip distal end 232 of the spring clip 228 may protrude beyond the corresponding frame edge 238 when the spring clip 228 is in the engaged configuration. When the spring clip 228 is pressed through the corresponding assembly lumen 269 (FIG. 3M), the spring clip 228 may be pressed toward the spring post 230, causing the spring clip distal end 232 to be more flush with the corresponding frame edge 238, thus allowing the central frame assembly portion 206-5 to be pressed through the assembly lumen 269.

[0127] For the first inner frame 192-2 and the second inner frame 192-3, the respective frame mounting portions 206-2, 206-3 may include frame clips, as shown. For simplicity, the description of the frame clips related to the frame mounting portions will be limited to the second inner mounting portion 206-3. The first inner mounting portion 206-2 may include the same or similar features as the second inner mounting portion 206-3. As shown, the second inner mounting portion 206-3 may include a clip notch 240 defined in an inner edge 242 of the second inner frame 192-3. In some embodiments, the clip notch 240 may be complementary to an inner locking post 260 defined in the mounting portion 176, as further shown in and described herein with respect to FIG. 3P. For example, an inner locking post 260 defined in the mounting portion 176 may be disposed within the clip notch 240, thus locking the second inner mounting portion 206-3 in place.

[0128] As further shown, the second inner mounting portion 206-3 can include a ramped portion 244 that can enable the second inner mounting portion 206-3 to deflect over the inner locking post 260 when the second inner frame 192-3 is pressed into the mounting portion 176. In some embodiments, the second inner frame 192-3 and the first inner frame 192-2 are connected and therefore can press simultaneously into the mounting portion 176. As shown, the first inner frame mounting portion 206-2 and the second inner mounting portion 206-3 can deflect away from each other as their respective ramped portions contact the inner locking post 260.

[0129] As shown, the second inner assembly portion 206-3 may further include a retention ledge 246 that may be contacted by an engagement ridge 250 disposed on the opposing proximal inner edge of the second outer assembly portion 206-4, as described herein. With respect to the second outer assembly portion 206-4, the second outer assembly portion 206-4 may include similar features relative to the second inner assembly portion 206-3. For example, the second outer assembly portion 206-4 may include a clip notch 248 and a ramp portion 252 that engage with an outer locking post 262 disposed in the assembly portion 176.

[0130] As described further herein, in some embodiments, the first inner assembly portion 206-2 and the second inner assembly portion 206-3 may be inserted into the assembly portion 176 first, followed by the first outer assembly portion 206-1 and the second outer assembly portion 206-4. The second outer assembly portion 206-4 and the second inner assembly portion 206-3 may press the engagement ridge 250 against the retention ledge 246, thereby providing a retention force between the engagement ridge 250 and the retention ledge 246, thereby ensuring that the clip notches 240, 248 remain engaged with their respective locking posts 260, 262.

[0131] 3P is a bottom view, shown through a cross-section, of the proximal end of the flexible substructure 190 disposed within the assembly portion 176, according to an embodiment of the present disclosure. As shown and previously described, the assembly portion can include an inner locking post 260 and an outer locking post 262. As described, in some embodiments, the first inner frame 192-2 and the second inner frame 192-3 can be inserted into the assembly portion 176. In some embodiments, an extension (e.g., a wire) can be attached to the proximal end of each inner and / or outer assembly portion 206-1, 206-2, ..., 206-4 and passed through openings 264, 268 defined between the inner locking post 260 and the outer locking posts 262, 266, as also shown in FIG. 3M. In some embodiments, the extensions can be pulled proximally to help bias the inner / outer assembly portions 206-1, 206-2, ..., 206-4 proximally and engage each inner / outer locking post 260 / 262, respectively.

[0132] As described, in some embodiments, when the inner mounting portions 206-2, 206-3 are biased into position, resulting in engagement between the clip notch 240 and the inner locking post 260, the angled portion 244 may contact the outer distal edge of the locking post 260. Contact between the angled portion 244 and the distal end of the locking post 260 may separate the second inner mounting portion 206-3 from the first inner mounting portion 206-2. Although not shown, the angled portion associated with the first inner mounting portion 206-2 may also contact the respective proximal edge of the locking post 260, separating the first inner mounting portion 206-2 from the second inner mounting portion 206-3. For example, in some embodiments, the first inner frame 192-2 and the second inner frame 192-3 may naturally bias in the configuration shown in FIG. 3P.

[0133] The first inner frame 192-2 and the second inner frame 192-3 may naturally deflect from the biased state when the inner assembly portions 206-2, 206-3 are inserted into the assembly portion 176. When the first inner frame 192-2 and the second inner frame 192-3 are inserted into the assembly portion 176 to a point where their respective clip notches (e.g., clip notches 240) align with the inner locking post 260, the first inner frame 192-2 and the second inner frame 192-3 may naturally return to the biased state, locking them into place relative to the inner locking post 260.

[0134] In some embodiments, the first outer frame 192-1 and the second outer frame 192-4 can be inserted into respective openings 264, 268 defined between the inner locking post 260 and the outer locking posts 262, 266. In some embodiments, the first inner assembly portion 206-2 and the second inner assembly portion 206-3 can be inserted into the openings 264, 268 and locked into place relative to the inner locking post 260, after which the first outer assembly portion 206-1 and the second outer assembly portion 206-4 can be inserted into the openings 264, 268. When the first outer assembly portion 206-1 and the second outer assembly portion 206-4 are inserted into their respective openings 264, 268, the inclined portions 252, 253 of the first outer assembly portion 206-1 and the second outer assembly portion 206-4 contact the respective inner distal edges of the outer locking posts 262, 266, causing the first outer assembly portion 206-1 and the second outer assembly portion 206-4 to deflect inwardly toward each other.

[0135] Each of the first and second outer assembly portions 206-1 and 206-4 may be proximally inserted through the respective openings 264, 268 until the clip notches 248, 270 of the respective first and second outer assembly portions 206-1 and 206-4 are aligned with the respective outer locking posts 262, 266. Once the outer locking posts 262, 266 are aligned with the first and second clip notches 248, 270, the first and second outer assembly portions 206-1 and 206-4 may expand laterally to seat the first and second outer locking posts 262, 266 within the respective clip notches 248, 270.

[0136] As previously described, each of the first outer assembly portion 206-1 and the second outer assembly portion 206-4 may include an engagement ridge 250. For simplicity, the description of the engagement ridge is limited to the second outer assembly portion 206-4, although the first outer assembly portion 206-1 includes the same or similar features. As shown, after insertion of the second outer assembly portion 206-4 and engagement of the clip notch 248 with the outer locking post 262, the engagement ridge 250 may engage the retention ledge 246. In some embodiments, the engagement ridge 250 may abut the retention ledge 246, thus preventing the clip notches 240, 248 from falling off along with the respective locking posts 260, 262.

[0137] As shown in phantom, the central frame 192-5 can include a central frame mounting portion 206-5. In some embodiments, the mounting portion 176 can define a mounting lumen 269 ( FIG. 3M ) extending longitudinally therethrough and sized similarly to the cross-section of the central arm 192-5. In some embodiments, the central mounting portion 206-5 can be advanced proximally through the longitudinally extending mounting lumen 269 in the mounting portion 176. As the central mounting portion 206-5 advances through the mounting lumen 269 in the mounting portion 176, the spring clip 236 can compress toward the spring post 230 until the spring clip passes through the mounting lumen 269, expanding the spring clip 236 and thus locking the central mounting portion 206-5 in place and allowing the central mounting portion 206-5 to not be pulled distally from the mounting lumen 269.

[0138] As further shown with respect to Figure 3M, in some embodiments, wire lumens 271, 273 can be defined in a distal face of assembly portion 176. In some embodiments, wire lumen 271 can provide space for threading wires into flexible tip portion 122 (Figure 3A) described herein.

[0139] FIG. 3Q is an isometric distal end view of the connecting stem section 150 according to an embodiment of the present disclosure. FIG. 3R is an isometric proximal end view of the connecting stem section 150 shown in FIG. 3G according to an embodiment of the present disclosure. As shown, the connecting stem section 150 may include an irrigation lumen 280 extending therethrough. As previously described, the irrigation lumen 280 may provide irrigation fluid from the proximal end of the connecting stem section 150 to the fluid input 168, as described for FIG. 3F. As further shown, the connecting stem section 150 may define a first sensor groove 148-1 and a second sensor groove 148-2, as described herein. The distal end of the connecting stem section 150 may include a tapered portion 284, which may define a cross-sectional longitudinal slot for inserting a flexible framework. In some embodiments, the tapered portion may interface with the inner surface of the manifold section 162.

[0140] As shown in FIG. 3Q, the irrigation lumen 280 may be defined within the proximal end of the connecting trunk section 150 along with the first and second sensor grooves 148-1 and 148-2. In some embodiments, the connecting trunk section 150 may include a central lumen 286 extending therethrough. As shown, the cross-section of the central lumen 286 may be oval in shape, although the cross-section may be other shapes (e.g., circular, square, rectangular, etc.). In some embodiments, one or more wires may pass through the central lumen 286 associated with an electrode 124 ( FIG. 3A ) disposed on the flexible tip section 122, a magnetic position sensor 209 ( FIG. 3J ) disposed on the flexible tip section 122, or other devices and / or sensors disposed on the flexible tip section 122.

[0141] 3J , in some embodiments, the high-density-electrode catheters described herein may include a magnetic position sensor disposed on the flexible tip section of the catheter. As shown in FIG. 3J , in some embodiments, the magnetic position sensor 209 may be disposed along a distal portion of the flexible tip section of the high-density-electrode catheter. In some embodiments, the position of the magnetic position sensor 209 may be determined and used to locate one or more portions of the flexible tip section described herein. In some embodiments, the flexible substructure 190 may include a magnetic position sensor mount 211 disposed on the distal portion 208 of the flexible substructure 190. In some embodiments, the magnetic position sensor mount 211 may house the magnetic position sensor 209. For example, the magnetic position sensor mount 211 may define a longitudinally extending slot 213 into which the magnetic position sensor 209, further shown with respect to FIGS. 3S and 3T, may be disposed.

[0142] In some embodiments, the magnetic position sensor mount 211 may serve as an electrode substructure for the central electrode 130 shown in FIG. 3A. In some embodiments, the magnetic position sensor 209 may be disposed within the slot 213, and a tubular conductive layer (e.g., the central electrode 130) may be disposed over the outer surface of the magnetic position sensor mount 211. As shown in FIG. 3J, a passage 215 may be defined within the proximal outer surface of the magnetic position sensor mount 211. In some embodiments, a wire may be disposed within the passage 215 and coupled (e.g., via solder) to the magnetic position sensor mount 211. Although not shown, the wire may electrically couple the magnetic position sensor mount 211, and thus the central electrode 130, to the computer system 20. This may enable a dual-purpose magnetic position sensing and electrode assembly.

[0143] In some embodiments, the magnetic position sensor mount 211 may be coupled to the distal coupler 136. In some embodiments, the distal coupler 136 and the magnetic position sensor mount 211 may be formed from a single piece of material. The magnetic position sensor mount 211 may be connected to the distal end of the central frame 192-5, thus connecting the central frame 192-5 to the distal coupler 136. In some embodiments, the magnetic position sensor mount 211 may include a keyed slot 217 that may be configured to receive the distal end of the central frame 192-5, as better shown in FIG. 3S.

