CN108209868B - 心脏的实时电解剖着色 - Google Patents

心脏的实时电解剖着色 Download PDF

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CN108209868B
CN108209868B CN201711324450.6A CN201711324450A CN108209868B CN 108209868 B CN108209868 B CN 108209868B CN 201711324450 A CN201711324450 A CN 201711324450A CN 108209868 B CN108209868 B CN 108209868B
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sensor
graphical image
heart
catheter
electrodes
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CN108209868A (zh
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A.科亨
L.苏兹达尼特斯基
E.菲里波夫
I.伊兰
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Biosense Webster Israel Ltd
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Abstract

本发明公开了使用具有多个传感器的探头来执行心导管插入术。心脏显示为第一图形图像。根据预定义的算法来处理来自传感器的信号以生成相应的输出。根据传感器的位置来在第一图形图像上选择小于第一图形图像中的所有的区域,并且在所选择的区域上将从传感器的输出导出的值显示为第二图形图像。然后,移除第二个图形图像并使用更新的版本替换第二图形图像。

Description

心脏的实时电解剖着色
技术领域
本发明涉及生物电的电流的测量。更具体地,本发明涉及系统,该系统用于使用插入到体内的工具记录来自心脏的生物电的信号。
背景技术
现在,常常使用包括用于标测心脏电活动的电生理学传感器的心脏导管来执行对心脏中电势的标测。通常,根据心脏内的位置来感测并记录心内膜中的时变电势,然后将其用于标测局部激活时间。由于通过心肌传导电脉冲所需的时间,心内膜中各点的激活时间不同。在心脏中任何点处的该电传导的方向常规地由激活矢量表示,该激活矢量垂直于等电激活波前,这两者都可来自激活时间的标测图。该激活波前通过心内膜中任意点的传播速率可表示为速度矢量。
标测激活波前和传导场有助于医师识别并诊断异常情况,诸如由于心脏组织中受损的电传播的区域造成的室性和房性心动过速以及心室和心房纤颤。
可通过观察现象诸如多个激活波前、激活矢量的反常集聚、或速度矢量的变化或矢量与正常值的偏差来识别心脏的激活信号的传导中的局部缺陷。此类缺陷的示例包括内曲区域,该内曲区域可与称为复杂碎裂电描记图的信号图案相关联。一旦通过此类标测来定位缺陷,就可对其进行消融(如果其功能异常),或以其他方式治疗以便尽可能恢复心脏的正常功能。
对心肌中电激活时间的标测要求心脏内传感器的位置在每次测量时是已知的。以往,使用心脏内的单个可活动电极传感器来执行此类标测,其中传感器相对于固定的外部参考电极来测量激活时间。然而,该技术需要校正,例如利用对与身体阻抗无关的阻抗的调整进行阻抗校正。此外,使用单个电极来标测电激活时间是一个冗长的过程,该过程通常在荧光成像下进行,并且因此将患者暴露于不期望的电离辐射。此外,在心律不齐的心脏中,单个位置处的激活时间可在连续搏动之间改变。
由于单个电极标测的缺点,一些发明者已提出使用多个电极来在心内膜中的不同位置处同时测量电势,从而根据描述允许更快速和方便地标测激活时间。包含位置传感器的导管可用于确定心脏表面上的点的轨线。这些轨线可用于推断运动特性,诸如组织的收缩性。如在授予Ben Haim并全文以引用方式并入本文的美国专利5,738,096中所公开的,当在心脏中的足够数量的点处对轨线信息进行采样时,可构建绘示此类运动特性的标测图。
