JP2001518345A - Myocardial revascularization using high frequency energy - Google Patents

Abstract

SUMMARY OF THE INVENTION The present invention provides an apparatus and method for performing revascularization of a patient's heart wall with at least one burst of RF energy at intervals of about 1 to about 500 msec (preferably, about 30 to 130 msec). About. The device has an elongated, coated, conductive shaft having an uncoated end configured to emit RF energy. A myocardial revascularization method for the human heart is described, wherein an elongated flexible device having a high frequency cutter is used. In embodiments, the device is configured to be introduced percutaneously. In another embodiment, the device is configured to be surgically introduced. The RF energy emitter is advanced to a predetermined location near the desired area of the heart wall. The device is activated to remove tissue, thereby forming a revascularization groove.

Description

DETAILED DESCRIPTION OF THE INVENTION

Related Application This application is related to US patent application Ser. No. 08 / 517,4, filed Aug. 9, 1995.
U.S. Patent Application No. 08, filed October 2, 1997, which is a continuation of
No./942,874 and U.S. Patent Application No. 08, filed November 12, 1997.
/ 968,184 is a continuation-in-part application. The above application is incorporated by reference into the present application.

BACKGROUND OF THE INVENTION [0002] The present invention is particularly directed to performing myocardial revascularization (TMR) and delivering a therapeutic agent to various locations on a patient's heart wall, or for other uses. Resecting the tissue of the heart wall, particularly forming a groove in the heart wall.

[0003] As currently utilized, TMR involves creating multiple grooves in the ventricular arrhythmia wall of a patient's heart with laser energy. T using laser energy
The first trial treatment for MR surgery was performed by Miloseini et al. A paper on laser equipment for general surgery (William and Wilkinson; 1989, 216-
223). Other disclosures of TMR surgery are described in Kobe J. et al. Med. Sci3
2, pages 151-161, see Okabe et al., October 1986, U.S. Pat. No. 4,658,817 (Hardy). These prior arts include intraoperative TMR.
The procedure is described, which requires an opening in the chest, starting from the epicardium, and forming a groove that extends completely through the heart wall.

US Pat. No. 5,554,152, issued Dec. 20, 1994 (Aita et al.)
Discloses an apparatus for TMR. This device is introduced through the chest wall.
Therefore, the chest is opened during surgery by a chest opening procedure, or by a minimally invasive procedure that introduces the device into the patient's chest cavity through a small opening in the chest with a penetrating scope. .

In US Pat. No. 5,389,096 (Aita et al.), A percutaneous TMR procedure is described, in which an optical fiber device utilizing an elongated flexible laser is applied to a patient's peripheral arteries (eg, the femur). (Artery) and advanced through the aorta until the distal end of the device reaches the left ventricle of the patient. In the left ventricle, the distal end of the fiber optic device is directed toward the desired location in the patient's endocardium, urged against the endocardial surface, and a laser beam is emitted from the distal end to form a groove. You.

No. 08 / 078,443, filed Jun. 15, 1993 (
Aita et al.) Describe an intravascular device for regenerating myocardial blood vessels. This device is
It is introduced percutaneously and advanced to the left ventricle of the patient's heart, where laser energy begins revascularization through the endocardium and into the myocardium.

[0007] Laser-based revascularization has been shown to be medically effective for a variety of patients, particularly those who are not suitable for bypass surgery, patients who are not suitable for angioplasty or thermal incision. However, to date, laser devices have been very effective. What is needed is an inexpensive and medically effective laser device. The above and other needs of the present invention are satisfied.

SUMMARY OF THE INVENTION The present invention relates to a method and apparatus for regenerating blood vessels in a portion of a patient's heart by emitting radio frequency (RF) energy to ablate tissue in a portion of the patient's heart. The invention also relates to a method and a device for ablating tissue in the heart wall of a patient to form a groove with the high-frequency energy.

