Source: https://patents.google.com/patent/US20060217699
Timestamp: 2018-04-24 14:43:14
Document Index: 417982499

Matched Legal Cases: ['art.\n2', 'art.\n9', 'art.\n11', 'art.\n13', 'art.\n14', 'art.\n15']

US20060217699A1 - Cardiac ablation system and method for treatment of cardiac arrhthmias and transmyocardial revascularization - Google Patents
Cardiac ablation system and method for treatment of cardiac arrhthmias and transmyocardial revascularization Download PDF
US20060217699A1
US20060217699A1 US11429948 US42994806A US2006217699A1 US 20060217699 A1 US20060217699 A1 US 20060217699A1 US 11429948 US11429948 US 11429948 US 42994806 A US42994806 A US 42994806A US 2006217699 A1 US2006217699 A1 US 2006217699A1
US11429948
Wang Paul J
This application is a continuation of application Ser. No. 10/695,110, filed on Oct. 28, 2003 (to issue as U.S. Pat. No. 7,041,095) which is a continuation of U.S. application Ser. No. 10/032,302, filed on Dec. 21, 2001, now abandoned, which is a continuation of U.S. application Ser. No. 09/082,047, filed on May 20, 1998 (now U.S. Pat. No. 6,527,767). The entire disclosures of the foregoing patents and applications are hereby incorporated by reference.
In atrial fibrillation the regular pumping action of the atria is replaced by a disorganized, ineffective quivering caused by chaotic conduction of electrical signals through the upper chambers of the heart. Although not immediately life threatening, atrial fibrillation may cause up to a 30% reduction in cardiac output and can lead to more serious conditions, including the formation of blood clots in the atria that can dislodge and travel to the brain resulting in stroke. Currently, the only curative treatment for atrial fibrillation is the surgical “maze procedure”, an open heart procedure in which the surgeon makes several incisions in the right and left atria creating scar tissue to electrically separate portions of the atria Despite clinical success of the maze procedure, it is time-consuming and demanding. The procedure requires open heart surgery and is very expensive. Accordingly, only a modest number of maze procedures are performed annually in a limited number of centers.
FIG. 1 is a simplified and diagrammatic sagittal section view of the interior of the left side of the heart showing an endocardial ablating catheter of the prior art within a large vessel and left atrium;
FIGS. 10A J is a cross sectional diagrammatic view of the various arrays of ablators on the surface of the arm of the epicardial gripper or the surface of the probe of the electrode system;
FIGS. 16A B is a diagrammatic view of cooling ablators in a portion of the probe of the electrode system;
As shown in FIGS. 3 9, the arms 54 of the gripper 52 generally comprise an elongate body pre-formed into a generally curved or curvilinear shape. The shape corresponds to the geometry of the epicardial surface to be ablated.
The arms of the gripper are formed from an electrically non-conductive, inert, material. Suitable materials for the arms include, but are not limited to, Pebax®, polyethylene, or polyester. Other materials, with the above characteristics, which retain their shape at body temperature are also contemplated. The gripper may be formed of shape memory materials, for example, nitinol. The gripper may be enclosed within a sheath dimensioned for insertion through a small orifice. After the gripper is inserted, the sheath is removed and the gripper arms assume a pre-formed shape.
Each of the arms of the gripper 52 have an inner surface 64 and an outer surface 66 defining a cross section. The cross section may be substantially circular, semi-circular, rectangular, V-shaped, D-shaped or the cross-section may have multiple radii as illustrated in FIGS. 10A J. In one embodiment, ablators 68 may be positioned on the inner surface 64 as shown in FIGS. 3 9. Ablators ablate cardiac tissue. Ablation destroys or removes the function of tissue. In some cases ablation is followed by revascularization of the cardiac tissue. As shown in cross section in FIG. 10, in other embodiments the ablators are disposed on one or more surfaces of one or more arms. In various embodiments, as illustrated in FIGS. 3 9, ablators are positioned on one or more moveable arms, one or more fixed arms, or both.
