Catheter systems, tools and methods are disclosed for the selective and rapid application of DC voltage to drive irreversible electroporation, with the system controller configurable to apply voltages to an independently selected subsets of electrodes, such that voltages of one polarity are applied to a multiplicity of electrodes on a first medical device and voltages of the opposite polarity to a multiplicity of electrodes on a second medical device. The first and second medical devices can be epicardial catheters positioned such that their opposing distal tips are approximately aligned and whose segments with electrodes collectively wrap around the pulmonary veins.

A tissue treatment system configured to ablate a tissue, the system comprising: (a) a clamp assembly comprising a first jaw mechanism and a second jaw mechanism configured to receive and compress a tissue therebetween; (b) a first electrode disposed on the first jaw mechanism and configured to contact the tissue; and (c) a second electrode disposed on the second jaw mechanism and configured to contact the tissue, where the first electrode and the second electrode are configured so that at least one of an ablation energy output of the first electrode and an ablation energy output of the second electrode is automatically adjusted to accommodate variable tissue thicknesses between the first electrode and the second electrode.

Systems, devices, and methods for electroporation ablation therapy are disclosed herein, with a cinch device for positioning an ablation catheter relative to tissue during a cardiac ablation procedure. In some embodiments, a distal end of a first device may be advanced into a proximal end of a first lumen of a second device. The first device may be advanced from a distal end of the first lumen and the first device may be looped around tissue of a patient. The first device may be advanced into a distal end of a second lumen of the second device. The distal end of the first device may be advanced from a proximal end of the second lumen. The proximal and distal ends of the first device may be advanced away from a proximal end of the second device to increase contact between the first device and the tissue.

Methods of performing surgical operations and associated devices are disclosed. An example method may include locating a first position on a first surface of a biological tissue; locating a second position on a second opposing surface of the biological tissue, the second position corresponding to the first position; and marking the second position on the second surface. The second surface may be generally opposite the first surface. An example method may include, after marking the second position, performing a therapeutic procedure on the biological tissue in the vicinity of the second position.

Systems, devices, and methods for electroporation ablation therapy are disclosed, with a protection device for isolating electronic circuitry, devices, and/or other components from a set of electrodes during a cardiac ablation procedure. A system can include a first set of electrodes disposable near cardiac tissue of a heart and a second set of electrodes disposable in contact with patient anatomy. The system can further include a signal generator configured to generate a pulse waveform, where the signal generator coupled to the first set of electrodes and configured to repeatedly deliver the pulse waveform to the first set of electrodes. The system can further include a protection device configured to selectively couple and decouple an electronic device to the second set of electrodes.

A method and apparatus are disclosed for a needle for gaining access to the pericardial cavity of a heart. The needle includes an elongate member (e.g. a main shaft) defining a lumen and a side-port in fluid communication with the lumen; a blunt atraumatic tip for delivering energy for puncturing tissue; and a guiding surface (e.g. a ramp) for directing a device (e.g. a guidewire) through the side-port. The method includes using the needle for tenting a pericardium and delivering energy for puncturing the pericardium, and advancing a guidewire or other device through the needle and into the pericardial cavity.

Provided herein are ablation systems having an ablation component with an ablation chamber and an insulation chamber, wherein the ablation chamber comprises a plurality of channels defined there. Other embodiments include ablation systems having a substrate source, a cooling component, and an ablation component. Certain systems are closed-loop systems that reuse the cooling substrate.

Improved mapping and ablation procedures and corresponding devices are provided. A variety of methods and apparatuses can be used for the treatment of cardiac arrhythmias by identifying the location of an arrhythmia source and ablating that source. The methods and apparatuses can provide an improved means of electrical mapping of the heart to identify the location of the arrhythmia source and advancing an ablation electrode to that location so that it may be ablated.

An apparatus and methods for performing ablation of myocardial tissues are disclosed. The apparatus includes a plurality of ablation electrode configurations to which nanosecond pulsed electric fields are applied. The methods relate to therapies to treat cardiac arrhythmias, such as, atrial fibrillation and scar-related ventricular tachycardia, amongst others. The affected myocardial tissues are ablated creating a plurality of lesions enabled by the nanosecond pulsed electric fields applied to either penetrating electrodes, endo-endo electrodes, or endo-epi electrodes. Different electrophysiological tests are performed to assess the application of nanosecond pulsed electric field ablation to specific desired tissue location within the heart. Test results show the potential to overcome limitations of current ablation therapies, thereby providing patients and doctors a superior treatment for cardiac arrhythmias.

Cardiac tissue ablation catheters including an inflatable and flexible toroidal or spherically shaped balloon disposed at a distal region of an elongate member, a flexible circuit carried by an outer surface of the balloon, the flexible circuit including, a plurality of flexible branches conforming to the radially outer surface of the balloon, each of the plurality of flexible branches including a substrate, a conductive trace carried by the substrate, and an ablation electrode carried by the substrate, the ablation electrode in electrical communication with the conductive trace, and an elongate shaft comprising a guidewire lumen extending in the elongate member and extending from a proximal region of the inflatable balloon to distal region of the inflatable balloon and being disposed within the inflatable balloon, wherein a distal region of the elongate shaft is secured directly or indirectly to the distal region of the inflatable balloon.