Controlled tissue ablation techniques
Apparatus and methods are described, including a method for use with tissue of a renal nerve ( 770 ) passing longitudinally within a wall of a renal artery ( 8 ) of a subject. Using one or more stimulating electrodes ( 850 a, 850 b ) disposed within the renal artery, the tissue is stimulated by passing a stimulating current through the wall of the renal artery. Using a sensor ( 26 ), a rate of change of blood pressure of the subject is sensed, following the start of the stimulation of the tissue. In response to the rate of change, it is decided whether to ablate the tissue, and in response to deciding to ablate the tissue, the tissue is ablated. Other applications are also described.
1. Apparatus for use with tissue of a renal nerve passing longitudinally within a wall of a renal artery of a subject, the apparatus comprising:
a catheter, configured to be placed within the renal artery;
one or more stimulating electrodes coupled to the catheter and configured to stimulate the tissue of the renal nerve by passing a stimulating current through the wall of the renal artery;
a sensor configured to sense blood pressure information of the subject; and
a control unit, configured to:
drive the one or more stimulating electrodes to stimulate the tissue of the renal nerve,
receive the blood pressure information from the sensor,
based on the received blood pressure information, compute a maximum intra-heartbeat blood pressure increase rate for at least one heartbeat that follows a start of the driving of the one or more stimulating electrodes to stimulate the tissue of the renal nerve,
compare the maximum intra-heartbeat blood pressure increase rate to a threshold, and
generate, in response to the comparison, an output indicating whether an ablation of the tissue of the renal nerve should be performed.
2. The apparatus according to claim 1 , wherein:
the control unit is further configured to:
prior to the driving of the one or more stimulating electrodes, perform a prior driving of the one or more stimulating electrodes to stimulate the tissue of the renal nerve, and
compute the threshold by computing the maximum intra-heartbeat blood pressure increase rate for at least one heartbeat that follows a start of the prior driving of the one or more stimulating electrodes.
3. The apparatus according to claim 1 , wherein:
the at least one heartbeat that follows the start of the driving of the one or more electrodes to stimulate the tissue of the renal nerve is exactly one heartbeat that follows the start of the driving of the one or more electrodes to stimulate the tissue of the renal nerve,
the maximum intra-heartbeat blood pressure increase rate for the at least one heartbeat is a maximum intra-heartbeat blood pressure increase rate for the exactly one heartbeat, and
the control unit is configured to:
based on the received blood pressure information, compute the maximum intra-heartbeat blood pressure increase rate for the exactly one heartbeat,
compare, to the threshold, the maximum intra-heartbeat blood pressure increase rate for the exactly one heartbeat, and
generate the output in response to the comparison, to the threshold, of the maximum intra-heartbeat blood pressure increase rate for the exactly one heartbeat.
4. The apparatus according to claim 1 , wherein:
the at least one heartbeat that follows the start of the driving of the one or more electrodes to stimulate the tissue of the renal nerve is a plurality of heartbeats that follow the start of the driving of the one or more electrodes to stimulate the tissue of the renal nerve,
the maximum intra-heartbeat blood pressure increase rate for the at least one heartbeat is a maximum intra-heartbeat blood pressure increase rate for the plurality of heartbeats, and
the control unit is configured to:
based on the received blood pressure information, compute the maximum intra-heartbeat blood pressure increase rate for the plurality of heartbeats,
compare, to the threshold, the maximum intra-heartbeat blood pressure increase rate for the plurality of heartbeats, and
generate the output in response to the comparison, to the threshold, of the maximum intra-heartbeat blood pressure increase rate for the plurality of heartbeats.
5. The apparatus according to claim 1 , wherein:
the at least one heartbeat that follows a start of the driving of the one or more electrodes to stimulate the tissue of the renal nerve is a plurality of heartbeats that follow the start of the driving of the one or more electrodes to stimulate the tissue of the renal nerve,
the maximum intra-heartbeat blood pressure increase rate for the at least one heartbeat is a maximum intra-heartbeat blood pressure increase rate for each of the plurality of heartbeats, and
the control unit is configured to:
based on the received blood pressure information, compute the maximum intra-heartbeat blood pressure increase rate for each of the plurality of heartbeats,
from the maximum intra-heartbeat blood pressure increase rate for each of the plurality of heartbeats, compute a mean maximum intra-heartbeat blood pressure increase rate for the plurality of heartbeats,
compare, to the threshold, the mean maximum intra-heartbeat blood pressure increase rate, and
generate the output in response to the comparison, to the threshold, of the mean maximum intra-heartbeat blood pressure increase rate.
