Source: http://www.google.com/patents/US5769846?dq=7,446,777
Timestamp: 2017-01-23 04:57:22
Document Index: 705288577

Matched Legal Cases: ['art 1', 'art 1', 'art 1', 'art 1', 'art 1', 'art 1']

Patent US5769846 - Ablation apparatus for cardiac chambers - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsAn endocardial ablation apparatus, for introduction into a heart chamber formed by a wall, is provides. The ablation apparatus includes an inflatable, flexible porous membrane adapted to receive an electrolytic solution, and become inflated to substantially conform an exterior surface of the membrane...http://www.google.com/patents/US5769846?utm_source=gb-gplus-sharePatent US5769846 - Ablation apparatus for cardiac chambersAdvanced Patent SearchTry the new Google Patents, with machine-classified Google Scholar results, and Japanese and South Korean patents.Publication numberUS5769846 APublication typeGrantApplication numberUS 08/426,614Publication dateJun 23, 1998Filing dateApr 21, 1995Priority dateJun 24, 1994Fee statusPaidAlso published asUS5681308, WO1996000041A1Publication number08426614, 426614, US 5769846 A, US 5769846A, US-A-5769846, US5769846 A, US5769846AInventorsStuart D. Edwards, Hugh R. SharkeyOriginal AssigneeStuart D. EdwardsExport CitationBiBTeX, EndNote, RefManPatent Citations (33), Non-Patent Citations (12), Referenced by (372), Classifications (89), Legal Events (6) External Links: USPTO, USPTO Assignment, EspacenetAblation apparatus for cardiac chambers
US 5769846 AAbstract
An endocardial ablation apparatus, for introduction into a heart chamber formed by a wall, is provides. The ablation apparatus includes an inflatable, flexible porous membrane adapted to receive an electrolytic solution, and become inflated to substantially conform an exterior surface of the membrane to the wall of the heart chamber. An inner lumenal member is surrounded by and attached to the membrane. The inner lumenal member includes a lumen that permits blood flow through the inner lumenal member and heart chamber. An introducer catheter introduces the membrane and inner lumenal member into a selected heart chamber. A plurality of RF electrodes define a circuit positioned in the membrane or on an exterior surface of the inner lumenal member. The RF electrodes transfer thermal energy to the electrolytic solution. The electrolytic solution is the electrode that provides ablation of a selected site of the heart chamber. An RF power source is coupled to the RF electrodes. A source of electrolytic solution is coupled to the membrane.
1. A cardiac ablation device for ablating tissue within a chamber of the heart, comprising:an introducer catheter; a plurality of RF electrodes; a fluid permeable expandable member surrounding the electrodes; a member support attached to the expandable member, the member support, catheter and fluid permeable expandable member being arranged so as to allow blood flow through the heart chamber when the expandable member is expanded adjacent to the chamber; an electrical connector device connecting the electrode to an RF energy source; and a source adapted to provide an electrolytic fluid to the expandable member to expand the expandable member to conform to at least a portion of the heart chamber and to cause said fluid to create a thermal path between the electrodes and an inner surface of the heart chamber. 2. The ablation apparatus of claim 1, further comprising:electrical resources for acquiring electrical data from the heart and providing electrical function feedback to the RF power source which then supplies a therapeutic output to selected treatment electrodes of the plurality. 3. The ablation apparatus of claim 2, wherein the electrical resources includes devices for supplying a predetermined voltage at a predetermined frequency to heat the electrolytic solution to cause ablation in a preselected location in the wall of the heart chamber.
4. The ablation apparatus of claim 1, wherein the circuit is multiplexed.
5. The ablation apparatus of claim 1, wherein the membrane is secured to a distal end of the catheter for insertion into and removal from the heart chamber.
7. The ablation apparatus of claim 1, wherein the plurality of treatment electrodes are positioned in a spaced apart relationship from the conductive surface.
8. An endocardial ablation apparatus for introduction into a heart chamber formed by a wall, comprising:an expandable, flexible, fluid permeable member adapted to receive an electrolytic solution and become expanded to substantially conform a surface of the member to a surface within a heart chamber; a catheter for introducing the member into a heart chamber in a non-expanded state; a membrane support attached to the member, the membrane support, catheter and fluid permeable member being constructed so as to allow blood flow through the heart chamber when the fluid permeable member is expanded adjacent to a chamber wall; means for delivering an electrolytic solution to the member to expand the member; a plurality of treatment electrodes covered by the member; an RF power source coupled to the treatment electrodes; and a source of electrolytic solution fluidly coupled to the member, the solution coupling RF and thermal energy sufficient to ablate a portion of the tissue to the heart chamber. 9. The ablation apparatus of claim 8, further comprising:electrical resources for acquiring electrical data from the heart and providing electrical function feedback to the RF power source which then supplies a therapeutic output to selected treatment electrodes of the plurality. 10. The ablation apparatus of claim 9, wherein the electrical resources includes devices for supplying a predetermined voltage at a predetermined frequency to heat the electrolytic solution to cause ablation in a preselected location in the wall of the heart chamber.
11. The ablation apparatus of claim 8, wherein the circuit is multiplexed.
12. The ablation apparatus of claim 8, wherein the member is secured to a distal end of the catheter for insertion into and removal from the heart chamber.
14. An endocardial ablation apparatus for introduction into a heart chamber formed by a wall, comprising:an inflatable, flexible porous membrane adapted to receive an electrolytic solution and become inflated to substantially conform an exterior surface of the membrane to the wall of the heart chamber; a membrane support attached to the membrane; an introducer catheter that introduces the membrane and membrane support into a selected heart chamber, said catheter, membrane support and porous membrane being constructed to permit blood flow through the heart chamber when said porous membrane is inflated adjacent to the wall in the heart chamber; a plurality of RF electrodes defining a circuit positioned in or surrounded by the membrane, the RF electrodes transferring thermal energy to the electrolytic solution providing an ablation of a selected site of the heart chamber; an RF power source coupled to the RF electrodes; and a source of electrolytic solution coupled to the membrane for coupling thermal energy to the selected site. 15. The ablation apparatus of claim 14, wherein the membrane support comprises an inner lumenal member including a lumen that permits blood flow through the inner lumenal member and the heart chamber, and wherein the plurality of RF electrodes are positioned on the exterior surface of the inner lumenal member.
16. The ablation apparatus of claim 15, wherein the lumen extends along a longitudinal axis of the inner lumenal member.
17. The ablation apparatus of claim 15, wherein the lumen does not pass blood through the inner lumenal member to the membrane.
18. The ablation apparatus of claim 15, wherein the membrane and the inner lumenal member include a plurality of adjacently positioned apertures permitting blood flow at an inlet of the superior vena cava, an inlet of the inferior vena cava, and at the tricuspid valve annulus.
19. The ablation apparatus of claim 15, wherein the plurality of RF electrodes are positioned between the exterior surface of the inner lumenal member and the exterior surface of the membrane.
20. The ablation apparatus of claim 14, further comprising:electrical resources in electrical communication with the RF electrodes for acquiring electrical data from the heart and providing electrical function feedback to the RF power source which then supplies a therapeutic output to selected RF electrodes of the plurality. 21. The ablation apparatus of claim 20, wherein the RF power source supplies a bipolar therapeutic output to selected RF electrodes such that the apparatus operates in a bipolar mode.
22. The ablation apparatus of claim 20, wherein the electrical resources includes members for recording mapping potentials encountered by the RF electrodes.
23. The ablation apparatus of claim 20, wherein the electrical resources includes devices for supplying a predetermined voltage at a predetermined frequency to selected RF electrodes to cause ablation in a preselected location in the wall of the heart chamber.
24. The ablation apparatus of claim 14, further comprising:a plurality of recording electrodes positioned on an exterior surface of the support member. 25. The ablation apparatus of claim 24, wherein the membrane support comprises an inner luminal member including a lumen and wherein the RF electrodes are positioned on an exterior surface of the inner luminal member.
26. The ablation apparatus of claim 14, further comprising:a ground pad electrode attached to an exterior surface of a patient. 27. The ablation apparatus of claim 14, wherein the circuit is a flexible circuit.
28. The ablation apparatus of claim 14, wherein the plurality of RF electrodes are multiplexed.
29. The ablation apparatus of claim 14, wherein the circuit is multiplexed.
30. The ablation apparatus of claim 14, wherein the membrane is rolled around the introducer catheter distal end for removal from the heart chamber.
31. The ablation apparatus of claim 14, wherein the circuit includes one or more impedance monitors.
32. The ablation apparatus of claim 14, wherein the circuit includes one or more temperature monitors.
33. The ablation apparatus of claim 14, wherein the circuit includes one or more devices to monitor circuit continuity.
34. The ablation apparatus of claim 14, wherein the circuit includes a plurality of segments.
35. The ablation apparatus of claim 14, wherein the membrane includes a deposition of ions to improve RF and thermal energy transfer.
36. The ablation apparatus of claim 14, wherein the exterior surface of the membrane is coated with an anticoagulating material.
This application is a continuation-in-part of U.S. patent application Ser. No. 08/345,142 entitled "Ablation Apparatus For Cardiac Chambers" by Edwards filed Nov. 28, 1994 now U.S. Pat. No. 5,681,308, which is a continuation-in-part of U.S. patent application Ser. No. 08/319,373 entitled "Thin Layer Ablation Apparatus" by Baker et al, filed Oct. 6, 1994 now U.S. Pat. No.5,575,788, which is a continuation-in-part of U.S. patent application Ser. No. 08/286,862 entitled "Thin Layer Ablation Apparatus" by Edwards et al, filed Aug. 4, 1994 now U.S. Pat. No. 5,558,672, which is a continuation-in-part of U.S. patent application Ser. No. 08/272,162 entitled "Thin Layer Ablation Apparatus" by Edwards, et al, filed Jul. 7, 1994 now U.S. Pat. No. 5,569,241, which is a continuation-in-part of U.S. patent application Ser. No. 08/265,459 entitled "Thin Layer Ablation Apparatus" by Edwards filed Jun. 24, 1994 now U.S. Pat. No. 5,505,730, all of which are incorporated by reference.
This invention relates to an ablation and mapping apparatus for use in the field of cardiac arrhythmia, and more particularly to an apparatus for treating atrial fibrillation.
The Sino Atrial ("SA") node provides impulses which control the normal rhythmic contractions of the heart atria and the ventricles. This involves the transmission of the normal cardiac conduction pathways in the atria and the ventricles, which cause the heart to contract and relax in an orderly sequence at a rate set by the SA node.
A depolarization impulse begins with the SA node and spreads as an electrical wave in the SA node in the right atrium to the left atrium and down toward the lower chambers of the heart. At the junction of the atria and the ventricles there is another node known as the atrioventricular (AV) node. The impulse is conducted through the AV node in a slower fashion so as to coordinate the mechanical function of the atria and ventricles. The impulse continues to a common pathway, known as the bundle of HIS between the right and left ventricles, and then into the Purkinje system and into multiple paths, the right and left bundle branches, each bundle branch supplying one ventricle. Each bundle branch divides into an extensive network of finer paths of conducting tissue, which spread from the inner to the outer surfaces of the heart and are referred to as the Purkinje fibers. These fibers conduct the depolarization impulse into all portions of the ventricular myocardium.
As long as this depolarization impulse system is intact impulses are transmitted normally and the normal sinos rhythm is maintained. Sometimes there are variations from the normal rhythm of the heart beat which are manifested as abnormal spontaneous contractions or as rapid sequences of impulses that dangerously speed the heart rhythm (tachycardia), or the heart rate may slow below normal (bradycardia) which can also compromise the individual. These abnormalities are clinically referred to as arrhythmias and they can cause numerous unwanted and potentially dangerous complications for patients.
The arrhythmogenic focus that initiates tachyarrhythmias is most often located in the endocardium or interior surface of the heart. Since the heart muscle contractions result from the progression of an excitation wave of electrical impulses. The location of an arrhythmogenic focus is accomplished by identifying the point from where the abnormal excitation wave originates by the use of intra-cardiac mapping.
Ventricular tachycardia (VT) and other ventricular arrhythmias, have been treated with a number of drugs such as lidocaine, quinidine, aminodrone and procainamide. Beta blocking drugs have also been used. Certain surgical procedures have been used to ablate the foci of arrhythmias in either the atria or the ventricles, when drug therapy has been ineffective in preventing tacharrhythmias.
