Abstract:
An ablation system for treating atrial fibrillation in a patient comprises an elongate shaft having proximal and distal ends, a lumen therebetween and a housing adjacent the distal end of the elongate shaft. An energy source is coupled to the housing and is adapted to deliver energy to a target tissue so as to create a zone of ablation in the target tissue that blocks abnormal electrical activity thereby reducing or eliminating the atrial fibrillation in the patient. A sensor is adjacent the energy source and adapted to detect relative position of the energy source to the target tissue or characteristics of the target tissue. The system also has a reflecting element operably coupled with the energy source and adapted to redirect energy emitted from the energy source in a desired direction or pattern.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application is a non-provisional of, and claims the benefit of U.S. Provisional Patent Application No. 61/082,064 (Attorney Docket No. 027680-000700US), filed Jul. 18, 2008, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The present invention relates generally to medical devices, systems and methods, and more specifically to improved devices, systems and methods for creating an ablation zone in tissue. The device may be used to treat atrial fibrillation. 
         [0004]    The condition of atrial fibrillation (AF) is characterized by the abnormal (usually very rapid) beating of the left atrium of the heart which is out of synch with the normal synchronous movement (“normal sinus rhythm”) of the heart muscle. In normal sinus rhythm, the electrical impulses originate in the sino-atrial node (“SA node”) which resides in the right atrium. The abnormal beating of the atrial heart muscle is known as fibrillation and is caused by electrical impulses originating instead in the pulmonary veins (“PV”) [Haissaguerre, M. et al., Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins, New England J Med., Vol. 339:659-666]. 
         [0005]    There are pharmacological treatments for this condition with varying degrees of success. In addition, there are surgical interventions aimed at removing the aberrant electrical pathways from the PV to the left atrium (“LA”) such as the Cox-Maze III Procedure [J. L. Cox et al., The development of the Maze procedure for the treatment of atrial fibrillation, Seminars in Thoracic &amp; Cardiovascular Surgery, 2000; 12: 2-14; J. L. Cox et al., Electrophysiologic basis, surgical development, and clinical results of the maze procedure for atrial flutter and atrial fibrillation, Advances in Cardiac Surgery, 1995; 6: 1-67; and J. L. Cox et al., Modification of the maze procedure for atrial flutter and atrial fibrillation. II, Surgical technique of the maze III procedure, Journal of Thoracic &amp; Cardiovascular Surgery, 1995; 2110:485-95]. This procedure is shown to be 99% effective [J. L. Cox, N. Ad, T. Palazzo, et al. Current status of the Maze procedure for the treatment of atrial fibrillation, Seminars in Thoracic &amp; Cardiovascular Surgery, 2000; 12: 15-19] but requires special surgical skills and is time consuming. 
         [0006]    There has been considerable effort to copy the Cox-Maze procedure for a less invasive percutaneous catheter-based approach. Less invasive treatments have been developed which involve use of some form of energy to ablate (or kill) the tissue surrounding the aberrant focal point where the abnormal signals originate in the PV. The most common methodology is the use of radio-frequency (“RF”) electrical energy to heat the muscle tissue and thereby ablate it. The aberrant electrical impulses are then prevented from traveling from the PV to the atrium (achieving conduction block within the heart tissue) and thus avoiding the fibrillation of the atrial muscle. Other energy sources, such as microwave, laser, and ultrasound have been utilized to achieve the conduction block. In addition, techniques such as cryoablation, administration of ethanol, and the like have also been used. 
         [0007]    There has been considerable effort in developing catheter based systems for the treatment of AF using radiofrequency (RF) energy. One such method is described in U.S. Pat. No. 6,064,902 to Haissaguerre et al. In this approach, a catheter is made of distal and proximal electrodes at the tip. The catheter can be bent in a J shape and positioned inside a pulmonary vein. The tissue of the inner wall of the pulmonary vein (PV) is ablated in an attempt to kill the source of the aberrant heart activity. Other RF based catheters are described in U.S. Pat. No. 6,814,733 to Schwartz et al., U.S. Pat. No. 6,996,908 to Maguire et al., U.S. Pat. No. 6,955,173 to Lesh, and U.S. Pat. No. 6,949,097 to Stewart et al. 
         [0008]    Another source used in ablation is microwave energy. One such device is described by Dr. Mark Levinson [(Endocardial Microwave Ablation: A New Surgical Approach for Atrial Fibrillation; The Heart Surgery Forum, 2006] and Maessen et al. [Beating heart surgical treatment of atrial fibrillation with microwave ablation. Ann Thorac Surg 74: 1160-8, 2002]. This intraoperative device consists of a probe with a malleable antenna which has the ability to ablate the atrial tissue. Other microwave based catheters are described in U.S. Pat. No. 4,641,649 to Walinsky; U.S. Pat. No. 5,246,438 to Langberg; U.S. Pat. No. 5,405,346 to Grundy et al.; and U.S. Pat. No. 5,314,466 to Stem et al. 
