# US 11,998,265 B2 · Respiration control during cardiac ablation

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- Number: US 11,998,265 B2
- Document ID: US11998265B2
- Status: Granted
- Kind: B2
- Application number: 16/724,683
- Filed: 2019-12-23
- Published: 2021-06-24
- Granted: 2024-06-04
- Earliest claimed: 2019-12-23
- Assignees: Biosense Webster (Israel) Ltd.
- Applicants: Biosense Webster (Israel) Ltd.
- Inventors: Assaf Govari
- Web page: https://patentgrep.com/patent/US11998265B2

## CPC

- A61B 18/1492: {having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence)}
- A61B 5/065: {Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe}
- A61B 5/6853: {with a balloon}
- A61B 5/6858: {with a distal basket, e.g. expandable basket}
- A61M 16/00: Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators (iron lungs A61H31/02); Tracheal tubes
- A61B 2018/00351: {Heart}
- A61B 2018/00357: {Endocardium}
- A61B 2018/00577: {Ablation}
- A61B 2018/00613: {Irreversible electroporation}
- A61B 2018/00761: {Duration}
- A61B 2018/00827: {Current}
- A61B 2018/00875: {Resistance or impedance}
- A61B 2034/2051: {Electromagnetic tracking systems}
- A61B 2090/3954: {magnetic, e.g. NMR or MRI}
- A61M 2202/0208: Oxygen
- A61M 2205/05: combined with other kinds of therapy
- A61M 2230/202: partial carbon oxide pressure, e.g. partial dioxide pressure (P-CO2)
- A61M 2230/205: partial oxygen pressure (P-O2)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)}

## Abstract

A method for invasive cardiac treatment, including inserting a catheter via a transvascular route into a beating heart of a patient who is anesthetically paralyzed and intubated for ventilation, and, after inserting the catheter, temporarily halting ventilation of the patient. The method includes moving the catheter between a plurality of locations of myocardial tissue of the heart while the ventilation is halted; and ablating the myocardial tissue of the heart at the plurality of locations while the ventilation is halted.

## Claims

### Claim 1

A method for invasive cardiac treatment, comprising: (a) inserting a catheter via a transvascular route into a beating heart of a patient who is anesthetically paralyzed and intubated for ventilation prior to ablation; (b) causing, by a processor of a computing system, ventilation to the patient to increase a level of oxygen in the patient prior to ablation of the patient's myocardial heart tissue; (c) monitoring, continuously, by the processor, oxygen and carbon dioxide levels of the patient; (d) causing, by the processor, ventilation of the patient to be temporarily halted prior to ablation; (e) causing, by the processor, a power source to be activated to ablate myocardial tissue at one or more locations of the heart while the ventilation is temporarily halted and while the monitored oxygen and carbon dioxide levels of the patient are within acceptable limits; (f) causing, by the processor, the power source to be deactivated to cease ablation at any of the one or more locations when the monitored oxygen and carbon dioxide levels of the patient are not within acceptable limits; (g) resuming, by the processor, ventilation until the monitored levels of oxygen and carbon dioxide are within acceptable limits; and (h) repeating, by the processor, steps (c)-(g) until the invasive cardiac treatment is complete.

### Claim 2 (depends on 1)

The method according to claim 1, wherein the catheter is selected from one of a balloon, a basket, a lasso, a focal, and a multi-spline catheter.

### Claim 3 (depends on 1)

The method according to claim 1, wherein the catheter comprises an electrode, and wherein ablating the myocardial tissue comprises ablating the tissue with radio-frequency energy, injected into the tissue via the electrode, configured to cause cell necrosis.

### Claim 4 (depends on 1)

The method according to claim 1, wherein the catheter comprises an electrode, and wherein ablating the myocardial tissue comprises ablating the tissue with radio-frequency energy, injected into the tissue via the electrode, configured to cause irreversible electroporation so as to cause cell apoptosis.

