Methods, apparatuses, and systems for the treatment of disease states and disorders

Abstract

Apparatuses, systems and methods are provided for treating pulmonary tissues via delivery of energy, generally characterized by high voltage pulses, to target tissue using a pulmonary tissue modification system (e.g., an energy delivery catheter system). Example pulmonary tissues include, without limitation, the epithelium (the goblet cells, ciliated pseudostratified columnar epithelial cells, and basal cells), lamina propria, submucosa, submucosal glands, basement membrane, smooth muscle, cartilage, nerves, pathogens resident near or within the tissue, or a combination of any of these. The system may be used to treat a variety of pulmonary diseases or disorders such as or associated with COPD (e.g., chronic bronchitis, emphysema), asthma, interstitial pulmonary fibrosis, cystic fibrosis, bronchiectasis, primary ciliary dyskinesia (PCD), acute bronchitis and/or other pulmonary diseases or disorders.

1 . (canceled) 
     
     
         2 . A method of treating cardiac tissue of a patient comprising:
 positioning a catheter having at least one electrode so that at least one of the at least one electrode is able to deliver pulsed electric field energy to an area of the cardiac tissue, wherein the pulsed electric field energy destroys cells while leaving its associated extracellular matrix undamaged;   positioning a return electrode in relation to the at least one electrode so as to allow at least one of the at least one electrode to function in a monopolar fashion;   delivering pulsed electric field energy through at least one of the at least one electrode in the monopolar fashion so that the pulsed electric field energy flows to the area of the cardiac tissue and toward the return electrode; and   delivering pulsed electric field energy through at least one of the at least one electrode in a bipolar fashion so that the pulsed electric field energy flows from one of the at least one electrode, to the area of the cardiac tissue and toward another of the at least one electrode.   
     
     
         3 . A method as in  claim 2 , wherein the catheter is connectable with a generator having at least two energy delivery algorithms, the method further comprising selecting one of the at least two energy delivery algorithms to actuate one of the delivering steps. 
     
     
         4 . A method as in  claim 3 , the method further comprising selecting another of the at least two energy delivery algorithms to actuate the other of the delivering steps. 
     
     
         5 . A method as in  claim 2 , wherein the catheter is connectable with a generator having at least one energy delivery algorithm, the method further comprising selecting one of the at least one energy delivery algorithms that actuates both of the delivering steps. 
     
     
         6 . A method as in  claim 5 , wherein the one of the at least one energy delivery algorithms actuates both of the delivering steps actuating one of the delivery steps and then switching to the other of delivering steps. 
     
     
         7 . A method as in  claim 2 , wherein the delivering pulsed electric field energy through at least one of the at least one electrode in a bipolar fashion comprises delivering pulsed electric field energy through a plurality of the at least one electrode in a multiplexed fashion. 
     
     
         8 . A method as in  claim 7 , wherein delivering pulsed electric field energy through the plurality of the at least one electrode comprises cycling delivery of energy through any pair of two electrodes of the at least one electrode wherein one of each pair of the two electrodes is neutral. 
     
     
         9 . A method as in  claim 2 , further comprising switching between the delivering steps. 
     
     
         10 . A method as in  claim 9 , wherein the switching is configured to achieve a desired treatment area and/or depth of treatment. 
     
     
         11 . A method as in  claim 2 , wherein the catheter has a distal end that is pre-shaped to include a semi-circular, circular or looped shape, and wherein the at least one electrode comprises a plurality of electrodes along the semi-circular, circular or looped shape. 
     
     
         12 . A method as in  claim 11 , wherein delivering pulsed electric field energy through at least one of the at least one electrode in the monopolar fashion comprises delivering pulsed electric field energy through all of the plurality of electrodes. 
     
     
         13 . A method as in  claim 11 , wherein delivering pulsed electric field energy through at least one of the at least one electrode in the bipolar fashion comprises delivering pulsed electric field energy between pairs of the plurality of electrodes. 
     
     
         14 . A method as in  claim 2 , wherein the at least one electrode comprises a plurality of wires. 
     
     
         15 . A method as in  claim 2 , wherein the at least one electrode comprises a plurality of electrodes along a rounded expandable member. 
     
     
         16 . A method as in  claim 2 , wherein the delivering steps provide sufficient pulsed electric field energy to the area of the cardiac tissue so as to treat aberrant cardiac arrhythmias. 
     
     
         17 . A method as in  claim 2 , wherein positioning the return electrode in relation to the at least one electrode so as to allow the at least one of the at least one electrode to function in a monopolar fashion comprises positioning the return electrode on a surface of the patient. 
     
     
         18 . A method as in  claim 2 , wherein positioning the return electrode in relation to the at least one electrode so as to allow the at least one of the at least one electrode to function in a monopolar fashion comprises positioning the return electrode within the patient. 
     
     
         19 . A method as in  claim 2 , wherein positioning the catheter comprises positioning at least one of the at least one electrode in contact with blood so that the blood functions as a virtual electrode. 
     
     
         20 . A method as in  claim 2 , further comprising delivering a solution through the catheter to the area of the cardiac tissue. 
     
     
         21 . A method as in  claim 2 , wherein positioning the catheter comprises serially positioning the catheter so as to deliver the pulsed electric field energy to focal regions of the area of cardiac tissue.