Methods and devices for ablation

• US 7,338,486 B2
• Filed: 09/10/2002
• Issued: 03/04/2008
• Est. Priority Date: 10/22/1996
• Status: Expired due to Fees

• Current Assignee: St. Jude Medical (Abbott Laboratories Incorporated)
• Original Assignee: St. Jude Medical (Abbott Laboratories Incorporated)
• Inventors: Podmore, Jonathan L., Sliwa, John W., Vaska, Matthias, Morse, Stephen A., Anderson, Scott C., Champsaur, Gerard, Crowe, John E., Miller, Gary Henry
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US10/238,937
• Publication Number:
  US 20030078571A1
• Time in Patent Office: 2,002 Days
• Field of Search: 606/27, 606/28, 606/41, 606/42, 606 48- 50, 600/439, 600/459, 600/461, 600/462, 600/466, 601/2, 601/3, 607/122, 607/115, 607/116, 607/101, 128/898
• US Class Current: 606/27
• CPC Class Codes: A61B 17/22012 in direct contact with, or very close to, the obstruction or concrement for removing obstructions in blood vessels by laser A61B18/245
• CPC Class Codes: A61B 17/2202 the ultrasound transducer being inside patient's body at the distal end of the catheter
• CPC Class Codes: A61B 17/2251 characterised by coupling elements between the apparatus, e.g. shock wave apparatus or locating means, and the patient, e.g. details of bags, pressure control of bag on patient
• 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 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• 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 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• 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 2017/00252 for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/2253 using a coupling gel or liquid
• CPC Class Codes: A61B 2017/3419 : Sealing means between cannula and body
• CPC Class Codes: A61B 2018/00005 : Cooling or heating of the probe or tissue immediately surrounding the probe
• 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 2018/00214 : Expandable means emitting energy, e.g. by elements carried thereon
• 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 2018/00375 : Ostium, e.g. ostium of pulmonary vein or artery
• 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 2018/00898 : Alarms or notifications created in response to an abnormal condition
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1213 : creating an arc
• 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 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/147 : Electrodes transferring energy by capacitive coupling, i.e. with a dielectricum between electrode and target tissue
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2018/2283 : with pivotable mirrors
• 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 2090/395 : with marking agent for marking skin or other tissue
• 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 1/056 : Transvascular endocardial electrode systems
• 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 2007/0078 : with multiple treatment transducers
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

An ablating device has a cover which holds an interface material such as a gel. The cover contains the interface material during initial placement of the device. The ablating device may also have a removable tip or a membrane filled with fluid. In still another aspect, the ablating device may be submerged in liquid during operation.

Claims

1. A method of ablating cardiac tissue, comprising the steps of:

providing an ablating device having at least one ablating element, the ablating element capable of directing focused ultrasound energy at a desired focal length and being focused along a focal axis, and where at least one ablating element is capable of being tilted with respect to an adjacent ablating element;

positioning the ablating device on an epicardial surface so that the desired focal length extends transmurally through the thickness of the target;

ablating tissue with the ablating element with the device positioned on the epicardial surface; and

moving the ablating element during the ablating step so that the focused ultrasound energy moves through the tissue to form a continuous transmural lesion in the tissue, the moving step being carried out by moving the ablating device across the epicardial surface during the ablating step.

2. The method of claim 1, wherein the angle of the at least one ablating element capable of being tilted is adjustable so that the angle relative to the target tissue may be varied.

3. The method of claim 1, wherein the moving step is carried out with the ablating element continuing to ablate tissue.

4. The method of claim 1, wherein:

the providing step is carried out with the ablating device being coupled to a guide member; and

the moving step is carried out with the ablating device being moved relative to the guide member.

5. The method of claim 4, further comprising:

positioning the guide member at a fixed position relative to the target tissue;

the moving step being carried out a number of times with the guide member being at the fixed position.

6. The method of claim 1, wherein the desired focal length is 2-20 mm.

7. A method of ablating cardiac tissue, comprising the steps of:

providing an ablating device having at least two ablating elements, the ablating elements capable of directing focused ultrasound energy at a desired focal length and being focused along a focal axis, and where at least one ablating element is tilted or is capable of being tilted with respect to the direction ultrasound energy is directed from at least one other ablating element;

positioning the ablating device on a cardiac surface, wherein the focal axis is positioned at an angle with respect to the epicardial surface so that the desired focal length extends to a target tissue area; and

ablating tissue with the ablating elements.

8. The method of claim 7, wherein the ablating device is coupled to a guide member.

9. The method of claim 7, further comprising moving the ablating device during the ablating step so that the focused ultrasound energy moves through the cardiac tissue.

10. The method of claim 7, wherein the desired focal length is 2-20 mm.

11. A method of ablating cardiac tissue, comprising the steps of:

providing an ablating device having at least one ablating element, the ablating element capable of directing focused ultrasound energy at a desired, focal length and being focused along a focal axis, and where at least one ablating element is capable of being tilted with respect to the ablating device in order to change the direction the focused ultrasound energy is directed;

positioning the ablating device on an epicardial surface so that;

the desired focal length extends transmurally through the thickness of the target;

ablating tissue with the ablating element with the device positioned on the epicardial surface; and

moving the ablating element during the ablating step so that the focused ultrasound energy moves through the tissue to form a Continuous transmural lesion in the tissue, the moving step being carried out by moving the ablating device across the epicardial surface during the ablating step.

12. The method of claim 11, wherein the angle of the at least one ablating element being tilted is adjustable so that the angle relative to the target tissue may be varied.

13. The method of claim 11, wherein the moving step is carried out with the ablating element continuing to ablate tissue.

14. The method of claim 11, wherein:

the providing step is carried out with the ablating device being coupled to a guide member; and

the moving step is carried out with the ablating device being moved relative to the guide member.

15. The method of claim 14, further comprising:

positioning the guide member at a fixed position relative to the target tissue;

the moving step being carried out a number of times with the guide member being at the fixed position.

16. The method of claim 11, wherein the desired focal length is 2-20 mm.