[0144] FIG. 3S is a bottom view of the distal portion 208′ of the flexible substructure 190′ shown in FIG. 3J , with the addition of electrodes 124, distal outer substructure tubing 290, and an atraumatic tip 292, according to an embodiment of the present disclosure. As shown, the first outer arm 126-1 and the second outer arm 126-4 can include several electrodes 124 disposed thereon. In some embodiments, the substructures forming the first outer arm 126-1 and the second outer arm 126-4 can be covered with a tube, which can be a dual-lumen tube as shown and described in FIG. 3J . In some embodiments, the tube can be formed from a non-conductive material, such as a polymer, as described herein. As shown, the first inner frame 192-2 is shown covered with a tube at a location distal to the electrodes 124.

[0145] In some embodiments, a dual-lumen tube may be used to cover the portion of the flexible substructure along which the electrodes are disposed. For example, in some embodiments, at least one wire may be associated with each electrode and routed proximally along the flexible tip portion. Using a dual-lumen tube for the portion of the flexible substructure along which the electrodes are disposed allows the wires to be disposed in a first lumen of the dual-lumen tube and the frame (e.g., first inner frame 192-2) to be routed in a second lumen of the dual-lumen tube. For portions of the flexible substructure that do not include electrodes, in some embodiments, a single-lumen tube 290 may be used to cover the flexible substructure, as shown for the first outer arm 126-1 and the second outer arm 126-4.

[0146] In some embodiments, as described herein, the flexible substructure 190′ may include a magnetic position sensor mount 211 disposed on the distal portion 208 of the flexible substructure 190′. In some embodiments, the magnetic position sensor mount 211 may house the magnetic position sensor 209. For example, the magnetic position sensor mount 211 may define a longitudinally extending slot 213 in which the magnetic position sensor 209 may be disposed.

[0147] In some embodiments, the magnetic position sensor mount 211 may serve as an electrode substructure for the central electrode 130 shown in Figure 3A. In some embodiments, the magnetic position sensor 209 may be disposed within the slot 213, and a tubular conductive layer (e.g., the central electrode 130) may be disposed over the outer surface of the magnetic position sensor mount 211.

[0148] In some embodiments, the magnetic position sensor mount 211 may be coupled to the distal coupler 136. In some embodiments, the distal coupler 136 and the magnetic position sensor mount 211 may be formed from a single piece of material. The magnetic position sensor mount 211 may be connected to the distal end of the central frame 192-5, thus connecting the central frame 192-5 to the distal coupler 136. In some embodiments, the magnetic position sensor mount 211 may include a keyed slot 217 that may be configured to receive the distal end of the central frame 192-5, as better shown in FIG. 3S. For example, as shown, the keyed slot 217 may be complementary to the shape of the distal end of the central frame 192-5. As shown, the keyed slot 217 may be a semicircular slot defined in the magnetic position sensor mount 211.

[0149] The distal end of the central frame 192-5 may include a complementary shape, in this example a semicircular end 294. The semicircular end 294 is disposed within a keyed slot 217, which prevents the central frame 192-5 from being pulled proximally from the magnetic position sensor mount 211. This may be beneficial when the flexible lower structure 190′ is in a storage state. For example, when the flexible lower structure is disposed within an introducer / sheath in a collapsed state, the distance between the first outer arm 126-1 and the second outer arm 126-2 may be reduced, and the distance between the first inner arm 126-2 and the second inner arm 126-3 (FIG. 3A) may be reduced. This increases the longitudinal length of the flexible lower structure 190′, thereby pulling the central frame 192-5 distally. The keyed relationship between the slot 217 and the distal end of the center frame 192-5 may prevent the center frame 192-5 from being pulled away from the magnetic position sensor mount 211.

[0150] As further shown in FIG. 3S, an atraumatic tip 292 may be disposed at the distal end of the distal coupler 136. In some embodiments, the atraumatic tip 292 may be formed from a flexible material (e.g., rubber). The atraumatic tip 292 may cushion the distal coupler 136 when contacting tissue. For example, the atraumatic tip 292 may cushion the distal coupler 136 when contacting cardiac tissue when located in the cardiac region. In some embodiments, the atraumatic tip 292 may mechanically fasten to the distal end of the distal coupler 136. In some embodiments, the atraumatic tip 292 may be attached to the distal end of the distal coupler 136 via an adhesive.

[0151] FIG. 3T is a bottom isometric view of the distal portion 208″ of the flexible substructure 190″ shown in FIG. 3J with the addition of the electrode 124, distal inner substructure tubing 296, and atraumatic tip 292, according to an embodiment of the present disclosure. As previously described, a dual-lumen tube may be disposed over the portion of the inner frame including the electrode 124 to form the first inner arm 126-2 and the second inner arm 126-3. The portions of the outer arms 126-1, 126-2 and inner arms 126-3, 126-4 distal to the electrode 124 may include single-lumen tubes such as those shown for the distal outer substructure tubing 290 and the distal inner substructure tubing 296.

[0152] In some embodiments, the outer arms 126-1, 126-2 and the inner arms 126-3, 126-4 can include single-lumen tubing covering the entire arm. For example, the electrodes 124 can be disposed throughout the single-lumen tubing and the inner and outer frames, with wires electrically coupling the electrodes 124 disposed within the single lumen. In some embodiments, the outer arms 126-1, 126-2 and the inner arms 126-3, 126-4 can include dual-lumen tubing covering the entire arm. As previously described herein with respect to FIG. 3A , additional electrodes can be disposed on distal portions of the outer and inner arms 126-1, 126-2, . . . 126-4, as indicated by arrows 156-1, 156-2. Thus, in some embodiments, additional electrodes can be disposed on the dual-lumen tubing.

[0153] 3S, the magnetic position sensor 209, in some embodiments, can include a number of coils 219, which can be wound around a core 221. In some embodiments, the magnetic position sensor 209 can be covered with an outer layer 223. For example, in some embodiments, the outer layer 223 (e.g., a sleeve and / or coating) can be disposed over the magnetic position sensor 209. In some embodiments, the outer layer 223 can be a heat shrink material. As will be explained, the magnetic position sensor 209 is disposed within a longitudinally extending slot 213, which in some embodiments can be filled with an adhesive material to prevent the ends of the magnetic position sensor 209 and / or the center frame 192-5 from loosening.

[0154] FIG. 3U is a bottom isometric view of the distal portion 208''' of the flexible substructure 190''' shown in FIG. 3J, without the distal coupler 136 and the magnetic position sensor mount 211, in accordance with an embodiment of the present disclosure. The magnetic position sensor 209 is shown in the position where the magnetic position sensor 209 would be disposed if disposed within the magnetic position sensor mount 211. As shown, the magnetic position sensor 209 may be located along the distal portion 208''' of the flexible substructure 190'''.

[0155] As described herein, the magnetic position sensor 209 can sense a position and / or orientation that can be provided to the computer system 20. The computer system 20 can use the position and / or orientation sensed by the magnetic position sensor 209 to determine the position and / or orientation of the flexible tip section 122 (FIG. 3A). As shown, the magnetic position sensor 209 can be axially aligned with the longitudinal axis of the central frame 192-5. However, in some embodiments, the magnetic position sensor 209 can be tilted relative to the central frame 192-5. For example, the magnetic position sensor 209 can be tilted laterally relative to the longitudinal axis of the central frame 192-5 and / or the flexible tip section 122, or the catheter shaft attached to the flexible tip section 122. In some embodiments, the magnetic position sensor 209 can be tilted up or down relative to the longitudinal axis of the central frame 192-5 and / or the flexible tip section 122, or the catheter shaft attached to the flexible tip section 122.

[0156] Although the magnetic position sensor 209 is shown as being located along the distal portion 208''', particularly distal to the center frame 192-5, the magnetic position sensor 209 may be disposed elsewhere along the flexible substructure. In some embodiments, the magnetic position sensor 209 may be disposed proximally or distally relative to the location shown in FIG. 3U. In some embodiments, the magnetic position sensor 209 may be disposed laterally relative to the location shown in FIG. 3U. For example, in some embodiments, the magnetic position sensor 209 may be disposed at a different location along the distal portion 208''', while still being able to sense the position and / or orientation of the distal portion 208'''.

[0157] In some embodiments, magnetic position sensors 209 may be located along at least one of the first outer arm 192-1 and the second outer arm 192-4 and / or along at least one of the first inner frame 192-2 and the second inner frame 192-3. In some embodiments, magnetic position sensors may be disposed on one or more of the inner and / or outer frames to determine the position and / or orientation of one of the frames and / or a portion of one of the frames relative to the other frame. Figure 4 shows one embodiment providing for the placement of magnetic position sensors in different locations on the distal portion of the flexible tip section of the catheter.

[0158] FIG. 4 is a top view of a catheter 300, according to an embodiment of the present disclosure, having a flexible tip section 302 with a pair of magnetic position sensors 304-1, 304-2 disposed on a distal portion of the flexible tip section 302. The catheter 300 may include a longitudinally extending catheter shaft 306 having one or more ring electrodes 308-1, 308-2 disposed thereon. In some embodiments, the ring electrodes 308-1, 308-2 may be used for position sensing, diagnostic, and / or therapeutic purposes. While one or more ring electrodes 308-1, 308-2 are described with respect to FIG. 4, other embodiments described herein may include the same or similar electrodes, e.g., to the embodiments described in FIGS. 5, 6, and 7. In some embodiments, the flexible tip section 302 can be coupled to the catheter shaft 306 via a proximal coupler 310 from which extend a first outer arm 312-1, a second outer arm 312-4, a first inner arm 312-2, and a second inner arm 312-3.

[0159] As shown, multiple electrodes 314 may be disposed on the arms 312-1, 312-2, 312-3, and 312-4. While a total of 16 electrodes 314 are shown on the arms 312-1, 312-2, 312-3, and 312-4, the number of electrodes disposed on the arms may be more or less than 16. In some embodiments, the multiple electrodes 314 may be used for position sensing, diagnostic, and / or therapeutic purposes. In some embodiments, one or more magnetic position sensors may be disposed on one of the inner arms 312-1, 312-2 and / or outer arms 312-3, 312-4. For example, as shown, a pair of magnetic position sensors 304-1, 304-2 may be disposed on distal portions of the first outer arm 312-1 and the second outer arm 312-4. A pair of magnetic position sensors 304-1, 304-2 are disposed on the distal portions of the first outer arm 312-1 and the second outer arm 312-4, although the magnetic position sensors 304-1, 304-2 may be disposed on other portions of the flexible tip portion 302 (e.g., the first inner arm 312-2 and the second inner arm 312-3).

[0160] In some embodiments, the magnetic position sensors 304-1, 304-2 may be formed via several windings of wire formed from a conductive material (e.g., copper) around the first outer arm 312-1 and the second outer arm 312-2. In some embodiments, several windings may be made over each sensor core 316-1, 316-2, which may be formed from a magnetically permeable material. For example, in some embodiments, the sensor cores 316-1, 316-2 are disposed over a portion of one of the arms 312-1, 312-2, 312-3, 312-4, and multiple windings of conductive wire may be made over the sensor cores 316-1, 316-2.

