Enhanced signal navigation and capture systems and methods
Navigation and tissue capture systems and methods for navigation to and/or capture of selected tissue using the innate electrical activity of the selected tissue and/or other tissue are described. In the context of left atrial appendage closure, the systems and methods can be used to navigate to the left atrial appendage and capture/control the appendage while a closure instrument (suture, clip, ring) is placed over the appendage and tightened down or a closure method (ablation, cryogenic procedures, stapling, etc.) is performed to close the left atrial appendage. The use of innate electrical activity for navigating devices may be used in connection with other tissues and/or areas of the body.
1. A method of navigating to and capturing a left atrial appendage (LAA), the method comprising:
advancing a distal end of a capture shaft and a capture device into a pericardial sac,
wherein the capture device is attached to the distal end of the capture shaft,
wherein the capture device comprises a first jaw and a second jaw, wherein the first jaw and the second jaw comprise an open configuration in which the first jaw and the second jaw are open and a closed configuration in which the first jaw and the second jaw are closed, wherein an interior surface of the first jaw is located closer to an interior surface of the second jaw when the first jaw and the second jaw are in the closed configuration than when the first jaw and the second jaw are in the open configuration,
wherein a first electrode is located on an interior surface of the first jaw,
wherein a second electrode is located on an interior surface of the second jaw,
advancing the capture device into the pericardial sac;
moving the first and second jaws to the open configuration after advancing the capture device into the pericardial sac;
moving the first and second jaws from the open configuration towards the closed configuration after moving the first and second jaws to the open configuration in the pericardial sac;
obtaining a first cardiac electrical signal using the first and second electrodes after moving the first and second jaws from the open configuration towards the closed configuration; and
determining that the first cardiac electrical signal is consistent with the capture of LAA tissue in between the first and second jaws;
advancing a ligation element into the pericardial sac and positioning the ligation element to occlude the LAA after determining that the first cardiac signal is consistent with the capture of LAA tissue between the first and second jaws and while holding the first and second jaws in the closed configuration;
ligating the LAA using the ligation element after positioning the ligation element to ligate the LAA;
obtaining a second cardiac electrical signal using the first and second electrodes after ligating the LAA while holding the first and second jaws in the closed configuration; and
determining that the second cardiac electrical signal obtained after ligating the LAA is consistent with ligation of the LAA.
2. A method according to claim 1 , wherein determining that the second cardiac electrical signal obtained after occluding the LAA is consistent with ligation of the LAA comprises identifying a decrease in the second cardiac electrical signal as compared to the first cardiac electrical signal.
3. A method according to claim 1 , wherein the first and second electrodes are electrically isolated from the capture device.
4. A method according to claim 1 , wherein the capture shaft comprises a capture shaft electrode, and wherein the method comprises:
advancing the capture shaft electrode into the pericardial space;
obtaining a third cardiac electrical signal using the capture shaft electrode; and
determining that the third cardiac electrical signal is indicative of contact between the capture shaft electrode and ventricular tissue within the pericardial space or determining that the third cardiac electrical signal is indicative of contact between the capture shaft electrode and atrial tissue within the pericardial space.
5. A method according to claim 4 , wherein the capture shaft comprises two capture shaft electrodes.
6. A method according to claim 1 , wherein the capture shaft comprises a capture shaft electrode, and wherein the method comprises:
advancing the capture shaft electrode into the pericardial space;
obtaining a third cardiac electrical signal using the capture shaft electrode; and
determining that the third cardiac electrical signal is indicative of contact between the capture shaft electrode and atrial tissue within the pericardial space.
7. A method according to claim 6 , wherein the capture shaft comprises two capture shaft electrodes.
8. A method according to claim 1 , wherein the capture shaft and the capture device are delivered to the pericardial sac in an approach that does not pass through the rib cage.
9. A method according to claim 1 , the method further comprising:
injecting image enhancement fluid into the pericardial sac;
wherein advancing the capture device into the pericardial sac comprises advancing the capture device towards the LAA using a visual image obtained after injecting image enhancement fluid into the pericardial sac; and
moving the first and second jaws from the open configuration towards the closed configuration after advancing the capture device towards the LAA using the visual image.
10. A method according to claim 9 , wherein the image enhancement fluid comprises a fluoroscopic contrast agent and the visual image comprises a fluoroscopic image.