In one embodiment, the method includes inserting an elongated shaft having an RF energy emitter (radiating device) into a patient's vasculature. Preferably, a device is provided for guiding the device. The RF energy emitter is guided inside the left ventricle and is positioned relative to a desired location on the intraventricular wall. Next, the RF energy emitter is activated to remove the damaged tissue. The RF energy emitter may be advanced to remove tissue until a predetermined groove or removal region is formed to a desired depth. As a method of controlling the depth of the groove formation, there is a method of using X-ray fluoroscopy or ultrasonic fluoroscopy, or a method of moving the blood vessel regenerating means a predetermined distance. In addition, the amount of intrusion can be controlled using a mechanical intrusion control device disclosed in U.S. Patent Application No. 08 / 486,978. The RF energy emitter is repositioned elsewhere in the heart wall and repeated until sufficient grooves or excised areas of tissue have been formed for a given revascularization.

According to one embodiment of the present invention, tissue is cut by emitting an RF burst within the patient's heart wall for a time of about 1-500 msec, preferably about 30-130 msec. High frequency bursts can be continuous radiation or discontinuous radiation (
That is, pulsed radiation). In the case of pulsed radiation, it includes a plurality of consecutive pulses, which may or may not have the same width (duration), frequency or amplitude.

Preferably, the RF radiation is controlled such that the heart tissue is exposed to RF energy for a desired time, particularly a time that does not interfere with the patient's heartbeat (eg, after the R-wave and before the T-wave).
One to about ten RF energy bursts are required to effectively form the desired groove in the patient's heart wall, and preferably one RF emission during one heart beat. The source of RF energy is about 150-500 watts (preferably, about 200-500 watts).
300 watts) of peak output power.

[0012] Preferably, the RF energy emitter is driven at one or more energy levels. Initially, grooving or tissue cutting breaks at relatively high energy levels to position and secure the RF cutting device. Subsequent procedures may be performed at lower energy levels to increase control.

A preferred device for revascularizing a patient's heart wall has an RF emitting member. The member has a proximal end and an uncoated (bare) distal end configured to emit RF energy. The device is introduced into the patient's body and advanced through the patient's body until the uncoated tip is positioned near the surface of the patient's heart wall. The at least one RF energy radiation emitted from the RF energy source is R
It is transmitted to the uncoated tip via the F energy transmission member. The RF energy is then emitted from the tip and irradiates the heart wall with which the tip is in contact. In a preferred embodiment, the groove formed in the heart wall has an aspect ratio (ie, depth to width) of at least 1 (preferably at least 2).

[0014] Tissue particles generated by the RF energy emitter form an embolus when they escape into the patient's blood circulation. Thus, in many embodiments, the RF energy emitter has a perfusion and aspiration lumen to remove particles from the patient's body. Alternatively, the RF energy emitter is configured to produce particles (approximately 6-10 μm in diameter) that are small enough to safely propagate through the smallest branches of the vasculature.

One embodiment of the present invention employs percutaneous means, in which a flexible RF energy emitter modifies the patient's vasculature until the distal end of the device reaches a ventricle, such as the left ventricle. Taken forward. The RF energy transmitting member is advanced so that the uncoated end emitting the RF energy contacts the inner surface of the heart wall forming part of the ventricle. When at least one burst of RF energy is emitted from the bare end of the device to the patient's heart wall, tissue is cut or excised in the heart wall and angiogenesis of the heart wall region occurs.

Another embodiment of the present invention employs a minimally invasive approach. Here, a small incision is made in the patient's chest with or without a trocar cavity. Also, until the distal end of the RF transmission member contacts the exterior of the patient's heart, an elongated R
The F energy transmitting member is advanced into the patient's chest cavity. One or more bursts of RF energy are emitted from the distal end to cut tissue within the patient's heart and revascularize, similar to the above-described embodiments of the present invention. As with the transmyocardial revascularization technique, similar procedures using lasers are used with open thoracic surgery, such as coronary artery bypass surgery.

