Catheter Systems for Cardiac Arrhythmia Ablation

Abstract

A plurality of catheter-based ablation apparatus embodiments are provided that address several areas of atrial target tissue and which feature firm and consistent ablation element to tissue contact enabling the creation of effective continuous lesions.

What is claimed is: 
     
         1 - 86 . (canceled) 
     
     
         87 . A device for ablating selected tissue in a body organ chamber, including heart chambers, comprising:
 (a) a guide body sheath having a deflectable distal end portion;   (b) an electrodeless guidewire having relatively stiff and soft portions and adapted to exit and reenter said deflectable distal end portion of said guide body sheath to form a stable electrodeless guidewire loop that is controllable in the body organ chamber to create forced contact with selected tissue of the heart;   (c) a catheter guide shaft having an ablating energy element adapted for creating a lesion on the selected tissue, the catheter guide shaft able to travel over and be fully supported by said electrodeless guidewire, said electrodeless guidewire being of sufficient stiffness and controllable to create forced contact between said ablating energy element and said selected tissue at a plurality of desired locations along said stable electrodeless guidewire loop;   (d) a control handle at a proximal portion of said guide body sheath operatively coupled to the electrodeless guidewire and containing a loop control slide element comprising first and second guidewire locks whereby the size, shape and disposition of the loop can be adjusted and fixed.   
     
     
         88 . The device for ablating the selected tissue as in  claim 87  wherein manipulation of the control handle loop control slide element allows the ablating energy element to make contact with said selected tissue in the body organ chamber at multiple locations and thereby create continuous lesions. 
     
     
         89 . The device for ablating the selected tissue as in  claim 87  wherein said ablating energy element further comprises a plurality of thermistors and a plurality of electrodes insulated from one another for temperature monitoring and real-time electrical activity assessment of lesion maturation. 
     
     
         90 . The device for ablating the selected tissue as in  claim 87  wherein said control handle loop control slide element comprises a movable locking device connected to said catheter guide shaft for controlling a position of said ablating energy element along said electrodeless guidewire. 
     
     
         91 . The device for ablating the selected tissue as in  claim 87  wherein said ablating energy element comprises an ablation balloon device that is made to contain a cryogenic fluid that is selected from the group consisting of liquid nitrous oxide (N 2 O) and other cryogenic fluids. 
     
     
         92 . A device for ablating selected tissue comprising:
 (a) a guide body sheath having a deflectable distal end portion with an opening therein;   (b) an ablation catheter sheath extendable from said deflectable distal end portion of said guide body sheath and having a J-shaped distal end portion configured with a leading 180° guiding bend that enables guiding of the device into a pulmonary vein orifice or other conduit and which continues in a form of a trailing loop which is provided with an array of spaced recording and stimulation elements configured to extend circumferentially around an interior surface of said pulmonary vein orifice or other conduit;   (c) a cryogenic ablation balloon device on said ablation catheter sheath, said cryogenic ablation balloon device being guided, supported on, stabilized and anchorable in position just proximal to said J-shaped distal end portion by said ablation catheter sheath;   (d) a control handle disposed at a proximal end of the guide body sheath for controlling an extension of said ablation catheter from said guide body sheath, said control handle comprising a locking member whereby the disposition of the ablation catheter sheath can be adjusted and fixed; and   (e) wherein said cryogenic ablation balloon device further comprises a distal ring electrode placed distal to the entire inflatable ablation balloon device and a proximal ring electrode placed proximal to the cryogenic ablation balloon device for measuring impedance during a cryogenic ablation procedure for determining an extent of ice formation on the distal ring electrode, indicative of circumferential ice formation on the outer balloon that extends to cover the distal ring electrode indicating pulmonary vein occlusion and lesion adequacy and maturation.   
     
     
         93 . The device for ablating the selected tissue as in  claim 92  wherein when said cryogenic ablation balloon device is adapted to be placed in a pulmonary vein orifice whereby pulmonary vein occlusion and continuous circumferential ablation can be assessed by impedance measurements between said proximal ring electrode and said distal ring electrode obtained when a low-power, high-frequency voltage is applied therebetween. 
     
     
         94 . The device for ablating the selected tissue as in  claim 92  wherein said inflatable cryogenic ablation balloon device is connected to said ablation catheter sheath that is arranged to travel over a guidewire. 
     
     
         95 . The device for ablating the selected tissue as in  claim 92  wherein said control handle is also configured to adjust a position of the cryogenic ablation balloon device riding on said ablation catheter sheath. 
     
     
         96 . The device for ablating the selected tissue as in  claim 92  wherein said stable electrodeless guidewire loop includes a tip segment attached to the deflectable distal end portion of the guide body sheath. 
     
     
         97 . A device for ablating selected tissue comprising:
 (a) A catheter;   (b) a catheter handle;   (c) a controller apparatus coupled to the catheter handle;   (d) an ablation/recording device coupled to the catheter handle;   (e) a guidewire extending from the catheter handle, said guidewire comprising a proximal end, a stiff body, soft distal end, and a loop;   (f) an ablation delivery sheath comprising an ablation element positioned on the ablation delivery sheath,
 wherein the controller apparatus is adapted to lock the soft distal end of the guidewire in place, allow the proximal end of the guidewire to be extended and retracted to adjust the size of the loop, and lock the proximal end of the guidewire in place to fix the size of the loop; and 
 wherein the ablation/recording device assess movement and position of the ablation/recording element. 
   
     
     
         98 . The device for ablating selected tissue of  claim 97  wherein the ablation element is a balloon. 
     
     
         99 . The device for ablating selected tissue of  claim 97  wherein the ablation delivery sheath is a deflectable transeptal sheath. 
     
     
         100 . The device for ablating selected tissue of  claim 97  wherein the ablation/recording element includes a measuring ruler placed on a sliding track. 
     
     
         101 . The device for ablating selected tissue of  claim 97  wherein the loop is formed by extending the soft distal end of the guidewire and a selected portion of the stiff body portion of the guidewire from a distal end of the ablation delivery sheath and causing the soft distal end of the guidewire to reenter the ablation delivery sheath. 
     
     
         102 . A device for ablating selected tissue comprising:
 a. an ablation/recording element having a shaft and adapted to create a continuous lesion and permit recording;   b. an anchoring J shaped guidewire with a soft distal end and stiff body adapted to be inserted into an anatomical location and allow the ablation element to be tracked over the guidewire; and   c. a J-shaped multi-electrode lasso catheter adapted to be inserted via the shaft of the ablation/recording element.   
     
     
         103 . The device for ablating selected tissue of  claim 102  wherein the ablation/recording element comprises a cryo-balloon device including a balloon, a distal ring of a small width placed at an anterior surface of the balloon, and a proximal ring, wherein said distal ring and said proximal ring are adapted to measure impedance. 
     
     
         104 . The device for ablating selected tissue of  claim 103  wherein rising impedance is correlated with of ice formation and lesion maturation. 
     
     
         105 . The device for ablating selected tissue of  claim 102  wherein the balloon is adapted to allows electrical recording over the surface of the ablation/recording element and impedance recording.