Methods and devices for ablation

• US 20020173784A1
• Filed: 02/15/2002
• Published: 11/21/2002
• Est. Priority Date: 10/22/1996
• Status: Active Grant

• Current Assignee: St. Jude Medical (Abbott Laboratories Incorporated)
• Original Assignee: Epicor Inc. (Evoqua Water Technologies Corp.)
• Inventors: Vaska, Matthias, Morse, Stephen A., Anderson, Scott C., Podmore, Jonathan L., Sliwa, John W. Jr., Champsaur, Gerard, Crowe, John E., Miller, Gary Henry
• Granted Patent: US 6,840,936 B2
• Time in Patent Office: Days
• US Class Current: 606/28
• CPC Class Codes: A61B 17/22012 in direct contact with, or very close to, the obstruction or concrement for removing obstructions in blood vessels by laser A61B18/245
• CPC Class Codes: A61B 17/2202 the ultrasound transducer being inside patient's body at the distal end of the catheter
• CPC Class Codes: A61B 17/2251 characterised by coupling elements between the apparatus, e.g. shock wave apparatus or locating means, and the patient, e.g. details of bags, pressure control of bag on patient
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00252 for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/2253 using a coupling gel or liquid
• CPC Class Codes: A61B 2017/3419 : Sealing means between cannula and body
• CPC Class Codes: A61B 2018/00005 : Cooling or heating of the probe or tissue immediately surrounding the probe
• CPC Class Codes: A61B 2018/00023 : closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/0016 : Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00214 : Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00232 : having an irregular shape
• CPC Class Codes: A61B 2018/00261 : arranged in a line
• CPC Class Codes: A61B 2018/00285 : Balloons
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00351 : Heart
• CPC Class Codes: A61B 2018/00363 : Epicardium
• CPC Class Codes: A61B 2018/00375 : Ostium, e.g. ostium of pulmonary vein or artery
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00654 : with individual control of each of a plurality of energy emitting elements
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00839 : Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/00898 : Alarms or notifications created in response to an abnormal condition
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/142 : at least partly surrounding the target, e.g. concave, curved or in the form of a cave
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/147 : Electrodes transferring energy by capacitive coupling, i.e. with a dielectricum between electrode and target tissue
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2018/2283 : with pivotable mirrors
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2090/395 : with marking agent for marking skin or other tissue
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/056 : Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/3629 : in combination with non-electric therapy
• CPC Class Codes: A61N 2007/0078 : with multiple treatment transducers
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

An ablating device has a cover which holds an interface material such as a gel. The cover contains the interface material during initial placement of the device. The ablating device may also have a removable tip or a membrane filled with fluid. In still another aspect, the ablating device may be submerged in liquid during operation.

Claims

1. A method of ablating tissue, comprising the steps of:

providing an ablation device having an ablating element;

positioning the ablating device against a target tissue;

emitting energy from an emitter so that the energy passes through the target tissue;

measuring the energy which passes through the target tissue with a receiver; and

ablating the target tissue with the ablating element.

2. The method of claim 1, wherein:

the ablating step is carried out by placing the ablating device at an epicardial location, the ablating step being carried out to electrically isolate a portion of the heart.

3. The method of claim 1, wherein at least one of the emitting and measuring steps is carried out with the ablating element.

4. The method of claim 1, wherein the emitting step is carried out with the ablating element.

5. The method of claim 1, wherein the emitting step is carried out intermittently when the ablating step is temporarily stopped.

6. The method of claim 1, wherein the measuring step is carried out with the ablating element.

7. The method of claim 1, wherein the measuring step is carried out intermittently when the ablating step is temporarily stopped.

8. The method of claim 1, wherein:

the measuring step is carried out by measuring the amount of energy received at the receiver.

9. The method of claim 1, further comprising the step of:

indicating a change in the characteristic of the energy to the user.

10. The method of claim 9, wherein:

the indicating step is carried out by indicating a decrease in energy magnitude transmitted through the target tissue.

11. The method of claim 9, wherein:

the indicating step is carried out with the characteristic of the energy including frequency.

12. The method of claim 1, wherein:

the providing step is carried out with an intravascular device;

introducing the intravascular device into the patient'"'"'s vascular system;

wherein at least one of the emitting and measuring steps are carried out with the intravascular device.

13. The method of claim 1, wherein:

the measuring step is carried out with the ablating elements being the receiver.

14. The method of claim 1, wherein:

the emitting step is carried oat by emitting ultrasound energy.

15. The method of claim 1, wherein:

the emitting step is carried out by emitting energy from the ablating element; and

the measuring step is carried out by receiving energy at a plurality of receivers.

16. The method of claim 1, wherein:

the providing step is carried out with the ablating device having a plurality of ultrasound ablating elements; and

the emitting and measuring steps are carried out by emitting and measuring the energy with the plurality of ultrasound ablating elements.

17. The method of claim 1, wherein:

the providing step is carried out with the ablating device forming a closed loop; and

the positioning step is carried out to form the closed loop around a portion of the heart.

18. The method of claim 1, wherein:

the emitting and ablating steps are carried out at the same time with the energy being used to ablate the target tissue.

19. The method of claim 1, wherein:

the providing step is carried out with the ablating element being an ultrasound element; and

the emitting step is carried out with the ultrasound energy being different than the ablating step.

20. The method of claim 1, wherein:

the providing step is carried out with the ablating element producing focused ultrasound.