6. A method for use with tissue of a renal nerve passing longitudinally within a wall of a renal artery of a subject, the method comprising:
using one or more stimulating electrodes disposed within the renal artery, stimulating the tissue of the renal nerve by passing a stimulating current through the wall of the renal artery;
using a sensor, determining a maximum intra-heartbeat blood pressure increase rate for at least one heartbeat that follows a start of the stimulating of the tissue of the renal nerve;
in response to the maximum intra-heartbeat blood pressure increase rate, deciding whether to ablate or to not ablate the tissue of the renal nerve; and
in response to deciding to ablate the tissue of the renal nerve, ablating the tissue of the renal nerve.
7. The method according to claim 6 , wherein determining the maximum intra-heartbeat blood pressure increase rate comprises sensing respective maximum intra-heartbeat blood pressure increase rates for a plurality of heartbeats, and wherein deciding whether to ablate the tissue of the renal nerve comprises deciding whether to ablate the tissue of the renal nerve in response to an average of the respective maximum intra-heartbeat blood pressure increase rates.
8. The method according to claim 6 , wherein:
determining the maximum intra-heartbeat blood pressure increase rate comprises determining respective maximum intra-heartbeat blood pressure increase rates for a plurality of heartbeats,
the method further comprises identifying a largest maximum intra-heartbeat blood pressure increase rate of the plurality of heartbeats, and
wherein deciding whether to ablate the tissue of the renal nerve comprises deciding whether to ablate the tissue of the renal nerve in response to the largest maximum intra-heartbeat blood pressure increase rate.
9. The method determining the maximum intra-heartbeat blood pressure increase rate according to claim 6 ,
wherein stimulating the tissue of the renal nerve comprises stimulating the tissue of the renal nerve during a second stimulation,
wherein the method further comprises, prior to the second stimulation:
using the one or more stimulating electrodes to stimulate the tissue of the renal nerve by passing the stimulating current through the wall of the renal artery, during a first stimulation;
using the sensor, determining a maximum intra-heartbeat blood pressure increase rate for at least one heartbeat that follows a start of the first stimulation; and
performing a first ablation of the tissue of the renal nerve, and
wherein deciding whether to ablate the tissue of the renal nerve comprises deciding whether to perform a second ablation of the tissue of the renal nerve, in response to a difference between (i) the maximum intra-heartbeat blood pressure increase rate for the at least one heartbeat that follows the start of the first stimulation, and (ii) the maximum intra-heartbeat blood pressure increase rate for the at least one heartbeat that follows the start of the second stimulation.
10. The method according to claim 6 ,
wherein stimulating the tissue of the renal nerve comprises stimulating the tissue of the renal nerve by passing the stimulating current through the wall of the renal artery at each of a plurality of sites,
wherein determining the maximum intra-heartbeat blood pressure increase rate comprises determining a maximum intra-heartbeat blood pressure increase rate for each of the stimulations of the plurality of sites, and
wherein deciding whether to ablate the tissue of the renal nerve comprises (a) deciding to ablate the tissue of the renal nerve at at least one of the plurality of sites, and (b) deciding not to ablate the tissue of the renal nerve at at least another one of the plurality of sites, in response to the determined maximum intra-heartbeat blood pressure increase rates.
11. The method according to claim 10 , wherein the plurality of sites includes a plurality of longitudinal sites along the wall of the renal artery, and wherein passing the respective stimulating currents through the wall of the renal artery at the plurality of sites comprises passing the respective stimulating currents through the wall of the renal artery at the plurality of longitudinal sites.
12. The method according to claim 10 , wherein the plurality of sites includes a plurality of circumferential sites along the wall of the renal artery, and wherein passing the respective stimulating currents through the wall of the renal artery at the plurality of sites comprises passing the respective stimulating currents through the wall of the renal artery at the plurality of circumferential sites.
13. The method according to claim 6 , wherein determining the maximum intra-heartbeat blood pressure increase rate for the at least one heartbeat that follows the start of the stimulating of the tissue of the renal nerve comprises determining the maximum intra-heartbeat blood pressure increase rate for exactly one heartbeat that follows the start of the stimulating of the tissue of the renal nerve.