BR102019000017A2 - Mapeamento anatômico rápido com o uso de preenchimento de volume - Google Patents

Mapeamento anatômico rápido com o uso de preenchimento de volume Download PDF

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Publication number
BR102019000017A2
BR102019000017A2 BR102019000017-1A BR102019000017A BR102019000017A2 BR 102019000017 A2 BR102019000017 A2 BR 102019000017A2 BR 102019000017 A BR102019000017 A BR 102019000017A BR 102019000017 A2 BR102019000017 A2 BR 102019000017A2
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Brazil
Prior art keywords
distal end
end assembly
deformed
organ
processor
Prior art date
Application number
BR102019000017-1A
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English (en)
Inventor
Assaf COHEN
Ido Ilan
Itai Doron
Fady Massarwi
Original Assignee
Biosense Webster (Israel) Ltd.
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Publication date
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Publication of BR102019000017A2 publication Critical patent/BR102019000017A2/pt

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Abstract

"método e aparelho para mapeamento anatômico rápido com o uso de preenchimento de volume". a presente invenção se refere a um método que inclui receber um ou mais sinais indicativos de uma posição de um conjunto de extremidade distal de uma sonda médica dentro de um órgão de um paciente. com base nos sinais recebidos, um volume interno que é confinado no conjunto de extremidade distal é determinado. um mapa anatômico do órgão é atualizado para denotar o volume interno do conjunto de extremidade distal como pertencente a um interior do órgão.

Description

[001] A presente invenção se refere de modo geral a mapeamento anatômico, e particularmente a métodos e sistemas para mapeamento anatômico cardíaco.
ANTECEDENTES DA INVENÇÃO [002] O mapeamento anatômico das cavidades cardíacas é frequentemente empregado durante procedimentos cardíacos invasivos. Por exemplo, a publicação de pedido de patente US 2010/0168550 descreve um sistema para construir múltiplos envoltórios modelados indicativos da geometria e/ou do volume de uma câmara cardíaca. O sistema é configurado para coletar uma pluralidade de pontos de dados de local à medida que um eletrodo faz a varredura do interior da câmara. Cada um dos pontos de dados coletados tem uma fase cardíaca medida associada na qual esse ponto foi adquirido. O sistema é configurado para agrupar os locais coletados pelo eletrodo em conjuntos com base na fase. Cada conjunto é caracterizado por uma fase associada específica de seus locais de eletrodo constituintes. O sistema é configurado para gerar, para cada conjunto, um respectivo modelo de envoltório que irá representar a câmara na fase associada. Os envoltórios, uma vez construídos, podem ser usados para ou em conexão com uma variedade de procedimentos de diagnóstico, de mapeamento e/ou terapêuticos. O sistema é configurado também para verificar que o eletrodo esteja em contato com o tecido cardíaco antes de usar o ponto de dados coletado na construção do envoltório (por exemplo, com o uso de um parâmetro de ângulo de fase para verificar o contato).
[003] Como outro exemplo, a publicação de pedido de patente US
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2/17
2006/0178587 descreve sistemas e métodos para calibrar cálculos com base nas medições originadas de um cateter. Uma modalidade compreende um método para calibrar cálculos de volume de uma cavidade preenchida por fluido, como uma câmara cardíaca. Neste método, um primeiro cateter configurado para medir características elétricas e um segundo cateter configurado para medir características geométricas são inseridos em uma cavidade preenchida com fluido. As características elétricas da cavidade preenchida com fluido são medidas com o primeiro cateter e as características geométricas da cavidade são medidas com o segundo cateter. Um segmento de volume é determinado com base nas características geométricas medidas da cavidade, e um segmento de volume correspondente é determinado com base nas características elétricas medidas da cavidade. Como o cálculo geométrico do volume é sabidamente mais acurado, o cálculo de volume baseado nas medições elétricas é ajustado (calibrado) para corresponder ao cálculo geométrico.
[004] A publicação de pedido de patente US n° 2014/0095105 descreve um algoritmo para corrigir e/ou dimensionar um sistema de coordenadas baseado em corrente elétrica que pode incluir a determinação de uma ou mais funções de transformação ou interpolação globais e/ou uma ou mais funções de transformação locais. As funções de transformação globais e locais podem ser determinadas calculandose um tensor métrico global e vários tensores métricos locais. Os tensores métricos podem ser calculados com base em distâncias predeterminadas e medidas entre sensores próximos em um cateter. SUMÁRIO DA INVENÇÃO [005] Uma modalidade da presente invenção fornece um método que inclui receber um ou mais sinais indicativos de uma posição de um conjunto de extremidade distal de uma sonda médica em um órgão de um paciente. Com base nos sinais recebidos, um volume interno que
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3/17 é confinado no conjunto de extremidade distal é determinado. Um mapa anatômico do órgão é atualizado para denotar o volume interno do conjunto de extremidade distal como pertencente a um interior do órgão.
