Loop ablation apparatus and method

• US 20060009759A1
• Filed: 06/02/2005
• Published: 01/12/2006
• Est. Priority Date: 06/02/2004
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Briscoe, Roderick E., Daigle, Tom P., Francischelli, David E., Podbeliski, Adam A., Haeg, Daniel Charles, Chrisitian, Steven C., Steinbrink, Marie T.
• Granted Patent: US 7,678,108 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• 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 2018/00291 using suction
• 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 2018/00577 Ablation
• CPC Class Codes: A61B 2018/1407 Loop
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes

Abstract

Embodiments of the invention provide an ablation apparatus for ablating target tissue adjacent pulmonary veins of a patient. The ablation apparatus can include a tube capable of being advanced around the pulmonary veins to form a loop. The tube can receive or include electrodes to ablate target tissue. Some embodiments provide a loop ablation device, which may include a cannula and two or more electrode rods carrying two or more bipolar electrodes. The electrode rods can be advanced through the distal ends toward the proximal ends of the loop and toward the target tissue. The bipolar electrodes can receive energy to ablate the target tissue. The bipolar electrodes may be surrounded by the liquid within the cannula while ablating the target tissue. The loop ablation device can further include a rotating grasping mechanism coupled to the electrode rods.

Claims

1. An ablation apparatus for ablating target tissue adjacent pulmonary veins of a patient, the ablation apparatus comprising:

a tube capable of being advanced around the pulmonary veins to form a loop, the loop including distal ends and proximal ends; and

at least two carrier elements carrying at least two bipolar electrodes,

the at least two carrier elements being advanced through the distal ends toward the proximal ends of the loop and toward the target tissue,

the proximal ends of the loop being moved toward one another,

the at least two carrier elements being rotated so that the loop rolls substantially off of the pulmonary veins onto the target tissue, and

the at least two bipolar electrodes receiving energy to ablate the target tissue.

2. The ablation apparatus of claim 1 and further comprising a feed catheter and a retrieval catheter each including opposite and attracting magnets on distal ends, the feed catheter and the retrieval catheter advancing the tube around the pulmonary veins to form the loop.

3. The ablation apparatus of claim 2 wherein at least one of the feed catheter and the retrieval catheter includes a guide constructed of a shape-memory alloy.

4. The ablation apparatus of claim 1 and further comprising a rigid sleeve and a guide constructed of a shape-memory alloy that feed the tube toward and around the pulmonary veins.

5. The ablation apparatus of claim 1 wherein the tube is constructed of a semi-porous polymer;

and further comprising a liquid source that provides a liquid to the tube, the liquid weeping out of the tube onto the target tissue.

6. The ablation apparatus of claim 5 wherein the liquid includes saline.

7. The ablation apparatus of claim 1 wherein the at least two carrier elements include cam-shaped sections, the cam-shaped sections being rotated so that the loop rolls substantially off of the pulmonary veins onto the target tissue

8. The ablation apparatus of claim 6 wherein the cam-shaped sections are shaped to rotate the at least two rigid elements approximately 45 degrees to approximately 180 degrees.

9. The ablation apparatus of claim 1 wherein one of the at least two carrier elements is inserted into one of the proximal ends and another of the at least two carrier elements is inserted into the other of the proximal ends.

10. The ablation apparatus of claim 1 wherein the at least two bipolar electrodes are at least one of direct and indirect.

11. The ablation apparatus of claim 1 wherein the at least two electrodes receive energy including at least one of radio frequency energy, crogenic energy, thermal energy, chemical energy, pharmacological energy, ultrasound energy, microwave energy, laser energy, and radiation energy.

12. The ablation apparatus of claim 1 wherein the tube is disposable.

13. The ablation apparatus of claim 1 and further comprising a stiffener extending along at least a portion of a length of the tube, the stiffener resisting rotation of the tube.

14. A method of ablating target tissue of the left atrium of a patient, the patient having a superior vena cava, an inferior vena cava, a transverse sinus, an oblique sinus, a pericardium, left pulmonary veins, and right pulmonary veins, the method comprising:

performing a right thoracotomy;

providing a tube constructed of a porous and flexible material;

inserting the tube through the right thoracotomy under the superior vena cava into the transverse sinus of the pericardium until the tube loops around the left pulmonary veins;

visualizing the tube through the oblique sinus; and

pulling the tube until it extends below the inferior vena cava.

15. The method of claim 14 and further comprising inserting at least one electrode into the tube and energizing the at least one electrode to ablate the target tissue.

