Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization

• US 6,527,767 B2
• Filed: 05/20/1998
• Issued: 03/04/2003
• Est. Priority Date: 05/20/1998
• Status: Expired due to Fees

• Current Assignee: New England Medical Center
• Original Assignee: New England Medical Center
• Inventors: Wang, Paul J., Rastegar, Hassan
• Primary Examiner(s): Kearney, Rosiland S.
• Application Number:
  US09/082,047
• Publication Number:
  US 20020058934A1
• Time in Patent Office: 1,749 Days
• Field of Search: 606/32, 606/41, 606/45, 606/46, 606/47, 606/48, 606/49, 606/50, 607/129, 607/130, 607/99, 128/898
• US Class Current: 606/32
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 2017/2945 Curved jaws
• CPC Class Codes: A61B 2018/0212 using an instrument inserted into a body lumen, e.g. catheter
• CPC Class Codes: A61B 2018/0225 using an instrument for clamping tissue, e.g. forceps
• CPC Class Codes: A61B 2018/0262 using a circulating cryogenic fluid
• CPC Class Codes: A61B 2018/1432 curved
• CPC Class Codes: A61B 2018/1467 using more than two electrodes on a single probe

Abstract

A medical device, and related method, use epicardial ablators and detectors for intraoperative epicardial approaches to ablation therapy of cardiac conduction pathways. An epicardial gripper is sized to grasp the cardiac circumference or smaller structures on the epicardial surface of the heart. Ablators are disposed on the arms of the gripper for epicardial ablation of cardiac conduction tissue. In another embodiment of the invention, an electrode system includes a flexible, adjustable probe forming a loop for epicardial ablation. Ablators are provided on one or multiple surfaces of the probe for epicardial ablation of cardiac conduction tissue. In yet another embodiment of the invention, an endocardial ablator detection system provides an indicator adjacent an ablator on an endocardial catheter, and a detector on an epicardial probe. The epicardial probe detects signals transmitted by the indicator on the endocardial catheter to localize the position of the endocardial ablator relative to the epicardial surface. The surgeon uses this information for guidance in adjusting the position of the endocardial ablator according to therapeutic objectives of cardiac ablation.

Claims

1. A method of ablating cardiac tissue from an epicardial location, comprising the steps of:

providing an ablating device having a plurality of ablating elements, the plurality of ablating elements being coupled to a substrate, the substrate forming a loop with the ablating elements positioned on a radially inner surface of the loop, wherein the ablating elements direct energy inward and not outward relative to the loop to prevent damaging tissue outside the loop;

positioning the ablating device at an epicardial surface so that the loop is positioned around a cardiac structure; and

ablating tissue with the ablating elements thereby ablating tissue around the cardiac structure to treat a cardiac arrhythmia.

2. The method of claim 1, wherein:

the providing step is carried out with the ablating elements directing energy radially inward relative to the loop.

3. The method of claim 1, wherein:

the providing step is carried out with the loop being a closed loop.

4. The method of claim 1, wherein:

the positioning step is carried out with the loop being self-retaining around the cardiac structure.

5. The method of claim 1, wherein:

the providing step is carried out with the device having a band-like shape.

6. The method of claim 1, wherein:

the providing step is carried out with the loop generally lying in a plane with the ablating elements directing energy radially inward, the device being flexible to permit bending between the ablating elements while still substantially maintaining the loop on the plane.

7. The method of claim 1, wherein:

the providing step is carried out with the plurality of ablating elements being spaced apart.

8. The method of claim 1, wherein:

the ablating step is carried out by turning at least some of the ablating elements on and off.

9. The method of claim 8, wherein:

the ablating step is carried out with the ablating elements being turned on and off sequentially.

10. The method of claim 1, wherein:

the ablating step is carried out by turning the ablating elements on and off in a specified pattern.

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

using ultrasound to assess whether the contact surface is in contact with the epicardial surface.

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

using ultrasound to determine the depth of ablation.

13. The method of claim 1, wherein:

the ablating step is carried out to treat tachycardia.

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

cooling the ablating elements.

15. The method of claim 1, wherein:

the providing step is carried out with the ablating elements being an element selected from the group consisting of RF, ultrasound, laser, and cryogenic elements.

16. The method of claim 1, wherein:

the providing step is carried out with a contact surface of the ablating element being curved.