[006] Em algumas modalidades, o método inclui calcular, com base nos sinais recebidos, as posições de um ou mais sensores acoplados ao conjunto de extremidade distal e derivar o volume interno a partir das posições dos sensores.
[007] Em algumas modalidades, o método inclui calcular o volume interno com base nas posições dos sensores e em um formato geométrico conhecido do conjunto de extremidade distal.
[008] Em uma modalidade, o método inclui verificar se o conjunto de extremidade distal está deformado e denotar o volume interno do conjunto de extremidade distal como pertencente ao interior do órgão apenas quando o conjunto de extremidade distal não estiver deformado.
[009] Em outra modalidade, o método inclui, em resposta à detecção de que o conjunto de extremidade distal está deformado, atualizar o mapa anatômico para denotar apenas ao menos parte de uma superfície externa do conjunto de extremidade distal como pertencente ao interior do órgão.
[0010] Em algumas modalidades, o método inclui verificar se uma superfície associada ao conjunto de extremidade distal é plana.
[0011] Em algumas modalidades, o método inclui verificar se um formato geométrico real do conjunto de extremidade distal se desvia de um formato geométrico não deformado conhecido do conjunto de extremidade distal.
[0012] Em uma modalidade, o método inclui verificar se o conjunto de extremidade distal está deformado e inclui identificar o contato mecânico entre o conjunto de extremidade distal e uma superfície do órgão.
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4/17 [0013] É adicionalmente fornecido, de acordo com uma modalidade da presente invenção, um aparelho que inclui uma interface elétrica e um processador. O processador é configurado para receber através da interface elétrica um ou mais sinais indicativos de uma posição de um conjunto de extremidade distal de uma sonda médica dentro de um órgão de um paciente. Com base nos sinais recebidos, o processador está configurado para determinar um volume interno que está confinado no conjunto de extremidade distal e para atualizar um mapa anatômico do órgão para denotar o volume interno do conjunto de extremidade distal como pertencente a um interior do órgão.
[0014] A presente invenção será mais bem compreendida a partir da descrição detalhada a seguir das modalidades da mesma, tomadas em conjunto com os desenhos nos quais: BREVE DESCRIÇÃO DOS DESENHOS [0015] A Figura 1 é uma ilustração esquemática pictórica de um sistema para mapeamento anatômico de acordo com uma modalidade da presente invenção;
[0016] As Figuras 2A e 2B são mapas de volume renderizados de anatomia de cavidade mapeados por cateteres de mapeamento Lasso® e Pentaray®, respectivamente, de acordo com modalidades da presente invenção; e [0017] A Figura 3 é um fluxograma que ilustra esquematicamente um método para mapeamento anatômico de uma cavidade cardíaca, de acordo com uma modalidade da presente invenção.
DESCRIÇÃO DETALHADA DAS MODALIDADES
VISÃO GERAL [0018] Um interior de um órgão de um paciente, como uma cavidade cardíaca, pode ser mapeado com o uso de um cateter de mapeamento que pode utilizar vários sensores conectados em sua extremidade distal para mapeamento enquanto está dentro do órgão. Com uso
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5/17 de sinais de localização que os vários sensores geram, um processador pode calcular os locais dos vários sensores, como os locais dos eletrodos de detecção, dentro do órgão (por exemplo, a cavidade). Com uso dos locais calculados, o processador pode ainda derivar um mapa anatômico da cavidade. O processo acima pode gerar mapas precisos da cavidade, ainda requer uma quantidade relativamente grande de tempo para concluir.
[0019] As modalidades da presente invenção que são aqui descritas fornecem sistemas e métodos aprimorados para o mapeamento anatômico de cavidades cardíacas. As técnicas reveladas reduzem significativamente o tempo de mapeamento ao se adicionar repetidamente ao mapa volumes internos durante um processo de mapeamento. Os volumes internos são volumes internos que estão confinados entre os sensores do cateter (isto é, um volume interno que é confinado em um conjunto de extremidade distal) e nos quais, portanto, é altamente improvável que haja tecido. Dessa forma, esses volumes podem ser considerados com alta probabilidade como o volume interno da cavidade cardíaca e, portanto, podem ser inteiramente adicionados a um mapa em formação. A título de exemplo, o método apresentado pode usar cateteres de múltiplos eletrodos como os cateteres Lasso® (isto é, que compreendem uma seção de fio-guia em espiral) ou Pentaray® (isto é, que compreendem uma seção de múltiplos raios). Os múltiplos eletrodos de detecção dispostos em tais cateteres têm uma geometria que confina um volume interno, conforme mostrado abaixo.