One surgical approach involves a thoracotomy with an incision through the pericardium and heart muscle. The arrhythmogenic focus is located, frozen or surgically removed. The surgical procedure utilizes either a hand held electrical mapping probe or a computerized array of electrodes that are placed on the endocardium (inner wall) or the epicardium (outside wall) of the heart, which acquire electrical activation data to identify the site of origin of the arrhythmia. Less traumatic solutions have been developed.
Various types of intervention catheters have been developed and used for diagnosis and treatment of a number of cardiac abnormalities to avoid the trauma of open heart surgery, which requires a prolonged period of hospitalization and recuperation. In percutaneous catheter procedures, a catheter with recording electrodes is positioned in the heart under fluoroscopic guidance. Following acquisition of the electrical activation data, ablation energy is then delivered via the catheters either in a radiology suite or in the cardiac catheterization lab.
Catheters have been proposed to map arrhythmogenic foci, as disclosed in U.S. Pat. Nos.: 5,156,151; 5,255,697; 5,228,442; 5,263,493 and 5,279,299. However, these catheters fail to provide for the identification, isolation and quick instruction to treat an arrhythmogenic focus. The successful use of radio frequency (RF) energy to eliminate VT requires an accurate "pace map" of the earliest local activation from a catheter in contact with the endocardium.
For patients with coronary artery disease, failure to eliminate VT using RF energy delivered through a catheter has been hypothesized to be due to the small size and shallow depth of the lesion created by RF energy, preventing it from reaching subendocardial (or deeper) regions of the heart. Additional contributing factors may also include inaccurate mapping in scarred ventricles or a location of the arrhythmogenic focus at sites below the surface of the endocardium. Direct current and RF energy have been utilized in these attempts.
There has been successful elimination of idiopathic, usually in the right ventricular VT, in patients without structural heart disease with direct current countershocks, however, complications such as trauma and risk of ventricular perforation associated with direct current countershocks make this technique less desirable unless very low energies are used.
It would be desirable to provide an ablation apparatus which is inserted into a heart chamber, such as an atrium which expands from a folded configuration, identifies and localizes the arrhythmogenic focus and then quickly instructs an energy delivery source to treat the arrhythmogenic focus. There is a need to treat arrhythmogenic foci deep in the endocardium with a system that can be in intimate contact with the irregular surface of the endocardium. It would be desirable to provide a cardiac ablation apparatus which provides ablation depths suitable to effectively treat arrhythmogenic foci (transmurally across the muscular wall of the heart), including an ability to reach the subendocardial or deeper region of the heart.
Accordingly, an object of the present invention is to provide a cardiac ablation apparatus which provides a plurality of RF electrode segments for the controlled ablation of the endocardium and transmural regions of the heart muscle.
Another object of the present invention is to provide a cardiac ablation apparatus which provides an expandable member that can simultaneously address the entire surface of a chamber and surrounds an inner lumenal member which provides blood flow through an interior lumen of the inner lumenal member.
A further object of the present invention is to provide a cardiac ablation apparatus which positions the RF electrodes on an exterior surface of an inner lumenal member that uses an electrolytic solution to effectively ablate selected zones of tissue, without intimate contact between the RF electrodes and the heart chamber.
Yet another object of the present invention is to provide a cardiac ablation apparatus which provides an electrolytic solution delivered through the microporous membrane to the endocardium that acts as a part of the RF circuit.
Another object of the invention is to provide a cardiac ablation apparatus which includes a microporous membrane, inner lumenal member and electrodes positioned on an outside surface of the inner lumenal member.
Still another object of the invention is to provide a cardiac ablation apparatus which includes a microporous membrane, inner lumenal member, RF electrodes positioned on at outside surface of the inner lumenal member, and a plurality of recording electrodes positioned on an exterior surface of the membrane.
A further object of the invention is to provide a cardiac ablation apparatus which provides a flexible circuit of RF electrodes with segments that can be multiplexed to provide tailored areas of ablation.
Yet another object of the present invention is to provide a cardiac ablation and mapping apparatus that includes a microporous membrane in direct contact with the endocardium, and resources to map the heart in order to determine the origin of the arrhythmia by identifying the location of endocardial activation and then to ablate an arrhythmogenic focus with an electrolytic solution.
These and other objects of the invention are provided in an endocardial mapping and ablation apparatus that is introduced into a heart chamber, particularly an atrium, to treat atrial fibrillation. An inflatable flexible porous membrane is adapted to receive an electrolytic solution and become inflated to substantially conform an exterior surface of the membrane to the wall of the heart chamber. An inner lumenal member is surrounded by and attached to the membrane. The inner lumenal member includes a lumen that permits blood flow through the inner lumenal member and the heart chamber. An introducer catheter introduces the membrane and inner lumenal member into a selected heart chamber. A plurality of RF electrodes define a circuit positioned in the membrane or on an exterior surface of the inner lumenal member. The RF electrodes transfer thermal energy to the electrolytic solution. The electrolytic solution is the electrodes provides an ablation of a selected site of the heart chamber. An RF power source is coupled to the RF electrodes. A source of electrolytic solution is coupled to the membrane.
The ablation apparatus further includes electrical resources for acquiring electrical data from the heart and providing electrical function feedback to the RF generator, which then supplies a therapeutic output of RF energy to the plurality of RF electrodes in response to the electrical data with a transfer of energy from the RF electrodes to an electrolyte solution in close proximity to the RF electrodes. The inner lumenal member structure includes the lumen that permits blood to flow through the right atrium at the inlet of the superior vena cava, the inlet of the inferior vena cava and at the tricuspid annulus. Blood does not flow from the lumen into the membrane. A ground pad can be attached to an exterior surface of a patient for monopolar use or the apparatus can be operated in a bipolar mode.
Attachment members are positioned on a catheter distal end and attach to the membrane or inner lumenal member. After the procedure is completed, the membrane and inner lumenal member are rolled around the catheter distal end and removed from the heart chamber.
An exterior surface of the membrane, e.g., the surface located adjacent to the endocardium, can be coated with an anti-coagulating material.
The RF electrodes can also be positioned in an interior of the membrane. In this embodiment, the RF electrodes are spaced apart from the membrane's exterior surface so that there is no direct contact between the RF electrodes and the endocardium. Instead the actual electrode which transmits ablative energy to the selected endocardium site is the electrolytic solution.
The RF electrodes can form a flexible circuit with associated thermocouples. Individual RF electrodes are treated as segments in the flexible circuit. These segments can be multiplexed by energizing different RF electrodes. Ablation of the endocardium can be at a desired level, including the subendocardium and deeper, based on the detected characteristic of the arrhythmogenic focus.
The present invention provides mapping and detection of the arrhythmogenic foci, ablation at the appropriate depth and subsequent re-mapping, and allows the blood to flow through the heart chamber is substantially uninterrupted. The RF ablation energy is delivered from the RF electrodes to surrounding electrolytic solution. The heated electrolytic solution transfers thermal energy from the RF electrodes and creates an ablation at selected endocardium sites
FIG. 1 is a perspective view of the cardiac ablation and mapping apparatus of the invention illustrating the creation of ablation zones suitable for the "MAZE" procedure. An ablation MAZE is illustrated.
FIG. 3 is a perspective view of an exterior wall of the inner lumenal member of the invention with the electrodes positioned on the exterior wall.
FIG. 4 is an illustration of an ablation device with direct ablation of the endocardium by an electrolytic solution which has been in thermal contact with the RF electrodes.
FIG. 5 is a diagram of the relative impedance of the circuit of the present invention.
FIG. 6 is a cross-sectional view of the ablation and mapping apparatus of the invention with the RF electrodes positioned within the membrane.
FIG. 7 is a perspective view of a circuit on the exterior of the inner lumenal member with RF electrode segments.
FIG. 8 is an illustration of a plurality of RF electrodes suitable for use with the present invention.
FIG. 11 is a cross-sectional view of the ablation apparatus being positioned in the right atrium, which illustrates the seating of the apparatus in the atrium.
FIG. 15 is schematic diagram of the cardiac ablation and mapping system of the invention.
The present invention provides a cardiac ablation and mapping system 10, which includes a cardiac ablation and mapping apparatus. Cardiac ablation and mapping apparatus includes a microporous membrane, surrounding an inner lumenal member, a plurality of RF electrodes that are positioned between an exterior surface of the inner lumenal member and an exterior surface of the microporous membrane, and a plurality of recording electrodes positioned on the exterior surface of the membrane. The membrane is made of a material that permits it to closely conform to the wall of the heart and expand by the introduction of fluid, such as an electrolytic solution. The inner lumenal member can be a balloon or other suitable mechanical apparatus, which permits blood to flow uninterrupted through a lumen of the inner lumenal member when it is positioned in the heart chamber but does not permit blood to pass through the lumen and into the microporous membrane.
The ablation apparatus is introduced into a selected heart chamber in a non-expanded configuration, in a folded or rolled configuration around a distal end of a catheter. Once the ablation apparatus is positioned in the desired heart chamber it is expanded. The expansion occurs when electrolytic solution is introduced into the membrane. The RF electrodes are not in direct physical contact with the heart wall. Recording electrodes and electrical resources are included to map the heart to acquire electrical activation data to seek the origin of the arrhythmia, provide early local endocardial activation, electrical function feedback to an RF generator, and then provide a therapeutic output via the RF electrodes and surrounding electrolytic solution to ablate an arrhythmogenic focus.
An uneven penetration of energy to the endocardium can be produced. This is particularly desired in the MAZE procedure. Across the endocardium, tissue is ablated in a maze like pattern, eliminating reentry pathways.
Referring now to FIGS. 1 and 2, cardiac ablation and mapping system 10, particularly suitable for the right atrium includes a cardiac ablation and mapping apparatus 12. Ablation apparatus 12 includes a porous membrane 14 which surrounds an inner lumenal member 16. Inner lumenal member 16 provides a separation of membrane 14 and the electrolytic solution from the flow of blood through a lumen formed in the inner lumenal member 16, as more fully explained hereafter. Membrane 14 can be of the microporous type and be made of Mylar, expanded PFT such as Gortex available from Gore Company and the like. Membrane 14 is relatively strong and sufficiently heat resistant for the amount of thermal energy that is supplied to the endocardium. The flow rate of electrolytic solution through membrane 14 is determined by, (i) the porosity of membrane 14 and (ii) the introduction rate of the electrolytic solution to membrane 14. A plurality of recording electrodes 15 are positioned on an exterior surface of membrane 14. Recording electrodes 15 can be MAP monophasic action potential electrodes, comprised of a silver or a silver chloride matrix which can be either deposited on the surface of membrane 14 or more conventional intracardial electrode compositions. Alternatively, recording electrodes 15 can be independent electrodes that are placed on the outside surface of membrane 14.
Membrane 14 substantially surrounds inner lumenal member 16. Inner lumenal member 16 includes a sealed proximal end 18 and a sealed distal end 20. It will be appreciated that ends 18 and 20 can be configured to be positioned next to the associated venous inlet or valve, to more readily orient ablation apparatus 12 and position it properly in the left or right atrium. Ends 18 and 20 are sealed but include an aperture 22 and 24 respectively, formed therein, defining a central lumen 26 which extends in a general longitudinal direction through inner lumenal member 16 permitting blood to flow through inner lumenal member 16 and the heart chamber. Inner lumenal member 16 is attached to membrane 14 and is expanded to a non-distensible state when membrane 14 is inflated with solution.
A catheter 28, with a distal end 30, may be attached to membrane 14 or inner lumenal member 16 with attachment devices including, but not limited to hooks, loops and the like. Catheter 28 may be a combination of a latex/silicon rubber composite that has a non-pliable, non-flexible, inner sleeve or glove. Catheter 28 can also serve as a "spine" for ablation apparatus 12. Membrane 14 and inner lumenal member 16 are initially in a folded or rolled type of basket, non-expanded configuration, and wound around catheter distal end 30. Catheter distal end 30 can be introduced into the right atrium through, (i) the subclavian vein, requiring a catheter 28 length of about 30 to 40 cm, (ii) the internal jugular, requiring a catheter 28 length of about 30 to 40 cm or (iii) the femoral artery, requiring a catheter 28 length of about 110 cm.