Ablators may be positioned on the arms in a variety of ways. In one embodiment, the ablator is a single, linear ablator as shown in FIGS. 3 8. In another embodiment, multiple ablators may be arranged on the arms in a patterned array, such as, for example, a linear array as illustrated in FIG. 9. The spacing of the ablators depend on the geometry of the tissue to be ablated. The number of ablators and the dimensions of individual ablators may be determined by tissue geometry, the arm shape, and the requirement for arm flexibility. In one embodiment, each ablator is preferably made of platinum, about 0.2 5 mm thick and about 1 5 mm long. In another embodiment, the platinum is preferably 2 mm thick and preferably about 4 mm long. In yet another embodiment, the ablators comprise detachable, reattachable ablators.
The probe 92 of the electrode system 90 is formed from a non-conductive, flexible, adjustable material. Suitable materials for the probe include but are not limited to Pebax, polyethylene, polyester, polyurethane, silicone and Teflon. The probe may be formed of shape memory materials, for example, nitinol. The probe may be enclosed within a sheath dimensioned for insertion through a small orifice. After the probe is inserted, the sheath is removed and the probe assumes a pre-formed shape. As illustrated in FIGS. 10A J, the probe comprises a cross section defined by the probe surfaces, at least one surface being a contact surface. As illustrated in FIG. 10C or 10F, in one embodiment, the cross section of the probe may be substantially D-shaped. In other embodiments shown in FIGS. 10A J, the cross section of the probe may be circular, semi-circular, rectangular, V-shaped, D-shaped or the cross section may have multiple radii.
The electrode system 90 includes one ablator or a plurality of ablators. The one or more ablators 68 positioned on the probe 92 is arranged in any array, such as a linear array. The spacing between ablators 68 depends on the geometry of the cardiac tissue to be ablated. The number of ablators, position of the ablators, and dimension of the ablators depend on the geometry of the cardiac tissue to be ablated, the surface of the probe on which the ablators are placed and the requirements for probe flexibility. In one embodiment, as illustrated in FIG. 15, multiple ablators 68 are arranged in a linear array along one contact surface of the probe 92, the probe 92 having a substantially rectangular cross section. In other embodiments as illustrated in cross section of FIG. 10A, a single long ablator or multiple continuous or discontinuous ablator elements may be longitudinally disposed on one semicircle of a probe the probe having a substantially circular cross section. In still other embodiments as illustrated in FIGS. 10C J, the ablators may be positioned around the circumference of the probe, around three sides of a substantially D-shaped probe, as multiple points, or around one to three sides of a substantially rectangular probe.
In one embodiment (not shown) the ablators are ultrasound transducers. The ablators in another embodiment are made of platinum. In one embodiment, the platinum is about 0.2 5 mm thick and about 1 5 mm long. In another embodiment, the platinum is about 2 mm thick and about 4 mm long.
1. A method of treating cardiac arrhythmia using epicardial ablation comprising the steps of
gripping an epicardial surface of the heart with the gripper device to position the ablator in contact with at least a portion of the heart along a circumference of the heart; and
applying said ablator to said epicardial surface at least once such that cardiac conductive tissue is ablated to create a lesion that encircles the heart.
2. The method of claim 1, wherein the step of applying said ablator comprises applying RF energy to said epicardial surface.
3. The method of claim 1, wherein the step of applying said ablator comprises applying laser energy to said epicardial surface.
4. The method of claim 1, wherein the step of applying said ablator comprises applying ultrasonic energy to said epicardial surface.
5. The method of claim 2, wherein the step of applying said ablator comprises applying RF energy to said epicardial surface using a plurality of ablators disposed on said inner surface of at least two arms.
6. The method of claim 3, wherein the step of applying said ablator comprises applying laser energy to said epicardial surface using a plurality of ablators disposed on said inner surface of at least two arms.
7. The method of claim 4, wherein the step of applying said ablator comprises applying ultrasonic energy to said epicardial surface using a plurality of ablators disposed on said inner surface of at least two arms.
8. A gripping apparatus for treating cardiac arrhythmia which forms encircling lesions upon an epicardial surface, the apparatus comprising
at least two moveable arm members, each moveable arm member having an inner and outer surface and at least one ablator on each of the moveable arm members;
wherein each moveable arm member is curved such that each moveable arm member may contact at least a curved portion of a circumference of a heart.
