Patent Description:
In some procedures, a catheter with one or more RF electrodes may be used to provide ablation within the cardiovascular system. The catheter may be inserted into a major vein or artery (e.g., the femoral artery) and then advanced to position the electrodes within the heart or in a cardiovascular structure adjacent to the heart (e.g., the pulmonary vein). The one or more electrodes may be placed in contact with cardiac tissue or other vascular tissue and then activated with RF energy to thereby ablate the contacted tissue. In some cases, the electrodes may be bipolar. In some other cases, a monopolar electrode may be used in conjunction with a ground pad or other reference electrode that is in contact with the patient that is in contact with the patient. Irrigation may be used to draw heat from ablating components of an ablation catheter; and to prevent the formation of blood clots near the ablation site.

Examples of ablation catheters are described in <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; and <CIT>.

Some catheter ablation procedures may be performed after using electrophysiology (EP) mapping to identify tissue regions that should be targeted for ablation. Such EP mapping may include the use of sensing electrodes on a catheter (e.g., the same catheter that is used to perform the ablation or a dedicated mapping catheter). Such sensing electrodes may monitor electrical signals emanating from conductive endocardial tissues to pinpoint the location of aberrant conductive tissue sites that are responsible for the arrhythmia. Examples of an EP mapping system are described in <CIT>. Examples of EP mapping catheters are described in <CIT>; <CIT>; and <CIT>.

When using an ablation catheter, it may be desirable to ensure that the one or more electrodes of the ablation catheter are sufficiently contacting target tissue. For instance, it may be desirable to ensure that the one or more electrodes are contacting target tissue with enough force to effectively apply RF ablation energy to the tissue; while not applying a degree of force that might tend to undesirably damage the tissue. To that end, it may be desirable to include one or more force sensors or pressure sensors to detect sufficient contact between one or more electrodes of an ablation catheter and target tissue.

In addition to using force sensing or EP mapping, some catheter ablation procedures may be performed using an image guided surgery (IGS) system. The IGS system may enable the physician to visually track the location of the catheter within the patient, in relation to images of anatomical structures within the patient, in real time. Some systems may provide a combination of EP mapping and IGS functionalities, including the CARTO <NUM>® system by Biosense Webster, Inc. of Irvine, California. Examples of catheters that are configured for use with an IGS system are disclosed in <CIT>; and various other references that are cited herein.

<CIT> describes a self-holding medical device control handle with cam actuated clutch mechanism. <CIT> describes a basket catheter with a microelectrode array distal tip. <CIT> describes a catheter with improved loop contraction and greater contraction displacement. <CIT> describes a bidirectional steering catheter.

While several catheter systems and methods have been made and used, it is believed that no one prior to the inventors has made or used the invention described, illustrated and claimed herein.

The drawings and detailed description that follow are intended to be merely illustrative and are not intended to limit the scope of the invention as contemplated by the inventors.

As will be realized, the invention is capable of other different or equivalent aspects, all without departing from the invention.

Any one or more of the teachings, expressions, versions, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, versions, examples, etc. that are described herein. The following-described teachings, expressions, versions, examples, etc. should therefore not be viewed in isolation relative to each other. Various suitable ways in which the teachings herein may be combined will be readily apparent to those skilled in the art in view of the teachings herein.

<FIG> shows an exemplary medical procedure and associated components of a cardiac catheter system that may be used to provide EP mapping or cardiac ablation as referred to above. In particular, <FIG> shows a physician (PH) grasping a handle assembly (<NUM>) of a catheter assembly (<NUM>), with an end effector (<NUM>) of a catheter (<NUM>) (shown in <FIG> and <FIG> but not shown in <FIG>) of catheter assembly (<NUM>) disposed in a patient (PA) to map potentials in tissue or ablate tissue in or near the heart (H) of the patient (PA). As shown in <FIG>, catheter assembly (<NUM>) includes handle assembly (<NUM>), catheter (<NUM>) extending distally from handle assembly (<NUM>), end effector (<NUM>) located at a distal end of catheter (<NUM>), and a deflection drive assembly (<NUM>) associated with handle assembly (<NUM>).

As will be described in greater detail below, end effector (<NUM>) includes various components configured to deliver RF energy to targeted tissue sites, provide EP mapping functionality, track external forces imparted on end effector (<NUM>), track the location of end effector (<NUM>), or disperse irrigation fluid. As will also be described in greater detail below, deflection drive assembly (<NUM>) is configured to deflect end effector (<NUM>) and a distal portion of catheter (<NUM>) away from a central longitudinal axis (LA) defined by a proximal portion of catheter (<NUM>).

