METHOD FOR CLOSURE AND ABLATION OF ATRIAL APPENDAGE

• US 20170100183A1
• Filed: 10/09/2015
• Published: 04/13/2017
• Est. Priority Date: 10/09/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: IAIZZO, Paul A., GOFF, Ryan P.
• Granted Patent: US 10,786,302 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 18/1492 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 2017/00358 Snares for grasping
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/0212 using an instrument inserted into a body lumen, e.g. catheter
• 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 2018/0293 using an instrument interstitially inserted into the body, e.g. needle
• CPC Class Codes: A61B 2018/141 Snare
• CPC Class Codes: A61B 2217/007 with irrigation system
• CPC Class Codes: A61B 2218/002 Irrigation

Abstract

A device, system, and method for ligating the left atrial appendage without creating pro-arrhythmic tissue. The device may generally include a snare including a thermally transmissive distal portion and a suture including a distal portion, both distal portions having a lasso-shaped configuration that may be positioned proximate the base of the left atrial appendage. Once the distal portions of the snare and the suture are tightened around the base of the left atrial appendage, the thermally transmissive distal portion of the snare may be activated to create an ablation lesion in adjacent left atrial appendage tissue. The lesion may be created with radiofrequency energy or through cryoablation by the circulation of refrigerant within the thermally transmissive distal portion of the snare.

Claims

1. A device for ligating a left atrial appendage, the device comprising:

a first elongate body including a proximal portion and a thermally transmissive distal portion; and

a second elongate body having a proximal portion and a distal portion, the distal portion of the second elongate body being releasably engageable with the proximal portion of the second elongate body.

2. The device of claim 1, wherein the thermally transmissive distal portion of the first elongate body has a lasso-shaped configuration.

3. The device of claim 2, wherein the lasso-shaped configuration of the thermally transmissive distal portion of the first elongate body has an adjustable diameter.

4. The device of claim 2, wherein the distal portion of the second elongate body has a lasso-shaped configuration.

5. The device of claim 4, wherein the lasso-shaped configuration of the distal portion of the second elongate body has an adjustable diameter.

6. The device of claim 4, wherein the distal portion of the first elongate body includes a first slidable element that is slidably engaged with a portion of the first elongate body.

7. The device of claim 6, wherein the first slidable element is also slidably engaged with a portion of the second elongate body.

8. The device of claim 6, wherein the distal portion of the second elongate body includes a second slidable element that is slidably engaged with a portion of the second elongate body.

9. The device of claim 1, the device further including a first sheath and a second sheath being disposed about at least a portion of the first sheath, at least a portion of each of the first elongate body and the second elongate body being within the first sheath, the first sheath being slidable relative to the first elongate body, second elongate body, and the second sheath.

10. The device of claim 8, wherein the thermally transmissive distal portion of the first elongate body is configured to transmit radiofrequency energy.

11. The device of claim 10, wherein at least the thermally transmissive distal portion of the first elongate body is composed of an electrically conductive material.

12. The device of claim 8, wherein the first elongate body defines a fluid lumen therein, the fluid lumen being configured to be in fluid communication with a source of refrigerant.

13. The device of claim 12, wherein the distal portion of the first elongate body is configured to reach a temperature that is sufficiently low enough to ablate adjacent tissue.

14. A system for ligating a left atrial appendage, the system including:

a ligation device including;

a snare having an elongate body having a proximal portion and a thermally transmissive distal portion, the thermally transmissive distal portion having a lasso-shaped configuration defining a first diameter; and

a suture having an elongate body having a proximal portion and a distal portion, the distal portion having a lasso-shaped configuration defining a second diameter; and

a console in at least one of electrical communication and fluid communication with the thermally transmissive distal portion of the snare.

15. The system of claim 14, wherein each of the first diameter and the second diameter are independently adjustable within a range of a plurality of diameters.

16. The system of claim 15, wherein the range of the plurality of diameters includes a diameter sized to allow the left atrial appendage to pass therethrough and a diameter sized to ligate the left atrial appendage.

17. The system of claim 14, wherein the console includes a radiofrequency energy generator, the thermally transmissive distal portion of the snare being configured to transmit radiofrequency energy from the radiofrequency energy generator to the left atrial appendage.

18. The system of claim 14, wherein the console includes a refrigerant source, the thermally transmissive distal portion defining a fluid lumen therein that is in fluid communication with the refrigerant source.

19. The system of claim 14, the ligation device further including:

an inner sheath surrounding at least a portion of the snare elongate body and the suture elongate body; and

an outer sheath surrounding at least a portion of the first sheath, the inner sheath being slidable relative to the snare, the suture, and the outer sheath.

20. A method of ligating a left atrial appendage of a patient, the method comprising:

adjusting a diameter of a lasso-shaped, thermally transmissive distal portion of a first medical device to a first diameter such that the distal portion of the first medical device is in contact with the left atrial appendage;

adjusting a diameter of a lasso-shaped distal portion of a second medical device to a second diameter such that the distal portion of the second medical device is in contact with the left atrial appendage, the second diameter being approximately the same as the first diameter; and

ablating a portion of the left atrial appendage proximate the distal portion of the second medical device with the distal portion of the first medical device.

21. The method of claim 20, further comprising adjusting the diameter of the distal portion of the second medical device such that the distal portion of the second medical device.

22. The method of claim 21, further comprising removing the first medical device from the patient.