Generally, cardiac ablation and mapping apparatus 12 can be a monopolar or bipolar RF electrode system that is capable of expanding so that membrane 14 becomes expanded within the heart chamber, and RF and thermal energy are delivered by electrolytic solution to the wall of the heart through membrane 14. RF and thermal energy are passed by the electrolytic solution through the endocardium and subendocardium or deeper, for a time period sufficient to achieve a desired level of ablation at an arrhythmogenic focus. It can be used in the "MAZE" procedure which does not address a particular focus but creates a condition where reentry is inhibited.
In a monopolar mode, an RF current flows through body tissue from a return electrode in the form of a conductive pad applied to the patient's outer skin. Maximum heating occurs where the current density is the greatest. The electric current flowing through the endocardium causes heating due to the resistance of the tissue. Intravascular or cardial ablation can be accomplished as a relatively simple medical procedure.
Membrane 14 conforms tightly with the interior of the heart so that substantially all of the heart wall is in contact with the exterior surface of membrane 14. Membrane 14 fits substantially into the entire heart chamber and does not have to be moved about the heart to complete the treatment. Membrane 14 is made of a material that suitably conforms to a surface to be ablated and can have a thickness in the range of about 0.01 to 2.0 cm. Fluid flow can be continuous or non-continuous. The electrolytic solution delivered to membrane 14 can be heated, as more fully explained below.
Referring now to FIG. 3, a plurality of RF electrodes 34 are positioned on an exterior surface of inner lumenal member 16. There is no direct contact or RF electrodes 34 to the endocardium.
An electrolytic solution, including but not limited to saline, flows through membrane 14 and comes in thermal contact with RF electrodes 34. Thermal energy is then delivered, via the electrolytic solution, to the endocardium. Thus, the actual electrode for thermal treatment purposes is not RF electrodes 34 but is the electrolytic solution which receives thermal energy from RF electrodes 34, as illustrated in FIG. 4.
The impedance of the circuit of the present invention is illustrated in FIG. 5. There is a constant impedance from the RF energy source to RF electrodes 34. When electrolytic solution is placed in intimate contact with RF electrodes 34 there is a decrease in impedance. At the tissue interface the impedance increases because there is higher resistance. Through the rest of the body, and to ground, the impedance is then constant.
RF electrodes 34 can also be positioned in membrane 14, as shown in FIG. 6. Again, energy transfer occurs through the electrolytic solution which is in contact with RF electrodes 34. The electrolytic solution serves as a thermal transfer electrode and there is no direct contact of RF electrodes 34 to the endocardium.
Referring now to FIG. 7, a circuit 38 which can be flexible and made of individual circuit segments 40, can be a printed circuit that is deposited, etched or painted with a conductive ink on inner lumenal member 16, or on a separate support member. Each circuit segment 40 or RF electrode 34 connects to a separate feedwire 42, with all of the wires going to a ribbon connector 44. Feedwires 42 are insulated. Each RF electrode 34 or circuit segment 40, is wired with a constantan wire in order to receive RF energy from an RF energy source. A copper wire is connected to each constantan wire. This results in the formation of a T type thermocouple "TC".
RF power is applied to the desired RF electrode 34 delivering thermal energy only to the electrolytic solution in proximity with the desired RF electrode, which then transfers thermal energy to a selected site of the endocardium. The use of different RF electrodes 34 permits circuit 38 to be multiplexed. The size of individual RF electrodes 34 and circuit segments 40 is designed to provide the correct current density. RF power can be sequentially supplied to each RF electrode 34 and feedwire 42 in ribbon connector 44, or it can be applied to only certain selected feedwires 42. Enabling only selected RF electrodes 34 to deliver RF and thermal energy individually to the electrolytic solution and then to the endocardium.
One or more impedance monitors 46 can be used to confirm, before an ablation event, so that good coupling of energy is achieved. Also, included is one or more thermal sensors 48. Thermal sensors 48 are conventional thermistors or thermocouples and can be positioned on RF electrodes 34 or segments 40.
With reference now to FIG. 8, individual RF electrodes 34 can be used and multiplexed in either mono-polar or bi-polar configurations. Circuit segments 40 and RF electrodes 34 are capable of multiplexing so that only one delivers RF energy to surrounding electrolytic solution at a particular time period. RF energy is selectively delivered so that the amount of energy delivered by each circuit segment 40 or RF electrode 34 can vary depending on the detected characteristics of endocardium at a particular area.
In FIG. 9, ablation apparatus 12 is shown as being introduced through the jugular or subclavian veins. In FIG. 10, ablation recording electrodes 15 are shown as being positioned on an exterior surface of membrane 14 in a folded or rolled configuration as ablation apparatus 12 is introduced into the right atrium. Ablation apparatus 12 begins to unfold in FIG. 11, with end 20 seeking its position in the tricuspid annulus. In FIG. 12, ablation apparatus 12 has become expanded so that membrane 14, and recording electrodes 15, are in a contacting relationship with the wall of the right atrium. Blood flow is not impeded and flows through lumen 26 of inner lumenal member 16 through apertures 22 and 24 respectively. With ablation apparatus 12 in its expanded state and positioned in an atrium there is constrained contraction of the atrium. Mapping and analysis of the heart chamber activation, with the use of recording electrodes 15, occurs substantially at once and can occur within less than ten heart beats or sufficiently long enough to obtain the required intracavitary map.
FIG. 13, shows, uninterrupted blood flow through the superior vena cava, inferior vena cava and the tricuspid value. The electrical data output and intracavitary map can be presented on a viewing screen.
In FIG. 14, ablation apparatus 12 is introduced into the left atrium . There are four pulmonary veins. Ablation apparatus 12 covers only two of the pulmonary veins at one time and the mitral valve. Therefore, ablation apparatus 12 is flipped over in the right atrium to cover the other two pulmonary veins and mitral valve. Ablation apparatus 12 is introduced into the left atrium either with a puncture type of structure across the septal wall or through a patent ductus.
Referring now to FIG. 15, endocardial ablation and mapping system 10 is illustrated. A high voltage connector 50 and a signal connector are connected to the electrodes (not shown) and form part of catheter 28. A cable 29 is connected to an interface module 54 which supplies and receives signals to and from the electrodes and from a computer 58 that is provided with a disc drive 60 and a monitor 62. Computer 58 is also provided with a keyboard (not shown) for use in controlling the operation of computer 58.
As shown in FIG. 16, ablation system 10 can include an RF energy source 66 and an electrolytic solution source 68, all coupled to ablation apparatus 12. RF energy source 66 can incorporate a controller as well as both temperature and impedance monitoring devices. An output is associated with RF energy source 66.
Electrolytic solution source 68 can include a pump/pressure flow control device 70, well known to those skilled in the art. A heating device for heating the electrolytic solution can be associated with electrolytic solution source 68. Suitable heating devices include, but are not limited to coils, bipolar RF electrodes, catalysts, and other devices.
Referring to FIGS. 15-17, as soon as distal end 30 of catheter 28 is positioned within the desired chamber, energy conduction connector 50 and signal connector 52 are interconnected with mating connectors 74 and 76, so that the plurality of electrodes are connected to interface module 54 and computer 58. Membrane 14 is then expanded by electrolytic solution causing membrane 14 to become distended and be self-retained in the heart.
Electrolytic solution in membrane 14 can be heated to a pre-selected temperature which can be modified and adjusted as necessary. For example, electrolytic solution can be heated and maintained at a temperature between about 40 to 50 degrees C. The electrolytic solution can be brought to a first temperature when it is introduced into membrane 14. The initial temperature of the electrolytic solution is insufficient to create tissue ablation. RF energy is delivered to selected RF electrodes 34 transferring thermal energy to surrounding electrolytic solution, which then contacts endocardial tissue causing a desired ablation effect. The amount of energy transferred from RF electrodes 34 to the surrounding electrolytic solution is sufficient to cause the surrounding electrolytic solution to become an electrode that transfers thermal energy to endocardial tissue and result in ablation. Providing pre-heated electrolytic solution to membrane 14 merely reduces the level of necessary RF energy delivered to RF electrodes.
Once this is accomplished, membrane 14 is in a contacting and conforming relationship to the wall of the chamber of the heart. Thermal energy is conducted through membrane 14 and to a selected tissue site of the heart chamber to cause ablation. When membrane 14 becomes expanded its exterior surface and recording electrodes 15 are in a contacting relationship with the wall of the chamber. Membrane 14 moves with the chamber with its constrained contraction and expansion. Lumen 26 in inner lumenal member 16 permits blood to flow in and out of the heart chamber.
Electrical resources acquire electrical data from the heart and provide electrical function feedback to RF generator 66. RF generator 66 then supplies a therapeutic output to RF electrodes 34. These electrical resources map the heart with recording electrodes 15 to acquire activation data, seek the origin of the arrhythmia, provide early local endocardium activation, provide ablation, further mapping, and further ablation if required.
Operation and use of cardiac ablation and mapping apparatus 12 in connection with interrace module 56 and computer 58 is now described.
In one specific embodiment, the plurality of RF electrodes 34 can be operated in the bipolar mode. Bipolar RF electrode pairs are connected to a differential amplifier 78. Each of the differential amplifiers 78 are provided with input circuitry 80, which consists of current limiting resistors R1 and R2 connected to diodes D1 and D2 on opposite sides of the input line, with the diode D2 being connected to ground and diode D1 being connected to a positive voltage. Diodes D4 and D6 are connected to the other input line with diode D4 being connected to ground and diode D6 being connected to the positive voltage. These serially connected diodes serve to protect the inputs to differential amplifiers 78 during the time that ablation voltages are being applied.
The input circuitry has the capability of limiting the voltage rise at the inputs of differential amplifiers 78 to approximately 1/2 volt. Differential amplifiers 78 have a suitable gain as for example typically between 100 and 500.
Outputs of differential amplifiers 78 are connected by a number of lines depending of the number of RF electrodes and pairs to an analog multiplexer 82. Multiplexer 82 can have a number of inputs, as for example, 64. Inputs are connected to circuit 38 at connector 44. Certain inputs can be grounded. While other inputs can be connected to a positive voltage supply. One or two of the inputs can be utilized for providing a synchronization signal for demultiplexing, as hereinafter described.
Multiplexer 82 is driven by a 6 bit binary counter 84, which is supplied with a clock frequency from an oscillator 86 that is controlled by crystal 88 of a suitable frequency as for example, 200 KHz. The 200 KHz oscillator frequency can provide a five microsecond cycle length per channel. Counter 84 supplies an output 90 on six lines 92 to multiplexer 82. Multiplexer 82 is provided with an output line 94 which is controlled by binary counter 84, so that the output from each of the amplifiers 78 appear on output line 94 for the five microsecond pulse length provided by oscillator 86.
Information can be received on as many as 56 channels with each channel having a 5 microsecond duration, followed by a synchronizing pulse that is 20 microseconds wide to complete one cycle of multiplexer 82 of 320 microseconds, followed by the next 320 microsecond cycle. This provides an effective sampling rate of about 3000 samples per second.
Output 94 is connected to a buffer amplifier 100 which provides its output 102 on pin 3 of connector 52. The other pins 1 and 2 in connector 52 are connected to ground and a plus voltage, respectively, in interface module 54.
A multiplexer chip 104 is connected to leads 106 which in turn are connected to selected RF electrodes 34 (FIG. 15). The power of multiplexer chip 104, associated with cardiac ablation and mapping apparatus 12, is supplied from interface module 54 through pins 1 and 2 of connector 76, as shown in FIG. 17. Pin 3 of connector 76 receives the output signal from pin 3 of connector 52 and supplies it through a line 108 to a demultiplexer 110. Demultiplexer 110 is supplied with a plurality of output channels 112. Assuming there are 64 input channels in multiplexer 82, there will be a corresponding number of output channels 112 in demultiplexer 110.
The information on line 108, containing the synchronizing signal, is also supplied through a capacitor Cl to a phase locked loop 114, and is connected to an RF filter network 116 consisting of a resistor R5 and a capacitor C2 connected to ground. Phase locked loop 114 is provided with an output line 118 and has provided thereon a reconstructed 200 KHz voltage controlled oscillator output which is supplied to a counter 120. Counter 120 is provided with a plurality of output lines 122 which are connected to demultiplexer 110. Lines 122 are provided with frequencies ranging from 100 KHz to 3,125 KHz, with the 3,125 being connected to phase locked loop 114 by a line 124 which serves to couple the VCO output to phase locked loop 114. The use of the phase locked loop 114 allows the reconstruction of the 200 KHz clock, which is synchronized to the 200 KHz in multiplexer chip 104.