[0161] In some embodiments, one or more magnetic position sensors may be formed on a substructure associated with one of arms 312-1, 312-2, 312-3, and 312-4. For example, while magnetic position sensors 304-1 and 304-2 are shown as being disposed around arms 312-1 and 312-4, the magnetic position sensors may be disposed on one or more substructures of arms 312-1, 312-2, 312-3, and 312-4. For example, the substructures forming arms 312-1, 312-2, 312-3, and 312-4 may include one or more slots in which the magnetic position sensors may be disposed. Alternatively and / or additionally, the magnetic position sensors may wrap around the substructures forming one or more of arms 312-1, 312-2, 312-3, and 312-4.

[0162] In some embodiments, one or more electrodes may be disposed across one or more of the magnetic position sensors 304-1, 304-2, as described with respect to FIG. 3A . For example, in some embodiments, one or more electrodes may define a lumen through which one or more of the magnetic position sensors 304-1, 304-2 extend. In some embodiments, electrodes may not be disposed across the entire magnetic position sensor 304-1, 304-2. For example, as previously described herein, one or more electrodes may be disposed across only a portion of the magnetic position sensor 304-1, 304-2, such as the top half and / or bottom half. In some embodiments, one or more spot electrodes may be disposed on one or more of the magnetic position sensors. In some embodiments, a flexible circuit may be disposed across one or more of the magnetic position sensors 304-1, 304-2 with one or more electrodes disposed thereon.

[0163] As shown, the magnetic position sensors 304-1, 304-2 may be formed on portions of the outer arms 312-1, 312-4 that diverge from the longitudinal axis defined by the catheter 300. In some embodiments, the magnetic position sensors 304-1, 304-2 may be electrically coupled to the computing system 20 via one or more wires 318 (e.g., one or more twisted pair wires). As shown, in some embodiments, the wires 318 may not be enclosed through a lumen (e.g., a dual lumen) associated with one of the arms 312-1, 312-2, 312-3, 312-4. The wires 318 may extend proximally from each of the magnetic position sensors 304-1, 304-2 along the catheter shaft 306 between the first inner arm 312-2 and the second inner arm 312-3. In some embodiments, as previously described, the flexible tip section 302 may include a central arm along which the wire 318 may extend.

[0164] In some embodiments, the wires 318 may extend along one of the first outer arm 312-1 and the second outer arm 312-4 and / or the first inner arm 312-2 and the second inner arm 312-4. In some embodiments in which the wires travel under one or more of the arms 312-1, 312-2, 312-3, 312-4, it may be beneficial to maintain symmetry between the arms 312 along which the wires extend. For example, it may be beneficial to have one set of wires extend under the first outer arm 312-1 and another set of wires extend under the second outer arm 312-4, and / or to have one set of wires extend under the first inner arm 312-2 and another set extend under the second inner arm 312-3. Maintaining symmetry between the arms 312 along which the wires extend may maintain symmetry in the deflection of the arms 312. For example, if the wires associated with the magnetic position sensors 304-1, 304-2 extend along the first outer arm 312-1 and the first inner arm 312-2, the flexible tip portion 302 may experience unbalanced deflection due to increased mechanical stiffness of the sides of the flexible tip portion 302 that include the wires (e.g., the first outer arm 312-1 and the second outer arm 312-2).

[0165] 5A is an isometric view of a high-density-electrode catheter 320 including six longitudinally extending arms 322-1, 322-2, ..., 322-6, in accordance with an embodiment of the present disclosure. In some embodiments, the high-density-electrode catheter 320 may include a flexible tip portion 324 formed from first and second outer arms 322-1, 322-6, first and second inner arms 322-3, 322-4, and first and second intermediate arms 322-2, 322-5. As shown, each of the arms 322-1, 322-2, ..., 322-6 may support a plurality of electrodes 326. In some embodiments, each of arms 322-1, 322-2, ..., 322-6 can support seven electrodes 326, allowing an array of 42 electrodes 326 to be disposed on flexible tip portion 324. In some embodiments, a greater or lesser number of electrodes 326 can be disposed on flexible tip portion 324.

[0166] In some embodiments, the flexible tip section 324 can be coupled to the catheter shaft (not shown) via a proximal coupler 327. In some embodiments, the proximal ends of the arms 322-1, 322-2, ..., 322-6 can be disposed within a proximal coupler 328. The proximal coupler 328 can be of the same design as the distal coupler head 144 shown in and described with respect to FIG. 3D. For example, one of the inner arms 322-3, 322-4 can be disposed within a lumen 160 shown in FIG. 3D. In some embodiments, the proximal coupler 328 can include the same or similar features as the distal coupler head 144 shown and described with respect to FIGS. 3A-3D. In some embodiments, the lumen 160 shown in FIG. 3D can provide a location for disposing a substructure associated with one of the inner arms 322-3, 322-4. As previously mentioned, each of arms 322-1, 322-2, ..., 322-6 can include a substructure over which a tube can be disposed. In some embodiments, the tube disposed over the substructure can be a dual lumen and / or a single lumen tube.

[0167] In some embodiments, the proximal coupler 328 may include an irrigation port (e.g., irrigation port 330-1). In some embodiments, the proximal coupler 328 may include four irrigation ports, although only irrigation port 330-1 is visible in FIG. 5A . As shown, the proximal coupler 328 may connect to the distal end of a connecting trunk section 332 described herein. In some embodiments, the connecting trunk section 332 may include a first magnetic position sensor 334-1 and a second magnetic position sensor (hidden from the view), which may be coupled via sensor cables 335-1 and 335-2, respectively. In some embodiments, the connecting trunk section 332 may define a first sensor groove 336-1 and a second sensor groove (hidden from the view).

[0168] As shown, in some embodiments, the first outer arm 322-1 and the second outer arm 322-6 and the first intermediate arm 322-2 and the second intermediate arm 322-5 may extend from a distal end of the proximal coupler 328 along a common plane and couple at their distal ends via the distal coupler 338. In some embodiments, the first inner arm 322-3 may extend distally from the distal end of the proximal coupler 328 below the common plane toward the distal coupler 338, and the second inner arm 322-4 may extend distally from the distal end of the proximal coupler 328 above the common plane toward the distal coupler 338 where the second inner arm 322-4 joins the first inner arm 322-3. At the distal coupler, the first inner arm 322-3 and the second inner arm 322-4 may couple with the first outer arm 322-1 and the second outer arm 322-6 and the first intermediate arm 322-2 and the second intermediate arm 322-5. Because the first inner arm 322-3 and the second inner arm 322-4 extend from the proximal coupler 328 on either side of a common plane, the diameter of the proximal coupler 328 may be smaller. For example, six frames do not extend distally from the proximal coupler 328 in a common plane, which may require a wider proximal coupler.

[0169] As shown, each set of arms 322-1, 322-2, ..., 322-6 can extend through assembly lumens 340-1, 340-2, 340-3 defined in distal coupler 338. Although arms 322-1, 322-2, ..., 322-6 are shown as being coupled at their distal ends, in some embodiments, arms 322-1, 322-2, ..., 322-6 may not be coupled and may not include distal coupler 338. As further shown and described herein, arms 322-1, 322-2, ..., 322-6 can include dual lumen tubes (e.g., FIG. 3K) disposed over a portion of the infrastructure (e.g., outer frame 342-1) that includes electrodes 326. In some embodiments, the single lumen tubes 344, 346 may cover the portions of the substructure forming each of the arms 322-1, 322-2, . . . , 322-6 that do not have electrodes disposed thereon.

[0170] In some embodiments, although not shown, additional electrodes may be disposed along distal portions of arms 322-1, 322-2, ..., 322-6, as indicated by arrows 348-1, 348-2. For example, while Figure 5A shows electrodes 326 linearly aligned with one another along linear portions of arms 322-1, 322-2, ..., 322-6, embodiments of the present disclosure may benefit from additional electrodes disposed along the regions of arms 322-1, 322-2, ..., 322-6 indicated by arrows 348-1, 348-2.

[0171] 5B is a distally facing isometric view of the high-density electrode catheter 320 shown in FIG. 5A including six longitudinally extending arms 322-1, 322-2, . . . , 322-6, according to an embodiment of the present disclosure. As shown, the proximal coupler 327 can include an assembly portion 370, as further shown and described with respect to FIG. 3M. In some embodiments, the proximal coupler 327 can include a manifold portion 372 that includes the same or similar features as those described with respect to the manifold portion 162 shown in FIG. 3F.

[0172] 5B and 5C, in some embodiments, the flexible circuit 374 may be disposed on one or more portions of the arms 322-1, 322-2, ..., 322-6 and / or on the substructure of one of the arms 322-1, 322-2, ..., 322-6. In some embodiments, several electrodes may be disposed on the flexible circuit 374 disposed on one or more of the arms 322-1, 322-2, ..., 322-6. As shown in FIG. 5C, a ring electrode is disposed around each of the arms 322-1, 322-2, ..., 322-6. Alternatively and / or in addition, in some embodiments, the flexible circuit may be disposed along one or more of the arms 322-1, 322-2, ..., 322-6, and electrodes may be formed on the flexible circuit. In some embodiments, this may reduce and / or eliminate the number of wires extending through each of arms 322-1, 322-2, ..., 322-6, allowing for the use of smaller diameter arms 322-1, 322-2, ..., 322-6.

[0173] In some embodiments, the flexible circuit 374 can extend from the proximal end of one or more of the arms 322-1, 322-2, ..., 322-6. For example, in Figures 5B and 5C, the flexible circuit 374 is shown extending from the proximal end of the second outer arm 322-6 toward the distal end of the second outer arm 322-6. For reference, the flexible circuit 374 is shown disposed over the electrode 326, but in use, the flexible circuit 374 can replace the electrode 326, with the electrode disposed on the flexible circuit 374.

[0174] Although not shown, in some embodiments, one or more electrical traces may be formed in flexible circuit 374 to electrically couple one or more electrodes disposed on flexible circuit 374 to computer system 20 and / or computer system 64. In some embodiments, the locations of the electrodes disposed on flexible circuit 374 may correspond to the locations of electrodes 326.

[0175] In some embodiments, the flexible circuit 374 may extend along the outer surface of the second outer arm 322-6 and transition at a transition point 375 to extend along the top surface of the second outer arm 322-6 and the bottom surface of the second outer arm 322-6. In some embodiments, a linear flexible circuit may be used, with the flexible circuit 374 transitioning from the outer surface of the second outer arm 322-6 to the top surface of the second outer arm 322-6 and the bottom surface of the second outer arm 322-6. For example, in some embodiments, the flexible circuit may be disposed completely along the top and / or bottom surfaces of the second outer arm 322-6. However, due to a curve in the proximal portion of the second outer arm 322-6, the flexible circuit disposed on the top / bottom surfaces of the second outer arm 322-6 may need to be configured with a curve that matches the proximal curve of the second outer arm 322-6. Thus, embodiments of the present disclosure may provide a linear (e.g., axially extending) flexible circuit 374 that may be disposed along the top and bottom of the second outer arm 322-6 and over the curved portion of the second outer arm 322-6.

