Abstract: Systems and methods for anchoring and restraining gastrointestinal prostheses are disclosed. In various examples, the systems and methods include securing a gastrointestinal device within a patient's anatomy by extending an anti-migration anchor through a plurality of portions of the gastrointestinal device to couple together the plurality of portions of the gastrointestinal device. In some examples, the anti-migration anchor extends through tissue situated between the plurality of portions of the gastrointestinal device.

Abstract: An electrode coupling output system provides indication to the physician, via electrode guidance instrumentation, concerning the electrical coupling of an electrode, such as an ablative or mapping electrode, with a patient. The output can be provided to the physician via an output device incorporated into the handle set of the electrode catheter. For example, a visual, audio or mechanical output can be provided via the handle set. Additionally or alternatively, the output can be provided to the physician via a navigation system. The indication may be provided by changing the color or other display characteristics of the electrode on the navigation system display or by way of providing a waveform indicating the electrode coupling. In this manner, electrode coupling information is provided to a physician in a manner that minimizes physician distraction.

Abstract: A brush electrode and a method for using the brush electrode for tissue ablation are disclosed. The brush electrode comprises a plurality of flexible filaments or bristles for applying ablative energy (e.g., RF energy) to target tissue during the formation of spot or continuous linear lesions. Interstitial spaces are defined among the filaments of the brush electrode, and the interstitial spaces are adapted to direct conductive or nonconductive fluid, when present, toward the distal ends of the brush filaments. The brush electrode facilitates electrode-tissue contact in target tissue having flat or contoured surfaces. The flexible filaments may be selectively trimmed to give a desired tip configuration or a desired standoff distance between the tissue and the conductive filaments in the brush electrode. Also, the filaments may be grouped into clusters. A shielded-tip brush electrode, including a flexible boot, is also disclosed.

Abstract: An electrode catheter and a method for assessing catheter-tissue contact for tissue ablation are disclosed. An exemplary electrode catheter comprises a flexible catheter shaft. At least one piezoelectric sensor is oriented coaxial to the flexible catheter shaft. The at least one piezoelectric sensor is responsive to movement of the flexible catheter shaft by generating electrical signals corresponding to the amount of movement. The system may also include an output device electrically connected to the at least one piezoelectric sensor. The output device receives the electrical signals for dynamically assessing a level of contact between the flexible catheter shaft and a moving tissue. In another exemplary embodiment, the system may be implemented in a hydrodynamic environment.

Abstract: Side-port sheaths for catheter placement and translation are disclosed. The sheaths include a side-port opening through which a gliding catheter may be deployed during diagnosis or treatment of tissue. The side-port sheath may include a suspension ribbon used to deploy, or that aids in the deployment of, the embedded gliding catheter. The suspension ribbon may be slideably or fixably engaged with an outer surface of the sheath of the gliding catheter.

Abstract: A method of navigating a medical device through a body of a patient includes providing a topography of at least a portion of the body, accepting user input defining a navigation path, robotically navigating the medical device to a starting point on the path, and robotically navigating the medical device along the navigation path to an endpoint. Waypoints defining the navigation path may be input on a graphical representation of the topography using a user interface such as a pointing device or touchscreen. The navigation path may also be defined by tracing a substantially continuous path on the graphical representation. A therapy may be administered while robotically navigating the medical device along the navigation path, either forward or in reverse, or while navigating the medical device along a return path defined by a plurality of virtual breadcrumbs generated as the medical device traverses the navigation path.

Abstract: A robotic surgical system includes a track, a catheter holding device including a catheter receiving portion translatably associated with the track, a translation servo mechanism to control translation of the catheter holding device relative to the track, a catheter deflection control mechanism, a deflection servo mechanism to control the catheter deflection control mechanism, and a controller to control at least one of the servo mechanisms. The catheter receiving portion is adapted for quick installation and removal of a catheter. The catheter receiving portion may be rotatable, with a rotation servo mechanism to control the rotatable catheter receiving portion. The controller controls at least one of the deflection and rotation servo mechanisms to maintain a substantially constant catheter deflection as the catheter rotates. An introducer, which may be steerable, and an expandable, collapsible sterile tube may also be provided.

Abstract: A method of generating a diagnosis map of at least a portion of the heart includes inserting an electrode within the portion of a heart, robotically moving the electrode therein, measuring electrophysiology information at a point on the surface of the heart, associating the measured electrophysiology information with position information for the point on the surface of the heart, repeating the measuring and associating steps for a plurality of points on the surface of the heart, thereby generating a plurality of surface diagnostic data points, and generating the diagnosis map therefrom. The electrode may be moved within the heart randomly, pseudo-randomly, or according to one or more predetermined patterns. A three-dimensional model of the portion of the heart may be provided and presented as a graphical representation, either with or without information indicative of the measured electrophysiology information superimposed thereon.

Abstract: A system for ablating tissue includes an ablation catheter for insertion into the body of a patient and a robotic controller for moving the catheter within the body. The robotic controller advances the catheter until the catheter contacts the tissue surface, maintains contact between the catheter and the tissue surface, and moves the catheter along a predetermined path to create a substantially continuous lesion of ablated tissue. A display device may be used to present a graphical representation of an area of tissue to be ablated. A user interface permits selection of a plurality of treatment points on the graphical representation. The interface is preferably coupled to the controller and catheter such that the controller may cause the catheter to automatically ablate tissue at and between the plurality of treatment points in response to the received user input.

