Methods of treating cardiac arrhythmia

• US 20070055230A1
• Filed: 10/31/2006
• Published: 03/08/2007
• Est. Priority Date: 06/02/1999
• Status: Active Grant

• Current Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: Tom, Curtis, Mueller, Richard, Murphy-Chutorian, Douglas, Chee, U., Kermode, James
• Granted Patent: US 8,187,251 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 17/282 Jaws
• CPC Class Codes: A61B 17/32037 for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
• CPC Class Codes: A61B 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• 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 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/1425 Needle
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/067 for measuring angles
• CPC Class Codes: A61B 2218/002 Irrigation
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61M 2025/0089 Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
• CPC Class Codes: A61M 37/0092 using ultrasonic, sonic or infrasonic vibrations, e.g. phonophoresis
• CPC Class Codes: A61M 5/30 Syringes for injection by jet action, without needle, e.g. for use with replaceable ampoules or carpules

Abstract

Methods and apparatus of embodiments of the invention are adapted to treat tissue inside a patient'"'"'s body. Aspects of the invention can be used in a wide variety of applications, but certain embodiments provide minimally invasive alternatives for treating atrial fibrillation by delivering a tissue-damaging agent to selected areas of the heart. One exemplary embodiment of the invention provides a method of treating cardiac arrhythmia. This method includes positioning a distal tissue-contacting portion of a body in surface contact with a tissue surface of cardiac tissue; detecting the surface contact between the tissue-contacting portion and the tissue surface; and thereafter, injecting a tissue-ablating agent into the cardiac tissue through the tissue-contacting portion of the body.

Claims

1. A method of treating cardiac arrhythmia comprising:

positioning a tissue grasping member adjacent a target tissue of a vessel, the target tissue having two spaced-apart wall segments, wherein the tissue grasping member comprises at least first and second opposed tissue contacting members each having first and second tissue contacting surfaces spaced apart from one another to define a gap therebetween, and each further having a fluid delivery conduit disposed in the gap and spaced apart from the target tissue;

moving the opposed tissue contacting members of the tissue grasping member toward one another to deform the target tissue such that the wall segments are moved closer to, but remain spaced from, one another, such that blood flow through the portion of the vessel deformed by the tissue contacting members is substantially unconstricted; and

ablating target tissue in contact with the tissue contacting members to create a lesion extending through both wall segments.

2. A method of at least partially electrically isolating a pulmonary vein from a heart atrium having two spaced apart wall segments, comprising:

juxtaposing the two wall segments along a first plane;

ablating tissue in both wall segments along the first plane with an ablating member to form a lesion along a first length of each wall segment;

moving the ablating member;

juxtaposing the two wall segments along a second plane; and

ablating tissue in both wall segments along the second plane with the ablating member to form a lesion along a second length of each wall segment, the second length adjoining the first length.

3. The method of claim 2, further comprising:

moving the ablating member again;

juxtaposing the two wall segments along a third plane; and

ablating tissue in both wall segments along the third plane with the ablating member to form a lesion along a third length of each wall segment.

4. The method of claim 2, wherein the first and second lengths at least substantially circumscribe the pulmonary vein.

5. The method of claim 2, further comprising repositioning the ablating member and ablating tissue to form at least one additional lesion which, together with the first and second lengths, forms a series of lesions which at least substantially circumscribes the pulmonary vein.

6. A method for creating a line of ablated tissue on a cardiac vessel having opposed walls, comprising:

bringing the opposed walls of the cardiac vessel closer together, but not in contact with one another, along a distance within a plane, such that blood flow from the pulmonary vein into the atrium is substantially unconstricted; and

ablating tissue in the opposing walls along the plane to form a corresponding line of ablated tissue through the opposed walls.

7. A method of treating cardiac arrhythmia comprising:

guiding a body of an injectate delivery device within a patient'"'"'s thoracic cavity to position a distal tissue-contacting portion of the body in surface contact with a tissue surface of cardiac tissue;

detecting the surface contact between the tissue-contacting portion and the tissue surface; and

thereafter,

injecting a tissue-ablating agent into the cardiac tissue through the tissue-contacting portion of the body.

8. The method of claim 7, wherein the tissue-ablating agent is pressurized to a delivery pressure of at least about 400 psi to inject the tissue-ablating agent into the cardiac tissue.

9. The method of claim 7, wherein the tissue-ablating agent is pressurized to a delivery pressure of about 600 psi to about 2000 psi to inject the tissue-ablating agent into the cardiac tissue.

10. The method of claim 7, wherein the tissue-ablating agent is injected into the cardiac tissue to a depth of at least about 2 mm.

11. The method of claim 7, wherein the tissue-ablating agent is injected into the cardiac tissue at an elevated pressure through a plurality of outlet ports along the tissue-contacting portion.

12. The method of claim 7, wherein the tissue-contacting portion of the body comprises a blunt distal tip of the body having a tissue-contact sensor, the tissue-contact sensor being used to detect the surface contact.

13. The method of claim 7, wherein the tissue-contacting portion of the body comprises an elongate surface of a distal length of the body.

14. The method of claim 7, wherein the tissue-contacting portion of the body comprises an elongate surface of a distal length of the body having a tissue-contact sensor, the tissue-contact sensor being used to detect the surface contact.

15. The method of claim 7, wherein the injectate delivery device further comprises a selectively deployable needle, injecting the tissue-damaging agent comprising advancing the needle through the tissue surface into the cardiac tissue and delivering a tissue-damaging fluid through a lumen of the needle.

16. The method of claim 7, wherein the step of detecting surface contact comprises supplying an excitation voltage to a plurality of electrodes positioned on the tissue-contacting portion of the body and measuring a level of at least one current conducted by the plurality of electrodes, wherein the level depends upon a degree of contact between at least two of the electrodes and the tissue surface.

17. The method of claim 7, wherein surface contact is detected with a plurality of electrodes positioned on the tissue-contacting portion of the body, further comprising measuring an EKG of the cardiac tissue with the electrodes.

18. A method of treating atrial fibrillation comprising:

guiding an elongate, flexible body into proximity with an exterior tissue surface of a predetermined portion of a cardiac tissue;

bringing an elongate tissue-contacting portion of the body into surface contact with the tissue surface, the tissue-contacting portion including a plurality of electrodes;

measuring a level of at least one current conducted by the plurality of electrodes, wherein the level depends on a degree of contact between at least two of the electrodes and the tissue surface; and

thereafter,

injecting a tissue-damaging fluid into the cardiac tissue at an elevated pressure through a plurality of outlets in the tissue-contacting portion of the body to define a plurality of jets of the tissue-damaging fluid which pass through an entire thickness of the cardiac tissue, creating a transmural signal-impeding lesion in the cardiac tissue.