Demultiplexer 110 serves to demultiplex the information supplied from multiplexer 82 and supplies it on the 56 channels 112 to circuitry 126; which includes sample and hold circuitry, filter circuitry and A/D converters, to provide an output on lines 128 in the form of a signal that is supplied to computer 58 and display monitor 62. Computer 58 is provided with software that has the capability of analyzing information being supplied to it by utilizing sampling techniques well known to those in the art. Computer 58 performs an analysis of the information including but not limited to mapping of the heart to acquire electrical activation data and early endocardial activation. With the use of propagation and delay time analysis computer 58 identifies and isolates the area within a heart chamber which may contain an arrhythmogenic focus to be ablated. This information is displayed on the screen of monitor 62 so that it can be reviewed by the physician who then decides whether or not ablation is desirable.
After the mapping has been accomplished by use of cardiac ablation and mapping apparatus 12 (recording electrodes 15), and an arrhythmogenic focus has been located, the same cardiac ablation and mapping apparatus 12, while still in place in the heart chamber, is used for accomplishing the ablation with electrolytic solution receiving RF energy from RF electrodes 34. The attending physician inputs the desired commands to the keyboard connected to computer 58 to give the command to proceed with an ablation. As soon as such a command is received by computer 58, it sends a channel number serially to pin 3 of connector 74; which is connected to the corresponding pin 3 of connector 50 in a serial to parallel shift register 130 that is disposed in electrode grid ablation apparatus 12. Shift register 130 supplies the channel number to demultiplexer 110 on the six lines 132 to a high voltage demultiplexer 134. Shift register 130 is provided with a clocking signal on pin 4 of connector 50 that is supplied with a clock signal on the corresponding pin 4 of connector 74 from computer 58.
The output of computer 58 is also connected to a high voltage ablation power supply 136. High voltage ablation power supply 136 is programmable as to channel number and the amount of energy to be supplied on the channel. High voltage ablation power supply 136 supplies its output to pins 1 and 2 of connector 74, connected to corresponding pins 1 and 2 of connector 50, which are connected to demultiplexer 134. Demultiplexer 134 is provided with high voltage transistors which can tolerate the ablation voltages supplied by ablation power supply 136. Ablation power supply 136 can supply a high voltage, high frequency (typically 50-100 volts at 750 KHz to 1 MHz) pulse across the pins 1 and 2 of connector 74. This high voltage pulse appears on the corresponding the pins 1 and 2 of connector 50, and is supplied by demultiplexer 134 to the appropriate channel and appropriate RF electrode 34 or RF electrode pair through lines 138 connected to leads 106. This pulse is transmitted across a RF electrode 34 or RF electrode pair, and causes an ablation, of suitable depth, to occur in the endocardium of the right atrium. Alternatively, ablation can be accomplished between one or more RF electrodes 34 and an external ground RF electrode placed on the chest of the patient. In this manner, it can be seen that a highly controlled ablation is provided which is precisely positioned with respect to the selected RF electrodes 34 which can be multiplexed, and a maze type of ablation can be produced.
Several milliseconds after the ablation pulse has been supplied to the appropriate RF electrode or electrode pair, mapping can again be resumed to ascertain whether or not arrhythmogenic foci are still present. If the mapping indicates that atrial fibrillation is inducible additional pulses can be programmed by computer 58 and supplied to other appropriate RF electrodes 34 until the arrhythmias can no longer be initiated.
Programmed stimulation can be performed by using a selectable number of recording electrodes 15. In this mode of operation, interface 54 provides a programmable level of low voltage pulses (5-10 volts) via the high voltage connector 58 to stimulate the heart with synchronized pulses in order to induce or convert an arrhythmia.
Cardiac ablation and mapping apparatus 12 can be provided with an increased number or decreased number of RF electrodes 34 if desired. Any number of channels can be readily provided in multiplexer 82 and demultiplexer 110. The shape of circuit segments 40 can be made so that they conform to the wall of the heart, through membrane 14, as it expands and contracts through the entire cardiac cycle. Segments 40 do not directly touch the wall of the heart chamber. Instead, they are preferably formed on the exterior of inner lumenal member 16. Membrane 14 maintains intimate contact with the wall of the heart chamber, minimizing the amount of energy which is dissipated into the blood pool within the cavity of the heart during ablation.
Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS1620929 *Feb 5, 1925Mar 15, 1927Wallerich George WHeat-therapy method and meansUS1827306 *Sep 14, 1925Oct 13, 1931Fischer & Co H GElectrodeUS3645265 *Jun 25, 1969Feb 29, 1972Majzlin GregoryIntrauterine cauterizing deviceUS3840016 *Mar 7, 1973Oct 8, 1974Lindemann HElectrocoagulation-bougie for the intrauterine tube sterilizationUS3924628 *Dec 1, 1972Dec 9, 1975Paul E BinghamCyrogenic bladder for necrosing tissue cellsUS3948270 *Oct 15, 1974Apr 6, 1976Hasson Harrith MUterine cannulaUS4057063 *Feb 27, 1976Nov 8, 1977U.S. Philips CorporationDevice for sterilization by transuterine tube coagulationUS4676258 *Jun 5, 1986Jun 30, 1987Kureha Kagaku Kogyo Kabushiki KaishaDevice for hyperthermiaUS4799479 *Jan 8, 1987Jan 24, 1989The Beth Israel Hospital AssociationMethod and apparatus for angioplastyUS4865047 *Jun 30, 1988Sep 12, 1989City Of HopeHyperthermia applicatorUS4949718 *Sep 9, 1988Aug 21, 1990Gynelab ProductsIntrauterine cauterizing apparatusUS4960133 *Nov 21, 1988Oct 2, 1990Brunswick Manufacturing Co., Inc.Esophageal electrodeUS4961435 *Oct 17, 1988Oct 9, 1990Kureha Kagaku Kogyo Kabushiki KaishiHigh-frequency capacitive heating electrode deviceUS4979948 *Apr 13, 1989Dec 25, 1990Purdue Research FoundationMethod and apparatus for thermally destroying a layer of an organUS5047028 *May 3, 1990Sep 10, 1991Quinghua QianMethod for inducing thrombosis in blood vesselsUS5084044 *Jul 14, 1989Jan 28, 1992Ciron CorporationApparatus for endometrial ablation and method of using sameUS5151100 *Jul 3, 1990Sep 29, 1992Boston Scientific CorporationHeating cathetersUS5156151 *Feb 15, 1991Oct 20, 1992Cardiac Pathways CorporationEndocardial mapping and ablation system and catheter probeUS5186181 *Jul 27, 1990Feb 16, 1993Cafiero FranconiRadio frequency thermotherapyUS5188122 *Jun 20, 1990Feb 23, 1993Rocket Of London LimitedElectromagnetic energy generation methodUS5191883 *May 22, 1990Mar 9, 1993Prutech Research And Development Partnership IiDevice for heating tissue in a patient's bodyUS5228442 *Dec 3, 1992Jul 20, 1993Cardiac Pathways CorporationMethod for mapping, ablation, and stimulation using an endocardial catheterUS5232444 *Jun 21, 1989Aug 3, 1993Just HansjoergDilatation catheterUS5236413 *May 7, 1990Aug 17, 1993Feiring Andrew JMethod and apparatus for inducing the permeation of medication into internal tissueUS5255697 *Oct 23, 1991Oct 26, 1993Working Inc.Walking support apparatusUS5263493 *Jul 7, 1992Nov 23, 1993Boaz AvitallDeflectable loop electrode array mapping and ablation catheter for cardiac chambersUS5277201 *May 1, 1992Jan 11, 1994Vesta Medical, Inc.Endometrial ablation apparatus and methodUS5279299 *Jul 24, 1992Jan 18, 1994Cardiac Pathways CorporationEndocardial mapping and ablation system and catheter probeUS5290306 *Nov 29, 1989Mar 1, 1994Cordis CorporationPuncture resistant balloon catheterUS5311866 *Sep 23, 1992May 17, 1994Endocardial Therapeutics, Inc.Heart mapping catheterUS5344402 *Jun 30, 1993Sep 6, 1994Cardiovascular Dynamics, Inc.Low profile perfusion catheterUS5505730 *Jun 24, 1994Apr 9, 1996Stuart D. EdwardsThin layer ablation apparatusUS5588432 *Jul 10, 1995Dec 31, 1996Boston Scientific CorporationCatheters for imaging, sensing electrical potentials, and ablating tissue* Cited by examinerNon-Patent CitationsReference1Mumford et al., "Sterilization Needs In The 1990's: The Case For Quinacrine Nonsurgical Female Sterilization", American Journal of Obstetrics & Gynecology, United Kingdom, vol. 167, No. 5, pp. 1203-1207, Nov. 1992.2 *Mumford et al., Sterilization Needs In The 1990 s: The Case For Quinacrine Nonsurgical Female Sterilization , American Journal of Obstetrics & Gynecology , United Kingdom, vol. 167, No. 5, pp. 1203 1207, Nov. 1992.3Neuwirth et al., "The Endometrial Ablator: A New Instrument", Obstetrics & Gynecology, vol. 83, No. 5, Part 1, pp. 792-796, May 1994.4 *Neuwirth et al., The Endometrial Ablator: A New Instrument , Obstetrics & Gynecology , vol. 83, No. 5, Part 1, pp. 792 796, May 1994.5Phipps et al., "Experimental and Clinical Studies With Radiofrequency-Induced Thermal Endometrial Ablation for Functional Menorrhagia", Obstetrics & Gynecology, United Kingdom, vol. 76, No. 5, Part 1, pp. 876-881, Nov. 1990.6Phipps et al., "Treatment of Functional Menorrhagia By Radiofrequency-Induced Thermal Endometrial Ablation", The Lancet, United Kingdom, vol. 335, pp. 374-376, Feb. 17, 1990.7 *Phipps et al., Experimental and Clinical Studies With Radiofrequency Induced Thermal Endometrial Ablation for Functional Menorrhagia , Obstetrics & Gynecology , United Kingdom, vol. 76, No. 5, Part 1, pp. 876 881, Nov. 1990.8 *Phipps et al., Treatment of Functional Menorrhagia By Radiofrequency Induced Thermal Endometrial Ablation , The Lancet , United Kingdom, vol. 335, pp. 374 376, Feb. 17, 1990.9Prior et al., "Treatment of Menorrhagia By Radiofrequency Heating", Int. J. Hyperthermia, United Kingdom, vol. 7, No. 1, 22-230, pp. 213-216, 1991.10 *Prior et al., Treatment of Menorrhagia By Radiofrequency Heating , Int. J. Hyperthermia , United Kingdom, vol. 7, No. 1, 22 230, pp. 213 216, 1991.11Singer et al., "Preliminary Clinical Experience With A Thermal Balloon Endometrial Ablation Method To Treat Menorrhagia", Obstetrics & Gynecology, vol. 83, No. 5, Part 1, pp. 732-734, May 1994.12 *Singer et al., Preliminary Clinical Experience With A Thermal Balloon Endometrial Ablation Method To Treat Menorrhagia , Obstetrics & Gynecology , vol. 83, No. 5, Part 1, pp. 732 734, May 1994.