Device and method for forming a circumferential conduction block in a pulmonary vein

• US 7,044,135 B2
• Filed: 08/30/2002
• Issued: 05/16/2006
• Est. Priority Date: 05/09/1997
• Status: Expired due to Term

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Lesh, Michael D.
• Primary Examiner(s): McDermott, Corrine
• Assistant Examiner(s): Matthews, William H
• Application Number:
  US10/233,157
• Publication Number:
  US 20030065307A1
• Time in Patent Office: 1,355 Days
• Field of Search: 128/898, 604/96.01, 604/113, 604/114, 604/97.01, 606/41, 606/45, 606/47, 607/62, 607/122, 607/125, 607/126, 607/130
• US Class Current: 128/898
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/10 Power sources therefor
• 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 18/1815 using microwaves
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/22054 with two balloons
• CPC Class Codes: A61B 2017/22067 Blocking; Occlusion A61B2017/22054 takes precedence
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/00107 Coatings on the energy applicator
• 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 2018/00273 Anchoring means for temporary attachment of a device to tissue
• 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 2018/00369 Heart valves
• CPC Class Codes: A61B 2018/00375 : Ostium, e.g. ostium of pulmonary vein or artery
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00642 : with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00815 : measured by a thermistor
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00839 : Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/00898 : Alarms or notifications created in response to an abnormal condition
• CPC Class Codes: A61B 2018/00994 : combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61M 2025/1075 : having a balloon composed of several layers, e.g. by coating or embedding
• CPC Class Codes: A61M 2210/125 : Heart
• CPC Class Codes: A61M 25/1002 : characterised by balloon shape A61M25/1006, A61M25/1009 take precedence
• CPC Class Codes: A61N 7/022 : intracavitary

Abstract

This invention is a method for treating a patient diagnosed with atrial arrhythmia by forming a circumferential conduction block along a circumferential path of tissue in a pulmonary vein wall that circumscribes the pulmonary vein lumen and transects the electrical conductivity of the pulmonary vein such that conduction is blocked along the longitudinal axis of the vein wall and into the left atrial wall. The method is performed to treat a patient with a focal arrythmogenic origin along the pulmonary vein wall by either ablating the focal origin or by isolating the focal origin from the atrial wall with the circumferential conduction block. The circumferential conduction block is also formed in a pulmonary vein in order to bridge the adjacent ends of two linear lesions, wherein each linear lesion is formed to extend between the pulmonary vein and another adjacent pulmonary vein in a less-invasive “maze”-type procedure. A circumferential ablation element in a circumferential ablation device assembly is used in a percutaneous translumenal catheter technique in order to form the circumferential conduction block in the pulmonary vein wall.

Claims

1. A method for treating arrhythmia, comprising:

positioning a radially extendable member at a location where a pulmonary vein extends from an atrium;

the extendable member having a longitudinal axis and being radially collapsed along the longitudinal axis;

radially extending the extendable member transverse to the longitudinal axis such that the extendable member in the radially extended condition substantially contacts a circumferential region of tissue at the location and that substantially circumscribes the longitudinal axis; and

ablating a region of tissue at a location where a pulmonary vein extends from an atrium so as to block electrical communication between cardiac tissue in the pulmonary vein and a region of the atrium that includes other pulmonary veins.

2. A method as recited in claim 1, wherein ablating a region of tissue comprises positioning an ablation element at the region of tissue and activating the ablation element so as to ablate the region of tissue.

3. A method as recited in claim 2, wherein the ablation element is positioned such that the ablated region of tissue lies between a portion of cardiac tissue in the pulmonary vein and the region of the atrium that includes the other pulmonary veins.

4. A method as recited in claim 2, further comprising anchoring the ablation element at the location.

5. A method as recited in claim 4, wherein the ablation element is coupled to the radially extendable member;

and

wherein said anchoring involves engaging a wall of the pulmonary vein with the radially extendable member.

6. A method as recited in claim 5, wherein engaging the wall of the pulmonary vein involves expanding said radially extendable member.

7. A method as recited in claim 6, wherein expanding the radially extending member comprises delivering a pressurized inflation medium to an interior of an inflatable balloon.