         [0009]    Another catheter based method utilizes the cryogenic technique where the tissue of the atrium is frozen below a temperature of −60 degrees C. This results in killing of the tissue in the vicinity of the PV thereby eliminating the pathway for the aberrant signals causing the AF [A. M. Gillinov, E. H. Blackstone and P. M. McCarthy, Atrial fibrillation: current surgical options and their assessment, Annals of Thoracic Surgery 2002; 74:2210-7]. Cryo-based techniques have been a part of the partial Maze procedures [Sueda T., Nagata H., Orihashi K. et al., Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations, Ann Thorac Surg 1997; 63:1070-1075; and Sueda T., Nagata H., Shikata H. et al.; Simple left atrial procedure for chronic atrial fibrillation associated with mitral valve disease, Ann Thorac Surg 1996; 62: 1796-1800]. More recently, Dr. Cox and his group [Nathan H., Eliakim M., The junction between the left atrium and the pulmonary veins, An anatomic study of human hearts, Circulation 1966; 34:412-422, and Cox J. L., Schuessler R. B., Boineau J. P., The development of the Maze procedure for the treatment of atrial fibrillation, Semin Thorac Cardiovasc Surg 2000; 12:2-14] have used cryoprobes (cryo-Maze) to duplicate the essentials of the Cox-Maze III procedure. Other cryo-based devices are described in U.S. Pat. Nos. 6,929,639 and 6,666,858 to Lafintaine and U.S. Pat. No. 6,161,543 to Cox et al. 
         [0010]    More recent approaches for the AF treatment involve the use of ultrasound energy. The target tissue of the region surrounding the pulmonary vein is heated with ultrasound energy emitted by one or more ultrasound transducers. One such approach is described by Lesh et al. in U.S. Pat. No. 6,502,576. Here the catheter distal tip portion is equipped with a balloon which contains an ultrasound element. The balloon serves as an anchoring means to secure the tip of the catheter in the pulmonary vein. The balloon portion of the catheter is positioned in the selected pulmonary vein and the balloon is inflated with a fluid which is transparent to ultrasound energy. The transducer emits the ultrasound energy which travels to the target tissue in or near the pulmonary vein and ablates it. The intended therapy is to destroy the electrical conduction path around a pulmonary vein and thereby restore the normal sinus rhythm. The therapy involves the creation of a multiplicity of lesions around individual pulmonary veins as required. The inventors describe various configurations for the energy emitter and the anchoring mechanisms. 
         [0011]    Yet another catheter device using ultrasound energy is described by Gentry et al. [Integrated Catheter for 3-D Intracardiac Echocardiography and Ultrasound Ablation, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, Vol. 51, No. 7, pp 799-807]. Here the catheter tip is made of an array of ultrasound elements in a grid pattern for the purpose of creating a three dimensional image of the target tissue. An ablating ultrasound transducer is provided which is in the shape of a ring which encircles the imaging grid. The ablating transducer emits a ring of ultrasound energy at 10 MHz frequency. In a separate publication [Medical Device Link, Medical Device and Diagnostic Industry, February 2006], in the description of the device, the authors assert that the pulmonary veins can be imaged. 
         [0012]    While these devices and methods are promising, improved devices and methods for creating a heated zone of tissue, such as an ablation zone are needed. Furthermore, it would also be desirable if such devices could create single or multiple ablation zones to block abnormal electrical activity in the heart in order to lessen or prevent atrial fibrillation. It would also be desirable if such devices could be used in the presence of blood or other body tissues without coagulating or clogging up the ultrasound transducer. Such devices and methods should be easy to use, minimally invasive, cost effective and simple to manufacture. 
         [0013]    2. Description of Background Art 
         [0014]    Other devices based on ultrasound energy to create circumferential lesions are described in U.S. Pat. Nos. 6,997,925; 6,966,908; 6,964,660; 6,954,977; 6,953,460; 6,652,515; 6,547,788; and 6,514,249 to Maguire et al.; U.S. Pat. Nos. 6,955,173; 6,052,576; 6,305,378; 6,164,283; and 6,012,457 to Lesh; U.S. Pat. Nos. 6,872,205; 6,416,511; 6,254,599; 6,245,064; and 6,024,740; to Lesh et al.; U.S. Pat. Nos. 6,383,151; 6,117,101; and WO 99/02096 to Diederich et al.; U.S. Pat. No. 6,635,054 to Fjield et al.; U.S. Pat. No. 6,780,183 to Jimenez et al.; U.S. Pat. No. 6,605,084 to Acker et al.; U.S. Pat. No. 5,295,484 to Marcus et al.; and WO 2005/117734 to Wong et al. 
       BRIEF SUMMARY OF THE INVENTION 
       [0015]    The present invention relates generally to medical devices and methods, and more specifically to medical devices and methods used to deliver energy to tissue as a treatment for atrial fibrillation and other medical conditions. 
         [0016]    In a first aspect of the present invention, an ablation system for treating atrial fibrillation in a patient comprises an elongate shaft having a proximal end, a distal end, and lumens therebetween. A housing is adjacent the distal end of the elongate shaft and an energy source is coupled to the housing. The energy source is adapted to deliver energy to a target tissue so as to create a zone of ablation in the target tissue that blocks abnormal electrical activity thereby reducing or eliminating the atrial fibrillation in the patient. The system also has a reflecting element operably coupled with the energy source and adapted to redirect energy emitted from the energy source in a desired direction or pattern. 
