Methods of ablating tissue using a catheter injection system
At the present time, physicians often treat patients with atrial fibrillation (AF) using radiofrequency (RF) catheter systems to ablate conducting tissue in the wall of the Left Atrium of the heart around the ostium of the pulmonary veins. These systems are expensive and take time consuming to use. The present invention circular ablation system CAS includes a multiplicity of expandable needles that can be expanded around a central axis and positioned to inject a fluid like ethanol to ablate conductive tissue in a ring around the ostium of a pulmonary vein quickly and without the need for expensive capital equipment. The expansion of the needles is accomplished by self-expanding or balloon expandable structures. The invention includes centering means so that the needles will be situated in a pattern surrounding the outside of the ostium of a vein. Also included are members that limit the distance of penetration of the needles into the wall of the left atrium. The present invention also has application to ablating tissue around the ostium of a renal artery for the treatment of hypertension.
1. A method of treating a target tissue, the method including:
advancing an ablation system through a target vessel until a distal end of the ablation system lies near the target tissue, the ablation system including at least a guiding catheter, a diameter-increasing structure, an inner tube, and two needles;
advancing the diameter-increasing structure of the ablation system from a first position within the guiding catheter to a second position outward from the guiding catheter toward and against a lumenal wall of the target vessel to position the distal end generally equidistant from two points of the lumenal wall, wherein the diameter-increasing structure does not penetrate the luminal wall and wherein the inner tube is located distal to the diameter-increasing structure;
after advancing the diameter-increasing structure toward the lumen wall, advancing the two needles outward around a circumference and at least partially through the lumenal wall of the target vessel at the two points and into the target tissue and wherein the inner tube is located distal to the two needles; and
evaluating electrical activity with at least one needle of the at least two needles, wherein the at least one needle acts as a diagnostic electrode; and
simultaneously injecting ablative fluid through the two needles into the target tissue.
2. The method of claim 1 where the at least one needle is electrically connected to a proximal end of the ablation system.
3. The method of claim 1 further including delivering electric current or RF energy to the target tissue.
4. The method of claim 1 where the at least one needle senses signals from the target tissue.
5. The method of claim 1 where the ablative fluid comprises ethyl alcohol.
6. The method of claim 1 where the diameter-increasing structure is a mechanical structure.
7. The method of claim 1 further including limiting the penetration of the at least two needles into the target tissue.
8. The method of claim 1 where the two needles are coupled to a manifold.
9. The method of claim 1 where one or more of the needles is electrically connected to a proximal end of the ablation system.
10. The method of claim 1 where one or more of the needles acts as a diagnostic electrode for evaluation of the electrical activity in the area of an ostial wall.
11. The method of claim 1 where one or more of the needles act as diagnostic electrodes for measurement of electrical activity within an ostial wall of the target vessel.
12. The method of claim 1 where one or more of the needles act as electrodes for sensing signals from an ostial wall of the target vessel.
13. The method of claim 1 where the depth of penetration of the one or more needles is limited.
14. The method of claim 1 where the diameter-increasing structure is manually expandable.
15. The method of claim 1 further including producing a multiplicity of interlocking circles of ablation.
16. The method of claim 1 further including producing a ring of ablated tissue.
17. The method of claim 1 further including advancing one or more diagnostic electrophysiology catheters.
18. The method of claim 1 wherein at least one needle has a stop which limits further penetration into the tissue.
19. The method of claim 1 wherein the two needles penetrate a preset distance into the target tissue until further advancement is simultaneously limited.
20. The method of claim 1 wherein the two needles penetrate a preset fixed distance of between 0.5 mm and 1 cm into tissue based on a position of a stop.