Catheters, catheter systems, and methods for puncturing through a tissue structure
A percutaneous catheter system for use within the human body and an ablation catheter for ablating a selected tissue region within the body of a subject. The percutaneous catheter system can include two catheters thai are operatively coupled to one another by magnetic coupling through a tissue structure. The ablation catheter can include electrodes positioned within a central portion. The ablation catheter is positioned such that the central portion of a flexible shaft at least partially surrounds the selected tissue region. Each electrode of the ablation catheter can be activated independently to apply ablative energy to the selected tissue region. The ablation catheter can employ high impedance structures to change the current density at specific points. Methods of puncturing through a tissue structure using the percutaneous catheter system are disclosed. Also disclosed are methods for ablating a selected tissue region using the ablation catheter.
1. A method of treating a heart of a subject from the pericardial space of the heart, comprising:
positioning within the body of the subject a catheter having a proximal portion, a distal portion, and a central portion disposed between the proximal portion and the distal portion, the central portion including a set of electrodes, such that the central portion of the catheter is disposed in the pericardial space of the heart of the subject, and such that the central portion of the catheter at least partially encircles the left pulmonary veins and the right pulmonary veins in the pericardial space of the heart of the subject; and
delivering electrical energy to at least a portion of the left atrium of the heart of the subject using two or more electrodes of the set of electrodes, wherein the portion of the left atrium includes: a first wall portion of the left atrium; an endocardial space of the left atrium; and a second wall portion of the left atrium.
2. The method of claim 1 , the positioning the catheter including passing the catheter through one or more pericardial reflections of the heart of the subject.
3. The method of claim 1 , the positioning the catheter including inserting the catheter into the body of the subject using a subxiphoid pericardial access point.
4. The method of claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a lesion.
5. The method of claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a circumferential lesion without repositioning the catheter.
6. The method of claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a lesion via irreversible electroporation.
7. The method of claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a lesion around an ostium or ostia of one or more of the left pulmonary veins and the right pulmonary veins formed in the left atrium.
8. The method of claim 1 , the delivering the electrical energy including delivering direct current impulses.
9. The method of claim 1 , the delivering the electrical energy including delivering the electrical energy in synchronization with the cardiac cycle of the subject.
10. The method of claim 1 , further comprising monitoring the cardiac cycle of the subject, the delivering the electrical energy including delivering the electrical energy in synchronization with the cardiac cycle of the subject.
11. The method of claim 1 , further comprising monitoring the cardiac cycle of the subject using one or more electrodes of the set of electrodes, the delivering the electrical energy including delivering the electrical energy in synchronization with the cardiac cycle of the subject.
12. The method of claim 1 , the electrical energy including one or more current impulses, the delivering the electrical energy including delivering one or more current impulses for every heart beat of the subject.
13. The method of claim 1 , wherein the catheter is an ablation catheter, further comprising creating a target path within the body of the subject using one or more percutaneous catheters, the positioning the ablation catheter including positioning the ablation catheter in the target path.
14. The method of claim 1 , wherein the portion of the left atrium is a first portion, further comprising delivering electrical energy to a second portion of the left atrium of the heart of the subject using two or more electrodes of the set of electrodes.
15. The method of claim 1 , wherein the portion of the left atrium is a first portion, the positioning the catheter including positioning the catheter in a first position, further comprising:
repositioning the catheter in a second position different from the first position, such that the central portion of the catheter at least partially encircles the left pulmonary veins and the right pulmonary veins in the pericardial space of the heart of the subject; and
delivering electrical energy to a second portion of the left atrium of the heart of the subject using two or more electrodes of the set of electrodes.
16. The method of claim 1 , wherein the delivering includes:
identifying one or more intended current vectors for delivering the electrical energy, the one or more intended current vectors passing through the endocardial space of the left atrium;
selecting, based on the one or more intended current vectors, the two or more electrodes; and
delivering the electrical energy using the two or more electrodes and along the one or more current vectors.
17. The method of claim 1 , the positioning the catheter including passing the catheter over a guidewire within the body of the subject.