Method of ablating tissue around the pulmonary veins

• US 6,314,962 B1
• Filed: 11/15/1999
• Issued: 11/13/2001
• Est. Priority Date: 10/22/1996
• Status: Expired due to Term

• Current Assignee: St. Jude Medical (Abbott Laboratories Incorporated)
• Original Assignee: Epicor Inc. (Evoqua Water Technologies Corp.)
• Inventors: Vaska, Matthias, Richman, Roxanne L., Anderson, Scott C., Gallup, David A., Pless, Benjamin, Ulstad, Jack E. Jr.
• Primary Examiner(s): Reip, David O.
• Assistant Examiner(s): Woo, Julian W.
• Application Number:
  US09/440,339
• Time in Patent Office: 729 Days
• Field of Search: 606/32, 606/33, 606/34, 606/41, 606/47, 128/898, 600/374
• US Class Current: 128/898
• 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 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• 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 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/3419 Sealing means between cannula and body
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00232 having an irregular shape
• CPC Class Codes: A61B 2018/00261 arranged in a line
• CPC Class Codes: A61B 2018/00285 Balloons
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00351 Heart
• 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 2018/00654 with individual control of each of a plurality of energy emitting elements
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00839 : Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/142 : at least partly surrounding the target, e.g. concave, curved or in the form of a cave
• CPC Class Codes: A61B 2018/145 : wherein the effectors remain parallel during closing and opening
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/3629 : in combination with non-electric therapy
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

The invention provides apparatus and methods for mapping conduction pathways and creating lesions in the heart wall for the treatment of atrial fibrillation. The apparatus may include at least one epicardial ablation probe having a plurality of electrodes for creating a lesion. The apparatus and method facilitate the formation of a lesion which electrically isolates the pulmonary veins from the surrounding myocardium.

Claims

1. A method of ablating tissue around the pulmonary veins, comprising the steps of:

providing a first ablating device having at least one ablating element, the first ablating device having an end;

introducing the first ablating device into the space between the pericardium and the epicardium;

positioning the end adjacent to at least one of the right superior and right inferior pulmonary veins; and

ablating tissue near to the pericardial reflection extending between the right superior and right inferior pulmonary veins with the ablating device.

2. The method of claim 1, wherein:

the ablating step is carried out while leaving the pericardial reflections extending between the vena cava and the pulmonary veins intact.

3. The method of claim 1, wherein:

the positioning step is carried out with the end of the first ablating device having a curved shape which extends around the at least one of the right superior and right inferior pulmonary veins.

4. The method of claim 1, wherein:

the providing step is carried out with the first ablating device having a second end, the second end having a curved shape which extends around the other of the right superior and right inferior pulmonary veins.

5. The method of claim 1, further comprising the steps of:

introducing a second ablating device into the space between the pericardium and the epicardium;

positioning an end of the second ablating device adjacent to the pericardial reflection extending between the vena cava and the pulmonary veins; and

ablating tissue with the second ablating device.

6. The method of claim 5, wherein:

the positioning step is carried out with the end of the second ablating device being positioned adjacent the pericardial reflection superior to the right superior pulmonary vein.

7. The method of claim 5, wherein:

the positioning steps are carried out so that the ends of the first and second ablating devices are on opposite sides of the pericardial reflection extending between the vena cava and the pulmonary veins.

8. The method of claim 7, further comprising the step of:

ablating tissue adjacent to the pericardial reflection extending between the vena cava and the pulmonary veins with at least one of the first and second ablating devices.

9. The method of claim 7, wherein:

the ablating step is carried out by ablating tissue adjacent to both pericardial reflections between the vena cava and the pulmonary veins with at least one of the first and second ablating devices.

10. The method of claim 1, wherein:

the positioning step is carried out with the first ablating device having a portion which extends from the end toward the other of the right inferior and superior pulmonary veins.

11. A method of ablating tissue around the pulmonary veins, comprising the steps of:

providing a first ablating device having at least one ablating element, the first ablating device having an end, a distal portion extending from the end and a proximal portion extending from the distal portion;

introducing the first ablating device into the space between the pericardium and the epicardium;

positioning the end superior to the right superior pulmonary vein, the distal portion extending to a position inferior to the right inferior pulmonary vein; and

ablating the tissue lying beneath the distal portion.

12. The method of claim 11, wherein:

the ablating step is carried out while leaving the pericardial reflections extending between the vena cava and the pulmonary veins intact.

13. The method of claim 11, wherein:

the providing step is carried out with the first ablating device having an anchoring device which resists movement of the end of the ablating device the anchoring device is actuated.

14. The method of claim 11, further comprising the steps of:

actuating the anchoring device; and

displacing the proximal portion so that the distal portion moves toward the pulmonary veins after the actuating step, the anchoring device resisting movement of the ablating device when actuated.

15. The method of claim 11, wherein:

the positioning step is carried out with the end of the ablating device having a curved shape which extends around the right superior pulmonary vein.

16. The method of claim 11, further comprising the steps of:

introducing a second ablating device into the space between the pericardium and the epicardium;

positioning an end of the second ablating device in the transverse pericardial sinus; and

ablating tissue adjacent to the pericardial reflection extending between the right and left superior pulmonary veins with the second ablating device.

17. The method of claim 16, wherein:

the positioning steps are carried out so that the ends of the first and second ablating devices are on opposite sides of the pericardial reflection extending between the superior vena cava and the right superior pulmonary vein.

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

ablating tissue beneath the pericardial reflection extending between the vena cava and the pulmonary veins with at least one of the first and second ablating devices.

19. The method of claim 18, wherein:

the ablating step is carried out by ablating tissue beneath both pericardial reflections between the vena cava and the pulmonary veins with at least one of the first and second ablating devices.