Method and devices for performing biatrial coagulation

• US 8,465,479 B2
• Filed: 01/11/2010
• Issued: 06/18/2013
• Est. Priority Date: 01/09/2009
• Status: Active Grant

• Current Assignee: Atricure, Inc.
• Original Assignee: Ncontact Surgical, Inc.
• Inventors: Whayne, James G., Fleischman, Sidney D., Sicvol, Christopher W.
• Primary Examiner(s): MAI, HUY KIM
• Application Number:
  US12/685,583
• Publication Number:
  US 20100179524A1
• Time in Patent Office: 1,254 Days
• Field of Search: 606 13- 15, 606/21, 606/27, 606/33, 606/49, 128/898
• US Class Current: 606/14
• 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 18/06 caused by chemical reaction , e.g. moxaburners
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• 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 18/201 with beam delivery through a hollow tube, e.g. forming an articulated arm through a flexible conduit A61B18/22; Hand-pieces therefor
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00809 measured thermochromatically
• CPC Class Codes: A61B 2018/00821 measured by a thermocouple
• CPC Class Codes: A61B 2018/126 bipolar

Abstract

Methods and devices described herein facilitate improved treatment of body organs.

Claims

1. A method of coagulating tissue to create a bi-atrial coagulation pattern on a first and a second atrial surfaces where the first atrial surface and the second atrial surface are located on opposite sides of the cardiac tissue, the method comprising:

positioning a first coagulation device adjacent to the first atrial surface of the cardiac tissue;

creating a first partial coagulation pattern on the first atrial surface with the first coagulation device, where the first partial coagulation pattern comprises at least a first plurality of lesions where at least two of the first plurality of lesions are separated by a gap section, where the gap section allows an electrical impulse to flow therethrough in the cardiac tissue;

positioning a second coagulation device adjacent to the second atrial surface of the cardiac tissue; and

creating a second partial coagulation pattern on second surface with the second coagulation device, where the second partial coagulation pattern comprises at least one lesion across the gap to form the complete coagulation pattern such that the electrical impulse cannot flow across the complete coagulation pattern.

2. The method of claim 1, where positioning the second coagulation device adjacent to the second atrial surface comprises determining a position of the second coagulation device through the cardiac tissue from the first atrial surface.

3. The method of claim 2, further comprising applying a locational energy at the second atrial surface in an amount insufficient to ablate or coagulate tissue and observing the locational energy from the first atrial surface to determine the position of the second coagulation device.

4. The method of claim 3, where second coagulation device further includes an additional energy source for applying the locational energy.

5. The method of claim 3, further comprising a non-ablative energy device that applies the non-ablative energy.

6. The method of claim 5, where the non-ablative energy comprises an energy selected from the group consisting of visible light, coherent light, ultraviolet light, magnetic energy, electrical energy.

7. The method of claim 3, further comprising advancing a scope into a body where the scope comprises at least one visualization element configured to observe the locational energy from the first atrial surface and where positioning the second coagulation device comprises moving the second coagulation device in response to observing the locational energy.

8. The method of claim 2, further comprising positioning a first sensor on the first atrial surface and positioning a second sensor on the second atrial surface at or near the position of the second coagulation device and determining a proximity between the first and second sensors determine the position of the second coagulation device on the first atrial surface.

9. The method of claim 1, where the second coagulation lesion creates an electrical barrier across cardiac tissue without dissecting a pericardial reflection.

10. The method of claim 1, where the first coagulation device comprises a device selected from the group consisting of an RF energy device, a laser device, an infrared heating heater device, a chemical ablation device, a cryogenic device, a microwave energy device, and a resistive heating device.

11. The method of claim 1, where the first atrial surface comprises an epicardial surface and the second atrial surface comprises an endocardial surface.

12. The method of claim 1, where the first atrial surface comprises an endocardial surface and the second atrial surface comprises an epicardial surface.

13. The method of claim 1, where the first coagulation device is advanced through a port or trocar positioned in a body and where the second coagulation device is advanced through a vascular path in the body.

14. The method of claim 1, where the first coagulation device is advanced through a vascular path in a body, and the second coagulation device is advance through a port or trocar positioned in the body.

15. A method of creating a contiguous lesion pattern in a body, the contiguous lesion pattern comprising multiple lesions on both an interior cardiac surface and an exterior cardiac surface, where the interior and exterior cardiac surfaces are located on opposite sides of a cardiac tissue, the method comprising:

creating an interior coagulation lesion on an interior cardiac surface;

monitoring the exterior cardiac surface for change in the cardiac tissue to identify the location of the interior coagulation lesion on the interior cardiac surface;

creating an exterior coagulation lesion on the exterior cardiac surface; and

where monitoring the exterior cardiac surface allows placement of the interior coagulation lesion and exterior coagulation to overlap, intersect, and/or join and form the contiguous coagulation lesion pattern such that an electrical impulse travelling in the cardiac tissue cannot cross the contiguous lesion pattern.

16. The method of claim 15, where monitoring the exterior cardiac surface comprises monitoring for an increase in a temperature on the exterior cardiac surface while creating, the interior coagulation lesion to identify the location of the interior coagulation on the interior cardiac surface.

17. The method of claim 16, where creating the exterior coagulation lesion comprises creating the exterior coagulation lesion with a second coagulation device, and where monitoring an increase in temperature comprises monitoring the increase in temperature with a. temperature sensing element coupled to the second coagulation device.

18. The method of claim 15, where monitoring the exterior cardiac surface comprises advancing an infrared temperature detecting device into the body and where monitoring an increase in temperature comprises monitoring the increase in temperature with the infrared temperature detecting device.

19. The method of claim 18, where the infrared temperature detecting device is advanced through an access device positioned within the body.

20. The method of claim 15, where monitoring the exterior cardiac surface comprises irradiating the exterior cardiac surface with an illumination source, where the illumination source produces a visible change on the exterior cardiac. surface to identify the interior coagulation lesion.

21. The method of claim 20, where irradiating the exterior cardiac surface with the illumination source comprises exciting naturally occurring fluorophores in the cardiac tissue and observing for reduced regions of autoflorenscense to identify the location of the interior coagulation lesion.

22. The method of claim 20, further comprising administering a dye to a vascular system of the body and where irradiating the exterior cardiac surface with the illumination source comprises exciting producing a fluorescing effect in the dye to identify the location of the interior coagulation lesion.

23. The method of claim 15, further comprising creating the exterior coagulation lesion prior to creating the interior coagulation lesion.

24. The method of claim 15, where a portion of the contiguous lesion pattern surrounds or is along at least one pericardial reflection without requiring dissection of the pericardial reflection.