         [0017]    The housing may be rotatable about its longitudinal axis and the energy may be redirected by the reflecting element in a generally circular pattern. The energy source may be recessed from a distal end of the housing such that the energy source does not contact the target tissue in operation. 
         [0018]    The energy source may comprise an ultrasound transducer that is adapted to emit a beam of ultrasound energy. The beam may have a frequency in the range of 5 to 20 MHz and a generator may be electrically coupled with the ultrasound transducer. The generator may provide an excitation voltage of 5 to 300 volts peak-to-peak to the ultrasound transducer. The excitation voltage may have a duty cycle ranging from 0% to 100%, and may have a repetition frequency of about 40 KHz. The energy source may be adapted to deliver one of radiofrequency energy, microwaves, photonic energy, thermal energy, and cryogenic energy. The energy source may comprise a flat face, a concave face or a convex face. The face may be adapted to act as a lens for focusing the energy delivered by the energy source. 
         [0019]    The system may comprise a sensor adjacent the energy source and that is adapted to detect relative position of the energy source to the target tissue or characteristics of the target tissue. The sensor may be adapted to detect a gap between a surface of the target tissue and the energy source. The sensor may be adapted to determine characteristics of the target tissue such as tissue thickness or ablation zone depth. The sensor may comprise an ultrasound transducer. The energy source may comprise the same ultrasound transducer as the sensor. Other sensors may comprise an infrared sensor or strain gage. 
         [0020]    The reflecting element may be non-expandable. It may redirect the energy in a collimated beam through a portion of the housing or it may redirect the energy in a focused beam that converges toward a focal point or a focal ring, or it may alter the focus of the beam to provide a more uniformly collimated beam. The reflecting element may comprise an angled outer surface that is adapted to redirect the energy. The angle of the outer surface may range from 30 to 60 degrees relative to a longitudinal axis of the housing. The angled face may comprise a flat surface. The reflecting element may comprise a curved outer surface that redirects the energy. The reflecting element may redirect the energy through a sidewall of the housing. The reflecting element may be movable relative to the energy source so that the energy exits the housing at varying angles or so that the energy is reflected outward away from the housing in a circular pattern. The reflecting element may be adapted to redirect the energy from the energy source to form a ring shaped beam of energy. The reflecting element may comprise a liquid-gas interface or a bowl-shaped reflector that is centered around a longitudinal axis of the housing. The liquid-gas interface may comprise a plurality of expandable reflectors positioned adjacent one another. The reflecting element may comprise two reflecting portions each having a different shape or angle relative to the energy source so that the energy is redirected in two or more directions or patterns. The energy may be redirected in a first pattern comprising a collimated beam and the energy may be redirected in a second pattern comprising a focused beam. 
         [0021]    The system may further comprise a processor that is adapted to control the energy provided by the energy source based on information received from the sensor. The system may have a lens adjacent the energy source and that is adapted to adjust beam pattern of the energy emitted from the energy source. 
         [0022]    The target tissue may comprise left atrial tissue, a pulmonary vein or tissue adjacent thereto. The zone of ablation may comprise a linear ablation path or an arcuate ablation path. The zone of ablation may comprise a transmural ablation zone. 
         [0023]    In another aspect of the present invention, a method for treating atrial fibrillation by ablating tissue in a patient comprises providing an ablation system comprising an elongate shaft having a distal tip assembly. The distal tip assembly comprises an energy source and a reflecting element. The distal tip assembly is advanced adjacent the tissue and energy is delivered from the energy source to the tissue. Energy from the energy source is reflected off of the reflecting element so as to redirect the energy emitted from the energy source in a desired direction or pattern. A partial or complete zone of ablation is created in the tissue, thereby blocking abnormal electrical activity and reducing or eliminating the atrial fibrillation. 
         [0024]    The step of advancing the distal tip assembly may comprise passing the distal tip through an atrial septal wall. The energy source may comprise an ultrasound transducer and the step of delivering the energy may comprise delivering a beam of ultrasound. The beam may comprise a frequency in the range of 5 to 20 MHz. Delivering the energy may comprise providing an excitation voltage ranging from 5 to 300 volts peak-to-peak to the ultrasound transducer. Delivering energy may comprise delivering one of radiofrequency energy, microwaves, photonic energy, thermal energy and cryogenic energy. 
         [0025]    The step of reflecting the energy may comprise redirecting the energy in a collimated beam of energy or focusing the energy so that it converges toward a focal point or a focal ring. Reflecting the energy may comprise redirecting the energy so that it exits a sidewall of the housing. The reflecting element may be non-expandable or it may comprise an expandable member such as a balloon or collapsible nested reflectors (e.g. similar to a collapsible parabolic dish used in satellite communications), and the step of reflecting the energy may comprise expanding the expandable member. Reflecting the energy may comprise moving the reflecting element relative to the housing such as by rotating it. The reflecting element may comprise a first reflecting portion and a second reflecting portion. The energy reflected off the first portion may be redirected in a first direction, and the energy reflected off the second portion may be redirected in a second direction different than the first direction. 