[0020] Em algumas modalidades, um sistema de mapeamento anatômico recebe uma pluralidade de sinais de múltiplos sensores acoplados a uma extremidade distal do cateter (isto é, acoplados ao conjunto de extremidade distal), por exemplo eletrodos de detecção conectados a um fio-guia em espiral de um cateter Lasso® ou aqueles
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6/17 conectados aos braços de um cateter Pentaray®. Com base na pluralidade de sinais, um processador no sistema de mapeamento anatômico calcula os locais dos eletrodos de detecção. Com base nos locais calculados, o processador calcula um formato de uma extremidade distal do cateter, como o formato das extremidades distais dos cateteres Lasso® ou Pentaray®.
[0021] O processador então determina se o formato da extremidade distal do cateter está deformado ou não (isto é, tem o formato não perturbado de uma extremidade distal livremente móvel, ou não). Uma extremidade distal pode ser deformada, por exemplo, por estar em contato com uma superfície da cavidade cardíaca (isto é, um contato mecânico entre o conjunto de extremidade distal e uma superfície do órgão). Há numerosos métodos para o processador determinar se a extremidade distal está deformada ou não, sendo que, a título de exemplo, dois desses métodos são aqui descritos para dois cateteres específicos:
(a) Em uma modalidade, o processador determina se o cateter Lasso® está deformado ou não pela verificação de quão planas são as superfícies do disco que os braços em espiral do cateter Lasso® abrangem, conforme detalhado abaixo.
(b) Em uma modalidade, o processador determina se o cateter Pentaray® está deformado ou não pela verificação de quão planas são as superfícies que quaisquer dois braços vizinhos do cateter Pentaray® podem definir.
[0022] Se o processador determinar que o formato do cateter está deformado, então o processador adiciona apenas o formato da extremidade distal (por exemplo, o contorno do fio-guia Lasso® ou os contornos dos braços do Pentaray®) ao mapa anatômico (isto é, o processador está atualizando o mapa anatômico para denotar apenas ao menos parte de uma superfície externa do conjunto de extremidade distal como pertencente ao interior do órgão). Se, por outro lado, o processador determina
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7/17 que o formato da extremidade distal não está deformado, o processador então calcula um volume interno (isto é, o volume de sangue situado entre os locais dos eletrodos medidos). O processador adiciona então o volume interno tridimensional calculado inteiro (isto é, o volume interno) ao mapa anatômico da cavidade. Em outras palavras, o processador denotará o volume interno do conjunto de extremidade distal como pertencente ao interior do órgão apenas quando o conjunto de extremidade distal não estiver deformado.
[0023] Em uma modalidade, o processador calcula esse volume interno por interpolação entre os locais medidos dos eletrodos de detecção.
[0024] Como um cateter de mapeamento tipicamente passa a maior parte do tempo de mapeamento sem estar deformado (isto é, livremente no acúmulo de sangue de uma cavidade cardíaca), os volumes internos do mapeamento conforme revelados na presente invenção são altamente eficientes. O processador tipicamente repete o processo de adição de volumes internos à medida que o cateter se move através de múltiplas posições dentro da cavidade, de modo a convergir rapidamente para um mapa volumétrico completo da cavidade. Os termos ‘localização’ e ‘posição’ são usados de forma intercambiável na descrição, e têm o mesmo significado.
[0025] A técnica revelada tem uma vantagem distinta que é poder encurtar significativamente o tempo necessário para se obter um mapa anatômico de uma cavidade. O tempo mais curto pode melhorar a precisão do mapa e potencialmente simplificar o procedimento clínico envolvido na aquisição e no uso de tal mapa. Além disso, como resultado do preenchimento com volumes internos, a técnica revelada produz uma representação de uma cavidade que tem ocorrências reduzidas de espaços vazios artificiais no mapa. Tal representação mostra melhor a realidade de uma anatomia contínua sem espaços vazios, o que
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8/17 é mais difícil de se obter de outro modo.
DESCRIÇÃO DO SISTEMA [0026] A Figura 1 é uma ilustração esquemática pictórica de um sistema para ablação intracardíaca de acordo com uma modalidade da presente invenção. Conforme visto, um médico 27 está usando um cateter eletroanatômico 29 para fazer o mapeamento anatômico do coração 23 de um paciente 25. O cateter 29 compreende, em sua extremidade distal, um cateter de mapeamento Pentaray® que tem cinco braços 20 a cada um dos quais estão acoplados um ou mais eletrodos de detecção 22. Uma extremidade distal do cateter compreende um sensor magnético 30. Durante o procedimento de mapeamento, o sensor magnético 30 gera sinais indicativos da posição e da orientação da extremidade distal do cateter Pentaray® dentro de uma cavidade.
