Methods and devices for endovascular ablation of a splanchnic nerve
Systems, devices, and methods for transvascular ablation of target tissue. The devices and methods may, in some examples, be used for splanchnic nerve ablation to increase splanchnic venous blood capacitance to treat at least one of heart failure and hypertension. For example, the devices disclosed herein may be advanced endovascularly to a target vessel in the region of a thoracic splanchnic nerve (TSN), such as a greater splanchnic nerve (GSN) or a TSN nerve root. Also disclosed are methods of treating heart failure, such as HFpEF, by endovascularly ablating a thoracic splanchnic nerve to increase venous capacitance and reduce pulmonary blood pressure.
1. A method of ablating a greater splanchnic nerve or a greater splanchnic nerve root to increase splanchnic venous blood capacitance, comprising:
advancing an elongate medical device into an azygous vein, the elongate medical device including a distal region, a flexible shaft with a fluid lumen therein, and an ablation element disposed at the distal region, the ablation element comprising a membrane in fluid communication with the fluid lumen, the ablation element at least partially defining a fluid chamber;
advancing the ablation element from the azygous vein into a T9, T10, or T11 intercostal vein;
when the ablation element is disposed in the intercostal vein, delivering a fluid through the fluid lumen and into the fluid chamber to expand the membrane into an expanded configuration that has a length from 5 mm to 20 mm and an outer diameter from 2 mm to 4 mm; and
delivering ablation energy from the ablation element to create a continuous circumferential lesion having a length in a range of 5 to 20 mm, and thereby ablate a portion of a thoracic splanchnic nerve or a thoracic splanchnic nerve root.
2. The method of claim 1 , wherein delivering the ablation energy creates the continuous lesion that also has a depth of at least 5 mm.
3. The method of claim 1 , wherein advancing the ablation element from the azygous vein into a T9, T10, or T11 intercostal vein comprises maintaining a position of the ablation element from an ostium of the azygos to the intercostal to up to 20 mm from the ostium.
4. The method of claim 1 , wherein the advancing step comprises maintaining a position of the ablation element from an ostium of the azygos to the intercostal to up to 15 mm from the ostium.
5. The method of claim 1 , wherein advancing the ablation element from the azygous vein into a T9, T10, or T11 intercostal vein comprises advancing the ablation element from the azygous into the T11 intercostal.
6. The method of claim 5 , further comprising performing an ablation confirmation test, and if needed, repositioning the ablation element into the T10 intercostal vein and delivering ablation energy from the ablation element to create a continuous lesion having a length in a range of 10 to 20 mm.
7. The method of claim 6 , further comprising performing an ablation confirmation test, and if needed, repositioning the ablation element into the T9 intercostal vein and delivering ablation energy from the ablation element to create a continuous lesion having a length in a range of 10 to 20 mm.
8. The method of claim 1 , wherein advancing the elongate medical device comprises advancing an elongate medical device that includes an ablation element comprising a membrane that has pores with a diameter in a range of 100 to 150 picometers.
9. The method of claim 8 , wherein delivering the fluid comprises delivering hypertonic saline through the fluid lumen and into a volume at least partially defined by the membrane.
10. The method of claim 9 , further comprising generating RF energy to an electrode disposed within the membrane, to thereby conduct RF energy to the conductive fluid, through the membrane, and into tissue to thereby create the continuous lesion.
11. The method of claim 9 , wherein expanding the membrane into the expanded configuration creates an ionic communication between the membrane and tissue in apposition with an external surface of the membrane.
12. The method of claim 11 , further comprising, prior to delivering the ablation energy, delivering stimulation energy to first and second stimulation electrodes carried by the medical device to determine if the ablation element is in a target location within the intercostal vein, and if necessary, moving the ablation element within the intercostal vein.
13. The method of claim 1 , wherein delivering energy comprises delivering energy from less than 100% of the circumference of the ablation element.
14. The method of claim 13 , wherein delivering energy comprises delivering energy from less than 50% of the circumference of the ablation element.