Cardiac ablation systems and methods of their use and manufacture involve an ablation mechanism, a stabilizer mechanism, and a cinching mechanism that urges the ablation mechanism toward a patient tissue. Embodiments encompass methods for administering epicardial and endocardial lesions, including box lesions and connecting lesions, to patient tissue.

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.

A system and method for the delivery of a medical device to a treatment location. The device may include an elongate body, the elongate body including a plurality of annular segments and a jacket disposed about the plurality of annular segments and defining an interior space, and a vacuum source in fluid communication with the interior space of the jacket. When a vacuum is applied to the interior space of the jacket, the jacket may constrict about the plurality of annular elements, thereby increasing the frictional forces between the plurality of segments and between the plurality of segments and an inner surface of the jacket.

The present invention includes devices and methods for pacing contact, lead, conduit or other medical fixture placement in tissues or organs. The invention features an articulating multiple suction foot device, comprising an inner vacuum conduit and foot slidingly contained within an outer vacuum conduit and foot, with the inner vacuum conduit and foot configured to extend beyond the outer vacuum suction foot, and to be further articulated once extended; as well as a separate tissue or waste removal vacuum assembly that extends within the inner vacuum conduit to the inner vacuum foot to remove cut tissue prior to its advancement beyond the outer vacuum suction foot. The device is configured to permit the placement foot, such as a suction foot, to articulate to a desired position with respect to the target tissue, while the pacing contact, lead, fluid conduit or other medical fixture is releasably attached to the placement foot to permit it to be released from the placement foot after stabilization on the target tissue site.

An apparatus includes a shaft, the shaft including a plurality of stepped sections along the length of the shaft. The apparatus further includes a plurality of electrodes disposed along the length of the shaft, each electrode characterized by a geometric aspect ratio of the length of the electrode to the outer diameter of the electrode. Each electrode is located at a different stepped section of the plurality of stepped sections of the shaft and includes a set of leads. Each lead of the set of leads is configured to attain an electrical voltage potential of at least about 1 kV. The geometric aspect ratio of at least one electrode of the plurality of electrodes is in the range between about 3 and about 20.

A system for pericardial puncture includes a medical device having an elongate shaft extending between a proximal end and a distal end, and having a distally facing electrode at the distal end of the shaft. An impedance meter is electrically connectable with the electrode for measuring an impedance associated with the electrode. A display is provided for displaying an indication of a position of the electrode. The indication of the position is based on of the impedance.

A method of ablating an epicardial tissue region, including positioning a medical device adjacent the epicardial tissue region, the medical device having a first electrode, a second electrode, and a third electrode located in between the first and second electrodes; delivering an irrigation fluid to the tissue region; and ablating at least a portion of the tissue region by sequentially activating the third electrode in a monopolar radiofrequency delivery mode and activating the first and second electrodes in a bipolar radiofrequency delivery mode.

According to some embodiments of the invention, a method for providing an atrial fibrillation (AF) ablation treatment plan includes receiving imaging data for at least a portion of an atrial region of a subject's heart, and processing the imaging data to characterize tissue as one of fibrotic tissue or non-fibrotic tissue. The method further includes calculating a metric of spatial distribution of at least a portion of the tissue characterized as fibrotic tissue from the processing the imaging data, identifying a cardiac tissue ablation target based on the metric, and providing an AF treatment plan that includes the cardiac tissue ablation target as at least a portion of the AF treatment plan.

Devices and methods are described for the treatment of heart conditions such as heart failure with preserved ejection fraction, including diastolic heart failure, by performing a pericardial modification procedure. Intraoperative test procedures for assessing the efficacy of the pericardial modification procedure are also described.

A medical device includes an insertion tube, having a distal end for insertion into a body of a subject and an opening at the distal end. A lumen, which includes a flexible tube which passes longitudinally through the insertion tube so as to communicate with the opening at the distal end of the insertion tube, is secured under tension inside the insertion tube.