SYSTEMS AND METHODS FOR EPICARDIAL NAVIGATION

• US 20100010488A1
• Filed: 01/23/2008
• Published: 01/14/2010
• Est. Priority Date: 01/23/2007
• Status: Active Grant

• Current Assignee: CVDEVICES, LLC
• Original Assignee: CVDEVICES, LLC
• Inventors: Kassab, Ghassan S., Navia, Jose A.
• Granted Patent: US 8,366,707 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• 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 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 2017/308 with suction cups
• CPC Class Codes: A61B 2018/00291 using suction
• 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 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 34/73 Manipulators for magnetic surgery

Abstract

Systems and methods for navigating a catheter along the epieardial surface of the heart are disclosed. At least some of the embodiments disclosed herein are useful for epieardial ablation, Various embodiments permit ablation of the epieardial surface of the heart using an external ablation catheter in the pericardial space and an internal guide catheter within the heart. Such a configuration allows the clinician to precisely target for ablation specific locations on the cardiac tissue.

Claims

1. A system for navigating a catheter on a surface of a tissue, comprising:

an external catheter comprising a distal end and a first magnet positioned at or near the distal end of the external catheter; and

an internal catheter comprising a distal end and a first magnet positioned at or near the distal end of the internal catheter;

wherein the internal catheter is configured for engaging the external catheter when a portion of the external catheter is positioned on or adjacent to a first surface of a tissue and a portion of the internal catheter is positioned on or adjacent to an opposing surface of the tissue, such that manipulation of the internal catheter is capable of directing the external catheter.

2. The system of claim 1, wherein:

the first surface of the tissue comprises an epicardial surface of a heart; and

the opposing surface of the tissue comprises an endocardial surface of the heart.

3. The system of claim 2, wherein:

the external catheter further comprises an ablation contact positioned at or near the distal end of the external surface, the ablation contact being configured to remove or destroy tissue.

4. The system of claim 3, wherein:

the first magnet of the internal catheter comprises a first electrode capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter.

5. The system of claim 4, wherein:

the internal catheter further comprises a second electrode positioned at or near the distal end of the internal catheter, the second electrode of the internal catheter being capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter.

6. The system of claim 5, wherein:

the internal catheter further comprises a pair of excitation electrodes positioned at or near the distal end of the internal catheter and a pair of detection electrodes positioned on the internal catheter between the pair of the excitation electrodes; and

a proximal end of each of the pair of excitation electrodes and each of the pair of detection electrodes is connected to a processor, the processor being capable of collecting conductance data.

7. The system of claim 6, wherein:

the internal catheter further comprises a third electrode and a fourth electrode, each of which is positioned at or near the distal end of the internal catheter and each of which is capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter; and

the internal catheter is capable of forming a loop within the heart such that the first, second, third, and fourth electrodes are located within the heart.

8. The system of claim 7, wherein:

the processor is capable of determining a profile of a body lumen using the conductance data.

9. The system of claim 8, wherein:

the internal catheter further comprises a passageway for passing a fluid through the internal catheter to the body lumen; and

the conductance data is determined at each of a plurality of locations.

10. The system of claim 9, wherein:

the conductance data comprises a first conductance value determined at each of the plurality of locations when the excitation electrodes and detection electrodes are immersed in a first fluid with a first conductivity and a second conductance value determined at each of the plurality of locations when the excitation electrodes and detection electrodes are immersed in a second fluid with a second conductivity; and

the first conductivity does not equal the second conductivity.

11. The system of claim 3, wherein:

the first magnet of the external catheter comprises a first electrode capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the internal catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the internal catheter.

12. The system of claim 11, wherein:

the external catheter further comprises a second electrode positioned at or near the distal end of the external catheter, the second electrode of the external catheter being capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the internal catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the internal catheter.

13. The system of claim 3,

the external catheter further comprises a second magnet positioned at or near the distal end of the external catheter.