As shown in <FIG>, catheter (<NUM>) includes an elongate flexible sheath (<NUM>), with end effector (<NUM>) being disposed at a distal end (<NUM>) of a first inner shaft (<NUM>) extending distally from sheath (<NUM>). End effector (<NUM>) and various components that are contained in sheath (<NUM>) will be described in greater detail below. Catheter assembly (<NUM>) is coupled with a guidance and drive system (<NUM>) via a cable (<NUM>). Catheter assembly (<NUM>) is also coupled with a fluid source (<NUM>) via a fluid conduit (<NUM>). A set of field generators (<NUM>) are positioned underneath the patient (PA) and are coupled with guidance and drive system (<NUM>) via another cable (<NUM>). Field generators (<NUM>) are merely optional.

Guidance and drive system (<NUM>) of the present example include a console (<NUM>) and a display (<NUM>). Console (<NUM>) includes a first driver module (<NUM>) and a second driver module (<NUM>). First driver module (<NUM>) is coupled with catheter assembly (<NUM>) via cable (<NUM>). In some variations, first driver module (<NUM>) is operable to receive EP mapping signals obtained via electrodes (<NUM>) of end effector (<NUM>) as described in greater detail below. Console (<NUM>) includes a processor (not shown) that processes such EP mapping signals and thereby provides EP mapping as is known in the art.

In versions where end effector (<NUM>) includes one or more ablation electrodes (not shown), first driver module (<NUM>) of the present example is further operable to provide RF power to such ablation electrodes, to thereby ablate tissue contacting the ablation electrodes. Second driver module (<NUM>) is coupled with field generators (<NUM>) via cable (<NUM>). Second driver module (<NUM>) is operable to activate field generators (<NUM>) to generate an alternating magnetic field around the heart (H) of the patient (PA). For instance, field generators (<NUM>) may include coils that generate alternating magnetic fields in a predetermined working volume that contains the heart (H).

First driver module (<NUM>) is also operable to receive position indicative signals from a navigation sensor assembly (<NUM>) in end effector (<NUM>). In such versions, the processor of console (<NUM>) is also operable to process the position indicative signals from navigation sensor assembly (<NUM>) to thereby determine the position of end effector (<NUM>) within the patient (PA). In some versions, navigation sensor assembly (<NUM>) includes two or more coils that are operable to generate signals that are indicative of the position and orientation of end effector (<NUM>) within the patient (PA). The coils are configured to generate electrical signals in response to the presence of an alternating electromagnetic field generated by field generators (<NUM>). Other components and techniques that may be used to generate real-time position data associated with end effector (<NUM>) may include wireless triangulation, acoustic tracking, optical tracking, inertial tracking, and the like. Alternatively, end effector (<NUM>) may lack a navigation sensor assembly (<NUM>).

Display (<NUM>) is coupled with the processor of console (<NUM>) and is operable to render images of patient anatomy. Such images may be based on a set of preoperatively or intraoperatively obtained images (e.g., a CT or MRI scan, <NUM>-D map, etc.). The views of patient anatomy provided through display (<NUM>) may also change dynamically based on signals from navigation sensor assembly (<NUM>) of end effector (<NUM>). For instance, as end effector (<NUM>) of catheter (<NUM>) moves within the patient (PA), the corresponding position data from navigation sensor assembly (<NUM>) may cause the processor of console (<NUM>) to update the patient anatomy views in display (<NUM>) in real time to depict the regions of patient anatomy around end effector (<NUM>) as end effector (<NUM>) moves within the patient (PA). Moreover, the processor of console (<NUM>) may drive display (<NUM>) to show locations of aberrant conductive tissue sites, as detected via electrophysiological (EP) mapping with end effector (<NUM>) or as otherwise detected (e.g., using a dedicated EP mapping catheter, etc.). By way of example only, the processor of console (<NUM>) may drive display (<NUM>) to superimpose the locations of aberrant conductive tissue sites on the images of the patient's anatomy, such as by superimposing an illuminated dot, a crosshair, or some other form of visual indication of aberrant conductive tissue sites.

The processor of console (<NUM>) may also drive display (<NUM>) to superimpose the current location of end effector (<NUM>) on the images of the patient's anatomy, such as by superimposing an illuminated dot, a crosshair, a graphical representation of end effector (<NUM>), or some other form of visual indication. Such a superimposed visual indication may also move within the images of the patient anatomy on display (<NUM>) in real time as the physician moves end effector (<NUM>) within the patient (PA), thereby providing real-time visual feedback to the operator about the position of end effector (<NUM>) within the patient (PA) as end effector (<NUM>) moves within the patient (PA). The images provided through display (<NUM>) may thus effectively provide a video tracking the position of end effector (<NUM>) within a patient (PA), without necessarily having any optical instrumentation (i.e., cameras) viewing end effector (<NUM>). In the same view, display (<NUM>) may simultaneously visually indicate the locations of aberrant conductive tissue sites detected through EP mapping. The physician (PH) may thus view display (<NUM>) to observe the real time positioning of end effector (<NUM>) in relation to the mapped aberrant conductive tissue sites and in relation to images of the adjacent anatomical structures in the patient (PA).

