Systems, devices, and methods for ablation using surgical clamps
Systems, devices, and methods for electroporation ablation therapy are disclosed, with the device including a first jaw including a plurality of first electrodes and a second jaw including a plurality of second electrodes. The first jaw and the second jaw may be substantially rigid, elongate, and collectively define a longitudinal axis. The first jaw and the second jaw may be configured to engage tissue therebetween during use.
1 . A method of ablating heart tissue at an atrial base of a pulmonary vein via irreversible electroporation, the method comprising:
clamping the atrial base of the pulmonary vein between a first jaw and a second jaw of an ablation apparatus, the first jaw including a plurality of first electrodes, the second jaw including a plurality of second electrodes, the first jaw and the second jaw being substantially rigid, elongate, and collectively defining a longitudinal axis, each electrode of the plurality of first electrodes having, within a cross-section of the first jaw and the second jaw that is orthogonal to the longitudinal axis, a width that is less than a length of that electrode, the plurality of first electrodes spaced apart laterally with respect to the longitudinal axis, each electrode of the plurality of second electrodes having, within the cross-section orthogonal to the longitudinal axis, a width that is less than a length of that electrode, the plurality of second electrodes spaced apart laterally with respect to the longitudinal axis, wherein the first and second pluralities of electrodes are disposed directly across from each other in the cross-section orthogonal to the longitudinal axis;
configuring an electrode of the plurality of first electrodes as an anode;
configuring an electrode of the plurality of second electrodes as a cathode, the anode and the cathode being, within the cross-section orthogonal to the longitudinal axis, disposed diagonally across and spaced apart laterally from other another; and
delivering ablative energy to the heart tissue via the anode and the cathode.
2 . The method of claim 1 , wherein the longitudinal axis has a straight portion and a curved portion.
3 . The method of claim 1 , wherein clamping the tissue comprises transitioning the first and second jaws between a first configuration for advancing the ablation apparatus and a second configuration for clamping the atrial base of the pulmonary vein.
4 . The method of claim 3 , wherein delivering the ablative energy includes delivering a pulse waveform to the heart tissue via the anode and the cathode.
5 . The method of claim 4 , wherein the pulse waveform includes:
a first level of a hierarchy including a first set of pulses, each pulse having a pulse time duration and a first time interval separating successive pulses;
a second level of the hierarchy including a plurality of first sets of pulses as a second set of pulses and a second time interval separating successive first sets of pulses, the second time interval being greater than a duration of the first time interval; and
a third level of the hierarchy including a plurality of second sets of pulses as a third set of pulses and a third time interval separating successive second sets of pulses, the third time interval being greater than a duration of the second level time interval.
6 . The method of claim 1 , further comprising: receiving signal data corresponding to electrical activity of the tissue using one or more electrodes of the plurality of first electrodes and the plurality of second electrodes; and generating electrocardiography data using the signal data.
7 . The method of claim 1 , further comprising positioning the first and second jaws through or around a body cavity prior to clamping the atrial base of the pulmonary vein between the first and second jaws.
8 . The method of claim 1 , wherein each electrode of the plurality of first electrodes and the plurality of second electrodes are independently addressable.
9 . A method of ablating heart tissue at an atrial base of a pulmonary vein via irreversible electroporation, the method comprising:
advancing an ablation apparatus to a location proximate the atrial base of the pulmonary vein, the ablation apparatus comprising a first jaw and a second jaw, the first jaw including a plurality of first electrodes arranged in parallel and spaced apart laterally along a length of the first jaw, the second jaw including a plurality of second electrodes arranged in parallel and spaced apart laterally along a length of the second jaw, the first jaw and the second jaw collectively defining a longitudinal axis, each electrode of the plurality of first electrodes having, within a cross-section of the first jaw and the second jaw that is orthogonal to the longitudinal axis, a width that is less than a length of that electrode, and each electrode of the plurality of second electrodes having, within the cross-section orthogonal to the longitudinal axis, a width that is less than a length of that electrode, the plurality of second electrodes spaced apart laterally with respect to the longitudinal axis, wherein the plurality of first electrodes are positioned in opposition the plurality of second electrode across the longitudinal axis;
clamping the atrial base of the pulmonary vein between the first jaw and the second jaw of the ablation apparatus;
configuring an electrode of the plurality of first electrodes as an anode;
configuring an electrode of the plurality of second electrodes as a cathode, the anode and the cathode being, within the cross-section orthogonal to the longitudinal axis, disposed diagonally across and spaced apart laterally from other another; and
delivering a pulse waveform to the heart tissue via the anode and the cathode.
