US5323781A — Methods for the diagnosis and ablation treatment …

Claim 1

Independent Claim 105 words

A closed-heart method for treating ventricular tachycardia in a myocardial infarct patient afflicted with ventricular tachycardia, said method comprising: (a) defining a thin layer of spared myocardial tissue positioned between the myocardial infarct scar tissue and the inner surface of the myocardium (the endocardium) of said patient wherein said defining step comprises the step of defining a thin layer having an endocardial surface area of at least 15 square centimeters; and then (b) ablating said thin layer of spared myocardial tissue by a closed-heart procedure with an ablation catheter so that said thin layer has an endocardial surface area of less than 15 square centimeters.

Claim 2

Dependent Claim 105 words

A closed-heart method for treating ventricular tachycardia in a myocardial infarct patient afflicted with ventricular tachycardia, said method comprising: (a) defining a thin layer of spared myocardial tissue positioned between the myocardial infarct scar tissue and the inner surface of the myocardium (the endocardium) of said patient wherein said defining step comprises the step of defining a thin layer having an endocardial surface area of at least 15 square centimeters; and then (b) ablating said thin layer of spared myocardial tissue by a closed-heart procedure with an ablation catheter so that said thin layer has an endocardial surface area of less than 15 square centimeters.

Claim 3

Dependent Claim 27 words

A method according to claim 1, wherein said defining step comprises the step of defining a thin layer having a thickness of up to about 5 millimeters.

Claim 4

Dependent Claim 28 words

A method according to claim 1, wherein said defining step comprises the step of defining a thin layer having a thickness of from about 0.25 to 2 millimeters.

Claim 5

Dependent Claim 31 words

A method according to claim 1, wherein said defining step comprises the step of defining a thin layer having an endocardial surface area of from about 20 to 40 square centimeters.

Claim 6

Dependent Claim 19 words

A method according to claim 1, wherein said defining step is carried out in the absence of ventricular tachycardia.

Claim 7

Dependent Claim 24 words

A method according to claim 1, wherein said defining step is carried out by detecting said thin layer of spared myocardial tissue by echocardiography.

Claim 8

Dependent Claim 27 words

A method according to claim 1, wherein said defining step is carried out by detecting said infarct overlying said thin layer of spared myocardial tissue by echocardiography.

Claim 9

Dependent Claim 26 words

A method according to claim 1, wherein said defining step is carried out by visualization of endocardial fibrosis beneath said thin layer of spared myocardial tissue.

Claim 10

Dependent Claim 24 words

A method according to claim 1, wherein said defining step is carried out by electrically stimulating the endocardium to detect an increased pacing threshold.

Claim 11

Dependent Claim 31 words

A method according to claim 1, wherein said defining step is carried out with a catheter mounted echocardiographic ultrasound crystal sensor inserted into the interior of the heart of said patient.

Claim 12

Dependent Claim 26 words

A method according to claim 1, wherein said defining step is carried out with an echocardiographic ultrasound crystal sensor positioned in the esophagus of said patient.

Claim 13

Dependent Claim 21 words

A method according to claim 1, wherein said ablating step comprises destroying all of said thin layer of spared myocardial tissue.

Claim 14

Dependent Claim 35 words

A method according to claim 1, wherein said ablating step comprises the step of electrically separating a portion of said thin layer sufficient in size to combat ventricular tachycardia from the remainder of the endocardium.

Claim 15

Dependent Claim 54 words

A method according to claim 13, wherein said electrically separating step comprises the step of creating a continuous lesion extending from the endocardium to said myocardial infarct scar tissue around said thin layer of spared myocardial tissue, said continuous lesion encircling said thin layer to electrically separate said thin layer from adjacent myocardial tissue.

Claim 16

Dependent Claim 64 words

A method according to claim 1, wherein said ablating step comprises the step of creating at least one elongate lesion in said thin layer extending from the endocardium to said myocardial infarct scar tissue, wherein said at least one elongate lesion divides said thin layer into a plurality of electrically separated portions, and wherein each of said portions is incapable of originating ventricular tachycardia.

Claim 17

Dependent Claim 19 words

A method according to claim 15, wherein said at least one elongate lesion comprises a plurality of elongate lesions.

Claim 18

Dependent Claim 34 words

A method according to claim 1, wherein said ablating step is followed by the step of verifying that said thin layer of spared myocardial tissue is no longer capable of originating a ventricular tachycardia.

Claim 19

Dependent Claim 19 words

A method according to claim 17, wherein said verifying step comprises a programmed pacing technique to induce ventricular tachycardia.

Claim 20

Dependent Claim 156 words

A closed-heart method for treating ventricular tachycardia in a myocardial infarct patient afflicted with ventricular tachycardia, said method comprising: (a) defining a thin layer of spared myocardial tissue positioned between the myocardial infarct scar tissue and the inner surface of the myocardium (the endocardium) of said patient, said thin layer having a thickness up to about five millimeters and an endocardial surface area of at least 15 square centimeters; and then (b) ablating said thin layer of spared myocardial tissue by creating at least one elongate lesion in said thin layer extending from the endocardium to said myocardial infarct scar tissue in a closed-heart procedure with an ablation catheter, wherein said at least one elongate lesion is configured to reduce any portion of said thin layer in electrical contact with the remainder of the endocardium to a size, in endocardial surface area, sufficient to combat ventricular tachycardia in said patient and less than 15 square centimeters.

