Method of ablating tissue from an epicardial location

• US 6,314,963 B1
• Filed: 11/15/1999
• Issued: 11/13/2001
• Est. Priority Date: 10/22/1996
• Status: Expired due to Fees

• Current Assignee: St. Jude Medical, Atrial Fibrillation Division, Inc. (Abbott Laboratories)
• Original Assignee: Epicor Inc. (Xylem, Inc.)
• Inventors: Vaska, Matthias, Richman, Roxanne L., Anderson, Scott C., Gallup, David A., Ulstad, Jack E. Jr., Pless, Banjamin
• Primary Examiner(s): Reip, David O.
• Assistant Examiner(s): Woo, Julian W.
• Application Number:
  US09/440,830
• 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 creating a continuous ablation lesion in heart tissue underlying a pericardial reflection, comprising the steps of:

providing a first ablating device and a second ablating device, the first and second ablating devices each having an end and an ablating element;

introducing the first and second ablating devices into the space between the pericardium and the epicardium;

positioning the first ablating device adjacent to a pericardial reflection;

positioning the second ablating device on an opposite side of the pericardial reflection;

ablating tissue with the first and second ablating devices to form a continuous, lesion in the heart tissue underlying the pericardial reflection.

2. The method of claim 1, wherein:

the ablating step is carried out with the first ablation device ablating tissue extending adjacent to the pericardial reflection extending between the right superior and right inferior pulmonary veins.

3. The method of claim 1, wherein:

the positioning steps are carried out with the ends of the first and second ablating devices being positioned on opposite sides of a pericardial reflection extending from the vena cava to the pulmonary veins.

4. The method of claim 1, further comprising the step of:

penetrating the pericardial reflection with at least one of the first and second ablating devices.

5. The method of claim 4, further comprising the step of:

interlocking the first and second ablating devices after the penetrating step.

6. The method of claim 1, wherein:

the positioning steps are carried out with the ends being aligned with one of the ablating devices emitting energy and the other of the ablating devices receiving the energy to align the ablating devices on opposite sides of a pericardial reflection.

7. The method of claim 1, wherein:

the positioning step is carried out with the second ablating device extending adjacent to the left inferior and superior pulmonary veins and having a curved shape to extend around the left superior pulmonary vein to extend toward the right superior pulmonary vein; and

the ablating step being carried out with the second ablating device ablating tissue extending adjacent the left superior and inferior pulmonary and extending adjacent to the left and right superior pulmonary veins.

8. The method of claim 1, wherein:

the positioning step is carried out so that the second device extends from the pericardial reflection extending between the right inferior pulmonary vein and the left inferior vena cava, around the left inferior vena cava, around the right superior vena cava and to the pericardial reflection between the superior vena cava and the right superior pulmonary vein.

9. A method of ablating tissue, comprising the steps of:

providing an ablating device having an ablating element;

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

advancing the ablating element toward an ablation site;

positioning the ablating element against the ablation site, the ablating device including a portion having a width and a height, the width being larger than the height to orient the ablating element against the ablation site; and

ablating tissue with the ablating element after the advancing and positioning steps.

10. The method of claim 9, wherein:

the providing step is carried out with a width to height ratio being 2-5.

11. The method of claim 9, wherein:

the providing step is carried out with width being about 6-35 mm and the height being about 3-17 mm.

12. The method of claim 9, wherein:

the advancing step is carried out with the portion extending around the right atrium.

13. The method of claim 9, wherein:

the advancing step is carried out with the ablation site extending from a position superior to the right superior pulmonary vein to a position inferior to the right inferior pulmonary vein.

14. The method of claim 9, wherein:

the advancing step is carried out with the ablation site extending from a position inferior to the left inferior pulmonary vein to a position superior to the left superior pulmonary vein.

15. The method of claim 9, wherein:

the providing step is carried out with the portion having a fin.

16. The method of claim 9, wherein:

the providing step is carried out with the ablating device including at least three expandable portions.

17. The method of claim 9, wherein;

the positioning step is carried out by expanding the portion of the device to increase the width.

18. The method of claim 9, wherein:

the positioning step is carried out with the portion having a first inflatable balloon which increases the width of the portion of the device.

19. The method of claim 18, wherein:

the positioning step is carried out with the portion having a second inflatable balloon which increases the width of the portion of the device.