16. The method of claim 14 and further comprising inserting at least two bipolar electrodes into the tube and energizing the at least two bipolar electrodes to ablate the target tissue.

17. The method of claim 14 and further comprising inserting and pulling the tube using a feed catheter and a retrieval catheter each including opposite and attracting magnets on distal ends.

18. The method of claim 17 and further comprising inserting and pulling the tube using a guide constructed of a shape-memory alloy.

19. The method of claim 14 and further comprising inserting and pulling the tube toward and around the pulmonary veins using a rigid sleeve and a guide constructed of a shape-memory alloy.

20. The method of claim 14 and further comprising providing a liquid to the tube and allowing the liquid to weep out of the tube onto the target tissue.

21. The method of claim 20 and further comprising irrigating the tube and the at least one electrode with a liquid including saline.

22. The method of claim 14 and further comprising rotating at least one carrier element coupled to the at least one electrode so that the tube rolls substantially off of the left and right pulmonary veins onto the target tissue.

23. The method of claim 22 wherein the at least one carrier element includes at least one cam-shaped section;

and further comprising rotating the at least one rigid element approximately 45 degrees to approximately 180 degrees.

24. The method of claim 14 and further comprising inserting a first rigid element into a first end of the tube and inserting a second rigid element into a second end of the tube.

25. The method of claim 14 and further comprising energizing the at least one electrode with at least one of radio frequency energy, crogenic energy, thermal energy, chemical energy, pharmacological energy, ultrasound energy, microwave energy, laser energy, and radiation energy.

26. The method of claim 14 and further comprising disposing of the tube after the target tissue is ablated.

27. The method of claim 14 and further comprising providing a tube including an electrode channel and a spacer channel and spacing the least one electrode from the left and right pulmonary veins.

28. An ablation apparatus for ablating target tissue adjacent pulmonary veins of a patient, the ablation apparatus comprising:

an arm including articulating segments and a conduit including at least one electrode, the articulating segments having at least one length;

an insertion tool coupled to the arm; and

a knob coupled to the insertion tool, the knob being rotatable in order to lock the articulating segments in an ablating position, the at least one electrode receiving energy to ablate the target tissue adjacent the articulating segments in the ablating position.

29. The ablation apparatus of claim 28 wherein the at least one electrode is one of at least a monopolar electrode, at least two bipolar electrodes, at least one indirect electrode, and at least one direct electrode.

30. The ablation apparatus of claim 28 wherein the arm includes a lumen and the conduit is coupled to the lumen, the lumen capable of advancing along a length of the arm.

31. The ablation apparatus of claim 30 wherein at least one of the insertion tool and the knob includes a lock for securing movement of the lumen along the length of the arm.

32. A method of ablating target tissue adjacent pulmonary veins of a patient, the method comprising:

attaching a conductive loop electrode tubing to the target tissue on an ablation path;

advancing a power and guide wire along the conductive loop electrode tubing, the power and guide wire being sheathed by a substantially low friction material; and

transmitting power to the power and guide wire to ablate the target tissue along the ablation path.

33. An ablation apparatus for ablating target tissue adjacent pulmonary veins of a patient, the ablation apparatus comprising:

an arm capable of being advanced around the pulmonary veins,

the arm including at least one electrode and at least one tube,

one of the at least one tubes receiving the at least one electrode,

one of the at least one tubes receiving and providing a liquid to the target tissue, and

the at least one electrode receiving energy to ablate the target tissue.

34. The ablation apparatus of claim 33 wherein a distal end of the arm includes a recess that can receive an overlapping proximal portion of the arm.

35. The ablation apparatus of claim 33 wherein the arm includes a cross-sectional profile including one of semi-circular and rectangular.

36. The ablation apparatus of claim 33 wherein a distal end of the arm includes a curvature having a minimum radius.

37. The ablation apparatus of claim 33 wherein the at least one tubes include two parallel tubes, the two parallel tubes having cross-sectional profiles including at least one of rectangular, triangular, and circular.

38. The ablation apparatus of claim 37 wherein the at least one tubes are coupled to one another with a male protrusion and a female recess.

39. The ablation apparatus of claim 33 and further comprising a stiffener extending along at least a portion of a length of the arm, the stiffener resisting rotation of the arm.

40. The ablation apparatus of claim 39 wherein the stiffener includes a rectangular cross-sectional profile.

41. The ablation apparatus of claim 33 wherein the at least one electrode includes a substantially flat overlapping coil providing a substantially continuous electrical pathway.