Fluid source (<NUM>) of the present example includes a bag containing saline or some other suitable irrigation fluid. Conduit (<NUM>) includes a flexible tube that is further coupled with a pump (<NUM>), which is operable to selectively drive fluid from fluid source (<NUM>) to catheter assembly (<NUM>). As described in greater detail below, such irrigation fluid may be expelled through the open distal end (<NUM>) of a second inner shaft (<NUM>) of end effector (<NUM>). Such irrigation may be provided in any suitable fashion as will be apparent to those skilled in the art in view of the teachings herein.

As shown in <FIG>, end effector (<NUM>) of the present example is operable to transition between a non-expanded state (<FIG>) and an expanded state (<FIG>). As will be described in greater detail below, this transitioning is driven by manipulation of an end effector expansion actuator (<NUM>) of handle assembly (<NUM>). In some versions, outer sheath (<NUM>) is configured to selectively slide over end effector (<NUM>) when end effector (<NUM>) is in the non-expanded state. In such versions, outer sheath (<NUM>) may be retracted proximally to expose end effector (<NUM>) to thereby enable end effector (<NUM>) to transition to the expanded state.

In the version depicted in <FIG>, end effector (<NUM>) is configured to define a bulbous or generally spherical shape when end effector (<NUM>) is in the expanded state. In such versions, end effector (<NUM>) may include an inflatable body (e.g., similar to a balloon). Alternatively, end effector (<NUM>) may include a plurality of strips or other structures that are configured to bow outwardly to define a bulbous or generally spherical shape when end effector (<NUM>) is in the expanded state. In such versions, the strips or other structures may define a generally cylindraceous shape or other substantially straight shape when end effector (<NUM>) is in the non-expanded state. The proximal end of each such strip or other structure may be fixedly secured relative to one shaft while the distal end of each such strip or other structure may be fixedly secured relative to another shaft. The strips or other structures may buckle and thereby bow outwardly in response to longitudinal translation of one of those shafts relative to the other of those shafts.

In the version depicted in in <FIG>, end effector (<NUM>) is configured to define a spiral shape when in the expanded shape. End effector (<NUM>) of the example shown in <FIG> is mounted to first inner shaft (<NUM>), which is internal to outer sheath (<NUM>). End effector (<NUM>) of this example includes a plurality of electrodes (<NUM>). In some versions, electrodes (<NUM>) are operable to provide bipolar EP mapping by picking up electrocardiogram signals from tissue as is known in the art. Electrodes (<NUM>) may cooperate in pairs in some implementations. Signals picked up by electrodes (<NUM>) may be communicated back through electrical conduits (not shown) in catheter (<NUM>) to console (<NUM>), which may process the signals to provide EP mapping to thereby identify locations of aberrant electrical activity within the cardiac anatomy. This may in turn allow the physician (PH) to identify the most appropriate regions of cardiac tissue to ablate (e.g., with RF energy, cryoablation, etc.), to thereby prevent or at least reduce the communication of aberrant electrical activity across the cardiac tissue.

As also shown in <FIG>, a pair of reference electrodes (<NUM>) are coaxially positioned about shaft (<NUM>). Such reference electrodes (<NUM>) may be utilized in conjunction with electrode pairs (<NUM>) during an EP mapping procedure. For instance, reference electrodes (<NUM>) may be utilized to pick up reference potentials from blood or saline that passes through the interior of end effector (<NUM>) during an EP mapping procedure. Such reference potentials may be used to reduce noise or far field signals, as is known in the art. In the present example, end effector (<NUM>) is configured such that reference electrodes (<NUM>) are positioned to avoid contacting tissue during use of end effector (<NUM>) in an EP mapping procedure; while still allowing blood and saline to flow freely through end effector (<NUM>) to reach reference electrodes (<NUM>).

By way of example only, electrodes (<NUM>, <NUM>, <NUM>) may be formed of platinum, gold, or any other suitable material. Electrodes (<NUM>, <NUM>, <NUM>) may include various coatings, if desired. For instance, electrode pairs (<NUM>) may include a coating that is selected to improve the signal-to-noise ratio of signals from electrode pairs (<NUM>). Such coatings may include, but need not be limited to, iridium oxide (IrOx) coating, poly(<NUM>,<NUM>-ethylenedioxythiophene) (PEDOT) coating, Electrodeposited Iridium Oxide (EIROF) coating, Platinum Iridium (PtIr) coating, or any other suitable coating. Various suitable kinds of coatings that may be used for electrodes (<NUM>, <NUM>, <NUM>) will be apparent to those skilled in the art in view of the teachings herein.

While only EP mapping electrodes (<NUM>) are shown in <FIG>, other versions of end effector (<NUM>) may include ablation electrodes in addition to, or in lieu of, including EP mapping electrodes (<NUM>). Such ablation electrodes may be used to apply RF energy to tissue that is in contact with the ablation electrodes, to thereby ablate the tissue. Each ablation electrode may be coupled with a corresponding trace or other electrical conduit on end effector (<NUM>), thereby enabling console (<NUM>) to communicate RF energy through electrical conduits (not shown) in catheter (<NUM>) to the traces or other conduits on end effector (<NUM>) to reach the ablation electrodes.

