Method and devices for performing biatrial coagulation

1. A method of treating tissue to create a bi-atrial treatment pattern on a first and a second tissue Where the first tissue and the second tissue are located on opposite sides of a cardiac tissue, the method comprising:

positioning a first treatment device adjacent to the first tissue;

creating a first partial treatment pattern on the first tissue with the first treatment device, wherein the first partial treatment pattern comprises at least a first plurality of areas of non-viable injury in the first tissue, wherein at least two of the areas of non-viable injury are separated by a gap that allows an electrical impulse to flow therethrough in the cardiac tissue:

determining a position on the second tissue for a second treatment device;

positioning the second treatment device at the position on the second tissue, wherein the second tissue is located on opposite sides of the first tissue; and

creating a second partial treatment pattern on the second tissue with the second treatment device, wherein the second partial treatment pattern comprises at least one area of injury in the second tissue across the gap to form a complete treatment pattern such that the electrical impulse cannot flow across the complete treatment pattern.

2. The method of . claim 1 , further comprising advancing a scope into a body, wherein the scope comprises at least one visualization element, and wherein determining the position of the second treatment device comprises using the visualization element.

3. The method of claim 1 , further comprising advancing a second treatment device to the second tissue to create the second partial treatment pattern.

4. The method of claim 1 , wherein the first treatment device and the second treatment device comprise opposite poles of an RF energy supply, and wherein energy flows between the first treatment device and second treatment device during application of the RF energy supply.

5. The method of claim 1 , wherein the first treatment device comprises a device selected from the group consisting of an RF energy device, a laser device, an infrared heating device, a chemical ablation device, a cryogenic device, a microwave energy device, and a resistive heating device.

6. The method of claim 1 , wherein the first tissue comprises an epicardial surface and the second tissue comprises an endocardial surface.

7. The method of claim 1 , wherein the first tissue comprises an endocardial surface and the second tissue comprises an epicardial surface.

8. The method of claim 1 , wherein the first treatment device is advanced through a port or trocar positioned in a body, and wherein the second treatment device is advanced through a vascular path in the body.

9. The method of claim 8 , wherein the port or trocar is located in an abdominal wall of the body and the first treatment device is advanced through the diaphragm.

10. The method of claim 8 , wherein no ports or trocars are positioned in a chest wall of the body.

11. The method of claim 5 , wherein the first tissue surface comprises an endocardial surface and the second tissue surface comprises an epicardial surface.

12. A method of creating a treatment pattern in a target tissue, where the target tissue comprises a first tissue surface and a second tissue surface, where the second tissue surface is on an opposite side of the first tissue surface, the method comprising:

positioning a first medical device adjacent to the first tissue surface;

forming a first portion of the treatment pattern along the first tissue surface using the first medical device such that the first portion of the treatment pattern is incomplete;

positioning a second medical device having at least one energy source adjacent to the second tissue surface;

applying energy adjacent to the second tissue surface using the energy source;

observing a location of the energy source through the target tissue from the first tissue surface to locate the second medical device; and

repositioning the second medical device on the second tissue surface in response to the location of the first portion of the treatment pattern and using the second medical device to form a second portion of the treatment pattern on the second tissue surface to complete the treatment pattern.

13. The method of claim 12 , further comprising advancing a scope into a body, wherein the scope comprises at least one visualization element, and wherein observing a location of the energy source through the target tissue from the first tissue surface to locate the second medical device comprises using the visualization element to identify the location of the energy.

14. The method of claim 12 , wherein the energy source comprises an energy selected from the group consisting of visible light, coherent light, ultraviolet light, magnetic energy, and electrical energy.

15. The method of . claim 12 , wherein observing a location of the energy source through the target tissue from the first tissue surface to locate the second medical device comprises placing a sensor device adjacent to the first tissue surface, wherein the sensor device measures the energy to determine a proximity between the second medical device and the sensor device.

16. The method of claim 12 , wherein the first tissue surface comprises an epicardial surface and the second tissue surface comprises an endocardial surface.

17. A method of completing a bi-atrial treatment pattern on a second tissue surface opposite to a first tissue surface where the first and second tissue surfaces are on opposite sides of a cardiac tissue, where the first tissue surface comprises a first partial coagulation pattern having a gap that allows an electrical impulse to flow therethrough in the cardiac tissue; the method comprising:

locating the gap on the second tissue surface;

positioning a treatment device adjacent to the gap on the second tissue surface;

coagulating the second tissue surface to produce at least one coagulation area at the gap, where the at least one coagulation area and the partial coagulation pattern form a complete coagulation pattern such that an electrical impulse cannot flow across the complete coagulation pattern.

18. The method of claim 17 , where locating the gap on the second tissue surface comprises applying a locational energy at the first tissue surface in an amount insufficient to ablate or coagulate tissue and observing the locational energy from the second tissue surface to determine the position of the gap.

19. The method of claim 18 , where the locational energy comprises an energy selected from the group consisting of visible light, coherent light, ultraviolet light, magnetic energy, electrical energy.

20. The method of claim 19 , further comprising advancing a scope into a body where the scope comprises at least one visualization element configured to observe the locational energy from the second surface and where positioning the treatment device comprises moving the treatment device in response to observing the locational energy.

21. The method of claim 17 , where the treatment device comprises a device selected from the group consisting of an RF energy device, a laser device, an infrared heating heater device, a chemical ablation device, a cryogenic device, a microwave energy device, and a resistive heating device.