* Cited by examinerReferenced byCiting PatentFiling datePublication dateApplicantTitleUS5921954Jul 10, 1996Jul 13, 1999Mohr, Jr.; Lawrence G.Treating aneurysms by applying hardening/softening agents to hardenable/softenable substancesUS6023638 *May 22, 1998Feb 8, 2000Scimed Life Systems, Inc.System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissueUS6024740Jul 8, 1997Feb 15, 2000The Regents Of The University Of CaliforniaCircumferential ablation device assemblyUS6091993 *Feb 19, 1998Jul 18, 2000American Medical Systems, Inc.Methods and apparatus for an electrode balloonUS6107699 *May 22, 1998Aug 22, 2000Scimed Life Systems, Inc.Power supply for use in electrophysiological apparatus employing high-voltage pulses to render tissue temporarily unresponsiveUS6161543Oct 15, 1997Dec 19, 2000Epicor, Inc.Methods of epicardial ablation for creating a lesion around the pulmonary veinsUS6164283Jan 29, 1999Dec 26, 2000The Regents Of The University Of CaliforniaDevice and method for forming a circumferential conduction block in a pulmonary veinUS6200333Dec 31, 1998Mar 13, 2001Broncus Technologies, Inc.Bronchial stenterUS6212426Nov 1, 1999Apr 3, 2001Scimed Life Systems, Inc.Systems and methods for conducting electrophysiological testing using high-voltage energy pulses to stun tissueUS6212433Jul 28, 1998Apr 3, 2001Radiotherapeutics CorporationMethod for treating tumors near the surface of an organUS6237605Sep 21, 1998May 29, 2001Epicor, Inc.Methods of epicardial ablationUS6245064Jan 11, 2000Jun 12, 2001Atrionix, Inc.Circumferential ablation device assemblyUS6254599Mar 22, 1999Jul 3, 2001Atrionix, Inc.Circumferential ablation device assemblyUS6273907Apr 7, 1997Aug 14, 2001Broncus Technologies, Inc.Bronchial stenterUS6277116 *Feb 17, 1999Aug 21, 2001VidadermSystems and methods for shrinking collagen in the dermisUS6283988Mar 1, 1999Sep 4, 2001Broncus Technologies, Inc.Bronchial stenter having expandable electrodesUS6283989Mar 29, 1999Sep 4, 2001Broncus Technolgies, Inc.Method of treating a bronchial tube with a bronchial stenter having diametrically adjustable electrodesUS6299633Oct 22, 1998Oct 9, 2001Broncus Technologies, Inc.Bronchial stenterUS6311090 *Aug 23, 1999Oct 30, 2001Thermage, Inc.Method and apparatus for controlled contraction of collagen tissueUS6311692Jul 19, 1999Nov 6, 2001Epicor, Inc.Apparatus and method for diagnosis and therapy of electrophysiological diseaseUS6314962Nov 15, 1999Nov 13, 2001Epicor, Inc.Method of ablating tissue around the pulmonary veinsUS6314963Nov 15, 1999Nov 13, 2001Epicor, Inc.Method of ablating tissue from an epicardial locationUS6328735 *Oct 30, 1998Dec 11, 2001E.P., LimitedThermal ablation systemUS6337998Jul 14, 1999Jan 8, 2002Robert S. BehlApparatus and method for treating tumors near the surface of an organUS6338726Feb 6, 1997Jan 15, 2002Vidacare, Inc.Treating urinary and other body stricturesUS6355030 *Sep 25, 1998Mar 12, 2002Cardiothoracic Systems, Inc.Instruments and methods employing thermal energy for the repair and replacement of cardiac valvesUS6383151Sep 11, 2000May 7, 2002Chris J. DiederichCircumferential ablation device assemblyUS6389311Mar 22, 2000May 14, 2002Scimed Life Systems, Inc.Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in interior body regionsUS6411852Apr 21, 1999Jun 25, 2002Broncus Technologies, Inc.Modification of airways by application of energyUS6421556Feb 28, 2001Jul 16, 2002Scimed Life Systems, Inc.Systems and methods for conducting electrophysiological testing using high-voltage energy pulses to stun tissueUS6428537May 22, 1998Aug 6, 2002Scimed Life Systems, Inc.Electrophysiological treatment methods and apparatus employing high voltage pulse to render tissue temporarily unresponsiveUS6468462May 6, 2000Oct 22, 2002Ams Research CorporationMethod for making an electrode balloonUS6470218Sep 5, 2000Oct 22, 2002Radiotherapeutics, Inc.Apparatus and method for treating tumors near the surface of an organUS6471697Jul 19, 1999Oct 29, 2002The Regents Of The University Of CaliforniaTissue ablation device and methodUS6474340Nov 15, 1999Nov 5, 2002Epicor, Inc.Apparatus and method for diagnosis and therapy of electrophysiological diseaseUS6484727Nov 15, 1999Nov 26, 2002Epicor, Inc.Apparatus and method for diagnosis and therapy of electrophysiological diseaseUS6488673Jul 8, 1999Dec 3, 2002Broncus Technologies, Inc.Method of increasing gas exchange of a lungUS6500174Nov 5, 1999Dec 31, 2002Atrionix, Inc.Circumferential ablation device assembly and methods of use and manufacture providing an ablative circumferential band along an expandable memberUS6502576Aug 17, 2000Jan 7, 2003The Regents Of The University Of CaliforniaDevice and method for forming a circumferential conduction block in a pulmonary veinUS6514249Mar 2, 2000Feb 4, 2003Atrionix, Inc.Positioning system and method for orienting an ablation element within a pulmonary vein ostiumUS6522930May 6, 1998Feb 18, 2003Atrionix, Inc.Irrigated ablation device assemblyUS6595989May 11, 2000Jul 22, 2003Atrionix, Inc.Balloon anchor wireUS6599288May 16, 2001Jul 29, 2003Atrionix, Inc.Apparatus and method incorporating an ultrasound transducer onto a delivery memberUS6607502Nov 5, 1999Aug 19, 2003Atrionix, Inc.Apparatus and method incorporating an ultrasound transducer onto a delivery memberUS6626899Jul 3, 2001Sep 30, 2003Nidus Medical, LlcApparatus and methods for treating tissueUS6634363Mar 27, 2000Oct 21, 2003Broncus Technologies, Inc.Methods of treating lungs having reversible obstructive pulmonary diseaseUS6652515Nov 5, 1999Nov 25, 2003Atrionix, Inc.Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wallUS6669687Jun 23, 2000Dec 30, 2003Vahid SaadatApparatus and methods for treating tissueUS6679269May 30, 2002Jan 20, 2004Scimed Life Systems, Inc.Systems and methods for conducting electrophysiological testing using high-voltage energy pulses to stun tissueUS6719755Jun 19, 2001Apr 13, 2004Epicor Medical, Inc.Methods and devices for ablationUS6752805Jun 8, 2001Jun 22, 2004Atrionix, Inc.Surgical ablation probe for forming a circumferential lesionUS6758830May 11, 2000Jul 6, 2004Atrionix, Inc.Catheter positioning systemUS6758847Jun 6, 2002Jul 6, 2004Atrionix, Inc.Circumferential ablation device assembly and methods of use and manufacture providing an ablative circumferential band along an expandable memberUS6790206Jan 31, 2002Sep 14, 2004Scimed Life Systems, Inc.Compensation for power variation along patient cablesUS6811544Dec 6, 2002Nov 2, 2004Alan K. SchaerCatheter positioning systemUS6837885Dec 13, 2000Jan 4, 2005Scimed Life Systems, Inc.Surgical probe for supporting inflatable therapeutic devices in contact with tissue in or around body orifices and within tumorsUS6889089Apr 11, 2001May 3, 2005Scimed Life Systems, Inc.Apparatus and method for treating tumors near the surface of an organUS6939313May 14, 2002Sep 6, 2005Vahid SaadatDevice for sensing parameters of a hollow body organUS6957101Aug 20, 2003Oct 18, 2005Joshua PorathTransient event mapping in the heartUS7041095Oct 28, 2003May 9, 2006New England Medical CenterCardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularizationUS7150745Jan 9, 2004Dec 19, 2006Barrx Medical, Inc.Devices and methods for treatment of luminal tissueUS7160255May 30, 2003Jan 9, 2007Vahid SaadatMethod and device for sensing and mapping temperature profile of a hollow body organUS7186262Jul 3, 2002Mar 6, 2007Vahid SaadatApparatus and methods for treating tissueUS7217284Sep 23, 2003May 15, 2007Houser Russell AApparatus and methods for treating tissueUS7247269Jul 21, 2003Jul 24, 2007Biosense Webster, Inc.Method for making a spiral array ultrasound transducerUS7276061Nov 6, 2002Oct 2, 2007Atrionix, Inc.Irrigated ablation device assemblyUS7530979Feb 19, 2003May 12, 2009BÂRRX Medical, Inc.Method of treating abnormal tissue in the human esophagusUS7632308Nov 23, 2005Dec 15, 2009Didier LoulmetMethods, devices, and kits for treating mitral valve prolapseUS7655005Dec 23, 2004Feb 2, 2010Biosense Webster, Inc.Circumferential ablation device assembly with dual expandable membersUS7670335Jul 21, 2003Mar 2, 2010Biosense Webster, Inc.Ablation device with spiral array ultrasound transducerUS7678108Jun 2, 2005Mar 16, 2010Medtronic, Inc.Loop ablation apparatus and methodUS7678111Nov 29, 2005Mar 16, 2010Medtronic, Inc.Device and method for ablating tissueUS7699805Nov 30, 2007Apr 20, 2010Medtronic, Inc.Helical coil apparatus for ablation of tissueUS7706882May 13, 2005Apr 27, 2010Medtronic, Inc.Methods of using high intensity focused ultrasound to form an ablated tissue areaUS7706894Apr 26, 2005Apr 27, 2010Medtronic, Inc.Heart wall ablation/mapping catheter and methodUS7731681Mar 22, 2004Jun 8, 2010Atrionix, Inc.Catheter positioning systemUS7740017Apr 29, 2005Jun 22, 2010Asthmatx, Inc.Method for treating an asthma attackUS7740623Jun 23, 2005Jun 22, 2010Medtronic, Inc.Devices and methods for interstitial injection of biologic agents into tissueUS7744562Oct 10, 2006Jun 29, 2010Medtronics, Inc.Devices and methods for interstitial injection of biologic agents into tissueUS7758576Jun 2, 2005Jul 20, 2010Medtronic, Inc.Clamping ablation tool and methodUS7758580Jun 2, 2005Jul 20, 2010Medtronic, Inc.Compound bipolar ablation device and methodUS7770584Dec 4, 2008Aug 10, 2010Asthmatx, Inc.Modification of airways by application of microwave energyUS7794460Aug 11, 2008Sep 14, 2010Medtronic, Inc.Method of ablating tissueUS7818039Jul 15, 2005Oct 19, 2010Medtronic, Inc.Suction stabilized epicardial ablation devicesUS7824399Feb 16, 2006Nov 2, 2010Medtronic, Inc.Ablation system and method of useUS7837679Jul 17, 2006Nov 23, 2010Asthmatx, Inc.Control system and process for application of energy to airway walls and other mediumsUS7853331May 25, 2006Dec 14, 2010Asthmatx, Inc.Medical device with procedure improvement featuresUS7854734Jul 17, 2006Dec 21, 2010Asthmatx, Inc.Control system and process for application of energy to airway walls and other mediumsUS7860555Oct 25, 2005Dec 28, 2010Voyage Medical, Inc.Tissue visualization and manipulation systemUS7860556Nov 16, 2006Dec 28, 2010Voyage Medical, Inc.Tissue imaging and extraction systemsUS7871409Feb 2, 2009Jan 18, 2011Medtronic, Inc.Endocardial dispersive electrode for use with a monopolar RF ablation penUS7875028Jul 8, 2009Jan 25, 2011Medtronic, Inc.Ablation device with jawsUS7881807May 29, 2003Feb 1, 2011Schaer Alan KBalloon anchor wireUS7918787Mar 16, 2007Apr 5, 2011Voyage Medical, Inc.Tissue visualization and manipulation systemsUS7921855Dec 11, 2006Apr 12, 2011Asthmatx, Inc.Method for treating an asthma attackUS7930016Nov 16, 2006Apr 19, 2011Voyage Medical, Inc.Tissue closure systemUS7931647Oct 20, 2006Apr 26, 2011Asthmatx, Inc.Method of delivering energy to a lung airway