End effector (<NUM>) of the present example further includes a position sensor (<NUM>) located near distal end (<NUM>) of second inner shaft (<NUM>). Position sensor (<NUM>) is operable to generate signals that are indicative of the position and orientation of end effector (<NUM>) within the patient (PA). By way of example only, position sensor (<NUM>) may be in the form of a wire coil or a plurality of wire coils (e.g., three orthogonal coils) that are configured to generate electrical signals in response to the presence of an alternating electromagnetic field generated by field generators (<NUM>). Position sensor (<NUM>) may be coupled with wire, a trace, or any other suitable electrical conduit along or otherwise through catheter (<NUM>), thereby enabling signals generated by position sensor (<NUM>) to be communicated back through electrical conduits (not shown) in catheter (<NUM>) to console (<NUM>). Console (<NUM>) may process the signals from position sensor (<NUM>) to identify the position of end effector (<NUM>) within the patient (PA). Other components and techniques that may be used to generate real-time position data associated with end effector (<NUM>) may include wireless triangulation, acoustic tracking, optical tracking, inertial tracking, and the like. In some versions, position sensor (<NUM>) may be omitted.

As noted above, catheter assembly (<NUM>) of the present example is coupled with a fluid source (<NUM>) via a fluid conduit (<NUM>). A fluid conduit (not shown) extends along the length of catheter (<NUM>) and is operable to deliver irrigation fluid (e.g., saline) out through the open distal end (<NUM>) of second inner shaft (<NUM>). For instance, the fluid conduit may distally terminate at distal end (<NUM>). In addition, or in the alternative, second inner shaft (<NUM>) may incorporate one or more laterally oriented irrigation ports that are in communication with the fluid conduit. Such irrigation ports may be spaced apart along the region of length corresponding to the longitudinal position of end effector (<NUM>). In either case, the irrigation fluid may provide cooling, flushing, or other effects at end effector (<NUM>) during operation of end effector (<NUM>) within the patient (PH). Various suitable ways in which catheter assembly (<NUM>) may provide irrigation will be apparent to those skilled in the art. Alternatively, some variations of catheter assembly (<NUM>) may lack irrigation capabilities, such that conduit (<NUM>), fluid source (<NUM>), and pump (<NUM>) may be omitted.

In addition to the foregoing, end effector (<NUM>) and other aspects of catheter assembly (<NUM>) may be configured and operable in accordance with at least some of the teachings of any one or more of the various patent documents that are referenced herein.

As noted above, catheter assembly (<NUM>) includes a deflection drive assembly (<NUM>) that is configured to deflect end effector (<NUM>) away from the central longitudinal axis (LA) defined by a proximal portion of catheter (<NUM>). Deflection drive assembly (<NUM>) of the present example incudes push-pull cables (<NUM>, <NUM>), a cable driver assembly (<NUM>), and a rocker arm (<NUM>). As will be described in greater detail below, the physician (PA) may actuate rocker arm (<NUM>) relative to handle assembly (<NUM>) such that cable driver assembly (<NUM>) actuates push-pull cables (<NUM>, <NUM>) in a simultaneous, longitudinally-opposing motion to selectively deflect end effector (<NUM>) laterally away from a longitudinal axis (LA), thereby enabling the physician (PH) to actively steer end effector (<NUM>) within the patient (PA).

Selected portions of deflection drive assembly (<NUM>) are operatively coupled to handle assembly (<NUM>). As best seen in <FIG>, handle assembly (<NUM>) includes a first casing portion (<NUM>) and a second casing portion (<NUM>). As best seen in <FIG>, casing portions (<NUM>, <NUM>) together define an internal cavity (<NUM>). As also shown in <FIG>, a central body (<NUM>) of rocker arm (<NUM>) extends into cavity (<NUM>). A pair of lateral wings (<NUM>) extend outwardly from central body (<NUM>). Cable driver assembly (<NUM>) is rotationally coupled with handle assembly (<NUM>) such that cable driver (<NUM>) is configured to rotate about an axis that is perpendicular to the longitudinal axis (LA). As cable driver assembly (<NUM>) rotates, wings (<NUM>) orbit about the axis of rotation. This movement of wings causes simultaneous opposing translation of push-pull cables (<NUM>, <NUM>) as described below.

