Endocardial electrical mapping catheter and method

Abstract

An endocardial mapping catheter . .for locating the ectopic focus of an abnormally functioning heart includes an actuator assembly and an elongated hollow support sheath which extends from the actuator assembly. A plurality of electrical probes are slidingly disposed for independent movement through the sheath, and each probe is attached to the actuator assembly for individual manipulation. A guide is mounted on the end of the sheath opposite the actuator assembly, at the distal end of the sheath, to radially deploy each electrical probe along a separate favorable trajectory as the probe is manipulated to move distally through the sheath. In operation, the probes are initially retracted into the sheath as the guide is positioned inside the left ventricle of the heart. Once the guide is positioned as desired, all of the probes are individually deployed until they have each made contact with the endocardium of the left ventricle. Timed responses are obtained from the probes, and a series of such responses from various guide locations in the left ventricle are recorded to accomplish circumferential endocardial mapping of the heart..!. .Iadd.comprising an elongate flexible support sheath having a proximal end and a distal end and a plurality of electrical probes. Each of the probes has a proximal end and a distal end and is slidably disposed in the support sheath. A guide is disposed on the distal end of the support sheath and has a plurality of passageways. Each of the passageways separately receives one of the probes and is formed with a surface having an arcuately extending distal portion. Actuators are carried by the proximal ends of the probes for deploying the distal ends of the probes from the support sheath. The arcuately extending distal portion of each surface serves to radially deploy the distal end of a probe from the guide along a favorable trajectory from the guide as the probe is individually moved distally through the support sheath..Iaddend.

We claim: 
     
       1. An endocardial mapping catheter which comprises: an elongated flexible support sheath having a proximal end and a distal end, said sheath having a lumen extending lengthwise therethrough;   a plurality of electrical probes, each of said probes having a proximal end and a distal end and being slidably disposed in said lumen;   a guide attached to said distal end of said support sheath, said guide having a plurality of passageways separately receiving one said probe to radially deploy said distal end of each said probe along a favorable trajectory from said guide as each said probe is individually moved distally through said lumen and said passageway;   a plurality of guide rods, each said guide rod having a distal end and a proximal end; and   a plurality of actuation levers, each said actuation lever being slidably mounted on one of said guide rods and fixedly attached to one of said probes for moving said probe to deploy said distal end of said probe.   
     
     
       2. A catheter as recited in claim 1 for measuring electrical responses from the endocardium of the left ventricle of the heart of a patient to ascertain the origin of an arrhythmia, wherein each said rod has a substantially rectangular cross-section and each said actuation lever is engageable with a respective said rod and is manipulable to individually and selectively deploy each said electrical probe into contact with the endocardium of the left ventricle to simultaneously measure said electrical responses from each said probe on substantially coplanar portions of the endocardium. 
     
     
       3. A catheter as recited in claim 2 further comprising means for recording said electrical responses. 
     
     
       4. A catheter as recited in claim 3 further comprising means for outwardly flaring said guide rods in a proximal direction to facilitate manipulation of said actuation levers. 
     
     
       5. A catheter as recited in claim 4 wherein said flaring means comprises a base attached to said distal ends of said plurality of guide rods, and a flaring disc distanced from said base and attached to said proximal ends of said plurality of guide rods. 
     
     
       6. A catheter as recited in claim 5 further comprising means for injecting fluid through said lumen of said support sheath and through said plurality of passageways in said guide. 
     
     
       7. A catheter as recited in claim 6 further comprising a plurality of electrical connectors, each said electrical connector being attached to one of said proximal ends of said probes for establishing an electrical connection between said probe and said means for recording said electrical responses. 
     
     
       8. A catheter as recited in claim 7 wherein at least one of said probes is a bi-polar wire. 
     
     
       9. An endocardial mapping catheter for determining electrical responses from portions of the endocardium of the left ventricle of the heart of a patient to ascertain the original of an arrhythmia which comprises: a plurality of electrode probes wherein each of said probes has a proximal end and a distal end;   means for collectively inserting said probes into said left ventricle;   means for individually and selectively deploying each said electrode probe into contact with said endocardium to circumferentially measure said electrical responses from each said probe on substantially coplanar portions of said endocardium;   a plurality of guide rods, each said guide rod having a distal end and a proximal end; and   a plurality of actuation levers, each said actuation lever being slidably mounted on one of said guide rods and fixedly attached to one or said probes for moving said probe to deploy said distal end of said probe.   
     
     
       10. A catheter as recited in claim 9 wherein said means for collectively inserting said probes into said left ventricle is an elongated flexible support sheath having a proximal end and a distal end, said sheath having a lumen extending lengthwise therethrough, and wherein each or said probes is slidably disposed in said lumen. 
     
     
       11. A catheter as recited in claim 10 wherein said means for deploying each said probe comprises a guide attached to said distal end of said support sheath, said guide having a plurality of passageways separately receiving one said probe and radially deploying said distal end of each said probe along a favorable trajectory as each said probe is individually moved distally said lumen and through said passageway. 
     