10 . The method of claim 9 , wherein the pulse waveform includes:
a first level of a hierarchy including a first set of pulses, each pulse having a pulse time duration and a first time interval separating successive pulses;
a second level of the hierarchy including a plurality of first sets of pulses as a second set of pulses and a second time interval separating successive first sets of pulses, the second time interval being greater than a duration of the first time interval; and
a third level of the hierarchy including a plurality of second sets of pulses as a third set of pulses and a third time interval separating successive second sets of pulses, the third time interval being greater than a duration of the second level time interval.
11 . The method of claim 10 , wherein delivering the pulse waveform includes delivering the pulse waveform in synchronization with a cardiac cycle.
12 . The method of claim 10 , wherein each electrode of the first plurality of electrodes has a first exposed portion with a height no less than 0.5 mm protruded from a side of the first jaw.
13 . The method of claim 12 , wherein each electrode of the second plurality of electrodes has a second exposed portion with a height no less than 0.5 mm protruded from a side of the second jaw.
14 . The method of claim 13 , wherein the first and second pluralities of electrodes are disposed directly across from each other in the cross-section orthogonal to the longitudinal axis.
15 . The method of claim 14 , wherein any two adjacent electrodes of the first plurality of electrodes are spaced apart by a first measure of between about 0.5 mm and about 10 mm, and any two adjacent electrodes of the second plurality of electrodes are spaced apart by a second measure of between about 0.5 mm and about 10 mm.
16 . The method of claim 13 , wherein each of the first and second jaws has a curved portion.
17 . The method of claim 16 , wherein the curved portion of each of the first and second jaws has a radius of curvature of about 1 cm or larger.
18 . A method of ablating heart tissue at an atrial base of a pulmonary vein via irreversible electroporation, the method comprising:
advancing an ablation apparatus to a location proximate the atrial base of the pulmonary vein, the ablation apparatus comprising a first jaw and a second jaw, the first jaw including a plurality of first electrodes arranged in parallel and spaced apart laterally along a length of the first jaw, the second jaw including a plurality of second electrodes arranged in parallel and spaced apart laterally along a length of the second jaw, the first jaw and the second jaw collectively defining a longitudinal axis, each electrode of the plurality of first electrodes having, within a cross-section of the first jaw and the second jaw that is orthogonal to the longitudinal axis, a width that is less than a length of that electrode, and each electrode of the plurality of second electrodes having, within the cross-section orthogonal to the longitudinal axis, a width that is less than a length of that electrode, the plurality of second electrodes spaced apart laterally with respect to the longitudinal axis;
clamping the atrial base of the pulmonary vein between the first jaw and the second jaw of the ablation apparatus;
configuring an electrode of the plurality of first electrodes as an anode;
configuring an electrode of the plurality of second electrodes as a cathode, the anode and the cathode being, within the cross-section orthogonal to the longitudinal axis, disposed diagonally across and spaced apart laterally from other another; and
delivering a pacing signal to the heart via a pacing stimulator; and
delivering a pulse waveform to the heart tissue via the anode and the cathode in synchronization with the pacing signal.
19 . The method of claim 18 , wherein delivering the pulse waveform includes delivering the pulse waveform substantially immediately following the pacing signal.
20 . The method of claim 19 , wherein the pulse waveform includes:
a first level of a hierarchy including a first set of pulses, each pulse having a pulse time duration and a first time interval separating successive pulses;
a second level of the hierarchy including a plurality of first sets of pulses as a second set of pulses and a second time interval separating successive first sets of pulses, the second time interval being greater than a duration of the first time interval; and
a third level of the hierarchy including a plurality of second sets of pulses as a third set of pulses and a third time interval separating successive second sets of pulses, the third time interval being greater than a duration of the second level time interval.