14. A system for use with a vacuum source for ablating a tissue of a heart, comprising:

an engagement catheter comprising a proximal end, a distal end, and first and second lumens extending between the proximal end and the distal end;

an external catheter comprising a distal end, an ablation contact positioned at or near the distal end of the external catheter, and a first magnet positioned at or near the distal end of the external catheter, wherein the external catheter is configured such that the external catheter is capable of at least partial insertion into the second lumen of the engagement catheter;

an internal catheter comprising a distal end and a first magnet positioned at or near the distal end of the internal catheter; and

a vacuum port located at the proximal end of the engagement catheter, the vacuum port being operatively connected to the first lumen of the engagement catheter and capable of operative connection to the vacuum source;

wherein the first lumen of the engagement catheter includes a suction port located at or near the distal end of the engagement catheter, the suction port being configured to removably attach to a targeted tissue on the interior of a wall of the heart, such that the suction port is capable of forming a reversible seal with the targeted tissue when the vacuum source is operatively attached to the vacuum port,

wherein the internal catheter is configured for engaging the external catheter when a portion of the external catheter is positioned on or adjacent to an epicardial surface of the heart and a portion of the internal catheter is positioned on or adjacent to an endocardial surface of the heart, such that manipulation of the internal catheter is capable of directing the external catheter, and

wherein the system is capable of enlarging a pericardial space between the targeted tissue and a pericardial sac that surrounds the heart by retracting the targeted tissue away from the pericardial sac.

15. The system of claim 14, wherein:

the internal catheter further comprises a second magnet;

the first magnet of the internal catheter comprises a first electrode capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter; and

the second magnet of the internal catheter comprises a second electrode capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter.

16. The system of claim 15, wherein:

the internal catheter further comprises a pair of excitation electrodes positioned at or near the distal end of the internal catheter and a pair of detection electrodes positioned on the internal catheter between the pair of the excitation electrodes; and

a proximal end of each of the pair of excitation electrodes and each of the pair of detection electrodes is connected to a processor, the processor being capable of collecting conductance data.

17. The system of claim 16, wherein:

the conductance data comprises a first conductance value determined at each of a plurality of locations when the excitation electrodes and detection electrodes are immersed in a first fluid with a first conductivity and a second conductance value determined at each of the plurality of locations when the excitation electrodes and detection electrodes are immersed in a second fluid with a second conductivity; and

the first conductivity does not equal the second conductivity.

18. The system of claim 17, wherein:

the internal catheter further comprises a third electrode and a fourth electrode, each of which is positioned at or near the distal end of the internal catheter and each of which is capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter; and

the internal catheter is capable of forming a loop within the heart such that the first, second, third, and fourth electrodes are located within the heart.

19. A method of ablating a tissue, comprising:

providing an external catheter comprising a distal end, a first magnet positioned at or near the distal end of the external catheter, and an ablation contact positioned at or near the distal end of the external catheter, the ablation contact being configured to remove or destroy tissue;

providing an internal catheter comprising a distal end and a first magnet positioned at or near the distal end of the internal catheter, the internal catheter being configured for engaging the external catheter;

placing the distal end of the external catheter adjacent to a first surface of the tissue;

placing the distal end of the internal catheter adjacent to an opposing surface of the tissue;

manipulating the internal catheter to direct the ablation contact of the external catheter to contact a first targeted location on the first surface of the tissue; and

ablating the first targeted location on the first surface of the tissue.

20. The method of claim 19, wherein:

the tissue comprises cardiac tissue;

the first surface of the tissue comprises the epicardial surface of the cardiac tissue; and

the opposing surface of the tissue comprises the endocardial surface of the cardiac tissue.

21. The method of claim 20, wherein:

the step of manipulating the internal catheter to direct the ablation contact of the external catheter to contact a first targeted location on the first surface of the tissue comprises (i) engaging the first magnet of the external catheter with the first magnet of the internal catheter such that moving the first magnet of the internal catheter moves the first magnet of the external catheter, (ii) moving the first magnet of the internal catheter along the endocardial surface of the cardiac tissue such that the ablation contact of the external catheter moves along the epicardial surface of the cardiac tissue to the first targeted location on the epicardial surface of the cardiac tissue.

22. The method of claim 20, wherein:

the first magnet of the internal catheter comprises a first electrode capable of transitioning between a magnetized state, in which the electrode attracts the first magnet of the external catheter, and a nonmagnetized state, in which the electrode does not significantly attract the first magnet of the external catheter.

23. The method of claim 22, wherein:

the step of manipulating the internal catheter to direct the ablation contact of the external catheter to contact a first targeted location on the first surface of the tissue comprises (i) engaging the first magnet of the external catheter with the first electrode of the internal catheter such that moving the first electrode of the internal catheter moves the first magnet of the external catheter, and (ii) moving the first electrode of the internal catheter along the endocardial surface of the cardiac tissue such that the ablation contact of the external catheter moves along the epicardial surface of the cardiac tissue to the first targeted location on the epicardial surface of the cardiac tissue.