心脏中某个点处的电活动通常通过推进多电极导管来测量,以在心室中的多个点处同时测量电活动。从时间变化的电势导出的记录称为电描记图,该电势由一个或多个电极测量。电描记图可通过单极性引线或双极性引线测量,并且被用于(例如)确定在某点处的电传播的开始,该点被称为局部激活时间。
Zino等人的共同转让的美国专利申请公布号20160120427中(其公开内容以引用方式并入本文)描述了在监视器上从心脏获得的电解剖数据的近实时数据显示。在不超过所述心脏的心动周期的持续时间的时间间隔期间,执行如下步骤:从所述电极和所述传感器中的至少一者读取数据,以及调用处理器来对所述数据执行算法。所述数据为所述算法的多个输入中的一个输入,并且所述算法的结果包括所述数据的转换。将该算法的结果呈现在监视器上以修改电解剖标测图。
发明内容
在常规心导管插入术中,彩色电解剖标测图直到使用者开始消融之前都是稳定的。一旦用户开始消融,心脏的电解剖行为就会发生变化,但显示的标测图保持不变。要查看消融的结果,用户需要创建一个新的标测图并重新着色。这需要花费时间和精力。
根据本发明的公开的实施方案,在一种操作模式中,展示并着色了初始着色单一(例如灰色)的标示图。周期性地移除着色,并根据更新的信息重新着色标测图。用户使用任何被使用的导管来选择标测图的区域。这些区域根据参数的值被实时着色以呈现功能性的显示。用户可选择由着色表示的参数,例如单极电势,双极电势或局部激活时间。
根据本发明的实施方案,提供了通过将探针插入到活体受检者的心脏来进行的导管插入术方法,该探针的远侧部分具有设置在其上的多个传感器。该方法还通过以下方式来迭代地执行:将心脏显示为第一图形图像;根据预定义的算法来处理来自传感器的信号以生成相应的输出;在第一图形图像上选择小于第一图形图像中的所有的区域;在所选择的区域上以图形方式将该输出的至少一部分显示为第二图形图像;以及然后移除第二图形图像。
根据该方法的一个方面,传感器是电极,并且信号是生物电的电压。
根据该方法的另一方面,预定义的算法包括波前传播的计算,并且输出是处于传感器的相应位置处的局部激活时间。
根据该方法的另一个方面,该传感器是温度传感器。
根据该方法的另一个方面,该传感器是接触力传感器。
根据该方法的另一个方面,该传感器是位置传感器。
根据该方法的一个附加的方面,在经过时间间隔之后执行移除第二图形图像。
该方法的一个方面包括根据心肺循环来选通来自传感器的信号。
根据本发明的实施方案进一步提供了一种设备,该设备包括具有多个电极和多个传感器的探头、用于在所述探头处于活体受检者的心脏中的位置处时从所述电极和传感器接收数据的电路、存储器、显示监视器,和连接到存储器和显示监视器的处理器。该设备是操作的以用于迭代地将心脏显示为第一图形图像,根据预定义的算法处理来自传感器的信号以生成相应的输出,以在第一图像上选择小于第一图形图像中的所有的区域,在所选择的区域上以图形方式将该输出的至少一部分显示为第二图形图像,以及然后移除第二图形图像。
该设备可包括连接至来自传感器的信号的选通电路,该选通电路是操作的以用于根据心肺循环来选通传感器输出。
附图说明
为更好地理解本发明,通过示例的方式参考本发明的具体实施方式,该具体实施方式应结合以下附图来阅读,其中类似的元件使用类似的附图标号,并且其中:
图1是用于评估心脏中电活动的系统的图示,该系统根据本发明的公开实施方案构造和操作;
图2是根据本发明的实施方案,用于对心脏的电生理学标测图的进行实时着色的方法的流程图;
图3是根据本发明的实施方案在心导管插入术期间产生的屏幕显示。
图4是根据本发明的实施方案在图3中示出的在导管插入术期间另一时间的屏幕显示。
具体实施方式
在以下的具体实施方式中,示出了许多具体细节,以便提供对本发明的各种原理的全面理解。然而,对于本领域的技术人员而言将显而易见的是,并非所有这些细节都是实施本发明所必需的。在这种情况下,未详细示出熟知的电路、控制逻辑以及用于常规算法和过程的计算机程序指令的细节,以免不必要地使一般概念模糊不清。
以引用方式并入本文的文献将被视作本申请的整体部分,不同的是,就任何术语在这些并入文件中以与本说明书中明确或隐含地作出的定义矛盾的方式定义而言,应仅考虑本说明书中的定义。
