Systems and methods for conducting electrophysiological testing using high-voltage energy pulses to stun heart tissue

• US 5,759,158 A
• Filed: 08/19/1997
• Issued: 06/02/1998
• Est. Priority Date: 07/28/1995
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: EP Technology (Boston Scientific Corporation)
• Inventors: Swanson, David K.
• Primary Examiner(s): Karn, William F.
• Assistant Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US08/914,860
• Time in Patent Office: 287 Days
• Field of Search: 128/642, 128/697, 128/695, 606/33, 606/34, 606/41, 606/42, 607/7, 607/9, 607/11, 607/25, 607/128
• US Class Current: 600/508
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• 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 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2018/00041 Heating, e.g. defrosting
• CPC Class Codes: A61B 2018/00065 porous
• CPC Class Codes: A61B 2018/00107 Coatings on the energy applicator
• CPC Class Codes: A61B 2018/00136 with polymer
• CPC Class Codes: A61B 2018/00148 with metal
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/0022 Balloons
• CPC Class Codes: A61B 2018/00267 having a basket shaped structure
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/1286 having a specific transformer
• CPC Class Codes: A61B 2018/1465 Deformable electrodes
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2090/065 for measuring contact or contact pressure
• CPC Class Codes: A61B 2562/043 in a linear array
• CPC Class Codes: A61B 2562/046 in a matrix array
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6856 : with a distal loop
• CPC Class Codes: A61B 5/6858 : with a distal basket, e.g. expandable basket
• CPC Class Codes: A61N 1/3622 : comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3702 : Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

Systems and methods for diagnosing and treating cardiac disorders transmit an electrical energy pulse that temporarily stuns a zone of myocardial tissue, temporarily rendering it electrically unresponsive. The systems and methods sense an electrophysiological effect due to the transmitted pulse. The systems and methods alter an electrophysiological property of myocardial tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect. The alteration of the electrophysiological property can be accomplished, for example, by tissue ablation or by the administration of medication. In a preferred implementation, radio frequency energy is used to both temporarily stun myocardial tissue and to ablate myocardial tissue through a common electrode.

Claims

1. A method for conducting diagnostic electrophysiological testing of myocardial tissue comprising the steps of

transmitting an electrical energy pulse that temporarily renders a zone of myocardial tissue electrically unresponsive for at least one second, and

sensing an electrophysiological effect due to the transmitted pulse.

2. A method according to claim 1

and further including the step of altering an electrophysiological property of myocardial tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect.

3. A method according to claim 2

wherein the step of altering the electrophysiological property includes ablating myocardial tissue in or near the zone.

4. A method according to claim 3

wherein, in the step of ablating myocardial tissue, electrical energy is used.

5. A method according to claim 3

wherein, in the step of ablating myocardial tissue, light energy is used.

6. A method according to claim 2

wherein the step of altering the electrophysiological property includes injecting chemical into the myocardial tissue.

7. A method according to claim 1

wherein the transmitted electrical energy pulse comprises a DC waveform.

8. A method according to claim 1

wherein the transmitted electrical energy pulse comprises an AC waveform.

9. A method according to claim 1

wherein the transmitted electrical energy pulse comprises a radio frequency energy waveform.

10. A method according to claim 9

and further including the step of altering an electrophysiological property of myocardial tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect using a radio frequency waveform to ablate myocardial tissue.

11. A method for ablating myocardial tissue comprising the steps of

transmitting an electrical energy pulse that temporarily renders myocardial tissue electrically unresponsive for at least one second,

sensing an electrophysiological effect due to the transmitted pulse, and

ablating the myocardial tissue based, at least in part, upon the sensed electrophysiological effect.

12. A method according to claim 11

wherein the transmitted electrical energy pulse comprises a DC waveform.

13. A method according to claim 11

wherein the transmitted electrical energy pulse comprises an AC waveform.

14. A method according to claim 11

wherein the transmitted electrical energy pulse comprises a radio frequency energy waveform.

