Navigation and tissue capture systems and methods

Abstract

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 - 70 . (canceled) 
     
     
         71 . A method of navigating a device to a left atrial appendage, the method comprising:
 delivering a capture device on a capture shaft into a pericardial sac, wherein the capture device comprises a first jaw and a second jaw, wherein each of the first jaw and the second jaw comprises an interior surface, 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 the interior surface of the first jaw is located closer to the 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, and wherein a first electrode is located on the internal surface of the first jaw and a second electrode is located on the internal surface of the second jaw;   moving the first jaw and the second jaw from the open configuration to the closed configuration after delivering the capture device into the pericardial sac, wherein moving the first jaw and the second jaw captures a left atrial appendage between the first jaw and the second jaw;   moving the first jaw and the second jaw from the open configuration to the closed configuration after moving the first jaw and the second jaw from the open configuration to the closed configuration;   locking the first jaw and the second jaw in the closed configuration after moving the first jaw and the second jaw from the open configuration to the closed configuration;   detecting an EGM signal using the first electrode on the first jaw and the second electrode on the second jaw of the capture device after moving the first jaw and the second jaw from the open configuration to the closed configuration to capture the left atrial appendage within the pericardial sac and confirming capture of the left atrial appendage by the capture device by determining if the EGM signal is associated with tissue of the left atrial appendage;   wherein delivering the capture device on the capture shaft into the pericardial sac comprises advancing the capture device over ventricular myocardium tissue before the capture device reaches the left atrial appendage, detecting a capture shaft EGM signal using a capture shaft electrode located on the capture shaft proximal from the capture device, and confirming that the capture shaft electrode is contacting ventricular tissue using the capture shaft EGM signal.   
     
     
         72 . A method of navigating a device to the left atrial appendage according to  claim 71 , the method further comprising confirming capture of atrial tissue by the capture device by electrically stimulating the atrial tissue and confirming that the atrial tissue is being paced. 
     
     
         73 . A method of navigating a device to the left atrial appendage according to  claim 71 , the method further comprising determining that the left atrial appendage is not captured between the first jaw and the second jaw if the EGM signal is not associated with tissue of the left atrial appendage. 
     
     
         74 . A method of navigating a device to the left atrial appendage according to  claim 71 , wherein the first jaw and the second jaw comprise atraumatic nesting retention structure located at distal ends of each of the first jaw and the second jaw, wherein proximal ends of each of the first jaw and the second jaw are located between the distal ends of the first jaw and the second jaw and a distal end of the capture shaft;
 wherein moving the first jaw and the second jaw to the closed configuration comprises atraumatically capturing tissue in the atraumatic nesting retention structure.   
     
     
         75 . A method of navigating a device to the left atrial appendage according to  claim 74 , wherein the first electrode is located proximally from the atraumatic nesting structure, and wherein the atraumatic nesting retention structure does not form a part of the first electrode. 
     
     
         76 . A method according to  claim 71 , the method further comprising:
 injecting image enhancement liquid into the pericardial sac; and   wherein delivering the capture device into the pericardial sac comprises advancing the capture device in the pericardial sac using a visual image obtained after injecting image enhancement fluid into the pericardial sac.   
     
     
         77 . A method of navigating a capture device to a left atrial appendage, the method comprising:
 delivering a capture device on a capture shaft into a pericardial sac, wherein the capture device comprises a first jaw and a second jaw comprising 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;   moving the first jaw and the second jaw from the open configuration to the closed configuration after delivering the capture device into the pericardial sac, wherein moving the first jaw and the second jaw captures a left atrial appendage between the first jaw and the second jaw;   locking the first jaw and the second jaw in the closed configuration after moving the first jaw and the second jaw from the open configuration to the closed configuration;   detecting an electrical signal in the pericardial sac using an electrode on the capture device after moving the first jaw and the second jaw from the open configuration to the closed configuration to capture the left atrial appendage;   confirming capture of the left atrial appendage by the capture device after moving the first jaw and the second jaw from the open configuration to the closed configuration to capture the left atrial appendage by determining if the electrical signal is associated with electrical signals generated by tissue of the left atrial appendage;   wherein delivering the capture device on the capture shaft into the pericardial sac comprises advancing the capture device over ventricular myocardium tissue before the capture device reaches the left atrial appendage, detecting a capture shaft EGM signal using a capture shaft electrode located on the capture shaft proximal from the capture device, and confirming that the capture shaft electrode is contacting ventricular tissue using the capture shaft EGM signal.   
     