[0017] The RF energy emitter has an RF energy transmission member. This transmission member
Except at the end, it is protected over its entire length. The distal end is uncoated and is configured to contact the surface of the heart wall and radiate RF energy to adjacent tissue of the heart wall. The bare (uncoated) end is about 0.025 to 0.2 inches (0.64 to 5.1 mm), preferably about 0.04 to about 0.08 inches (1 to
2 mm) and about 0.1 to about 5 mm, preferably about 1.5 to about 3.5 mm
Having a length of The distal end may be solid or hollow. Also, the distal end may be relatively sharp or not sharp. However, the distal end should not be so sharp that it does not penetrate the heart tissue when pressed against the heart wall while in contact with the heart wall during the emission of RF energy. The average power level should be about 50-500 watts, preferably about 100-300 watts. The frequency of the RF current should not be less than 100 kHz, preferably about 2 kHz.
50 kHz to about 500 kHz.

The methods and devices of the present invention are used to effectively cut tissue in a patient's heart wall, implant a vessel in the cut area, and create a groove in the heart wall. . The above and other advantages of the present invention will be apparent from the following detailed description of the present invention and the accompanying drawings.

(Detailed Description of the Drawings) FIGS. 1 and 2 show an RF device 10 embodying the configuration of the present invention. This RF device has an RF energy transmission member 11. The RF energy transmission member 11 is configured to be electrically connected to a source 12 of RF energy, and emits pulsed RF energy supplied from the source and transmitted from the RF energy transmission member. And an uncoated end 13 configured as described above.
The RF energy transmission member 11 has a conductor 14. The conductor 14 may be hollow or solid and comprises one or more strands and an insulating jacket 15 made of a suitable insulating polymer material. A preferred RF energy source is the Excalibur RF generator available from Aspen Labalatri, Conmed, Inglewood, Colorado, USA.

The output from the RF energy source 12 is pulsed by a pulse trigger device 16. The pulse trigger device 16 includes a monostable circuit (one-shot circuit) 17
(Such as CD4047 sold by National Semiconductor). The monostable circuit 17 receives the trigger signal 18 from the conductor 19 and
, And generates a pulse output signal 20 and transmits it to the NPN transistor 21. The pulse output signal 20 from the monostable circuit 17 is applied to the transistor 2 during the time of the output signal.
1 is driven. The output of the transistor 21 is transmitted to a reed relay 22 configured to close by receiving the output from the transistor 21. The output of the reed relay 22 is sequentially sent to the foot switch 23. Foot switch 2
When 3 is closed and reed relay 22 is closed, the RF energy supply is activated and emits RF energy during the output of reed relay 22.

FIG. 3 shows details of the monostable circuit shown in FIG. The monostable circuit has 14 pins (
In FIG. 3, it is shown as pins an. ). The monostable circuit shown in FIG. 3 has a plurality of pins indicated by the letters a to n in order to prevent confusion with other codes.
The monostable circuit (model number CD4047) has a plurality of pins numbered 1-14. A trigger signal from the ECG unit is received on pin h. When a trigger signal is received, an ON signal is output from pin j. The duration of the ON signal from the pin j is controlled by the resistance R and the capacitance C of the RC circuit connected to the pins a to c as shown. Typically, to control the duration of the output signal 20 to be about 50 to about 300 msec, the resistance R is about 0.1 to about 1 megohm and the capacitance C is about 0.
08 to about 0.12 microfarads.

FIG. 4 shows a trigger signal 18 based on the patient's heart cycle (beat cycle) 30.
1 shows an outline of an apparatus for producing the above. The signal from the patient's heart 31 is detected by a conventional ECG unit. Further, the detected signal is transmitted to the trigger creating device 32 that can be accommodated in the ECG unit. Trigger signal generator 32 is pre-programmed to output one or more trigger signals 18 at predetermined times between R and T waves in signal period 30.

FIG. 5 shows a transport device for transcutaneous RF devices. This device comprises an outer catheter 40
, Shaped end 41, port 4 at the end of the outer catheter
2, and a lumen extending along the interior of the outer catheter to a distal port. The device also has an inner catheter 44. The inner catheter 44 is slidably and rotatably disposed within the lumen of the outer catheter 40, and has an end portion 45, an end 46, and a port 47 provided at the end of the inner catheter. , Having a lumen 48 extending to the distal port. The RF energy radiating section (emitter) 50 is slidably disposed within the lumen of the inner catheter 44. The distal portion of the inner catheter 44 is bent at an angle with respect to the inner catheter main shaft portion 51 to direct the RF energy emitter 50 out of the distal end of the inner catheter. In this way, the position of the distal end 52 of the RF energy emitter 50 is raised, lowered, and rotated within the lumen of the inner catheter 44, and the position of the inner end of the lumen within the outer catheter 40 is increased. It can be adjusted by raising / lowering and rotating the catheter. In this manner, the distal end 52 of the RF energy emitter 50 can be oriented in a desired direction and towards the endocardium forming the left ventricle 53. Longitudinal and rotational movement of the catheter 44 provides access to a large area of the endocardium.

