Treatment device having multifunctional sensing elements and method of use
A device, system, and method for treating an area of tissue and evaluating lesion formation and quality. The system may include a medical device having a plurality of mapping electrodes on a treatment element, the plurality of mapping electrodes being configured to record from the area of tissue at least one of unipolar impedance measurements, bipolar impedance measurements, local electrical activity, and pace threshold measurements before, during, and after circulation of the cryogenic fluid within the treatment element. These measurements may be transmitted to a control unit having processing circuitry configured to compare pre-treatment measurements, in-treatment measurements, and/or post-treatment measurements to each other and/or to threshold values to determine occlusion and/or lesion quality, such as lesion transmurality.
1. A method of determining lesion transmurality, the method comprising:
positioning a treatment element of a medical device in contact with an area of tissue, the treatment device being in fluid communication with a source of cryogenic fluid and including a cryoballoon, a plurality of mapping electrodes directly coupled to an outer surface of the cryoballoon and positioned to contact the area of tissue, a first plurality of electrodes, and a second plurality of electrodes different than the first plurality of electrodes;
recording, with each of the plurality of mapping electrodes, the first plurality of electrodes, and the second plurality of electrodes, from the area of tissue, at least one of a pre-treatment unipolar impedance measurement, a pre-treatment bipolar impedance measurement, a pre-treatment pace threshold measurement, and a pre-treatment electrogram amplitude;
transmitting, with each of the plurality of mapping electrodes, the first plurality of electrodes, and the second plurality of electrodes, at least one pre-treatment recording to a control unit having processing circuitry;
circulating the cryogenic fluid within the cryoballoon to lower the temperature of the cryoballoon to a temperature that is sufficient to ablate tissue;
ceasing the circulation of the cryogenic fluid within the cryoballoon;
recording, with each of the plurality of mapping electrodes, the first plurality of electrodes, and the second plurality of electrodes, from the area of tissue, at least one of a corresponding post-treatment unipolar impedance measurement, a post-treatment bipolar impedance measurement, a post-treatment pace threshold measurement, and a post-treatment electrogram amplitude;
transmitting, with each of the plurality of mapping electrodes, the first plurality of electrodes, and the second plurality of electrodes, the at least one post-treatment measurement to the control unit;
comparing, with the control unit, the at least one pre-treatment measurement to the at least one post-treatment measurement; and
determining, with the control unit, lesion transmurality in the area of tissue based on the comparison.
2. The medical method of claim 1 , further comprising:
before ceasing the circulation of cryogenic fluid within the cryoballoon, recording from the area of tissue at least one of a corresponding in-treatment unipolar impedance measurement, an in-treatment bipolar impedance measurement, an in-treatment electrogram, and an in-treatment pace threshold measurement; and
transmitting the at least one in-treatment measurement to the control unit.
3. The medical method of claim 2 , further comprising:
comparing the at least one in-treatment measurement to at least one of a corresponding pre-treatment measurement and a corresponding post-treatment measurement.
4. The medical method of claim 3 , wherein the at least one in-treatment measurement is a unipolar impedance measurement, the at least one of a corresponding pre-treatment measurement and a corresponding post-treatment measurement is a pre-treatment unipolar impedance measurement, the comparing the at least one pre-treatment unipolar impedance measurement to the at least one in-treatment measurement includes comparing the pre-treatment unipolar impedance measurement to the in-treatment unipolar measurement, the method further comprising:
establishing at least one of a threshold ice ball thickness;
correlating the comparison between the pre-treatment and in-treatment unipolar impedance measurement to an ice ball thickness; and
comparing the correlated ice ball thickness to the threshold ice ball thickness;
wherein determining lesion transmurality includes determining the lesion is transmural when the correlated ice ball thickness is at least equal to the threshold ice ball thickness.
5. The medical method of claim 4 , further comprising:
automatically ceasing the circulation of cryogenic fluid within the cryoballoon when the transmural lesion is determined to have been created.
6. The medical method of claim 2 , further comprising:
recording, from a first plurality of electrodes, at least one of a pre-treatment measurement an in-treatment measurement, or a post-treatment measurement.
7. The medical method of claim 6 , further comprising:
recording, from a second plurality of electrodes, at least one of a pre-treatment measurement an in-treatment measurement, or a post-treatment measurement.
8. A method for treating an area of tissue with a medical device, the method comprising:
navigating to a target treatment location using an elongate body having a distal portion, a proximal portion, and a distal tip;
transitioning an expandable treatment element to an expanded configuration;
prior to treating the area of tissue, recording, with a first plurality of electrodes, a first pace threshold;
prior to treating the area of tissue, recording, with a second plurality of electrodes different than the first plurality of electrodes, a second pace threshold;
prior to treating the area of tissue, recording, with a plurality of mapping electrodes on the expandable treatment element, a third pace threshold;
circulating a cryogenic fluid from a cryogenic fluid source through the expandable treatment element to form an ice ball between the expandable treatment element and the area of tissue;
after treating the area of tissue, recording, with the first plurality of electrodes, a fourth pace threshold;
after treating the area of tissue, recording, with the second plurality of electrodes, a fifth pace threshold;
after treating the area of tissue, recording, with the plurality of mapping electrodes on the expandable treatment element, a sixth pace threshold; and
comparing, with processing circuitry, the first recording, the second recording, and the third recording with the fourth recording, the fifth recording, and the sixth recording to determine lesion quality.
9. The medical method of claim 8 , further comprising, after recording, transmitting to the processing circuitry.
10. The medical method of claim 8 , wherein recording includes recording at least one of a unipolar impedance measurement, a bipolar impedance measurement, local electrical activity, or a pace threshold measurement.
11. The medical method of claim 8 , further comprising, before ceasing circulation of cryogenic fluid within the expandable treatment element, recording from the area of tissue an in-treatment pace threshold.
12. The medical method of claim 11 , further comprising comparing the in-treatment measurement to at least one of a corresponding pre-treatment pace threshold or a corresponding post-treatment pace threshold.