     
       12. A catheter as recited in claim 11 further comprising means for outwardly flaring said guide rods in a proximal direction to facilitate manipulation of said actuation levers, said flaring means including a base attached to said distal ends or said plurality of guide rods, and a flaring disc distanced from said base and attached to said proximal ends of said plurality of guide rods. 
     
     
       13. A catheter as recited in claim 12 wherein said guide rods have substantially rectangular cross sections to inhibit rotation of fluid actuation levers and said probes, and said catheter further comprises means for injecting fluid through said lumen of said support sheath and through said plurality of passageways in said guide. 
     
     
       14. A catheter as recited in claim 13 further comprising a means for recording said electrical responses and a plurality or electrical connectors, each said electrical connector being attached to one of said proximal ends of said probes for establishing an electrical connection between said probe and said means for recording said electrical responses. 
     
     
       15. A catheter as recited in claim 14 wherein at least one of said probes is a bi-polar wire. 
     
     
       16. A method for measuring electrical responses from portions of the endocardium of the left ventricle of the heart of a patient to ascertain the origin of an arrhythmia using an endocardial mapping catheter comprising a hollow elongated flexible support sheath having a proximal end and a distal end, a plurality of electrical probes slidably disposed in the sheath, each said probe having a distal end, a guide attached to the distal end of the support sheath to radially deploy the distal ends of the probes along a favorable trajectory as each probe is individually moved distally through the support sheath, the catheter further comprising an actuator assembly having a plurality of guide rods and a plurality of actuation levers with each lever slidably mounted on one of the guide rods and fixedly attached to one of the probes for moving the probe to deploy the distal end of the probe; the method comprising the steps of: A) selectively positioning said guide of said support sheath in said left ventricle;   B) individually deploying said probes to establish electrical contact between said probes and said endocardium of said left ventricle;   C) recording electrical responses from said endocardium through said probes for a selected number of cardiac cycles;   D) withdrawing said probes into said sheath;   E) repositioning said guide in said left ventricle to repeat steps B, C, and D, as necessary; and   F) mapping the . .recording.!. .Iadd.recorded .Iaddend.electrical responses from said endocardium to locate the site of arrhythmogenesis.   
     
     
       17. A method as recited in claim 16 wherein said deploying step is accomplished by sequentially extending substantially diametrically opposite probes, in pairs, until all said probes are placed in contact with the endocardium for circumferential endocardial mapping. .Iadd. 
     
     
       18.  An endocardial mapping catheter which comprises an elongate flexible support sheath having a proximal end and a distal end, a plurality of probes, each of said probes having a proximal end and a distal end and being slidably disposed in said support sheath, at least one electrode mounted on the distal end of each probe, guide means disposed on said distal end of said support sheath for directing the probes from the sheath, said guide means having a plurality of passageways, each of said passageways separately receiving one of said probes and being formed with a surface having an arcuately extending distal portion, means carried by the proximal ends of said probes for deploying the distal ends of said probes from said support sheath whereby the arcuately extending distal portion of each surface serves to radially deploy said distal end of a probe from said guide means along a favorable trajectory from said guide means as said probe is moved distally through said support sheath..Iaddend..Iadd.19. A catheter as in claim 18 for sensing electrical signals from the endocardium of a heart of a patient wherein said means carried by the proximal ends of said probes is manipulatable to individually and selectively deploy each probe into contact with the endocardium to sense said electrical signals with the electrodes..Iaddend..Iadd.20. A catheter as in claim 19 further comprising means for recording said electrical signals..Iaddend..Iadd.21. A catheter as in claim 20 further comprising a plurality of electrical connectors, each said electrical connector being attached to one of said proximal ends of said probes for establishing an electrical connection between said probe and said means for recording said electrical signals..Iaddend..Iadd.22. A catheter as in claim 18 wherein at least one of said probes is a bipolar wire..Iaddend..Iadd.23. An endocardial mapping catheter for sensing electrical signals from portions of an endocardium of a heart of a patient comprising a plurality in excess of two probes, each of said probes having a proximal end portion and a distal end portion, at least one electrode mounted on the distal end portion of each probe, introducer means having proximal and distal extremities and at least one lumen extending between the proximal and distal extremities for collectively inserting said probes into the heart and means secured to the proximal end portion of each probe for individually and selectively moving said probe in the at least one lumen so as to deploy the probe into contact with the endocardium and measure electrical signals picked up by the at least one electrode mounted on the distal end portion of each probe on spaced apart portions of the endocardium..Iaddend..Iadd.24. A catheter as in claim 23 wherein said introducer means is an elongate flexible support sheath..Iaddend..Iadd.25. A catheter as in claim 24 wherein said support sheath is provided with a plurality of spaced apart openings in the distal extremity, each of said probes being disposed in a separate opening..Iaddend..Iadd.26. A catheter as in claim 24 further comprising guide means formed on the distal extremity of said support sheath for directing the probes from the sheath, said guide means having a plurality of passageways, each passageway separately receiving one of said probes and radially deploying said distal end portion of the probe along a favorable trajectory as the probe is individually moved distally through 
     
