Cardiac ablation devices and methods

• US 7,591,818 B2
• Filed: 07/20/2005
• Issued: 09/22/2009
• Est. Priority Date: 12/04/2001
• Status: Active Grant

• Current Assignee: Atricure, Inc.
• Original Assignee: Endoscopic Technologies Incorporated (Atricure, Inc.)
• Inventors: Bertolero, Arthur A., Ibrahim, Tamer
• Primary Examiner(s): GIBSON, ROY DEAN
• Application Number:
  US11/186,148
• Publication Number:
  US 20050288666A1
• Time in Patent Office: 1,525 Days
• Field of Search: 606/41, 606/51, 606/52, 606205-209
• US Class Current: 606/51
• CPC Class Codes: A61B 1/12 with cooling or rinsing arrangements
• 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 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1477 Needle-like probes
• 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 18/1492 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 18/20 using laser
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2017/2945 Curved jaws
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/0022 Balloons
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00345 Vascular system
• 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 2018/00404 : Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• 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 2018/0225 : using an instrument for clamping tissue, e.g. forceps
• CPC Class Codes: A61B 2018/0262 : using a circulating cryogenic fluid
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2018/1432 : curved
• CPC Class Codes: A61B 2090/373 : using light, e.g. by using optical scanners
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 5/0536 : Impedance imaging, e.g. by tomography
• CPC Class Codes: A61N 1/0587 : Epicardial electrode systems; Endocardial electrodes piercing the pericardium

Abstract

Devices and methods provide for ablation of cardiac tissue for treating cardiac arrhythmias such as atrial fibrillation. Although the devices and methods are often be used to ablate epicardial tissue in the vicinity of at least one pulmonary vein, various embodiments may be used to ablate other cardiac tissues in other locations on a heart. Devices generally include at least one tissue contacting member for contacting epicardial tissue and securing the ablation device to the epicardial tissue, and at least one ablation member for ablating the tissue. Various embodiments include features, such as suction apertures, which enable the device to attach to the epicardial surface with sufficient strength to allow the tissue to be stabilized via the device. For example, some embodiments may be used to stabilize a beating heart to enable a beating heart ablation procedure. Many of the devices may be introduced into a patient via minimally invasive introducer devices and the like. Although devices and methods of the invention may be used to ablate epicardial tissue to treat atrial fibrillation, they may also be used in veterinary or research contexts, to treat various heart conditions other than atrial fibrillation and/or to ablate cardiac tissue other than the epicardium.

Claims

1. Apparatus for ablating heart tissue comprising:

a tubular introducer cannula having an internal lumen;

a first elongate jaw and a second elongate jaw, the first and second elongate jaws being sized and configured for insertion through the internal lumen of the introducer cannula in a side-by-side configuration, a first guidewire lumen extending from a proximal end to a distal end of the first elongate jaw and a second guidewire lumen extending from a proximal end to a distal end of the second elongate jaw;

a first ablation electrode located on an inner surface of the first elongate jaw near a distal end of the first elongate jaw and a second ablation electrode located on an inner surface of the second elongate jaw near a distal end of the second elongate jaw; and

a first connection wire extending from the first ablation electrode to a proximal end of the first elongate jaw and a second connection wire extending from the second ablation electrode to a proximal end of the second elongate jaw;

wherein the first elongate jaw and the second elongate jaw are configured such that, when inserted through the internal lumen of the tubular introducer cannula in a side-by-side configuration, the first inner surface and second inner surface separate from one another as the distal ends of the first elongate jaw and the second elongate jaw extend beyond a distal end of the tubular introducer cannula, allowing the first ablation electrode and the second ablation electrode to be placed on opposing sides of a portion of heart tissue to be ablated, and, when the first elongate jaw and the second elongate jaw are withdrawn partially into the internal lumen of the tubular introducer cannula, the first inner surface and second inner surface are urged toward one another, pressing the first ablation electrode and the second ablation electrode against the portion of heart tissue to be ablated.

2. The apparatus of claim 1, wherein the first ablation electrode and the second ablation electrode are configured with a plurality of electrode segments.

3. The apparatus of claim 1, wherein the first ablation electrode and the second ablation electrode are configured with a plurality of individually addressable electrode segments.

4. The apparatus of claim 1, wherein the first elongate jaw and the second elongate jaw are configured to urge the first ablation electrode and the second ablation electrode toward one another in parallel alignment.

5. The apparatus of claim 1, wherein the first elongate jaw and the second elongate jaw are configured such that the distal ends of the first elongate jaw and the second elongate jaw close around the tissue first to prevent the tissue from being squeezed out from between the first ablation electrode and the second ablation electrode.

6. The apparatus of claim 1, wherein the first elongate jaw and the second elongate jaw each include a malleable portion.

7. The apparatus of claim 1, further comprising a guidewire sized and configured to enter through the first guidewire lumen of the first elongate jaw and exit through the second guidewire lumen of the second elongate jaw.

8. Apparatus for ablating heart tissue comprising:

a tubular introducer cannula having an internal lumen;

a first elongate jaw and a second elongate jaw, the first and second elongate jaws being sized and configured for insertion through the internal lumen of the introducer cannula in a side-by-side configuration;

a first ablation electrode located on an inner surface of the first elongate jaw near a distal end of the first elongate jaw and a second ablation electrode located on an inner surface of the second elongate jaw near a distal end of the second elongate jaw; and

a first connection wire extending from the first ablation electrode to a proximal end of the first elongate jaw and a second connection wire extending from the second ablation electrode to a proximal end of the second elongate jaw;

wherein the first elongate jaw and the second elongate jaw are configured such that, when inserted through the internal lumen of the tubular introducer cannula in a side-by-side configuration, the first inner surface and second inner surface separate from one another as the distal ends of the first elongate jaw and the second elongate jaw extend beyond a distal end of the tubular introducer cannula, allowing the first ablation electrode and the second ablation electrode to be placed on opposing sides of a portion of heart tissue to be ablated, and, when the first elongate jaw and the second elongate jaw are withdrawn partially into the internal lumen of the tubular introducer cannula. the first inner surface and second inner surface are urged toward one another, pressing the first ablation electrode and the second ablation electrode against the portion of heart tissue to be ablated, and wherein the first ablation electrode and the second ablation electrode are configured as helically coiled electrodes.