9. A gripping apparatus for treating cardiac arrhythmia which forms encircling lesions upon an epicardial surface, the apparatus comprising
at least two moveable arm members, each moveable arm member having an inner and outer surface and at least one ablator on each of the moveable arm members; and
an epicardial detector to assist in positioning the gripping apparatus for an ablation treatment;
10. The gripping apparatus of claim 9, wherein the epicardial detector comprises an ultrasound probe located on the inner surface of a first moveable arm member of said at least two moveable arm members to assess contact between the first moveable arm member and a surface of the heart.
11. The gripping apparatus of claim 9, wherein said at least two moveable arm members comprises a first moveable arm member and a second moveable arm member pivotally coupled such that the inner surfaces of the first and second moveable arm members face each other and form a substantially closed loop.
12. The gripping apparatus of claim 9, wherein the number of moveable arm members is two, and wherein the inner surfaces of the moveable arms face each other and are positioned such that they substantially encircle a circumference of the heart.
13. An apparatus for treating cardiac arrhythmia which forms encircling lesions upon an epicardial surface, the apparatus comprising
a substrate forming a substantially closed loop, the substrate having an inner surface and an outer surface;
at least one ablator on the inner surface; and
an epicardial detector to assist in positioning the apparatus for an ablation treatment;
wherein the substrate is curved such that it can contact at least a curved portion of a circumference of a heart.
14. The apparatus of claim 13, wherein the epicardial detector comprises an ultrasound probe located on the inner surface to assess contact between the substrate and a surface of the heart.
15. The apparatus of claim 13, wherein the substrate is flexible and adjustable to form loops of different sizes.
16. The apparatus of claim 13, wherein said at least one ablator comprises a plurality of ablators that are arranged on the substrate to create an ablation site interior to the substantially closed loop.
17. The apparatus of claim 13, further comprising a suction device to help maintain contact between the at least one ablator and the epicardial surface.
US11429948 1998-05-20 2006-05-09 Cardiac ablation system and method for treatment of cardiac arrhthmias and transmyocardial revascularization Abandoned US20060217699A1 (en)
US09082047 US6527767B2 (en) 1998-05-20 1998-05-20 Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization
US10032302 US20020052602A1 (en) 1998-05-20 2001-12-21 Device and method for forming a lesion
US10695110 US7041095B2 (en) 1998-05-20 2003-10-28 Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization
US11429948 US20060217699A1 (en) 1998-05-20 2006-05-09 Cardiac ablation system and method for treatment of cardiac arrhthmias and transmyocardial revascularization
US20060217699A1 true true US20060217699A1 (en) 2006-09-28
ID=22168706
US09082047 Expired - Fee Related US6527767B2 (en) 1998-05-20 1998-05-20 Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization
US10032302 Abandoned US20020052602A1 (en) 1998-05-20 2001-12-21 Device and method for forming a lesion
US10318293 Abandoned US20040204706A1 (en) 1998-05-20 2002-12-12 Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization
US10695110 Active US7041095B2 (en) 1998-05-20 2003-10-28 Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization
US11429948 Abandoned US20060217699A1 (en) 1998-05-20 2006-05-09 Cardiac ablation system and method for treatment of cardiac arrhthmias and transmyocardial revascularization
US (5) US6527767B2 (en)
EP (2) EP1079747B1 (en)
DE (2) DE69926625D1 (en)
WO (1) WO1999059486A3 (en)
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EP1593349A1 (en) 2005-11-09 application
EP1079747A2 (en) 2001-03-07 application
DE69926625T2 (en) 2006-06-08 grant
US20020052602A1 (en) 2002-05-02 application
US20040087941A1 (en) 2004-05-06 application
US7041095B2 (en) 2006-05-09 grant
US6527767B2 (en) 2003-03-04 grant
DE69926625D1 (en) 2005-09-15 grant
WO1999059486A2 (en) 1999-11-25 application
EP1593349B1 (en) 2013-09-25 grant
US20020058934A1 (en) 2002-05-16 application
WO1999059486A3 (en) 2000-04-06 application
EP1079747B1 (en) 2005-08-10 grant