         [0026]    The zone of ablation may comprise a linear or arcuate zone of ablation. The step of creating the zone of ablation may comprise encircling the zone of ablation around a pulmonary vein or left atrial tissue. The zone of ablation may comprise a transmural lesion. 
         [0027]    The method may further comprise cooling the energy source with a cooling fluid. The system may further comprise a sensor that is adapted to sense relative position of the energy source to the target tissue or characteristics of the target tissue. The ablation system may further comprise a processor, and the method may further comprise controlling energy delivery based on information from the sensor. 
         [0028]    The method may comprise sensing a gap distance between the energy source and a surface of the tissue with the sensor. The method may also include sensing characteristics of the tissue such as tissue thickness or depth of the ablation zone, with the sensor. The sensor may comprise an ultrasound sensor and the energy source may also comprise the same ultrasound transducer. The method may include switching modes between delivering energy with the ultrasound transducer and sensing tissue characteristics with the ultrasound transducer sensor. 
         [0029]    These and other embodiments are described in further detail in the following description related to the appended drawing figures. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0030]      FIGS. 1 and 2  are drawings of the system of the preferred embodiments of the invention; 
           [0031]      FIGS. 3A-3B  illustrate the reflecting surface of the system and energy beam of the preferred embodiments of the invention; and 
           [0032]      FIG. 4-5  are drawings of the energy beam and the zone of ablation of the preferred embodiment of the invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0033]    The following description of preferred embodiments of the invention is not intended to limit the invention to these embodiments, but rather to enable any person skilled in the art to make and use this invention. 
         [0034]    As shown in  FIG. 1 , the energy delivery system  10  of the preferred embodiments includes an energy source  12  that functions to provide a source of ablation energy; a reflecting surface  100  that functions to redirect the ablation energy from the energy source  12 ; a sensor; and a processor (not shown), coupled to the sensor and to the energy source  12 , which may controls the energy source  12  based on the information from the sensor. The energy delivery system  10  is preferably designed for delivering energy to tissue, more specifically, for delivering ablation energy to tissue, such as heart tissue, to create a conduction block—isolation and/or block of conduction pathways of abnormal electrical activity, which typically originate from the pulmonary veins in the left atrium—for treatment of atrial fibrillation in a patient. The system  10 , however, may be alternatively used with any suitable tissue in any suitable environment and for any suitable reason. 
         [0035]    The Energy Source. As shown in  FIG. 1 , the energy source  12  of the preferred embodiments functions to provide a source of ablation energy. The ablation energy is preferably in the form of an energy beam  20  emitted from the energy source  12 . The energy source  12  is preferably an ultrasound transducer that emits an ultrasound beam, but may alternatively be any suitable energy source that functions to provide a source of ablation energy. Some suitable sources of ablation energy may include radio frequency (RF) energy, microwaves, photonic energy, and thermal energy. The therapy could alternatively be achieved using cooled fluids (e.g., cryogenic fluid). The energy delivery system  10  preferably includes a single energy source  12 , but may alternatively include any suitable number of energy sources  12 . For example, the system  10  may include multiple energy sources configured in a ring, such that in combination they emit an annular shaped energy beam  20 . 
         [0036]    The energy source  12  is preferably an ultrasound transducer that is preferably made of a piezoelectric material such as PZT (lead zirconate titanate) or PVDF (polyvinylidine difluoride), or any other suitable ultrasound beam emitting material. The transducer may further include coating layers such as a thin layer of a metal. Some suitable transducer coating metals may include gold, stainless steel, nickel-cadmium, silver, plastic, metal-filled graphite, a metal alloy, and any other suitable material that functions to increase the efficiency of coupling of the energy beam  20  into the surrounding fluid  28  or performs any other suitable functions. The transducer is preferably a cylindrical transducer, as shown in  FIGS. 3A and 3B , such that it preferably emits energy beam  20  from the outer face of the cylinder (e.g. radially out from the face of the energy source). The energy beam  20  is preferably emitted radially 360 degrees around the energy source  12 , but may alternatively be emitted from any suitable portions) of the energy source. The transducer may alternatively be a generally flat transducer, such as a disc, as shown in  FIGS. 1 and 2 . The disc transducer preferably emits energy beam  20  from at least one of the faces of the disc. The faces of the disc that emit the energy beam  20  are preferably flat, but may alternatively be either concave or convex to achieve an effect of a lens. The disc transducer preferably has a circular geometry, but may alternatively be elliptical, polygonal, doughnut shaped, or any other suitable shape. 