9. Apparatus for ablating heart tissue comprising:

a tubular introducer cannula having an internal lumen;

a first elongate jaw and a second elongate jaw, the first and second elongate jaws being sized and configured for insertion through the internal lumen of the introducer cannula in a side-by-side configuration;

a first ablation electrode located on an inner surface of the first elongate jaw near a distal end of the first elongate jaw and a second ablation electrode located on an inner surface of the second elongate jaw near a distal end of the second elongate jaw; and

a first connection wire extending from the first ablation electrode to a proximal end of the first elongate jaw and a second connection wire extending from the second ablation electrode to a proximal end of the second elongate jaw;

wherein the first elongate jaw and the second elongate jaw are configured such that, when inserted through the internal lumen of the tubular introducer cannula in a side-by-side configuration, the first inner surface and second inner surface senarate from one another as the distal ends of the first elongate jaw and the second elongate jaw extend beyond a distal end of the tubular introducer cannula, allowing the first ablation electrode and the second ablation electrode to be placed on opposing sides of a portion of heart tissue to be ablated, and, when the first elongate jaw and the second elongate jaw are withdrawn partially into the internal lumen of the tubular introducer cannula. the first inner surface and second inner surface are urged toward one another, pressing the first ablation electrode and the second ablation electrode against the portion of heart tissue to be ablated, and wherein the first ablation electrode and the second ablation electrode comprise a deformable conductive material to evenly distribute contact pressure and tissue ablation depth over a variable thickness portion of tissue.

10. Apparatus for ablating heart tissue comprising:

a tubular introducer cannula having an internal lumen;

a first elongate jaw and a second elongate jaw, the first and second elongate jaws being sized and configured for insertion through the internal lumen of the introducer cannula in a side-by-side configuration;

a first ablation electrode located on an inner surface of the first elongate jaw near a distal end of the first elongate jaw and a second ablation electrode located on an inner surface of the second elongate jaw near a distal end of the second elongate jaw; and

a first connection wire extending from the first ablation electrode to a proximal end of the first elongate jaw and a second connection wire extending from the second ablation electrode to a proximal end of the second elongate jaw;

wherein the first elongate jaw and the second elongate jaw are configured such that, when inserted through the internal lumen of the tubular introducer cannula in a side-by-side configuration, the first inner surface and second inner surface separate from one another as the distal ends of the first elongate jaw and the second elongate jaw extend beyond a distal end of the tubular introducer cannula, allowing the first ablation electrode and the second ablation electrode to be placed on opposing sides of a portion of heart tissue to be ablated, and, when the first elongate jaw and the second elongate jaw are withdrawn partially into the internal lumen of the tubular introducer cannula, the first inner surface and second inner surface are urged toward one another, pressing the first ablation electrode and the second ablation electrode against the portion of heart tissue to be ablated, and wherein the first elongate jaw and the second elongate jaw each include a remotely steerable hinge joint to facilitate accessing a desired target tissue, while maintaining the first ablation electrode and the second ablation electrode in an approximately parallel alignment.

11. A method of ablating heart tissue within a patient, comprising:

positioning a tubular introducer cannula having an internal lumen through a thoracic access incision in the chest of the patient;

inserting a distal end of a first elongate jaw and a distal end of a second elongate jaw through the internal lumen of the introducer cannula in a side-by-side configuration, the first elongate jaw and the second elongate jaw having, respectively, a first ablation electrode located on an inner surface of the first elongate jaw near the distal end of the first elongate jaw and a second ablation electrode located on an inner surface of the second elongate jaw near the distal end of the second elongate jaw, and a first connection wire extending from the first ablation electrode to proximal end of the first elongate jaw and a second connection wire extending from the second ablation electrode to proximal end of the second elongate jaw;

advancing the distal ends of the first elongate jaw and the second elongate jaw beyond a distal end of the tubular introducer cannula, causing the first inner surface and second inner surface to separate from one another;

placing the first ablation electrode and the second ablation electrode on opposing sides of a portion of heart tissue to be ablated;

withdrawing the first elongate jaw and the second elongate jaw partially into the internal lumen of the tubular introducer cannula, urging the first inner surface and second inner surface toward one another, pressing the first ablation electrode and the second ablation electrode against the portion of heart tissue to be ablated;

applying bipolar ablation energy to the first ablation electrode and the second ablation electrode through the first connection wire and the second connection wire to ablate the portion of heart tissue between the first ablation electrode and the second ablation electode;

further comprising inserting a guidewire through a first guidewire lumen extending through the first elongate jaw and withdrawing the guidewire through a second guidewire lumen extending through the second elongate jaw, thereby capturing the portion of heart tissue and positioning it between the first ablation electrode and the second ablation electrode.

12. The method of claim 11, wherein the first ablation electrode and the second ablation electrode apply bipolar ablation energy to ablate a portion of heart tissue along an atrial base of the pulmonary veins, thereby electrically isolating the pulmonary veins from the left atrium.

13. The method of claim 12, wherein the second ablation electrode is a ground electrode and wherein the first ablation electrode applies energy towards the second ablation electrode.

14. The method of claim 11, wherein the thoracic access incision comprises a minimally invasive access port in the chest of the patient.