using markersUS7938123Dec 1, 2008May 10, 2011Asthmatx, Inc.Modification of airways by application of cryo energyUS7949407Dec 29, 2006May 24, 2011Asthmatx, Inc.Energy delivery devices and methodsUS7959626Jul 20, 2007Jun 14, 2011Medtronic, Inc.Transmural ablation systems and methodsUS7959627Nov 23, 2005Jun 14, 2011Barrx Medical, Inc.Precision ablating deviceUS7959628Jun 27, 2007Jun 14, 2011Atrionix, Inc.Irrigated ablation device assemblyUS7963963Jan 21, 2005Jun 21, 2011Medtronic, Inc.Electrosurgical hemostatUS7967816Jan 25, 2002Jun 28, 2011Medtronic, Inc.Fluid-assisted electrosurgical instrument with shapeable electrodeUS7975703 *Aug 31, 2006Jul 12, 2011Medtronic, Inc.Device and method for needle-less interstitial injection of fluid for ablation of cardiac tissueUS7976539Jul 19, 2005Jul 12, 2011Hansen Medical, Inc.System and method for denaturing and fixing collagenous tissueUS7992572Nov 7, 2006Aug 9, 2011Asthmatx, Inc.Methods of evaluating individuals having reversible obstructive pulmonary diseaseUS7993336Dec 4, 2006Aug 9, 2011Barrx Medical, Inc.Methods and systems for determining physiologic characteristics for treatment of the esophagusUS7993337May 12, 2009Aug 9, 2011The Regents Of The University Of CaliforniaCircumferential ablation device assemblyUS7997278Nov 23, 2005Aug 16, 2011Barrx Medical, Inc.Precision ablating methodUS8007493Feb 16, 2007Aug 30, 2011Syneron Medical Ltd.Methods and devices for treating tissueUS8012149May 25, 2010Sep 6, 2011Barrx Medical, Inc.Methods and systems for determining physiologic characteristics for treatment of the esophagusUS8050746Jul 10, 2007Nov 1, 2011Voyage Medical, Inc.Tissue visualization device and method variationsUS8078266Feb 5, 2008Dec 13, 2011Voyage Medical, Inc.Flow reduction hood systemsUS8131350Dec 20, 2007Mar 6, 2012Voyage Medical, Inc.Stabilization of visualization cathetersUS8133216Feb 16, 2007Mar 13, 2012Syneron Medical Ltd.Methods and devices for treating tissueUS8137333Jul 25, 2007Mar 20, 2012Voyage Medical, Inc.Delivery of biological compounds to ischemic and/or infarcted tissueUS8142426Feb 16, 2007Mar 27, 2012Syneron Medical Ltd.Methods and devices for treating tissueUS8150499Nov 19, 2010Apr 3, 2012Kardium Inc.Automatic atherectomy systemUS8161978Mar 18, 2010Apr 24, 2012Asthmatx, Inc.Methods for treating asthma by damaging nerve tissueUS8162933Mar 3, 2004Apr 24, 2012Medtronic, Inc.Vibration sensitive ablation device and methodUS8162941Dec 20, 2010Apr 24, 2012Medtronic, Inc.Ablation device with jawsUS8172837Jun 14, 2010May 8, 2012Medtronic, Inc.Clamping ablation tool and methodUS8181656Feb 23, 2006May 22, 2012Asthmatx, Inc.Methods for treating airwaysUS8192426Dec 18, 2007Jun 5, 2012Tyco Healthcare Group LpDevices and methods for treatment of luminal tissueUS8197476Oct 26, 2011Jun 12, 2012Hermes Innovations LlcTissue ablation systemsUS8197477Oct 26, 2011Jun 12, 2012Hermes Innovations LlcTissue ablation methodsUS8221310Aug 30, 2007Jul 17, 2012Voyage Medical, Inc.Tissue visualization device and method variationsUS8221402Dec 9, 2005Jul 17, 2012Medtronic, Inc.Method for guiding a medical deviceUS8221415Jul 27, 2007Jul 17, 2012Medtronic, Inc.Method and apparatus for tissue ablationUS8235983Jul 12, 2007Aug 7, 2012Asthmatx, Inc.Systems and methods for delivering energy to passageways in a patientUS8235985Sep 11, 2008Aug 7, 2012Voyage Medical, Inc.Visualization and ablation system variationsUS8251070Apr 4, 2006Aug 28, 2012Asthmatx, Inc.Methods for treating airwaysUS8251992Jul 3, 2008Aug 28, 2012Tyco Healthcare Group LpMethod and apparatus for gastrointestinal tract ablation to achieve loss of persistent and/or recurrent excess body weight following a weight-loss operationUS8257413Sep 22, 2006Sep 4, 2012Asthmatx, Inc.Modification of airways by application of energyUS8262649Jul 27, 2007Sep 11, 2012Medtronic, Inc.Method and apparatus for tissue ablationUS8267094Dec 4, 2008Sep 18, 2012Asthmatx, Inc.Modification of airways by application of ultrasound energyUS8273012Jul 30, 2007Sep 25, 2012Tyco Healthcare Group, LpCleaning device and methodsUS8273072Nov 18, 2009Sep 25, 2012Medtronic, Inc.Devices and methods for interstitial injection of biologic agents into tissueUS8273080Feb 16, 2007Sep 25, 2012Syneron Medical Ltd.Methods and devices for treating tissueUS8295902Nov 11, 2009Oct 23, 2012Shifamed Holdings, LlcLow profile electrode assemblyUS8323241Jun 24, 2010Dec 4, 2012Shifamed Holdings, LlcSteerable medical delivery devices and methods of useUS8333012Oct 8, 2009Dec 18, 2012Voyage Medical, Inc.Method of forming electrode placement and connection systemsUS8333204Jun 22, 2009Dec 18, 2012Hansen Medical, Inc.Apparatus and methods for treating tissueUS8333764May 12, 2004Dec 18, 2012Medtronic, Inc.Device and method for determining tissue thickness and creating cardiac ablation lesionsUS8353908Dec 28, 2009Jan 15, 2013Novasys Medical, Inc.Treatment of tissue in sphincters, sinuses, and orificesUS8369930Jun 16, 2010Feb 5, 2013MRI Interventions, Inc.MRI-guided devices and MRI-guided interventional systems that can track and generate dynamic visualizations of the devices in near real timeUS8372068Aug 13, 2009Feb 12, 2013Hermes Innovations, LLCTissue ablation systemsUS8377055Jul 25, 2011Feb 19, 2013Covidien LpMethods and systems for determining physiologic characteristics for treatment of the esophagusUS8382753Aug 13, 2009Feb 26, 2013Hermes Innovations, LLCTissue ablation methodsUS8396532Jun 16, 2010Mar 12, 2013MRI Interventions, Inc.MRI-guided devices and MRI-guided interventional systems that can track and generate dynamic visualizations of the devices in near real timeUS8398631Oct 27, 2008Mar 19, 2013Covidien LpSystem and method of treating abnormal tissue in the human esophagusUS8403927Apr 5, 2012Mar 26, 2013William Bruce ShingletonVasectomy devices and methodsUS8409219Sep 30, 2009Apr 2, 2013Medtronic, Inc.Method and system for placement of electrical lead inside heartUS8412318Aug 18, 2005Apr 2, 2013Novasys Medical, Inc.Treatment of tissue in sphincters, sinuses, and orificesUS8414573Oct 11, 2006Apr 9, 2013Medtronic, Inc.Device and method for ablation of cardiac tissueUS8417321Aug 24, 2011Apr 9, 2013Voyage Medical, IncFlow reduction hood systemsUS8419613Sep 13, 2011Apr 16, 2013Voyage Medical, Inc.Tissue visualization deviceUS8419726Feb 9, 2012Apr 16, 2013Syneron Medical Ltd.Methods and devices for treating tissueUS8439908Jul 3, 2008May 14, 2013Covidien LpAblation in the gastrointestinal tract to achieve hemostasis and eradicate lesions with a propensity for bleedingUS8443810Jun 20, 2006May 21, 2013Asthmatx, Inc.Methods of reducing mucus in airwaysUS8459268Apr 24, 2012Jun 11, 2013Asthmatx, Inc.Methods for treating airwaysUS8464723Jun 28, 2011Jun 18, 2013Asthmatx, Inc.Methods of evaluating individuals having reversible obstructive pulmonary diseaseUS8465486Jul 25, 2012Jun 18, 2013Asthmatx, Inc.Modification of airways by application of energyUS8469950Feb 3, 2008Jun 25, 2013Cardionova Ltd.Intra-atrial apparatus and method of use thereofUS8480667May 25, 2006Jul 9, 2013Asthmatx, Inc.Medical device with procedure improvement featuresUS8483831Feb 17, 2009Jul 9, 2013Holaira, Inc.System and method for bronchial dilationUS8489172Jan 25, 2008Jul 16, 2013Kardium Inc.Liposuction systemUS8489192Jun 14, 2012Jul 16, 2013Holaira, Inc.System and method for bronchial dilationUS8500732Oct 26, 2009Aug 6, 2013Hermes Innovations LlcEndometrial ablation devices and systemsUS8512327Mar 12, 2012Aug 20, 2013Syneron Medical Ltd.Methods and devices for treating tissueUS8512337Aug 20, 2004Aug 20, 2013Medtronic, Inc.Method and system for treatment of atrial tachyarrhythmiasUS8523883Aug 18, 2011Sep 3, 2013Hansen Medical, Inc.Apparatus and methods for treating tissueUS8529562Nov 13, 2009Sep 10, 2013Minerva Surgical, IncSystems and methods for endometrial ablationUS8532746Feb 24, 2012Sep 10, 2013Kardium Inc.Automatic atherectomy systemUS8534291May 31, 2006Sep 17, 2013Asthmatx, Inc.Methods of treating inflammation in airwaysUS8540708Oct 26, 2009Sep 24, 2013Hermes Innovations LlcEndometrial ablation methodUS8545551Oct 29, 2009Oct 1, 2013Hansen Medical, Inc.Methods, devices, and kits for treating mitral valve prolapseUS8568409Oct 31, 2007Oct 29, 2013Medtronic Advanced Energy LlcFluid-assisted medical devices, systems and methodsUS8584681Apr 22, 2010Nov 19, 2013Asthmatx, Inc.Method for treating an asthma attackUS8585693Mar 23, 2012Nov 19, 2013Syneron Medical Ltd.Methods and devices for treating tissueUS8623010Jun 9, 2009Jan 7, 2014Medtronic, Inc.Cardiac mapping instrument with shapeable electrodeUS8632533Feb 23, 2010Jan 21, 2014Medtronic Advanced Energy LlcFluid-assisted electrosurgical deviceUS8640711Dec 9, 2010Feb 4, 2014Asthmatx, Inc.Method for treating an asthma attackUS8641711May 2, 2008Feb 4, 2014Covidien LpMethod and apparatus for gastrointestinal tract ablation for treatment of obesityUS8646460Jul 30, 2007Feb 11, 2014Covidien LpCleaning device and methodsUS8657805May 8, 2008Feb 25, 2014Intuitive Surgical Operations, Inc.Complex shape steerable tissue visualization and manipulation catheterUS8663245Apr 19, 2007Mar 4, 2014Medtronic, Inc.Device for occlusion of a left atrial appendageUS8690873Jul 9, 2013Apr 8, 2014Hermes Innovations LlcEndometrial ablation devices and systemsUS8694071Feb 11, 2011Apr 8, 2014Intuitive Surgical Operations, Inc.Image stabilization techniques and methodsUS8702694Dec 20, 2005Apr 22, 2014Covidien LpAuto-aligning ablating device and method of useUS8702695Mar 13, 2009Apr 22, 2014Covidien LpAuto-aligning ablating device and method of useUS8706260Oct 27, 2011Apr 22, 2014Medtronic, Inc.Heart wall ablation/mapping catheter and methodUS8708953Nov 1, 2013Apr 29, 2014Shifamed Holdings, LlcSteerable medical delivery devices and methods of useUS8709008May 9, 2008Apr 29, 2014Intuitive Surgical Operations, Inc.Visual electrode ablation systemsUS8715278Nov 11, 2009May 6, 2014Minerva Surgical, Inc.System for endometrial ablation utilizing radio frequencyUS8728073Oct 10, 2006May 20, 2014Biosense Webster, Inc.Multi-region staged inflation balloonUS8731672Jun 18, 2013May 20, 2014Holaira, Inc.System and method for bronchial dilationUS8733367Mar 28, 2013May 27, 2014Asthmatx, Inc.Methods of treating inflammation in airwaysUS8740846Dec 17, 2012Jun 3, 2014Verathon, Inc.Treatment of tissue in sphincters, sinuses, and orificesUS8740895Jun 28, 2013Jun 3, 2014Holaira, Inc.Delivery devices with coolable energy emitting assembliesUS8758229Dec 20, 2007Jun 24, 2014Intuitive Surgical Operations, Inc.Axial visualization systemsUS8768433Dec 21, 2012Jul 1, 2014MRI Interventions, Inc.MRI-guided devices and MRI-guided interventional systems that can track and generate dynamic visualizations