15. A method for ablating myocardial tissue comprising the steps of

transmitting a radio frequency energy pulse to temporarily rendered myocardial tissue electrically unresponsive for at least one second,

sensing an electrophysiological effect due to the transmitted radio frequency energy pulse, and

ablating the myocardial tissue based, at least in part, upon the sensed electrophysiological effect.

16. A method for ablating myocardial tissue comprising the steps of

transmitting a radio frequency energy pulse into myocardial tissue to temporarily render the myocardial tissue electrically unresponsive for at least one second,

sensing an electrophysiological effect due to the transmitted pulse, and

transmitting radio frequency energy to ablate the myocardial tissue based at least in part, upon the sensed electrophysiological effect.

17. A method for ablating heart tissue comprising the steps of

sensing at least one electrical event in a region of myocardial tissue,

transmitting into an area of the region an electrical energy pulse that temporarily renders myocardial tissue in the area electrically unresponsive for at least one second,

sensing a change in the electrical event while myocardial tissue in the area is electrically unresponsive, and

ablating myocardial tissue in or near the area.

18. A method according to claim 17

wherein the transmitted electrical energy pulse comprises a DC waveform.

19. A method according to claim 17

wherein the transmitted electrical energy pulse comprises an AC waveform.

20. A method according to claim 17

wherein the transmitted electrical energy pulse comprises a radio frequency energy waveform.

21. A system for conducting diagnostic electrophysiological testing of myocardial tissue comprising

an electrode,

a body supporting the electrode proximate to a region of myocardial tissue,

a first element coupled to the electrode including means for transmitting through the electrode an electrical energy pulse that temporarily renders a zone of myocardial tissue electrically unresponsive for at least one second, and

a second element including means supported proximate to the region of myocardial tissue for sensing an electrophysiological effect due to the transmitted pulse and providing an output.

22. A system according to claim 21, wherein the first element includes operative means supported proximate to the zone for altering an electrophysiological property of myocardial tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect.

23. A system according to claim 22

wherein the operative means alters the electrophysiological property by ablating myocardial tissue in or near the zone.

24. A system according to claim 23

wherein the operative means transmits electrical energy to ablate myocardial tissue.

25. A system according to claim 23

wherein the operative means transmits light energy to ablate myocardial tissue.

26. A system according to claim 22

wherein the operative means injects chemical into the myocardial tissue.

27. A system according to claim 21

wherein the means of first element transmits an electrical energy pulse comprising a DC waveform.

28. A system according to claim 21

wherein the means of first element transmits an electrical energy pulse comprising an AC waveform.

29. A system according to claim 21

wherein the means of first element transmits an electrical energy pulse comprising a radio frequency energy waveform.

30. A system according to claim 21, wherein the first element includes means supported proximate to the zone for altering an electrophysiological property of myocardial tissue in or near the zone based, at least in part, upon the sensed electrophysiological effect using a radio frequency waveform to ablate myocardial tissue.

31. A system for ablating myocardial tissue comprising

an electrode,

a body supporting the electrode in operative association with a region of myocardial tissue,

an element coupled to the electrode including transmitting means for transmitting through the electrode an electrical energy pulse that temporarily renders myocardial tissue electrically unresponsive for at least one second, and

ablation means, operably connected to the body, supported proximal to the myocardial tissue region for ablating the myocardial tissue region.

32. A system according to claim 31

wherein the transmitting means transmits an electrical energy pulse comprising a DC waveform.

33. A system according to claim 32 wherein the ablation means transmits radio frequency energy to ablate myocardial tissue.

34. A system according to claim 31

wherein the transmitting means transmits an electrical energy pulse comprising an AC waveform.

35. A system according to claim 34 wherein the ablation means transmits radio frequency energy to ablate myocardial tissue.

36. A system according to claim 31

wherein the transmitting means transmits an electrical energy pulse comprising radio frequency energy.