As shown in FIG. 6, the present invention also includes a method for revascularizing the myocardium 54 of a human heart 56. The EF device 10 has an elongate shaft 60 having an RF energy emitter 50 disposed at the distal end, and a conventional Serdininger (S) technique is applied to the patient's vasculature.
inserted through one of the major vessels by an elderinger technique. The RF energy emitter 50 is advanced into the left ventricle 53 and positioned at a desired location in the heart muscle 62 that requires high blood circulation due to a revascularization disease. RF
The energy emitter 50 acts against the muscle 62 to remove tissue, forming a revascularization groove 64. The tissue region to be cut or excised is the endocardium 6
6 and should penetrate the myocardium 54 a predetermined distance without penetrating the epicardium 68. When deactivated, the RF energy emitter 50 is withdrawn from the groove 64 and relocated elsewhere in the muscle 62.

In another method of the present invention, the RF device 10 has an RF energy emitter 50 at the distal end and is introduced through a small opening in the patient's chest. RF device 1
The 0 is advanced until the RF energy emitter 50 is positioned against the ischemic cells of the muscle 62 of the patient. RF energy emitter 50 is activated and pressed toward muscle 62. The tissue is gradually removed into the epicardium 68, the myocardium 54, and the endocardium 66, forming a revascularization groove 64 leading to the left ventricle 53. As described above, the RF energy emitter 50 is then stopped and withdrawn from the muscle 62 and repositioned. In either method, the operator must have a sufficient number of grooves 6 to treat the ischemic condition.
The above procedure is repeated until 4 or similar revascularization sites are formed in muscle 62.

In operation, the RF energy emitter 50 is held in place in the heart muscle 62 by controlling back and forth movement and pressure, thereby ensuring that the RF energy emitter 50 does not move during groove formation. . Alternatively, the RF energy emitter 50 can be maintained in place by supplying a vacuum to the distal portion.

If the RF energy emitter 5 can switch quickly and intermittently between an active state and a non-active state, the groove will be formed during times of the heart cycle that are not suitable for performing the groove formation. May be synchronized with the patient's cardiac cycle to prevent The RF energy emitter 50 is preferably controlled by automatic control means to prevent treatment from taking place during the T-wave portion of the ECG.

The RF energy emitter 50 may also operate at two or more stages of energy levels. The initial stage of tissue removal to penetrate the epicardium 66 is preferably performed at a relatively high energy level. By forming the groove at this energy level at high speed, the RF energy emitter 50 can be stably fixed inside the groove 64. The remaining tissue removal may be performed at a low energy level for slow groove formation and high accuracy.

In the embodiment shown in FIG. 2, a plurality of control lines (operation lines) 70 are connected at their ends to the shaft 60 end 72 by, for example, an adhesive. Various adhesives including an instant adhesive can be used as the adhesive. At least two, preferably four, control lines 70 are arranged around the shaft 60 in an axial direction, preferably symmetrically. Moving the control line 70 in the axial direction changes the deflection angle of the distal end 72 of the shaft 60 relative to the proximal end. A mechanism (not shown) such as a link or a knob may be provided at the base end of the control line 70 to operate the control line 70. Control line 70 is preferably about 3 mils of stainless steel wire, but could be an equivalent filament such as nylon or any other suitable material having a suitable tensile strength.

