DETACHABLE ABLATION TIP FOR LEFT ATRIAL APPENDAGE CLOSURE DEVICE
20230355302 · 2023-11-09
Inventors
Cpc classification
A61B17/12177
HUMAN NECESSITIES
A61B2018/1475
HUMAN NECESSITIES
A61B17/12172
HUMAN NECESSITIES
A61B18/1492
HUMAN NECESSITIES
International classification
Abstract
The present disclosure generally relates to devices, systems, and methods for ablating and occluding a body lumen or cavity, including those implementations for occluding the left atrial appendage of the heart. An example assembly includes a connector assembly having a connector assembly proximal end and a connector assembly distal end, the connector assembly proximal and distal ends being opposite ends of the connector assembly; and an expandable frame that is detachably disposed at the connector assembly distal end, the expandable frame having a plurality of deployment positions that includes a first deployed position in which the expandable frame is in a focal arrangement and a second deployed position in which the expandable frame is in a wide area arrangement; and where the connector assembly is operatively connected to the expandable frame and configured to facilitate moving the expandable frame between the plurality of deployment positions.
Claims
1. An ablation catheter comprising: an elongate hollow shaft having a shaft proximal end, a shaft distal end, and a lumen extending along the elongate hollow shaft; a handle that is disposed at the shaft proximal end; a connector assembly having a connector assembly proximal end and a connector assembly distal end; and an expandable frame that is detachably disposed at the connector assembly distal end, the expandable frame having a plurality of deployment positions that includes a first deployed position in which the expandable frame is in a focal arrangement and a second deployed position in which the expandable frame is in a wide area arrangement; wherein the connector assembly extends from the handle to the expandable frame and is operatively connected to both the handle and the expandable frame and is configured to facilitate moving the expandable frame between the plurality of deployment positions; and wherein the ablation catheter is configured to direct energy to the expandable frame so as to ablate tissue at or around the expandable frame.
2. The ablation catheter of claim 1, wherein the expandable frame comprises a threaded socket and the connector assembly comprises a threaded wire that is receivable within the threaded socket such that the expandable frame is attached by threading the connector assembly into the expandable frame.
3. The ablation catheter of claim 2, wherein the expandable frame is detached by unthreading the connector assembly from the expandable frame.
4. The ablation catheter of claim 2, wherein the connector assembly includes a hypotube that extends through the handles and the threaded wire that is attached to the hypotube and the expandable frame.
5. The ablation catheter of claim 2, wherein the handle includes a housing and a deployment assembly arranged together with the housing such that actuating the handle thereby moves the expandable frame between the plurality of deployment positions.
6. The ablation catheter of claim 5, wherein the deployment assembly includes a switch and a translator that is operatively connected to both the switch and the connector assembly such that actuating the handle comprises actuating the switch, the translator facilitating movement of the connector assembly relative to the elongate hollow shaft to thereby move the expandable frame between the plurality of deployment positions.
7. The ablation catheter of claim 5, wherein the deployment assembly comprises a torque knob with which to detach the expandable frame from the ablation catheter.
8. The assembly of claim 1, wherein a biocompatible covering disposed over at least a part of the expandable frame.
9. The assembly of claim 1, wherein the expandable frame comprises an electrode that facilitates delivering ablative energy to generate a volume of ablated tissue having a shape and size that corresponds to a deployment position of the expandable frame.
10. The assembly of claim 1, wherein the expandable frame is formed as a closed basket with an ablation electrode positioned at a distal end of the expandable frame.
11. A method for occluding portions of a heart, the method comprising: delivering an ablation catheter into the heart such that an intracardial portion of the ablation catheter is positioned adjacent a portion of the heart that is to be ablated, the ablation catheter comprising: an elongate hollow shaft having a shaft proximal end, a shaft distal end, and a lumen extending along the elongate hollow shaft; an expandable frame that is detachably disposed at the shaft distal end, the expandable frame having a plurality of deployment positions that includes a first deployed position in which the expandable frame is in a focal arrangement and a second deployed position in which the expandable frame is in a wide area arrangement; and a handle that is disposed at the shaft proximal end and operatively connected to the expandable frame such that actuation of the handle moves the expandable frame between the plurality of deployment positions, and wherein the ablation catheter is configured to direct energy to the expandable frame so as to ablate tissue at or around the expandable frame; and deploying the expandable frame into the portion of the heart that is to be ablated.
