Surgical system and procedure for treatment of medically refractory atrial fibrillation

• US 20040106918A1
• Filed: 06/12/2002
• Published: 06/03/2004
• 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: W. Boyd, Stephen, Gifford, Hanson S. III, Vaska, Matthias, Cox, James L., Merrick, Daniel D.
• Granted Patent: US 7,387,126 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• 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 18/1447 wherein sliding surfaces cause opening/closing of the end effectors
• 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 18/20 using laser
• 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 2017/00575 : for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/00946 : malleable
• CPC Class Codes: A61B 2017/0243 : for immobilizing local areas of the heart, e.g. while it beats trocars attached to inner organs or inner body tissue A61B2017/3488
• CPC Class Codes: A61B 2017/047 : having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body J-shaped suture needles A61B2017/0608
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/2931 : with releasable head
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2945 : Curved jaws
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3419 : Sealing means between cannula and body
• CPC Class Codes: A61B 2017/3486 : Balloon
• CPC Class Codes: A61B 2017/3492 : against the outside of the body
• 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 2018/00291 : using suction
• 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 2018/0212 : using an instrument inserted into a body lumen, e.g. catheter
• CPC Class Codes: A61B 2018/0225 : using an instrument for clamping tissue, e.g. forceps
• CPC Class Codes: A61B 2018/0262 : using a circulating cryogenic fluid
• CPC Class Codes: A61B 2018/1432 : curved
• CPC Class Codes: A61B 2018/145 : wherein the effectors remain parallel during closing and opening
• CPC Class Codes: A61B 2018/1465 : Deformable electrodes
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 2/2427 : Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/0252 : for access to the lungs
• CPC Class Codes: A61M 2039/0276 : for introducing or removing fluids into or out of the body
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3355 : Controlling downstream pump pressure
• CPC Class Codes: A61M 2205/366 : by liquid heat exchangers
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• CPC Class Codes: A61M 39/0247 : Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body peritoneal dialysis catheters A61M1/285; tracheostomy devices A61M16/0465; measuring pressure within the body A61B5/03; colostomy devices A61F5/445; gastrotomy feeding tubes A61J15/0015; means for fixing a feeding tube outside of the body A61J15/0053
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

The invention provides surgical systems and methods for ablating heart tissue within the interior and/or exterior of the heart. A plurality of probes is provided with each probe configured for introduction into the chest for engaging the heart. Each probe includes an elongated shaft having an elongated ablating surface of a predetermined shape. The elongated shaft and the elongated ablating surface of each probe are configured to ablate a portion of the heart. A sealing device affixed to the heart tissue forms a hemostatic seal between the probe and the penetration in the heart to inhibit blood loss therethrough.

Claims

1. A method for treatment of a heart comprising the steps of:

forming a penetration through a muscular wall of the heart into an interior chamber thereof;

positioning a distal end of an elongated ablating device having an elongated ablating surface through the penetration; and

contacting the elongated ablating surface of the ablating device with a first selected portion of an interior surface of the muscular wall for transmural ablation thereof.

2. The method of claim 1 further including the step of:

manipulating the device through said penetration to strategically contact the elongated ablating surface with a second selected portion of the interior surface of the muscular wall for transmural ablation thereof.

3. The method of claim 1 further including the steps of:

repeating the forming, positioning and contacting steps to form a plurality of strategically positioned lesions.

4. The method of claim 3 wherein,

the lesions are formed to create a predetermined conduction pathway in the muscular wall.

5. The method of claim 1 wherein,

the interior chamber is selected from a right atrium and a left atrium.

6. The method of claim 1 wherein,

the ablating surface is disposed at an angle of at most about 90 degrees relative to the longitudinal axis of the shaft.

7. The method of claim 1 further including the step of:

forming a hemostatic seal between the device and the penetration to inhibit blood loss through the penetration.

8. The method of claim 7 wherein:

the seal forming step is carried out by placing a purse-string suture in the muscular wall of the heart around the penetration.

9. The method of claim 1 wherein,

the heart remains beating throughout the forming, positioning, and contacting steps.

10. The method of claim 1 further including the step of:

arresting the patient'"'"'s heart.

11. The method of claim 10 wherein,

the arresting step is performed by endovascularly occluding the ascending aorta.

12. The method of claim 1 wherein,

the ablating device is a radiofrequency probe.

13. The method of claim 1 wherein,

the ablating device is a laser probe.

14. The method of claim 1 wherein,

the ablating device is a microwave probe.

15. The method of claim 1 wherein,

the ablating device is a fluid delivery probe.

16. A method for ablating medically refractory atrial fibrillation of the heart comprising the steps of:

forming a penetration through a wall of the heart;

positioning a distal end of an ablating device having an elongated ablating surface through the penetration;

forming a hemostatic seal between the ablating device and the penetration to inhibit blood loss therethrough;

contacting the elongated ablating surface with at least one selected portion of an interior surface of the heart for transmural ablation thereof to form at least one elongated transmural lesion.

17. The method of claim 16, further comprising the step of:

repeating the forming, positioning, and contacting steps to form a plurality of lesions, the plurality of lesions cooperating to generally form a conduction pathway between the sinoatrial node and the atrioventricular node.

18. The method of claim 16 wherein,

the interior chamber is selected from a right atrium and a left atrium.

19. The method of claim 16, wherein at least one hemostatic seal is formed by tightening a purse-string suture in the heart wall around the respective penetration.

20. A system for transmurally ablating heart tissue in a body cavity surrounded by a chest wall comprising:

a probe having an elongated shaft positionable through the chest wall and into a penetration extending through a wall of the patient'"'"'s heart, said shaft having a substantially elongated ablating surface proximate a distal end thereof for manipulative contact with at least one selected surface of the wall of the heart for transmural ablation thereof; and

a sealing device fixable to the heart tissue around said penetration for forming a hemostatic seal around the shaft and the transmural penetration to inhibit blood loss therebetween.