Conduction block systems and methods
Tissue treatment systems for cardiac surgical procedures can include an ablation and monitoring assembly having a first ablation element, a second ablation element, and a monitoring mechanism. Treatment methods may involve placing an ablation and monitoring assembly of the tissue treatment system at a patient tissue treatment site, applying a first ablative energy to a first tissue location via the first ablation element and a second ablative energy to a second tissue location via the second ablation element, monitoring a condition of the first tissue location with the monitoring mechanism, and modulating application of the first ablative energy to the first tissue location in response to the condition of the first tissue location while maintaining application of the second ablative energy to the second tissue location. Embodiments also include techniques for assessing a conduction delay across a lesion that involve evaluating local activation rates on various sides of a lesion.
1. A method of operating a tissue treatment system during a cardiac surgical procedure, comprising:
placing an ablation and monitoring assembly of the tissue treatment system at a patient tissue treatment site, the ablation and monitoring assembly comprising a first ablation element, a second ablation element, a stimulation electrode and a sensing electrode;
applying a first ablative energy to a first tissue location via the first ablation element and simultaneously applying a second ablative energy to a second tissue location via the second ablation element;
monitoring a condition of the first tissue location by delivering a stimulation energy to the first tissue location with the stimulation electrode, sensing a tissue near the first tissue location with the sensing electrode to detect whether the tissue near the first tissue location is sufficiently stimulated in response to the stimulation energy where monitoring the condition occurs while applying the first ablative energy and the second ablative energy, wherein the sensing electrode detects a stimulation response during delivery of one or more of the first ablative energy and the second ablative energy;
modulating application of the first ablative energy to the first tissue location while monitoring the condition of the first tissue location and while maintaining application of the second ablative energy to the second tissue location via the second ablation element, wherein the second ablation element maintains the second ablative energy;
sensing a tissue near the second tissue location to determine a conduction block status of the second tissue location;
evaluating a first local activation rate at a first site on a first side of a conduction block;
evaluating a second local activation rate at a second site on a second side of the conduction block;
performing a pacing procedure to assess a conduction delay if both the first local activation rate and the second local activation rate are less than a predetermined excitation rate; and
performing a sensing procedure to assess the conduction delay if either of the first local activation rate or the second local activation rate exceed the predetermined excitation rate.
2. The method of claim 1 , further comprising evaluating an electrocardiogram of the tissue near the first tissue location.
3. The method of claim 1 , wherein the monitoring step comprises visually inspecting the tissue near the first tissue location.
4. The method of claim 1 , wherein the ablation and monitoring assembly comprises a plurality of stimulation electrodes.
5. The method of claim 1 , wherein the patient tissue treatment site comprises epicardial tissue at or near one or more pulmonary veins of the patient.
6. The method of claim 1 , comprising placing the ablation and monitoring assembly at the patient tissue treatment site with an obturator and introducer assembly.
7. The method of claim 1 , wherein the tissue treatment system comprises a tissue contacting assembly, and the ablation and monitoring assembly is at least partially disposed within the tissue contacting assembly.
8. The method of claim 1 , further comprising determining whether the ablation and monitoring assembly is in sufficient contact with the patient tissue treatment site.
9. The method of claim 1 , wherein the monitoring step comprises detecting a conduction block at the first tissue location.
10. The method of claim 1 , comprising contacting the patient tissue treatment site with a suction mechanism of the tissue treatment system.
11. The method of claim 1 , wherein the first ablation element comprises a monopolar electrode.
12. The method of claim 1 , wherein the first ablation element comprises a bipolar electrode.
13. The method of claim 1 , further comprising continuing application of the first ablative energy to the first tissue location after the tissue near the first tissue location ceases to be stimulated in response to the stimulation energy.
14. A method of operating a tissue treatment system during a cardiac surgical procedure, comprising:
placing an ablation and monitoring assembly of the tissue treatment system at a patient tissue treatment site, the ablation and monitoring assembly comprising an ablation element a stimulation electrode and a sensing electrode;
applying a first ablative energy to a first tissue location via a first portion of the ablation element and simultaneously applying a second ablative energy to a second tissue location via a second portion of the ablation element;
monitoring a condition of the first tissue location by delivering a stimulation energy to the first tissue location with the stimulation electrode, sensing a tissue near the first tissue location with the sensing electrode to detect whether the tissue near the first tissue location is sufficiently stimulated in response to the stimulation energy, where monitoring the condition occurs while applying first ablative energy and the second ablative energy, wherein the sensing electrode detects a stimulation response during delivery of one or more of the first ablative energy and the second ablative energy;
modulating application of the first ablative energy to the first tissue location while monitoring the condition of the first tissue location and while maintaining application of the second ablative energy to the second tissue location via the second ablation element, wherein the second ablation element maintains the second ablative energy;
sensing a tissue near the second tissue location to determine a conduction block status of the second tissue location;
evaluating a first local activation rate at a first site on a first side of a conduction block;
evaluating a second local activation rate at a second site on a second side of the conduction block;
performing a pacing procedure to assess a conduction delay if both the first local activation rate and the second local activation rate are less than a predetermined excitation rate; and
performing a sensing procedure to assess the conduction delay if either of the first local activation rate or the second local activation rate exceed the predetermined excitation rate.
15. The method of claim 14 , further comprising continuing application of the first ablative energy to the first tissue location after the tissue near the first tissue location ceases to be stimulated in response to the stimulation energy.