37. A system according to claim 36 wherein the ablation means transmits radio frequency energy to ablate myocardial tissue.

38. A system according to claim 31 wherein the ablation means transmits radio frequency energy to ablate myocardial tissue.

39. A system for ablating myocardial tissue comprising

an electrode,

a body supporting the electrode proximal to a region of myocardial tissue,

a first element coupled to the electrode including means for transmitting through the electrode an electrical energy pulse that temporarily renders myocardial tissue electrically unresponsive for at least one second, and

a second element coupled to the electrode including means for transmitting electrical energy through the electrode to ablate the myocardial tissue region.

40. A system for ablating myocardial tissue comprising

an electrode,

a body supporting the electrode proximal to a region of myocardial tissue,

a generator of radio frequency energy coupled to the electrode and operable in a first mode and in a second mode, and

a controller conditioning the generator for operation in the first mode, during which the generator generates for transmission by the electrode at least one pulse of radio frequency energy that creates a temporary electrical conduction block in myocardial tissue for at least one second, the controller also conditioning the generator for operation in the second mode, during which the generator generates for transmission by the electrode radio frequency energy that ablates myocardial tissue.

41. An electrical energy generating device adapted to be coupled to an electrode comprising

first means for, when activated, generating for transmission by the electrode an electrical energy pulse that temporarily renders myocardial tissue electrically unresponsive for at least one second,

second means for, when activated, generating for transmission by the electrode electrical energy to ablate myocardial tissue, and

a switch to select for activation either the first means or the second means.

42. A device according to claim 41

wherein the electrical energy pulse generated by the first means comprises a DC waveform.

43. A device according to claim 42 wherein the electrical energy generated by the second means comprises radio frequency energy.

44. A device according to claim 41

wherein the electrical energy pulse generated by the first means comprises an AC waveform.

45. A device according to claim 44 wherein the electrical energy generated by the second means comprises radio frequency energy.

46. A device according to claim 41

wherein the electrical energy pulse generated by the first means comprises a radio frequency energy waveform.

47. A device according to claim 46 wherein the electrical energy generated by the second means comprises radio frequency energy.

48. A device according to claim 41 wherein the electrical energy generated by the second means comprises radio frequency energy.

49. A method of treating myocardial tissue, comprising the steps of:

transmitting an electrical energy pulse that temporarily renders a zone of myocardial tissue electrically unresponsive without propagating a depolarization; and

sensing an electrophysiological effect due to the transmitted pulse.

50. A method as claimed in claim 49, further comprising the step of:

altering an electrophysiological property of the myocardial tissue in or near the zone, based at least in part, upon the sensed electrophysiological effect.

51. A method as claimed in claim 50, wherein the step of altering an electrophysiological property comprises ablating myocardial tissue in or near the zone.

52. A method as claimed in claim 50, wherein the step of altering an electrophysiological property comprises transmitting a radio frequency energy pulse to the myocardial tissue in or near the zone.

53. A method as claimed in claim 49, wherein the step of transmitting an electrical energy pulse comprises transmitting a radio frequency energy pulse.

54. A method as claimed in claim 49, further comprising the step of:

sensing a change in the electrical event while myocardial tissue in the area is electrically unresponsive.

55. An apparatus for use proximate to a region myocardial tissue, comprising:

an electrode;

first means for transmitting an electrical energy pulse through the electrode that temporarily renders a zone of myocardial tissue electrically unresponsive without propagating a depolarization; and

second means for sensing an electrophysiological effect in the region of myocardial tissue due to the transmitted pulse and providing an output.

56. An apparatus as claimed in claim 55, wherein the first means comprises means for transmitting radio frequency energy.

57. An apparatus as claimed in claim 55, further comprising:

third means for altering an electrophysiological property of the myocardial tissue in or near the zone.

58. An apparatus as claimed in claim 55, further comprising:

third means for ablating myocardial tissue in or near the zone.