综述
现在转到附图,首先参见图1,其为用于评估活体受检者心脏中电活动的系统10的图解示意图,系统10是根据本发明的公开实施方案构造和操作的。该系统包括导管14,由操作者16将该导管经由皮肤穿过患者的血管系统插入到心脏12的腔室或血管结构中。操作者16,通常为医师,使导管的远侧末端18例如在消融目标位点处与心脏壁接触。可根据公开于美国专利6,226,542和6,301,496中和公开于共同转让的美国专利6,892,091中的方法来制备电活动标测图,这些专利的公开内容以引用方式并入本文。
系统10可包括用合适的软件编程以用于实施下文所述功能的通用目的或嵌入式计算机处理器。因此,虽然在本文其它附图中示出的系统10的部分被示为包括若干独立功能性块,但是这些功能块不必是独立的物理实体,而是可表示(例如)存储在存储器中可被处理器访问的不同计算任务或数据对象。这些任务可在运行于单个处理器上或运行于多个处理器上的软件中进行。该软件可在有形非暂态介质(诸如CD-ROM或非易失性存储器)上被提供给一个处理器或多个处理器。另选地或除此之外,系统10可包括数字信号处理器或硬连线逻辑部件。一种采用系统10的元件的商品可以商品名
Figure GDA0001614955350000051
3系统购自加利福尼亚州钻石吧市钻石峡谷路3333,CA 91765的30Biosense Webster公司(30BiosenseWebster,Inc.,3333Diamond Canyon Road,Diamond Bar,CA 91765)。此系统可由本领域的技术人员进行修改以实施本文所述的本发明的原理。
可以通过施加热能对例如通过电活动图评价而确定为异常的区域进行消融,例如,通过将射频电流通过导管中的金属线传导至远侧末端18处的一个或多个电极,这些电极将射频能量施加到心肌。能量被吸收在组织中,从而将组织加热到一定温度(通常为约50℃),在该温度下组织会永久性地失去其电兴奋性。此手术成功后,此过程在心脏组织中形成非传导性的消融灶,这些消融灶可中断导致心律失常的异常电通路。本发明的原理可应用于不同的心脏腔室,以诊断并治疗多种不同的心律失常。
导管14通常包括柄部20,在柄部上具有合适的控制器,以使操作者16能够按消融手术的期望对导管的远侧端部进行操纵、定位和定向。为了协助操作者16,导管14的远侧部分包括向位于控制台24中的处理器22提供信号的位置传感器(未示出)。处理器22可以履行如下所述的若干处理功能。
导管14为多电极导管,该导管可以是如球囊37的右部分中所示的篮形导管或如左部分中所示的样条导管。在存在多个电极32的任何情况下,这些电极用作感测电极,并在篮形或样条电极上具有已知位置,并且彼此关系已知。因此,一旦导管例如通过构建当前位置标示图位于心脏中,则心脏中每个电极32的位置为已知的。一种用于生成当前位置标测图的方法描述于授予Bar Tal等人的共同转让美国专利8,478,383中,该专利以引用方式并入本文。
可以使电信号经由缆线34从位于导管14的远侧末端18处或附近的电极32,在心脏12和控制台24之间来回传送。可以通过缆线34和电极32将起搏信号和其它控制信号从控制台24传送至心脏12。
线连接件35将控制台24与体表电极30和用于测量导管14的位置和取向坐标的定位子系统的其它部件连接在一起。处理器22或另一个处理器(未示出)可以是定位子系统的元件。电极32和体表电极30可用于按照以引用方式并入本文的授予Govari等人的美国专利7,536,218中所提出的在消融位点处测量组织阻抗。用于获得物理参数的传感器,诸如电极或温度传感器(未示出),通常为热电偶或热敏电阻器,可安装在导管14的远侧末端18附近。
控制台24通常包含一个或多个消融功率发生器25。导管14能够适用于利用任何已知的消融技术将消融能量传导到心脏,例如,射频能量、超声能量和激光产生的光能。共同转让的美国专利No.6,814,733、6,997,924和7,156,816中公开了此类方法,这些专利以引用方式并入本文。
在一个实施方案中,定位子系统包括磁定位跟踪构造,该磁定位跟踪构造利用磁场生成线圈28,通过以预定的工作容积生成磁场并感测导管处的这些磁场来确定导管14的位置和取向。合适的定位子系统在以引用方式并入本文的美国专利7,756,576以及上述美国专利7,536,218中有所描述。