     
         78 . A method according to  claim 77 , the method further comprising confirming capture of atrial tissue by the capture device by electrically stimulating the atrial tissue using the electrode on the capture device and confirming that the atrial tissue is being paced. 
     
     
         79 . A method according to  claim 77 , wherein the electrode on the capture device comprises a first electrode on the first jaw and a second electrode on the second jaw, and wherein detecting the electrical signal comprises detecting the electrical signal using the first electrode and the second electrode. 
     
     
         80 . A method according to  claim 77 , wherein the method further comprises determining that the left atrial appendage is not captured between the first jaw and the second jaw if the electrical signal is not associated with tissue of the left atrial appendage. 
     
     
         81 . A method according to  claim 77 , wherein the capture device comprises atraumatic nesting retention structure that comprises structure located at a distal end of the first jaw and structure located at a distal end of the second jaw, wherein a proximal end of the first jaw is located between the distal end of the first jaw and the distal end of the capture shaft, and wherein a proximal end of the second jaw is located between the distal end of the second jaw and a distal end of the capture shaft;
 wherein moving the first jaw and the second jaw to the closed configuration comprises atraumatically capturing tissue in the atraumatic nesting retention structure.   
     
     
         82 . A method according to  claim 81 , wherein the electrode on the capture device is located proximally from the atraumatic nesting structure such that the atraumatic nesting retention structure does not form a part of the electrode. 
     
     
         83 . A navigation and tissue capture system comprising:
 a capture device comprising 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;   a capture shaft comprising an elongated body comprising a proximal end and a distal end, wherein the distal end of the capture shaft is attached to the capture device;   a capture shaft electrode attached to the capture shaft proximate the distal end of the capture shaft, wherein the capture shaft electrode is located proximal of the capture device;   a capture shaft electrode conductor extending from the capture shaft electrode towards the proximal end of the capture shaft, wherein the capture shaft conductor comprises an electrical monitoring apparatus connector;   a plurality of first electrodes attached to the first jaw of the capture device, wherein the plurality of first electrodes face the interior surface of the second jaw; and   a plurality of second electrodes attached to the second jaw of the capture device, wherein the plurality of second electrodes face the interior surface of the first jaw.   
     
     
         84 . A system according to  claim 83 , wherein the plurality of first electrodes are exposed on the interior surface of the first jaw of the capture device. 
     
     
         85 . A system according to  claim 84 , wherein the plurality of second electrodes are exposed on the interior surface of the second jaw of the capture device. 
     
     
         86 . A system according to  claim 85 , wherein the plurality of first electrodes are positioned on the first jaw and the plurality of second electrodes are positioned on the second jaw such that closure of the first jaw and the second jaw in the absence of tissue between the first jaw and the second jaw places the plurality of first electrodes and the plurality of second electrodes in contact with each other. 
     
     
         87 . A system according to  claim 83 , wherein the plurality of first electrodes comprise ring electrodes extending around an exterior surface of the first jaw. 
     
     
         88 . A system according to  claim 87 , wherein the plurality of second electrodes comprise ring electrodes extending around an exterior surface of the second jaw. 
     
     
         89 . A system according to  claim 83 , wherein the capture shaft electrode comprises a first capture shaft electrode and wherein the system further comprises a second capture shaft electrode attached to the capture shaft proximate the distal end of the capture shaft, wherein the second capture shaft electrode is located proximal of the capture device. 
     
     
         90 . A system according to  claim 83 , wherein at least one of the first jaw and the second jaw rotate about an axis oriented generally transverse to a longitudinal axis of the capture shaft when the first jaw and the second jaw move between the open configuration and the closed configuration, wherein the longitudinal axis extends between the proximal end and the distal end of the capture shaft. 
     
     
         91 . A system according to  claim 83 , wherein the capture device comprises an atraumatic capture device. 
     
     
         92 . A system according to  claim 83 , wherein the capture shaft comprises an actuator extending through the capture shaft to the capture device, wherein the actuator is operably attached to the capture device such that movement of the actuator within the capture shaft proximally and distally moves the capture device between the closed configuration and the open configuration.