[0176] As shown in FIG. 5D , the flexible circuit 374 may bifurcate into a top flexible circuit 377-1 and a bottom flexible circuit 377-2 at a transition point 375. In some embodiments, the top flexible circuit 377-1 and the bottom flexible circuit 377-2 may bifurcate from a single flexible circuit 374. However, in some embodiments, the top flexible circuit 377-1 and the bottom flexible circuit 377-2 may be formed from separate flexible circuits. For example, two separate flexible circuits may extend distally along the second outer arm 322-6 from a proximal end of the second outer arm 322-6 toward a distal end of the second outer arm 322-6. Thus, the top flexible circuit 377-1 may be formed from a separate flexible circuit from the bottom flexible circuit 377-2. In some embodiments, portions of the flexible circuits proximal to the transition point 375 may overlap one another. Although the above description is given for the second outer arm 322-6, the other arms 322-1, 322-2, ..., 322-5 of the electrode catheter 320' may include flexible circuits and respective transition points as described with respect to the second outer arm 322-6.

[0177] In some embodiments, the flexible circuit 374 may extend along the outer surface of the second outer arm 322-6 and transition at a transition point 375 to an extension along either the top surface of the second outer arm 322-6 or the bottom surface of the second outer arm 322-6. For example, in some embodiments, the flexible circuit 374 may extend along one of the top or bottom of the second outer arm 322-6. While the above description is made with respect to the second outer arm 322-6, the other arms 322-1, 322-2, ..., 322-5 of the electrode catheter 320' may include flexible circuits and respective transition points as described with respect to the second outer arm 322-6.

[0178] Although described with respect to Figures 5B, 5C, and 5D, flexible circuits may be disposed on other embodiments described herein. For example, the embodiments of the present disclosure described with respect to at least Figures 3A-4 and 6A-11 may include one or more flexible circuits disposed on a flexible tip portion.

[0179] FIG. 5C illustrates the high-density electrode catheter 320′ of FIG. 5A in accordance with an embodiment of the present disclosure, further illustrating the distal end of the proximal coupler 327 and frame mounting portions 362-1, 362-2, . . . , 362-6. In some embodiments, each of the arms 322-1, 322-2, . . . , 322-6 can include a substructure frame 342-1, 342-2, 342-3, as described herein. For example, referring to FIG. 5C, various portions of the frames 342-1, 342-2, 342-3 are shown. As further shown, the proximal portions of the frames 342-1, 342-2, 342-3 can include frame mounting portions 362-1, 362-2, . . . , 362-5 (362-3, 362-6 are hidden from view), as described with respect to FIGS. 3N-3P. Frame mounting portions 362-1, 362-2, ..., 362-6 may be disposed within mounting portion 176, which is further described with respect to Figure 3M. In some embodiments, the same mounting portion 176, including five longitudinally extending arms, may be used for catheter 120 shown in Figure 3A as may be used for catheter 320 shown in Figure 5A, which includes six longitudinally extending arms.

[0180] In some embodiments, the framework mounting portion 362-4 associated with the second inner arm 322-4 includes the same features as the framework mounting portion 206-5 shown in Figure 3O and may be inserted into a mounting lumen (e.g., mounting lumen 269 shown in Figure 3M). In some embodiments, the framework mounting portion (hidden from view) associated with the first inner arm 322-4 includes the same features as the framework mounting portion 206-5 shown in Figure 3O and may be inserted into a mounting lumen (e.g., mounting lumen 275 shown in Figure 3M).

[0181] Although one or more magnetic position sensors are not shown on the device illustrated in FIGS. 5A-5D , in some embodiments, one or more magnetic position sensors may be disposed thereon. For example, in some embodiments, a device having six longitudinally extending arms may include one or more magnetic position sensors disposed thereon. In some embodiments, the magnetic position sensors may be disposed on portions of the first outer arm 322-1 and the second outer arm 322-6. For example, in some embodiments, the magnetic position sensors may be disposed on distal portions of the first outer arm 322-1 and the second outer arm 322-6 in a configuration similar to that shown and described with respect to FIG. 4 . In some embodiments, one or more magnetic position sensors may be disposed on one or more distal portions of the first intermediate arm 322-2 and the second intermediate arm 322-5 in a configuration similar to that shown and described with respect to FIG. 4 . In some embodiments, one or more magnetic position sensors may be disposed on one or more distal portions of the first inner arm 322-3 and the second inner arm 322-4 in a configuration similar to that shown and described with respect to FIG.

[0182] FIG. 6A is an isometric view of a substructure 378 of a flexible tip section 380 of a high-density electrode catheter according to an embodiment of the present disclosure. As shown, the flexible tip section 380 may include a first outer frame 382-1, a second outer frame 382-7, a first intermediate frame 382-2, a second intermediate frame 382-6, a first inner frame 382-3, a second inner frame 382-5, and a central frame 382-4. The flexible tip section 380 may include similar or identical features to those described for the high-density electrode catheter 120 of FIG. 3A, except for the additional first intermediate frame 382-2 and second intermediate frame 382-6. As further shown and described with respect to FIG. 6B, a proximal assembly section 394 may be used within which all seven frames 382-1, 382-2, . . . , 382-7 may be disposed.

[0183] As further shown, the central frame 382-4 can include a nonlinear extension feature 384, as previously described herein. The nonlinear extension feature 384 allows the central frame 382-4 to extend in response to a storage (e.g., folded) configuration of the flexible tip 380, as described herein. In some embodiments, the distal end of the central arm 382-4 can connect with the magnetic position sensor mount 386 via a keyed slot 388 and a corresponding keyed distal end (hidden from view) of the central frame 382-4.

[0184] In some embodiments, a magnetic position sensor (not shown) may be disposed within a longitudinally extending slot 390 defined in the magnetic position sensor mount 386 to enable determination of the position and orientation of the distal end of the flexible tip 380. In some embodiments, as previously described herein, a conductive jacket may be disposed over the magnetic position sensor mount 386, which may also serve as an electrode. As further shown, in some embodiments, the magnetic position sensor mount 386 may be coupled to a distal coupler 392 that may couple the distal ends of each of the frames 382-1, 382-2, ..., 382-7. As described herein, in some embodiments, a coupler may not be used, and the frames 382-1, 382-2, ..., 382-7 may be freely disposed relative to one another.

[0185] In some embodiments, proximal mounting portion 394 may define an insertion lumen (e.g., insertion lumen 396) for each proximal mounting portion (not shown) of frames 382-1, 382-2, ..., 382-7. In some embodiments, a wire lumen (e.g., wire lumen 398) may be defined adjacent each insertion lumen 396 to allow wires associated with one or more electrical sensors (e.g., electrodes) or other devices disposed on substructure 378 to be passed therethrough.

[0186] FIG. 6B is a proximal end view of the assembly portion 394 shown in FIG. 6A , according to an embodiment of the present disclosure. In some embodiments, the proximal assembly portion 394 can be disposed on the distal end of a catheter shaft (not shown). In some embodiments, several insertion lumens 396 are defined in the distal face of the proximal assembly portion 394. For simplicity, the description of the insertion lumens is limited to the insertion lumens 396. As described with respect to FIGS. 3N and 3P for the five-arm flexible tip portion, each proximal assembly portion of the frame can be inserted into a respective insertion lumen 396. For example, the proximal assembly portion of the first intermediate frame 382-3 can include a spring clip feature similar or the same as that described with respect to the central assembly portion 206-5 described with respect to FIGS. 3N through 3P. Thus, the proximal assembly portion 394 of the first intermediate frame 382-3 can be pushed proximally through the insertion lumen 396, allowing the proximal assembly portion of the first intermediate frame 382-3 to lock into place relative to the proximal assembly portion 394. As described with respect to FIG. 6B, the proximal assembly portion 394 can include seven insertion lumens and seven wire lumens 398 to accommodate each of the frames 382-1, 382-2, ..., 382-7 and their associated wiring.

[0187] 7 illustrates a distal flexible tip section 400 of a high-density-electrode catheter having a particular electrode configuration according to an embodiment of the present disclosure. As shown, the distal flexible tip section 400 may include a first outer arm 402-1, a first inner arm 402-2, a central arm 402-3, a second inner arm 402-4, and a second outer arm 402-5, all coupled by a distal coupler 403. As shown, several electrodes 404-1, 404-2, ..., 404-19 may be disposed on each of the arms 402-1, 402-2, ..., 402-5. As shown, the spacing between each row of electrodes 404-1, 404-5, 404-12, 404-19, indicated by dotted lines 406, may have equal spacing between each electrode 404-1, 404-5, 404-12, 404-19.

[0188] In some embodiments, the spacing between each electrode 404 in each row of electrodes can range from 3 to 5 millimeters. In some embodiments, the spacing between each electrode 404 in each row of electrodes 404 can be 4 millimeters. As shown, the electrodes 404-9, 404-10, 404-11 disposed on the central arm 404-3 can be longitudinally staggered relative to the electrodes disposed on the first and second outer arms 404-1 and 404-5 and the first and second inner arms 404-2 and 404-4. In some embodiments, the electrodes 404-9, 404-10, 404-11 disposed on the central arm 404-3 may be longitudinally staggered relative to the electrodes disposed on the first and second outer arms 404-1 and 404-5 and the first and second inner arms 404-2 and 404-4 by a length ranging from 1 to 3 millimeters. In some embodiments, the stagger length may be 2 millimeters.

[0189] In some embodiments, the electrodes disposed on the central arm 404-3 and the electrodes disposed on the first and second inner arms 404-2 and 404-4 may form a pattern of decreasing spacing, represented by the dotted housing 408. In some embodiments, the spacing length between each electrode 404-6, 404-10, 404-11, 404-13 intersected by the dotted housing 408 may include lengths ranging from 1.5 to 3.5 millimeters. In some embodiments, the spacing length may be 2.8 millimeters. While specific ranges are provided herein, the ranges are approximate and the spacing between electrodes may be less or greater than the provided ranges.

[0190] 7, an additional electrode 410 may be disposed at the distal end of central arm 404-3. As previously described herein, the additional electrode 410 may be used for diagnostic, mapping, and / or therapeutic purposes. In some embodiments, as further described herein, a magnetic position sensor may be disposed within the additional electrode 410 to provide mapping functionality for distal flexible tip portion 400.

[0191] 8A through 8E illustrate various electrode spacing configurations for electrodes disposed on a distal flexible tip portion of a high-density-electrode catheter according to embodiments of the present disclosure. For FIGS. 8A through 8E, the overall dimensions indicated by lines "a" and "b" (e.g., a x b) may be the same. However, the density and configuration of electrode spacing may vary. While specific ranges are provided herein for FIGS. 8A through 8E, the ranges are approximate, and the spacing between electrodes may be less than or greater than the provided ranges. In some embodiments, although a specific number of electrodes are shown for FIGS. 8A through 8E, the embodiments illustrated herein may include more or fewer electrodes than those shown.

[0192] As shown in Figure 8A, multiple electrodes 424-1, 424-2, 424-3 are disposed on a flexible framework 420 formed from multiple arms 422-1, 422-2, 422-3, 422-4, including a first outer arm 422-1, a first inner arm 422-2, a second inner arm 422-3, and a second outer arm 422-4. For ease of reference, only electrodes 424-1, 424-2, 424-3 will be referenced herein, but the principles described for electrodes 424-1, 424-2, 424-3 also apply to the other electrodes shown in Figure 8A. As shown in Figure 8A, 16 electrodes may be disposed on the flexible framework.