如上所述,导管14联接到控制台24,这使得操作者16能够观察并调控导管14的功能。控制台24包括处理器,优选的是具有适当信号处理电路的计算机,该处理器可以包括可被配置用于根据心肺循环来选通传感器读数的选通电路。该处理器耦合以驱动监控器29。信号处理电路通常接收、放大、过滤并数字化来自导管14的信号,这些信号包括由以上提到的传感器和位于导管14远侧的多个位置感测电极(未示出)生成的信号。控制台24和定位系统接收并使用数字化信号,以计算导管14的位置和取向,并如下文另外详细描述地分析来自电极的电信号。
通常,系统10包括为简明起见而未示出于附图中的其它元件。例如,系统10可包括心电图(ECG)监视器,该心电图(ECG)监视器被耦接以接收来自一个或多个身体表面电极的信号,以向控制台24提供ECG同步信号。如上文提及,系统10通常还包括基准位置传感器,其位于附接于受检者身体外部的外加基准补片上,或者位于插入到心脏12中并相对于心脏12保持在固定位置的内置导管上。系统10可从外部成像模态诸如MRI单元等接收图像数据,并且系统10包括图像处理器,该图像处理器可结合在处理器22中或由处理器22调用以用于生成并显示如下所述的图像。
操作
现在参考图2,图2是根据本发明的实施方案的用于对心脏的电生理学标测图进行实时着色的方法的流程图。为了显示的清晰性,在图2中以具体的线性顺序示出了处理步骤。然而,将显而易见的是,这些步骤中的多个可并行地、异步地或以不同的顺序执行。本领域的技术人员还应当理解,另选地,过程可例如在状态图表中被表示为多个相互联系的状态或事件。此外,可能并非全部所示出的过程步骤需要用来实施该方法。
在初始步骤39处,使用熟知的方法将一根或多根心脏导管引入受检者的心脏中。
接着在步骤41处,准备心脏或心室结构的重建,即,在三维空间中进行几何定义。这可以通过分析来自其他模态的图像来实现,即,已经使用心室模型已经注册的预采集磁共振成像或荧光镜透视图像进行分割。通过不同模式获取或制备的图像注册是已知的,例如来自以引用方式并入本文的美国专利申请公开号2007/0049817和Altmann等人的共同转让的美国专利No.7,517,318。在Merschon等人的共同转让的美国专利No.9,265,434中公开了另一种生成重建的方法,名称为Dynamic Feature Rich Anatomical Reconstructionfrom a Point Cloud(来自点云的动态特征丰富解剖重构),该专利以引用方式并入本文。在该方法中,心房形状被表示为在边界域内的所有点定义的场函数的等值面。其他重建方法在本领域中是已知的,并且可以用于例如Reisfeld的美国专利No.6,226,542中公开的,以及Govari等人的美国专利申请公布No.2009/0177089,这些专利共同转让并以引用的方式并入本文。另选地,CARTOMERGETM模块和上述CARTO系统的其他设施可以使用在相同或不同会话中准备的心脏的图像来完成该步骤。
在步骤41完成时,重建显示为单一颜色或色调,没有对比度。在这个阶段,该表示不传达功能性电解剖信息,而是简单地描绘受检者心脏结构的模型。
接着在步骤43处,读取该导管上的一个或多个传感器。传感器可以是多电极导管上的选定的电极组,例如长条上的电极,或已知与心内膜接触的一组电极。传感器可以是例如作为上述定位系统(图1)的组件的位置传感器、标测电极或物理状态传感器,所述物理状态诸如温度、电压和电相位信息、接触力或这些物理状态的组合。
尽管可以在监视器29(图1)上以图形方式显示原始数据,例如,来自导管上的热电偶的温度读数。更常见的是,在步骤45中,数据在一段时间间隔内累积并根据一些算法进行处理,以绘制功能性电解剖标测图。例如,可以在心动周期上积累电压以导出空间LAT。作为另一示例,可显示反射数据的二阶导数,如Govari等人的共同转让美国专利申请公开No.20150305812中所述,该专利名称为Prevention ofSteam Pops during Ablation(在消融期间防止蒸汽爆裂),以引用方式并入本文。在所有这些情况下,测量或导出的信息的值可使用伪色表示值的范围,方便地显示在监视器29上。至于电极,信息可选通到心肺循环,并且可以是单极或双极电势。
