A sheath is transluminally introduced a sheath into an atrium of a heart of a subject. A guide member is advanced out of the sheath and to a chorda tendinea of the heart, the guide member having a proximal portion that includes a longitudinal element, and a distal portion that includes a helical chord-engaging element. The chord-engaging element is wrapped around the chorda tendinea. While the chord-engaging element remains wrapped around the chorda tendinea, (i) the chord-engaging element is slid over the chorda tendinea toward a papillary muscle that is coupled to the chorda tendinea; and (ii) subsequently, a tool is moved out of the sheath and toward the papillary muscle by sliding the tool along the longitudinal element. Other embodiments are also described.

A system and method for performing a non-fluoroscopic transseptal procedure may comprise a catheter and a device comprising a sheath, an introducer and a transducer embedded on the introducer and configured to perform a measurement during the non-fluoroscopic transseptal procedure. In this system, the transducer may be embedded on the outer surface of the introducer, or embedded on the inner surface of the introducer, or embedded within the introducer. The transducer may be a ring transducer or a circular transducer. The measurement is based on a plurality of ultrasonic pulses transmitted from the transducer, and the measurement determines a location of the catheter and/or a puncture location. In another embodiment, the transducer is embedded on a needle instead of an introducer.

Methods and devices described herein facilitate ablation patterns on the heart within a pericardial sac and without opening or deflating the lungs.

An atrial appendage closure device is provided that includes an insertion rod having a first end and a second end. An occluding member having an outer surface and an inner surface is connected to the first end of the insertion rod. The occluding member is moveable between a retracted position and a deployed position such that, in the deployed position, the occluding member is configured to provide a seal between a left atrial appendage and a left atrium of a heart. An anchoring member is further connected to the insertion rod and is configured to slide along the insertion rod to secure the device to a wall of a left atrial appendage. Methods for occluding a left atrial appendage that make use of the closure devices are also provided.

A self-contained, battery powered transseptal crossing system is disclosed. An elongate, flexible electrically conductive needle body has a proximal end and a distal end. An insulation layer surrounds the sidewall and leaves exposed a distal electrode tip. A generator is configured to deliver RF energy to the electrode tip, and includes a processor configured to take impedance measurements at the tip to confirm contact with the intra atrial septum and/or confirm entry into the left atrium.

Methods and devices are disclosed for puncturing tissue, comprising a puncture device for puncturing tissue and a supporting member for supporting the puncture device. The puncture device is capable of being insertable within the supporting member and being selectively usable in co-operation therewith during a portion of a procedure for puncturing tissue and wherein the puncture device is usable independently therefrom during another portion of the procedure. The puncture device comprises visual or tactile markers for determining the relative positioning between puncture device and supporting member.

A steerable transseptal punch system and method of using the steerable transseptal punch system to access the left atrium.

Methods and devices are disclosed for puncturing tissue, comprising an assembly for puncturing a target tissue. The puncture device of the assembly has a distal tip configured to puncture the target tissue and at least one proximal marker, formed on the proximal portion of the puncture device. The supporting member of the assembly includes a proximal end, a distal end, and a lumen for receiving the puncture device. The puncture device is configured to enable advancement and withdrawal of the supporting member overtop of the puncture device. Alignment of the proximal end of the supporting member and the at least one proximal marker of the puncture device occurs when the distal tip of the puncture device protrudes from the distal end of the supporting member.

A delivery device includes an inner shaft, an outer sheath, a nosecone, and a tether component. The outer sheath is slidably disposed over the inner shaft. The nosecone is removably coupled to the inner shaft. The nosecone includes a delivery configuration for delivery to a treatment site, a radially compressed configuration in which a portion of the nosecone is configured to traverse through a heart wall, and a radially expanded configuration in which an outer surface of the nosecone contacts an outer surface of the heart wall. The tether component includes a first end coupled to the nosecone. The nosecone is configured to plug a piercing in the heart wall when in the radially expanded configuration.

This document relates to devices and methods for the treatment of heart conditions. For example, this document provides devices and methods for treating heart failure with preserved ejection fraction, including diastolic heart failure, by performing a pericardial modification procedure. The methods for treating diastolic heart failure of a patient include: creating an opening in a parietal layer, and only in the parietal layer, of a pericardial tissue of the patient. The creation of this opening reduces pressure exerted by the pericardial tissue on a heart of the patient.