[0027] Os eletrodos 22 adquirem e/ou injetam sinais indicativos de seus locais no coração 23. Um processador 28 recebe os sinais magnéticos e elétricos através de uma interface elétrica 35 e usa informações contidas nesses sinais para calcular um formato da extremidade distal do cateter Pentaray®. Em algumas modalidades, o formato calculado é refinado pelo processador 28 com base no cálculo que leva em consideração as restrições físicas derivadas da geometria conhecida do cateter (por exemplo, o formato geométrico conhecido do conjunto de extremidade distal), como as distâncias entre eletrodos vizinhos.
[0028] Em algumas modalidades, o processador 28 atualiza um mapa anatômico 31 de uma cavidade do coração 23 com o formato reconstruído da extremidade distal. Em algumas modalidades da presente invenção, o processador 28 constrói um mapa anatômico 31 de maneira rápida, ao preencher volumes inteiros da cavidade confinados dentro do formato reconstruído. Durante e/ou após o procedimento, o processador 28 pode exibir o mapa anatômico 31 em uma tela 26.
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9/17 [0029] Em algumas modalidades, conforme notado acima, o processador 28 recebe sinais do sensor magnético 30 em resposta a campos magnéticos de geradores de campo externos (não mostrados), com o propósito de medir um respectivo local preciso em três dimensões (eixos x, y e z) e orientação (rolamento, guinada e arfagem) da extremidade distal do cateter no coração. Os geradores de campo magnético são tipicamente colocados em posições conhecidas externas ao paciente 25, por exemplo, abaixo da mesa sobre a qual o paciente está deitado. Os sinais de posição são indicativos da posição do sensor 30 em um sistema de coordenadas do sistema de mapeamento anatômico.
[0030] O método de localização e orientação com o uso de detecção de campos magnéticos externos é implementado em várias aplicações médicas, por exemplo, no sistema CARTO™, produzido por Biosense Webster Inc. (Irvine, Califórnia, EUA) e é descrito em detalhes nas patentes U.S. 5.391.199, 6.690.963, 6.484.118, 6.239.724, 6.618.612 e 6.332.089, na publicação de patente PCT WO 96/05768 e nas publicações de pedido de patente U.S. 2002/0065455 A1, 2003/0120150 A1 e 2004/0068178 A1, cujas descrições estão todas aqui incorporadas por referência.
[0031] Em modalidades alternativas, durante o procedimento, os respectivos locais individuais de eletrodos 22 são rastreados com uso de uma técnica de localização atual avançada (ACL - Advanced Current Location). Na técnica ACL, uma pluralidade de eletrodos externos 24 é acoplada ao corpo do paciente 25; por exemplo, seis eletrodos externos 24 podem ser acoplados ao tórax do paciente, e outros três eletrodos externos podem ser acoplados às costas do paciente. (Para facilidade de ilustração, apenas um eletrodo externo é mostrado na Figura 1). Embora os eletrodos 22 estejam dentro do coração 23 do paciente, as correntes elétricas passam entre os eletrodos 22 e os eletrodos exPetição 870190019411, de 26/02/2019, pág. 12/24
10/17 ternos 24. Com base nas razões entre as amplitudes de corrente resultantes medidas nos eletrodos externos 24 (ou entre as impedâncias indicadas por essas amplitudes), e dadas as posições conhecidas dos eletrodos de extremidade 24 no corpo do paciente, o processador 28 calcula o local de cada um dos eletrodos 22 no coração do paciente. O processador pode assim associar os sinais de impedância recebidos dos eletrodos 22 com o local no qual o sinal foi detectado.
[0032] A técnica ACL de rastreamento de locais dos eletrodos é implementada em várias aplicações médicas, por exemplo no sistema CARTO™, produzido pela Biosense Webster Inc. (Irvine, Califórnia, EUA) e é descrita em detalhes nas patentes U.S. 8.456.182, 7.756.576, 7.869.865, 7.848.787 e 7.848.789, cujas descrições estão todas aqui incorporadas a título de referência.
