Systems, devices, and methods for delivery of pulsed electric field ablative energy to endocardial tissue
Systems, devices, and methods for electroporation ablation therapy are disclosed, with the system including a pulse waveform signal generator for medical ablation therapy, and an endocardial ablation device includes at least one electrode for ablation pulse delivery to tissue. The signal generator may deliver voltage pulses to the ablation device in the form of a pulse waveform. The system may include a cardiac stimulator for generation of pacing signals and for sequenced delivery of pulse waveforms in synchrony with the pacing signal.
1. A method, comprising:
advancing a guidewire and a sheath into a left atrium through a transseptal opening;
advancing an ablation device into the left atrium over the guidewire, the ablation device including:
a catheter shaft defining a longitudinal axis and a shaft lumen therethrough; and
a set of splines coupled to the catheter shaft, a distal portion of each spline of the set of splines extending distally from a distal end of the catheter shaft, each spline of the set of splines including a set of electrodes formed on a surface of each spline of the set of splines, the set of splines configured to transition between a first configuration in which the distal portion of each spline of the set of splines is disposed a first distance from a distal end of the catheter shaft and a second configuration in which the distal portion of each spline from the set of splines is disposed a second distance less than the first distance from the distal end of the catheter shaft;
transitioning the ablation device from the first configuration into the second configuration;
advancing the ablation device to toward a pulmonary vein of a set of pulmonary veins; and
delivering an ablation pulse waveform to the ablation device such that the ablation device generates a set of electric field lines generally parallel with a longitudinal axis of a set of myocardial cells disposed circumferentially in an atrial wall of the left atrium.
2. The method of claim 1 , wherein a magnitude of the electric field lines is E and a magnitude of a tangential component of the electric field lines relative to the atrial wall is E t , and E t /E is greater than about 0.3.
3. The method of claim 1 , wherein the ablation pulse waveform has a voltage amplitude of between about 500 V and 3000 V.
4. The method of claim 1 , wherein a ratio of the first distance to the second distance is between about 3:1 and about 25:1.
5. The method of claim 1 , wherein at least a portion of each spline of the set of splines has a radius of curvature between about 7 mm and about 25 mm.
6. The method of claim 1 , further comprising:
creating a first access site in a patient;
advancing the guidewire through the first access site and into a right atrium;
advancing a dilator and a sheath over the guidewire and into the right atrium;
advancing the dilator from the right atrium into the left atrium through an interatrial septum to create the transseptal opening; and
dilating the transseptal opening using the dilator.
7. The method of claim 1 , further comprising creating a second access site in the patient for advancing a pacing device for cardiac stimulation.
8. The method of claim 7 , further comprising:
advancing the pacing device into a right ventricle;
generating a pacing signal for cardiac stimulation of the heart; and
applying the pacing signal to the heart using the pacing device, the ablation pulse waveform generated in synchronization with the pacing signal.
9. The method of claim 8 , wherein the ablation pulse waveform includes a time offset with respect to the pacing signal.
10. The method of claim 1 , further comprising:
recording first electrophysiology data of the left atrium before delivering the ablation pulse waveform; and
recording second electrophysiology data of the left atrium after delivering the ablation pulse waveform.
11. The method of claim 10 , wherein the first and second electrophysiology data include intracardiac electrocardiogram (ECG) signal data of at least one pulmonary vein.
12. The method of claim 10 , wherein the first and second electrophysiology data is recorded using the ablation device in a configuration different from the first configuration.
13. The method of claim 10 , further comprising advancing a diagnostic catheter into the left atrium and recording the first and second electrophysiology data using the diagnostic catheter.
14. The method of claim 1 , wherein the ablation device disposed in the left atrium transitions from the first configuration into the second configuration without contacting the atrial wall and the pulmonary vein.
15. The method of claim 1 , further comprising disposing the ablation device in an endocardial space of the left atrium such that at least one spline of the set of splines is in contact with a pulmonary vein ostium.
16. The method of claim 15 , wherein the at least one spline of the set of splines in contact with the pulmonary vein ostium forms a “C” shape.
17. The method of claim 1 , further comprising configuring a first set of electrodes of a first subset of splines as an anode and a second set of electrodes of a second subset of splines as a cathode, such that the first set of electrodes and the second set of electrodes act as an anode-cathode pair,
the ablation pulse waveform delivered to the ablation device via the first set of electrodes and the second set of electrodes acting as the anode-cathode pair.
18. The method of claim 1 , further comprising fluoroscopically visualizing a radiopaque portion of the ablation device during one or more steps.