12. The method of claim 11, further comprising positioning a deployed portion of the expandable frame to be adjacent tissue that is to be ablated, and generating ablative energy at the expandable frame to ablate tissue at or around the expandable frame.
13. The method of claim 12, further comprising moving the expandable frame into at least one of the focal arrangement and the wide area arrangement.
14. The method of claim 13, wherein the ablation catheter further includes: a connector assembly that extends from the handle to the expandable frame so as to operatively connect the handle to the expandable frame; and a deployment assembly that is arranged at the handle to correspond actuating the handle with directing the expandable frame to move between the plurality of deployment positions, the deployment assembly including a switch and a translator that is operatively connected to both the switch and the connector assembly such that actuating the handle comprises actuating the switch, the translator facilitating movement of connector assembly relative to the elongate hollow shaft to thereby move the expandable frame between the plurality of deployment positions; and wherein moving the expandable frame into at least one of the focal arrangement and the wide area arrangement comprises actuating the handle.
15. The method of claim 12, wherein deploying the expandable frame into a portion of the heart that is to be ablated comprises detaching the expandable frame into a portion of the heart that is to be occluded.
16. An occlusive implant delivery system comprising: an ablation catheter comprising: an elongate hollow shaft having a shaft proximal end, a shaft distal end, and a lumen extending along the elongate hollow shaft; an expandable frame that is detachably disposed at the shaft distal end, the expandable frame having a plurality of deployment positions that includes a first deployed position in which the expandable frame is in a focal arrangement and a second deployed position in which the expandable frame is in a wide area arrangement; and a handle that is disposed at the shaft proximal end and operatively connected to the expandable frame such that actuation of the handle moves the expandable frame between the plurality of deployment positions, and wherein the ablation catheter is configured to direct energy to the expandable frame so as to ablate tissue at or around the expandable frame; and a generator that is operatively connected to the ablation catheter so as to cause the ablation catheter to generate ablative energy at the expandable frame.
17. The system of claim 16, wherein the generator and the ablation catheter are configured to perform pulsed field ablation.
18. The system of claim 17, wherein the expandable frame is formed as a closed basket and comprises an ablation electrode at a distal end of the expandable frame.
19. The system of claim 16, wherein the generator and the ablation catheter are configured to perform bi-polar pulsed field ablation.
20. The system of claim 19, wherein the expandable frame is formed as a closed basket and comprises an ablation electrode at a distal end of the expandable frame, and wherein the ablation catheter comprises a second ablation catheter that is positioned on the elongate hollow shaft and is proximal to the ablation electrode.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
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[0054] While the invention is amenable to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and are described in detail below. The intention, however, is not to limit the invention to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the scope of the invention as defined by the appended claims.
DETAILED DESCRIPTION
[0055] For purposes of promoting an understanding of the principles of the present disclosure, reference is now made to the examples illustrated in the drawings, which are described below. The illustrated examples disclosed herein are not intended to be exhaustive or to limit the disclosure to the precise form disclosed in the following detailed description. Rather, these exemplary embodiments were chosen and described so that others skilled in the art may use their teachings. It is not beyond the scope of this disclosure to have a number (e.g., all) the features in a given example used across all examples. Thus, no one figure should be interpreted as having any dependency or requirement related to any single component or combination of components illustrated therein. Additionally, various components depicted in a given figure may be, in examples, integrated with various ones of the other components depicted therein (and/or components not illustrated), all of which are considered to be within the ambit of the present disclosure.
[0056] The terms “couples,” “coupled,” “connected,” “attached,” and the like along with variations thereof are used to include both arrangements wherein two or more components are in direct physical contact and arrangements wherein the two or more components are not in direct contact with each other (e.g., the components are “coupled” via at least a third component), but yet still cooperate or interact with each other.
[0057] Throughout the present disclosure and in the claims, numeric terminology, such as first and second, is used in reference to various components or features. Such use is not intended to denote an ordering of the components or features. Rather, numeric terminology is used to assist the reader in identifying the component or features being referenced and should not be narrowly interpreted as providing a specific order of components or features.
