Catheters, catheter systems, and methods for puncturing through a tissue structure and ablating a tissue region

Abstract

A percutaneous catheter system for use within the human body and an ablation catheter for ablating a selected tissue region within the body of a subject. The percutaneous catheter system can include two catheters that are operatively coupled to one another by magnetic coupling through a tissue structure. The ablation catheter can include electrodes positioned within a central portion. The ablation catheter is positioned such that the central portion of a flexible shaft at least partially surrounds the selected tissue region. Each electrode of the ablation catheter can be activated independently to apply ablative energy to the selected tissue region. The ablation catheter can employ high impedance structures to change the current density at specific points. Methods of puncturing through a tissue structure using the percutaneous catheter system are disclosed. Also disclosed are methods for ablating a selected tissue region using the ablation catheter.

What is claimed is: 
     
         1 . A method, comprising:
 positioning a catheter external to a heart of a subject, such that a central portion of the catheter at least partially encircles the left pulmonary veins and the right pulmonary veins of the heart, the central portion of the catheter including a set of electrodes; and   delivering electrical energy to at least a portion of the left atrium of the heart using two or more electrodes of the set of electrodes, the portion of the left atrium including: a first wall portion of the left atrium; the endocardial space of the left atrium; and a second wall portion of the left atrium.   
     
     
         2 . The method of  claim 1 , the delivering the electrical energy including ablating tissue in the first wall portion and the second wall portion of the left atrium to create a lesion. 
     
     
         3 . The method of  claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a circumferential lesion in the wall of the left atrium without repositioning the catheter. 
     
     
         4 . The method of  claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a lesion in the wall of the left atrium via irreversible electroporation. 
     
     
         5 . The method of  claim 1 , the delivering the electrical energy including ablating tissue in the portion of the left atrium to create a lesion around an ostium or ostia of one or more of the left pulmonary veins and the right pulmonary veins formed in the left atrium. 
     
     
         6 . The method of  claim 1 , the delivering the electrical energy including delivering direct current impulses. 
     
     
         7 . The method of  claim 1 , the delivering the electrical energy including delivering biphasic impulses. 
     
     
         8 . The method of  claim 1 , the delivering the electrical energy including delivering the electrical energy in synchronization with the cardiac cycle of the subject. 
     
     
         9 . The method of  claim 1 , further comprising monitoring the cardiac cycle of the subject, the delivering the electrical energy including delivering the electrical energy in synchronization with the cardiac cycle of the subject. 
     
     
         10 . The method of  claim 1 , further comprising monitoring the cardiac cycle of the subject using one or more electrodes of the set of electrodes, the delivering the electrical energy including delivering the electrical energy in synchronization with the cardiac cycle of the subject. 
     
     
         11 . The method of  claim 1 , the electrical energy including one or more current impulses, the delivering the electrical energy including delivering one or more current impulses for every heartbeat of the subject. 
     
     
         12 . The method of  claim 1 , wherein the portion of the left atrium is a first portion, further comprising delivering electrical energy to a second portion of the left atrium using two or more electrodes of the set of electrodes. 
     
     
         13 . The method of  claim 1 , wherein the portion of the left atrium is a first portion, the positioning the catheter including positioning the catheter in a first position, further comprising:
 repositioning the catheter in a second position different from the first position, such that the central portion of the catheter at least partially encircles the left pulmonary veins and the right pulmonary veins external to the heart; and   delivering electrical energy to a second portion of the left atrium using two or more electrodes of the set of electrodes.   
     
     
         14 . The method of  claim 1 , wherein the delivering includes:
 identifying one or more intended current vectors for delivering the electrical energy, the one or more intended current vectors passing through the endocardial space of the left atrium;   selecting, based on the one or more intended current vectors, the two or more electrodes; and   delivering the electrical energy using the two or more electrodes and along the one or more current vectors.   
     
     
         15 . The method of  claim 1 , further comprising surgically creating an opening in the body of the patient to permit passage of the catheter prior to positioning the catheter. 
     
     
         16 . The method of  claim 1 , the positioning the catheter including manually positioning the catheter. 
     
     
         17 . The method of  claim 1 , the positioning the catheter including positioning the central portion of the catheter in a pericardial space of the heart using a Seldinger technique. 
     
     
         18 . The method of  claim 1 , further comprising surgically exposing the anterior chest of the patient prior to positioning the catheter. 
     
     
         19 . The method of  claim 1 , further comprising surgically exposing the upper abdomen of the patient prior to positioning the catheter.