19. The method of claim 1 , wherein the ablation pulse waveform includes:
a first level of a hierarchy of the ablation pulse waveform includes a first set of pulses, each pulse having a pulse time duration, a first time interval separating successive pulses;
a second level of the hierarchy of the ablation pulse waveform includes a plurality of first sets of pulses as a second set of pulses, a second time interval separating successive first sets of pulses, the second time interval being at least three times the duration of the first time interval; and
a third level of the hierarchy of the ablation pulse waveform includes a plurality of second sets of pulses as a third set of pulses, a third time interval separating successive second sets of pulses, the third time interval being at least thirty times the duration of the second level time interval.
20. An apparatus, comprising:
a catheter shaft defining a longitudinal axis and a shaft lumen therethrough;
a set of splines extending from a distal end of the shaft lumen, each spline of the set of splines including a set of electrodes formed on a surface of that spline; and
a distal cap coupled to a distal portion of each spline of the set of splines, the distal portion of each spline of the set of splines configured for translation along the longitudinal axis to correspondingly transition the set of splines between a first configuration in which the set of splines are generally parallel to the longitudinal axis of the catheter shaft and a second configuration in which at least a portion of each spline of the set of splines has a radius of curvature between about 7 mm and about 25 mm.
21. The apparatus of claim 20 , wherein each spline of the set of splines in the second configuration has a shape of more than half a turn of a deformed helix.
22. The apparatus of claim 20 , wherein the set of splines in the second configuration is configured to abut a tissue wall, wherein the set of electrodes on at least two of the splines are configured to generate an electric field comprising a magnitude and a tangential component of the electric field lines relative to the tissue wall, wherein the tangential component is greater than half of the magnitude in a substantial portion of the tissue wall between the at least two splines.
23. The apparatus of claim 20 , wherein each spline of the set of splines in the second configuration includes an elliptical cross-section, and the elliptical cross-section includes a major axis length between about 1 mm and about 2.5 mm and a minor axis length between about 0.4 mm and about 1.4 mm.
24. The apparatus of claim 20 , wherein the set of electrodes for each spline in the set of splines includes an insulated electrical lead associated therewith and configured for sustaining a voltage potential of at least about 700 V without dielectric breakdown.
25. The apparatus of claim 20 , wherein the set of electrodes for each spline in the set of splines includes at least one electrode configured for ablation and at least one electrode configured for measuring electrophysiology data.
26. A system, comprising:
a signal generator configured for generating an ablation pulse waveform;
a pacing device coupled to the signal generator and configured for generating a pacing signal for cardiac stimulation during use, and for transmitting an indication of the pacing signal to the signal generator;
the signal generator further configured for generating the pulse waveform in synchronization with the indication of the pacing signal; and
an ablation device coupled to the signal generator and configured for receiving the pulse waveform, the ablation device including:
a catheter shaft defining a longitudinal axis and a shaft lumen therethrough;
a set of splines extending from a distal end of the shaft lumen, each spline of the set of splines including a set of electrodes formed on a surface of that spline; and
a distal cap coupled to a distal portion of each spline of the set of splines, the distal portion of each spline of the set of splines configured for translation along the longitudinal axis to correspondingly transition the set of splines between a first configuration in which the set of splines is generally parallel to the longitudinal axis of the catheter shaft and a second configuration in which at least a portion of each spline of the set of splines has a radius of curvature between about 7 mm and about 25 mm.
27. The system of claim 26 , wherein each spline of the set of splines in the second configuration has a shape of more than half a turn of a deformed helix.
28. The system of claim 26 , wherein the set of splines in the second configuration is configured to abut a tissue wall, wherein the set of electrodes on at least two of the splines are configured to generate an electric field comprising a magnitude and a tangential component of the electric field lines relative to the tissue wall, wherein the tangential component is greater than half of the magnitude in a substantial portion of the tissue wall between the at least two splines.
29. An apparatus, comprising:
a catheter shaft defining a longitudinal axis and a shaft lumen therethrough;
a set of splines extending from a distal end of the shaft lumen, each spline of the set of splines including a set of electrodes formed on a surface of that spline; and
a distal cap coupled to a distal portion of each spline of the set of splines, the distal portion of each spline of the set of splines configured for translation along the longitudinal axis to correspondingly transition the set of splines between a first configuration and a second configuration, the first configuration including the distal cap coupled to a distal end of the catheter shaft at a first distance and the second configuration including the distal cap coupled to the distal end of the catheter shaft at a second distance, and a ratio of the first distance to the second distance is between about 5:1 and about 25:1.