21. A device for ablating a target tissue, comprising:

a plurality of ablating elements;

an emitter which emits energy toward the target tissue;

a receiver which receives energy transmitted through the target tissue;

a control system coupled to the ablating elements, the emitter, and the receiver, the control system determining a change in an energy characteristic of the energy transmitted from the emitter to the receiver.

22. The device of claim 21, wherein:

the control system has an indicator which indicates the energy characteristic, the indicator providing the user with an indication of a change in the energy characteristic.

23. The device of claim 21, wherein:

at least one of the ablating element acts as the receiver.

24. The device of claim 21, wherein:

the control system controls the ablating element to stop emitting ablating energy while receiving energy transmitted through the target tissue from the emitter.

25. The device of claim 21, wherein:

at least one of the ablating elements acts as the emitter.

26. The device of claim 25, wherein:

the control system controls the ablating element to emit ablating energy which is different than energy emitted which is received by the receiver.

27. The device of claim 21, wherein:

at least one of the ablating element acts as the receiver. at least one of the ablating elements acts as the emitter.

28. The device of claim 21, wherein:

the indicator provides an indication of the magnitude of the energy received by the receiver.

29. The device of claim 21, wherein:

the indicator provides an indication of the frequency of the energy passing through the target tissue.

30. The device of claim 21, further comprising:

an intravascular device which acts as at least one of the emitter and receiver.

31. A method of ablating cardiac tissue, comprising the steps of:

providing an ablating device having at least one ablating element, the ablating element having a focus;

positioning the ablating device on a epicardial surface, wherein the focus is positioned at an angle with respect to the epicardial surface; and

ablating tissue with the ablating element with the device positioned on the epicardial surface to form a first lesion.

32. The method of claim 31, wherein:

the positioning step is carried out with the focus being angled with respect to the epicardial surface so that the focus extends through a substantial portion of the thickness of the target tissue.

33. The method of claim 31, wherein:

the positioning step is carried out with the focus being angled with respect to the epicardial surface so that the focus extends through the entire thickness of the target tissue.

34. The method of claim 31, wherein:

the providing step is carried out with the angle of the ablating element being adjustable so that the angle of the focus relative to the target tissue may be varied.

35. The method of claim 31, further comprising the step of:

moving the ablating element; and

ablating tissue again after the moving step to form a second lesion continuous with the first lesion.

36. The method of claim 31, wherein:

the moving step is carried out with the ablating element continuing to ablate tissue.

37. The method of claim 31, wherein:

the moving step is carried out by moving the ablating device across the epicardial surface.

38. The method of claim 31, wherein:

the providing step is carried out with the ablating device being coupled to a guide member; and

the moving step is carried out with the ablating device being moved relative to the guide member.

39. The method of claim 38, further comprising:

positioning the guide member at a fixed position relative to the target tissue;

the moving step being carried out a number of times with the guide member being at the fixed position.

40. The method of claim 31, wherein:

the providing step is carried out with the ablating element producing focused ultrasound.

41. A device for ablating tissue, comprising:

a shaft; and

a plurality of ablating elements coupled to the shaft, the plurality of ablating elements being configured to produce a continuous lesion in a target tissue.

42. The device of claim 41, wherein:

the plurality of ablating elements are focused ultrasound ablating elements.

43. The device of claim 41, further comprising:

at least two electrodes on a bottom side of the plurality of ablating elements.

44. The device of claim 41, further comprising:

a control system coupled to the plurality of ablating elements, the control system controlling the ablating elements.

45. The device of claim 41, wherein:

the shaft has a rigid portion and a flexible portion at a distal end of the rigid portion, the flexible portion having a coil covered by a flexible sheath, the distal portion being deformable.

47. The method of claim 46, wherein:

the moving step is carried out with an inflatable element.

48. The method of claim 46, wherein:

the moving step is carried out with the ablating element continuing to ablate tissue while moving the ablating element.

49. The method of claim 46, wherein:

the moving step is carried out by moving the ablating device along the epicardial surface.

50. The method of claim 46, wherein:

the providing step is carried out with the ablating device being coupled to a guide member; and

the moving step is carried out with the ablating device being moved relative to the guide member.

51. The method of claim 50, further comprising the step of:

positioning the guide member at a fixed position relative to the target tissue;

the moving step being carried out a number of times with the guide member being at the fixed position.

52. The method of claim 50, wherein:

the providing step is carried out with the guide member being a tube.

53. The method of claim 52, wherein:

the providing step is carried out with the tube having an opening; and

the positioning step is carried out with the ablating element positioned to emit energy through the opening.

54. The method of claim 53, wherein:

the providing step is carried out with the ablating element being a laser.

55. The method of claim 46, wherein:

the providing step is carried out with the ablating element having a focus; and

the positioning step is carried out with the focus being angled with respect to the epicardial surface so that the focus extends through at least a substantial portion of the thickness of the target tissue.

56. The method of claim 46, wherein:

the positioning step is carried out with the focus being angled with respect to the epicardial surface so that the focus extends through the entire thickness of the target tissue.

57. The method of claim 46, wherein:

the providing step is carried out with the ablating element producing focused ultrasound.

58. The method of claim 46, wherein:

the moving step is carried out by moving the abating element toward or away from the epicardial surface.

59. The method of claim 46, wherein:

the moving step is carried out by moving the ablating element along an arc above the epicardial surface.

46. A method of ablating cardiac tissue, comprising the steps of:

providing an ablating device having at least one ablating element;

positioning the ablating device on a epicardial surface;

ablating tissue with the ablating element with the device positioned on the epicardial surface to form a first lesion;

moving the ablating element to a new position; and

ablating tissue to form a second lesion at the new position which is continuous with the first lesion.