[0193] In some embodiments, the spacing between each of the horizontally spaced electrodes may be equal. As used herein, the terms "horizontally spaced" and "horizontal spacing" may be used interchangeably with the terms "laterally spaced" and "lateral spacing," respectively. For example, the spacing between electrodes 424-1 and 424-3 may be equal to other horizontally spaced electrodes disposed on flexible framework 420. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 424-1, 424-3) may range from 2 to 5 millimeters. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 424-1, 424-3) may be 4 millimeters.

[0194] In some embodiments, the spacing between each of the vertically spaced electrodes may be equal. As used herein, the terms "vertically spaced" and "vertical spacing" may be used interchangeably with the terms "longitudinally spaced" and "longitudinal spacing," respectively. For example, the spacing between electrodes 424-1 and 424-2 may be equal to other vertically spaced electrodes disposed on flexible framework 420. In some embodiments, the spacing between each of the vertically spaced electrodes (e.g., electrodes 424-1, 424-2) may range from 2 to 5 millimeters. In some embodiments, the spacing between each of the vertically spaced electrodes (e.g., electrodes 424-1, 424-2) may be 4 millimeters.

[0195] As shown in FIG. 8B , a plurality of electrodes 430-1, 430-2, ..., 430-11 are disposed on a flexible framework 426 formed from a plurality of arms 428-1, 428-2, ..., 428-5, including a first outer arm 428-1, a first inner arm 428-2, a central arm 428-3, a second inner arm 428-4, and a second outer arm 428-5. In some embodiments, a greater density of electrodes may be disposed on the first inner arm 428-2, the central arm 432, and the second inner arm 428-4. For ease of reference, only electrodes 424-1, 424-2, ..., 424-9 are referenced herein, however, the principles described for electrodes 424-1, 424-2, ..., 424-9 also apply to the other electrodes shown in FIG. 8B . As shown in FIG. 8B, 29 electrodes may be disposed on a flexible framework.

[0196] In some embodiments, the spacing between each of the horizontally spaced electrodes disposed on the first outer arm 428-1, the first inner arm 428-2, the second inner arm 428-4, and the second outer arm 428-5 may be equal (e.g., electrodes 430-1, 430-2, 430-4, 430-5). In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., 424-1, 424-3) may range from 2 to 5 millimeters. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., 424-1, 424-3) may be 4 millimeters.

[0197] In some embodiments, the spacing between each of the vertically spaced electrodes on the first outer arm 428-1 and the second outer arm 428-5 may be equal (e.g., electrodes 430-1, 430-8). In some embodiments, a higher density of electrodes is disposed on the first inner arm 428-2 and the second inner arm 428-4 and the central arm 428-3, but the spacing between each of the vertically spaced electrodes (e.g., electrodes 430-1, 430-8) on the first outer arm 428-1 and the second outer arm 428-5 may be maintained between certain electrodes (e.g., electrodes 430-2, 430-9) disposed on the first inner arm 428-2, the central arm 428-3, and the second inner arm 428-4. For example, the spacing between electrodes 430-2, 430-9 disposed on second inner arm 428-4 may be equal to the spacing between electrodes 430-1, 430-8 disposed on second outer arm 428-5. In some embodiments, the spacing between each of the vertically spaced apart electrodes (e.g., 430-1, 430-8) may range from 2 to 5 millimeters. In some embodiments, the spacing between each of the vertically spaced apart electrodes (e.g., 424-1, 424-8) may be 4 millimeters.

[0198] In some embodiments, the spacing between electrodes (e.g., electrodes 430-2, 430-3, 430-6, 430-7) disposed on the first inner arm 428-2 and second inner arm 428-4 and central arm 428-3 may include smaller spacing between electrodes (e.g., electrodes 430-1, 430-8) disposed on the first outer arm 428-1 and second outer arm 428-5, which may result in a greater density of electrodes disposed on the first inner arm 428-2, central arm 428-3, and second inner arm 428-4. In some embodiments, the greater density of electrodes disposed on the first inner arm 428-2, central arm 428-3, and second inner arm 428-4 may provide greater granularity of sensing by the flexible framework 426. In some embodiments where electrodes are used for ablation, a greater density of electrodes disposed on the first inner arm 428-2, the central arm 428-3 and the second inner arm 428-4 may result in a denser ablation pattern.

[0199] In some embodiments, the spacing between each of the vertically spaced apart electrodes (e.g., electrodes 430-2, 430-6 and electrodes 430-3, 430-7) disposed on the first inner arm 428-2, the central arm 428-3, and the second inner arm 428-4 may range from 1 to 3 millimeters. In some embodiments, the spacing between each of the vertically spaced apart electrodes (e.g., electrodes 430-2, 430-6 and electrodes 430-3, 430-7) may be 2 millimeters. In some embodiments, the spacing between each of the horizontally spaced apart electrodes (e.g., electrodes 430-3, 430-2 and electrodes 430-7, 430-6) disposed on the first inner arm 428-2, the central arm 428-3, and the second inner arm 428-4 may range from 1 to 3 millimeters. In some embodiments, the spacing between each of the horizontally spaced electrodes (eg, electrodes 430-3, 430-2 and electrodes 430-7, 430-6) may be 2 millimeters.

[0200] In some embodiments, the first plurality of electrodes are disposed on the first outer arm 428-1 and the second outer arm 428-5, and the first inner arm 428-2 and the second inner arm 428-4, and the central arm 432 (e.g., electrodes 430-1, 430-2, 430-4, 430-5, 430-8, 430-9, 430-10, 430-11) may have equal spacing therebetween. In one example, the spacing between each of the electrodes 430-1, 430-2, 430-4, 430-5, 430-8, 430-9, 430-10, 430-11 may be a first dimension (e.g., 2 millimeters). In some embodiments, a second plurality of electrodes may be disposed on the first and second inner arms 428-2 and 428-4 and the central arm 432 (e.g., electrodes 430-2, 430-3, 430-6, 430-7) and may have equal spacing therebetween. In one example, the spacing between each of the electrodes 430-2, 430-3, 430-6, 430-7 may be a second dimension (e.g., 1 millimeter). In some embodiments, the second dimension may be smaller than the first dimension, resulting in a greater density of electrodes disposed on the first and second inner arms 428-2 and 428-4 and the central arm 432.

[0201] As further shown, flexible framework 426 may include a magnetic position sensor 432 disposed on a distal portion of central arm 428-3. In some embodiments, the position of magnetic position sensor 432 may be determined, and thus the position of the distal portion of flexible framework 426. Magnetic position sensor 432 may be a five-degree-of-freedom and / or six-degree-of-freedom sensor. While magnetic position sensor 432 is shown as being disposed on central arm 428-3, magnetic position sensor 432 may be disposed on other portions of the flexible framework. In some embodiments, magnetic position sensor 432 is not limited to a single magnetic position sensor but may include two or more magnetic position sensors. In some embodiments, as previously described herein, magnetic position sensor 432 may be disposed within a magnetic position sensor mount, which may also serve as an additional electrode. Thus, in some embodiments, flexible framework 426 may include 30 electrodes.

[0202] As shown in FIG. 8C , multiple electrodes 442-1, 442-2, 442-3 are disposed on a flexible framework 438 formed from multiple arms 440-1, 440-2, ..., 440-5, including a first outer arm 440-1, a first inner arm 440-2, a central arm 440-3, a second inner arm 440-4, and a second outer arm 440-5. In some embodiments, the multiple arms 440-1, 440-2, ..., 440-5 may include an equal density of electrodes 442-1, 442-2, 442-3. For ease of reference, only electrodes 442-1, 442-2, 442-3 will be referenced, but the principles described for electrodes 440-1, 440-2, 440-3 also apply to the other electrodes shown in FIG. 8C . As shown in FIG. 8C, 25 electrodes may be disposed on a flexible framework.

[0203] In some embodiments, the spacing between each of the horizontally spaced electrodes may be equal. For example, the spacing between electrodes 442-1 and 442-3 may be equal to the spacing between other horizontally spaced electrodes disposed on flexible framework 438. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 442-1, 442-3) may range from 2 to 4 millimeters. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 442-1, 442-3) may be 3 millimeters. In some embodiments, the spacing between each of the vertically spaced electrodes may be equal. For example, the spacing between electrodes 442-1 and 442-2 may be equal to the spacing between other vertically spaced electrodes disposed on flexible framework 438. In some embodiments, the spacing between each of the vertically spaced electrodes (e.g., electrodes 442-1, 442-2) may range from 2 to 4 millimeters. In some embodiments, the spacing between each of the vertically spaced electrodes (eg, electrodes 442-1, 442-2) may be 3 millimeters.

[0204] As further shown, flexible framework 438 may include a magnetic position sensor 444 disposed on a distal portion of central arm 440-3. In some embodiments, magnetic position sensor 444 may be used in determining the position and orientation of the distal portion of the flexible framework. Magnetic position sensor 444 may be a five-degree-of-freedom and / or six-degree-of-freedom sensor. In some embodiments, as previously described herein, magnetic position sensor 444 may be disposed within a magnetic position sensor mount that may also serve as an additional electrode. Thus, in some embodiments, flexible framework 438 may include 30 electrodes.

[0205] As shown in FIG. 8D , multiple electrodes 454-1, 454-2, 454-3 are disposed on a flexible framework 450 formed from multiple arms 452-1, 452-2, ..., 452-6, including a first outer arm 452-1, a first middle arm 452-2, a first inner arm 452-3, a second inner arm 452-4, a second middle arm 452-5, and a second outer arm 452-6. For ease of reference, only electrodes 454-1, 454-2, 454-3 are referenced, but the principles described for electrodes 454-1, 454-2, 454-3 also apply to the other electrodes shown in FIG. 8D . As shown in FIG. 8D , 36 electrodes may be disposed on the flexible framework 450.

[0206] In some embodiments, the spacing between each of the horizontally spaced electrodes may be equal. For example, the spacing between electrodes 454-1 and 454-3 may be equal to the spacing between other horizontally spaced electrodes disposed on flexible framework 450. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 454-1, 454-3) may range from 1.4 to 3.4 millimeters. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 454-1, 454-3) may be 2.4 millimeters.

[0207] In some embodiments, the spacing between each of the vertically spaced electrodes may be equal. For example, the spacing between electrodes 454-1 and 454-2 may be equal to the spacing between other vertically spaced electrodes disposed on flexible framework 450. In some embodiments, the spacing between each of the vertically spaced electrodes (e.g., electrodes 454-1, 454-2) may range from 1.4 to 3.4 millimeters. In some embodiments, the spacing between each of the vertically spaced electrodes (e.g., electrodes 454-1, 454-2) may be 2.4 millimeters.

[0208] As shown in FIG. 8E, multiple electrodes 462-1, 462-2, 462-3 are disposed on a flexible framework 460 formed from multiple arms 462-1, 462-2, . . . , 462-7, including a first outer arm 462-1, a first middle arm 462-3, a first inner arm 463-3, a central arm 462-4, a second inner arm 462-5, a second middle arm 462-6, and a second outer arm 462-7. For ease of reference, only electrodes 462-1, 462-2, 462-3 are referenced, but the principles described for electrodes 462-1, 462-2, 462-3 also apply to the other electrodes shown in FIG. 8E. As shown in FIG. 8E, 49 electrodes may be disposed on the flexible framework 460.