     
        said passageway..Iaddend..Iadd.27.  A catheter as in claim 26 further comprising means for recording said electrical signals and a plurality of electrical connectors, each electrical connector being attached to one of said proximal end portions of said probes for establishing an electrical connection between said probe and said means for recording said electrical signals..Iaddend..Iadd.28. A catheter as in claim 27 wherein at least one of said probes is a bipolar wire..Iaddend..Iadd.29. A method for sensing electrical signals from portions of an endocardium of a chamber of a heart of a patient to ascertain the origin of an arrhythmia using an endocardial mapping catheter comprising an elongate flexible support sheath having a proximal end and a distal end, a plurality of electrical probes slidably disposed in said sheath, each probe having a distal end, guide means provided on the distal end of the support sheath to radially deploy the distal ends of the probes along a favorable trajectory as each probe is moved distally through the support sheath and means secured to each of the probes for moving the probe to deploy the distal end of the probe, the method comprising the steps of (a) selectively positioning said guide means of said support sheath in the chamber, (b) deploying said probes to establish electrical contact between said electrodes and the endocardium of the chamber, (c) recording electrical signals from the endocardium through said probes for a selected number of cardiac cycles, (d) withdrawing said probes into said sheath, (e) repositioning said guide means in the chamber to repeat steps (b) (c) and (d) as necessary and (f) mapping the recorded electrical signals from the endocardium to locate the site of arrhythmogenesis..Iaddend..Iadd.30. A method as in claim 29 wherein said deploying step is accomplished by sequentially extending substantially diametrically opposite probes in pairs until all said electrodes are placed in contact with the endocardium for circumferential endocardial mapping..Iaddend..Iadd.31. An endocardial mapping catheter for sensing electrical signals from portions of an endocardium of a heart of a patient comprising a body having proximal and distal extremities, said body having a plurality of spaced apart passageways extending therethrough to respective openings at the distal extremity of said body, a plurality of mapping probes having proximal and distal end portions, each of said mapping probes being slidably mounted in said body and extending through a separate passageway in said body, at least one electrode mounted on the distal end portion of each mapping probe and means secured to the proximal end portions of said mapping probes for individually moving said mapping probes in said passageways to move the distal end portions of said mapping probes from the distal extremity of said body into the heart of the patient so that the electrodes can sense electrical signals from the endocardium and thus ascertain the origin of an arrhythmia..Iaddend..Iadd.32. A catheter as in claim 31 wherein the passageways in said distal extremity of the body are positioned so that they exit from the body to provide a favorable trajectory for each mapping probe as it is individually moved through the passageway in the body..Iaddend..Iadd.33. A catheter as in claim 32 wherein said passageways in said body are disposed so that the distal end portions of the mapping probes engage the endocardium in circumferentially spaced apart positions disposed substantially in a single plane..Iaddend..Iadd.34. A catheter as in claim 31 further comprising means for simultaneously recording electrical signals received by the mapping probes from the endocardium of the heart..Iaddend..Iadd.35. A method for mapping the endocardium of a heart of a patient accessible through a vessel of the patient by the use of a sheath having a distal extremity with a plurality of spaced apart openings therein and a plurality of separate mapping probes having proximal and distal extremities, at least one electrode mounted on the distal extremity of each mapping probe, comprising introducing the sheath into the vessel of the patient, introducing the plurality of mapping probes into the sheath and through the openings, individually moving each mapping probe through a separate opening, moving the distal extremities of the mapping probes into contact with the endocardium and sensing the electrical signals from the endocardium of the heart with the electrodes mounted on the distal extremities of the mapping probes..Iaddend..Iadd.36. A method as in claim 35 further comprising the step of recording simultaneously the signals sensed by the electrodes..Iaddend..Iadd.37. A method as in claim 35 further comprising the step of positioning the distal extremities of the mapping probes on the endocardium so that they contact the endocardium in circumferentially spaced apart positions lying substantially in a single plane..Iaddend..Iadd.38. A method as in claim 37 further comprising repositioning the distal extremities of the mapping probes so that they lie in circumferentially spaced apart positions lying substantially in another single plane spaced apart from said first named single plane and thereafter sensing electrical signals in the another single plane with the electrodes..Iaddend..Iadd.39. A method for mapping an endocardium in a chamber of a heart of a patient by the use of a sheath having a distal extremity and a plurality of separate probes having distal extremities, at least one electrode mounted on the distal extremity of each probe, comprising introducing the sheath into the body of the patient, introducing the probes into the sheath so that each probe extends through the sheath, individually deploying each of the probes from the distal extremity of the sheath into the chamber of the heart, moving the distal extremities of the probes into contact with portions of the endocardium and measuring the electrical signals picked up by the electrodes mounted on the distal extremities of the probes from the endocardium of the heart..Iaddend..Iadd.40. A method as in claim 39 using a plurality in excess of two probes..Iaddend.