Further, the outer pipe member 74 may surround the control line 70 and the shaft 60 to form a protective cover. Outer tube member 74 is secured at its distal end to distal end 72 of shaft 60 behind RF energy emitter 50. The control line 70 may be located in a spaced groove 76 mounted on the outer surface of the shaft 60 to allow precise control of the tip during surgery. Groove 76 is 30
Preferably, it is constructed of a gauge polyamide tube. Thus, the control line 70
Remain in the control area outside the shaft 60 in a guided and separated state. Thus, the RF device 10 can accurately guide the control line 70 by remote control.

Another means of guiding the guide shaft 60 and the RF energy emitter 50 to the proper location in the heart is to provide a shaft inside a biaxially steerable deflectable guide catheter for additional maneuverability and control. It is to arrange. No. 08 / 438,743, filed May 10, 1995, discloses a mobile device and method for myocardial revascularization as described above. In practice, the position of the device can be observed with an esophageal ultrasound imaging device, a transthoracic ultrasound imaging device, or a transthoracic fluoroscopic imaging device. Accordingly, it is preferred to provide one or more radiopaque mark bands at the distal end 72 of the shaft 60 for chest fluoroscopic imaging. This causes the RF energy emitter 50 to create a groove 64 in the myocardium 54 of the ischemic heart muscle 62.
Are collimated and controlled to form

As alternative means for cutting, thermal means or other radiating means are preferred. For example, FIG. 8 illustrates an RF device 100 having a heat remover or ablator 78.
Is shown. The heat remover 78 is covered around the heat conductive probe 82 and
00 has an electrode 80 extending in the length direction. The diameter of the probe 82 is about 1.0 to 5
. Should be 0 mm. The base end of the electrode 80 is connected to a high-frequency generator (not shown). By applying high frequency energy at the appropriate frequency and power through the electrodes 80, resistive heat transmitted through the probe 82 is generated. Normal,
About 30 MHZ is required for probe 82 to generate enough heat to cut the heart tissue.
Energy of z-10 GHz is suitable.

As shown in FIG. 9, the high-frequency energy may be dielectrically heated. The end of the RF device 10 has a ferrite probe 84 at the end. The high-frequency generating means (not shown) radiates energy of a frequency that allows the ferrite high-frequency energy to be inductively heated as shown in FIG. RF device 10
Has a ferrite probe 84 at the end. The high-frequency generating means (not shown) emits energy at a frequency at which the body tissue penetrates into the patient's body, but radiates energy at a frequency that the ferrite probe easily absorbs and generates heat for cutting.

Example 18 pulsed RF energy was used to form 18 grooves in an anesthetized medium dog heart. The characteristics of the groove formed when the wattage was changed by changing the wattage, the size of the tip, and the type of the RF device were determined. The results are shown in the table below.

[0035]

Those skilled in the art will appreciate that various modifications can be made to the present invention without departing from the scope of the invention. In the foregoing, various myocardial revascularization devices and methods have been described using an elongated revascularization device. The revascularization can be performed from inside the left ventricle or from outside the heart. From the above description and the accompanying drawings, it is apparent to those skilled in the art that various modifications can be made to the present invention. Therefore, the present invention is limited only by the following claims.

[Brief description of the drawings]

FIG. 1 is a schematic view of a heart tissue revascularization device embodying features of the present invention.

FIG. 2 is a cross-sectional view of the RF energy transmission member of the device taken along line 2-2 of FIG.

FIG. 3 is a schematic diagram of the monostable circuit shown in FIG. 1;

FIG. 4 is a schematic diagram of an apparatus for generating a trigger signal based on a patient's heart beat.

FIG. 5: RF for positioning the working end near the endocardium of the patient's heart wall
It is a side view of the feed device for energy emitters.

FIG. 6 is a partial cross-sectional side view of a human heart showing myocardial revascularization or transplantation according to the present invention.

FIG. 7 is a longitudinal cross-sectional view of a distal end of a deflectable elongated RF device embodying features of the present invention.

FIG. 8 is a longitudinal sectional view of an RF device used in an embodiment of the present invention.

FIG. 9 is a longitudinal sectional view of an RF device used in an embodiment of the present invention.