[0209] In some embodiments, the spacing between each of the horizontally spaced electrodes may be equal. For example, the spacing between electrodes 464-1 and 464-3 may be equal to the spacing between other horizontally spaced electrodes disposed on flexible framework 460. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 464-1, 464-3) may range from 1 to 3 millimeters. In some embodiments, the spacing between each of the horizontally spaced electrodes (e.g., electrodes 464-1, 464-3) may be 2 millimeters. In some embodiments, the spacing between each of the vertically spaced electrodes may be equal. For example, the spacing between electrodes 464-1 and 464-2 may be equal to the spacing between other vertically spaced electrodes disposed on flexible framework 460. In some embodiments, the spacing between each of the vertically spaced electrodes (e.g., electrodes 464-1, 464-2) may range from 0.5 to 3 millimeters. In some embodiments, the spacing between each of the vertically spaced electrodes (eg, electrodes 464-1, 464-2) may be 2 millimeters.

[0210] As further shown, flexible framework 460 may include a magnetic position sensor 466 disposed on a distal portion of central arm 462-4. In some embodiments, magnetic position sensor 466 may be used in determining the position and orientation of the distal portion of the flexible framework. Magnetic position sensor 466 may be a five-degree-of-freedom and / or six-degree-of-freedom sensor. In some embodiments, as previously described herein, magnetic position sensor 466 may be disposed within a magnetic position sensor mount that may also serve as an additional electrode. Thus, in some embodiments, flexible framework 438 may include 50 electrodes.

[0211] FIG. 9 is an isometric rear view of a distal tip assembly 480 including a magnetic position sensor mount 486 and a distal coupler 482, according to an embodiment of the present disclosure. As shown, the distal coupler 482 may define one or more crossover lumens 484-1, 484-2 extending therethrough, as described herein. One or more arms (not shown) associated with a flexible framework may be disposed through the one or more crossover lumens 484-1, 484-2. In some embodiments, the magnetic position sensor mount 486 may extend proximally from the distal coupler 482. In some embodiments, the magnetic position sensor mount 486 may include a first sensor groove 488-1 and a second sensor groove 488-2 ( FIG. 9 ) defined in an outer surface 490 of the magnetic position sensor mount 486. In some embodiments, first sensor groove 488-1 and second sensor groove 488-2 can be angled relative to each other and / or relative to the longitudinal axis of high-density electrode catheter 486. In some embodiments, first sensor groove 488-1 and second sensor groove 488-2, and the magnetic position sensors further shown in FIG. 10 and disposed within first sensor groove 488-1 and second sensor groove 488-2, can include features described with respect to U.S. patent application Ser. No. 15 / 585,859, which is incorporated by reference herein as if fully set forth herein.

[0212] For example, in some embodiments, the magnetic position sensors can be tilted relative to one another when disposed within the first sensor groove 488-1 and the second sensor groove 488-2, allowing for determination of the roll of the magnetic position sensor mount 486 and associated distal coupler 482, and therefore the roll of the flexible framework coupled to the distal coupler 482 and / or magnetic position sensor mount 486.

[0213] Although magnetic position sensor mount 486 is shown connected to distal coupler 482, magnetic position sensor mount 486 may be disposed along other portions of the flexible framework of the high-density electrode catheters described herein. For example, magnetic position sensor mount 486 and associated magnetic position sensors may be disposed along the central arm, inner arm, middle arm, and / or outer arm described herein.

[0214] As described further herein, in some embodiments, the magnetic position sensor mount 486 may form an electrode. In some embodiments, a conductive material (not shown) may surround the magnetic position sensor mount 486, which may form an electrode. For example, at least a central electrode 130, such as that shown and described with respect to FIG. 3A, may be disposed over the magnetic position sensor mount 486.

[0215] FIG. 10 is a side view of a distal tip assembly 500 including a magnetic position sensor mount 506 and a distal coupler 502, according to an embodiment of the present disclosure. As shown, the distal coupler 502 may define one or more crossover lumens 504-1, 504-2 extending therethrough, as described herein. One or more arms (not shown) associated with a flexible framework may be disposed through the one or more crossover lumens 504-1, 504-2. In some embodiments, the magnetic position sensor mount 506 may extend proximally from the distal coupler 502. In some embodiments, the magnetic position sensor 506 may include a first sensor groove 508-1 and a second sensor groove 508-2 ( FIG. 9 ) defined in an outer surface 510 of the magnetic position sensor mount 506. In some embodiments, the first sensor groove 508-1 and the second sensor groove 508-2 can be angled relative to each other and / or relative to the longitudinal axis of the magnetic position sensor mount 506. In some embodiments, the first sensor groove 508-1 and the second sensor groove 508-2, and the magnetic position sensor 512-1 (magnetic position sensor 512-2 is hidden from view) disposed within the first sensor groove 508-1 and the second sensor groove (sensor groove 508-2 is hidden from view), can include features described with respect to U.S. Patent Application No. 15 / 585,859, which is incorporated by reference herein as if fully set forth herein.

[0216] For example, in some embodiments, the magnetic position sensors 512-1, 512-2 can be tilted relative to one another when disposed within the first sensor groove 508-1 and the second sensor groove 508-2, allowing for determination of the roll of the magnetic position sensor mount 506 and associated distal coupler 502, and therefore the roll of the flexible framework coupled to the distal coupler 502 and / or magnetic position sensor mount 506.

[0217] Although magnetic position sensor mount 506 is shown connected to distal coupler 502, magnetic position sensor mount 506 may be disposed along other portions of the flexible framework of the high-density electrode catheters described herein. For example, magnetic position sensor mount 506 and associated magnetic position sensors may be disposed along the central arm, inner arm, middle arm, and / or outer arm described herein.

[0218] As shown in FIG. 10 , first twisted pair wires 514-1 and second twisted pair wires 514-2 can electrically couple the magnetic position sensors 512-1, 512-2 to one or more of the computer systems 20, 64 shown in FIGS. 1A and 1B . As further shown in FIG. 10 , electrode wires 518 are shown extending from the proximal end of the magnetic position sensor mount 506, which can be electrically coupled to electrodes disposed on the magnetic position sensor mount and one or more of the computer systems 20, 64. Also shown extending from the proximal end of the magnetic position sensor mount is a central frame 516 of a flexible framework described herein. In some embodiments, the central frame 516 can be coupled to the proximal end of the magnetic position sensor mount 506, for example, as described herein with respect to FIGS. 3J and 3S .

[0219] 11 is a top view of a high-density electrode catheter 530 having staggered electrodes 534-1, 534-2, ..., 534-25, in accordance with an embodiment of the present disclosure. As shown, the high-density electrode catheter 530 can include a flexible framework formed from a first outer arm 532-1, a first inner arm 532-2, a central arm 532-3, a second inner arm 532-4, and a second outer arm 532-5. In some embodiments, the proximal ends of the arms 532-1, 532-2, ..., 532-5 can be disposed within a proximal coupler 536 described herein, which can be assembled onto the distal end of a catheter shaft (not shown). The distal ends of the arms 532-1, 532-2, ..., 532-5 can be assembled with a distal coupler 538. However, in some embodiments, arms 532-1, 532-2, . . . , 532-5 may not be coupled to one another.

[0220] As shown, central arm 532-3 can include extension features 540 as described herein. In some embodiments, central arm 532-3 can include an electrode 542 disposed at a distal end of central arm 532-3. In some embodiments, the core of electrode 542 can include a magnetic position sensor (not shown) that can be used to determine the position and / or orientation of flexible framework 531.

[0221] In some embodiments, as shown, each of the arms 532-1, 532-2, ..., 532-5 can include an electrode 534-1, 534-2, ..., 534-25 disposed thereon. As shown, the electrodes on each of the arms 532-1, 532-2, ..., 532-5 can be staggered. For example, on the first outer arm 532-1, the electrodes 534-1, 534-2, ..., 534-5 can be staggered relative to the electrodes 534-6, 534-7, ..., 534-10 disposed on the first inner arm 532-2. As shown, the electrodes 534 disposed on each arm can be staggered relative to the electrodes 534 disposed on the adjacent arm.

[0222] In some embodiments, a group (e.g., a group) of electrodes 534 may be formed by electrodes 534 disposed on the first inner arm 532-2 and electrodes 534 disposed on the first outer arm 532-1 and central arm 532-3; a group of electrodes 534 may be formed by electrodes 534 disposed on the central arm 532-3 and electrodes 534 disposed on the first inner arm 532-2 and second inner arm 532-4; ​​and / or a group of electrodes 534 may be formed by electrodes 534 disposed on the second inner arm 532-4 and electrodes 534 disposed on the central arm 532-3 and second outer arm 532-5. For example, the grouping of electrodes 534-1, 534-6, 534-7, 534-11 for first outer arm 532-1, first inner arm 532-2 and central arm 532-3 is shown by parallelogram 544.

[0223] In some embodiments, staggered electrodes 534-1, 534-2, ..., 534-25 disposed on each arm 532-1, 532-2, ..., 532-5 can be advantageous because it provides a compromise between the spacing between each of the electrodes 534-1, 534-2, ..., 534-25 and the total number of electrodes 534-1, 534-2, ..., 534-25. In one example, the spacing between each electrode in a group of electrodes 543-1, 534-6, 534-7, 534-11 can be the same. For example, the spacing between electrodes 534-1 and 534-7 can be the same as the spacing between electrodes 534-1 and 534-6, which in turn can be the same as the spacing between electrodes 534-6 and 534-7. 11 allows for reduced spacing between electrodes 534 while using the same number of electrodes as an embodiment in which electrodes 534-1, 534-2, ..., 534-25 are not staggered. In some embodiments in which the electrodes are not staggered but are aligned with one another along the cross-sectional longitudinal axis of the flexible tip portion, more electrodes and / or more arms may be required to achieve the same spacing between electrodes in a staggered set, such as those shown with respect to FIG.

[0224] FIG. 12A is a top view of a substructure 548 of a flexible tip of a high-density electrode catheter according to an embodiment of the present disclosure, where the substructure 548 includes magnetic position sensors 554-1, 554-2 within an outer frame. As shown, the substructure 548 may include a first outer frame 550-1 and a second outer frame 550-2. In some embodiments, FIG. 12A illustrates a portion of the entire substructure associated with the flexible tip of the high-density electrode catheter. For example, FIG. 12A illustrates the outer substructure portion of the entire substructure, which may also include a middle frame and / or an inner frame, as discussed further herein. For example, the substructure to which the first outer frame 550-1 and the second outer frame 550-2 belong may have a total of two to eight arms, although in some embodiments, embodiments of the present disclosure may include nine or more arms. As shown, the first frame 550-1 and the second frame 550-2 may include frame mounting portions 552-1, 552-2.

[0225] In some embodiments, the magnetic position sensors 554-1, 554-2 may be disposed along the first outer frame 550-1 and the second outer frame 550-2, as shown in FIG. 12A. In some embodiments, the magnetic position sensors 554-1, 554-2 may be disposed along the top, bottom, inside, and / or outside of each of the first outer frame 550-1 and the second outer frame 550-2. In some embodiments, the first outer frame 550-1 and the second outer frame 550-2 may include mounting features that may be configured to enable mounting of the magnetic position sensors 554-1, 554-2 along the first outer frame 550-1 and the second outer frame 550-2.

