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  Method and system for atrial defibrillationUSPTO Application #: 20060100669Title: Method and system for atrial defibrillation Abstract: A method and system for atrial defibrillation in a patient are provided. The method comprises introducing into the patient a catheter comprising an elongated catheter body having proximal and distal ends and at least one lumen therethrough, and a basket-shaped electrode assembly at the distal end of the catheter body. The electrode assembly has proximal and distal ends and comprises a plurality of spines connected at their proximal and distal ends, each spine comprising an elongated spine electrode along its length. The electrode assembly has an expanded arrangement wherein the spines bow radially outwardly and a collapsed arrangement wherein the spines are arranged generally along the axis of the catheter body. The method further comprises introducing the electrode assembly into the heart of the patient and applying defibrillation energy to the tissue through one or more of the elongated electrodes. The system comprises a catheter as described above in combination with an external defibrillator electrically connected to the catheter. (end of abstract)
Agent: Christie, Parker & Hale, LLP - Pasadena, CA, US Inventors: Kristine B. Fuimaono, Shahram Moaddeb USPTO Applicaton #: 20060100669 - Class: 607004000 (USPTO) Related Patent Categories: Surgery: Light, Thermal, And Electrical Application, Light, Thermal, And Electrical Application, Electrical Therapeutic Systems, Combined Cardioverting/defibrillating And Pacing The Patent Description & Claims data below is from USPTO Patent Application 20060100669. Brief Patent Description - Full Patent Description - Patent Application Claims
CROSS-REFERENCE TO RELATED APPLICATION(S) [0001] This application is a continuation of U.S. application Ser. No. 10/040,977, filed Dec. 31, 2001, now U.S. Pat. No. 6,980,858, issued Dec. 27, 2005, the entire contents of which are incorporated herein by reference. BACKGROUND OF THE INVENTION [0002] Atrial fibrillation (also called "AF" or "A Fib") is the most common abnormal heart rhythm. It is a very fast, uncontrolled heart rhythm caused when the upper changes of the heart (the atria) quiver instead of beating. During atrial fibrillation, the upper chambers of the heart beat between 350 and 600 times per minute, causing the pumping function of the upper chambers to not work properly. As a result, blood is not completely emptied from the heart's chambers, causing it to pool and sometimes clot. In about 5 percent of patients with atrial fibrillation, clotted blood dislodges from the atria and results in a stroke. The American Heart Association estimates that, in the United States, atrial fibrillation is responsible for over 70,000 strokes each year. [0003] Various methods exist for treating atrial fibrillation. One such method is cardiac ablation, which is a medical procedure performed to prevent abnormal electrical impulses from ever beginning in the first place. In an ablation procedure, the electrophysiologist first pinpoints the precise area in the heart at which the abnormal signals start through a mapping procedure. The electrophysiologist then eliminates the small area of tissue that is causing the arrhythmia by ablating that tissue. With a procedure known as AV nodal ablation, the electrophysiologist ablates the AV node, keeping the abnormal impulses from traveling to the heart's lower chambers. A pacemaker is used to regulate the heartbeat after this therapy. [0004] Another method for treating atrial fibrillation is AF suppression. With this method, an implanted pacemaker stimulates the heart in a way that preempts any irregular rhythms. In about half of the atrial fibrillation cases, medication can be effective in controlling the rate at which the upper and lower chambers of the heart beat. Standard medications used for atrial fibrillation include beta-blockers (such as carvedilol and propanolol) and calcium-channel clockers (like verapamil and diltiazem), which slow the heart rate. Digoxin, which slows the heart rate through the AV node, thereby decreasing the rate at which the electrical impulses conduct from the upper to lower chambers, can also be used. Other medications, such as disopyramide, flecainide, procainamide and sotalol, are used to chemically convert AF back to normal rhythm. In many cases, anticoagulants, such as heparin, are also used to "thin" the blood to reduce the risk of clot formation. [0005] Cardioversion can also be used to treat atrial fibrillation. Cardioversion involves changing an abnormal heart rate back to a normal one. Cardioversion can be done using medication or electricity. In electrical cardioversion, energy is applied to the heart to "jolt" it out of atrial fibrillation. Two types of electrical cardioversion exist, external and internal. For external cardioversion, two external paddles are placed on the patient's chest or on the chest and back. A high-energy electrical shock is sent through the patches and through the body to the heart. The energy shocks the heart out of atrial fibrillation and back into normal rhythm. [0006] Internal cardioversion uses a similar approach, but instead of paddles being placed on the outside of the body, a catheter is inserted through a vein to the heart. The electrical energy