[0033] A ilustração do exemplo mostrado na Figura 1 é escolhida puramente por uma questão de clareza conceitual. Outros tipos de geometrias de detecção, e em particular a do cateter de mapeamento Lasso® (produzido por Biosense Webster, Inc.), também podem ser empregados. De modo geral, o processador 28 pode ser incorporado como um único processador, ou como um conjunto de processadores em rede ou em cluster trabalhando de forma cooperativa. O processador 28 é tipicamente um dispositivo de computação digital programado que compreende uma unidade de processamento central (CPU), uma memória de acesso aleatório (RAM), armazenamento secundário não volátil, como um disco rígido ou unidade de CD-ROM, interfaces de rede e/ou dispositivos periféricos. Códigos de programa, incluindo programas de software e/ou dados, são carregados na RAM para execução e processamento pela CPU e os resultados são gerados para exibição, saída, transmissão ou armazenamento, como é conhecido na técnica. O código de programa e/ou os dados podem ser baixados para o computador em forma eletrônica, através de uma rede, por exemplo,
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11/17 ou podem ser, alternativa ou adicionalmente, fornecidos e/ou armazenados em mídias tangíveis não transitórias, como memória magnética, óptica ou eletrônica. Tal código e/ou dados de programa, quando fornecidos ao processador, produzem uma máquina ou computador para fins especiais configurado para executar as tarefas descritas aqui. [0034] Embora a modalidade ilustrada se refira especificamente ao uso de cateter de mapeamento de múltiplos braços Pentaray®, o cateter de mapeamento Lasso® é igualmente adequado para a descrição acima, conforme explicado abaixo. Além disso, outros tipos de extremidades distais do cateter podem ser adequados, como os de um cesto ou de um balão.
MAPEAMENTO ANATÔMICO RÁPIDO UTILIZANDO PREENCHIMENTO DE VOLUME [0035] As Figuras 2A e 2B mostram mapas de volume renderizados de anatomia de cavidade mapeados por cateteres de mapeamento Lasso® e Pentaray®, respectivamente, de acordo com modalidades da presente invenção. Um inserto 55 no lado esquerdo da Figura 2A ilustra esquematicamente um cateter Lasso® que compreende um fioguia Lasso 42 ao qual múltiplos eletrodos de detecção 22 estão conectados.
[0036] Conforme visto, um sensor magnético 30a é encaixado em um segmento de base da extremidade distal do cateter. O cateter Lasso® é mostrado no inserto 55 em sua configuração de espaço livre (isto é, não deformada). O cateter Lasso® foi usado para mapear o tecido mostrado nas Figuras 2A (I) e 2A (II). Ambas as figuras mostram um mapeamento resultante de uma porção de uma cavidade em uma determinada posição do cateter Lasso® no interior de uma cavidade de um coração 23. As Figuras 2A (I) e Figura 2A (II) foram compilados a partir de dados de localização adquiridos quando o cateter foi posicionado dentro do acúmulo de sangue da cavidade e fora da superfície da cavidade, de modo
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12/17 que o cateter Lasso® não foi deformado pelo contato de uma superfície do tecido.
[0037] A Figura 2A (I) mostra o mapeamento de cavidade resultante conforme obtido sem a técnica revelada. Conforme visto, um formato mapeado 52 é limitado a locais sobre o fio-guia em espiral lasso 42, próximo aos eletrodos de detecção 22 (isto é, a uma porção do volume da cavidade que está em grande parte seguindo o formato do conjunto de extremidade distal do cateter).
[0038] Em uma modalidade, o formato 52 é calculado pelo processador 28 que ajusta um modelo de computador de um formato da extremidade distal do cateter Lasso® aos respectivos locais. Em outra modalidade, o formato é calculado quando o processador 28 interpola ao menos parte dos locais medidos. Independentemente do método de cálculo, nenhuma informação é fornecida sobre um volume 51 que fio-guia Lasso 42 confina. A Figura 2A (II) mostra uma modalidade da presente invenção, nas quais o processador 28 deriva o volume confinado 50 (isto é, volume interno) com base nos locais de eletrodo que calculou da mesma maneira que a Figura 2A (I). Conforme visto, é obtido um preenchimento de volume 50 confinado substancial. O volume confinado 50 é derivado em adição ao formato da extremidade distal do cateter, enquanto o formato derivado (que poderia envolver a estrutura da extremidade distal) não é mostrado na Figura 2A (II) por uma questão de clareza.
[0039] Um inserto 57 da Figura 2B (I) ilustra esquematicamente um cateter Pentaray® que compreende uma estrutura de múltiplos raios 43 à qual os eletrodos de detecção 22 são conectados. Conforme visto, um sensor magnético 30b é encaixado em um segmento de base da extremidade distal do cateter. O cateter Pentaray® é mostrado em sua configuração de espaço livre (isto é, não deformada pelo contato com uma superfície de tecido). O cateter Pentaray® foi usado para mapear
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13/17 o tecido mostrado nas Figuras 2B (I) e Figura 2B (II), que foram compilados quando o cateter Pentaray® foi posicionado em um acúmulo de sangue de uma cavidade de um coração 23 (isto é, onde o cateter Pentaray® não foi deformado). A Figura 2B (I) mostra o mapeamento de cavidade obtido sem a técnica revelada. Conforme visto, um formato mapeado 62 é limitado aos locais abrangidos pelos cinco braços de estrutura de múltiplos raios 43, próximo aos eletrodos de detecção
22.
