Method for interrupting conduction paths within the heart

• US 20030191462A1
• Filed: 04/02/2003
• Published: 10/09/2003
• Est. Priority Date: 05/03/1996
• Status: Active Grant

• Current Assignee: Clemens J. Jacobs, Tjong Hauw Sie
• Original Assignee: Clemens J. Jacobs, Tjong Hauw Sie
• Inventors: Jacobs, Clemens J., Sie, Tjong Hauw
• Granted Patent: US 7,128,740 B2
• Time in Patent Office: Days
• US Class Current: 606/32
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation

Abstract

A method for making transmural lesions in one or more walls of the atria of the heart in open-heart surgery. The lesion blocks electrical impulses in a direction crosswise to the lesion. The method uses a probe having a handle (1), a closed electrode (2) at an end of the probe, a relatively rigid member (5) of physiologically acceptable plastic connecting the probe and the electrode, and means (6, 7) for coupling the probe to an RF power source.

Claims

1. A method of treating an arrhythmia in the heart of a patient by ablative treatment of the atrium of the heart comprising:

(a) providing a surgical instrument having a handle and a first electrode affixed to the handle;

(b) providing a second electrode;

(c) providing a power source in electrical connection with the first and second electrodes;

(d) performing an open-heart surgical procedure in which a first electrode is placed proximal to a first portion of a wall of the atrium and the second electrode is placed proximal to a second portion of the wall of the atrium such that one of the first and second electrodes is on the inside of the atrium and the other of the first and second electrodes is on the outside of the atrium;

(e) transferring energy from the power source to the first electrode to cause a transmural lesion to form in the wall of the atrium between the first and second electrodes.

2. The method of claim 1, further comprising:

(f) moving the first electrode to another portion of the wall of the atrium;

(g) transferring energy from the power source to the first electrode to cause a transmural lesion to form in the another portion of the wall of the atrium; and

(h) repeating (f) to (g) to form at least one elongated, continuous transmural lesion in the atrium.

3. The method of claim 1, wherein the first electrode has an elongated shape.

4. The method of claim 1, further comprising monitoring the temperature of the first electrode.

5. The method of claim 4, wherein the temperature of the first electrode during the transfer of electrical energy is limited to a regulated preset value in the range of 50 to 70 degrees C.

6. The method of claim 1, further comprising delivering a physiologically acceptable liquid to the wall of the atrium.

7. The method of claim 6, wherein the physiologically acceptable liquid is a salt solution.

8. The method of claim 1, wherein the power source provides RF energy to the first electrode.

9. The method of claim 2, wherein the elongated, continuous transmural lesion encircles at least one pulmonary vein.

10. The method of claim 9, wherein the first electrode is moved to form a second, transmural lesion intersecting with the encircling lesion.

11. The method of claim 9, wherein the encircling lesion encircles all of the heart'"'"'s pulmonary veins.

12. The method of claim 9, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the right atrium.

13. The method of claim 9, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the left atrium.

14. The method of claim 10, wherein the second lesion formed extends across the left atrium toward the left atrial appendage.

15. The method of claim 2, wherein the first electrode is moved along the atrial wall without lifting the first electrode away from the wall.

16. A method of treating an arrythmia in the heart of a patient by ablative treatment of the atrium of the heart comprising:

(a) providing a surgical instrument having a handle with a first electrode affixed to the handle and a fluid outlet;

(b) providing a second electrode;

(c) providing a power source in electrical connection with the first and second electrodes;

(d) performing an open-heart surgical procedure in which the first electrode is placed proximal to a first portion of a wall of the atrium and the second electrode is placed proximal to a second portion of the wall of the atrium such that one of the first and second electrodes is on the inside of the atrium and the other of the first and second electrodes is on the outside of the atrium;

(e) transferring a physiologically acceptable liquid to the fluid outlet;

(f) transferring energy from the power source to the first electrode to cause a transmural lesion to form in the wall of the atrium between the first and second electrodes.

17. The method of claim 16, further comprising:

(g) moving the first electrode to another portion of the wall of the atrium;

(h) transferring energy from the power source to the first electrode to cause a transmural lesion to form in the another portion of the wall of the atrium; and

(i) repeating (g) to (h) to form at least one elongated, continuous transmural lesion in the atrium.

18. The method of claim 16, wherein the first electrode has an elongated shape.

19. The method of claim 16, further comprising monitoring the temperature of the first electrode.

20. The method of claim 19, wherein the temperature of the first electrode during the transfer of electrical energy is limited to a regulated preset value in the range of 50 to 70 degrees C.