Wings (<NUM>) of cable driver assembly (<NUM>) are configured to couple with a respective push-pull cable (<NUM>, <NUM>) such that rotation of wings (<NUM>) about the axis of rotation of cable driver (<NUM>) will pull cables (<NUM>, <NUM>) in accordance with the description herein. Each wing (<NUM>) defines a cable recess (<NUM>) and a plug opening (<NUM>) extending into cable recess (<NUM>). Cable recess (<NUM>) is dimensioned to receive intermediary portions of push-pull cables (<NUM>, <NUM>), while plug opening (<NUM>) is dimensioned to receive cable plug (<NUM>) such that cable plug (<NUM>) actuates with wings (<NUM>). Cable recess (<NUM>) is dimensioned to accommodate cable plug (<NUM>) such that intermediary portions of push-pull cables (<NUM>, <NUM>) may wrap around cable plug (<NUM>) as shown in <FIG>, thereby suitably coupling intermediary portions of push-pull cables (<NUM>, <NUM>) with cable driver assembly (<NUM>). Cable plugs (<NUM>) interact with push-pull cables (<NUM>, <NUM>) such that proximal movement of a cable plug (<NUM>) pulls the corresponding push-pull cable (<NUM>, <NUM>) proximally.

An interior of second casing portion (<NUM>) includes a partition wall (<NUM>) and a pair of tension adjustment channels (<NUM>) located on opposite lateral sides of partition wall (<NUM>). Partition wall (<NUM>) and respective tension adjustment channels (<NUM>) together define a sliding channel (<NUM>). Each sliding channel (<NUM>) slidably houses a respective sliding body (<NUM>, <NUM>). Sliding bodies (<NUM>, <NUM>) are attached to respective push-pull cables (<NUM>, <NUM>). Sliding bodies (<NUM>, <NUM>) and sliding channels (<NUM>) may together assist in guiding the simultaneous opposing translation of portions of push-pull cables (<NUM>, <NUM>) extending distally from sliding bodies (<NUM>, <NUM>) in accordance with the description herein.

Tension adjustment channels (<NUM>) include a linear array laterally extending, rectangular projections. Tension adjustment channels (<NUM>) are configured to receive respective tension blocks (<NUM>, <NUM>), which also each have a complementary linear array of laterally extending rectangular projections. The complementary rectangular projections of tensions blocks (<NUM>, <NUM>) and tension adjustment channels (<NUM>) are configured to longitudinally fix tension blocks (<NUM>, <NUM>) relative to second casing portion (<NUM>). In other words, tensions adjustment channels (<NUM>) are configured to receive tension blocks (<NUM>, <NUM>) in a tongue-and-groove fashion to fix tension blocks (<NUM>, <NUM>) relative to handle assembly (<NUM>). Tensions blocks (<NUM>, <NUM>) may be selectively inserted along various suitable locations within adjustment channels (<NUM>) in order to serve as a mechanical ground for push-pull cables (<NUM>, <NUM>). Tension blocks (<NUM>, <NUM>) may be inserted along various locations within adjustment channels (<NUM>) in order to adjust the tension within push-pull cables (<NUM>, <NUM>) to thereby accommodate for length variations of push-pull cables (<NUM>, <NUM>) due to various factors, such as manufacturing tolerance variations, deformation of push-pull cables (<NUM>, <NUM>), etc..

Push-pull cables (<NUM>, <NUM>) are fixedly secured to respective proximal end blocks (<NUM>, <NUM>). As best seen in <FIG>, proximal end blocks (<NUM>, <NUM>) are housed within tension adjustment channels (<NUM>) just distal to tension blocks (<NUM>, <NUM>). Tension blocks (<NUM>, <NUM>) therefore prevent proximal end blocks (<NUM>, <NUM>) from actuating proximally within adjustment channels (<NUM>), thereby serving as a mechanical ground for push-pull cables (<NUM>, <NUM>). Tension blocks (<NUM>, <NUM>) define a through hole that push-pull cables (<NUM>, <NUM>) extend through such that push-pull cables (<NUM>, <NUM>) may extend from proximal end blocks (<NUM>, <NUM>) through adjustment channels (<NUM>) in order to suitably couple with cable driver assembly (<NUM>). Alternatively, tension blocks (<NUM>, <NUM>) and respective proximal end blocks (<NUM>, <NUM>) may be formed of a single piece.

As best shown in <FIG>, the distal ends of push-pull cables (<NUM>, <NUM>) are coupled with end effector (<NUM>). Various suitable ways in which push-pull cables (<NUM>, <NUM>) may be coupled with end effector (<NUM>) will be apparent to those skilled in the art in view of the teachings herein.

<FIG> show exemplary use of deflection drive assembly (<NUM>) to deflect end effector (<NUM>) and the distal portion of catheter (<NUM>) away from the central longitudinal axis (LA). <FIG> show various sections of catheter assembly (<NUM>) when end effector (<NUM>) is in a neutral, non-deflected position. <FIG> shows rocker arm (<NUM>) in a neutral rotational position relative to handle assembly (<NUM>). As best shown in <FIG>, when rocker arm (<NUM>) is in the first rotational position, cable driver assembly (<NUM>) is in a corresponding first rotation position such that sliding bodies (<NUM>, <NUM>), and therefore push-pull cables (<NUM>, <NUM>), are in a first longitudinal position associated with end effector (<NUM>) being in the non-deflected position as shown in <FIG>.