接着在步骤47中,选择在步骤41中准备的三维空间心脏重建的区域进行显示。基于导管上传感器当前的位置自动创建该区域,并且显示器在空间上指示从传感器的读数导出的信息。在该位置可影响半径,并且因此显示区域的大小是用户可定义的。
该区域显示内的信息可表示为本领域已知的伪色,或者可在任何其它合适的图形显示中示出。未选择的区域保持单色。由于创建和更新显示器仅限于感兴趣的区域,所以该算法可更快速地执行并节省计算机资源,因为不需要重画整个心脏的功能性标测图。此外,操作员可以免受信息超载。
接着在步骤49中,从传感器读取数据并在步骤45中根据需要处理数据之后,输出值仅在步骤47中选择的区域上以伪色显示。处理数据可以是例如波前传播的计算,并且输出值可以是传感器相应位置处的局部激活时间。
一旦显示信息,控制进行到延迟步骤51,在步骤51中等待步骤49的导致显示再生的事件。该事件可以经过预定义的时间间隔。
接着在步骤53中,根据系统性能,步骤49的显示被擦除,暂时导致监视器29上的单色图像的再现。控制随后返回到步骤43以使用传感器的新读数迭代地显示过程。可以在步骤47中选择不同的区域,特别是先前迭代时导管已经在心脏中操纵的情况下。在一个实施方案中,根据当前的操作模式,区域显示被删除并且每隔16ms,或在每次选通间隔,更新为新数据。
实施例
现在参见图3,图3为根据本发明的实施方案在心导管插入术期间产生的屏幕显示55。心脏左心房的重建57显示为大部分单色的灰色形式。导管59,61已经插入到心脏中。导管61是其远侧端部位于肺静脉口的消融导管。导管尖端附近的着色区域63表示静脉口消融位点的温度。导管59是具有多个标测电极67的套索导管。电极67一部分着色的区域65是该区域中的局部激活时间的标测图,该区域可以随着消融进行而变化。彩色区域63,65由图中不同的阴影图案表示。
现在参见图4,图4为根据本发明的实施方案的类似于图3中在导管插入术期间的另一时间获取的另一屏幕显示69。重建57已经被旋转,以便更好地显示某些感兴趣的区域。由区域65表示的参数已经改变,如相比于图3中着色差异所指示的那样。
本领域技术人员应当理解,本发明不限于上文具体示出和描述的内容。相反,本发明的范围包括上文所述各种特征的组合与子组合两者,以及本领域的技术人员在阅读上述说明书时可想到的不在现有技术范围内的上述各种特征的变型和修改。

Claims (8)

1.一种设备,包括:
探头,所述探头具有多个电极和多个传感器;
电路,所述电路用于在所述探头处于活体受检者的心脏中的位置处时从所述电极和所述传感器接收数据;
存储器;
显示监视器;和
处理器,所述处理器连接到所述存储器和所述显示监视器并且是操作的以用于迭代地执行以下步骤:
将所述心脏显示为第一图形图像,其中所述第一图形图像是单色的;
根据预定义的算法来处理来自所述传感器的信号以生成相应的输出;
基于所述传感器的位置在所述第一图形图像上选择小于所述第一图形图像中的所有图形图像的区域,其中所述区域的大小由用户限定;
在所选择的区域上以图形方式将所述输出的至少一部分显示为第二图形图像,其中所述第二图形图像使用伪色,所述伪色表示所述输出的值的范围;以及
然后移除所述第二图形图像。
2.根据权利要求1所述的设备,其中,所述传感器是电极,并且所述信号是生物电的电压。
3.根据权利要求2所述的设备,其中,所述预定义的算法包括波前传播的计算,并且所述输出是处于所述传感器的相应位置处的局部激活时间。
4.根据权利要求1所述的设备,其中,所述传感器是温度传感器。
5.根据权利要求1所述的设备,其中,所述传感器是接触力传感器。
6.根据权利要求1所述的设备,其中,所述传感器是位置传感器。
7.根据权利要求1所述的设备,其中,在经过时间间隔之后执行移除所述第二图形图像。
8.根据权利要求1所述的设备,还包括与来自所述传感器的信号链接的选通电路,所述选通电路是操作的以用于根据心肺循环来选通来自所述传感器的所述信号。
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