### Claim 5 (depends on 1)

The method according to claim 1, wherein the catheter comprises a magnetic position sensor, and wherein inserting the catheter comprises tracking a position of the catheter within the beating heart using the magnetic position sensor.

### Claim 6 (depends on 1)

The method according to claim 1, wherein the catheter comprises an electrode, and wherein inserting the catheter comprises tracking a position of the catheter within the beating heart in response to at least one of currents traversing the electrode and impedances measured between the electrode and conducting patches positioned on the patient.

### Claim 7 (depends on 1)

The method according to claim 1, wherein ablating the myocardial tissue of the heart at the none or more locations comprises ablating the tissue at the one or more locations for up to 4 seconds.

### Claim 8 (depends on 1)

The method according to claim 1, wherein ablating the myocardial tissue of the heart at the one or more locations comprises ablating the tissue at the one or more locations for up to 4 minutes.

### Claim 9

Apparatus for invasive cardiac treatment, comprising:
one or more processors; and
a non-transitory computer readable medium storing a plurality of instructions, which when executed, cause the one or more processors to:
(a) cause a supply of ventilation from a ventilator to a patient to be adjusted to increase a level of oxygen in the patient prior to ablation of the patient's myocardial heart tissue using a catheter that has been inserted via a transvascular route into the heart of the patient,
(b) cause oxygen and carbon dioxide levels of the patient to be monitored continuously,
(c) cause ventilation of the patient prior to ablation to be halted temporarily,
(d) cause a power source to be activated to ablate myocardial tissue at one or more locations of the heart while the ventilation is temporarily halted and while the monitored levels of oxygen and carbon dioxide are within acceptable limits,
(e) cause the power source to be deactivated to cease ablation at the one or more locations when monitored oxygen and carbon dioxide levels are not within acceptable limits,
(f) cause ventilation to be resumed until the monitored levels of oxygen and carbon dioxide are within acceptable limits, and
(g) repeat steps (c)-(f) until the invasive cardiac treatment is complete.

### Claim 10 (depends on 9)

The apparatus according to claim 9, and comprising meters configured to measure the oxygen level and the carbon dioxide level of the patient.

### Claim 11 (depends on 9)

The apparatus according to claim 9, wherein the catheter is selected from one of a balloon, a basket, a lasso, a focal, and a multi-spline catheter.

### Claim 12 (depends on 9)

The apparatus according to claim 9, wherein the catheter comprises an electrode, and wherein ablating the myocardial tissue comprises ablating the tissue with radio-frequency energy, injected into the tissue via the electrode, configured to cause cell necrosis.

### Claim 13 (depends on 9)

The apparatus according to claim 9, wherein the catheter comprises an electrode, and wherein ablating the myocardial tissue comprises ablating the tissue with radio-frequency energy, injected into the tissue via the electrode, configured to cause irreversible electroporation so as to cause cell apoptosis.

### Claim 14 (depends on 9)

The apparatus according to claim 9, wherein the catheter comprises a magnetic position sensor, and wherein inserting the catheter comprises tracking a position of the catheter within the beating heart using the magnetic position sensor.

### Claim 15 (depends on 9)

The apparatus according to claim 9, wherein the catheter comprises an electrode, and wherein inserting the catheter comprises tracking a position of the catheter within the beating heart in response to at least one of currents traversing the electrode and impedances measured between the electrode and conducting patches positioned on the patient.

### Claim 16 (depends on 9)

The apparatus according to claim 9, and comprising a meter configured to measure the oxygen level of the patient, and wherein the plurality of instructions further cause the one or more processors to increase the oxygen level using the ventilation prior to halting the ventilation.

### Claim 17 (depends on 9)

The apparatus according to claim 9, wherein ablating the myocardial tissue of the heart at the one or more locations comprises ablating the tissue at the one or more locations for up to 4 seconds.

### Claim 18 (depends on 9)

The apparatus according to claim 9, wherein ablating the myocardial tissue of the heart at the one or more locations comprises ablating the tissue at the one or more locations for up to 4 minutes.