Surgical system and procedure for treatment of medically refractory atrial fibrillation

Abstract

The invention provides surgical systems and methods for ablating heart tissue within the interior and/or exterior of the heart. A plurality of probes is provided with each probe configured for introduction into the chest for engaging the heart. Each probe includes an elongated shaft having an elongated ablating surface of a predetermined shape. The elongated shaft and the elongated ablating surface of each probe are configured to ablate a portion of the heart. A sealing device affixed to the heart tissue forms a hemostatic seal between the probe and the penetration in the heart to inhibit blood loss therethrough.

What is claimed is:  
     
         1 . A method for treatment of a heart comprising the steps of: 
 forming a penetration through a muscular wall of the heart into an interior chamber thereof;    positioning a distal end of an elongated ablating device having an elongated ablating surface through the penetration; and    contacting the elongated ablating surface of the ablating device with a first selected portion of an interior surface of the muscular wall for transmural ablation thereof.    
     
     
         2 . The method of  claim 1  further including the step of: 
 manipulating the device through said penetration to strategically contact the elongated ablating surface with a second selected portion of the interior surface of the muscular wall for transmural ablation thereof.  
 
     
     
         3 . The method of  claim 1  further including the steps of: 
 repeating the forming, positioning and contacting steps to form a plurality of strategically positioned lesions.  
 
     
     
         4 . The method of  claim 3  wherein, 
 the lesions are formed to create a predetermined conduction pathway in the muscular wall.  
 
     
     
         5 . The method of  claim 1  wherein, 
 the interior chamber is selected from a right atrium and a left atrium.  
 
     
     
         6 . The method of  claim 1  wherein, 
 the ablating surface is disposed at an angle of at most about 90 degrees relative to the longitudinal axis of the shaft.  
 
     
     
         7 . The method of  claim 1  further including the step of: 
 forming a hemostatic seal between the device and the penetration to inhibit blood loss through the penetration.  
 
     
     
         8 . The method of  claim 7  wherein: 
 the seal forming step is carried out by placing a purse-string suture in the muscular wall of the heart around the penetration.  
 
     
     
         9 . The method of  claim 1  wherein, 
 the heart remains beating throughout the forming, positioning, and contacting steps.  
 
     
     
         10 . The method of  claim 1  further including the step of: 
 arresting the patient's heart.  
 
     
     
         11 . The method of  claim 10  wherein, 
 the arresting step is performed by endovascularly occluding the ascending aorta.  
 
     
     
         12 . The method of  claim 1  wherein, 
 the ablating device is a radiofrequency probe.  
 
     
     
         13 . The method of  claim 1  wherein, 
 the ablating device is a laser probe.  
 
     
     
         14 . The method of  claim 1  wherein, 
 the ablating device is a microwave probe.  
 
     
     
         15 . The method of  claim 1  wherein, 
 the ablating device is a fluid delivery probe.  
 
     
     
         16 . A method for ablating medically refractory atrial fibrillation of the heart comprising the steps of: 
 forming a penetration through a wall of the heart;    positioning a distal end of an ablating device having an elongated ablating surface through the penetration;    forming a hemostatic seal between the ablating device and the penetration to inhibit blood loss therethrough;    contacting the elongated ablating surface with at least one selected portion of an interior surface of the heart for transmural ablation thereof to form at least one elongated transmural lesion.    
     
     
         17 . The method of  claim 16 , further comprising the step of: 
 repeating the forming, positioning, and contacting steps to form a plurality of lesions, the plurality of lesions cooperating to generally form a conduction pathway between the sinoatrial node and the atrioventricular node.    
     
     
         18 . The method of  claim 16  wherein, 
 the interior chamber is selected from a right atrium and a left atrium.  
 
     
     
         19 . The method of  claim 16 , wherein at least one hemostatic seal is formed by tightening a purse-string suture in the heart wall around the respective penetration.  
     
     
         20 . A system for transmurally ablating heart tissue in a body cavity surrounded by a chest wall comprising: 
 a probe having an elongated shaft positionable through the chest wall and into a penetration extending through a wall of the patient's heart, said shaft having a substantially elongated ablating surface proximate a distal end thereof for manipulative contact with at least one selected surface of the wall of the heart for transmural ablation thereof; and    a sealing device fixable to the heart tissue around said penetration for forming a hemostatic seal around the shaft and the transmural penetration to inhibit blood loss therebetween.