Mapping and ablation applicators and methods of their use
Devices and methods for mapping tissue, such as cardiac tissue, and applying electrical energy to ablate the tissue may include an applicator region comprising two or more wire electrodes that extend between the arms of the device as well as a plurality of mapping and/or sensing electrodes (e.g., ring electrodes) on the arms and/or the elongate body. These devices may sense electrical activity using the mapping electrodes and may deliver energy between the first wire electrode and the second wire electrode to ablate, for example, cardiac tissue.
1 . A method of treating a tissue, the method comprising:
positioning an applicator region of a device against the tissue of a treatment area; and
applying a pulsed electrical treatment between a first electrode comprising a first plurality of wire electrode portions extending between a plurality of arms comprising a first arm and a second arm and a second electrode comprising a second plurality of wire electrode portions extending between the plurality of arms, wherein the first plurality of wire electrode portions and the second plurality of wire electrode portions are attached to the plurality of arms so that the first plurality of wire electrode portions is radially outward of the second plurality of wire electrode portions as the applicator region is applied against the tissue.
2 . The method of claim 1 , further comprising sensing a signal with one or more mapping and/or sensing electrodes on the first arm, on the second arm, and/or on an elongated body from which the applicator region extends.
3 . The method of claim 2 , the method comprising sensing one or more electrical properties of the tissue using the one or more mapping and/or sensing electrodes prior to applying the pulsed electrical treatment, in between the application of pulses of the pulsed electrical treatment, and/or after applying the pulsed electrical treatment.
4 . The method of claim 2 , wherein the sensed signal is used to generate a geometrical and/or activation map of a heart and/or a location of the applicator region relative to the tissue.
5 . The method of claim 1 , wherein the tissue is a cardiac tissue, a wall of a body vessel, a pulmonary vein, and/or other anatomical structure.
6 . The method of claim 1 , wherein applying the pulsed electrical treatment comprises applying pulses of less than 5 microseconds.
7 . The method of claim 1 , wherein applying the pulsed electrical treatment comprises applying pulses having a rise and/or fall time of less than 50 ns.
8 . The method of claim 1 , wherein applying the pulsed electrical treatment comprises applying pulses having a pulse voltage between 1 kV and 30 kV.
9 . The method of claim 1 , wherein applying the pulsed electrical treatment comprises applying pulses having a frequency of between 0.1 Hertz and 100,000 Hertz.
10 . The method of claim 1 , wherein the method comprises circumferential single-shot treatment or point-by-point treatment.
11 . The method of claim 1 , further comprising expanding at least one of the first plurality of wire electrode portions and the second plurality of wire electrode portions from a delivery configuration to a deployed or expanded configuration.
12 . The method of claim 1 , the method comprising deploying the first plurality of wire electrode portions and the second plurality of wire electrode portions from a delivery instrument.
13 . The method of claim 12 , wherein deploying comprises expanding the first electrode to have a larger diameter or circumference than the second electrode.
14 . The method of claim 1 , wherein the first plurality of wire electrode portions is separated by a minimum distance, d, from the second plurality of wire electrode portions along a length of the first plurality of wire electrode portions.
15 . The method of claim 1 , wherein the applicator region extends from an elongate body comprising a flexible portion and wherein positioning comprises bending the flexible portion of the elongate body to steer the applicator region towards the tissue.
16 . The method of claim 15 , wherein the flexible portion of the elongate body is configured to be controllably bent in one or more planes.
17 . The method of claim 1 , further comprising sensing position and/or orientation of the applicator region using an electromagnetic (EM) sensor within the device.
18 . The method of claim 1 , further comprising determining electrical impedance of the tissue.
19 . The method of claim 1 , further comprising preventing or minimizing blood lysing with an insulating cover or coating on a side of the first electrode and the second electrode that does not face the tissue of the treatment area.
20 . The method of claim 1 , wherein the method is for treating endoluminal cancer, tissue cancer, and/or cardiac conditions and diseases.
21 . The method of claim 1 , wherein the first plurality of wire electrode portions is electrically coupled together to form a single electrode of a first polarity and the second plurality of wire electrode portions is electrically coupled together to form a single electrode of a second polarity.
22 . The method of claim 1 , wherein each portion of the first plurality of wire electrode portions and the second plurality of wire electrode portions are individually energized and applying the pulsed electrical treatment between the first electrode and the second electrode comprises applying the pulsed electrical treatment only between one or more portions of the first and second plurality of wire electrode portions.
23 . A method of treating a cardiac tissue, the method comprising:
sensing a signal in one or more mapping electrodes on a first arm and/or a second arm of an applicator region of an ablation and mapping device, and/or on an elongate body from which the applicator region extends; and
delivering a pulsed electrical treatment between a first electrode comprising a first plurality of wire electrode portions extending between the first arm and the second arm of the applicator region and a second electrode comprising a second plurality of wire electrode portions extending between the first arm and the second arm of the applicator region, wherein the first plurality of wire electrode portions and the second plurality of wire electrode portions are attached to the first and second arms of the applicator region so that the first plurality of wire electrode portions is radially outward of the second plurality of wire electrode portions while the applicator region is applied against the cardiac tissue.
24 . A method of treating a tissue within a subject's body, the method comprising:
positioning a first ring comprising a first plurality of wire electrodes and a second ring comprising a second plurality of wire electrodes within the subject's body, so that a first active region of the first ring is in electrical communication with a first region of a wall of an anatomical structure, and so that a second active region of the second ring is in electrical communication with a second region of the wall of the anatomical structure, the second active region of the second ring is radially and/or longitudinally separated from the first region of the wall of the anatomical structure and is substantially concentric with the first active region of the first ring; and
applying a pulsed electrical treatment between the first active region and the second active region.
25 . The method of claim 24 , wherein the anatomical structure comprises pulmonary vein antrums, pulmonary vein ostiums, and/or other heart wall muscle or tissue.
26 . The method of claim 24 , wherein the first plurality of wire electrodes extends between a plurality of arms comprising a first arm and a second arm and the second plurality of wire electrodes extends between the plurality of arms, the method further comprising sensing a signal with one or more mapping and/or sensing electrodes at least on the first arm and/or on the second arm.
27 . The method of claim 24 , further comprising mapping the anatomical structure using 3D electro-anatomical mapping.
28 . The method of claim 24 , wherein the first active region of the first ring comprises at least one of the first plurality of wire electrodes.
29 . The method of claim 28 , wherein the second active region of the second ring comprises at least one of the second plurality of wire electrodes.
30 . The method of claim 24 , wherein applying the pulsed electrical treatment comprises circumferentially ablating the wall of the anatomical structure in a single shot ablation.
31 . The method of claim 24 , wherein applying the pulsed electrical treatment comprises point by point ablating the wall of the anatomical structure.