24. The method of claim 22, wherein:

the step of manipulating the internal catheter to direct the ablation contact of the external catheter to contact a first targeted location on the first surface of the tissue comprises (i) positioning the first electrode of the internal catheter, (ii) switching the first electrode of the internal catheter to the magnetized state such that the ablation contact of the external catheter is moved to the first targeted location on the first surface of the tissue.

25. The method of claim 22, wherein:

the internal catheter further comprises a second electrode, the second electrode being capable of transitioning between a magnetized state, in which the second electrode attracts the magnet of the external catheter, and a nonmagnetized state, in which the second electrode does not significantly attract the magnet of the external catheter.

26. The method of claim 23, further comprising the steps of:

manipulating the internal catheter to direct the ablation contact of the external catheter to contact a second targeted location on the first surface of the tissue; and

ablating the second targeted location on the first surface of the tissue.

27. The method of claim 26, wherein:

the step of manipulating the internal catheter to direct the ablation contact of the external catheter to contact a second targeted location on the first surface of the tissue further comprises (i) switching the first electrode of the internal catheter to the nonmagnetized state, and (ii) switching the second electrode of the internal catheter to the magnetized state such that the ablation contact of the external catheter is moved to the second targeted location on the first surface of the tissue.

28. The method of claim 27, further comprising:

ablating the first surface of the tissue between the first targeted location on the first surface of the tissue and the second targeted location on the first surface of the tissue.

29. The method of claim 22, wherein:

the first magnet of the external catheter comprises a first electrode.

30. The method of claim 29, wherein:

the external catheter further comprises a second magnet positioned at or near the distal end of the external catheter.

31. The method of claim 28, wherein:

the internal catheter further comprises third and fourth electrodes positioned at or near the distal end of the internal catheter; and

the internal catheter forms a loop within the heart, such that the first, second, third, and fourth electrodes are located within the heart.

32. The method of claim 31, further comprising:

ablating the first surface of the tissue in a specified circumference, the circumference being approximately defined by the loop of the internal catheter.

33. The method of claim 28, wherein:

the internal catheter further comprises a pair of excitation electrodes positioned at or near the distal end of the internal catheter and a pair of detection electrodes positioned on the internal catheter between the pair of excitation electrodes.

34. The method of claim 33, wherein:

the step of manipulating the internal catheter to direct the ablation contact of the external catheter to contact a first targeted location on the first surface of the tissue further comprises (i) measuring a first conductance value at a first location, (ii) measuring a second conductance value at a second location, and (iii) determining a profile of a body lumen based on the first conductance value and the second conductance value.

35. A method of ablating a targeted tissue on an epicardial surface of a heart, comprising:

providing an external catheter comprising a distal end, a first magnet positioned at the distal end of the external catheter, and an ablation contact positioned at the distal end of the external catheter, wherein the ablation contact is configured to remove or destroy tissue;

providing an internal catheter comprising a distal end, a first electrode positioned at or near the distal end of the internal catheter, and a second electrode positioned at or near the distal end of the internal catheter;

placing the distal end of the internal catheter within the heart, such that the first and second electrodes are positioned within the heart at a desired ablation location and in a desired ablation pattern;

activating the first electrode of the internal catheter such that the ablation contact of the external catheter is directed to the targeted tissue at a first location;

activating the ablation contact to ablate the targeted tissue;

deactivating the first electrode of the internal catheter; and

activating the second electrode of the internal catheter such that the ablation contact of the external catheter is directed to the targeted tissue at a second location;

wherein the targeted tissue is ablated by the ablation contact between the first location and the second location.

36. The method of claim 35, further comprising:

extending into a blood vessel an elongated tube having a proximal end, a distal end, and a first lumen, such that the distal end of the tube is in contact with a targeted tissue on the interior of a wall of the heart;

aspirating the targeted tissue on the interior of the wall of the heart such that the wall of the heart is retracted away from a pericardial sac surrounding the heart to enlarge a pericardial space between the pericardial sac and the wall of the heart;

accessing the pericardial space through the targeted tissue; and

inserting at least the distal end of the external catheter into the pericardial space.

37. The method of claim 36, further comprising:

introducing an impedance catheter into the heart;

measuring a first conductance value at a first location in the body; and

measuring a second conductance value at a second location in the body.

38. The method of claim 37, further comprising:

determining a profile of a body lumen using the conductance data.