is delivered through the catheter to the inside of the heart to stop the atrial fibrillation. Internal cardioversion has met with high success and provides a desirable alternative to external cardioversion. Notably, internal cardioversion requires far lower energy levels than external cardioversion and thus can provide a more comfortable procedure for patients by eliminating the trauma, discomfort and risk associated with high-energy external cardioversion. [0007] Electrophysiologists are developing clinical techniques targeted toward the use of catheter-based ablation as a therapeutic alternative in the treatment of focally induced atrial fibrillation. An important component of these efforts are methods for quickly and reliably inducing and converting the AF arrhythmia while the patient is in the electrophysiology lab. SUMMARY OF THE INVENTION [0008] The present invention is directed to an method and system for performing internal cardioversion utilizing a catheter having a basket-shaped electrode assembly. [0009] In one embodiment, the invention is directed to a method for atrial defibrillation in a patient in need thereof comprising introducing into the patient a catheter. The catheter comprises an elongated catheter body having proximal and distal ends and at least one lumen therethrough, and a basket-shaped electrode assembly at the distal end of the catheter body. The electrode assembly has proximal and distal ends and comprises a plurality of spines connected at their proximal and distal ends, each spine comprising an elongated spine electrode along its length. The electrode assembly has an expanded arrangement wherein the spines bow radially outwardly and a collapsed arrangement wherein the spines are arranged generally along the axis of the catheter body. The method further comprises introducing the electrode assembly into the heart of the patient and applying defibrillation energy to the tissue through one or more of the elongated electrodes. [0010] In another embodiment, the invention is directed to a system for atrial defibrillation in a patient. The system comprises a catheter as described above in combination with an external defibrillator electrically connected to the catheter. [0011] In a particularly preferred embodiment, the invention is directed to a system for atrial defibrillation in a patient comprising a catheter. The catheter comprises an elongated catheter body having proximal and distal ends, a length of at least about 90 cm, and at least one lumen therethrough. The catheter body has one or more ring electrodes mounted at or near its distal end. The catheter further comprises a basket-shaped electrode assembly at the distal end of the catheter body, the electrode assembly having proximal and distal ends and comprising at least three spines connected at their proximal and distal ends. Each spine comprises an elongated spine electrode along its length, wherein each spine electrode has a length ranging from about 30 mm to about 80 mm. The electrode assembly has an expanded arrangement wherein the spines bow radially outwardly and a collapsed arrangement wherein the spines are arranged generally along the axis of the catheter body. The electrode assembly has a tip electrode mounted at its distal end. The system further comprises an external defibrillator electrically connected to the catheter, an interface switch box that connects the external defibrillator to the catheter and that permits the selection of spine electrodes through which defibrillation energy is to be delivered, an ECG recorder electrically connected to the catheter through the interface switch box, and an external pacer electrically connected to the catheter through the interface switch box. [0012] The inventive method and system offer several advantages over existing methods and systems. First, the basket-shaped electrode assembly has a larger surface area than conventional catheters and permits better current distribution to cover a majority of both atria during treatment. The larger surface area also reduces the impedance and energy requirements. The ability of the electrode assembly to expand and contract permits adjustability of the electrodes and better contact with tissue. The electrode assembly can also be placed within the pulmonary artery for better current distribution in the left atrium. BRIEF DESCRIPTION OF THE DRAWINGS [0013] These and other features and advantages of the present invention will be better understood by reference to the following detailed description when considered in conjunction with the accompanying drawings wherein: [0014] FIG. 1 is a perspective view of a catheter according to the invention. [0015] FIG. 2 is a close-up perspective view of the basket-shaped electrode assembly and the distal end of the catheter body of the catheter shown in FIG. 1. [0016] FIG. 3 is a side cross-sectional view of the control handle of the catheter shown in FIG. 1. [0017] FIG. 4 is a perspective view of an alternative basket-shaped electrode assembly in accordance with the invention. [0018] FIG. 5 is a schematic diagram of a system in accordance with the invention. [0019] FIG. 6 is a side cross-sectional view of the distal end of a catheter according to the invention showing an exemplary steering mechanism. DETAILED DESCRIPTION OF THE INVENTION Continue reading... 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