Cardiac ablation system and method for treatment of cardiac arrhythmias and ...

(54) CARDIAC ABLATION SYSTEM AND

METHOD FOR TREATMENT OF CARDIAC
ARRHYTHMIAS AND TRANSMYOCARDIAL
REVASCULARIZATION

(75) Inventors: Paul J. Wang, Chestnut Hill; Hassan Rastegar, Newton, both of MA (US)

(73) Assignee: New England Medical Center, Boston, MA (US)

( * ) Notice: This patent issued on a continued prosecution application filed under 37 CFR 1.53(d), and is subject to the twenty year patent term provisions of 35 U.S.C. 154(a)(2).

Subject to any disclaimer, the term of this patent is extended or adjusted under 35 U.S.C. 154(b) by 0 days.

(21) Appl. No.: 09/082,047

(22) Filed: May 20, 1998

(65) Prior Publication Data

US 2002/0058934 Al May 16, 2002

(51) Int. CI.7 A61B 18/04

(52) U.S. CI 606/32; 606/41; 607/99;

128/898

(58) Field of Search 606/32, 41, 45,

606/46, 47, 48, 49, 50; 607/129, 130, 99;

128/898

(56) References Cited

U.S. PATENT DOCUMENTS

5,156,151 A 10/1992 Imran 128/642

5,396,887 A 3/1995 Imran 128/642

5,400,783 A 3/1995 Pomeranz et al 128/642

5,427,119 A 6/1995 Swartz et al 128/772

5,443,463 A 8/1995 Stern et al 606/51

5,452,733 A 9/1995 Sterman et al 128/898

5,462,545 A 10/1995 Wang et al 606/41

(List continued on next page.)

A medical device, and related method, use epicardial ablators and detectors for intraoperative epicardial approaches to ablation therapy of cardiac conduction pathways. An epicardial gripper is sized to grasp the cardiac circumference or smaller structures on the epicardial surface of the heart. Ablators are disposed on the arms of the gripper for epicardial ablation of cardiac conduction tissue. In another embodiment of the invention, an electrode system includes a flexible, adjustable probe forming a loop for epicardial ablation. Ablators are provided on one or multiple surfaces of the probe for epicardial ablation of cardiac conduction tissue. In yet another embodiment of the invention, an endocardial ablator detection system provides an indicator adjacent an ablator on an endocardial catheter, and a detector on an epicardial probe. The epicardial probe detects signals transmitted by the indicator on the endocardial catheter to localize the position of the endocardial ablator relative to the epicardial surface. The surgeon uses this information for guidance in adjusting the position of the endocardial ablator according to therapeutic objectives of cardiac ablation.

16 Claims, 13 Drawing Sheets

52

U.S. PATENT DOCUMENTS

5,497,774 A 3/1996 Swartz et al 128/658

5,505,730 A 4/1996 Edwards 606/41

5,555,883 A 9/1996 Avitall 128/642

5,558,073 A 9/1996 Pomeranz et al 128/642

5,571,215 A 11/1996 Sterman et al 623/66

5,575,766 A 11/1996 Swartz et al 604/53

5,575,788 A 11/1996 Baker et al 606/41

5,575,810 A 11/1996 Swanson et al 607/99

5,595,183 A 1/1997 Swanson et al 128/697

5,617,854 A 4/1997 Munsif 128/642

5,637,090 A 6/1997 McGee et al 604/95

5,673,695 A 10/1997 McGee et al 128/642

5,676,662 A 10/1997 Fleischhacker et al 606/41

5,687,723 A 11/1997 Avitall 128/642

5,688,267 A 11/1997 Panescu et al 606/41

5,690,611 A 11/1997 Swartz et al 604/53

5,730,127 A 3/1998 Avitall 128/642

5,730,704 A 3/1998 Avitall 600/374

5,733,280 A 3/1998 Avitall 606/23

5,797,960 A 8/1998 Stevens et al 606/213

5,904,711 A * 5/1999 Flom et al 607/129

6,142,994 A * 11/2000 Swanson et al 606/41

6,152,920 A * 11/2000 Thompson et al 606/41

6,161,543 A 12/2000 Cox et al 128/898

6,237,605 Bl * 5/2001 Vaska et al 128/898

6,245,064 Bl * 6/2001 Lesh et al 606/34

FOREIGN PATENT DOCUMENTS

WO WO 97/06727 2/1997

WO WO 97/17904 5/1997

WO WO 97/25916 7/1997

WO WO 97/25918 7/1997

WO WO 97/25919 7/1997

WO WO 97/32525 9/1997

WO WO 97/37607 10/1997

WO WO 97/45156 12/1997

OTHER PUBLICATIONS

Chevalier et al., "Video-assisted Thoracoscopic Radio Frequency Catheter Ablation of the Left Atrium Prevents Inducibility of Atrial Fibrillation in Dogs", Circulation (1997) 96: 575.

Cox, J.L. et al., "The Surgical Treatment of Atrial Fibrilla-
tion. III. Development of a Definitive Surgical Treatment",
J. thorac Cardiovasc Surg. (1991) 101: 569-583.
Jais, P. et al., "Catheter Ablation for Paroxysmal Atrial
Fibrillation: High Success Rates with Ablation in the Left
Atrium", Circulation (1996) 94: 1-675.
Lindsay et al., "Intraoperative Observation and Epicardial
Mapping after Attempted Catheter Ablation of Atrial Fibril-
lation", Circulation (1997) 96:450.

Nakagawa et al., "Use of Atrial Potential Attenuation to Identify Endpoint of Radiofrequency Application for Continuous Transmural Linear Atrial Ablation", Circulation (1997) 96: 577.

Lee et al., "Minimally Invasive Epicardial Atrial Linear Ablation Using Cooled Radiofrequency Energy", Circulation (1997) 96: 577.

Sharma et al., "A Comparison of Sequential with Simultaneous Delivery of RF Energy Application at Multiple Electrodes to Produce Linear Continuous Lesions", Circulation (1997) 96: 576.

Sie, H.T et al., "Radiofrequency Ablation of Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery: First Experience", Circulation (1996) 84: 1-675. Sie et al., "Radiofrequency Ablation of Atrial Fibrillation in Patients Undergoing Valve Surgery", Ciculation (1997) 96: 450.

Thomas et al., "An Endocardial Radiofrequency Ablative Technique for Cure of Atrial Fibrillation During Cardiac Surgery", Circulation (1997) 96: 450.

* cited by examiner