42. The ablation apparatus of claim 33 wherein the arm includes articulating segments, the articulating segments having at least one length.

43. The ablation apparatus of claim 42 wherein the articulating segments have a shorter length and a longer length, the shorter length providing increased flexibility.

44. The ablation apparatus of claim 33 wherein the liquid includes saline.

45. The ablation apparatus of claim 33 wherein the arm includes a first segment coupled to a second segment by at least one adapter and at least one of a non-extensible flexible cable, a braided material embedded in the arm, a hinge, and a spherical joint.

46. The ablation apparatus of claim 33 and further comprising a removal tool including a hook that engages a non-extensible flexible cable that couples a first segment to a second segment of the arm.

47. The ablation apparatus of claim 33 wherein at least a portion of the arm includes at least one of a plurality of slits and a reduced cross-sectional area to increase a flexibility of the at least one portion of the arm.

48. The ablation apparatus of claim 33 wherein a portion of the arm includes a reduced cross-sectional area and a semi-circular cross-sectional profile.

49. The ablation apparatus of claim 33 and further comprising at least one vacuum pod coupled to at least a portion of the arm, the at least one vacuum pod holding a surface of the arm to the target tissue.

50. The ablation apparatus of claim 33 wherein the at least one tube includes a leader portion having a reduced cross-sectional area and a follower portion having an increased cross-sectional area, the follower portion being positioned adjacent the pulmonary veins during ablation.

51. The ablation apparatus of claim 33 wherein the at least one tube including the at least one electrode is offset from a remainder of the arm providing an insulator to protect the pulmonary veins.

52. The ablation apparatus of claim 33 wherein the arm and the at least one electrode includes at least two independently-activated segments in order to prevent occluding all of the pulmonary veins simultaneously.

53. An ablation apparatus for ablating target tissue adjacent pulmonary veins of a patient, the ablation apparatus comprising:

an arm capable of being advanced around the pulmonary veins,

the arm including at least one electrode and at least one tube,

one of the at least one tubes receiving the at least one electrode,

one of the at least one tubes receiving at least one light marker to aid in positioning of the at least one electrode, and

the at least one electrode receiving energy to ablate the target tissue.

54. The ablation apparatus of claim 53 wherein the at least one light marker includes at least one of a light rod, a fiber optic bundle, and a light-emitting diode.

55. The ablation apparatus of claim 53 wherein the at least one light marker includes at least two light markers that are color-coded.

56. A loop ablation device for ablating target tissue adjacent pulmonary veins of a patient, the loop ablation device comprising:

a cannula capable of being advanced around the pulmonary veins to form a loop, the loop including distal ends and proximal ends, the cannula receiving a liquid;

at least two electrode rods carrying at least two bipolar electrodes, the at least two electrode rods being advanced through the distal ends toward the proximal ends of the loop and toward the target tissue, the at least two bipolar electrodes receiving energy to ablate the target tissue, the at least two bipolar electrodes being surrounded by the liquid within the cannula while ablating the target tissue; and

a rotating grasping mechanism coupled to the at least two electrode rods, the rotating grasping mechanism rotating the at least two electrode rods within the cannula.

57. The loop ablation device of claim 56 wherein the at least two electrode rods include at least one of curved tips and cam-shaped portions.

58. The loop ablation device of claim 57 wherein the cam assembly rotates the at least two electrodes so that the loop substantially rolls off of the pulmonary veins onto the target tissue adjacent at least one of the curved tips and the cam-shaped portions.

59. The loop ablation device of claim 56 wherein the cannula is constructed of a material including expanded polytetrafluoroethylene.

60. The loop ablation device of claim 56 wherein the at least two electrode rods include handle ends and insulating sleeves.

61. The loop ablation device of claim 56 wherein the rotating grasping mechanism includes C-shaped clamps, and wherein the C-shaped clamps include channels that receive the at least two electrode rods.

62. The loop ablation device of claim 61 wherein the C-shaped clamps hold the at least two electrode rods with a magnetic force.

63. The loop ablation device of claim 56 wherein the at least two bipolar electrodes receive at least one of radio frequency energy, cryogenic energy, thermal energy, ultrasound energy, laser energy, radiation energy and microwave energy.

64. The loop ablation device of claim 56 wherein the liquid includes saline.

65. The loop ablation device of claim 56 wherein the rotating grasping mechanism includes a cam assembly with a thumb lever that can be used to rotate the at least two electrodes.