[Procedural Amendment] Submission of translation of Article 34 Amendment of the Patent Cooperation Treaty

[Submission date] April 3, 2000 (200.4.3)

[Procedure amendment 1]

[Document name to be amended] Statement

[Correction target item name] Claims

[Correction method] Change

[Correction contents]

[Claims]

────────────────────────────────────────────────── ─── Continuation of the front page (31) Priority claim number 09 / 107,077 (32) Priority date June 29, 1998 (June 29, 1998) (33) Priority claim country United States (US) ( 81) Designated countries EP (AT, BE, CH, CY, DE, DK, ES, FI, FR, GB, GR, IE, IT, LU, MC, NL, PT, SE), OA (BF, BJ, CF, CG, CI, CM, GA, GN, GW, ML, MR, NE, SN, TD, TG), AP (GH, GM, KE, LS, MW, SD, SZ, UG, ZW), EA (AM, AZ, BY, KG, KZ, MD, RU, TJ, TM), AL, AM, AT, AU, AZ, BA, BB, BG, BR, BY, CA, CH, CN, CU, CZ, DE, K, EE, ES, FI, GB, GE, GH, GM, HR, HU, ID, IL, IS, JP, KE, KG, KP, KR, KZ, LC, LK, LR, LS, LT, LU, LV, MD, MG, MK, MN, MW, MX, NO, NZ, PL, PT, RO, RU, SD, SE, SG, SI, SK, SL, TJ, TM, TR, TT, UA, UG , UZ, VN, YU, ZW (72) Inventor Randy J. Kesten Ada Avenue 181 No. 41, Ada Avenue, Mountain View, California 94043, USA 4C060 KK50 MM25

Claims (49)