Abstract: The present invention provides apparatus and methods of closing internal tissue punctures. The apparatus and method provide for an introducer sheath having at least one side port enabling aspiration of an internal tissue puncture site and injection of a sealant.

Abstract: A curved ablation catheter imparts ablative energy to target tissue, for example, along a trabecular slope, e.g., in the right atrium along the isthmus between the ostium of the inferior vena cava and the tricuspid valve. The catheter is formed with a preset curvature that, when deployed, both translates linearly and increases in radius to aid in the formation of spot or continuous linear lesions. A method of treating atrial flutter employs the curved ablation catheter.

Abstract: Multipolar, multi-lumen, virtual-electrode catheters having at least one surface electrode, and methods for treatment (e.g., treatment of cardiac arrhythmias) with such catheters are disclosed. The catheters have at least two internal lumens, and at least one internal, flexible electrode rides in each internal lumen. The flexible electrodes carry treatment energy (e.g., radiofrequency energy). The energy exits the catheters via at least one exit feature (e.g., slots, portholes, or micro-pores). The methods for treatment include operating the catheters in different modes depending upon location and type of treatment to be performed. The treatment energy delivered by one of the internal, flexible electrodes may be directed to the other internal, flexible electrode; or the energy delivered by one or both of the internal, flexible electrodes may be directed to one or more surface electrodes. The delivered energy establishes at least one electric field, and possibly one or more lesions, in the tissue.

Abstract: An internal tissue puncture closure method and apparatus. The method and apparatus provide a folded sealing plug that provides more surface area than conventional plugs to more fully cover and seal an external situs of an internal tissue puncture. The folded sealing plug may have a weave pattern that tends to cause the sealing plug to corkscrew into the internal tissue puncture as it is compressed toward an anchor placed inside of the tissue puncture.

Abstract: An electrophysiology apparatus is used to measure electrical activity occurring in a heart of a patient and to visualize the electrical activity and/or information related to the electrical activity. A three-dimensional map of the electrical activity and/or the information related to the electrical activity is created.

Abstract: Virtual-electrode catheters and methods for using such virtual-electrode catheters are disclosed. For example, bipolar and multipolar, virtual-electrode catheters having at least one internal electrode and at least one surface electrode, and methods of using these catheters for treatment of cardiac arrhythmias via, for example, radiofrequency (RF) ablation are disclosed. The catheters may comprise a catheter body with an internal lumen extending within it and adapted to flowingly receive a conductive fluid. An exit feature defining a flow path from the internal lumen to the catheter's outer surface may exist through a sidewall of the catheter body. A conductor is mounted within the internal lumen adjacent to the exit feature and is adapted to deliver treatment energy to the tissue via the conductive fluid in the internal lumen. At least one surface electrode is mounted on the outer surface of the catheter body adjacent to the exit feature.

Abstract: An ablation catheter has improved fluid distribution structures. An ablation section at a distal end of the catheter is designed to provide a more uniform fluid flow emanating from the catheter. By creating a uniform fluid flow, a more uniform tissue lesion results and the possibility of charring the tissue is reduced. A combination of mesh material layers, porous materials, and dispersion channels or openings are used to achieve the uniform flow. The amount of fluid used as a virtual electrode to ablate the tissue is greatly reduced with the present invention. Further, the catheter may be used to create a single, uniform linear lesion by successive application of energy to adjacent portions of the ablation section, thus reducing the power required to create the desired lesion.

Abstract: Methods and apparatus for locating a device with respect to a blood vessel. An expandable or extrudable member transverse to the device locates an internal surface of a proximal wall of the blood vessel. A typical application of such methods and apparatus is providing relative position between a femoral arterial wall and a closure device axis. Predetermined location positions are recognized as a positive stop transmitted to a physician via tactile feedback.

Abstract: The present invention describes apparatus and methods for tying a filament across subcutaneous punctures. According to some embodiments, the apparatus and methods provide pre-tied knots that are inserted into a bodily lumen. Needles flanking the subcutaneous puncture are inserted into the lumen and grab the pre-tied knots. The pre-tied knots are pulled through tiny holes flanking the subcutaneous puncture by the needles, leaving an internal length of the filament across the subcutaneous puncture. The filament is then externally tied, closing the subcutaneous puncture.

Abstract: An introducer sheath has multiple distal slots allowing for translation of a catheter within a cardiac cavity. A pair of longitudinal slots are provided on opposite sides of the sheath near the distal end. A portion of the catheter may deploy from one of the slots while the ablation tip deploys from the opposing slot. The sheath design provides greater maneuverability for the catheter in a direction orthogonal to the tissue to be ablated, while restricting lateral movement of the catheter. The longitudinal direction of the slots further aids in the formation of linear lesions using the catheter.

Abstract: A curved ablation catheter imparts ablative energy to target tissue, for example, along a trabecular slope, e.g., in the right atrium along the isthmus between the ostium of the inferior vena cava and the tricuspid valve. The catheter is formed with a preset curvature that, when deployed, both translates linearly and increases in radius to aid in the formation of spot or continuous linear lesions. A method of treating atrial flutter employs the curved ablation catheter.