Apparatus and method for diagnosis and therapy of electrophysiological disease

• US 20030079753A1
• Filed: 08/30/2002
• Published: 05/01/2003
• 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, Richman, Roxanne L., Anderson, Scott C., Gallup, David A., Pless, Benjamin, Ulstad, Jack E. Jr.
• Granted Patent: US 6,949,095 B2
• Time in Patent Office: Days
• US Class Current: 128/898
• 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 18/1402 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 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/3419 Sealing means between cannula and body
• 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 2018/00232 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 2018/00392 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 2018/142 : at least partly surrounding the target, e.g. concave, curved or in the form of a cave
• CPC Class Codes: A61B 2018/145 : wherein the effectors remain parallel during closing and opening
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• 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 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 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/3629 : in combination with non-electric therapy
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

The invention provides apparatus and methods for mapping conduction pathways and creating lesions in the heart wall for the treatment of atrial fibrillation. The apparatus may include at least one epicardial ablation probe having a plurality of electrodes for creating a lesion. The apparatus and method facilitate the formation of a lesion which electrically isolates the pulmonary veins from the surrounding myocardium.

Claims

1. A method of positioning an ablating surface against tissue, comprising the steps of:

providing an ablating device having a first ablating portion, a second ablating portion and an end;

introducing the ablating device into the space between the pericardium and the epicardium;

positioning the end of the ablating element in the transverse pericardial sinus so that the first ablating surface is positioned in the transverse pericardial sinus; and

moving the second ablating portion toward the pulmonary veins after the positioning step; and

ablating the tissue adjacent to the pulmonary veins with the first and second ablating portions.

2. The method of claim 1, wherein:

the ablating step is carried out with the first ablating portion extending adjacent to the pericardial reflection extending between the right superior and left superior pulmonary veins.

3. The method of claim 1, wherein:

the moving step is carried out with the second ablating portion extending adjacent the pericardial reflection between the left inferior and right interior pulmonary veins.

4. The method of claim 1, wherein:

the providing step is carried out with the ablating device having a proximal portion and a distal portion.

5. The method of claim 4, wherein:

the anchoring step is carried out with an expandable device on the ablating device, the expandable device being expanded to resist movement of the expandable device during the moving step.

6. The method of claim 5, wherein:

the anchoring step is carried out with the expandable device being an inflatable balloon.

7. The method of claim 4, wherein:

the moving step is carried out by advancing a member into the proximal portion which shapes the proximal portion.

8. The method of claim 7, wherein:

the moving step is carried out with the member having a shape which moves the proximal portion nearer to the pulmonary veins.

9. The method of claim 7, wherein:

the moving step is carried out with the member being malleable.

10. The method of claim 9, wherein:

the moving step is carried out with the member having a predetermined shape.

11. A method of forming ablations to electrically isolate a structure of a patient'"'"'s heart, comprising the steps of:

providing a first ablating device having a first ablating element;

introducing the first ablating device into a space between the pericardium and epicardium;

positioning a part of the first ablating device against a structure of the patient'"'"'s heart;

moving another part of the ablating device around the structure of the patient'"'"'s heart after the positioning step; and

ablating tissue to create a lesion with the first ablating element.

12. The method of claim 11, wherein:

the positioning step is carried out with the structure is a structure selected from the group consisting of the pulmonary veins, inferior vena cava, superior vena cava, aorta, pulmonary artery, atrial appendage and pericardial reflections.

13. The method of claim 11, wherein:

the positioning step is carried out with the part of the ablating device which engages the structure having a curved shape.

14. The method of claim 13, wherein:

the ablating step is carried out with the curved part of the ablating device ablating around a portion of a vessel.

15. The method of claim 13, wherein:

the ablating step is carried out with the curved part having a radius of curvature of 4 to 30 mm.

16. The method of claim 11, wherein:

the providing step is carried out by providing a second ablating device, the second ablating device having a second ablating element; and

the ablating step is carried out by ablating tissue with the first and second ablating elements.

17. A method of creating a continuous lesion in tissue, comprising the steps of:

providing an ablating device having an ablating element;

introducing the ablating device into a space between the epicardium and pericardium;

ablating tissue after the introducing step to create a first lesion;

moving the ablating device after the ablating step;

positioning the ablating device at a location so that a second lesion formed with the ablating element will be continuous with the first lesion;

ablating tissue with the ablating element to create the second lesion continuous with the first lesion.

18. The method of claim 17, wherein:

the providing step is carried out with the ablating device having a locating device positioned adjacent the ablating element, the locating device locating a position of the first lesion.

19. The method of claim 17, wherein:

the providing step is carried out with the ablating device having first and second electrodes.

20. The method of claim 19, further comprising the step of:

measuring relative electrogram amplitude between the first and second electrodes.

21. The method of claim 19, further comprising the step of:

sending an electrical impulse with one of the electrodes.