Methods for treating heart arrhythmia

Abstract

Methods and apparatus are provided for treatment of heart arrhythmia via renal neuromodulation. Such neuromodulation may effectuate irreversible electroporation or electrofusion, ablation, necrosis and/or inducement of apoptosis, alteration of gene expression, action potential attenuation or blockade, changes in cytokine up-regulation and other conditions in target neural fibers. In some embodiments, such neuromodulation is achieved through application of an electric field. In some embodiments, such neuromodulation is achieved through application of neuromodulatory agents, of thermal energy and/or of high intensity focused ultrasound. In some embodiments, such neuromodulation is performed in a bilateral fashion.

1 . A method for treating heart arrhythmia, the method comprising: 
 introducing a modulation instrument proximate a neural fiber that contributes to renal function of a kidney of a patient; and    delivering energy and/or a neuromodulatory agent to the neural fiber via the modulation instrument in order to modulate a function of the neural fiber, thereby systemically reducing sympathetic tone in the patient.    
   
   
       2 . The method of  claim 1 , wherein delivering energy further comprises delivering an electric field.  
   
   
       3 . The method of  claim 2 , wherein delivering the electric field further comprises delivering a pulsed electric field.  
   
   
       4 . The method of  claim 2 , wherein delivering the electric field further comprises delivering a continuous electric field.  
   
   
       5 . The method of  claim 1 , wherein delivering a neuromodulatory agent further comprises delivering a drug to the neural fiber.  
   
   
       6 . The method of  claim 1 , wherein modulating the function of the neural fiber further comprises at least partially denervating the kidney.  
   
   
       7 . The method of  claim 1 , wherein modulating the function of the neural fiber further comprises inducing an effect in the neural fiber chosen from the group consisting of irreversible electroporation, electrofusion, ablation, necrosis, apoptosis, gene expression alteration, cytokine up-regulation alteration, and combinations thereof.  
   
   
       8 . The method of  claim 1 , wherein delivering energy further comprises delivering thermal energy.  
   
   
       9 . The method of  claim 1 , wherein delivering energy further comprises delivering high intensity focused ultrasound.  
   
   
       10 . The method of  claim 1 , wherein systemically reducing sympathetic tone in the patient further comprises decreasing a load on a heart of the patient.  
   
   
       11 . A method for treating heart arrhythmia, the method comprising: 
 introducing a modulation instrument proximate a neural fiber that contributes to renal function of a kidney of a patient; and    delivering energy and/or a neuromodulatory agent to the neural fiber via the modulation instrument in order to modulate a function of the neural fiber, thereby decreasing a load on a heart of the patient.    
   
   
       12 . The method of  claim 11 , wherein delivering energy further comprises delivering an electric field.  
   
   
       13 . The method of  claim 12 , wherein delivering the electric field further comprises delivering a pulsed electric field.  
   
   
       14 . The method of  claim 12 , wherein delivering the electric field further comprises delivering a continuous electric field.  
   
   
       15 . The method of  claim 11 , wherein delivering the neuromodulatory agent further comprises delivering a drug to the neural fiber.  
   
   
       16 . The method of  claim 11 , wherein modulating the function of the neural fiber further comprises at least partially denervating the kidney.  
   
   
       17 . The method of  claim 11 , wherein modulating the function of the neural fiber further comprises inducing an effect in the neural fiber chosen from the group consisting of irreversible electroporation, electrofusion, ablation, necrosis, apoptosis, gene expression alteration, cytokine up-regulation alteration, and combinations thereof.  
   
   
       18 . The method of  claim 11 , wherein delivering the energy further comprises delivering thermal energy.  
   
   
       19 . The method of  claim 11 , wherein delivering the energy further comprises delivering high intensity focused ultrasound.  
   
   
       20 . The method of  claim 11 , wherein decreasing the load on the heart of the patient further comprises systemically reducing sympathetic tone in the patient.  
   
   
       21 . A method for treating heart arrhythmia, the method comprising: 
 introducing a modulation instrument proximate a neural fiber that contributes to renal function of a kidney of the patient; and    delivering energy and/or a neuromodulatory agent to the neural fiber via the modulation instrument in order to modulate a function of the neural fiber,    wherein introducing the modulation instrument further comprises percutaneously introducing the modulation instrument.    
   
   
       22 . The method of  claim 21 , wherein percutaneously introducing the modulation instrument further comprises introducing the modulation instrument via a laparoscopic approach.  
   
   
       23 . The method of  claim 21 , wherein percutaneously introducing the modulation instrument further comprises introducing the modulation instrument via an endoluminal approach.  
   
   
       24 . The method of  claim 21 , wherein delivering energy further comprises delivering an electric field.  
   
   
       25 . The method of  claim 24 , delivering the electric field further comprises delivering a pulsed electric field.  
   
