Use of tools, mapping systems, catheters, electrodes or any devices targeting any autonomic nerve(s) structure(s) in the human heart for the diagnostic, treatment and/or prevention of the recurrence of cardiac arrhythmias.

• US 20090253974A1
• Filed: 04/08/2008
• Published: 10/08/2009
• Est. Priority Date: 04/08/2008
• Status: Abandoned Application

• Current Assignee: Marc Mounir Rahme
• Original Assignee: Marc Mounir Rahme
• Inventors: Rahme, Marc Mounir
• Application Number:
  US12/099,225
• Publication Number:
  US 20090253974A1
• Time in Patent Office: Days
• US Class Current: 600/372
• 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 2018/00363 Epicardium
• CPC Class Codes: A61B 2018/00577 Ablation

Abstract

Treatment of atrial fibrillation, targeting the triggering autonomic nerve structures have been shown high efficacy for converting to a sinus rhythm state. However, the efficacy is limited to a short time (<3 months) with a high degree of recurrence of atrial arrhythmias. The recurrence rate was directly correlated to the time of follow-up which would support the role of the autonomic nerve regenerative (or re-establishment) activities for the incidence of the recurrence of atrial arrhythmias (ex. persistent atrial fibrillation). Furthermore, the recurrence degree of atrial fibrillation has not been shown any statistically significant difference between any of the currently used methods within any targeted area. Therefore, the long term inefficacy matter could be related either to the existing technologies or to their uses. The autonomic nerve’ rotors which had triggered first the occurrence of atrial fibrillation would be regenerated its primary activities over time and therefore, triggering again their recurrence.

Claims

1. :

A method of treating the recurrence of atrial arrhythmias, wherein delivering energy via catheter ablation ^π

to specific areas of the epicardium, the method comprising the step of;

Inserting an electrophysiology ablation catheter having a tip section with an ablation electrode pointed toward the right or left atrial epicardium and directing the catheter to specific autonomic nerve structure stabilizing the ablation electrode at said epicardial nerve structure; and

delivering effective energy through the electrode sufficient to attenuate the electrophysio logical autonomic signals”

generated by this area and causing the recurrence and perpetuation of the said atrial arrhythmias.

4. The method according to any one of claims 1, 2 or 3 further comprising the step of using additional tools ^π

, such as a neurostimulator, in order to re-test the attenuation of the electrophysiological activation of an autonomic nerve structure ^Ω

* thereby prevent the nerve structure from re-establishing innervations such as regenerative activities.

5. The method of claim 4, wherein said preventing autonomic nerve structure’

regenerative activities ^Ω

* further comprises prevention of the recurrence of atrial arrhythmias.

6. The method of claim 4, wherein said preventing the endothelium from re-establishing innervations activities with an autonomic nerve structure”

further comprises prevention of the recurrence of atrial arrhythmias.

7. The method according to any one of claims 1, 2 or 3 further comprising the step of locally infusing the endomyocardium by a vagal antagonist agent prevents the recurrence of atrial arrhythmias.

8. The method according to any one of claims 1, 2 or 3 further comprising the step of locally infusing the endomyocardium by vasoactive intestinal peptide compound treats the occurrence of atrial arrhythmias with an ability to prevent its recurrence.

9. The method according to any one of claims 1, 2 or 3 further comprising the step of locally infusing the endomyocardium by an ionic-channel of acetylcholine-sensitive K⁺—

currents agent ^Φ

prevents the recurrence of atrial arrhythmias.

10. The method according to any one of claims 1, 2 or 3 further comprising the step of locally infusing the epicardium by an ionic-channel of acetylcholine-sensitive K⁺−

currents agent (prevents the recurrence of atrial arrhythmias.

11. The method according to any one of claims 1, 2 or 3 further comprising the step of infusing an anticoagulant agent prevents the occurrence of stroke.

2. A method of treating the recurrence of atrial arrhythmias, wherein delivering energy via catheter ablation ^π

to specific areas of the endomyocardium, the method comprising the step of;

Inserting an electrophysiology ablation catheter having a tip section with an ablation electrode into the right or left atrial chambers and pointed toward the endomyocardium and directing the catheter to specific autonomic nerve structure;

stabilizing the ablation electrode at said endocardial nerve structure; and

delivering effective energy through the electrode sufficient to attenuate the electrophysiological autonomic signals ^Ω

generated by this area and causing the recurrence and perpetuation of the said atrial arrhythmias.

3. A method of treating the recurrence of atrial arrhythmias via denervating directly an autonomic nerve structure *, the method comprising the steps of:

using a multi array real time mapping system ^δ

for identifying areas of autonomic nerve structures generated electrohysiological autonomic signals ^Ω

which lead to the occurrence of atrial arrhythmias;

locally delivering an effective energy ^λ

through the electrode sufficient to attenuate the electrophysiological autonomic signals generated by this area and causing the recurrence and perpetuation of the said atrial arrhythmias.

12. A method of preventing the recurrence of atrial arrhythmias wherein administrating an I_KACh antagonist compound ^Φ

to a patient treats and prevents the recurrence of atrial arrhythmias, the method comprising at least one of;

1) Oral administration of the said compound,

2) IV infusing the said compound,

3) a direct application of the compound via a drug eluting patch on the atrial epicardium, and

4) a direct application of the compound via a drug eluting catheter on the atrial endocardium. ^λ

;

A source of energy would included and not limited to radiofrequency stimulus, microwave stimulus, ultrasound stimulus and laser stimulus;

cryoablation application would be included (even if it is not using or delivering a source of energy). ^π

;

comprising and not limited to ablation catheter(s), electrode(s), tools, surgical device(s), surgical tool(s) and/or tool(s) for neurostimulating for the epicardium, myocardium and/or endocardium. *;

Autonomic nerve structure is defined as any autonomic nerve located on the cardiac myocardium, epicardium and/or endocardium;

the nomination of such nerve structure could be technically modified and used in the literature for charming matter, however, all terms and definitions lead to the same nerve structure which include and not limited to the ganglionated plexi, ganglia, ansa, axon, somata, dendrites, fibers, gap junction, synapse, inter- or intra-connection between two different part of the said nerve structure. ^Ω

;

Including and not limited to ectopic extra beats, high frequency, dominant frequency, complex fractionated atrial electrograms, significant decreases of the P wave'"'"'s durations, autonomic bradycardia or tachycardia intensities, degree of heart rate variability (such R-R variations), AV block modification, and/or initiating of arrhythmia(s). ^δ

;

A mapping system which utilizes point-by-point electrogram acquisition and analysis to project complex fractionated electrogram, dominant frequency, any other autonomic nervous system data transformations on 2 or 3D maps and/or an x-ray procedure that uses the help of a computer to produce a detailed picture of a cross section of the cardiac endothelium (epicardium, myocardium, epicardium). Φ

;

including and not limited to I_KACh and/or multiple muscarinic acetylcholine-receptor subtypes that could mediate kinetically and biophysically distinct K⁺−

currents such as the 1—

I_KACh (M2 receptor blocker or blocker of I_KM2);

2—

I_KM3 (M3 receptor blocker) and 3—

I_KM4 (M4 receptor blocker).