Devices and Methods for Electrosurgical Navigation
A method and apparatus or system are disclosed for a procedure with minimal or no fluoroscopy, for example an electrosurgical procedure, and which uses a three dimensional mapping system. The procedure typically involves electrical measurement of the electrode of a needle to determine its position. Some embodiments further include intracardiac echocardiography (ICE) for tracking devices. The apparatus includes a needle with a tip electrode, an electroanatomical mapping (EAM) system, and an electrical generator, wherein a switching device is used to restrictively electrically connect the needle to only one of the mapping system or generator at a given time.
1 . An electrosurgical switch box comprising;
A switch;
a first connector associated with the electrosurgical switch box for connecting an energy delivery device to the electrosurgical switch box;
a second connector associated with the electrosurgical switch box for connecting a power supply to the electrosurgical switch box; and
a third connector associated with the electrosurgical switch box for connecting an electrophysiological diagnostic system to the electrosurgical switch box;
the switch being operable in a first position. wherein the first connector is electrically coupled to the second connector, and a second position, wherein the first connector is electrically coupled to the third connector.
2 . The electrosurgical switch box of claim 1 , wherein the switch is a rocker switch for providing visibility.
3 The electrosurgical switch box of claim 1 , wherein the electrosurgical switch box includes a plurality of supports configured to prevent slippage.
4 . The electrosurgical switch box of claim 1 , wherein the first connector is a four pin male connector.
5 . The electrosurgical switch box of claim 1 , wherein the second connector is a four pin female connector.
6 . The electrosurgical switch box of claim 1 , wherein the third connector is a single pin connector.
7 . The electrosurgical switch box of claim 1 , further comprising a casing wherein the casing is comprised of plastic which is an electrical insulator.
8 . The electrosurgical switch box of any of claims 1 to 7 , further comprising a plurality of markings for indicating a function of each of the connectors.
9 . The electrosurgical switch box of claim 8 , further comprising a first marking positioned proximate the first connector and illustrating an electrosurgical puncture device.
10 . The electrosurgical switch box of claim 8 , further comprising a second marking proximate the second connector and Illustrating a generator.
11 . The electrosurgical switch box of claim 8 , further comprising a third marking proximate the third connector and illustrating a diagnostic system.
12 . The electrosurgical switch box of any of claims 1 to 13 , further comprising a marking illustrating a generator associated with the first position of the switch and a marking illustrating a diagnostic system associated with the second position of the switch.
13 . A system including:
an energy delivery device;
an electroanatomical mapping system;
a power supply; and
a switch box comprising a switch;
wherein the switch box is operable to be connected between the energy delivery device, the electroanatomical mapping system and the power supply;
the switch being operable in a first position, whereby, in use, electrical energy is permitted to flow between the power supply and the energy delivery device, and a second position, whereby, in use, electrical energy is permitted to flow between the energy delivery device and the electroanatomical mapping system.
14 . The system of claim 13 , wherein the energy delivery device comprises an electrosurgical needle having an electrode.
15 . The system of claim 14 , wherein the needle comprises a metal shaft, the metal shaft being covered with an electrical insulator, and a distal tip of the shaft being electrically exposed to define the electrode.
16 . The system of claim 14 , wherein the electrode defines a rounded, atraumatic tip.
17 . The system of claim 13 , wherein the energy delivery device comprises a flexible energy delivery device.
18 . The system of claim 17 , wherein the flexible energy delivery device comprises a wire having a distal electrode for delivering energy.
19 . The system of any one of claims 13 - 18 , wherein the power supply comprises an electrosurgical generator.
20 . The system of any one of claims 13 - 18 . wherein the power supply comprises a battery.
21 . The system of any one of claims 13 - 18 , wherein the electroanatomical mapping system is operable to be connected to a coronary sinus catheter.
22 . The system of any one of claims 13 - 18 , wherein the electroanatomical mapping system is operable to be connected to an intracardiac echocardiography (ICE) system.
23 . The system of any one of claims 13 - 18 , wherein the electroanatomical mapping system is operable to be connected to an esophageal probe.
24 . The system of claim 23 , wherein the esophageal probe contains an imaging element that may be visualized using the electroanatomical mapping system.
25 The system of claim 24 , wherein the imaging element is a decapolar catheter.
26 . The system of any one of claims 13 - 18 , wherein the electroanatomical mapping system is connected to a mapping catheter.
27 . The system of claim 26 . wherein the mapping catheter is an ablation catheter.
