Maneuverable electrophysiology catheter for percutaneous or intraoperative ablation of cardiac arrhythmias

• US 5,824,005 A
• Filed: 08/22/1995
• Issued: 10/20/1998
• Est. Priority Date: 08/22/1995
• Status: Expired due to Term

• Current Assignee: Board of Regents of the University of Texas System (University of Texas System)
• Original Assignee: Board of Regents of the University of Texas System (University of Texas System)
• Inventors: Motamedi, Massoud, Ware, David L.
• Primary Examiner(s): Cohen, Lee S.
• Application Number:
  US08/517,961
• Time in Patent Office: 1,155 Days
• Field of Search: 606/15, 606/17, 606/41, 606/49, 606/33, 607/89, 607/101, 607/122, 607/126, 128/642, 601/2, 600/374
• US Class Current: 606/15
• 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 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00053 Mapping
• 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 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61B 2018/2261 with scattering, diffusion or dispersion of light
• CPC Class Codes: A61N 5/0601 Apparatus for use inside the body

Abstract

A catheter capable of both sensing myocardial electrical activity and delivering ablating energy within myocardial tissue is disclosed. The catheter comprises electrodes on the outer sheath and contains a movable fiber optic cable that can be percutaneously advanced beyond the catheter body and into the myocardium for myocardial heating and coagulation, or modification of tissues responsible for cardiac arrhythmias. The fiber optic tip is designed to diffuse ablating energy radially to ablate a larger volume of tissue than is possible with a bare fiber optic tip. In addition, the tip is treated so that energy is not propagated in a forward direction, thus helping to prevent unwanted perforation of the heart tissue.

Claims

1. Apparatus for ablation of cardiac tissue comprising:

a catheter adapted to access the cardiovascular system, said catheter having a distal end and a proximal end; and

a conductor extending along and within said catheter for transmitting coherent light energy to said distal end of said catheter, said conductor having a distal end which is extensible beyond the distal end of the catheter and also retractable within the catheter, said distal end of the conductor configured to penetrate cardiac tissue and to direct energy from and radially and axially relative to the conductor when the conductor is extended beyond the distal end of the catheter.

2. The apparatus of claim 1, wherein said catheter has an outer sheath and wherein said apparatus further comprises one or more electrode pairs positioned on said sheath of the catheter proximate said distal end of said catheter.

3. The apparatus of claim 2, wherein one of said electrode pairs is positioned on the distal end of the catheter.

4. The apparatus of claim 2, wherein an electrode pair is positioned on a retractable probe slidably disposed in the catheter and extendable beyond the distal end of said catheter for sensing of intramural electrical activity.

5. The apparatus of claim 2, further comprising a physiological recorder switchably connected to at least one of said electrode pairs operable to map local cardiac electrical activity.

6. The apparatus of claim 2, further comprising an electrical stimulating device switchably connected to at least one of said electrode pairs operable to pace the heart.

7. The apparatus of claim 1, further comprising a stabilizer positioned on an outer surface of the catheter to stabilize the catheter within a body organ.

8. The apparatus of claim 7, wherein said stabilizer comprises an inflatable balloon positioned at the exterior of said distal end of said catheter and operable to expand radially relative to the catheter.

9. The apparatus of claim 1, wherein the conductor comprises an optical wave guide and the energy is laser energy.

13. A method of treating cardiac arrhythmia comprising the steps of:

(a) positioning the distal end of the apparatus of claim 1 proximate the endocardium;

(b) identifying the tissue involved in the arrhythmia;

(c) extending the distal end of the conductor into the tissue; and

(d) transmitting ablating energy through the conductor into the tissue.

14. The method of claim 13, wherein the conductor comprises a wave guide and the ablating energy comprises laser energy.

10. A maneuverable catheter for ablation of myocardial tissue in a heart, said catheter comprising a retractable tip, a conductor, and a source of radiative energy, wherein said tip is connected through said conductor disposed within said catheter to said source of radiative energy, and wherein said retractable tip is extensible through an endocardial layer and into the myocardium of said heart for lateral diffusion of ablating radiative energy into myocardial tissue when said catheter is inserted intravascularly to position said retractable tip adjacent said endocardial layer of said heart.

