Devices and methods for left atrial appendage closure
Described here are devices, systems, and methods for closing the left atrial appendage. The methods described here utilize a closure device for closing the left atrial appendage and guides or expandable elements with ablation or abrading elements to ablate or abrade the left atrial appendage. In general, these methods include positioning a balloon at least partially within the atrial appendage, positioning a closure assembly of a closure device around an exterior of the atrial appendage, inflating the balloon, partially closing the closure assembly, ablating the interior tissue of the atrial appendage with the inflated balloon, removing the balloon from the atrial appendage, and closing the atrial appendage with the closure assembly.
1 . A method of closing an atrial appendage comprising:
positioning a balloon at least partially within an interior of the atrial appendage;
positioning a closure assembly of a closure device around an exterior of the atrial appendage, wherein the closure assembly comprises a loop;
inflating the balloon at least partially within the interior of the atrial appendage;
partially closing the loop to close the atrial appendage around the inflated balloon;
ablating the interior tissue of the atrial appendage with the inflated balloon;
removing the balloon from the atrial appendage through the closure assembly; and
closing the atrial appendage with the closure assembly.
2 . The method of claim 1 , further comprising positioning a distal end of a first guide element in the interior of the atrial appendage and positioning a distal end of a second guide element in a pericardial space externally of the atrial appendage.
3 . The method of claim 2 , wherein the first guide element and the second guide element each comprise a magnet, and further comprising aligning the first guide element and the second guide element across tissue of the atrial appendage.
4 . The method of claim 2 , wherein positioning a closure device comprises advancing the closure device along the second guide element.
5 . The method of claim 2 , wherein the balloon is part of the first guide element.
6 . The method of claim 2 , wherein the balloon is part of a balloon catheter and wherein positioning the balloon comprises advancing the balloon catheter along the first guide element.
7 . The method of claim 1 , wherein the balloon comprises an electrode positioned on an exterior surface of the balloon, and wherein ablating the interior tissue of the atrial appendage comprises ablating the interior tissue of the atrial appendage with the electrode.
8 . The method of claim 7 , wherein the balloon comprises at least two electrodes, the method further comprising monitoring a tissue parameter with at least one of the electrodes during ablation of the interior tissue.
9 . The method of claim 1 , wherein ablating the interior tissue of the atrial appendage comprises cryoablating the interior tissue of the atrial appendage.
10 . The method of claim 1 , wherein ablating the interior tissue of the atrial appendage comprises ablating the interior tissue of the atrial appendage using heated fluid contained in the balloon.
11 . The method of claim 1 , further comprising releasing the loop from the closure assembly to hold the atrial appendage closed.
12 . The method of claim 1 , wherein the closure assembly comprises an electrode, and further comprising ablating an exterior of the atrial appendage with the electrode.
13 . The method of claim 1 , further comprising cryoablating an exterior surface of the atrial appendage with the closure assembly.
14 . A method of closing an atrial appendage comprising:
positioning a distal end of a first guide element in the interior of the atrial appendage;
advancing a balloon catheter along the first guide element, wherein the balloon catheter comprises a balloon;
positioning a distal end of a second guide element in a pericardial space externally of the atrial appendage, wherein the first guide element is aligned across the second guide element on opposite sides of the heart;
advancing a closure assembly of a closure device around an exterior of the atrial appendage along the second guide;
inflating the balloon within the atrial appendage;
withdrawing the first guide element from the interior of the atrial appendage; closing the atrial appendage with the closure assembly;
advancing a portion of the first guide element into contact with tissue around an ostium of the closed atrial appendage; and
ablating the contacted tissue with the first guide member.
15 . The method of claim 14 , wherein the first guide element and the second guide element each comprise a magnet, and further comprising aligning the first guide element and the second guide element across tissue of the atrial appendage.
16 . The method of claim 14 , wherein the first guide element comprises an electrode positioned at the distal end of the first guide element.
17 . The method of claim 14 , further comprising advancing a wire from a distal end of the first guide element, wherein advancing a portion of the first guide member into contact with tissue around the ostium of the closed atrial appendage comprises advancing the wire into contact with the tissue around the ostium of the closed atrial appendage.
18 . The method of claim 17 , further comprising cryoablating the tissue around the ostium with the wire.
19 . The method of claim 14 , wherein the closure assembly comprises an electrode, the method further comprising ablating an exterior of the atrial appendage with the electrode.
20 . The method of claim 14 , further comprising cryoablating an exterior surface of the atrial appendage with the closure assembly.