When the physician (PH) desires to deflect end effector (<NUM>) in a first direction relative to central longitudinal axis (LA) to a first deflected position shown in <FIG>, the physician (PH) may rotate rocker arm (<NUM>) relative to casing portions (<NUM>, <NUM>) to the position shown in <FIG>. As best shown in <FIG>, rotation of rocker arm (<NUM>) to the rotational position shown in <FIG> drives cable driver assembly (<NUM>) into a corresponding rotational position such that plug (<NUM>) associated with push-pull cable (<NUM>) drives push-pull cable (<NUM>) proximally. Additionally, plug (<NUM>) associated with push-pull cable (<NUM>) is driven distally, allowing push-pull cable (<NUM>) to actuate distally.

Proximal translation of push-pull cable (<NUM>) drives sliding body (<NUM>) proximally within the respective sliding channel (<NUM>), which also allows sliding body (<NUM>) to slide distally within sliding channel (<NUM>). Proximal translation of sliding body (<NUM>) drives the section of intermediate portion (<NUM>) extending distally from sliding body (<NUM>), as well as distal portion (<NUM>), proximally. Since distal portion (<NUM>) may not actuate proximally out of end effector (<NUM>), as described above, proximal translation of distal portion (<NUM>) drives end effector (<NUM>) to bend to the position shown in <FIG>.

Similarly, when the physician (PH) desires to deflect end effector (<NUM>) in a section direction relative to central longitudinal axis (LA) to a second deflected position shown in <FIG>, the physician (PH) may rotate rocker arm (<NUM>) relative to handle assembly (<NUM>) to the position shown in <FIG>. As best shown in <FIG>, rotation of rocker arm (<NUM>) to the rotational position shown in <FIG> drives cable driver assembly (<NUM>) into a corresponding rotational position such that plug (<NUM>) associated with push-pull cable (<NUM>) drives push-pull cable (<NUM>) proximally. Additionally, plug (<NUM>) associated with push-pull cable (<NUM>) is driven distally, allowing push-pull cable (<NUM>) to actuate distally.

Proximal translation of push-pull cable (<NUM>) drives sliding body (<NUM>) proximally within sliding channel (<NUM>), which also allows sliding body (<NUM>) slide distally within sliding channel (<NUM>). Proximal translation of sliding body (<NUM>) drives the section of intermediate portion (<NUM>) extending distally from sliding body (<NUM>), as well as distal portion (<NUM>), proximally. Since distal portion (<NUM>) may not actuate proximally out of end effector (<NUM>), as described above, proximal translation of distal portion (<NUM>) drives end effector (<NUM>) to bend to the position shown in <FIG>.

In some versions, catheter assembly (<NUM>) is operable to deform catheter (<NUM>) such that end effector (<NUM>) is deflected a full <NUM> degrees. In other words, the distal portion of catheter (<NUM>) may be bent by push-pull cables (<NUM>, <NUM>) to a point where end effector (<NUM>) is oriented proximally, along an axis that is parallel with yet laterally offset from the longitudinal axis (LA). Various suitable ways in which such a <NUM>-degree bend angle may be achieved will be apparent to those skilled in the art in view of the teachings herein. It should also be understood that such <NUM>-degree bending may be provided bi-directionally, such that end effector (<NUM>) may be deflected to the left a full <NUM> degrees or to the right a full <NUM> degrees.

In the foregoing examples, rotation of rocker arm (<NUM>) about an x-y plane (as shown in <FIG> results in lateral deflection of end effector (<NUM>) away from the longitudinal axis (LA), with the deflection also being along the x-y plane. In some other versions, end effector (<NUM>) deflects along the x-z plane, in addition to or as an alternative to deflecting along the x-y plane. Various other suitable mechanisms that may be used to drive push-pull cables (<NUM>, <NUM>) in a simultaneous, longitudinally-opposing fashion will be apparent to those skilled in the art in view of the teachings herein. Similarly, various other suitable mechanisms that may be used to drive lateral deflection of end effector (<NUM>) away from the longitudinal axis (LA) will be apparent to those skilled in the art in view of the teachings herein.

As shown in <FIG> and <FIG>, end effector expansion actuator (<NUM>) is operable to drive end effector (<NUM>) to transition between a non-expanded state (<FIG> and <FIG>) and an expanded state (<FIG> and <FIG>). End effector expansion actuator (<NUM>) of the present example is in the form of a slider that is operable to translate longitudinally relative to casing portions (<NUM>, <NUM>) between a distal position (<FIG> and <FIG>) and a proximal position (<FIG> and <FIG>). End effector expansion actuator (<NUM>) is coupled with end effector (<NUM>) via a push-pull cable (<NUM>), which extends along the length of catheter (<NUM>). A proximal end of push-pull cable (<NUM>) is coupled with a base (<NUM>) of end effector expansion actuator (<NUM>). A distal end of push-pull cable (<NUM>) is coupled with a corresponding component of end effector (<NUM>). Various suitable ways in which push-pull cable (<NUM>) may be coupled with end effector expansion actuator (<NUM>) and second inner shaft (<NUM>) will be apparent to those skilled in the art in view of the teachings herein.