[0058] For purposes of this disclosure, like reference numerals in the figures shall refer to like features unless otherwise indicated. For example, reference numeral 100 refers to an expandable frame in
[0059] Generally, disclosed herein are devices, systems, and methods for treatment of heart conditions related to fibrillations such as left atrial appendage fibrillation (LAAF). In this regard, examples of the present disclosure include occlusive implant delivery systems. These systems can perform hybrid ablation procedures using a single device. Such systems can include an ablation catheter as shown herein such as those with a detachable ablative, occlusion device (e.g., an occlusive implant) with an expandable frame that can be manipulated during operation to perform hybrid ablation procedures using different forms of ablation depending on the operation. For instance, the device can assume several arrangements, including a focal arrangement (see configuration A in
[0060] In one or more aspects of the present disclosure, an occlusion device may include an expandable frame and a biocompatible covering disposed over at least a part of the expandable frame. Such an occlusion device of the present disclosure may be used to, for example, occlude the left atrial appendage (LAA) of the heart for the treatment of, for example, sustained cardiac arrhythmia (e.g., atrial fibrillation). When an occlusion device of the present disclosure is properly positioned within the LAA, the occlusion device may have sufficient circumferential and/or radial strength to form a seal with the wall of the LAA (and resist the distortive forces that the LAA may exert on the occlusion device) in order to, for example, prevent emboli or blood clots from passing back into the blood stream.
[0061] More detail about the ablation catheter 10 will be discussed with reference to
[0062] A connector assembly 120 operatively connects the expandable frame 100 to the handle 110. In examples, the connector assembly 120 extends from the handle 110 to the expandable frame 100 to thereby operatively connect the handle 110 to the expandable frame 100. As shown in
[0063] With reference to
[0064] To facilitate deployment of the expandable frame 100 when it is an occlusion device, the deployment assembly 130 can be manipulated. For instance, with continued reference to
[0065] As discussed above, the ablation catheter 10 can generate electrical energy in the expandable frame 100 for ablation procedures. In this regard, illustratively, the expandable frame 100 includes an electrode 149 (e.g., an ablation electrode 149). The generator is configured to facilitates delivering ablative energy to generate a volume of ablated tissue having a shape and size that corresponds to the deployment position of the expandable frame 100. The expandable frame 100 is formed as a closed basket with an ablation electrode 149 positioned at a distal end of the expandable frame 100. In an ablation system, the ablation catheter 10 can be connected to a generator via a coupler 150 at the proximal end of the handle 110. Together, the ablation catheter 10 and generator are configured to generate energy to perform pulsed field ablation for example. A flex connector 152 can ensure that the coupler 150 is in communication with the expandable frame 100 (e.g., via the connector 143 and/or wires extending from the expandable frame 100 to the flex connector 152) even during actuation of the connector assembly 120 (e.g., via movement of the switch 132 and/or translator 134).
[0066] Multiple electrodes can be disposed in the ablation catheter 10 to perform multipolar ablation. In examples, the electrode 149 can be a subcomponent of an electrode assembly. In this regard, the electrode assembly can include first and second ablation electrodes 149, 153. Illustratively, one of the first and second electrodes 149, 153 is disposed at a distal end of the expandable frame 100 and the other is disposed proximal to the ablation electrode 149 (e.g., on the expandable frame 100, the elongate hollow shaft 12, or the connector 143). Of course, other arrangements of electrodes in the electrode assembly are also contemplated. For instance, there are examples where the ablation electrode is disposed at the proximal end of the expandable frame 100.
[0067] Certain design considerations are useful when constructing an expandable frame for use during operation, for instance during a cryoablation procedure. Visualization in rhythmia can be performed via a navigation sensor integration as are known in the art. Some implementations can use fluoro and TEE/ICE for visualization. Further, the expandable frame can be constructed from rigid materials that are navigable through body lumens and do not have any negative effects on long term LAAO.
