The present disclosure discusses a devices, systems and methods for transvascular, transvenous and/or transdural access, to the brain parenchyma, subarachnoid or subdural spaces. In some embodiments, the disclosed systems and methods may be used for local drug delivery, tissue biopsy, nanofluidic or microelectronic device/component delivery/insertion/implantation, in situ imaging, ablation of abnormal brain tissue and the like. Embodiments of the present disclosure include an access catheter system for extravascular procedures in the brain having an elongate, flexible tubular body, with at least one lumen extending axially there through between a proximal end, and a distal end. The access catheter system may include a side exit port and a distal end port. Further, the access catheter system may include a selective deflector positioned within the lumen configured to deflect a procedure catheter and permit a guide catheter.

The present disclosure provides catheter systems, electrode assemblies, and methods for electrically stimulating one or more points about the circumference of the renal artery to provide real time intraprocedural operational feedback to the operator of a renal denervation procedure to allow for more precise and thorough ablation of the renal artery and better patient outcomes. In many embodiments, an electrode assembly is provided that includes multiple splines that extend from an insulated proximal hub to an insulated distal hub and are interconnected to an electrical wire to allow the splines to independently function as electrical stimulation electrodes. The electrically active splines can then be energized at one or more desired points during a renal denervation procedure to provide operational feedback.

An expandable electrode assembly for use in a cardiac mapping procedure includes multiple bipolar electrode pairs including a first electrode located on an outer surface and a second electrode located on an inner surface of the individual splines forming the expandable electrode assembly. Such an electrode arrangement may produce improved electrical activation signals which may be used to produce a more accurate map of the electrical activity of a patient's heart.

An esophageal monitoring device includes a camera and, optionally, one or more lights to enable visualization of an interior of a subject's esophagus. Visualization of the interior of the subject's esophagus before and after a left atrial ablation procedure may enable a healthcare provider to determine whether or not the left atrial ablation procedure has damaged the subject's esophagus before the subject experiences any symptoms of such damage. An esophageal monitoring device may also include sensors and/or markers that enable a determination of its location within a subject's esophagus. Such an esophageal monitoring device may be configured for three-dimensional mapping, and enable the generation of an accurate three-dimensional map of the physical relationship between a subject's esophagus and the left atrium of his or her heart. Methods of monitoring a subject's esophagus while a left atrial ablation procedure is being conducted on the subject's hear are also disclosed.

An apparatus includes a tube, a support element, multiple spines proximally coupled to the tube, and multiple electrodes coupled to the spines. The spines include respective expandable superelastic elements, and respective polymeric elements extending from respective distal ends of the superelastic elements and coupled to a surface of the support element by virtue of being bent proximally, into alignment with the surface, at a distal end of the support element. Other examples are also described.

A method for introducing an elongate medical instrument with a shaped portion into the body of a subject includes at least partially straightening the shaped portion from an exterior of the elongate medical instrument. A retention element may then be introduced into an interior of the shaped portion to maintain the shaped portion in an at least partially straightened configuration as the external force is removed from the shaped portion. With the retention element in place, the shaped portion may be introduced to a desired location within a hollow interior of an internal organ. The retention element may then be removed to enable the shaped portion to return to its desired shape. A straightening apparatus includes the retention element, as well as an external element that at least partially straightens the shaped portion of the elongate medical instrument from the outside. A system includes the elongate medical instrument and the straightening apparatus.

Flexible high-density mapping catheter tips and flexible ablation catheter tips with onboard high-density mapping electrodes are disclosed. These tips can be used for diagnosing and treating cardiac arrhythmias. The flexible, distal tips are adapted to conform to tissue and comprise a plurality of microelectrodes mounted to permit relative movement among at least some of the microelectrodes. The flexible tip portions may comprise a flexible framework forming a flexible array of microelectrodes (for example, a planar or cylindrical array) adapted to conform to tissue and constructed at least in part from nonconductive material in some embodiments. The flexible array of microelectrodes may be formed from a plurality of rows of longitudinally-aligned microelectrodes. The flexible array may further comprise, for example, a plurality of electrode-carrying arms or electrode-carrier bands. Multiple flexible frameworks may be present on a single device. A delivery adapter having an internal compression cone is also disclosed.

A method is implemented by a mapping engine executed by a processor. The method includes receiving electrical activity from electrodes of a catheter. The method includes performing a spatial electrode signal analysis of the electrical activity for each electrode of the catheter. The method includes scaling a common signal component of the electrical activity identified by the spatial electrode signal analysis to determine a residual signal.

A system includes an expandable distal-end assembly, a proximal position sensor, a distal position sensor, and a processor. The expandable distal-end assembly is coupled to a distal end of a shaft for insertion into a cavity of an organ of a patient. The proximal and distal position sensors are located at a proximal end and a distal end of the distal-end assembly, respectively. The processor is configured to estimate a position and a longitudinal direction of the proximal sensor, and a position of the distal sensor, all in a coordinate system used by the processor. The processor is further configured to project the estimated position of the distal sensor on an axis defined by the estimated longitudinal direction, and calculate an elongation of the distal-end assembly by calculating a distance between the estimated position of the proximal sensor and the projected position of the distal sensor.

Electrographic flow mapping (EGF mapping) is a technique used for aiding catheter ablation when treating atrial fibrillation. Visualizing EGF fields during a cardiac catherization and ablation procedure is an important and necessary part of conducting the procedure. Several different visualization methods are described and disclosed herein that may be employed to visualize EGF fields and maps, including quiver plots, streamline plots, particle plots, particle trail plots, moving particle plots, and moving and fading particle plots.