of the devices in near real timeUS8777943Jun 28, 2013Jul 15, 2014Holaira, Inc.Delivery devices with coolable energy emitting assembliesUS8784338Jun 20, 2008Jul 22, 2014Covidien LpElectrical means to normalize ablational energy transmission to a luminal tissue surface of varying sizeUS8795271Jul 17, 2008Aug 5, 2014Boston Scientific Scimed, Inc.Surgical probe for supporting inflatable therapeutic devices in contact with tissue in or around body orifice and within tumorsUS8801707Aug 14, 2012Aug 12, 2014Medtronic, Inc.Method and devices for treating atrial fibrillation by mass ablationUS8805466May 12, 2011Aug 12, 2014Shifamed Holdings, LlcLow profile electrode assemblyUS8808280Apr 20, 2012Aug 19, 2014Holaira, Inc.Systems, assemblies, and methods for treating a bronchial treeUS8814845Feb 3, 2012Aug 26, 2014Intuitive Surgical Operations, Inc.Delivery of biological compounds to ischemic and/or infarcted tissueUS8821486Nov 11, 2010Sep 2, 2014Hermes Innovations, LLCTissue ablation systems and methodsUS8821488May 13, 2009Sep 2, 2014Medtronic, Inc.Tissue lesion evaluationUS8821489Apr 20, 2012Sep 2, 2014Holaira, Inc.Systems, assemblies, and methods for treating a bronchial treeUS8825133Jan 24, 2013Sep 2, 2014MRI Interventions, Inc.MRI-guided cathetersUS8840601Mar 24, 2011Sep 23, 2014Shifamed Holdings, LlcIntravascular tissue disruptionUS8845630Feb 6, 2009Sep 30, 2014Syneron Medical LtdDevices and methods for percutaneous energy deliveryUS8858609Feb 6, 2009Oct 14, 2014Intuitive Surgical Operations, Inc.Stent delivery under direct visualizationUS8870864Oct 28, 2011Oct 28, 2014Medtronic Advanced Energy LlcSingle instrument electrosurgery apparatus and its method of useUS8876818Jan 14, 2013Nov 4, 2014Covidien LpMethods and systems for determining physiologic characteristics for treatment of the esophagusUS8882756Dec 24, 2008Nov 11, 2014Medtronic Advanced Energy LlcFluid-assisted electrosurgical devices, methods and systemsUS8886288Jan 10, 2013Nov 11, 2014MRI Interventions, Inc.MRI-guided devices and MRI-guided interventional systems that can track and generate dynamic visualizations of the devices in near real timeUS8888769Nov 11, 2010Nov 18, 2014Asthmatx, Inc.Control system and process for application of energy to airway walls and other mediumsUS8906011Nov 16, 2007Dec 9, 2014Kardium Inc.Medical device for use in bodily lumens, for example an atriumUS8906012Jun 30, 2010Dec 9, 2014Medtronic Advanced Energy LlcElectrosurgical devices with wire electrodeUS8911439Nov 11, 2010Dec 16, 2014Holaira, Inc.Non-invasive and minimally invasive denervation methods and systems for performing the sameUS8920369May 3, 2012Dec 30, 2014Shifamed Holdings, LlcSteerable delivery sheathsUS8920411 *Jun 28, 2006Dec 30, 2014Kardium Inc.Apparatus and method for intra-cardiac mapping and ablationUS8920413May 25, 2006Dec 30, 2014Asthmatx, Inc.Energy delivery devices and methodsUS8920417Dec 28, 2012Dec 30, 2014Medtronic Advanced Energy LlcElectrosurgical devices and methods of use thereofUS8926603Mar 9, 2011Jan 6, 2015Hansen Medical, Inc.System and method for denaturing and fixing collagenous tissueUS8926635Oct 2, 2009Jan 6, 2015Medtronic, Inc.Methods and devices for occlusion of an atrial appendageUS8932208Oct 7, 2006Jan 13, 2015Maquet Cardiovascular LlcApparatus and methods for performing minimally-invasive surgical proceduresUS8932287Mar 23, 2011Jan 13, 2015Kardium Inc.Medical device for use in bodily lumens, for example an atriumUS8932289Sep 26, 2011Jan 13, 2015Holaira, Inc.Delivery devices with coolable energy emitting assembliesUS8934962Aug 31, 2007Jan 13, 2015Intuitive Surgical Operations, Inc.Electrophysiology mapping and visualization systemUS8940002Sep 28, 2011Jan 27, 2015Kardium Inc.Tissue anchor systemUS8944071Aug 20, 2012Feb 3, 2015Asthmatx, Inc.Method for treating an asthma attackUS8945109Apr 15, 2013Feb 3, 2015Syneron Medical LtdMethods and devices for treating tissueUS8956348Jul 20, 2011Feb 17, 2015Minerva Surgical, Inc.Methods and systems for endometrial ablationUS8961507Apr 20, 2012Feb 24, 2015Holaira, Inc.Systems, assemblies, and methods for treating a bronchial treeUS8961508Apr 20, 2012Feb 24, 2015Holaira, Inc.Systems, assemblies, and methods for treating a bronchial treeUS8961550Jan 25, 2013Feb 24, 2015Indian Wells Medical, Inc.Steerable endoluminal punchUS8968284Jun 14, 2013Mar 3, 2015Verathon Inc.Apparatus and methods for treating female urinary incontinenceUS8979833Jan 21, 2014Mar 17, 2015Syneron Medical Ltd.Methods and devices for treating tissueUS8998901Aug 23, 2013Apr 7, 2015Hermes Innovations LlcEndometrial ablation methodUS9005195Sep 26, 2011Apr 14, 2015Holaira, Inc.Delivery devices with coolable energy emitting assembliesUS9011423Mar 11, 2013Apr 21, 2015Kardium, Inc.Systems and methods for selecting, activating, or selecting and activating transducersUS9017320Mar 11, 2013Apr 28, 2015Kardium, Inc.Systems and methods for activating transducersUS9017321Mar 11, 2013Apr 28, 2015Kardium, Inc.Systems and methods for activating transducersUS9017324Jun 28, 2013Apr 28, 2015Holaira, Inc.Delivery devices with coolable energy emitting assembliesUS9023031Apr 29, 2009May 5, 2015Verathon Inc.Noninvasive devices, methods, and systems for modifying tissuesUS9023040Oct 26, 2010May 5, 2015Medtronic Advanced Energy LlcElectrosurgical cutting devicesUS9027564May 10, 2013May 12, 2015Asthmatx, Inc.Method for treating a lungUS9033976May 16, 2013May 19, 2015Asthmatx, Inc.Modification of airways by application of energyUS9039699Jul 12, 2011May 26, 2015Covidien LpMethods and systems for treatment of tissue in a body lumenUS9055906May 12, 2010Jun 16, 2015Intuitive Surgical Operations, Inc.In-vivo visualization systemsUS9060778Apr 26, 2012Jun 23, 2015Medtronic Ablation Frontiers LlcIntermittent short circuit detection on a multi-electrode catheterUS9072511Mar 15, 2012Jul 7, 2015Kardium Inc.Medical kit for constricting tissue or a bodily orifice, for example, a mitral valveUS9095350May 1, 2012Aug 4, 2015Medtronic Ablation Frontiers LlcImpedance detection of venous placement of multi-electrode cathetersUS9101735Jul 7, 2009Aug 11, 2015Intuitive Surgical Operations, Inc.Catheter control systemsUS9113896Dec 28, 2007Aug 25, 2015Medtronic, Inc.Method and apparatus for creating a bi-polar virtual electrode used for the ablation of tissueUS9119633Mar 5, 2013Sep 1, 2015Kardium Inc.Apparatus and method for intra-cardiac mapping and ablationUS9119634Nov 18, 2014Sep 1, 2015Kardium Inc.Apparatus and method for intra-cardiac mapping and ablationUS9125643Apr 30, 2014Sep 8, 2015Holaira, Inc.System and method for bronchial dilationUS9138289Jun 28, 2010Sep 22, 2015Medtronic Advanced Energy LlcElectrode sheath for electrosurgical deviceUS9149328Nov 11, 2010Oct 6, 2015Holaira, Inc.Systems, apparatuses, and methods for treating tissue and controlling stenosisUS9155452Apr 24, 2008Oct 13, 2015Intuitive Surgical Operations, Inc.Complex shape steerable tissue visualization and manipulation catheterUS9155587May 14, 2009Oct 13, 2015Intuitive Surgical Operations, Inc.Visual electrode ablation systemsUS9179970Jul 12, 2011Nov 10, 2015Covidien LpPrecision ablating methodUS9192287Jun 18, 2012Nov 24, 2015Intuitive Surgical Operations, Inc.Tissue visualization device and method variationsUS9192468Jan 23, 2014Nov 24, 2015Kardium Inc.Method for anchoring a mitral valveUS9198592Nov 18, 2014Dec 1, 2015Kardium Inc.Systems and methods for activating transducersUS9198713Jun 9, 2014Dec 1, 2015Covidien LpElectrical means to normalize ablational energy transmission to a luminal tissue surface of varying sizeUS9204921Dec 13, 2012Dec 8, 2015Cook Medical Technologies LlcRF energy controller and method for electrosurgical medical devicesUS9204964Jun 13, 2013Dec 8, 2015Kardium Inc.Medical device, kit and method for constricting tissue or a bodily orifice, for example, a mitral valveUS9216050May 1, 2012Dec 22, 2015Medtronic Ablation Frontiers LlcDetection of microbubble formation during catheter ablationUS9226648Dec 20, 2007Jan 5, 2016Intuitive Surgical Operations, Inc.Off-axis visualization systemsUS9227088May 3, 2010Jan 5, 2016Medtronic, Inc.Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesionsUS9254168Mar 16, 2010Feb 9, 2016Medtronic Advanced Energy LlcElectro-thermotherapy of tissue using penetrating microelectrode arrayUS9259264Apr 14, 2015Feb 16, 2016Kardium Inc.Systems and methods for activating transducersUS9259290Jun 8, 2010Feb 16, 2016MRI Interventions, Inc.MRI-guided surgical systems with proximity alertsUS9272132Oct 31, 2013Mar 1, 2016Boston Scientific Scimed, Inc.Medical device for treating airways and related methods of useUS9283374Nov 5, 2013Mar 15, 2016Boston Scientific Scimed, Inc.Devices and methods for delivering energy to body lumensUS9289257Nov 13, 2009Mar 22, 2016Minerva Surgical, Inc.Methods and systems for endometrial ablation utilizing radio frequencyUS9314289Aug 22, 2012Apr 19, 2016Covidien LpCleaning device and methodsUS9332893Aug 5, 2014May 10, 2016Intuitive Surgical Operations, Inc.Delivery of biological compounds to ischemic and/or infarcted tissueUS9333027Oct 3, 2013May 10, 2016Medtronic Advanced Energy LlcMethod of producing an electrosurgical deviceUS9333031Sep 10, 2015May 10, 2016Apama Medical, Inc.Visualization inside an expandable medical deviceUS9339618Nov 5, 2012May 17, 2016Holaira, Inc.Method and apparatus for controlling narrowing of at least one airwayUS9345541Sep 8, 2010May 24, 2016Medtronic Advanced Energy LlcCartridge assembly for electrosurgical devices, electrosurgical unit and methods of use thereofUS9358024May 14, 2013Jun 7, 2016Asthmatx, Inc.Methods for treating airwaysUS9364277Dec 12, 2013Jun 14, 2016Cook Medical Technologies LlcRF energy controller and method for electrosurgical medical devicesUS9364283Jul 26, 2012Jun 14, 2016Covidien LpMethod and apparatus for gastrointestinal tract ablation to achieve loss of persistent and/or recurrent excess body weight following a weight loss operationUS9381061Nov 23, 2011Jul 5, 2016Medtronic Advanced Energy LlcFluid-assisted medical devices, systems and methodsUS9393069May 3, 2012Jul 19, 2016Covidien LpDevices and methods for treatment of luminal tissueUS9398933Dec 27, 2013Jul 26, 2016Holaira, Inc.Methods for improving drug efficacy including a combination of drug administration and nerve modulationUS9408662May 7, 2012Aug 9, 2016Cook Medical Technologies LlcSphincterotome having expandable tinesUS9427281Mar 15, 2011Aug 30, 2016Medtronic Advanced Energy LlcBronchoscope-compatible catheter provided with electrosurgical deviceUS9439713Apr 14, 2015Sep 13, 2016Kardium Inc.Systems and methods for activating transducersUS9439735Jun 8, 2010Sep 13, 2016MRI Interventions, Inc.MRI-guided