It should be understood from the foregoing that longitudinal translation of end effector expansion actuator (<NUM>) is communicated to second inner shaft (<NUM>) via push-pull cable (<NUM>). As noted above, since the distal end of end effector (<NUM>) is secured to second inner shaft (<NUM>) and the proximal end of end effector (<NUM>) is secured to first inner shaft (<NUM>), longitudinal translation of second inner shaft (<NUM>) relative to first inner shaft (<NUM>) will cause end effector (<NUM>) to transition from a non-expanded state to an expanded state, or to transition from an expanded state to a non-expanded state, depending on the direction of translation of first inner shaft (<NUM>).

In some variations, at least a portion of end effector (<NUM>) is resiliently biased to urge end effector (<NUM>) toward the expanded state shown in <FIG>, <FIG>, and <FIG>. In some such versions, the resilience of end effector (<NUM>) may assist push-pull cable (<NUM>) and second inner shaft (<NUM>) in driving end effector (<NUM>) toward the expanded state. In some other versions, push-pull cable (<NUM>) drives the entire length of end effector (<NUM>) distally or proximally relative to outer sheath (<NUM>). In such versions, outer sheath (<NUM>) may compress end effector (<NUM>) to reach a non-expanded state when end effector (<NUM>) is proximally positioned within outer sheath (<NUM>); while the resilience of end effector (<NUM>) drives end effector (<NUM>) to the expanded state when end effector (<NUM>) is positioned distally from outer sheath (<NUM>). Other suitable ways in which end effector (<NUM>) may transition between the expanded state and the non-expanded state will be apparent to those skilled in the art in view of the teachings herein. Similarly, other suitable ways in which push-pull cable (<NUM>) may be utilized will be apparent to those skilled in the art in view of the teachings herein.

It may be desirable to ensure that, when end effector (<NUM>) moves away from or toward the longitudinal axis (LA) in response to rotation of rocker arm (<NUM>), the motion of end effector (<NUM>) is confined to the x-y plane. In other words, it may be desirable to ensure that end effector (<NUM>) does not also deflect along the x-z plane when end effector (<NUM>) deflects along the x-y plane. To that end, it may be desirable to provide reinforcement within catheter (<NUM>) to ensure that end effector (<NUM>) only deflects along one single plane without also deflecting along another plane. An example of such a reinforcement is shown in <FIG>, which depicts a cross-sectional view of catheter (<NUM>) taken along line <NUM>-<NUM> of <FIG>.

As shown in <FIG>, catheter (<NUM>) of the present example includes a tubular body (<NUM>) with a total of seven lumens (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) formed therein. Lumens (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) extend along the entire length of body (<NUM>). By way of example only, tubular body (<NUM>) may be formed of pellethane, pebax, nylon, or any other suitable material(s). A first outer sheath (<NUM>) is coaxially positioned about body (<NUM>); while a second outer sheath (<NUM>) is coaxially positioned about first outer sheath (<NUM>). In some versions, first outer sheath (<NUM>) is formed of a braided material, such as braided steel or braided polymeric fibers. By way of example only, first outer sheath (<NUM>) may be configured to provide substantial torsional strength to catheter (<NUM>), facilitating rotation of catheter (<NUM>) about the longitudinal axis (LA) without resulting in substantial winding or torsional build-up in catheter (<NUM>). Also in some versions second outer sheath (<NUM>) is formed of a polymeric material. By way of example only, second outer sheath (<NUM>) may be the same as outer sheath (<NUM>) described above. Alternatively, outer sheath (<NUM>) may be coaxially disposed about at least a portion of second outer sheath (<NUM>).

Lumen (<NUM>) of the present example is configured to accommodate push-pull cable (<NUM>). Similarly, lumen (<NUM>) is configured to accommodate push-pull cable (<NUM>). Lumens (<NUM>, <NUM>) are laterally offset from each other along the y-axis, such that lumens (<NUM>, <NUM>) and push-pull cables (<NUM>, <NUM>) are collectively positioned along the x-y plane. Lumen (<NUM>) includes a tubular insert (<NUM>); while lumen (<NUM>) also includes a tubular insert (<NUM>). Tubular inserts (<NUM>, <NUM>) extend along the length of shaft (<NUM>). Lumens (<NUM>, <NUM>) are laterally offset from each other along the z-axis, such that lumens (<NUM>. <NUM>) and tubular inserts (<NUM>, <NUM>) are collectively positioned along the x-z plane. With lumens (<NUM>, <NUM>) and push-pull cables (<NUM>, <NUM>) being collectively positioned along the x-y plane, and lumens (<NUM>. <NUM>) and tubular inserts (<NUM>, <NUM>) being collectively positioned along the x-z plane, it may be said that push-pull cables (<NUM>, <NUM>) and tubular inserts (<NUM>, <NUM>) are orthogonally oriented relative to each other, even though push-pull cables (<NUM>, <NUM>) and tubular inserts (<NUM>, <NUM>) all extend along the x-dimension.