11. A method of navigating to and capturing a left atrial appendage (LAA), the method comprising:
advancing a distal end of a capture shaft and a capture device into a pericardial sac,
wherein the capture device is attached to the distal end of the capture shaft,
wherein the capture device comprises a first jaw and a second jaw, wherein the first jaw and the second jaw comprise an open configuration in which the first jaw and the second jaw are open and a closed configuration in which the first jaw and the second jaw are closed, wherein an interior surface of the first jaw is located closer to an interior surface of the second jaw when the first jaw and the second jaw are in the closed configuration than when the first jaw and the second jaw are in the open configuration,
wherein a first electrode is located on an interior surface of the first jaw,
wherein a second electrode is located on an interior surface of the second jaw,
wherein the capture shaft comprises a capture shaft electrode;
injecting image enhancement fluid into the pericardial sac;
advancing the capture device and the capture shaft electrode into the pericardial sac towards the LAA using a visual image obtained after injecting image enhancement fluid into the pericardial sac;
moving the first and second jaws to the open configuration after advancing the capture device into the pericardial sac;
moving the first and second jaws from the open configuration towards the closed configuration after advancing the capture device towards the LAA using the visual image and after moving the first and second jaws to the open configuration in the pericardial sac;
obtaining a first cardiac electrical signal using the first and second electrodes after moving the first and second jaws from the open configuration towards the closed configuration; and
determining that the first cardiac electrical signal is consistent with the capture of LAA tissue in between the first and second jaws;
advancing a ligation element into the pericardial sac and positioning the ligation element to occlude the LAA after determining that the first cardiac signal is consistent with the capture of LAA tissue between the first and second jaws and while holding the first and second jaws in the closed configuration;
ligating the LAA using the ligation element after positioning the ligation element to ligate the LAA;
obtaining a second cardiac electrical signal using the first and second electrodes after ligating the LAA while holding the first and second jaws in the closed configuration;
determining that the second cardiac electrical signal obtained after ligating the LAA is consistent with ligation of the LAA;
obtaining a third cardiac electrical signal using the capture shaft electrode; and
determining that the third cardiac electrical signal is indicative of contact between the capture shaft electrode and ventricular tissue within the pericardial space or determining that the third cardiac electrical signal is indicative of contact between the capture shaft electrode and atrial tissue within the pericardial space.
12. A method according to claim 11 , wherein determining that the second cardiac electrical signal obtained after occluding the LAA is consistent with ligation of the LAA comprises identifying a decrease in the second cardiac electrical signal as compared to the first cardiac electrical signal.
13. A method according to claim 11 , wherein the first and second electrodes are electrically isolated from the capture device.
14. A method according to claim 11 , wherein the capture shaft comprises two capture shaft electrodes.
15. A method according to claim 11 , wherein the capture shaft and the capture device are delivered to the pericardial sac in an approach that does not pass through the rib cage.
16. A method according to claim 11 , wherein the image enhancement fluid comprises a fluoroscopic contrast agent and the visual image comprises a fluoroscopic image.
17. A method of navigating to and capturing a left atrial appendage (LAA), the method comprising:
advancing a distal end of a capture shaft and a capture device into a pericardial sac,
wherein the capture device is attached to the distal end of the capture shaft,
wherein the capture device comprises a first jaw and a second jaw, wherein the first jaw and the second jaw comprise an open configuration in which the first jaw and the second jaw are open and a closed configuration in which the first jaw and the second jaw are closed, wherein an interior surface of the first jaw is located closer to an interior surface of the second jaw when the first jaw and the second jaw are in the closed configuration than when the first jaw and the second jaw are in the open configuration,
wherein a first electrode is located on an interior surface of the first jaw,
wherein a second electrode is located on an interior surface of the second jaw, injecting image enhancement fluid into the pericardial sac;
advancing the capture device towards the LAA using a visual image obtained after injecting image enhancement fluid into the pericardial sac;
moving the first and second jaws to the open configuration after advancing the capture device into the pericardial sac;
moving the first and second jaws from the open configuration towards the closed configuration after advancing the capture device towards the LAA using the visual image;
obtaining a first cardiac electrical signal using the first and second electrodes after moving the first and second jaws from the open configuration towards the closed configuration; and
determining that the first cardiac electrical signal is consistent with the capture of LAA tissue in between the first and second jaws.
18. A method according to claim 17 , wherein the capture shaft and the capture device are delivered to the pericardial sac in an approach that does not pass through the rib cage.
19. A method according to claim 17 , wherein the image enhancement fluid comprises a fluoroscopic contrast agent and the visual image comprises a fluoroscopic image.