interventional systems that can track and generate dynamic visualizations of flexible intrabody devices in near real timeUS9445858Mar 5, 2014Sep 20, 2016Medtronic Advanced Energy LlcBipolar electrosurgical deviceUS9445862Apr 14, 2015Sep 20, 2016Kardium Inc.Systems and methods for selecting, activating, or selecting and activating transducersUS9452016Dec 20, 2013Sep 27, 2016Kardium Inc.Catheter systemUS9468364Nov 13, 2009Oct 18, 2016Intuitive Surgical Operations, Inc.Intravascular catheter with hood and image processing systemsUS9480525Mar 11, 2013Nov 1, 2016Kardium, Inc.High-density electrode-based medical device systemUS9486273Mar 11, 2013Nov 8, 2016Kardium Inc.High-density electrode-based medical device systemUS9486283Dec 20, 2013Nov 8, 2016Medtronic Advanced Energy LlcFluid-assisted electrosurgical deviceUS9492227Mar 1, 2013Nov 15, 2016Kardium Inc.Enhanced medical device for use in bodily cavities, for example an atriumUS9492228Mar 1, 2013Nov 15, 2016Kardium Inc.Enhanced medical device for use in bodily cavities, for example an atriumUS9504399Jun 28, 2013Nov 29, 2016Topera, Inc.Basket style cardiac mapping catheter having a flexible electrode assembly for sensing monophasic action potentialsUS9510732Jul 8, 2009Dec 6, 2016Intuitive Surgical Operations, Inc.Methods and apparatus for efficient purgingUS9510897Oct 26, 2011Dec 6, 2016Hermes Innovations LlcRF-electrode surface and method of fabricationUS9510905Jun 10, 2016Dec 6, 2016Advanced Cardiac Therapeutics, Inc.Systems and methods for high-resolution mapping of tissueUS9517103Jun 10, 2016Dec 13, 2016Advanced Cardiac Therapeutics, Inc.Medical instruments with multiple temperature sensorsUS9522036Jun 10, 2016Dec 20, 2016Advanced Cardiac Therapeutics, Inc.Ablation devices, systems and methods of using a high-resolution electrode assemblyUS9522037Jul 19, 2016Dec 20, 2016Advanced Cardiac Therapeutics, Inc.Treatment adjustment based on temperatures from multiple temperature sensorsUS9526401Jan 16, 2013Dec 27, 2016Intuitive Surgical Operations, Inc.Flow reduction hood systemsUS9526573Mar 1, 2013Dec 27, 2016Kardium Inc.Enhanced medical device for use in bodily cavities, for example an atriumUS9532831Jan 19, 2016Jan 3, 2017Kardium Inc.Systems and methods for activating transducersUS20030018358 *Jul 3, 2002Jan 23, 2003Vahid SaadatApparatus and methods for treating tissueUS20030060820 *Oct 21, 2002Mar 27, 2003Maguire Mark A.Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wallUS20030060822 *Nov 6, 2002Mar 27, 2003Schaer Alan K.Irrigated ablation device assemblyUS20030088187 *May 14, 2002May 8, 2003Vahid SaadatDevice for sensing parameters of a hollow body organUS20030158550 *Feb 19, 2003Aug 21, 2003Ganz Robert A.Method of treating abnormal tissue in the human esophagusUS20040002740 *May 7, 2003Jan 1, 2004The Regents Of The University Of CaliforniaSystem and method for forming a non-ablative cardiac conduction blockUS20040055572 *Sep 24, 2002Mar 25, 2004Caterpillar Inc.Hydraulic pump circuitUS20040059235 *May 30, 2003Mar 25, 2004Vahid SaadatMethod and device for sensing and mapping temperature profile of a hollow body organUS20040087941 *Oct 28, 2003May 6, 2004Wang Paul J.Cardiac system and method for treatment of cardiac arrhythmias and transmyocardial revascularizationUS20040098075 *Feb 24, 2003May 20, 2004The Regents Of The University Of CaliforniaCardiac stimulation system and methodUS20040106896 *Dec 23, 2002Jun 3, 2004The Regents Of The University Of CaliforniaSystem and method for forming a non-ablative cardiac conduction blockUS20040181188 *Mar 22, 2004Sep 16, 2004Schaer Alan K.Catheter positioning systemUS20040215235 *Jan 9, 2004Oct 28, 2004Barrx, Inc.Methods and systems for determining physiologic characteristics for treatment of the esophagusUS20050015953 *Jul 21, 2003Jan 27, 2005Yaron KeidarMethod for making a spiral array ultrasound transducerUS20050143727 *Dec 30, 2004Jun 30, 2005Koblish Josef V.Surgical probe for supporting inflatable therapeutic devices in contact with tissue in or around body orifices and within tumorsUS20050165388 *Dec 23, 2004Jul 28, 2005Sumita BholaCircumferential ablation device assembly with dual expandable membersUS20050165391 *Nov 24, 2004Jul 28, 2005Maguire Mark A.Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wallUS20050171524 *Jan 9, 2004Aug 4, 2005Barrx, Inc.Devices and methods for treatment of luminal tissueUS20050240116 *Jun 3, 2005Oct 27, 2005Vahid SaadatDevice for sensing parameters of a hollow body organUS20050271631 *May 12, 2005Dec 8, 2005Lee Randall JMaterial compositions and related systems and methods for treating cardiac conditionsUS20060083717 *Sep 26, 2005Apr 20, 2006Lee Randall JSystem and method for forming a non-ablative cardiac conduction blockUS20060084966 *Nov 24, 2004Apr 20, 2006Maguire Mark ATissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wallUS20060217699 *May 9, 2006Sep 28, 2006Wang Paul JCardiac ablation system and method for treatment of cardiac arrhthmias and transmyocardial revascularizationUS20070118184 *Dec 21, 2006May 24, 2007Asthmatx, Inc.Devices for modification of airways by transfer of energyUS20080004534 *Jun 28, 2006Jan 3, 2008Daniel GelbartIntra-cardiac mapping and ablation methodUS20080091182 *Feb 16, 2007Apr 17, 2008Primaeva Medical. Inc.Methods and devices for treating tissueUS20080091183 *Feb 16, 2007Apr 17, 2008Primaeva Medical, Inc.Methods and devices for treating tissueUS20080091184 *Feb 16, 2007Apr 17, 2008Primaeva Medical, Inc.Methods and devices for treating tissueUS20080091185 *Feb 16, 2007Apr 17, 2008Primaeva Medical, Inc.Methods and devices for treating tissueUS20080281389 *Feb 16, 2007Nov 13, 2008Primaeva Medical Inc.Methods and devices for treating tissueUS20090062787 *Jun 27, 2007Mar 5, 2009Schaer Alan KIrrigated ablation device assemblyUS20090099564 *Jul 17, 2008Apr 16, 2009Koblish Josef VSurgical Probe For Supporting Inflatable Therapeutic Devices In Contact With Tissue In Or Around Body Orifice And Within TumorsUS20090112205 *Feb 1, 2008Apr 30, 2009Primaeva Medical, Inc.Cartridge electrode deviceUS20090156958 *Mar 25, 2008Jun 18, 2009Mehta Bankim HDevices and methods for percutaneous energy deliveryUS20100030204 *Feb 3, 2008Feb 4, 2010Uri SteinIntra-atrial apparatus and method of use thereofUS20100160906 *Dec 17, 2009Jun 24, 2010Asthmatx, Inc.Expandable energy delivery devices having flexible conductive elements and associated systems and methodsUS20100204560 *Nov 11, 2009Aug 12, 2010Amr SalahiehLow profile electrode assemblyUS20100204694 *Feb 6, 2009Aug 12, 2010Primaeva Medical, Inc.Devices and methods for percutaneous energy deliveryUS20100217254 *Apr 20, 2009Aug 26, 2010Primaeva Medical, Inc.Methods for applying energy to tissue using isolated energy sourcesUS20100234876 *Mar 8, 2010Sep 16, 2010Boston Scientific Scimed, Inc.Apparatus and methods for recapturing an ablation balloonUS20100312094 *Jun 8, 2010Dec 9, 2010Michael GuttmanMri-guided surgical systems with preset scan planesUS20100331776 *Jun 24, 2010Dec 30, 2010Amr SalahiehSteerable Medical Delivery Devices and Methods of UseUS20110112523 *Nov 11, 2009May 12, 2011Minerva Surgical, Inc.Systems, methods and devices for endometrial ablation utilizing radio frequencyUS20110118718 *Nov 13, 2009May 19, 2011Minerva Surgical, Inc.Methods and systems for endometrial ablation utilizing radio frequencyUS20110172658 *Mar 23, 2011Jul 14, 2011Kardium Inc.Medical device for use in bodily lumens, for example an atriumUS20110291736 *Aug 9, 2011Dec 1, 2011Klimovitch Gleb VSwitching methods and apparatusUS20120016256 *Jul 13, 2011Jan 19, 2012Vanderbilt UniversityApparatus and method for detecting and measuring condition of esophageal mucosa and indications of gastroesophageal reflux diseaseUS20120095536 *Jun 20, 2011Apr 19, 2012Zoll Circulation, Inc.Method and system for control of a patient's body temperature by way of a transluminally insertable heat exchange catheterUS20130150929 *Feb 4, 2013Jun 13, 2013Zoll Circulation, Inc.Method and system for control of a patient's body temperature by way of a transluminally insertable heat exchange catheterUS20130317497 *Aug 3, 2013Nov 28, 2013Mederi Therapeutics Inc.Gerd treatment apparatus and methodWO2000006046A1 *Jul 20, 1999Feb 10, 2000Radiotherapeutics CorporationApparatus and method for treating tumors near the surface of an organWO2001000114A1 *Jun 23, 2000Jan 4, 2001Vahid SaadatApparatus and methods for treating tissueWO2008099380A2Feb 3, 2008Aug 21, 2008Cardionova Ltd.Intra-atrial apparatus and method of use thereof* Cited by examinerClassifications U.S. Classification606/41, 607/101, 606/194, 602/22, 606/28International ClassificationA61F2/958, A61N1/06, A61N1/08, A61B17/00, A61N1/05, A61B17/42, A61N1/40, A61M16/04, A61B18/00, A61B18/18, A61B18/14, A61M3/02, A61B18/04, A61B18/02Cooperative ClassificationA61B2090/3614, A61B2090/3782, A61B2018/00821, A61B2018/1253, A61B2018/00875, A61B2018/00898, A61B2018/00797, A61N1/06, A61B2018/1273, A61B2018/00761, A61B2018/00023, A61B2018/00755, A61M2025/1086, A61B2018/00666, A61B2018/00791, A61B2018/00577, A61M3/0279, A61B2018/00708, A61B18/148, A61B2017/4216, A61B2018/00892, A61B2018/00702, A61N1/40, A61B2018/00916, A61B2018/00869, A61B2018/00083, A61B2018/00886, A61B2018/00827, A61B2018/00654, A61B2018/046, A61B2018/00678, A61B2018/00494, A61B18/1492, A61B2018/126, A61M16/0481, A61N1/08, A61B2018/1472, A61B2017/00084, A61B2018/0262, A61B2018/00815, A61B2018/1467, A61B2018/00982, A61N1/056, A61M2025/1052, A61B2017/00106, A61B2018/00214, A61B2018/00011, A61B2018/00559, A61B2018/00029, A61B2018/00065, A61B2018/00113, A61B2018/00148, A61B2018/00077, A61B2018/00726, A61B2018/0091, A61M25/1002, A61B2018/124, A61B18/18, A61B2018/0022, A61B18/1815, A61B2218/002, A61B2017/003, A61B18/1485European ClassificationA61B18/14V, A61B18/14P, A61B18/14S, A61N1/05N, A61N1/40, A61N1/08, A61N1/06Legal EventsDateCodeEventDescriptionJun 5, 1995ASAssignmentOwner name: EDWARDS, STUART D., CALIFORNIAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SHARKEY, HUGH R.;REEL/FRAME:007508/0817Effective date: 19950522Sep 22, 1995ASAssignmentOwner name: EDWARDS, STUART D., CALIFORNIAFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SHARKEY, HUGH R.;REEL/FRAME:007657/0955Effective date: 19950817Sep 9, 1999ASAssignmentOwner name: BANK AMERICA VENTURES, AS COLLATERAL AGENT, CALIFOFree format text: SECURITY INTEREST;ASSIGNOR:CARDIAC PATHWAYS CORPORATION;REEL/FRAME:010206/0834Effective date: 19990520Aug 20, 2001FPAYFee paymentYear of fee payment: 4Nov 23, 2005FPAYFee paymentYear of fee payment: 8Nov 20, 2009FPAYFee paymentYear of fee payment: 12RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services