11. The maneuverable catheter of claim 10, wherein said ablating radiative energy is selected from the group consisting of laser, microwave and ultrasound.

12. The maneuverable catheter of claim 11, wherein said ablating radiative energy is from 400 to 3,000 nm wavelength laser.

15. A method for myocardial ablation for treatment of cardiac arrhythmias, comprising:

providing a catheter comprising mapping electrodes, stimulating electrodes, and a stabilizer, the catheter being insertable into the heart of a patient and a distal end of the catheter being maneuverable from external to the patient;

providing an optical fiber slidably disposed within the catheter, a distal end of the optical fiber comprising an ablation probe that is extensible beyond the distal end of the catheter and adapted for penetrating myocardial and endocardial tissue, the ablation probe being diffusive so as to deliver laser energy substantially radially into the tissue in which the probe is positioned;

providing electronic stimulating and mapping instruments coupled to the mapping electrodes and to the stimulating electrodes, and providing a laser energy source coupled to the optical fiber;

introducing the catheter into the body of a patient and guiding the catheter into the heart of the patient;

stimulating the heart into an arrhythmic condition using said stimulating electrodes;

mapping electrical signals produced by the heart and locating an arrhythmic site for ablation;

placing the distal end of the catheter proximate the arrhythmic site;

activating the stabilizer;

advancing the optical fiber through the catheter, thus penetrating the ablation probe through the endocardium and into myocardial tissue at the arrhythmic site;

ablating tissue at the arrhythmic site by introducing a desired amount of laser energy into the optical fiber, conducting the laser energy through the optical fiber to the ablation probe, and directing sufficient laser energy into the myocardial tissue at the arrhythmic site to ablate the tissue;

deactivating the stabilizer and removing the catheter and optical fiber from the body of the patient.

16. The method of claim 15 wherein said mapping electrodes are positioned on an electrode probe slideably disposed within the catheter that is extensible beyond the distal end of the catheter and designed to penetrate myocardial tissue.

17. The method of claim 16, further comprising attempting to stimulate the heart into an arrhythmic condition using said stimulating electrodes after the ablating step and before removing the catheter from the body.

18. A method for myocardial ablation for treatment of cardiac arrhythmias in a patient, comprising:

providing a catheter having a distal end and comprising mapping electrodes, stimulating electrodes and a stabilizer, the catheter being insertable into a heart of a patient and said distal end of the catheter being maneuverable from external to the patient;

providing an energy conductor having a distal end and slidably disposed within the catheter, said distal end of the energy conductor comprising an ablation probe that is extensible beyond the distal end of the catheter and adapted for penetrating endocardial and myocardial tissue;

providing electronic stimulating and mapping instruments coupled to the mapping electrodes and to the stimulating electrodes, and providing an ablating energy source coupled to the energy conductor;

introducing the catheter into the body of a patient and guiding the distal end of the catheter into the heart of the patient;

stimulating the heart into an arrhythmic condition using said stimulating electrodes;

mapping electrical signals produced by the heart and locating an arrhythmic site for ablation;

placing the distal end of the catheter proximate the arrhythmic site;

advancing the energy conductor through the catheter, thus penetrating the ablation probe through the endocardium and into the myocardium at the arrhythmic site;

ablating tissue at the arrhythmic site by introducing a desired amount of energy into the energy conductor, conducting the energy through the energy conductor to the ablation probe, and directing sufficient energy into the myocardium at the arrhythmic site to ablate the tissue; and

removing the catheter and optical fiber from the body of the patient.

19. The method of claim 18, further comprising attempting to stimulate the heart into an arrhythmic condition using said stimulating electrodes after the ablating step and before removing the catheter from the body.

20. The method of claim 18, wherein the energy source is a laser source, and the energy conductor comprises an optical fiber.