Methods and apparatus for locating the fossa ovalis

Abstract

The instant disclosure relates to a family of devices and methods for both measuring electrophysiological signals and delivering elongate medical devices. In an embodiment, a kit is described that includes a hollow catheter adapted to navigate a patient's vasculature having a hollow lumen terminating at a distal end, structure configured for sensing cardiac electrical activity adjacent the distal end of the hollow catheter and for acquiring electrograms. The fossa ovalis of a subject can be located therefrom and a second medical device can be advanced into and through the hollow lumen to such an extent that a distal tip of the second medical device protrudes beyond a proximal end and the distal end of the hollow catheter at the same time.

1 - 8 . (canceled) 
     
     
         9 . An apparatus comprising:
 a hollow catheter adapted to navigate a patient's vasculature to the right atrium, wherein the hollow catheter defines a lumen terminating at a distal end; and   means for measuring cardiac electrical activity coupled to the distal end of the hollow catheter;   wherein the lumen is configured to receive a second medical device therethrough.   
     
     
         10 . The apparatus according to  claim 9 , wherein the means for measuring cardiac electrical activity comprises a unipolar electrode positioned on the hollow catheter adjacent the distal end thereof. 
     
     
         11 . The apparatus according to  claim 9 , wherein the means for measuring cardiac electrical activity comprises a pair of bipolar electrodes including a first electrode coupled to a distal end of the hollow catheter and a second electrode coupled to the hollow catheter proximal of and spaced apart from the first electrode. 
     
     
         12 . The apparatus according to  claim 11 , wherein the distal end of the hollow catheter is tapered and the first electrode and second electrode are spaced apart a distance between about 2 mm and about 4 mm. 
     
     
         13 . The apparatus according to  claim 11 , wherein the first electrode and the second electrode are each configured to concurrently obtain both unipolar and bipolar measurements to provide the means for measuring cardiac electrical activity adjacent the distal end of the hollow catheter. 
     
     
         14 . The apparatus according to  claim 9 , wherein the second medical device comprises a transseptal needle. 
     
     
         15 . A kit comprising:
 a hollow catheter adapted to navigate a patient's vasculature having a lumen terminating at a distal end;   means for sensing cardiac electrical activity adjacent the distal end of the hollow catheter;   means for acquiring electrograms and locating the fossa ovalis therefrom in operable communication with the means for sensing cardiac electrical activity; and   a second medical device advanceable into and through the lumen to such an extent that a distal tip of the second medical device protrudes beyond a proximal end and the distal end of the hollow catheter at the same time.   
     
     
         16 . A kit according to  claim 15 , wherein the second medical device comprises a transseptal needle. 
     
     
         17 . A kit according to  claim 16 , wherein the hollow catheter is configured such that the distal end of the hollow catheter comprises both an electrophysiology mapping catheter for locating the fossa ovalis and a dilator suitable for penetrating the fossa ovalis during a transseptal puncture procedure by advancing the hollow catheter relative to the transseptal needle positioned within the lumen. 
     
     
         18 . A kit according to  claim 15 , further comprising a recording device configured for the generation and recording of unipolar and bipolar electrograms, the recording device in electrical communication with the electrodes of the hollow catheter, wherein the recording device generates the unipolar electrograms from the electrophysical activity of the interatrial septum sensed by the first electrode and the bipolar electrograms from the electrophysical activity of the interatrial septum sensed by both the first electrode and the second electrode. 
     
     
         19 . A kit according to  claim 18 , wherein the distal end of the hollow catheter is tapered, and the second electrode is spaced from the first electrode by a distance of between about 2 and about 4 mm. 
     
     
         20 . A kit according to  claim 18 , wherein the hollow catheter further comprises
 first and second electrical leads in electrical communication with the first and second electrodes, and   first and second cables at the proximate end of the hollow catheter,   wherein the first and second cables are in electrical communication with the first and second electrical leas and are configured to be attached to the recording device.   
     
     
         21 . An apparatus comprising:
 a catheter defining a lumen that is open at both a proximal end of the catheter and a distal end of the catheter, such that a device can be inserted into the proximal end of the catheter and through the lumen of the catheter, with a distal end of the device extending beyond the distal end of the catheter and a proximal end of the device remaining outside the proximal end of the catheter; and   one or more electrodes positioned within a distal region of the catheter.   
     
     
         22 . The apparatus according to  claim 21 , wherein the one or more electrodes comprises a unipolar electrode positioned adjacent the distal end of the catheter. 
     
     
         23 . The apparatus according to  claim 21 , wherein the one or more electrodes comprises a pair of bipolar electrodes, a first bipolar electrode of the pair of bipolar electrodes being positioned adjacent the distal end of the catheter and a second bipolar electrode of the pair of bipolar electrodes being positioned within the distal region of the catheter proximally of and spaced apart from the first bipolar electrode. 
     
     
         24 . The apparatus according to  claim 23 , wherein the second bipolar electrode is spaced from the first bipolar electrode by a distance of between 2 mm and 4 mm. 
     
     
         25 . The apparatus according to  claim 21 , wherein the device comprises a transseptal needle. 
     
     
         26 . The apparatus according to  claim 21 , further comprising a device for generating electrograms using electrophysiological activity measured by the one or more electrodes. 
     
     
         27 . The apparatus according to  claim 26 , wherein the device for generating electrograms is further configured to detect an anatomical landmark based upon the generated electrograms. 
     
     
         28 . The apparatus according to  claim 27 , wherein the anatomical landmark is a fossa ovalis and therein the device for generating electrograms is configured to use one or more of unipolar voltage reduction, signal fractionation, broadened signal, reduced local myocardial impedance, increased phase angle, increased pacing threshold, and reduced signal slew rate to detect the fossa ovalis.