28 . The system of claim 26 , wherein the mapping catheter is a lasso catheter.
29 . The system of any one of claims 13 - 18 further comprising a pin block for coupling to the switch box and to the electroanatomical system.
30 . The system of claim 29 , further comprising a splitter cable for coupling the switch box to the pin block. thereby providing a reference electrode for the electroanatomical mapping system.
31 . A method for gaining access to a region of a heart. the method comprising the steps of:
a) advancing an electrosurgical puncturing device into the heart;
b) visualizing a position of a tip of the electrosurgical puncturing device using an electroanatomical mapping system;
c) positioning the tip of the electrosurgical puncturing device at a target tissue; and
d) actuating a switch to electrically decouple the electrosurgical puncturing device from the electroanatomical mapping system while electrically coupling the electrosurgical puncturing device to an electrical generator.
32 . The method of claim 31 , further comprising a step (e) delivering energy from the generator through an electrode at a tip of the electrosurgical puncturing device to puncture the target tissue.
33 . The method of claim 31 , wherein step (c) further comprises using ICE to confirm tenting of the target tissue.
34 . The method of claim 31 , wherein step (c) further comprises advancing a tip of the electrosurgical puncturing device outside of a tubular support member, the tip comprising an electrode.
35 . The method of claim 31 , further comprising using the electroanatomical mapping system for electrically-based monitoring.
36 . The method of claim 35 , wherein the electrical based monitoring includes measuring current, impedance, and/or voltage.
37 . The method of claim 31 , further comprising, prior to step (a), advancing a guidewire and a sheath through a right femoral vein and inferior vena cava, and into a right atrium while using intracardiac echocardiography for visualization.
38 . The method of claim 31 , further comprising, prior to step (a), mapping a right atrium of the heart using ICE.
39 . The method of claim 38 , further comprising using a mapping catheter.
40 . The method of claim 31 , further comprising, prior to step (a), mapping a right side of the heart using ICE.
41 . The method of claim 40 . further comprising using a mapping catheter.
42 . The method of claim 40 , further comprising identifying one or more key anatomical features using [use full term] and displaying the key anatomical features on a display of the electroanatomical mapping system.
43 . The method of claim 42 , wherein the key anatomical features include: (a) an aortic root, (b) a fossa ovalis, and (c) a coronary sinus.
44 . The method of claim 31 , further comprising, prior to step (a), introducing an ICE catheter into a left femoral vein access location.
45 . The method of claim 31 , further comprising, prior to step (a), introducing a guidewire and a sheath into a right femoral vein access location.
46 . The method of claim 31 , wherein step (c) includes:
advancing a transceptal sheath through a superior vena cava to a brachiocephalic vein; advancing the electrosurgical puncturing device through the transseptal sheath; and
tracking and clocking down the electrosurgical puncturing device to the target tissue,
47 The method of claim 31 , wherein step (c) includes tenting the target tissue with the electrosurgical puncturing device.
48 . The method of claim 32 , wherein the target tissue is a septum, and the method further comprises the steps of setting the switch to a mode for sensing or mapping, and confirming a location of a tip of the electrosurgical puncturing device using the electroanatomical mapping system.
49 . The method of claim 32 , wherein the target tissue is a septum, and wherein the method further comprises the steps of advancing a sheath into a left atrium through the puncture and confirming the position of the sheath using ICE following the advancement.
50 . The method of claim 32 , wherein the target tissue is a septum, and wherein the method further comprises the steps of creating a second puncture and advancing a second sheath through the second puncture.
51 . The method of claim 32 , wherein the target tissue is a septum, and wherein the method further comprises a step of advancing a mapping catheter into a left atrium through the puncture.
52 . The method of claim 32 , wherein the target tissue is a septum, and wherein the method further comprises a step of advancing an ablation catheter into a left atrium through the puncture.
53 . The method of claim 52 , wherein the method further comprises the steps of inserting an esophageal probe through an esophagus and monitoring a temperature in the esophagus during the step of ablating . . . to prevent undesired tissue damage.
54 . The method of any one of claims 31 to 53 , wherein the electrosurgical puncturing device is an RF needle.
55 . The method of any one of claims 31 to 53 , wherein the electrosurgical puncturing device comprises a wire operable to delivery RF energy.
56 . The method of any one of claims 31 - 47 , wherein the target tissue is a septum of the heart.
57 . The method of any one of claims 31 - 47 , wherein the target tissue is a fossa ovalis.