         [0037]    As shown in  FIG. 1 , the energy source  12  of the preferred embodiments is preferably coupled to at least one electrical attachment  14 . The electrical attachment  14  of the preferred embodiments functions to energize the energy source  12  such that it emits an energy beam  20 . The energy delivery system  10  preferably includes two electrical attachments  14  and  14 ′, but may alternatively include any suitable number of electrical attachments to energize the energy source  12 . The energy delivery system  10  of the preferred embodiments also includes an electrical generator (not shown) that functions to provide power to the energy source  12  via the electrical attachment(s)  14 . When energized by the generator the energy source  12  emits an energy beam  20 . The generator provides the appropriate frequency and voltage to the energy source  12  to create the desired energy beam  20 . In the case of an ultrasound energy source  12 , the ultrasound frequency is preferably in the range of 1 to 25 MHz and more preferably in the range of 5 to 20 MHz. The energy of the energy beam  20  is determined by the excitation voltage applied to the energy source  12 . The voltage is preferably in the range of 5 to 300 volts peak-to-peak. In addition, a variable duty cycle is preferably used to control the average power delivered to the energy source  12 . The duty cycle preferably ranges from 0% to 100%, with a repetition frequency of approximately 40 kHz, which is preferably faster than the time constant of thermal conduction in the tissue. 
         [0038]    When energized with an electrical pulse or pulse train by the electrical attachment  14  and/or  14 ′, the energy source  12  emits an energy beam  20  (such as a sound wave). The properties of the energy beam  20  are determined by the characteristics of the energy source  12 , the matching layer, the backing (described below), and the electrical pulse from electrical attachment  14 . These elements determine the frequency, bandwidth, and amplitude of the energy beam  20  (such as a sound wave) propagated into the tissue. As shown in  FIG. 4 , the energy source  12  emits energy beam  20  such that it interacts with tissue  276  and forms a lesion (zone of ablation  278 ). The energy beam  20  is preferably an ultrasound beam. The tissue  276  is preferably presented to the energy beam  20  within the collimated length L. The front surface  280  of the tissue  276  is at a distance d ( 282 ) away from the face of a housing  16 . As the energy beam  20  travels through the tissue  276 , its energy is absorbed by the tissue  276  and converted to thermal energy. This thermal energy heats the tissue to temperatures higher than the surrounding tissue resulting in a heated zone  278 . In the zone  278  where the tissue is heated, the tissue cells are preferably rendered dead due to heat. The temperatures of the tissue are preferably above the temperature where cell death occurs in the heated zone  278  and therefore, the tissue is said to be ablated. Hence, the zone  278  is preferably referenced as the ablation zone or lesion. 
         [0039]    The shape of the lesion or ablation zone  278  formed by the energy beam  20  depends on the characteristics of suitable combination factors such as the energy beam  20 , the energy source  12  (including the material, the geometry, the portions of the energy source  12  that are energized and/or not energized, etc.), the matching layer, the backing, the electrical pulse from electrical attachment  14  (including the frequency, the voltage, the duty cycle, the length of the pulse, etc.), and the characteristics of target tissue that the beam  20  contacts and the length of contact or dwell time. These characteristics can be changed based on the information detected by the sensor (as described below), thereby changing the physical characteristics of the lesion. 
         [0040]    The housing  16  also functions to provide a barrier between the face of the energy source  12  and blood or tissue. When fluid flow is incorporated, the fluid may flow past the energy source thereby preventing blood from coagulating thereon. In preferred embodiments, the coolant flows past the energy source at approximately 1 ml/minute, but may be increased or decreased as desired. Additionally, since the energy source is disposed in the housing, the energy source will not directly contact tissue, thereby also preventing coagulation on the energy source. 
         [0041]    Additional details on the energy source, energy source configurations, the housing and adjacent components are disclosed in U.S. patent application Ser. No. 12/480,256 (Attorney Docket No. 027680-000310US) and Ser. No. 12/482,640 (Attorney Docket No. 027680-000510US), the entire contents of which are incorporated herein by reference. 
         [0042]    The Reflecting Surface. As shown in  FIG. 1 , the reflector  100  of the preferred embodiments functions to redirect the energy beam  20  from the energy source  12 . The reflecting surface  100  preferably redirects the energy beam  20  from the energy source  12  out of housing  16  and preferably towards the target tissue. The reflecting surface  100  preferably redirects the energy beam  20  such that it is a collimated beam exiting the housing  16  (as shown in  FIGS. 2 and 3 ), the reflecting surface  22  may alternatively redirect the energy beam  20  such that it is a focused beam that preferably converges towards a substantially single focal point or towards focal point ring. The reflecting surface is preferably one of several variations. In a first variation, as shown in  FIG. 1 , the reflecting surface  100  is an angled reflector device. The reflector device is preferably a cylindrical reflector with a face of the reflector at an angle to the longitudinal axis of the housing  16 . The energy source  12  is preferably positioned towards the distal end of the housing  16  with the front face pointing towards the reflector device, which is preferably positioned along the same axis (the longitudinal axis of the housing  16 ) as the energy source  12 . The energy beam  20  from the energy source  12  is preferably redirected from the reflecting surface such that it exits the housing  16  through a side portion of the housing. The reflector device is preferably made from a material that reflects the energy beam  20 , such as metal, but may alternatively be a gas filled reflector device such as a gas filled balloon. The angled face of the reflector is preferably flat, but may alternatively be a non-planar face, such as a curved, convex or concave surface. The angle of the reflector preferably ranges between substantially 0 degrees, more preferably substantially 30-60 degrees, and most preferably substantially 45 degrees. The reflector device is preferably set at a fixed angle with respect to the energy source  12 , but may alternatively be movable, such as rotated or pivoted, to alter the angle that the energy beam  20  will exit the housing  16 . Referring to  FIG. 1 , the reflector device is preferably secured to the housing  16  by means of a distal adhesive band  1418 , but may alternatively be coupled to the housing  16  with any other suitable chemical and/or mechanical connection such as adhesive, welding, pins and/or screws. The adhesive band  1418  preferably includes a passageway  1445  for the flow of a cooling fluid (as described below). 