   
       26 . The method of  claim 24 , wherein delivering the electric field further comprises delivering a stimulation electric field.  
   
   
       27 . The method of  claim 21 , wherein delivering a neuromodulatory agent further comprises delivering a drug.  
   
   
       28 . The method of  claim 21 , wherein modulating the function of the neural fiber further comprises at least partially denervating the kidney.  
   
   
       29 . The method of  claim 21 , wherein modulating the function of the neural fiber further comprises inducing an effect in the neural fiber chosen from the group consisting of irreversible electroporation, electrofusion, ablation, necrosis, apoptosis, gene expression alteration, cytokine up-regulation alteration, and combinations thereof.  
   
   
       30 . The method of  claim 21 , wherein delivering energy further comprises delivering thermal energy.  
   
   
       31 . The method of  claim 21 , wherein delivering energy further comprises delivering high intensity focused ultrasound.  
   
   
       32 . The method of  claim 21 , wherein modulating the function of the neural fiber further comprises decreasing a load on a heart of the patient.  
   
   
       33 . The method of  claim 21 , wherein modulating the function of the neural fiber further comprises systemically reducing sympathetic tone in the patient.  
   
   
       34 . A method for reducing a load on a heart of a patient, the method comprising: 
 introducing a modulation instrument proximate a neural fiber that contributes to renal function of a kidney of the patient; and    delivering energy or a neuromodulatory agent to the neural fiber via the modulation instrument in order to modulate a function of the neural fiber.    
   
   
       35 . The method of  claim 34 , wherein reducing the load on the heart of the patient further comprises treating heart arrhythmia.  
   
   
       36 . The method of  claim 34 , wherein modulating the function of the neural fiber further comprises at least partially denervating the kidney.  
   
   
       37 . The method of  claim 34 , wherein modulating the function of the neural fiber further comprises inducing an effect in the neural fiber chosen from the group consisting of irreversible electroporation, electrofusion, ablation, necrosis, apoptosis, gene expression alteration, cytokine up-regulation alteration, and combinations thereof.  
   
   
       38 . The method of  claim 34 , wherein reducing the load on the heart of the patient further comprises systemically reducing sympathetic tone in the patient.  
   
   
       39 . A method for systemically reducing sympathetic tone in a patient, the method comprising: 
 introducing a modulation instrument proximate a neural fiber that contributes to renal function of a kidney of the patient; and    delivering energy or a neuromodulatory agent to the neural fiber via the modulation instrument in order to modulate a function of the neural fiber.    
   
   
       40 . The method of  claim 39 , wherein systemically reducing sympathetic tone in the patient further comprises treating heart arrhythmia.  
   
   
       41 . The method of  claim 39 , wherein modulating the function of the neural fiber further comprises at least partially denervating the kidney.  
   
   
       42 . The method of  claim 39 , wherein modulating the function of the neural fiber further comprises inducing an effect in the neural fiber chosen from the group consisting of irreversible electroporation, electrofusion, ablation, necrosis, apoptosis, gene expression alteration, cytokine up-regulation alteration, and combinations thereof.  
   
   
       43 . The method of  claim 39 , wherein systemically reducing systemic sympathetic tone in the patient further comprises reducing a load on a heart of the patient.  
   
   
       44 . The method of  claim 1 , wherein treating heart arrhythmia further comprises treating heart arrhythmia chosen from the group consisting of atrial arrhythmia, ventricular arrhythmia, tachycardia, bradycardia, atrial tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia, ventricular fibrillation, long QT syndrome, sick sinus, conduction block and combinations thereof.  
   
   
       45 . The method of  claim 11 , wherein treating heart arrhythmia further comprises treating heart arrhythmia chosen from the group consisting of atrial arrhythmia, ventricular arrhythmia, tachycardia, bradycardia, atrial tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia, ventricular fibrillation, long QT syndrome, sick sinus, conduction block and combinations thereof.  
   
   
       46 . The method of  claim 21 , wherein treating heart arrhythmia further comprises treating heart arrhythmia chosen from the group consisting of atrial arrhythmia, ventricular arrhythmia, tachycardia, bradycardia, atrial tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia, ventricular fibrillation, long QT syndrome, sick sinus, conduction block and combinations thereof.  
   
   
       47 . The method of  claim 34 , wherein treating heart arrhythmia further comprises treating heart arrhythmia chosen from the group consisting of atrial arrhythmia, ventricular arrhythmia, tachycardia, bradycardia, atrial tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia, ventricular fibrillation, long QT syndrome, sick sinus, conduction block and combinations thereof.  
   
   
       48 . The method of  claim 39 , wherein treating heart arrhythmia further comprises treating heart arrhythmia chosen from the group consisting of atrial arrhythmia, ventricular arrhythmia, tachycardia, bradycardia, atrial tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia, ventricular fibrillation, long QT syndrome, sick sinus, conduction block and combinations thereof.