8. A method as recited in claim 1, wherein the ablated region of tissue has a circumferential pattern.

9. A method as recited in claim 8, wherein said positioning involves generally locating the ablation element at a generally central position relative to the circumferential pattern of the region of tissue.

10. A method as recited in claim 8, wherein said positioning involves contacting the region of tissue with the ablation element along a substantial portion of the circumferential pattern.

11. A method as recited in claim 1, further comprising substantially removing blood from the location before ablating the region of tissue.

12. A method as recited in claim 11, wherein removing blood comprises inflating an inflatable balloon.

13. A method as recited in claim 11, wherein removing blood comprises inflating at least a first balloon section on a distal side of the ablation element and inflating at least a second balloon section on a proximal side of the ablation element.

30. A method as recited in any one of claims 1, 14, 27, wherein ablating comprises contacting a region of tissue with an ablation element.

31. A method as recited in any one of claims 1, 14, 27, wherein ablating comprises emitting energy from an ablation element.

32. A method as recited in claim 31, wherein ablating comprises emitting energy from at least one electrode ablation element.

14. A method for treating atrial arrhythmia, comprising:

positioning a radially extendable member at a location where a pulmonary vein extends from an atrium;

the extendable member having a longitudinal axis and being radially collapsed along the longitudinal axis;

radially extending the extendable member transverse to the longitudinal axis;

engaging a pulmonary vein with a radially extendable member on a distal end portion of an ablation device assembly such that the extendable member in the radially extended condition substantially contacts a circumferential region of tissue at the location and that substantially circumscribes the longitudinal axis; and

ablating a region of cardiac tissue with said ablation device assembly.

15. A method as recited in claim 14, further comprising positioning an ablation element, which is disposed on the distal end portion of the ablation device assembly, at a location where the pulmonary vein extends from a chamber in the heart, wherein ablating a region of cardiac tissue involves ablating tissue adjacent to the ablation element when the ablation element is positioned at the location.

16. A method as recited in claim 15, wherein ablating a region of cardiac tissue comprises ablating an arcuate pattern of tissue that extends about a lumenal axis of the pulmonary vein.

17. A method as recited in claim 16, wherein ablating an arcuate pattern comprises ablating a circumferential pattern.

18. A method as recited in claim 17, wherein the circumferential pattern is formed in a single ablation step.

19. A method as recited in claim 14, wherein ablating a region of tissue comprises ablating a region of tissue that the extendable member engages.

20. A method as recited in claim 14, wherein ablating a region of tissue comprises ablating a region of tissue that lies next to a second region of tissue engaged by the extendable member.

21. A method as recited in claim 14, wherein engaging the pulmonary vein with a radially extendable member comprises expanding an expandable member from a radially collapsed position to a radially expanded position.

22. A method as recited in claim 21, further comprising expanding the expandable member radially outward relative to a longitudinal axis of the distal end portion in all radial directions.

23. A method as recited in claim 21, wherein expanding the expandable member comprises introducing an inflation medium into an interior of an inflatable balloon.

24. A method as recited in claim 14, further comprising removing blood from the location before ablating.

25. A method as recited in claim 24, wherein removing blood comprises inflating an inflatable balloon.

26. A method as recited in claim 24, wherein removing blood comprises inflating at least a first balloon section on a distal side of an ablation element and inflating at least a second balloon section on a proximal side of the ablation element.

27. A method for treating atrial arrhythmia in a heart of a patient, wherein the patient includes a plurality of pulmonary veins and each pulmonary vein extends from a unique location in an atrium of the heart, the method comprising:

positioning a radially extendable member at a location where a pulmonary vein extends from an atrium;

the extendable member having a longitudinal axis and being radially collapsed along the longitudinal axis;

radially extending the extendable member transverse to the longitudinal axis such that the extendable member in the radially extended condition substantially contacts a circumferential region of tissue at the location and that substantially circumscribes the longitudinal axis; and

ablating a first ablation lesion that substantially circumscribes only one of the locations.

28. A method as recited in claim 27, further comprising ablating a second ablation lesion that substantially circumscribes only a different one of said locations.

29. A method as recited in claim 28, further comprising forming a linear lesion between the first and second focations to connect the first and second ablation lesions.