[0040] Em uma modalidade, o formato 62 é calculado pelo processador 28 que ajusta um modelo de computador de um formato da extremidade distal do cateter Pentaray® aos respectivos locais. Em outra modalidade, o formato é calculado quando o processador 28 interpola ao menos parte dos locais medidos. Novamente, qualquer que seja o método de cálculo, não é fornecida nenhuma informação sobre um volume 61 que a estrutura de múltiplos raios 43 confina. Por outro lado, com a presente invenção, conforme visto na Figura 2B (II), um preenchimento de volume sanguíneo 60 tipo pirâmide pentagonal substancial é obtido quando o processador 28 faz uma série de cálculos similares àqueles descritos acima.
[0041] Para obter o preenchimento de volume visto nas Figuras 2A (II) e 2B (II), um processador, como o processador 28 pode, em uma modalidade, interpolar entre locais de sensor calculados, um volume sanguíneo respectivo confinado entre múltiplos eletrodos 22. O processador 28 pode empregar outros cálculos para calcular um volume confinado de uma cavidade com base, por exemplo, em um modelo geométrico do cateter que o processador 28 armazena.
[0042] As ilustrações do exemplo mostrado nas Figuras 2A e 2B são escolhidas puramente por uma questão de clareza conceitual. Outros cateteres de captura de volume podem usar o método apresentado, por
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14/17 exemplo, uma cesta e as extremidades distais do cateter-balão. As extremidades distais desses cateteres são tipicamente convexas, de modo que o volume interno confinado no mesmo é bem definido.
[0043] Em uma modalidade, o processador 28 é configurado para determinar se a extremidade distal do cateter Lasso® não está deformada ou está deformada pelo cálculo de superfícies em formato de disco circundadas por um subconjunto de sensores e verificando se as superfícies calculadas compreendem um plano no espaço (por exemplo, seguir uma equação sob a forma de Ax+By+Cz+D=0, em que x, y e z são coordenadas espaciais, e A, B, C, D são números reais) ou não, respectivamente.
[0044] Para verificar quão plana é a superfície (isto é, verificar se uma superfície associada ao conjunto de extremidade distal é plana), o processador encaixa uma superfície geral com o uso de um subconjunto de locais de eletrodo como condição de contorno. Se a superfície resultante se ajustar a uma equação de um plano no espaço, conforme descrito acima, com uma certa precisão, então o processador determina que a parte da extremidade distal que carrega o respectivo subconjunto de eletrodos de detecção não está deformada. O processo avança para analisar outro subconjunto de eletrodos que pode gerar as condições de contorno necessárias, e verificar a linearidade da superfície criada, e assim por diante, até que toda a estrutura da extremidade distal seja verificada. [0045] De modo similar, com o uso de subconjuntos de eletrodos de detecção para estabelecer condições de contorno, em uma modalidade, o processador determina se o cateter Pentaray® está deformado ou não através da verificação de quão planas são as superfícies que quaisquer dois braços vizinhos do cateter Pentaray® podem definir.
[0046] Em uma modalidade, o processador 28 é configurado para determinar dois ou mais braços vizinhos do cateter Pentaray® que não estão deformados e consequentemente atualizar o mapa 31 com uma
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15/17 área triangular confinada entre os braços vizinhos.
[0047] Em outra modalidade, o processador 28 é configurado para determinar se um ou mais braços da extremidade distal do Pentaray® estão deformados ou não com base na identificação da flexão geométrica dos braços. Tal flexão pode ser identificada com a criação de um ou mais desvios dos ângulos esperados entre os braços e/ou de um desvio do ângulo esperado entre um braço e a haste do cateter e/ou de um desvio da linearidade de um braço. Técnicas deste tipo são descritas, por exemplo, no pedido de patente US 15/610.865, depositado em 1 de junho de 2017, intitulado Using a Piecewise-Linear Model of a Catheter Arm to Identify Contact with Tissue que é atribuído ao cessionário do presente pedido de patente e cuja revelação está aqui incorporada a título de referência.
[0048] Em uma modalidade, o processador 28 é configurado para determinar se uma extremidade distal está deformada ou não com base em uma ou mais indicações de sensores de força de contato. Em geral, qualquer tipo adequado de sensor de contato ou método de detecção de contato pode ser usado.
[0049] Qualquer indicação de contato com o tecido e/ou de deformação da extremidade distal (isto é, do conjunto de extremidade distal) fará com que o processador 28 passe a fazer o mapeamento de um respectivo volume sem usar a técnica revelada.
