Sub-xyphoid method for ablating cardiac tissue
First Claim
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1. A method for ablating cardiac tissue of a patient employing sub-xyphoid access, the method including:
- making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage;
providing an ablation instrument including first and second elongated jaw members, the elongated jaw members being relatively moveable between a first open position and a second clamped position, each jaw member including at least one ablation member adapted to be connected to an ablation energy source, the ablation members being disposed to engage cardiac tissue at a selected cardiac location to ablate tissue therebetween;
introducing a fluid into an intrapericardial space to create and maintain a working space for accessing the selected cardiac location;
inserting the ablation instrument through the instrument receiving passage to a sub-xyphoid region;
advancing the ablation instrument through the sub-xyphoid region into the intrapericardial space to the selected cardiac location;
clamping the cardiac tissue between the first and second jaw members at the selected cardiac location; and
ablating the cardiac tissue at the selected location by energizing the ablation members.
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Abstract
A method and apparatus for transmural ablation using an instrument containing two electrodes or cryogenic probes. A clamping force is exerted on the two electrodes or probes such that the tissue of the hollow organ is clamped therebetween. Bipolar RF energy is then applied between the two electrodes, or the probes are cryogenically cooled, thus ablating the tissue therebetween. The method provides for ablating cardiac tissue of a patient utilizing a sub-xyphoid approach and identifying cardiac tissue prior to ablation.
640 Citations
24 Claims
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1. A method for ablating cardiac tissue of a patient employing sub-xyphoid access, the method including:
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making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage; providing an ablation instrument including first and second elongated jaw members, the elongated jaw members being relatively moveable between a first open position and a second clamped position, each jaw member including at least one ablation member adapted to be connected to an ablation energy source, the ablation members being disposed to engage cardiac tissue at a selected cardiac location to ablate tissue therebetween; introducing a fluid into an intrapericardial space to create and maintain a working space for accessing the selected cardiac location; inserting the ablation instrument through the instrument receiving passage to a sub-xyphoid region; advancing the ablation instrument through the sub-xyphoid region into the intrapericardial space to the selected cardiac location; clamping the cardiac tissue between the first and second jaw members at the selected cardiac location; and ablating the cardiac tissue at the selected location by energizing the ablation members. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method for identifying cardiac tissue for ablation, the method including:
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making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage; providing a locating instrument for identifying a selected cardiac location, the locating instrument including an elongated body and a distal end; inserting the locating instrument through the instrument receiving passage through a sub-xyphoid region; advancing the locating instrument through the sub-xyphoid region to position the distal end within an intrapericardial space; creating and maintaining a positive pressure within the intrapericardial space by injecting a fluid from the distal end into the intrapericardial space; and identifying the selected cardiac location prior to ablation. - View Dependent Claims (13, 14)
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15. A method for identifying and ablating cardiac tissue, the method including:
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making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage; providing a locating instrument for identifying a selected cardiac location, the locating instrument including an elongated body and a distal end; providing an ablation instrument including first and second elongated jaw members, the elongated jaw members being relatively movable between a first open position and a second clamped position, each jaw member including at least one ablation member adapted to be connected to an ablation energy source, the ablation members being disposed to engage cardiac tissue at the selected cardiac location to ablate tissue therebetween; introducing a fluid into an intrapericardial space to create and maintain a working space for accessing the selected cardiac location; inserting the locating instrument through the instrument receiving passage to a sub-xyphoid region; advancing the locating instrument through the sub-xyphoid region into the intrapericardial space to the selected cardiac location; identifying the selected cardiac location prior to ablation; inserting the ablation instrument through the instrument receiving passage to the sub-xyphoid region; advancing the ablation instrument through the sub-xyphoid region into the intrapericardial space to the selected cardiac location; clamping the cardiac tissue between the first and second jaw members at the selected cardiac location; and ablating the cardiac tissue at the selected location by energizing the ablation members. - View Dependent Claims (16, 17, 18, 19)
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20. A method for identifying and ablating cardiac tissue, the method including:
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making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage; providing a locating instrument for identifying a selected cardiac location, the locating instrument including an elongated body and a distal end; providing a bi-polar ablation instrument including first and second jaw members, the jaw members being relatively movable between a first open position and a second clamped position, each jaw member including at least one ablation member adapted to be connected to an ablation energy source, the ablation members being disposed to engage cardiac tissue at the selected cardiac location to ablate tissue therebetween; introducing a fluid into an intrapericardial space to create and maintain a working space for accessing the selected cardiac location; inserting the locating instrument through the instrument receiving passage to a sub-xyphoid region; advancing the locating instrument through the sub-xyphoid region into the intrapericardial space to the selected cardiac location; identifying the selected cardiac location prior to ablation; inserting the ablation instrument through the instrument receiving passage to the sub-xyphoid region; advancing the ablation instrument through the sub-xyphoid region into the intrapericardial space to the selected cardiac location; clamping the cardiac tissue between the first and second jaw members at the selected cardiac location; and ablating the cardiac tissue at the selected location by energizing the ablation members. - View Dependent Claims (21, 22, 23, 24)
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Specification