[0068] More details about the expandable frame 100 will now be discussed with reference to
[0069] As shown, an occlusion device may include an expandable frame 100 formed from, for example, a sheet. The expandable frame 100 may be suitable for use as a component of an occlusion device, which may also include covering 590 (e.g., a filter graft, membrane, etc.). Such a covering 590 may be supported by the expandable frame 100 (e.g., the covering 590 may extend over and from the proximal end of the expandable frame 100 toward the distal end of the expandable frame 100). The occlusion device (including the expandable frame 100 and covering 590) may include other components and may be combined with a delivery system for delivering the occlusion device to the LAA or other body lumen. In the one or more examples, the expandable frame 100 is depicted after manufacture, but before being loaded onto a catheter or deployed.
[0070] In the present disclosure, a support member or beam 530 of expandable frame 100 may include a number of segments. For example, each beam 530 may include a first segment 532 extending from the first hub 520 to the first circumferentially extending column 540 of strut pairs 542 and a second segment 538 extending from the first circumferentially extending column 540 of strut pairs 542 to another (e.g., a second, third, fourth, etc.) circumferentially extending column 540 of strut pairs 542.
[0071] Illustratively, the expandable frame 100 includes a first hub 520 (e.g., a proximal cap or ring) from which a plurality of beams 530 (e.g., support beams 530) extend longitudinally therefrom. The first segment 532 (e.g., the proximal portion) of each beam 530 may also be considered as a radial component of the beam 530 because when the expandable frame 100 is expanded the predominant length of the first segment 532 may extend radially outward from first hub 520. When collapsed, the expandable frame 100 can be substantially flat or significantly compacted relative to the expanded state.
[0072] As shown in
[0073] In some examples, in a deployed or expanded state, the first hub 520 (e.g., proximal ring) may be longitudinally adjacent (external) to the entire length of the beams 530, such that the beams 530 extend longitudinally away from the first hub 520 in a single longitudinal (distal) direction. In one or more examples, the first hub 520 may be inverted (internal) such that the beams 530 initially extend in a first (proximal) longitudinal direction away from the first hub 520 and then as the beams 530 turn and extend radially outward the beams 530 curve back over the first hub 520 in the opposite (distal) longitudinal direction. In one or more examples where the device has a second hub 570 (e.g., a distal ring), the second hub 570 may be configured with an internal (see, e.g.,
[0074] In examples wherein both the proximal end and distal end are closed, such as in the manner described herein, the columns 540 of strut pairs 542 may have a uniform orientation (all peaks “point” in the same direction) or, as shown, have opposing orientations relative to one or more other columns 540. In still other examples, an expandable frame 100 can include closed ends, and also include engagement anchors in the form of protrusions, indents, or other features of the expandable framework 100. For example, the framework may include one or more radially extending anchors (e.g., engagement barbs or other features) for improved securement of the framework into the surrounding tissue (e.g., the interior wall of the LAA) when the device is deployed.
[0075] Examples of the present disclosure include an expandable framework 100 that includes a biocompatible covering 590 disposed over at least a part of the expandable frame 100. In one or more examples, the covering 590 may take any of a wide variety of forms known to one of skill in the art. For example, a covering 590 may include a graft and/or a membrane and may include one or more layers. In one or more examples, a membrane or other covering 590 may be disposed over and about most of the proximal end of expandable frame 100. For example, a covering 590 may be substantially bowl-shaped, with an opening that extends around the portion of the occlusion device having the greatest diameter in the second configuration. In the one or more examples that include anchors as discussed above, the anchors may penetrate the covering 590 in both the first and second configurations (e.g., unexpanded and expanded states) to secure the covering 590 on the expandable frame 100. The covering 590 may be any of a wide variety of biocompatible fabric, mesh, membrane, or material known to one of skill in the art. For example, the covering 590 may be constructed of one or more layers of polyethylene terephthalate (PET). It should be recognized that the coverings described herein may be suitable for use with any of the examples of the expandable frame 100 shown or described herein.
[0076] Other suitable covering 590 materials may be employed as well. Examples may include, but are not limited to, polyethylene, polypropylene, polyvinyl chloride, polytetrafluoroethylene, including expanded polytetrafluoroethylene (ePTFE), fluorinated ethylene propylene, polyvinyl acetate, polystyrene, poly(ethylene terephthalate), naphthalene, dicarboxylate derivatives, such as polyethylene naphthalate, polybutylene naphthalate, polytrimethylene naphthalate, and trimethylenediol naphthalate, polyurethane, polyurea, silicone rubbers, polyamides, polyimides, polycarbonates, polyaldehydes, polyether ether ketone, natural rubbers, polyester copolymers, styrene-butadiene copolymers, polyethers, such as fully or partially halogenated polyethers, and copolymers and combinations thereof.