[0050] A Figura 3 é um fluxograma que ilustra esquematicamente um método para mapeamento anatômico de uma cavidade cardíaca, de acordo com uma modalidade da presente invenção. O procedimento pode começar com o médico 27 inserindo e posicionando o cateter de mapeamento 29 em uma cavidade do coração 23, em uma etapa de posicionamento 70.
[0051] Em seguida, em uma etapa de medição 72, o processador 28 adquire sinais de localização, por exemplo gerados pelo sensor
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16/17 magnético 30, ou pela detecção de impedâncias através dos eletrodos 24. Com base na localização dos sinais, o processador 28 calcula os locais dos eletrodos 22 na cavidade e, em seguida, deriva o formato da extremidade distal do cateter 29, em uma etapa de cálculo 74. Em uma modalidade, a derivação do formato do cateter é feita pela interpolação entre os locais medidos dos eletrodos 22.
[0052] Em uma etapa de verificação 76, o processador 28 compara o formato resultante da extremidade distal do cateter com um formato não perturbado conhecido da extremidade distal do cateter (por exemplo, com um modelo de computador da extremidade distal). Se o processador 28 determinar que o formato derivado não está deformado, o processador 28 calcula um respectivo volume que é confinado pelos locais dos eletrodos 22, em uma etapa de cálculo 78. O processador 28 atualiza o mapa anatômico 31 correspondentemente, em uma etapa de atualização 80, com o volume confinado (isto é, o volume interno) que o processador derivou conforme explicado acima. A atualização pode ou não incluir também a adição do formato da extremidade distal do cateter.
[0053] Se, por outro lado, o processador 28 determinar que o formato derivado da extremidade distal do cateter está deformado, o processador 28 atualiza o mapa anatômico 31 apenas com o formato deformado da extremidade distal em si, em uma etapa de mapeamento 82. Na pequena fração do tempo de mapeamento em que o cateter engata o tecido, não é feita nenhuma suposição sobre a existência de um volume confinado, de modo que não há nenhum risco de mapeamento de um tecido como sangue.
[0054] O método pode, então, retornar à etapa 72, em uma etapa de movimento 84, quando o médico 27 move o cateter para uma nova posição de modo a mapear uma região diferente da cavidade, até que o médico considere que o mapa anatômico 31 é suficiente.
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17/17 [0055] O fluxograma exemplificador mostrado na Figura 3 é escolhido puramente por uma questão de clareza conceitual. Em modalidades alternativas, outros tipos de ferramentas de mapeamento podem ser usados. Informações adicionais podem ser capturadas e mapeadas juntamente com os locais, como tipo de tecido e uma propriedade eletrofisiológica do tecido.
[0056] Embora as modalidades aqui descritas abordem principalmente o isolamento da veia pulmonar, os métodos e os sistemas aqui descritos podem ser usados também em outras aplicações, como mapeamento anatômico de qualquer cavidade do corpo com o uso de uma geometria de cateter que compreende um volume interno. Embora as modalidades aqui descritas se refiram principalmente a cateteres cardíacos, as técnicas reveladas podem ser usadas com qualquer outra sonda médica adequada em qualquer outro órgão adequado.
[0057] Dessa forma, será reconhecido que as modalidades descritas acima são citadas a título de exemplo e que a presente invenção não se limita ao que foi particularmente mostrado e descrito anteriormente neste documento. Em vez disso, o escopo da presente invenção inclui tanto combinações como subcombinações dos vários recursos anteriormente descritos neste documento, bem como variações e modificações dos mesmos que ocorreriam aos versados na técnica após a leitura da descrição acima e que não são revelados na técnica anterior. Os documentos incorporados a título de referência no presente pedido de patente devem ser considerados uma parte integrante do pedido exceto que, até o ponto em que quaisquer termos são definidos nesses documentos incorporados de uma maneira que entra em conflito com as definições feitas explícita ou implicitamente no presente relatório descritivo, apenas as definições no presente relatório descritivo devem ser consideradas.

Claims (16)

1. Método caracterizado pelo fato de que compreende:
receber um ou mais sinais indicativos de uma posição de um conjunto de extremidade distal de uma sonda médica dentro de um órgão de um paciente;
com base nos sinais recebidos, determinar um volume interno que está confinado no conjunto de extremidade distal; e atualizar um mapa anatômico do órgão para denotar o volume interno do conjunto de extremidade distal como pertencente a um interior do órgão.
2. Método, de acordo com a reivindicação 1, caracterizado pelo fato de que determinar o volume interno compreende calcular, com base nos sinais recebidos, posições de um ou mais sensores acoplados ao conjunto de extremidade distal e derivar o volume interno a partir das posições dos sensores.