[Claims] 1. An RF device for performing TMR, comprising: a) an elongate shaft having a proximal end and a distal end configured to access a patient's heart; and b) a distal end of the elongate shaft. An RF energy emitter for emitting RF energy to surrounding tissue. 2. The RF device of claim 1 including an elongated RF energy transmission member having a distal end electrically connected to said RF energy emitter. 3. The RF device of claim 1, wherein said RF transmission member further comprises an insulating sheath, said insulating sheath having a distal end disposed about at least a portion thereof. 4. The RF energy emitter has an uncoated distal portion on the elongate RF energy transmitting member, the distal portion extending distally beyond a distal end of the insulating sheath. RF equipment. 5. The RF of claim 4 wherein said uncoated end portion has a diameter of about 0.025 to about 0.20 inches for emitting a pulse of RF energy.
apparatus. 6. The RF device of claim 4, wherein said uncoated end portion has a length from about 0.1 to about 5 mm. 7. The uncoated end portion is about 1.5 to about 3.5 mm.
The RF device of claim 4 having a length of: 8. The uncoated end portion has a thickness of from about 0.04 to about 0.08.
5. The RF device of claim 4 having a length of mm. 9. An apparatus for cutting tissue in a wall of a patient's heart with one or more RF energy emissions, comprising: a) a source of RF energy; and b) an operative connection to an electrical signal generated by the patient's heart. C) operatively connected to the trigger signal generator and the RF energy supply, receiving the trigger signal from the trigger signal generator, driving the RF energy supply, and the trigger signal; A control unit that emits RF energy at least once in response to
d) a distal end configured to receive RF energy from the RF energy source; an elongate shaft configured to transmit RF energy received from the RF energy source; An uncoated end portion configured to radiate into the patient's heart to cut tissue of the heart
An apparatus comprising: an F energy transmission member; 10. The apparatus of claim 9, wherein said control unit controls the emission time of said RF energy burst. 11. The method of claim 1, wherein the trigger generator comprises:
10. The device of claim 9, wherein said device emits at least one trigger signal. 12. A method of forming a groove in the wall of a patient's heart, comprising: a) an uncoated end having a proximal end and a distal end, the uncoated end configured to emit an elongated electrical conductor and RF energy. B) introducing the elongate RF energy transmission device into a patient, wherein the uncoated distal end portion of the elongate RF energy transmission device has a surface of a heart wall of the patient. C) emitting one or more bursts of RF energy from the uncoated tip of the RF energy transmission device for at least one time period of at least about 1 to about 500 msec; A method of forming a groove in the heart by cutting the heart. 13. The method of claim 12, wherein the one or more bursts of RF energy are emitted from the tip for a period of about 30 to about 130 msec. 14. The method of claim 12, wherein said grooves are formed in a single time. 15. The method of claim 1, wherein at least one burst of RF energy emitted from the uncoated end portion comprises a plurality of pulses of RF energy.
Method 2. 16. The method of claim 15, wherein each of said plurality of pulses has a duration of at least 1 msec. 17. The method of claim 12, wherein about 2 to about 10 bursts of RF energy pulses are emitted from said uncoated end to form a groove. 18. A method of revascularizing a predetermined region of a patient's heart wall, comprising: a) having a proximal end and a distal end, having an uncoated distal portion configured to emit RF energy. Providing a flexible elongated RF energy transmission device; b) introducing said flexible elongated RF energy transmission device into a patient's vasculature;
Advancing the flexible elongate RF energy transmission device until the uncoated distal portion is positioned near a surface of the patient's heart wall so as to contact the surface; c) RF energy from an RF energy source. Transmitting RF energy through the transmission member to the uncoated end portion; d) at least one of the uncoated tip portion of the flexible elongate RF energy transmission device for a time of about 1 to about 500 msec. A method of emitting a burst of RF energy to cut tissue in a predetermined region of a patient's heart wall. 19. The method of claim 16, wherein said RF energy source has a peak power output of about 200 to about 500 watts. 20. A percutaneous method for revascularizing a predetermined area of a patient's heart wall, comprising: a) elongating an insulated electrical conductor member having a proximal end and a distal end; and radiating RF energy. Providing a flexible elongate RF energy transmission device having an uncoated end portion configured as follows: b) introducing said flexible elongate RF energy transmission device into a patient's vasculature;
Advancing the device until the uncoated distal portion is positioned and in contact with the surface of the patient's heart wall; c) from the RF energy source for about 1 to about 500 msec.
Sending at least one burst of RF energy through the energy transmitting device to the uncoated end portion; and d) emitting at least one burst of transmitted RF energy from the uncoated end portion to the patient. To irradiate a desired area of the heart wall. 21. The method of claim 20, wherein one groove is formed by cutting the tissue.
the method of. 22. The at least one burst of RF energy includes a plurality of RF energy bursts.