         [0043]    In the first variation of the reflecting surface  100 , the energy beam  20  exiting from the housing  16  is preferably directed along an ablation path such that it propagates into tissue. As the energy beam  20  propagates into the tissue along the ablation path, it preferably provides a partial or complete zone of ablation along the ablation path. The zone of ablation along the ablation path preferably has any suitable geometry to provide therapy, such as providing a conduction block for treatment of atrial fibrillation in a patient. The zone of ablation along the ablation path may alternatively provide any other suitable therapy for a patient. A linear ablation path is preferably created by moving the system  10 , and the energy source  12  within it, in an X, Y, and/or Z direction. A generally circular or elliptical ablation path is preferably created by rotating the energy source  12  about an axis. In a first version, the reflecting surface  100  is preferably rotated within the housing  16  and about the longitudinal axis of the housing  16 , such that as the energy source  12  is energized and emitting the energy beam  20 , the beam will be reflected out of the housing in  360  degrees. The energy beam  20  that is redirected by the reflecting surface  100  preferably exits a side portion of the housing though a window located around the circumference of the distal tip assembly  16 . The window is preferably made of a material that is transparent to ultrasound waves such as a poly 4-methyl, 1-pentene (PMP) material or may alternatively be an open window. In a second version, the entire system  10  will rotate, rotating the energy beam  20  that exits from at least one single portion of the housing  16 . The system  10  is preferably rotated about the longitudinal axis of the housing  16 , but may alternatively be rotated about an axis off set from the longitudinal axis of the housing  16 . In this version, the energy beam  20  preferably sweeps a generally circular path. 
         [0044]    In a second variation, as shown in  FIG. 2 , the reflecting surface  100  is also an angled reflector device. The reflector device is preferably a substantially flat reflecting device, with an inside face of the reflector at an angle to the front face of the energy source  12 . The energy source  12  is preferably positioned adjacent to a side wall of the housing  16  with the front face the energy source  12  pointing towards the reflector device. The energy beam  20  from the energy source  12  is preferably redirected from the reflecting surface such that it exits the housing  16  through an end portion of the housing. The energy beam  20  that is redirected by the reflecting surface  100  preferably exits the end portion of the housing though a window. The window is preferably an open window, but may alternatively be made of a material that is transparent to ultrasound waves such as a poly 4-methyl, 1-pentene (PMP) material. The reflector device is preferably made from a material that reflects the energy beam  20 , such as metal, but may alternatively be a gas filled reflector device such as a gas filled balloon. The angled face of the reflector is preferably flat, but may alternatively be a nonplanar face, such as a curved, convex or concave surface. The angle of the reflector preferably ranges between substantially 0-90 degrees, more preferably substantially 30-60 degrees, and most preferably substantially 45 degrees. The reflector device is preferably set at a fixed angle with respect to the energy source  12 , but may alternatively be movable, such as rotated or pivoted, to alter the angle that the energy beam  20  will exit the housing  16 . The reflecting surface  22  preferably includes a passageway  1445  for the flow  28  of a cooling fluid (as described below). 
         [0045]    In the second variation of the reflecting surface  100 , the energy beam  20  exiting from the housing  16  is preferably directed along an ablation path such that it propagates into tissue. As the energy beam  20  propagates into the tissue along the ablation path, it preferably provides a partial or complete zone of ablation along the ablation path. A linear ablation path is preferably created by moving the system  10 , and the energy source  12  within it, in an X, Y, and/or Z direction. Alternatively, a generally circular or elliptical ablation path is preferably created by rotating the housing  16  about an axis. In a first version, the housing  16  is preferably rotated about its longitudinal axis. Because the energy beam  20  is redirected by the reflecting surface  100 , as shown in  FIG. 2 , the energy beam  20  exits the housing at a distance from the longitudinal axis of the housing. Therefore, as the housing  16  is moved in a circular or elliptical path, the energy beam  20  will contact the tissue, creating a corresponding generally circular or elliptical ablation path. 
