Electrosurgical pericardial puncture
Devices and methods for providing access to the pericardial cavity while reducing risk of myocardial damage. One method comprises the steps of: (a) advancing a puncture device towards a heart, the puncture device including an energy delivery device at a distal end of the puncture device; (b) delivering a single pulse of a pulsed energy through the energy delivery device to a parietal pericardium of the heart to create a void relatively close to the energy delivery device while maintaining the distal end of the puncture device in a substantially stationary position relative to the parietal pericardium; (c) advancing the puncture device a short distance into the void; (d) checking if the puncture device has accessed the pericardial cavity by measuring pressure on the distal end of the puncture device; and (e) repeating steps (b), (c), and (d), if necessary, until the energy delivery device is located at least partially within the pericardial cavity. The methods may include a step of confirming that the puncture device is at least partially within the parietal cavity by injecting or aspirating fluid through a lumen in the puncture device or measuring the pressure or electrical impedance at the distal end of the puncture device.
1. A method of accessing a pericardial cavity of a heart, the method comprising the steps of: (a) advancing a puncture device towards a heart, the puncture device including an energy delivery device at a distal end of the puncture device; (b) delivering a single pulse of a pulsed energy through the energy delivery device to a parietal pericardium of the heart to create a void relatively close to the energy delivery device while maintaining the distal end of the puncture device in a substantially stationary position relative to the parietal pericardium; (c) advancing the puncture device a short distance into the void; (d) checking if the puncture device has accessed the pericardial cavity by measuring pressure on the distal end of the puncture device; and (e) repeating steps (b), (c), and (d), if necessary, until the energy delivery device is located at least partially within the pericardial cavity.
2. The method of claim 1 , wherein step (c) comprises advancing the puncture device a distance greater than 0 mm and less than 1 mm.
3. The method of claim 1 , wherein step (c) comprises advancing the puncture device a distance of about 1 mm.
4. The method of claim 1 , wherein step (c) comprises advancing the puncture device advancing the puncture device a distance greater than 0 mm and less than 0.4 mm.
5. The method of claim 1 , wherein step (c) comprises advancing the puncture device a distance of from about 0.4 mm to about 1 mm.
6. The method of claim 1 , wherein step (d) comprises measuring pressure using a transducer at the distal end of the puncture device.
7. The method of claim 1 , wherein the puncture device includes a lumen and an aperture at the distal end of the puncture device wherein the lumen is in fluid communication with the aperture, and step (d) comprises measuring pressure using an external pressure monitoring device which is in fluid communication with the lumen.
8. The method of claim 1 , wherein step (b) comprises using monopolar energy delivery.
9. The method of claim 1 , wherein step (b) comprises using bipolar energy delivery.
10. The method of claim 1 , wherein step (b) comprises using pulsed optical energy.
11. The method of claim 1 , wherein step (b) comprises using DC electrical energy.
12. The method of claim 1 , wherein step (d) comprises injecting a contrast fluid such that the contrast fluid can be seen surrounding a cardiac silhouette.
13. The method of claim 1 , wherein step (d) comprises aspirating fluid.
14. The method of claim 1 , further comprising visualizing a position of a cannula using medical imaging, the cannula defining a lumen for receiving the puncture device.
15. The method of claim 14 , further comprising positioning the cannula adjacent to a surface of a fibrous pericardium, using medical imaging.
16. The method of claim 15 , further comprising positioning the energy delivery device at a distal end of the lumen of the cannula, prior to delivering energy.
17. The method of claim 1 , further comprising plotting an electrocardiogram to confirm a position of the energy delivery device.
18. The method of claim 1 , further comprising identifying contact between the energy delivery device and a tissue of the heart using an electrical impedance.