In the present example, tubular inserts (<NUM>, <NUM>) are formed of a material that has greater rigidity than the material forming body (<NUM>), such that tubular inserts (<NUM>, <NUM>) serve as struts. Tubular inserts (<NUM>, <NUM>) may be formed of any suitable material, including but not limited to polyimide. Moreover, tubular inserts (<NUM>, <NUM>) may be co-extruded with body (<NUM>). Alternatively, tubular inserts (<NUM>, <NUM>) may be formed in any other suitable fashion.

In the present example, due to the material of tubular inserts (<NUM>, <NUM>) having greater stiffness or rigidity than the material of body (<NUM>), and due to the orthogonal positioning of push-pull cables (<NUM>, <NUM>) versus tubular inserts (<NUM>, <NUM>), tubular inserts (<NUM>, <NUM>) are configured to prevent deflection of catheter (<NUM>) along the x-z plane. In other words, when push-pull cables (<NUM>, <NUM>) are actuated to deflect end effector (<NUM>) and the distal portion of catheter (<NUM>) laterally along the x-y plane, tubular inserts (<NUM>, <NUM>) ensure that such deflection is confined to the x-y plane without any additional deflection occurring along the x-z plane. By ensuring that the deflection of end effector (<NUM>) and the distal portion of catheter (<NUM>) is only along a single plane, tubular inserts (<NUM>, <NUM>) may provide greater consistency and predictability in the operation of catheter assembly (<NUM>).

Lumen (<NUM>) of the present example is configured to accommodate push-pull cable (<NUM>). While lumen (<NUM>) is slightly offset from the radial center of body (<NUM>) in the present example, other versions may provide lumen (<NUM>) in the radial center of body (<NUM>). Even with lumen (<NUM>) and push-pull cable (<NUM>) being slightly offset from the radial center of body (<NUM>) in the present example, lumen (<NUM>) and push-pull cable (<NUM>) are close enough to the radial center of body (<NUM>) such that actuation of push-pull cable (<NUM>) does not apply a substantial eccentric load to body (<NUM>) when the distal end of catheter (<NUM>) and end effector (<NUM>) are in a laterally deflected state.

Lumen (<NUM>) of the present example is configured to accommodate wires (not shown). Such wires may be coupled with various electrical components in end effector (<NUM>), such as electrodes (<NUM>, <NUM>), position sensor (<NUM>), or any other components. Such wires may be braided, bundled, or otherwise arranged within lumen (<NUM>). Lumen (<NUM>) of the present example is configured to provide a path for fluid communication along the length of catheter (<NUM>). In particular, lumen (<NUM>) may provide a path for irrigation fluid from fluid source (<NUM>) and fluid conduit (<NUM>) to the open distal end (<NUM>) of a second inner shaft (<NUM>) of end effector (<NUM>). While lumens (<NUM>, <NUM>) are shown as having similarly sized diameters, other versions may provide a lumen (<NUM>) that is larger than lumen (<NUM>); or a lumen (<NUM>) that is larger than lumen (<NUM>).

Despite having seven lumens (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) and the other structural features described above, catheter (<NUM>) may have a substantially small outer diameter. By way of example only, catheter (<NUM>) may have an outer diameter less than or equal to approximately <NUM> French. Alternatively, catheter (<NUM>) may have any other suitable outer diameter.

Any of the instruments described herein may be cleaned and sterilized before and/or after a procedure. A device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, hydrogen peroxide, peracetic acid, and vapor phase sterilization, either with or without a gas plasma, or steam.

It should be understood that any of the examples described herein may include various other features in addition to or in lieu of those described above.

Various suitable ways in which the teachings herein may be combined will be readily apparent to those skilled in the art in view of the teachings herein. Such modifications and variations may be included within the scope of the claims.

Claim 1:
An apparatus, comprising:
(a) a handle (<NUM>);
(b) a catheter (<NUM>) extending distally from the handle, a proximal portion of the catheter defining a longitudinal axis, the catheter including:
(i) a body (<NUM>), the body defining:
(A) a first lumen (<NUM>),
(B) a second lumen (<NUM>),
(C) a third lumen (<NUM>),
(D) a fourth lumen (<NUM>), and
(E) a fifth lumen (<NUM>);
(ii) a first cable (<NUM>) positioned in the first lumen, the first cable being operable to translate relative to the body of the catheter,
(iii) a second cable (<NUM>) positioned in the second lumen, the second cable being operable to translate relative to the body of the catheter,
(iv) a third cable (<NUM>) positioned in the third lumen, the third cable being operable to translate relative to the body of the catheter,
(v) a first tubular insert being fixedly secured in the fourth lumen, and
(vi) a second tubular insert being fixedly secured in the fifth lumen, wherein the first and second tubular inserts have greater rigidity than the body of the catheter; and
(c) an end effector (<NUM>) extending distally from the catheter, the end effector including at least one electrode.