         [0046]    In a third variation, as shown in  FIGS. 3A and 3B , the reflecting surface  100  is also an angled, bowl-shaped reflector device centered around the longitudinal axis of the housing  16 . The inside surface of the reflector device is preferably a substantially linear surface (in cross section, as shown in  FIG. 3B ) at an angle to the front face of the energy source  12 . The angled face of the reflector is preferably flat, but may alternatively be a non-planar face, such as a curved, convex or concave surface, or combinations thereof. The energy source  12  is preferably a cylindrical energy source  12 , positioned along the longitudinal axis of the housing  16 . The energy beam  20  from the energy source  12  preferably exits the energy source radially and is preferably redirected from the reflecting surface such that it exits the housing  16  as a ring shaped energy beam (as shown in  FIG. 3A ) through an end portion of the housing. The energy beam  20  that is redirected by the reflecting surface  100  preferably exits the end portion of the housing though a window. The window is preferably an open window, but may alternatively be made of a material that is transparent to ultrasound waves such as a poly 4-methyl, 1-pentene (PMP) material. The reflector device is preferably made from a material that reflects the energy beam  20 , such as metal, but may alternatively be a gas filled reflector device such as a gas filled balloon. The angle of the reflector preferably ranges between substantially 0-90 degrees, more preferably substantially 30-60 degrees, and most preferably substantially 45 degrees. The reflector device is preferably set at a fixed angle with respect to the energy source  12 , but may alternatively be movable, such as rotated or pivoted, to alter the angle that the energy beam  20  will exit the housing  16 . 
         [0047]    In the third variation of the reflector  100 , the energy beam  20  exiting from the housing  16  is preferably ring-shaped, as shown in  FIG. 3A , and therefore preferably creates a ring shaped ablation path when it interacts with tissue and preferably provides a partial or complete zone of ablation along the ablation path. A linear ablation path is alternatively created by the energy source  12  emitting energy beam  20  from only a partial radial portion of the energy source and/or by moving the system  10 , and the energy source  12  within it, in an X, Y, and/or Z direction. Alternatively, the energy source of the third variation reflecting surface  100  may be a flat energy source (rather than a cylindrical one) with the front face towards a portion of the reflecting surface. To create an ablation path, the energy source  12  is preferably rotated about the longitudinal axis of the housing such that the energy beam  20  will be redirected by various portions of the reflecting surface, creating a circular ablation path. 
         [0048]    The Sensor. As shown in  FIG. 5 , the energy delivery system  10  of the preferred embodiments also includes a sensor that functions to detect the gap (e.g., the distance of the tissue surface from the energy source  12 ), the thickness of the tissue targeted for ablation, and the characteristics of the ablated tissue. The sensor is preferably an ultrasound transducer, but may alternatively be any suitable sensor, such as a strain gage, feeler gage, or IR sensor, to detect information with respect to the gap, the thickness of the tissue targeted for ablation, the characteristics of the ablated tissue, the location of elements of the system  10 , and/or any other suitable parameter or characteristic. 
         [0049]    The sensor is preferably the same transducer as the transducer of the energy source  12  operating in a different mode (such as A-mode, defined below), but may alternatively be a separate ultrasound transducer or an additional sensor  40 ′ as shown in  FIG. 3A  coupled to a top portion of the cylindrical energy source  12 . The system  10  may include multiple sensors such as a first sensor to detect information with respect to the target tissue, and a second sensor to detect information with respect to the location of the elements of the system  10 . By detecting information on the gap, the thickness of the tissue targeted for ablation, the characteristics of the ablated tissue, and/or the locations of the elements of the system  10 , the sensor preferably functions to guide the therapy provided by the ablation of the tissue. 
         [0050]    In the variations of the system  10  wherein the sensor is the same transducer as the transducer of the energy source  12  operating in a different mode (such as A-mode), the sensor preferably utilizes a pulse of ultrasound of short duration, which is generally not sufficient for heating of the tissue. This is a simple ultrasound imaging technique, referred to in the art as A Mode, or Amplitude Mode imaging. As shown in  FIG. 5 , sensor  40  preferably sends a pulse  290  of ultrasound towards the tissue  276 . A portion of the beam is reflected and backscattered as  292  from the front surface  280  of the tissue  276 . This reflected beam  292  is detected by the sensor  40  a short time later and converted to an electrical signal, which is sent to the electrical receiver (not shown). The reflected beam  292  is delayed by the amount of time it takes for the sound to travel from the sensor  40  to the front boundary  280  of the tissue  276  and back to the sensor  40 . This travel time represents a delay in receiving the electrical signal from the sensor  40 . Based on the speed of sound in the intervening media (fluid  286  and blood  284 ), the gap distance d ( 282 ) is determined. As the sound beam travels further into the tissue  276 , a portion  293  of it is scattered from the lesion  278  being formed and travels towards the sensor  40 . Again, the sensor  40  converts this sound energy into electrical signals and a processor (described below) converts this information into characteristics of the lesion formation such as thickness, etc. As the sound beam travels still further into the tissue  276 , a portion  294  of it is reflected from the back surface  298  and travels towards the transducer. Again, the sensor  40  converts this sound energy into electrical signals and the processor converts this information into the thickness t ( 300 ) of the tissue  276  at the point of the incidence of the ultrasound pulse  290 . As the catheter housing  16  is traversed in a manner  301  across the tissue  276 , the sensor  40  detects the gap distance d ( 282 ), lesion characteristics, and the tissue thickness t ( 300 ). The sensor preferably detects these parameters continuously, but may alternatively detect them periodically or in any other suitable fashion. This information is used in delivering continuous ablation of the tissue  276  during therapy as discussed below. 