Claim 21

Dependent Claim 156 words

A closed-heart method for treating ventricular tachycardia in a myocardial infarct patient afflicted with ventricular tachycardia, said method comprising: (a) defining a thin layer of spared myocardial tissue positioned between the myocardial infarct scar tissue and the inner surface of the myocardium (the endocardium) of said patient, said thin layer having a thickness up to about five millimeters and an endocardial surface area of at least 15 square centimeters; and then (b) ablating said thin layer of spared myocardial tissue by creating at least one elongate lesion in said thin layer extending from the endocardium to said myocardial infarct scar tissue in a closed-heart procedure with an ablation catheter, wherein said at least one elongate lesion is configured to reduce any portion of said thin layer in electrical contact with the remainder of the endocardium to a size, in endocardial surface area, sufficient to combat ventricular tachycardia in said patient and less than 15 square centimeters.

Claim 22

Dependent Claim 38 words

A method according to claim 19, wherein said ablating step comprises the step of electrically separating from the remainder of the endocardium a portion of said thin layer sufficient in size, in surface area to combat ventricular tachycardia.

Claim 23

Dependent Claim 54 words

A method according to claim 19, wherein said electrically separating step comprises the step of creating a continuous lesion extending from the endocardium to said myocardial infarct scar tissue around said thin layer of spared myocardial tissue, said continuous lesion encircling said thin layer to electrically separate said thin layer from adjacent myocardial tissue.

Claim 24

Dependent Claim 71 words

A method according to claim 19, wherein said ablating step comprises the step of creating at least one elongate lesion in said thin layer extending from the endocardium to said myocardial infarct scar tissue, wherein said at least one elongate lesion divides said thin layer into a plurality of electrically separated portions, and wherein each of said portions is reduced to a size, in surface area, sufficient to combat ventricular tachycardia.

Claim 25

Dependent Claim 19 words

A method according to claim 19, wherein said at least one elongate lesion comprises a plurality of elongate lesions.

Claim 26

Independent Claim 70 words

A method for prognosing the likelihood of ventricular tachycardia occurring in a myocardial infarct patient not previously diagnosed as afflicted with ventricular tachycardia, said method comprising detecting a thin layer of spared myocardial tissue positioned between the myocardial infarct scar tissue and the inner surface of the myocardium (the endocardium) in said patient, and; determining that said thin layer has an endocardial surface area of at least 15 square centimeters.

Claim 27

Independent Claim 70 words

A method for prognosing the likelihood of ventricular tachycardia occurring in a myocardial infarct patient not previously diagnosed as afflicted with ventricular tachycardia, said method comprising detecting a thin layer of spared myocardial tissue positioned between the myocardial infarct scar tissue and the inner surface of the myocardium (the endocardium) in said patient, and; determining that said thin layer has an endocardial surface area of at least 15 square centimeters.

Claim 28

Dependent Claim 13 words

A method according to claim 24, wherein said method is a closed-heart method.

Claim 29

Dependent Claim 83 words

A method according to claim 24, wherein said detecting step is carried out by: (a) determining if a thin layer of spared tissue exists between the infarct and the endocardium, and then (b) creating a map of the locations of the thin layer identified in said determining step to define the thin layer areas, and (c) evaluating the dimensions of said thin layer areas to determine if the contiguous portions of said thin layer areas are of sufficient size to support reentrant pathways.

Claim 30

Dependent Claim 27 words

A method according to claim 24, wherein said detecting step comprises the step of detecting a thin layer having a thickness of up to about 5 millimeters.

Claim 31

Dependent Claim 28 words

A method according to claim 24, wherein said detecting step comprises the step of detecting a thin layer having a thickness of from about 0.25 to 2 millimeters.

Claim 32

Dependent Claim 31 words

A method according to claim 24, wherein said detecting step comprises the step of detecting a thin layer having an endocardial surface area of from about 20 to 40 square centimeters.

Claim 33

Independent Claim 85 words

An apparatus for the ablation treatment of ventricular tachycardia, comprising: an intraventricular catheter; detecting means for detecting a thin layer of spared endocardial tissue connected to said intraventricular catheter; determining means for determining that said thin layer has an endocardial surface area of at least 15 square centimeters; ablation means for ablating said thin layer of spared endocardial tissue connected to said intraventricular catheter; and analyzing means operatively associated with said detecting means for prognosing the likelihood of ventricular tachycardia arising from said thin layer.

Claim 34

Independent Claim 85 words

An apparatus for the ablation treatment of ventricular tachycardia, comprising: an intraventricular catheter; detecting means for detecting a thin layer of spared endocardial tissue connected to said intraventricular catheter; determining means for determining that said thin layer has an endocardial surface area of at least 15 square centimeters; ablation means for ablating said thin layer of spared endocardial tissue connected to said intraventricular catheter; and analyzing means operatively associated with said detecting means for prognosing the likelihood of ventricular tachycardia arising from said thin layer.

Annuity Stage	Window Opens	Payment Deadline	Surcharge Period Until	Estimated Fee	Status
3.5 Years (Year 4)	1997-06-27	1997-12-27	1998-06-28	$2000.00	Window Closed / Lapsed
7.5 Years (Year 8)	2001-06-27	2001-12-27	2002-06-28	$3760.00	Window Closed / Lapsed
11.5 Years (Year 12)	2005-06-27	2005-12-27	2006-06-28	$7700.00	Window Closed / Lapsed

Methods for the diagnosis and ablation treatment of ventricular tachycardia

Abstract

Inventors

Bibliographic Details

Claims Analysis

References Cited (Backward Citations)

USPTO Annuity & Maintenance Windows

Assigned Categories & Tags

Assign Category Tag