[0226] In some embodiments, as shown, the first outer frame 550-1 and the second outer frame 550-2 may include slots 556-1, 556-2 defined along longitudinally extending portions of the first outer frame 550-1 and the second outer frame 550-2. As shown, in some embodiments, the slots 556-1, 556-2 define a central mounting space extending longitudinally along the first outer frame 550-1 and the second outer frame 550-2. As shown, the slots 556-1, 556-2 and associated magnetic position sensors 554-1, 554-2 are shown located proximate shoulder portions 558-1, 558-2. In some embodiments, the magnetic position sensors 554-1, 554-2 may be disposed along other portions of the first outer frame 550-1 and the second outer frame 550-2. For example, magnetic position sensors 554-1, 554-2 may be located along outer frames 550-1, 550-2 proximally from the location shown in FIG. 12A. In some embodiments, magnetic position sensors 554-1, 554-2 may be located within the proximal tip portion 560 of the outer substructure. Although two magnetic position sensors 554-1, 554-2 are shown disposed along outer frames 550-1, 550-2, fewer or more than two magnetic position sensors 554-1, 554-2 may be disposed along outer frames 550-1, 550-2.

[0227] In some described embodiments, the slots 556-1, 556-2 can be defined within portions of the first outer frame 550-1 and the second outer frame 550-2. With respect to the second slot 556-2, the slot can be defined along the second outer frame 550-2 such that a pair of slot frames 562-1, 562-2 define the slot 556-2. For example, in some embodiments, the second outer frame 550-2 can be cut to define the slot 556-2, leaving behind the first slot frame 562-1 and the second slot frame 562-2. In some embodiments, the portion of the outer frame 550-2 in which the slot 556-2 is defined can expand when material is removed from the outer frame 550-2 to define the slot 556-2, such that the combined lateral width of each slot frame 562-1, 562-2 can match the lateral width of the outer frame 550-2. As shown, the portion of the outer frame 550-2 includes an overhang 564 such that the portion of the outer frame 550-2 including the magnetic position sensor 554-2 is wider than other longitudinally extending portions of the outer frame 550-2. In some embodiments, the combined lateral width of the slotted frames 562-1, 562-2 may be less than or greater than the lateral width of other longitudinally extending portions of the outer frame 550-2, e.g., longitudinally extending portions of the outer frame 550-2 located proximal to the slotted frames 562-1, 562-2. Accordingly, despite the slot 556-2 being defined within the outer frame 550-2, the flexibility of the portion of the outer frame 550-2 including the magnetic position sensor may match or approximately match the flexibility of other longitudinally extending portions of the outer frame 550-2, such as those located proximal to the magnetic position sensor 554-2. Although the above description is directed to the second outer frame 550-2, the same may be applied to the other frames.

[0228] As shown, magnetic position sensor 554-2 can be located between slot frames 562-1 and 562-2. In some embodiments, the top and bottom surfaces of the magnetic position sensor can be flush with the top and bottom surfaces of outer frame 550-2. In some embodiments, the top and bottom surfaces of magnetic position sensor 554-2 can protrude above or be recessed below the top and / or bottom surfaces of outer frame 550-2.

[0229] In some embodiments, the slots 556-1, 556-2 may be defined via laser cutting. For example, in some embodiments, the substructure 548, including the slots 556-1, 556-2, may be defined via laser cutting. In some embodiments, the substructure 548, including the slots 556-1, 556-2, may be produced via molding. In some embodiments, the substructure 548 and the slots 556-1, 556-2 may be produced by two different processes. For example, the substructure 548 may be molded and the slots 556-1, 556-2 may be laser defined. In some embodiments, the slots 556-1, 556-2 and the substructure 548 may each be formed by the same method.

[0230] FIG. 12B is a close-up view of the flexible tip substructure of the high-density electrode catheter shown in FIG. 12A , further illustrating a magnetic position sensor 554-2 within the outer frame 550-2, according to an embodiment of the present disclosure. In some embodiments, the outer frame 550-2 can define a slot 556-2 defined by slot frames 562-1, 562-2. As shown, the magnetic position sensor 554-2 can be disposed between the slot frames 562-1, 562-2. In some embodiments, a passageway can be defined within the outer frame 550-2. For example, as shown in FIG. 12B , a through slot is defined within the outer frame 550-2, but in some embodiments, the passageway can define a recessed area defined within the outer frame 550-2. For example, the outer frame 550-2 can be recessed such that a passageway is defined within the surface of the outer frame 550-2, thus providing a pocket for the magnetic position sensor. Thus, the magnetic position sensor 554-2 may be set within the aisle so that the magnetic position sensor 554-2 contacts the bottom of the aisle, aiding in the placement of the magnetic position sensor 554-2.

[0231] FIG. 13A is a top view of a substructure 570 of a flexible tip of a high-density electrode catheter according to an embodiment of the present disclosure, where the substructure 570 includes magnetic position sensors 576-1, 576-2 within an outer frame. As shown, the substructure 570 may include a first outer frame 572-1 and a second outer frame 572-2. In some embodiments, FIG. 13A illustrates a portion of the entire substructure associated with the flexible tip of the high-density electrode catheter. For example, FIG. 13A illustrates the outer substructure portion of the entire substructure, which may also include a middle frame and / or an inner frame, as discussed further herein. For example, the substructure to which the first outer frame 572-1 and the second outer frame 572-2 belong may have a total of two to eight arms, although in some embodiments, embodiments of the present disclosure may include nine or more arms. As shown, the first frame 572-1 and the second frame 572-2 may include frame mounting portions 574-1, 574-2.

[0232] In some embodiments, the magnetic position sensors 576-1, 576-2 may be disposed along the first outer frame 572-1 and the second outer frame 572-2, as shown in FIG. 13A. In some embodiments, the magnetic position sensors 576-1, 576-2 may be disposed along the top, bottom, inside, and / or outside of each of the first outer frame 572-1 and the second outer frame 572-2. In some embodiments, the first outer frame 572-1 and the second outer frame 572-2 may include mounting features that may be configured to enable mounting of the magnetic position sensors 576-1, 576-2 along the first outer frame 572-1 and the second outer frame 572-2.

[0233] In some embodiments, as shown, the first outer frame 572-1 and the second outer frame 572-2 may include notches 578-1, 578-2 defined along longitudinally extending portions of the first outer frame 572-1 and the second outer frame 572-2. As shown, in some embodiments, the notches 578-1, 578-2 define mounting spaces extending longitudinally along the interior of the first outer frame 572-1 and the second outer frame 572-2. As shown, the notches 578-1, 578-2 and associated magnetic position sensors 576-1, 576-2 are shown located proximal to the shoulder portions 580-1, 580-2. In some embodiments, the magnetic position sensors 576-1, 576-2 may be disposed along other portions of the first outer frame 572-1 and the second outer frame 572-2. For example, magnetic position sensors 576-1, 576-2 may be located along outer frames 572-1, 572-2 proximally from the location shown in FIG. 13A. In some embodiments, magnetic position sensors 576-1, 576-2 may be located within a distal tip portion 582 of the outer substructure. Although two magnetic position sensors 576-1, 576-2 are shown disposed along outer frames 572-1, 572-2, fewer or more than two magnetic position sensors 576-1, 576-2 may be disposed along the outer frame.

[0234] In some described embodiments, the notches 578-1, 578-2 can be defined within portions of the first outer frame 572-1 and the second outer frame 572-2. With respect to the second notch 578-2, the notch can be defined along an inner edge of the second outer frame 572-2. In some embodiments, not shown, the notch 578-2 can be defined along an outer edge of the second outer frame 572-2.

[0235] In some embodiments, the second outer frame 572-2 may be cut to define a notch 578-2. In some embodiments, the portion of the outer frame 572-2 where the notch 578-2 is defined may expand such that the lateral width of the notch frame 584 may match the lateral width of the outer frame 572-2 when material is removed from the outer frame 572-2 to define the notch 578-2. As shown, the portion of the outer frame 572-2 includes an overhang 586 such that the portion of the outer frame 572-2 including the magnetic position sensor 576-2 is wider than other longitudinally extending portions of the outer frame 572-2. In some embodiments, the total lateral width of the notch frame 584 may be smaller or larger than the lateral width of other longitudinally extending portions of the outer frame 572-2, e.g., the longitudinally extending portion of the outer frame 572-2 located proximal to the notch frame 584. Accordingly, despite the notch 578-2 defined in the outer frame 572-2, the flexibility of the portion of the outer frame 572-2 that includes the magnetic position sensor may match or nearly match the flexibility of other longitudinally extending portions of the outer frame 572-2, such as those located proximate the magnetic position sensor 576-2. While the above description is directed to the second outer frame 572-2, the same may apply to the other frames.

[0236] In some embodiments, the top and bottom surfaces of the magnetic position sensor 576-2 may be flush with the top and bottom surfaces of the outer frame 572-2, hi some embodiments, the top and bottom surfaces of the magnetic position sensor 576-2 may protrude above or be recessed below the top and bottom surfaces of the outer frame 572-2.

[0237] In some embodiments, the notches 578-1, 578-2 may be defined via laser cutting. For example, in some embodiments, the substructure 570, including the notches 578-1, 578-2, may be defined via laser cutting. In some embodiments, the substructure 570, including the notches 578-1, 578-2, may be produced via molding. In some embodiments, the substructure 570 and the notches 578-1, 578-2 may be produced by two different methods. For example, the substructure 570 may be molded and the notches 578-1, 578-2 may be defined by a laser. In some embodiments, the notches 578-1, 578-2 and the substructure 570 may each be formed by the same method.

[0238] 13B is a close-up view of a portion of the flexible tip substructure of the high-density electrode catheter shown in FIG. 13A , further showing magnetic position sensor 576-2 within outer frame 572-2. In some embodiments, outer frame 572-2 can define notch 578-2 defined by notched arm 584. As shown, magnetic position sensor 576-2 can be disposed inside notched arm 584. In some embodiments, magnetic position sensor 576-2 can be disposed outside notched arm 584.

[0239] 14 is a top view of a high-density electrode catheter 600, according to an embodiment of the present disclosure, in which magnetic position sensors 602-1, 602-2 are disposed within outer arms 604-1, 604-5 of the high-density electrode catheter 600. As shown, the high-density electrode catheter 600 may include a proximal coupler 606 to which the longitudinally extending arms 604-1, 604-2, ..., 604-5 are coupled, as described herein. In some embodiments, one or more electrodes 608 may be disposed along one or more of the arms. In some embodiments, the high-density electrode catheter 600 may include more or fewer than five arms 604-1, 604-2, ..., 604-5.

[0240] In some embodiments, the high-density electrode catheter 600 can include magnetic position sensors disposed along one or more of the longitudinally extending arms 604-1, 604-2, ..., 604-5. As shown, the first magnetic position sensor 602-1 and the second magnetic position sensor 602-2 can be disposed along a portion of the first outer arm 604-1 and the second outer arm 604-5. In some embodiments, the frames associated with the first outer arm 604-1 and the second outer arm 604-5 can include the same or similar features as those described with respect to Figures 12A-13B.