21. The method of claim 20, comprising a pulse of energy. 23. The method of claim 22, wherein the RF energy of each pulse has a duration of at least 1 msec. 24. The method of claim 20, wherein said RF energy source has a peak power output of about 200 to about 500 watts. 25. A method of revascularizing a desired area of a patient's heart wall, comprising: a) a proximal end, an elongated coated shaft, and an uncoated distal portion configured to emit RF energy. B) introducing at least a distal portion of the RF energy transmitting member into a patient, until the uncoated distal portion contacts the surface near the surface of the patient's heart wall. C) radiating at least one burst of RF energy from the uncoated distal portion of the flexible elongate RF energy transmitting member during a desired time of the patient's cardiac cycle to effect the desired area of the patient's heart wall. A method of cutting a desired area of the patient's heart wall for revascularization. 26. The method of claim 25, wherein said RF energy emission is continuous during at least one of said plurality of bursts. 27. The method of claim 25, wherein said RF energy emission is discontinuous during at least one of said plurality of bursts. 28. The method of claim 27, wherein said discontinuous emission of RF energy is pulsed during at least one of said plurality of bursts. 29. The method of claim 28, wherein said pulsed RF energy radiation is a pulse train of a plurality of pulses. 30. The at least one burst of RF energy is emitted from the uncoated end portion for a time of about 1 to about 500 msec.
Method 5. 31. The method of claim 25, wherein at least one burst of RF energy is emitted from said uncoated end portion for a period of about 30 to about 150 msec. 32. A method of forming a groove in a desired area of a patient's heart wall, comprising: a) a proximal end, an elongated coated shaft, and an uncoated distal portion configured to emit RF energy. B) introducing at least a distal portion of said elongated RF energy transmitting member into a patient until the distal end portion is positioned near and in contact with the surface of the patient's heart wall; c) about 1 A method of irradiating at least one burst of RF energy from the uncoated distal portion for a time of about 500 msec to cut tissue to form a groove in a desired region of a patient's heart. 33. The method of claim 32, wherein a desired time of the patient's cardiac cycle is detected and the burst of RF energy is emitted from the uncoated end portion during the detected time. 34. The method of claim 33, wherein the desired time of the patient's cardiac cycle is between the R and T waves of the patient's cardiac cycle. 35. A method of performing a myocardial revascularization procedure on a desired area of a patient's heart wall, comprising: a) an elongated device having a proximal end and a distal end, and an elongated device having a thermal cutting instrument disposed at the distal end. B) introducing the device into the interior of a patient, directing the distal end of the device to a desired area of the patient's heart wall where the myocardial revascularization is to be performed; c) supplying energy to the thermal cutter. To form a revascularization groove in the myocardium. 36. The elongate device is a flexible endovascular device, comprising: a) loading the device into a patient's body and placing the device in a patient's heart until the distal portion is located in the ventricle of the patient's heart formed by the wall. A) advancing the device through a blood vessel; b) directing the distal end of the device toward a desired area of the patient's heart wall; c) supplying energy to the thermal cutter to perform a myocardial revascularization procedure. 36. The method of claim 35, wherein said cutting is performed. 37. The elongate device is configured to be introduced through the patient's thorax, a) directing the distal end of the device toward the epicardium in a desired area of the wall; b) 36. The method of claim 35, wherein energy is supplied to the thermal cutter to sequentially remove tissue from the epicardium, myocardium, and endocardium to form a revascularization groove. 38. The thermocutter advances the endocardium at a first energy level,
37. The method of claim 36, wherein the method advances the myocardium at a second energy level lower than the first energy level. 39. The method of claim 35, wherein the elongate device has a lumen for irrigating and aspirating a desired area of the heart wall to clean tissue cut from the patient's heart. 40. The method of claim 35, wherein the revascularization groove is formed with a thermal cutter at a temperature between about 60 to about 600 ° C. 41. The method of claim 35, wherein said thermal cutter has a ferrite probe and radiates said probe with high frequency energy to form a revascularization groove. 42. The method of claim 41, wherein said revascularization groove is formed by radiating said ferrite probe with high frequency energy at a frequency between about 30 MHz and about 10 GHz. 43. A method of forming a revascularization groove in a desired region of a patient's heart wall, comprising: a) providing an elongate shaft having a proximal end and a distal end and an RF energy emitter disposed at the distal end; b. C) introducing the shaft into a patient's body and directing the distal end of the device to a desired area of the wall where the revascularization groove is to be formed; c) supplying RF energy to the RF energy emitter to provide the myocardium with A method for forming a revascularization groove. 44. The elongate shaft is a flexible intraluminal shaft: a) advancing the shaft through the patient's blood vessel until the distal end of the shaft is positioned within the ventricle of the patient's heart formed by a wall; B) directing the end of the bath to the endocardium in the desired area of the wall; c) supplying energy to the RF energy emitter to remove tissue from the endocardium during formation of the revascularization groove. 44. The method of claim 43. 45. The elongate shaft is configured to be introduced through the patient's chest, a) directing a distal end of the shaft toward an epicardium in a desired area of the wall; b) 44. The method of claim 43, wherein RF energy is supplied to an RF energy emitter to sequentially remove tissue from the epicardium, myocardium, and endocardium to form a revascularization groove. 46. The RF energy emitter is advanced through the endocardium at a first energy level and advanced within the myocardium at a second energy level lower than the first energy level. 44 methods. 47. The method of claim 43, wherein said elongate shaft has means for cleaning and aspirating a desired area of said heart wall to clean tissue removed from said patient. 48. The RF energy emitter has a probe connected to first and second electrodes and extending in a longitudinal direction of the device, for supplying RF energy through the electrodes to fill the revascularization groove. 44. The method of claim 43, wherein forming. 49. The method of claim 48, wherein said revascularization groove is formed by supplying about 30 MHz to about 10 GHz of RF energy through said electrode.