21. The method of claim 16, wherein the physiologically acceptable liquid is a salt solution.

22. The method of claim 16, wherein the power source provides RF energy to the first electrode.

23. The method of claim 17, wherein the elongated, continuous transmural lesion encircles at least one pulmonary vein.

24. The method of claim 23, wherein the first electrode is moved to form a second, transmural lesion intersecting with the encircling lesion.

25. The method of claim 23, wherein the encircling lesion encircles all of the heart'"'"'s pulmonary veins.

26. The method of claim 23, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the right atrium.

27. The method of claim 23, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the left atrium.

28. The method of claim 24, wherein the second lesion formed extends across the left atrium toward the left atrial appendage.

29. The method of claim 17, wherein the first electrode is moved along the atrial wall without lifting the first electrode away from the wall.

30. A method of treating an arrhythmia in the heart of a patient by ablative treatment of the atrium of the heart comprising:

(a) providing a surgical instrument having a handle and an electrode affixed to the handle;

(b) providing a power source in electrical connection with the electrode;

(c) performing an open-heart surgical procedure in which the electrode is placed proximal to a portion of a wall of the atrium on the inside of the atrium;

(d) transferring energy from the power source to the electrode to cause a transmural lesion to form in the wall of the atrium;

(e) moving the electrode to another portion of the wall of the atrium;

(f) transferring energy from the power source to the electrode to cause a transmural lesion to form in the another portion of the wall of the atrium; and

(g) repeating (e) to (f) to form at least one elongated, continuous transmural lesion in the atrium encircling at least one pulmonary vein.

31. The method of claim 30, wherein the electrode has an elongated shape.

32. The method of claim 30, further comprising monitoring the temperature of the electrode.

33. The method of claim 32, wherein the temperature of the electrode during the transfer of electrical energy is limited to a regulated preset value in the range of 50 to 70 degrees C.

34. The method of claim 30, further comprising delivering a physiologically acceptable liquid to the wall of the atrium.

35. The method of claim 34, wherein the physiologically acceptable liquid is a salt solution.

36. The method of claim 30, wherein the power source provides RF energy to the electrode.

37. The method of claim 30, wherein the electrode is moved to form a second, transmural lesion intersecting with the encircling lesion.

38. The method of claim 30, wherein the encircling lesion encircles all of the heart'"'"'s pulmonary veins.

39. The method of claim 30, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the right atrium.

40. The method of claim 30, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the left atrium.

41. The method of claim 37, wherein the second lesion formed extends across the left atrium toward the left atrial appendage.

42. The method of claim 30, wherein the electrode is moved along the atrial wall without lifting the first electrode away from the wall.

43. A method of treating an arrhythmia in the heart of a patient by ablative treatment of the atrium of the heart comprising:

(a) providing a surgical instrument having a handle and an electrode affixed to the handle;

(b) providing a power source in electrical connection with the electrode;

(c) performing an open-heart surgical procedure in which the electrode is placed proximal to a portion of the inside wall of the atrium between a pulmonary vein and conductive pathways in the atrium;

(d) transferring energy from the power source to the electrode to cause a continuous, transmural lesion encircling at least one pulmonary vein to form in the portion of the wall of the atrium.

44. The method of claim 43, wherein the electrode has an elongated shape.

45. The method of claim 43, further comprising monitoring the temperature of the electrode.

46. The method of claim 45, wherein the temperature of the electrode during the transfer of electrical energy is limited to a regulated preset value in the range of 50 to 70 degrees C.

47. The method of claim 43, further comprising delivering a physiologically acceptable liquid to the wall of the atrium.

48. The method of claim 47, wherein the physiologically acceptable liquid is a salt solution.

49. The method of claim 43, wherein the power source provides RF energy to the electrode.

50. The method of claim 43, wherein the electrode is moved to form a second, transmural lesion intersecting with the encircling lesion.

51. The method of claim 43, wherein the encircling lesion encircles all of the heart'"'"'s pulmonary veins.

52. The method of claim 43, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the right atrium.

53. The method of claim 43, wherein a portion of the encircling lesion is formed between a pulmonary vein and conductive pathways in the left atrium.

54. The method of claim 53, wherein the second lesion formed extends across the left atrium toward the left atrial appendage.

55. The method of claim 43, wherein the electrode is moved along the atrial wall without lifting the first electrode away from the wall.