         [0051]    The Processor. The energy delivery system  10  of the preferred embodiments also includes a processor, coupled to the sensor  40  and to the electrical attachment  14 , that controls the electrical pulse delivered to the electrical attachment  14  and may modify the electrical pulse delivered based on the information from the sensor  40 . The processor is preferably a conventional processor or logic machine that can execute computer programs including a microprocessor or integrated circuit, but may alternatively be any suitable device to perform the desired functions. 
         [0052]    The processor preferably receives information from the sensor such as information related to the gap distance, the thickness of the tissue targeted for ablation, the characteristics of the ablated tissue, and any other suitable parameter or characteristic. Based on this information, the processor converts this information into a gap distance, a thickness of the tissue targeted for ablation, a characteristic of the ablated tissue, and any other suitable parameter or characteristic and/or controls the energy beam  20  emitted from the energy source  12  by modifying the electrical pulse sent to the energy source  12  via the electrical attachment  14  such as the frequency, the voltage, the duty cycle, the length of the pulse, and/or any other suitable parameter. The processor preferably also controls the energy beam  20  by controlling which portions of the energy source  12  are energized and/or at which frequency, voltage, duty cycle, etc. different portions of the energy source  12  are energized. Additionally, the processor may further be coupled to a fluid flow controller. The processor preferably controls the fluid flow controller to increase or decrease fluid flow based on the sensor detecting characteristics of the ablated tissue, of the unablated or target tissue, and/or any other suitable condition. 
         [0053]    By controlling the energy beam  20  (and/or the cooling of the targeted tissue), the shape of the ablation zone  278  is controlled. For example, the depth  288  of the ablation zone is preferably controlled such that a transmural (through the thickness of the tissue) lesion is achieved. Additionally, the processor preferably functions to minimize the possibility of creating a lesion beyond the targeted tissue, for example, beyond the outer atrial wall. If the sensor detects the lesion extending beyond the outer wall of the atrium or that the depth of the lesion has reached or exceeded a preset depth, the processor preferably turns off the generator and/or ceases to send electrical pulses to the electrical attachment(s)  14 . Additionally, if the sensor detects, for example, that the system  10  is not centered with respect to the pulmonary vein PV by detecting the distance of the target tissue with respect to the energy source and/or intended ablation path, the processor may either turn off the generator and/or cease to send electrical pulses to the electrical attachment(s)  14 , may alter the pulses sent to the electrical attachment, and/or may alter the operator or motor drive unit to reposition the system with respect to the target tissue. 
         [0054]    Additional Elements. As shown in  FIG. 1 , the energy delivery system  10  of the preferred embodiments may also include an elongate member  18 , coupled to the energy source  12 . The elongate member  18  is preferably a catheter made of a flexible multi-lumen tube, but may alternatively be a cannula, tube or any other suitable elongate structure having one or more lumens. The elongate member  18  of the preferred embodiments functions to accommodate pull wires, fluids, gases, energy delivery structures, electrical connections, therapy catheters, navigation catheters, pacing catheters, and/or any other suitable device or element. As shown in  FIG. 1 , the elongate member  18  preferably includes a housing  16  positioned at a distal portion of the elongate member  18  that functions to enclose the energy source  12  and the reflection surface  100 . The elongate member  18  further functions to move and position the energy source  12  and/or the housing  16  within a patient, such that the emitted energy beam  20  contacts the target tissue at an appropriate angle and the energy source  12  and/or the housing  16  is moved along an ablation path such that the energy source  12  provides a partial or complete zone of ablation along the ablation path. 
         [0055]    The energy delivery system  10  of the preferred embodiments may also include a lens or mirror, operably coupled to the energy source  12 , that functions to provide additional flexibility in adjusting the beam pattern of the energy beam  20 . The lens is preferably a standard acoustic lens, but may alternatively be any suitable lens to adjust the energy beam  20  in any suitable fashion. The lens may be used to focus or defocus the energy beam. For example, an acoustic lens could create a beam that is more uniformly collimated, such that the minimum beam width D 1  approaches the diameter D of the energy source  12 . This will provide a more uniform energy density in the ablation window, and therefore more uniform lesions as the tissue depth varies within the window. A lens could also be used to move the position of the minimum beam width D 1 , for those applications that may need either shallower or deeper lesion. This lens could be fabricated from plastic or other material with the appropriate acoustic properties, and bonded to the face of energy source  12 . Alternatively, the energy source  12  itself may have a geometry such that it functions as a lens, or the matching layer or coating of the energy source  12  may function as a lens. 
         [0056]    Although omitted for conciseness, the preferred embodiments include every combination and permutation of the various energy sources  12 , electrical attachments  14 , energy beams  20 , sensors  40 , and processors. 
         [0057]    As a person skilled in the art will recognize from the previous detailed description and from the figures and claim, modifications and changes can be made to the preferred embodiments of the invention without departing from the scope of this invention defined in the following claims.