[0077] According to principles of the present disclosure, ablation and occlusion methods are also disclosed herein. Each of these methods can use ablation catheters similar to those disclosed elsewhere herein. For instance, as shown in
[0078] Using the ablation catheters disclosed elsewhere herein, the expandable frame employed in these methods can be used for ablation, occlusion, or both. For instance, as discussed above, an operator can have the option to use both narrow and wide-area ablation with the expandable frame. Ablation typically occurs before the expandable frame is deployed depending on the application. Transitioning between the narrow and expanded states of the expandable frame (or from one state to the other) can corresponded to actuating a connector assembly of the ablation catheter. In this regard, distal-to-proximal translation (e.g., of a switch) can move the expandable frame from a pre-expansion state within an elongate shaft of the ablation catheter to the narrow state just outside the elongate shaft, and further advancement in the same direction can move the expandable frame to the wide-area state further still outside the elongate shaft. Of course, there are examples where other movements (e.g., distal to proximal, rotations, etc.) of the connector assembly similarly advance the expandable frame. Deploying the device at step 940 can include detaching the occlusion device from the ablation catheter using a deployment assembly. In this regard, this step 940 can include unthreading the occlusion device from a connector that is in threaded engagement with the occlusion device. The connector can be in the form of a hypotube that is operatively connected to a torque knob at a proximal end of the ablation catheter for easy access such that rotating the torque knob rotates the connector to thereby thread/unthread the occlusion device. Other attachment/detachment methods, such as those known in the art and disclosed elsewhere herein, are also contemplated.
[0079] It is well understood that methods that include one or more steps, the order listed is not a limitation of the claim unless there are explicit or implicit statements to the contrary in the specification or claim itself. It is also well settled that the illustrated methods are just some examples of many examples disclosed, and certain steps may be added or omitted without departing from the scope of this disclosure. Such steps may include incorporating devices, systems, or methods or components thereof as well as what is well understood, routine, and conventional in the art.
[0080] The connecting lines shown in the various figures contained herein are intended to represent exemplary functional relationships and/or physical couplings between the various elements. It should be noted that many alternative or additional functional relationships or physical connections may be present in a practical system. However, the benefits, advantages, solutions to problems, and any elements that may cause any benefit, advantage, or solution to occur or become more pronounced are not to be construed as critical, required, or essential features or elements. The scope is accordingly to be limited by nothing other than the appended claims, in which reference to an element in the singular is not intended to mean “one and only one” unless explicitly so stated, but rather “one or more.” Moreover, where a phrase similar to “at least one of A, B, or C” is used in the claims, it is intended that the phrase be interpreted to mean that A alone may be present in an embodiment, B alone may be present in an embodiment, C alone may be present in an embodiment, or that any combination of the elements A, B or C may be present in a single embodiment; for example, A and B, A and C, B and C, or A and B and C.
[0081] In the detailed description herein, references to “one embodiment,” “an embodiment,” “an example embodiment,” etc., indicate that the embodiment described may include a particular feature, structure, or characteristic, but every embodiment may not necessarily include the particular feature, structure, or characteristic. Moreover, such phrases are not necessarily referring to the same embodiment. Further, when a particular feature, structure, or characteristic is described in connection with an embodiment, it is submitted that it is within the knowledge of one skilled in the art with the benefit of the present disclosure to affect such feature, structure, or characteristic in connection with other embodiments whether or not explicitly described. After reading the description, it will be apparent to one skilled in the relevant art(s) how to implement the disclosure in alternative embodiments.
[0082] Furthermore, no element, component, or method step in the present disclosure is intended to be dedicated to the public regardless of whether the element, component, or method step is explicitly recited in the claims. No claim element herein is to be construed under the provisions of 35 U.S.C. 112(f), unless the element is expressly recited using the phrase “means for.” As used herein, the terms “comprises,” “comprising,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus
[0083] While the present disclosure has been described as having an exemplary design, the present invention may be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practices in the art to which this invention pertains.