3. Método, de acordo com a reivindicação 2, caracterizado pelo fato de que derivar o volume interno compreende calcular o volume interno com base nas posições dos sensores e em um formato geométrico conhecido do conjunto de extremidade distal.
4. Método, de acordo com a reivindicação 1, caracterizado pelo fato de que atualizar o mapa anatômico compreende verificar se o conjunto de extremidade distal está deformado, e denotar o volume interno do conjunto de extremidade distal como pertencente ao interior do órgão apenas quando o conjunto de extremidade distal não estiver deformado.
5. Método, de acordo com a reivindicação 4, caracterizado pelo fato de que, em resposta à detecção de que o conjunto de extremidade distal está deformado, atualizar o mapa anatômico para denotar apenas ao menos parte de uma superfície externa do conjunto de extremidade distal como pertencente ao interior do órgão.
6. Método, de acordo com a reivindicação 4, caracterizado pelo
Petição 870190000098, de 02/01/2019, pág. 26/62
2/3 fato de que verificar se o conjunto de extremidade distal está deformado compreende verificar se uma superfície associada ao conjunto de extremidade distal é plana.
7. Método, de acordo com a reivindicação 4, caracterizado pelo fato de que verificar se o conjunto de extremidade distal está deformado compreende verificar se um formato geométrico real do conjunto de extremidade distal se desvia de um formato geométrico não deformado conhecido do conjunto de extremidade distal.
8. Método, de acordo com a reivindicação 4, caracterizado pelo fato de que verificar se o conjunto de extremidade distal está deformado compreende identificar o contato mecânico entre o conjunto de extremidade distal e uma superfície do órgão.
9. Aparelho caracterizado pelo fato de que compreende:
uma interface elétrica; e um processador configurado para:
receber, através da interface elétrica, um ou mais sinais indicativos de uma posição de um conjunto de extremidade distal de uma sonda médica dentro de um órgão de um paciente;
com base nos sinais recebidos, determinar um volume interno que é confinado no conjunto de extremidade distal; e atualizar um mapa anatômico do órgão para denotar o volume interno do conjunto de extremidade distal como pertencente a um interior do órgão.
10. Aparelho, de acordo com a reivindicação 9, caracterizado pelo fato de que o processador é configurado para calcular, com base nos sinais recebidos, posições de um ou mais sensores acoplados ao conjunto de extremidade distal, e derivar o volume interno a partir das posições dos sensores.
11. Aparelho de acordo com a reivindicação 10, caracterizado pelo fato de que o processador é configurado para
Petição 870190000098, de 02/01/2019, pág. 27/62
3/3 calcular o volume interno com base nas posições dos sensores e em um formato geométrico conhecido do conjunto de extremidade distal.
12. Aparelho de acordo com a reivindicação 9, caracterizado pelo fato de que o processador é configurado para verificar se o conjunto de extremidade distal está deformado, e denotar o volume interno do conjunto de extremidade distal como pertencente ao interior do órgão apenas quando o conjunto de extremidade distal não estiver deformado.
13. Aparelho de acordo com a reivindicação 12, caracterizado pelo fato de que, em resposta à detecção de que o conjunto de extremidade distal está deformado, o processador é configurado para atualizar de modo correspondente o mapa anatômico para denotar apenas ao menos parte de uma superfície externa do conjunto de extremidade distal como pertencente ao interior do órgão.
14. Aparelho de acordo com a reivindicação 12, caracterizado pelo fato de que o processador é configurado para verificar se o conjunto de extremidade distal está deformado mediante a verificação de se uma superfície associada ao conjunto de extremidade distal é plana.
15. Aparelho de acordo com a reivindicação 12, caracterizado pelo fato de que o processador é configurado para verificar se o conjunto de extremidade distal está deformado mediante a verificação de se um formato geométrico real do conjunto de extremidade distal se desvia de um formato geométrico não deformado conhecido do conjunto de extremidade distal.
16. Aparelho, de acordo com a reivindicação 12, caracterizado pelo fato de que o processador é configurado para verificar se o conjunto de extremidade distal está deformado mediante a identificação do contato mecânico entre o conjunto de extremidade distal e uma superfície do órgão.
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US10918310B2 (en) 2021-02-16
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EP3508170B1 (en) 2024-03-13
EP3508170A1 (en) 2019-07-10
KR20190083308A (ko) 2019-07-11
US20190200901A1 (en) 2019-07-04
US20230098870A1 (en) 2023-03-30
JP7278771B2 (ja) 2023-05-22
IL263634B (en) 2022-12-01
RU2018145023A (ru) 2020-06-19
AU2018278859A1 (en) 2019-07-18
CN109998680A (zh) 2019-07-12
EP3508170C0 (en) 2024-03-13
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