[0241] As shown, the framework associated with the first arm 604-1 and the second arm 604-5 may include notches into which the magnetic position sensors 602-1, 602-2, respectively, may be disposed. In some embodiments, the framework associated with the first arm 604-1 and the second arm 604-5 may include slots, as described in Figures 12A and 12B. While the first arm 604-1 and the second arm 604-5 are generally described herein, in some embodiments, magnetic position sensors may be disposed on the other arms 604-2, 604-3, 604-4. The magnetic position sensors 602-1, 602-2 are disposed on the distal portions of the longitudinally extending portions of the first arm 604-1 and the second arm 604-5, however, the magnetic position sensors 602-1, 602-2 may be disposed distal to the location shown in the present invention and / or proximal to the location shown in the present invention.

[0242] In some embodiments, the framework associated with arms 604-1, 604-2, ..., 604-5 may include nitinol, stainless steel, or titanium, among other materials. In some embodiments, tubing may be disposed over magnetic position sensors 602-1, 602-2 to help hold the magnetic position sensors so they do not become dislodged. In some embodiments, tubing may be placed over magnetic position sensors 602-1, 602-2, with magnetic position sensors 602-1, 602-2 disposed inside outer tubing with electrodes 608 disposed on the outer tubing. In some embodiments, the outer tubing may help hold magnetic position sensors 602-1, 602-2 without the use of inner tubing.

[0243] Various device, system, and / or method embodiments have been described herein. As described in the specification and depicted in the accompanying drawings, numerous specific details have been set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments. However, it will be understood by those skilled in the art that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described herein. Those skilled in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and therefore, the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, which scope is defined only by the appended claims.

[0244] Throughout this specification, references to "various embodiments," "some embodiments," "one embodiment," or "an embodiment" mean that a particular feature, structure, or characteristic described in connection with an embodiment is included in at least one embodiment. Thus, appearances of phrases such as "various embodiments," "some embodiments," "one embodiment," or "embodiment" in various places within the specification do not necessarily all refer to the same embodiment. Furthermore, particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, a particular feature, structure, or characteristic illustrated or described in connection with one embodiment may be combined, in whole or in part, without limitation, with features, structures, or characteristics of one or more other embodiments, provided that such combination is not illogical or non-functional.

[0245] It will be understood that the terms "proximal" and "distal" may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term "proximal" refers to the portion of the instrument closest to the clinician, and the term "distal" refers to the portion located furthest from the clinician. It will be further understood that for brevity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein with reference to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting or absolute.

[0246] While at least one embodiment of a high-density catheter has been described above with a certain degree of particularity, those skilled in the art can make numerous modifications to the disclosed embodiments without departing from the spirit or scope of the present disclosure. All directional references (e.g., upper, lower, upward, downward, left, right, leftward, rightward, top, bottom, upward, downward, vertical, horizontal, clockwise, and counterclockwise) are used solely for identification purposes to aid the reader in understanding the present disclosure and do not create limitations, particularly with respect to the position, orientation, or use of the device. Joint references (e.g., affixed, attached, coupled, connected, etc.) should be interpreted broadly and may include intermediate members between the connection of elements and relative movement between elements. As such, joint references do not necessarily imply that two elements are directly connected and in a fixed relationship to one another. It is intended that all matter contained in the above description or shown in the accompanying drawings be interpreted merely as illustrative and not limiting. Changes in detail or structure may be made without departing from the spirit of the present disclosure, as defined in the appended claims.

[0247] Any patent, publication, or other disclosure material that is said to be incorporated by reference herein is incorporated herein, in whole or in part, only to the extent that the incorporated material does not contradict existing definitions, descriptions, or other disclosure material expressly set forth in this disclosure. As such, and to the extent necessary, the disclosure expressly set forth herein takes precedence over any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated herein by reference but that contradicts existing definitions, descriptions, or other disclosure material expressly set forth herein is incorporated only to the extent that no contradiction arises between the incorporated material and the existing disclosure material. The following items are elements of the claims as originally filed: (Item 1) 1. A high-density electrode catheter, comprising: a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis; a shaft magnetic position sensor disposed along a distal portion of the catheter shaft; a flexible tip section located adjacent the distal end of the catheter shaft, the flexible tip section including a flexible framework; a plurality of electrodes disposed on the flexible framework; a tip magnetic position sensor disposed on a portion of the flexible framework. (Item 2) 2. The high-density electrode catheter of item 1, wherein the tip magnetic position sensor is disposed on a distal portion of the flexible tip section. (Item 3) the distal portion of the flexible tip section defines a lumen; 2. The high-density electrode catheter of item 1, wherein the tip magnetic position sensor is disposed within the lumen. (Item 4) 4. The high-density electrode catheter of item 3, wherein the flexible tip section includes a plurality of longitudinally extending arms. (Item 5) Item 5. The high-density electrode catheter of item 4, wherein at least one of the plurality of longitudinally extending arms defines a lumen in which the magnetic position sensor is disposed. (Item 6) 5. The high-density electrode catheter of claim 4, further comprising an electrode disposed along at least one of the plurality of longitudinally extending arms, the electrode defining the lumen within which the magnetic position sensor is disposed. (Item 7) The flexible framework comprises: a first outer arm and a second outer arm; a central arm extending between the first outer arm and the second outer arm; 2. The high-density electrode catheter of item 1, wherein the first outer arm, the second outer arm, and the central arm extend distally relative to the distal end of the catheter shaft. (Item 8) the first outer arm, the second outer arm, and the central arm extend distally relative to the distal end of the catheter shaft; 8. The high-density electrode catheter according to item 7, wherein the tip magnetic position sensor is disposed at the distal end of the central arm. (Item 9) the central arm includes an electrode disposed at a distal end of the central arm; the electrode defines a longitudinally extending groove; 8. The high-density electrode catheter of claim 7, wherein the magnetic position sensor is disposed within the longitudinally extending groove. (Item 10) a distal coupler that couples the distal ends of the first outer arm, the second outer arm, and the central arm; 8. The high-density electrode catheter of item 7, wherein the distal coupler includes the tip magnetic position sensor. (Item 11) Item 11. The high-density electrode catheter of item 10, wherein the distal coupler defines a lumen in which the tip magnetic position sensor is disposed. (Item 12) Item 11. The high-density electrode catheter of item 10, wherein the distal coupler defines a keyed slot into which the distal end of the central arm is disposed. (Item 13) the flexible framework includes a first outer arm and a second outer arm; 2. The high-density electrode catheter of item 1, wherein the tip magnetic position sensor includes a first magnetic position sensor and a second magnetic position sensor disposed on the first outer arm and the second outer arm. (Item 14) 1. A high-density electrode catheter, comprising: a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis; a flexible tip section located adjacent the distal end of the catheter shaft, the flexible tip section including a flexible framework including a first outer arm, a second outer arm, and a central arm extending longitudinally; a plurality of electrodes disposed on each of the first outer arm, the second outer arm, and the central arm; a tip magnetic position sensor disposed on a distal portion of the central arm. (Item 15) a proximal coupler from which the first outer arm, the second outer arm, and the central arm extend; the central arm includes a single longitudinally extending arm; Item 15. The high-density electrode catheter of item 14, wherein the central arm includes an extension feature. (Item 16) the extension feature includes a bend formed in the single longitudinally extending arm; Item 16. The high-density electrode catheter of item 15, wherein the extension feature is configured to extend when the flexible tip section is in a collapsed state. (Item 17) the central arm includes a first longitudinally extending arm and a second longitudinally extending arm; the first outer arm, the second outer arm, the first inner arm, and the second inner arm exit the proximal coupler in a first plane; the first central arm and the second central arm exit the proximal coupler on opposite sides of the first plane; Item 16. The high-density electrode catheter of item 15, wherein the central arm, the first and second outer arms, and the proximal ends of the first and second central arms each include an assembly portion. (Item 18) Item 18. The high-density electrode catheter of item 17, wherein the assembly portion includes a clip that fastens to the proximal coupler. (Item 19) 1. A high-density electrode catheter, comprising: a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis; a flexible tip section located adjacent the distal end of the catheter shaft, the flexible tip section including a flexible framework; a flexible circuit disposed on the flexible framework, the flexible circuit including a plurality of electrodes disposed thereon; a tip magnetic position sensor disposed on a distal portion of the flexible framework. (Item 20) the flexible circuit is disposed on the top and bottom of the flexible framework; 20. The high-density electrode catheter of claim 19, wherein the flexible circuit transitions from an outer surface of the flexible framework to a top surface of the flexible framework and a bottom surface of the flexible framework at transition points. (Item 21) 21. The high-density electrode catheter of claim 20, wherein the flexible circuit extends distal to the transition point onto the top surface of the flexible framework and the bottom surface of the flexible framework.

Claims

1. A catheter comprising: a catheter shaft including a proximal end and a distal end, the catheter shaft defining a catheter shaft longitudinal axis; a flexible tip section located adjacent the distal end of the catheter shaft, the flexible tip section including first outer arm, second outer arm, first inner arm, second inner arm, and central arm extending longitudinally; a plurality of electrodes disposed on each of the first outer arm, the second outer arm, the first inner arm, the second inner arm, and the central arm; a proximal coupler having the first and second outer arms, the first and second inner arms, and the central arm extending therefrom, the first and second outer arms and the first and second inner arms exiting the proximal coupler in a first plane, and the central arm exiting the proximal coupler offset from the first plane; a first magnetic position sensor disposed on the first outer arm; a second magnetic position sensor disposed on the second outer arm; A catheter wherein the central arm extends away from the proximal coupler toward the first plane and then extends over the first plane.

2. A catheter as described in claim 1, wherein each of the first and second outer arm portions, the first and second inner arm portions, and the central arm portion defines a lumen.

3. The catheter of claim 2 , wherein the first magnetic position sensor is disposed within the lumen of the first outer arm.

4. The catheter of claim 2 , wherein the second magnetic position sensor is disposed within the lumen of the second outer arm.

5. The catheter of any one of claims 1 to 4, wherein the central arm includes an extension feature.

6. The catheter of claim 5 , wherein the elongated feature comprises a bend formed in the single longitudinally extending central arm.

7. The catheter of claim 5 , wherein the extension feature is configured to extend when the flexible tip section is in a collapsed state.

8. The catheter of any one of claims 1 to 7, wherein the proximal ends of the central arm, the first and second outer arms, and the first and second inner arms each include an assembly portion.

9. The catheter of claim 8 , wherein the assembly portion includes a clip that fastens to the proximal coupler.

10. The catheter of any one of claims 1 to 9, further comprising a distal coupler that couples distal portions of the first and second outer arms, the first and second inner arms, and the central arm.

11. The catheter of claim 10 , wherein the distal coupler defines a keyed slot into which the distal end of the central arm is disposed.

12. The catheter of any one of claims 1 to 11, wherein the plurality of electrodes are configured to deliver energy for ablating cardiac tissue of a patient using pulsed field ablation.

13. 13. The catheter of claim 12, wherein the pulsed field ablation comprises a short duration direct current pulse of 0.1 to 20 ms and a field strength of 0.1 to 1.0 kV / cm.

14. The catheter of any one of claims 1 to 13, wherein the plurality of electrodes are configured to sense electrical signals generated in the patient's cardiac tissue.

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